All participants received the same standardized six-hour online program, which combined trauma-informed care and developmental care principles. Investigators used the Trauma-Informed Care Scale and the Developmental Care Practices Scale for Neonatal Intensive Care Units to assess outcomes. Statistical analyses included descriptive statistics, independent-samples t tests, mixed analysis of variance and analysis of covariance. The design included two clinical-background groups, but the abstract does not describe an untreated group or an alternative educational intervention for comparison.

Mixed analysis of variance showed significant time effects for total Trauma-Informed Care Scale scores (F = 104.838, p < 0.001, partial eta squared = 0.507) and total Developmental Care Practices Scale scores (F = 55.989, p < 0.001, partial eta squared = 0.354). Significant time-by-group interactions were also reported for both outcomes, indicating that the magnitude of change differed between newly graduated and transferred nurses. Baseline differences between the groups decreased substantially after the intervention, and most between-group differences that were statistically significant at baseline were no longer statistically significant at the posttest.

The findings support an association between the educational intervention and changes in the measured scales, rather than demonstrating effects on nursing practice, family experience or infant clinical outcomes. The authors stated that structured education may improve trauma-informed care awareness and developmental care knowledge and attitudes among NICU nurses with different clinical backgrounds. They also described reduced competency differences and more standardized, family-centered neonatal care as potential contributions, not demonstrated outcomes. The available abstract does not provide the full study methods or results beyond the summarized information. Because the abstract describes a pretest–posttest intervention without an untreated or alternative-intervention comparator, the score changes cannot be attributed specifically to the program. Immediate posttest measurement also leaves retention unmeasured, and the focus on nurses in eight Istanbul hospitals limits generalizability to other settings, staff populations and clinical outcomes.

Subject of Research: Quasi-experimental evaluation of trauma-informed and developmental care education for NICU nurses

Article Title: Effects of trauma-informed and developmental care education on NICU nurses: a quasi-experimental study

Article References: Temizsoy, E., Kızılhan, S., Şakal, D., Öz, E., Andaç, M., & Hançer, G. (2026). Effects of trauma-informed and developmental care education on NICU nurses: a quasi-experimental study. BMC Nursing. https://doi.org/10.1186/s12912-026-05332-1

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05332-1

Keywords: NICU nursing, trauma-informed care, developmental care, online education, quasi-experimental study, nurse training, Istanbul, scale scores, Effects, trauma-informed, developmental, care

The research, published in BMC Nursing, was conducted at the Children’s Cancer Hospital Egypt (CCHE) 57357, one of the largest pediatric oncology centers in the Middle East. A team of nursing researchers led by Amira El-Sayed of October 6 University in Giza set out to answer a deceptively simple question: if you teach pediatric oncology nurses about mucormycosis in a systematic way, do their knowledge and their actual bedside practices improve? The answer, measured with rigorous before-and-after assessments, was a resounding yes, at least in the short term. The findings arrive at a moment when clinicians worldwide are paying renewed attention to fungal infections, which are increasingly recognized as a growing danger for patients whose immunity has been compromised by cancer therapy, transplantation, or other modern medical interventions.

Mucormycosis is caused by fungi in the order Mucorales, ubiquitous organisms that most healthy people encounter daily without consequence. In an immunocompromised host, however, these molds can germinate and invade blood vessels, causing tissue death, a process known as angioinvasion. The disease can manifest in the rhinocerebral form, attacking the sinuses and brain; the pulmonary form, destroying lung tissue; or the gastrointestinal and cutaneous forms, each carrying substantial mortality. Children with hematologic malignancies such as leukemia, and those undergoing hematopoietic stem cell transplantation, sit squarely in the highest-risk category. Neutropenia, the depletion of infection-fighting white blood cells induced by chemotherapy, removes the body’s primary cellular defense against these fungi. Because early diagnosis is difficult and treatment options are limited, prevention becomes paramount, and prevention in a hospital setting depends heavily on the vigilance of nursing staff.

Nurses occupy a uniquely influential position in infection prevention. They control the environment around the patient, from the cleanliness of surfaces and equipment to the handling of food, the management of personal protective equipment, and the early recognition of warning signs. Yet studies have repeatedly shown that knowledge about rare fungal infections among nursing staff can be patchy, particularly in resource-limited settings where formal training on emerging pathogens may be scarce. The Egyptian research team recognized this gap and designed a quasi-experimental study to test whether targeted education could close it. They enrolled 81 pediatric oncology nurses at CCHE 57357, measuring their baseline knowledge with a structured questionnaire and their actual infection-control behaviors with an observational checklist completed at the bedside.

The educational intervention itself consisted of three structured sessions covering the risk factors for mucormycosis, its pathophysiology, and the infection control measures that nurses can implement in daily practice. This content was not exotic. It included fundamentals such as environmental hygiene, appropriate use of personal protective equipment, meticulous hand hygiene, safe food handling for neutropenic patients, and surveillance for early signs of infection. But the study’s design ensured that the effect of this teaching could be quantified. Every participant completed the same knowledge assessment before and after the program, and trained observers evaluated the same set of practices using the same checklist at both time points, allowing direct comparison of scores across the intervention.

The results were striking. The mean knowledge score nearly doubled, rising from 5.82 plus or minus 0.91 before the program to 12.1 plus or minus 0.76 afterward, a difference that was statistically significant with a p-value below 0.001. The mean practice score, reflecting what observers actually saw nurses do rather than what they claimed to know, climbed from 3.86 plus or minus 1.13 to 7.58 plus or minus 1.02, also highly significant. In other words, the training did not merely fill heads with facts; it changed hands-on behavior at the bedside. Nurses who had completed the sessions were demonstrably more likely to perform the preventive measures that the checklist captured, from environmental controls to protective equipment use.

Equally interesting was the relationship between knowledge and practice. The researchers found a positive correlation between the two at both time points: before the intervention, the correlation coefficient was 0.348 with a p-value of 0.001, and after the intervention it was 0.382 with a p-value below 0.001. This suggests that what nurses know is linked to what they do, and that strengthening knowledge may be a viable pathway to strengthening practice. The correlation is moderate rather than perfect, which is a familiar pattern in health-services research; knowing the right thing does not always translate into doing it, particularly under the time pressures and staffing constraints of a busy oncology ward. But the consistency of the association before and after training reinforces the case for education as a lever for behavioral change.

The authors are careful, and rightly so, about the limits of what their study can claim. Because the design was a one-group pretest-posttest study without a control group, and because patient outcomes were not tracked, the findings cannot be interpreted as evidence that the training reduced actual mucormycosis infection rates. No children were followed to see whether their risk of fungal infection declined. The improvements measured were in nurse knowledge and observed practice, over a short-term horizon, and the study cannot rule out other explanations for the change, such as heightened attention from being observed or the general effect of participating in a research project. These are standard caveats for this study design, but they matter for anyone hoping to translate the results into policy.

Nevertheless, the study carries real weight for a field that urgently needs practical solutions. Invasive fungal infections in pediatric cancer patients are associated with prolonged hospitalizations, expensive antifungal therapy, and significant mortality, and the arsenal of preventive tools is limited. Environmental measures and vigilant nursing care are among the few interventions available on the front lines, and they cost far less than new drugs. If a three-session educational program can nearly double knowledge scores and substantially improve observed infection-control behavior among nurses caring for the most vulnerable children, that is an intervention worth replicating and testing more rigorously. The Egyptian team’s work provides a template: a structured curriculum, validated assessment tools, and an observational checklist that other institutions could adapt.

The broader lesson extends beyond mucormycosis. As fungal infections gain prominence in global health discussions, driven by rising numbers of immunocompromised patients and growing awareness of fungal threats, the healthcare workforce’s preparedness becomes a critical variable. This study demonstrates that targeted, relatively brief professional education can move the needle on both knowledge and practice in a specialized nursing population. The authors call for continuous professional development and targeted training to sustain and build on these gains, a reminder that a single educational burst is unlikely to be enough. For the nurses of CCHE 57357 and the children they care for, the message is clear: understanding the enemy is the first step in defending against it, and that understanding can be taught.

Subject of Research: Effect of a structured educational program on pediatric oncology nurses' knowledge and mucormycosis-prevention practices

Article Title: Changes in pediatric oncology nurses’ knowledge and observed mucormycosis-prevention practices following an educational programme: a one-group pretest-posttest study

Article References: El-Sayed, A., Alsharkawy, S., Hassan, E. A., Wahid, H., Ragab, N., & El-Hamid, H. A. (2026). Changes in pediatric oncology nurses’ knowledge and observed mucormycosis-prevention practices following an educational programme: a one-group pretest-posttest study. BMC Nursing, 25(1), Article 966. https://doi.org/10.1186/s12912-026-05382-5

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05382-5

Keywords: mucormycosis, pediatric oncology, nursing education, infection control, fungal infection, chemotherapy, immunocompromised children, quasi-experimental study, Egypt, nurse training, knowledge and practice, BMC Nursing

The study focused on a problem that intensive care clinicians know well: enteral nutrition intolerance. When critically ill patients cannot tolerate feeding delivered directly into the gastrointestinal tract, whether because of delayed gastric emptying, abdominal distension, vomiting, or other complications, clinicians face a painful dilemma. Interrupting nutrition starves the gut lining and may worsen intestinal permeability at precisely the moment the body needs metabolic support, while continuing to feed an intolerant patient risks aspiration, worsening distension, and further physiological stress. The reported incidence of enteral nutrition intolerance varies widely across intensive care units, and the new study set out to test whether the people administering the feeding, rather than the patients receiving it, might account for part of that variation.

To capture nursing competency in a quantifiable form, the researchers used the knowledge-attitudes-practices framework, a long-standing model in health services research that evaluates what clinicians know, how they feel about the importance of that knowledge, and how consistently they translate both into daily practice. Each enrolled patient was assigned to a high-KAP or low-KAP group based on the total nutrition KAP score of the nurse primarily responsible for their care. The design is elegant in its simplicity but also carries inherent limitations: patients were not randomized to nurses, and sicker patients could plausibly have been assigned differently. The investigators addressed this concern statistically by adjusting their analyses for age, sex, and admission APACHE II score, a widely used severity-of-illness index that quantifies physiological derangement on intensive care admission.

The primary endpoint of the study was the longitudinal trajectory of serum procalcitonin, a peptide precursor of the hormone calcitonin that has become one of the most closely watched biomarkers in critical care. Procalcitonin rises sharply in response to bacterial infection and systemic inflammation, and its dynamics over days can signal whether a patient’s inflammatory burden is resolving or escalating. Using a linear mixed-effects model, a statistical approach well suited to repeated measurements nested within individual patients, the researchers found that patients cared for by high-KAP nurses showed a more favorable declining trajectory after enteral nutrition was initiated. At day three of feeding, the estimated marginal mean procalcitonin level was 1.12 plus or minus 0.53 micrograms per liter in the high-KAP group, compared with 1.65 plus or minus 0.62 micrograms per liter in the low-KAP group. By day seven, the gap persisted: 0.76 versus 1.24 micrograms per liter.

This biomarker finding is the most intriguing element of the study because it hints at a biological mechanism rather than a mere process-of-care difference. The authors frame the result in terms of the systemic inflammatory response: better nursing management of enteral nutrition may protect the intestinal barrier, reducing bacterial translocation and the downstream inflammatory cascade that procalcitonin reflects. The gut in critical illness is not a passive conduit for calories but an immunologically active organ whose integrity influences the entire body. When feeding is delivered skillfully, with appropriate rate titration, head-of-bed positioning, monitoring of gastric residual volumes, and early recognition of intolerance, the intestinal mucosa may be better preserved, and the inflammatory signals that flood the bloodstream when the barrier fails may be blunted. The procalcitonin trajectories in this study are consistent with that physiological story, though the observational design cannot prove causation.

The clinical outcomes reinforced the biomarker signal. The crude incidence of enteral nutrition intolerance was 21 percent among patients cared for by high-KAP nurses, less than half the 45 percent observed in the low-KAP group. After multivariable adjustment for age, sex, and APACHE II score, higher nurse KAP remained independently associated with lower risk of intolerance, with an adjusted odds ratio of 0.57 and a 95 percent confidence interval of 0.32 to 0.98. The confidence interval is narrow enough to exclude no effect, though it also indicates appreciable statistical uncertainty, a reminder that a single cohort of 200 patients cannot settle the question definitively.

Length of stay and ventilation duration told a similar story. Patients in the high-KAP group spent fewer days in the intensive care unit, with an adjusted beta coefficient of minus 1.38 days and a 95 percent confidence interval spanning minus 2.67 to minus 0.09, and spent fewer days on mechanical ventilation, with an adjusted beta of minus 1.12 days and a confidence interval of minus 2.21 to minus 0.03. Both confidence intervals exclude zero, but only barely at their upper bounds, and the clinical meaning of a day or so of difference must be weighed against the possibility of residual confounding. Still, the direction of every measured association pointed the same way, which lends the overall pattern credibility even where any single estimate is modest.

The starkest contrast appeared in survival. Crude 28-day all-cause mortality was 9.0 percent in the high-KAP group compared with 21.0 percent in the low-KAP group, a difference of twelve percentage points in a population where every death is a tragedy and every avoided death a triumph. The authors did not report a fully adjusted mortality estimate in the abstract, and with only 200 patients the number of deaths is small enough that chance cannot be excluded as an explanation. Nevertheless, the finding aligns with a broader literature linking nutrition quality in critical care to survival, and it provides a compelling rationale for the interventional studies that the authors argue should follow.

What makes this study resonate beyond its statistical tables is what it implies about the invisible architecture of hospital care. Intensive care medicine celebrates its ventilators, dialysis machines, and precision pharmacology, yet the daily execution of something as mundane as feeding a patient depends on the accumulated knowledge of the nurse at the bedside. The knowledge-attitudes-practices framework captures a chain that runs from education through motivation to action, and the Shandong findings suggest that strengthening the first link may ripple all the way through to inflammatory biology and survival. The authors observed six participating intensive care units in Shandong Province and concluded that targeted training focused on nurses’ nutrition-related KAP merits further evaluation, a deliberately cautious recommendation that acknowledges the limits of an observational design.

Those limits deserve emphasis for readers weighing the findings. Patients were enrolled prospectively, but the exposure, the competency of their nurse, was not randomized, and unmeasured differences between the units, shifts, or patient populations could contribute to the observed associations. The study was approved by the Ethics Committee of Qilu Hospital of Shandong University under approval number KYLL-2025SL-350 and conducted according to the Declaration of Helsinki, with informed consent obtained from participating nurses and a waiver of written patient consent for the use of de-identified routine clinical data. The authors report no external funding and no competing interests. Within those constraints, the study offers a provocative and clinically actionable hypothesis: that investing in the nutrition education of intensive care nurses is not a soft measure but a potential determinant of inflammatory resolution, feeding tolerance, and survival. If randomized training interventions confirm these associations, the humble task of feeding the sickest patients in the hospital may take its rightful place among the measurable levers of critical care medicine.

Subject of Research: Associations between ICU nurses' nutrition knowledge-attitudes-practices and clinical outcomes in critically ill patients receiving enteral nutrition

Article Title: Associations between nurses’ nutrition knowledge, attitudes, and practices and systemic inflammatory response, feeding tolerance, and clinical prognosis in critically Ill patients– a prospective observational cohort study in intensive care units

Article References: Feng, H., Bi, R., & Meng, Z. (2026). Associations between nurses’ nutrition knowledge, attitudes, and practices and systemic inflammatory response, feeding tolerance, and clinical prognosis in critically Ill patients– a prospective observational cohort study in intensive care units. BMC Nursing. https://doi.org/10.1186/s12912-026-05487-x

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05487-x

Keywords: intensive care, enteral nutrition, nursing, procalcitonin, feeding intolerance, critical illness, nutrition knowledge-attitudes-practices, observational cohort, inflammatory response, mechanical ventilation, ICU outcomes, nurse training

Inhalation injury is one of the most feared complications of major burns. Hot gases and toxic smoke damage the delicate lining of the airway, causing swelling, secretions, and progressive respiratory failure that can develop over hours. For these patients, an artificial airway, typically a tube placed through the mouth or nose into the trachea, or a surgical opening in the neck, is often a life-saving necessity. But the tube itself introduces new risks: it can become blocked by thick secretions, dislodged, or colonized by bacteria leading to ventilator-associated pneumonia. The quality of day-to-day airway management, from humidification and suctioning to cuff pressure monitoring and secure fixation, therefore has a direct bearing on survival and recovery.

The research team, led by Fangfang Xia and colleagues in the hospital’s Department of Burns and Plastic Surgery, set out to measure how well artificial airway management was actually being delivered in their burn intensive care unit, and to identify which patient characteristics and staff-related factors predicted lapses in quality. They combined two complementary data streams. First, they performed a retrospective analysis of clinical records from all 223 patients admitted to the burn ICU between January and December 2025 who had burn injuries combined with inhalation injuries. The variables they extracted included sex, age, the total body surface area burned (TBSA), whether the patient developed acute respiratory distress syndrome (ARDS), the timing of artificial airway establishment, and any airway-related complications that occurred during the stay.

Second, recognizing that airway management is fundamentally a nursing-delivered intervention, the team surveyed 49 nursing staff members about their clinical experience, whether they had received formal airway management training, how often they attended training sessions each year, and how they documented their care. This dual approach, pairing patient outcomes with staff characteristics, allowed the investigators to look beyond the bedside and ask whether the structure of the care team itself shaped the quality of what patients received. The study was approved by the hospital’s institutional ethics committee and adhered to the principles of the Declaration of Helsinki, with all participants providing informed consent.

The headline numbers reveal a system that performs reasonably well but leaves meaningful room for improvement. The timely airway establishment rate, meaning the proportion of patients who received an artificial airway within the clinically appropriate window, stood at 82.1 percent. Overall quality compliance, a measure of how consistently management met established standards, reached 73.5 percent. In other words, roughly one in four patients did not receive airway care that fully met quality benchmarks, and nearly one in five did not have their airway established in a timely fashion. For a population in which respiratory compromise can escalate within hours, those gaps are clinically significant.

To move from description to explanation, the researchers performed multivariable logistic regression, a statistical technique that estimates the independent effect of each factor while holding the others constant. Five factors emerged as significant independent predictors of suboptimal airway management quality, all with P values below 0.05. Three were patient-related: a total body surface area burned of 60 percent or more, the concurrent development of ARDS, and delayed establishment of the artificial airway. Two were staff-related and, crucially, modifiable: nursing experience of less than three years, and an annual training frequency of fewer than two sessions.

The patient-related predictors make physiological sense. Patients with burns covering 60 percent or more of their body surface face massive fluid shifts, profound inflammatory responses, and prolonged immobility, all of which complicate airway care and increase the burden of secretions and edema. Those who develop ARDS require prolonged mechanical ventilation with high pressures and oxygen concentrations, which stresses every component of airway maintenance. And delayed airway establishment is both a marker of deteriorating physiology and a contributor to it: a patient whose swollen airway is intubated late may be harder to intubate safely, may accumulate aspirated secretions, and may start the course of artificial airway care from a worse baseline.

It is the two staff-related findings, however, that carry the clearest practical message, because they are the ones an institution can change. Nurses with less than three years of experience were significantly more likely to be involved in suboptimal airway management, suggesting that the skills required, precise suctioning technique, correct cuff pressure management, early recognition of tube obstruction or displacement, and sound clinical judgment about secretion load, are accumulated through years of bedside practice. Equally telling, nurses who attended fewer than two training sessions per year were at higher risk of suboptimal care. The message is that competency in artificial airway management is not a one-time credential but a perishable skill that decays without regular reinforcement.

The authors also observed that where quality fell short, it tended to manifest as inconsistent protocol adherence and incomplete documentation, rather than as dramatic single-point failures. This pattern is common in intensive care: the difference between adequate and excellent care often lies in the accumulation of small, unglamorous tasks performed correctly and recorded properly, shift after shift. Documentation matters not only for continuity between clinicians but also as a quality-control signal, since gaps in the record make it harder for teams to detect drifting practice standards before they produce complications.

Based on their findings, the researchers recommend a package of institutional reforms: risk stratification frameworks that flag patients with extensive burns or evolving ARDS for intensified airway surveillance; standardized assessment tools that make protocol adherence measurable rather than assumed; tiered, competency-based training programs that ensure less experienced nurses receive structured skill-building and that all staff receive training at least twice a year; and strengthened multidisciplinary collaboration between burn surgeons, intensivists, and nursing teams. The study, funded by Ningxia Medical University, is retrospective and conducted at a single center, so the authors’ results describe one institution’s experience rather than a universal benchmark. But the structure of the findings, that injury severity sets the stage while training and timing determine execution, offers a concrete, testable template for other burn units. In a field where the airway is quite literally the difference between breathing and not, the suggestion that two of the five decisive factors are as simple as experience and regular training is a conclusion worth acting on.

Subject of Research: Quality of artificial airway management and its modifiable predictors in burn patients with inhalation injury

Article Title: Quality of artificial airway management and its modifiable predictors in burn patients with inhalation injury: a retrospective cohort study

Article References: Xia, F., You, X., Zhou, X., Yao, M., & Yan, R. (2026). Quality of artificial airway management and its modifiable predictors in burn patients with inhalation injury: a retrospective cohort study. BMC Nursing. https://doi.org/10.1186/s12912-026-05433-x

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05433-x

Keywords: burn injury, inhalation injury, artificial airway management, nursing quality, ARDS, TBSA, nurse training, retrospective cohort study, burn intensive care, airway complications, protocol adherence, documentation

The scale of the problem is enormous. Recent global estimates indicate that 537 million adults were living with diabetes in 2021, a figure projected to climb to 783 million by 2045, with the steepest increases expected in low- and middle-income countries where healthcare infrastructure is often already stretched thin. Among the chronic complications of the disease, diabetic foot stands out as particularly devastating. Between 19 and 34 percent of people with diabetes will develop a foot ulcer during their lifetime, and the majority of lower limb amputations not caused by injuries are preceded by just such an ulcer. The International Working Group on the Diabetic Foot defines the condition broadly, encompassing infection, ulceration, or tissue damage in the feet of people with diabetes, typically accompanied by loss of protective sensation, foot deformities, or impaired blood flow—deficits that dramatically raise the risk of ulceration and slow healing once wounds appear.

What makes these figures so frustrating for clinicians is that diabetic foot complications are largely preventable. International guidelines consistently emphasize systematic foot examination, early identification of at-risk patients, appropriate footwear, prompt treatment of minor injuries, and structured patient education as the cornerstones of prevention. Yet translating that guidance into practice depends heavily on frontline healthcare workers—above all, nurses. In hospitals, outpatient diabetes clinics, primary care centers, and home care services, nurses are often the professionals with the most frequent and sustained contact with patients. They perform routine foot assessments, detect early signs of neuropathy and peripheral artery disease, counsel patients on self-care, and coordinate referrals to specialist services. Studies from multiple countries, however, have documented substantial gaps in nurses’ knowledge and clinical practice related to foot assessment, alongside limited access to structured training.

To determine whether educational programs can close those gaps, researchers conducted a systematic review of quasi-experimental studies published between 2015 and 2024, prospectively registered in PROSPERO and reported according to the PRISMA 2020 guidelines. The team searched Web of Science, the Cochrane Library, CINAHL via EBSCOhost, MEDLINE, and Scopus, screening 93 initial records down to nine studies that met their inclusion criteria. Each candidate study was appraised independently by two reviewers using the Joanna Briggs Institute critical appraisal checklist for quasi-experimental research, with studies scoring five or fewer points out of nine excluded. Sample sizes across the nine included trials ranged from 30 to 110 participants, and the settings spanned five continents—from university hospitals in Egypt and Iran to community health programs in Nigeria, Brazil, Pakistan, Japan, and Saudi Arabia.

The results were strikingly consistent. Every single one of the nine studies reported statistically significant improvements in nurses’ knowledge or clinical practice following structured education, regardless of country, setting, or teaching format. The magnitude of change was often dramatic. In one Egyptian study, nurses’ practical performance of neurovascular assessment—incorporating the standardized 10-gram monofilament test, tuning forks, and reflex hammers—improved from predominantly poor at baseline to good immediately after training, with total practical scores of 93.33 percent that remained at 90 percent one month later. In Brazil, a 20-hour theoretical and practical course for primary care nurses raised mean knowledge scores from 23.8 to 41.9, with the largest gains in neurological assessment techniques that had been weakest at the outset. A 16-week program in Pakistan lifted participating nurses from uniformly weak baseline knowledge to a position where more than half achieved good knowledge ratings, while an Egyptian geriatric-care study found that the proportion of nurses demonstrating good foot care practice surged from 14 percent before training to 100 percent one month afterward.

The review also offers practical clues about how best to teach these skills. The only head-to-head comparison of delivery formats, conducted among 80 nurses in Iran, pitted a five-module e-learning course against a face-to-face interactive workshop covering identical content. Both approaches improved knowledge significantly, but post-test scores were markedly higher in the workshop group, suggesting that active, participatory, hands-on formats hold an edge for acquiring technical assessment skills. At the same time, the authors note that e-learning remains more time- and cost-efficient and more flexible, raising the possibility that blended models combining online preparation with in-person practice could deliver both accessibility and effectiveness. A Japanese study further demonstrated that a multi-component package—PowerPoint materials, videos, booklets, picture cards, and on-site coaching delivered over three to five sessions across two months—could successfully improve foot care knowledge and practice among nurses and care workers in home care settings, extending the evidence beyond hospitals.

Yet the researchers are careful to temper enthusiasm with methodological caution. Applying the GRADE framework, they rated the overall certainty of evidence as very low for both knowledge and practice outcomes. All nine studies used quasi-experimental designs without randomization, most lacked concurrent control groups, and serious concerns about inconsistency and imprecision arose from heterogeneous interventions, varied measurement instruments, small samples, and short follow-up periods. Improvements measured immediately or one month after training cannot be assumed to persist, and none of the studies tracked whether better-trained nurses actually reduced ulcer incidence, amputation rates, or hospital admissions among their patients—arguably the outcomes that matter most.

The review also uncovers structural barriers that training alone cannot overcome. Even after completing education, nurses in many settings lacked access to basic diagnostic equipment such as monofilaments, tuning forks, and reflex hammers, forcing them to improvise with inappropriate tools or skip parts of the examination altogether. The authors argue that educational programs must therefore be paired with organizational support: adequate supplies, clinical protocols aligned with international guidelines, formal authorization for nurses to conduct regular foot examinations, and protected time for both training and systematic screening. They further recommend tailoring content to nurses’ prior experience, progressing from basic pathophysiology for novices to complex case management in specialized clinics, and extending training to community nurses, geriatric specialists, and home care workers as diabetes care increasingly shifts out of hospitals.

For researchers, the roadmap is clear. The authors call for randomized and cluster-randomized controlled trials comparing e-learning, workshops, blended learning, and mentoring models; longitudinal studies assessing skill retention at six to twelve months and beyond; standardized measurement instruments to enable meaningful comparisons across settings; and, critically, research linking nurse training to patient-level outcomes such as ulcer recurrence and amputation. Until such evidence accumulates, the review concludes that integrating competency-based diabetic foot care training into nursing professional development is a reasonable interim strategy—one supported by consistently positive, if methodologically limited, findings across five continents.

Subject of Research: Effectiveness of educational programs in improving nurses' knowledge and practice related to diabetic foot care

Article Title: Effectiveness of Educational Programmes on Knowledge and Practice Related to Diabetic Foot Care Among Nurses: A Systematic Review

Article References: Al‐Me'ani, M., Alqaisi, O., Dibas, M., Al‐Aaraj, H., & Rubbai, Y. (2026). Effectiveness of Educational Programmes on Knowledge and Practice Related to Diabetic Foot Care Among Nurses: A Systematic Review. Endocrinology, Diabetes &amp; Metabolism, 9(5), Article e70324. https://doi.org/10.1002/edm2.70324

Image Credits: AI Generated

DOI: 10.1002/edm2.70324

Keywords: diabetic foot care, nursing education, systematic review, diabetes complications, foot ulcer prevention, quasi-experimental studies, GRADE assessment, monofilament testing, nurse training, health policy, patient safety, continuing professional development