Journal of Modern Multidisciplinary Research
Journal of Modern Multidisciplinary Research (JMMR) is a peer-reviewed, open-access journal publishing high-quality research across diverse disciplines, including science, engineering, health, social sciences, business, and humanities. The journal welcomes original research articles, review papers, and short communications that advance knowledge and practice through multidisciplinary perspectives. JMMR is committed to research integrity, editorial transparency, and timely publication.
Authentic Nursing Leadership: A Concept Analysis
Authentic nursing leadership has become increasingly important in contemporary healthcare because nursing teams work in conditions shaped by workforce shortages, ethical pressure, emotional exhaustion, and expectations for safe, person-centered care. Although the concept is widely used in nursing leadership literature, it is sometimes applied broadly to describe positive, supportive, ethical, or transformational leadership behavior, which can obscure its distinctive meaning. This concept analysis clarifies authentic nursing leadership by identifying its defining attributes, antecedents, consequences, empirical referents, and conceptual boundaries. Walker and Avant’s concept analysis approach guided the analysis, supported by a structured synthesis of literature on authentic leadership in nursing and healthcare. Thirty studies and methodological sources were selected and synthesized to preserve the structure and scope of the selected article template. The analysis identified five defining attributes of authentic nursing leadership: self-awareness, relational transparency, internalized moral perspective, balanced processing, and genuine caring alignment with professional nursing values. Key antecedents included ethical organizational culture, psychological empowerment, leadership education, reflective practice, role clarity, feedback systems, and supportive work environments. Consequences were evident at individual, team, patient-care, and organizational levels, including increased trust in managers, stronger work engagement, higher job satisfaction, improved caring behavior, enhanced psychological safety, reduced burnout, lower turnover intention, and better safety climate. Empirical referents included the Authentic Leadership Questionnaire, Authentic Nurse Leadership Questionnaire, Authentic Leadership Inventory, nurse work environment scales, trust measures, safety climate tools, burnout instruments, work engagement scales, and performance measures. Overall, authentic nursing leadership emerged as a multidimensional and measurable leadership construct grounded in ethical self-regulation, transparent relationships, balanced decision-making, and value-congruent professional action. The findings provide a foundation for nursing education, leadership development, workforce retention strategies, unit-level assessment, and future empirical research on leadership practices that strengthen nurses and improve care quality.
The Determinants of Nurse Manager Competencies; A Systematic Review
Nurse managers play a pivotal role in healthcare organizations by influencing nursing workforce performance, practice environments, and patient care outcomes. However, the determinants that shape nurse manager competencies remain dispersed across the literature. This study aims to systematically review the determinants influencing nurse manager competencies and examine their associated organizational and clinical outcomes. A systematic review methodology was employed following the PRISMA guidelines. Relevant studies were identified through comprehensive searches of major electronic databases, and studies focusing on nurse manager competencies, leadership capabilities, and related determinants were included. After applying predefined inclusion and exclusion criteria, a total of 30 peer-reviewed studies were included in the final synthesis. The findings reveal that nurse manager competencies are influenced by a combination of behavioral, professional, and organizational determinants. Key determinants include leadership competency, managerial skills, communication competence, decision-making ability, leadership style, education and training, professional experience, organizational support, and work environment conditions. These determinants collectively shape the effectiveness of nurse managers in leading nursing teams and managing healthcare operations. The review also demonstrates that nurse manager competencies are strongly associated with important organizational outcomes such as staff job satisfaction, turnover intention, and patient care quality. Effective nurse manager leadership contributes to improved workplace environments, greater workforce stability, and enhanced healthcare service delivery. Overall, the findings highlight the importance of developing integrated leadership development strategies that strengthen nurse manager competencies through professional training, supportive organizational environments, and leadership development initiatives. Strengthening nurse manager competencies is essential for improving nursing leadership capacity and achieving better healthcare outcomes.
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Nurse Manager Competencies, Nurse Engagement and Work Environment Toward Nurses' Performance: Conceptual Framework
Nursing staff performance is a critical component of the quality of health care, patient safety, and the efficiency of health care organizations. Nurse managers play a pivotal role in influencing the work environment and professional practice of nurses in a context of growing complexity and turbulence that characterises health systems. This conceptual study presents an integrated framework of relationships to explore how nurse manager competencies, nurse engagement and the nursing work environment might impact nurse performance. Using leadership theories, the Job Demands-Resources (JD-R) model, and the magnet framework as a foundation, the study conceptualizes nurse manager competencies as multidimensional attributes of a nurse managers capacity including but not limited to leadership, communication, emotional intelligence, and clinical expertise. Nurse engagement, meanwhile, is framed as a mediating component of nurse emotional commitment and employee involvement with their work. Similar to the approaches of climate for sustainable development and performance practices, the organizational environment; in terms of support for climate, staffing adequacy, and autonomy, is treated as a contextual moderator that can act either as an enhancing or suppressing factor for performance outcomes. By establishing these linkages, the framework offers a theoretically informed foundation for empirical investigation and practical action to maximise the impact of the workforce on health systems. It anticipates that this conceptual model will inform future empirical studies and policy initiatives aimed at strengthening leadership development, enhancing nurse engagement, and improving organizational climates toward achieving excellence in nursing performance.
Factors Influencing the Effectiveness of Construction Safety Assessment Models: A Systematic Literature Review
The existing body of research on construction safety assessments is fragmented along the lines of technology, safety hazards, and assessment methods. This fragmentation prevents a systematic understanding of the conditions under which safety assessment models become valid, usable, and timely. The purpose of this review is to address this gap, by systematically identifying, assessing, and analyzing the factors that determine the assessment models’ effectiveness in construction safety. This review was based on 52 studies published within the predefined review period, drawn from an initial pool of 326 studies, and conducted a thematic synthesis of the studies, which included a synthesis of various assessment criteria, a method of counting studies, and the construction of a binary matrix on the coverage of the studies. According to the studies reviewed, the factors that determine the assessment models’ effectiveness can be grouped in the following domains: integrity of the evidence; contextual, and socio-organizational; and digital. The study results are based on the research of construction safety models and provide an auditable taxonomy of determinants, and an integrated interpretation of construction safety models, based on the technical, contextual, digital, and organizational needs, and can support design, validation, governance, and cross-context application of safety models and proactive construction safety governance.
The Determinants of Organizational Agility; A Systematic Review
Organizational agility has become a critical capability for organizations operating in uncertain, technology-driven, and highly competitive environments. Although previous studies have examined agility from different perspectives, the determinants of organizational agility remain fragmented across digital transformation, dynamic capabilities, leadership, knowledge management, technology, and contextual factors. This systematic review aims to identify, classify, and synthesize the key determinants of organizational agility and examine the major outcomes associated with agility in contemporary organizations. A systematic review approach was adopted to analyze 30 selected studies related to organizational agility. The review followed a structured identification, screening, eligibility, and inclusion process. The selected studies were analyzed using a literature review matrix and thematic synthesis to classify the main determinant categories and outcomes. The findings show that organizational agility is shaped by several interconnected determinants, including digital transformation, Industry 4.0, dynamic capabilities, leadership, organizational culture, knowledge management, organizational learning, IT capabilities, big data analytics, workforce agility, and contextual factors such as market turbulence and environmental uncertainty. The review also found that organizational agility is associated with improved performance, innovation, competitive advantage, resilience, sustainability, and market responsiveness. Organizational agility is a multidimensional strategic capability that depends on the interaction of behavioral, organizational, technological, and contextual determinants. Organizations seeking to remain competitive and resilient should develop integrated agility-building practices that combine digital capability, adaptive leadership, learning systems, knowledge sharing, and flexible structures.
The Determinants of Digital Innovation; A Systematic Review
Digital innovation has become a critical concern for organizations seeking to improve competitiveness, adaptability, service delivery, and value creation in increasingly digital environments. However, existing research on the determinants of digital innovation remains fragmented across different sectors, theoretical perspectives, and organizational contexts. This systematic review aims to synthesize existing literature on the determinants of digital innovation and identify the main technological, organizational, human, strategic, and contextual factors that influence digital innovation outcomes. A systematic review approach was adopted to examine 30 selected studies related to digital innovation, digital transformation, digital capabilities, organizational capabilities, leadership, culture, human capital, business model innovation, and performance outcomes. The studies were analyzed using a literature review matrix and thematic synthesis. The review process followed identification, screening, eligibility, and inclusion stages consistent with PRISMA 2020 logic. The findings show that digital innovation is shaped by multiple interacting determinants, including digital capabilities, technological capabilities, organizational capabilities, human capital, digital skills, leadership, organizational culture, agility, dynamic capabilities, and contextual conditions. The reviewed studies also indicate that digital innovation contributes to innovation performance, firm performance, competitive advantage, business model renewal, sustainable innovation, public-sector service transformation, and ecosystem development. Digital innovation should be understood as an integrated organizational process rather than a purely technological activity. Successful digital innovation requires alignment among technology, capabilities, people, strategy, culture, and context.
The Determinants of Renewable Energy Project Delays; A Systematic Review
The rapid expansion of renewable energy projects has become essential for achieving global sustainability goals, reducing greenhouse gas emissions, and improving energy security. Despite increasing investments in renewable energy infrastructure, many projects continue to experience significant delays during planning, financing, construction, and operational stages. These delays negatively affect project performance, increase implementation costs, reduce investor confidence, and hinder national energy transition objectives. Therefore, understanding the determinants contributing to renewable energy project delays is critical for improving project delivery efficiency and sustainability outcomes. This study systematically reviews the major determinants influencing renewable energy project delays by synthesizing evidence from existing academic literature. A systematic review methodology was adopted to identify, evaluate, and analyze peer-reviewed studies related to renewable energy project implementation challenges and delay factors. Following the application of predefined inclusion and exclusion criteria, 20 studies published between 2020 and 2025 were selected and analyzed. The findings revealed that renewable energy project delays are influenced by interconnected financial, regulatory, technical, managerial, stakeholder-related, and external factors. Financial constraints such as inadequate funding, high capital costs, and investment uncertainty were identified as major delay determinants. Regulatory barriers, including bureaucratic approval procedures and unstable governmental policies, also significantly affected project implementation. In addition, technical limitations, poor project planning, ineffective stakeholder coordination, and inadequate risk management practices contributed substantially to implementation inefficiencies. Social factors such as public opposition and limited community engagement further influenced project continuity, while external disruptions, particularly the COVID-19 pandemic, intensified project vulnerabilities through supply chain interruptions and operational challenges. The study concludes that renewable energy project delays require integrated management approaches involving effective financial planning, stable regulatory frameworks, stakeholder collaboration, and adaptive risk management strategies. The findings provide valuable insights for policymakers, project managers, investors, and researchers seeking to improve renewable energy project implementation and sustainability performance.
The Determinants of E-Governance Excellence; A Systematic Review
E-governance excellence has become a key priority for public-sector institutions seeking to improve service delivery, transparency, accountability, citizen trust, and administrative performance through digital transformation. However, its determinants remain fragmented across research streams such as e-government adoption, digital service quality, organizational readiness, digital inclusion, cybersecurity, artificial intelligence, and public value. This systematic review aims to identify, synthesize, and classify the main determinants of e-governance excellence into clear thematic categories that explain how governments can enhance digital public services and governance outcomes. A systematic review approach was used to examine relevant studies on e-governance, e-government, digital government, public-sector digital transformation, smart governance, citizen satisfaction, trust, transparency, inclusion, and public value. The review followed a structured selection process based on identification, screening, eligibility, and inclusion. A total of 30 studies were analyzed using a literature review matrix and thematic synthesis. The findings show that e-governance excellence is shaped by the interaction of technological, organizational, human, institutional, and contextual factors. Therefore, governments need integrated strategies that combine reliable digital systems, strong institutional governance, capable leadership, cybersecurity, citizen-centered service design, digital inclusion, and continuous performance improvement.
Nursing Leadership Competencies; A Concept Analysis
An abstract summarizes the major aspects of a paper. It should state a short introduction of background study, problem statement, purpose of the research, briefing about the used method, principal results and major conclusions. Citation or references and non-standard or uncommon abbreviations should be avoided in the abstract. The number of words should not exceed Nursing leadership competencies are essential for effective healthcare delivery, workforce sustainability, and patient safety; however, the concept remains inconsistently defined across nursing literature. This study aimed to clarify the concept of nursing leadership competencies using Walker and Avant’s concept analysis method. A systematic examination of nursing leadership literature was conducted to identify the uses of the concept and to determine its defining attributes, antecedents, consequences, and empirical referents. The analysis revealed that nursing leadership competencies constitute a multidimensional construct encompassing effective communication, relational and interpersonal competence, ethical and professional integrity, strategic and organizational capability, and leadership self-efficacy. Antecedents included leadership education, professional experience, organizational support, and individual motivation, while consequences were evident at individual, organizational, and patient-care levels, including leadership aspiration, improved work environments, and enhanced patient safety. Empirical referents comprised leadership competency frameworks, assessment instruments, and observable leadership behaviors. Clarifying this concept provides a coherent theoretical foundation to inform nursing leadership education, development, and future research.
Professional Training, Job Satisfaction and Self-Efficacy on Nursing Leadership Competencies; A Conceptual Framework
This paper presents a conceptual framework that examines the interconnections among professional training, job satisfaction, self-efficacy, and nursing leadership competencies. The framework is anchored in motivational and behavioral perspectives, integrating elements of Social Cognitive Theory, Herzberg’s Two-Factor Theory, and Transformational Leadership Theory. It argues that professional training functions as a critical foundation for developing leadership capacity by equipping nurses with the skills, confidence, and motivation necessary to manage complex healthcare challenges. Job satisfaction and self-efficacy are positioned as mediating mechanisms that explain how professional training translates into enhanced leadership competence. When nurses perceive their professional environment as supportive and fulfilling, and when they believe in their capability to lead effectively, they are more likely to demonstrate transformational behaviors that strengthen team performance and organizational outcomes. The proposed model offers both theoretical and practical value by linking continuous learning and psychological empowerment to leadership growth. It provides a pathway for healthcare leaders, educators, and policymakers to design evidence-based professional development strategies that foster empowerment, retention, and performance excellence in the nursing workforce, contributing to sustainable healthcare transformation and quality leadership practices.
Barriers to Adherence to Clinical Practice Guidelines in the Non-Surgical Management of Knee Osteoarthritis among Older Adults: A Systematic Review
Knee osteoarthritis (KOA) is a leading cause of pain, disability, and reduced independence among older adults. Although clinical practice guidelines consistently recommend education, structured exercise, weight management, and other non-surgical strategies as first-line care, implementation remains inconsistent. This systematic review identified and synthesised barriers to adherence with guidelines for non-surgical KOA management among adults aged 60 years and older. Guided by a pre-specified protocol and PRISMA reporting principles, searches were conducted in PubMed/MEDLINE, CINAHL, Embase, and Web of Science from database inception to December 2025. Eligible studies examined factors limiting guideline-concordant care. Two reviewers independently screened records, extracted data, and mapped barriers to the Theoretical Domains Framework, followed by narrative synthesis. Twenty-two studies were included. Barriers were concentrated in four areas: limited clinician knowledge and skills; beliefs and expectations regarding exercise, weight management, passive care, or surgery; social and professional influences, including inconsistent interdisciplinary messages; and environmental constraints, such as brief consultations, fragmented referral pathways, limited allied health access, and reimbursement barriers. Findings indicate that guideline adherence is shaped by interacting clinician, patient, professional, and system-level factors. Effective implementation requires integrated educational, behavioural, and service-redesign strategies tailored to older adults.
The Determinants of Low Back Pain; A Systematic Review
Low back pain is a highly prevalent and disabling musculoskeletal condition that imposes a substantial clinical, social, and economic burden worldwide. This systematic review aimed to synthesize current evidence on the prevalence, determinants, and outcomes of low back pain, with particular emphasis on behavioral, occupational, and contextual influences. Following PRISMA 2020 guidelines, relevant peer-reviewed studies were systematically identified, screened, and analyzed using predefined eligibility criteria, and findings were synthesized narratively and through structured evidence mapping. The reviewed literature indicates that low back pain affects diverse populations, with higher prevalence among older adults, women, and individuals exposed to physically demanding or ergonomically unfavorable work environments. Behavioral and psychosocial factors, including maladaptive pain beliefs, emotional distress, and reduced self-efficacy, alongside lifestyle factors such as obesity, physical inactivity, and poor sleep quality, were consistently associated with increased risk, pain chronicity, and functional limitation. Occupational exposures and adverse sociodemographic contexts further amplified disability, reduced quality of life, and increased healthcare utilization. Overall, the findings highlight the multifactorial and interdependent nature of low back pain, underscoring the need for integrated, biopsychosocial approaches to prevention, assessment, and management to reduce long-term disability and improve patient outcomes.
The Determinants of Digital Quality and Safety Education for Nurses (QSEN); A Systematic Review
The rapid advancement of digital technologies has transformed nursing education and expanded the ways nurses and nursing students develop quality and safety competencies. Digital learning, e-learning, virtual simulation, informatics-based education, and other technology-supported approaches are increasingly used to prepare nurses for safe, patient-centered, evidence-based, and high-quality care. Quality and Safety Education for Nurses (QSEN) provides a competency-based framework that emphasizes patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. However, the determinants influencing digital QSEN education remain dispersed across nursing education, informatics, patient safety, quality improvement, and digital learning literature. Therefore, this systematic review aimed to identify and synthesize the determinants of digital QSEN education among nurses and nursing students. Relevant studies addressing QSEN competencies, digital nursing education, e-learning, virtual simulation, informatics competence, patient safety education, teamwork, adverse event reporting, quality improvement, and digital self-efficacy were reviewed. A total of 30 studies were included and organized using a literature review matrix. The findings were synthesized narratively into educational, individual, clinical, organizational, and technological determinants. The review revealed that effective digital QSEN education is shaped by competency-based curriculum design, active digital learning strategies, informatics competence, digital health literacy, technology readiness, clinical relevance, leadership support, patient safety culture, and organizational readiness. Clarifying these determinants supports stronger digital nursing education and guides future research, curriculum development, and clinical practice planning.
The Antecedents of Patient Safety Competency; A Systematic Review
The increasing emphasis on safe, high-quality healthcare has made patient safety competency a core requirement for nursing practice and healthcare education. Patient safety competency refers to the knowledge, attitudes, skills, communication behaviors, teamwork abilities, and error-management practices required to prevent avoidable harm and respond effectively to adverse events. Although this competency is widely recognized as essential, its antecedents remain dispersed across educational, clinical, organizational, and individual contexts. Therefore, this systematic review aimed to identify, categorize, and synthesize the antecedents of patient safety competency among nurses, nursing students, and healthcare professionals. A systematic review approach guided by PRISMA 2020 was used to identify and screen relevant studies. Studies focusing on patient safety competency, its determinants, predictors, or related outcomes were included. Data were extracted, organized using a literature review matrix, and synthesized narratively and thematically. A total of 30 studies were included. The findings revealed that patient safety competency is shaped by educational, individual, clinical, organizational, and communication-related antecedents. Key antecedents included patient safety education, curriculum integration, simulation, e-learning, case discussion, adverse event analysis, knowledge, attitudes, self-efficacy, clinical competence, professionalism, systems thinking, compassion competence, experience, safety culture, leadership, teamwork, psychological safety, speaking up, organizational support, and error reporting. The review concludes that patient safety competency is multidimensional, requiring integrated education, clinical learning, leadership support, teamwork, psychological safety, and nonpunitive reporting cultures.
The rapid advancement of digital health technologies has significantly transformed healthcare delivery and expanded the use of remote healthcare services. Telerehabilitation has emerged as an important approach for providing rehabilitation services through information and communication technologies, enabling healthcare professionals to deliver assessment, intervention, monitoring, and patient education remotely. Despite its increasing adoption across healthcare systems, the concept of telerehabilitation remains inconsistently defined in the literature, leading to variability in its interpretation and implementation. Therefore, this study aimed to analyze and clarify the concept of telerehabilitation using the Walker and Avant concept analysis framework. A review of relevant literature addressing telerehabilitation, digital rehabilitation technologies, and remote rehabilitation services was conducted to identify the defining attributes, antecedents, consequences, and empirical referents of the concept. The analysis revealed five key defining attributes of telerehabilitation: remote delivery of rehabilitation services, the use of information and communication technologies, interaction between healthcare professionals and patients, monitoring and feedback mechanisms, and the implementation of structured therapeutic rehabilitation interventions. The findings also identified important antecedents, including technological infrastructure, access to digital devices, trained healthcare professionals, and institutional support, while the main consequences included improved access to rehabilitation services, enhanced patient engagement, and clinical outcomes comparable to traditional face-to-face rehabilitation. Clarifying the concept of telerehabilitation contributes to a stronger theoretical understanding of remote rehabilitation services and supports the development of standardized definitions and clinical frameworks that may guide future research and practice in rehabilitation sciences.
The Determinants of Knee Osteoarthritis Management; A Systematic Review
Knee osteoarthritis (KOA) is one of the most common musculoskeletal disorders worldwide and represents a major cause of pain, disability, and reduced functional capacity among adults. Effective management of knee osteoarthritis typically involves a combination of therapeutic approaches aimed at reducing symptoms and improving joint function; however, treatment outcomes are often influenced by multiple determinants related to patient behavior, rehabilitation strategies, and healthcare delivery. This systematic review aimed to identify and synthesize the key determinants influencing the management of knee osteoarthritis. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. A comprehensive literature search was performed across four major electronic databases: PubMed, Scopus, Web of Science, and CINAHL, using keywords related to knee osteoarthritis, management strategies, exercise therapy, rehabilitation, treatment adherence, and self-management. A total of 237 records were initially identified, and after screening and eligibility assessment, 20 studies were included in the final synthesis. The findings indicate that exercise-based management and physiotherapy interventions represent fundamental components in improving pain reduction and physical function among individuals with knee osteoarthritis. Psychosocial factors, including motivation, beliefs about treatment effectiveness, and perceived barriers to physical activity, were also identified as important determinants influencing patient engagement in rehabilitation programs. In addition, treatment adherence plays a critical role in determining the effectiveness of management strategies. Emerging evidence also highlights the potential role of digital self-management and telehealth-based interventions in improving patient participation and access to rehabilitation services. Overall, the management of knee osteoarthritis is influenced by multiple interrelated determinants, and integrating these factors into patient-centered management strategies may enhance treatment effectiveness and improve long-term clinical outcomes.
The Determinants of Quality Management Systems; A Systematic Review
Quality Management Systems have become important organizational mechanisms for improving process consistency, service quality, customer satisfaction, compliance, and organizational performance. However, the effectiveness of QMS implementation varies across sectors because organizations differ in leadership commitment, quality culture, resources, employee involvement, process control, and external pressures. This systematic review aimed to identify, classify, and synthesize the main determinants influencing the implementation and effectiveness of Quality Management Systems across organizational contexts. A systematic review approach was used to identify and synthesize relevant studies on QMS, ISO 9001, total quality management practices, implementation barriers, success factors, and performance outcomes. The review process followed the logic of PRISMA 2020, including identification, screening, eligibility assessment, and inclusion. A total of 30 studies were included and summarized using a literature review matrix. The findings showed that QMS implementation is shaped by managerial, organizational, human, technical, and external determinants. Leadership and management commitment, quality culture, employee involvement and training, resources, process documentation, audit and monitoring systems, customer focus, external factors, and implementation barriers were the most frequently reported themes. QMS was also associated with outcomes such as operational performance, customer satisfaction, service quality, stakeholder satisfaction, sustainability, environmental innovation, risk reduction, and organizational learning. QMS effectiveness depends on integrated implementation rather than certification alone. Organizations are more likely to achieve positive outcomes when QMS is supported by leadership, quality culture, employee capability, adequate resources, process discipline, and continuous monitoring.
Nurse Commitment: A Concept Analysis Using Walker and Avant’s Method
Nurse commitment is frequently linked to retention, quality of care, and patient safety, yet the concept is applied inconsistently across nursing and health services research. This concept analysis clarifies “nurse commitment” using Walker and Avant’s method by identifying defining attributes, antecedents, consequences, and empirical referents. A search was conducted in PubMed, CINAHL, Scopus, Web of Science, and Google Scholar for English-language, peer-reviewed sources published between 2021 and January 2026 addressing nurses’ professional commitment, organizational commitment, or commitment-related outcomes. Findings indicate that nurse commitment is a multidimensional psychological bond integrating professional and organizational orientations. Five defining attributes emerged: emotional attachment to nursing, sustained investment in professional development, alignment with nursing values, intention to remain in nursing practice, and dedication to patient-care excellence. Common antecedents included transformational leadership, perceived organizational support, adequate staffing and supportive work environments, professional values, autonomy, and effective socialization. Reported consequences encompassed lower turnover intention, reduced missed nursing care, improved patient safety and quality, and stronger organizational performance. Nurse commitment is distinct from job satisfaction or engagement and reflects an enduring professional–organizational bond shaped by leadership and work conditions and expressed in care excellence and intent to remain.
The Nurse Turnover Intentions; A Systematic Review
Nurse turnover intention (TI) has become a critical concern for healthcare systems worldwide due to its impact on workforce shortages, financial costs, and patient safety. High TI is a strong predictor of actual turnover, threatening the stability of healthcare delivery and exacerbating global nursing shortages. This systematic review aimed to synthesize empirical evidence on the prevalence and determinants of nurse turnover intention, evaluate the role of organizational and psychosocial factors, and identify research and policy gaps to inform workforce retention strategies. The review followed PRISMA 2020 guidelines. Electronic searches were conducted across PubMed, Scopus, Web of Science, and Google Scholar, covering literature from January 2000 to March 2025. Eligible studies included peer-reviewed empirical research and systematic reviews that examined turnover intention among nurses. Exclusion criteria included non-English language studies, theoretical papers, and studies without measurable outcomes on turnover intention. Screening and data extraction were performed independently by two reviewers, with quality appraisal guided by the JBI and MMAT tools. A total of 25 studies met the inclusion criteria. The prevalence of turnover intention among nurses ranged from 30% to over 50%, with the highest rates observed in intensive care and emergency settings. Key determinants included job dissatisfaction, burnout, stress, poor work environments, and lack of organizational support. Protective factors were supportive leadership, recognition, professional commitment, and vocational calling. The COVID-19 pandemic significantly increased turnover intention, with studies reporting heightened emotional exhaustion and new dynamics such as quiet quitting. Nurse turnover intention is a multifactorial issue shaped by individual, organizational, and systemic factors. Effective retention strategies must go beyond individual resilience-building to include structural reforms, such as improving staffing adequacy, strengthening leadership and recognition systems, and expanding mental health support. Addressing turnover intention proactively is vital for workforce sustainability, healthcare quality, and patient safety.
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The Determinants of Patient Safety Outcomes; A Systematic Review
Background: Patient safety is a key dimension of healthcare quality, yet preventable adverse events remain a global concern. Evidence suggests that safety outcomes are shaped by interacting determinants at individual, organizational, and system levels, necessitating a comprehensive synthesis of current research. Objective: This systematic review aimed to identify and synthesize key determinants of patient safety outcomes and examine their associations with adverse events, near misses, reporting practices, and overall safety performance. Methods: Following PRISMA 2020 guidelines, peer-reviewed studies published between 2020 and 2025 were systematically searched across major electronic databases. Eligible studies examined determinants influencing patient safety outcomes in healthcare settings. Data were extracted and thematically synthesized, with determinants categorized into behavioral, organizational, and contextual domains. Results: Patient safety outcomes were influenced by multiple interacting determinants. Behavioral factors included clinical competence, communication, fatigue, and professional conduct. Organizational determinants encompassed safety culture, leadership support, staffing adequacy, workload, reporting systems, and organizational learning. Contextual factors involved policy environments, resource availability, accreditation processes, and broader system constraints. These determinants were consistently associated with adverse events, healthcare-associated infections, medication errors, near misses, and mortality. Conclusions: Patient safety outcomes are multifactorial, arising from interactions across individual, organizational, and contextual levels. Improving safety requires integrated, system-wide strategies that address workforce behavior, organizational structures, and contextual conditions. A holistic, learning-oriented approach is essential to reduce preventable harm and enhance healthcare system resilience.
Patient safety outcomes; patient safety determinants; safety culture; adverse events; systematic review
The Determinants of Patient Safety Culture; A Systematic Review
Background: Patient safety culture is a cornerstone of high-quality healthcare, shaping patient outcomes and workforce performance. Despite global initiatives to improve safety, adverse events, underreporting of errors, and staff burnout persist, indicating gaps in the effective implementation of safety culture. Understanding its determinants is critical for guiding organizational strategies and policy interventions. Objective: This systematic review synthesizes empirical evidence on the prevalence, determinants, and outcomes of patient safety culture, with emphasis on behavioral, organizational, and contextual influences. Methods: The review followed PRISMA 2020 guidelines. Major electronic databases were systematically searched for studies examining patient safety culture among healthcare professionals. Eligible studies included quantitative research, systematic reviews, scoping reviews, and meta-analyses across diverse healthcare settings. Data were extracted and narratively synthesized using a structured review matrix. Results: Thirty studies were included. Patient safety culture was generally reported at low to moderate levels. Key determinants included leadership support, teamwork, communication openness, adequate staffing, training, and non-punitive responses to error. Strong safety culture was associated with reduced adverse events, improved incident reporting, higher patient safety ratings, and better staff well-being. Conversely, weak safety culture was linked to burnout, job stress, and increased turnover intentions. Conclusions: Patient safety culture is a multidimensional construct shaped by behavioral, organizational, and contextual factors. Enhancing leadership engagement, promoting teamwork and open communication, and addressing systemic workplace challenges are essential for improvement. A holistic, systems-based approach is necessary to achieve sustained gains in patient outcomes and workforce sustainability.
Patient safety culture; safety climate; healthcare quality; leadership
The Determinants of Digital Transformation in Public Institutions; A Systematic review
This study seeks to systematically review the key determinants of digital transformation in public institutions, addressing the growing need for a comprehensive understanding of this complex and multidimensional phenomenon. Digital transformation has emerged as a strategic priority for governments worldwide, driven by increasing demands for efficiency, transparency, and citizen-centric service delivery. A systematic literature review (SLR) was conducted using the PRISMA framework to ensure methodological rigor and transparency. A total of 20 peer-reviewed articles published between 2019 and 2024 were selected from major academic databases, including Scopus, Web of Science, and ScienceDirect. The selected studies were examined through thematic analysis to identify and classify the principal determinants influencing digital transformation. The findings indicate that digital transformation in public institutions is shaped by four primary dimensions: technological, organizational, environmental, and individual factors. Among these, technological, organizational, and environmental determinants are the most influential, whereas individual-level factors remain relatively underexplored. The analysis also underscores the growing importance of advanced technologies, particularly artificial intelligence, in accelerating transformation initiatives. Furthermore, the study highlights that successful digital transformation requires a holistic and integrated approach that aligns technological infrastructure with organizational readiness, supportive policy frameworks, and human capabilities. This research contributes to the existing literature by offering a comprehensive framework that synthesizes fragmented insights from prior studies. It also provides practical implications for policymakers and public sector leaders, emphasizing the need for balanced and coordinated strategies. Future research should focus on individual-level determinants and empirically validate the proposed framework across diverse institutional contexts.
Digital Transformation; Public Sector; E-Government; Artificial Intelligence; Systematic Review
The mediating role of organizational agility in the relationship between digital leadership and organizational excellence in Saudi SMEs
This study investigates the mediating role of organizational agility in the relationship between digital leadership and organizational excellence in Saudi small and medium-sized enterprises. The study was motivated by the growing importance of digital transformation and the increasing need for SMEs to strengthen their adaptability and competitive capacity within a rapidly changing business environment. A quantitative, deductive, and cross-sectional research design was adopted. Data were collected through a structured questionnaire from 352 managers, supervisors, department heads, team leaders, and decision-makers working in Saudi SMEs. The collected data were analyzed using Partial Least Squares Structural Equation Modeling to assess both the measurement model and the structural relationships among the study variables. The findings revealed that digital leadership has a significant positive effect on organizational agility and organizational excellence. The results also showed that organizational agility has a significant positive effect on organizational excellence. In addition, the indirect effect analysis confirmed that organizational agility mediates the relationship between digital leadership and organizational excellence. These findings indicate that digital leadership enhances organizational excellence not only directly, but also indirectly by strengthening the organization’s ability to respond flexibly and effectively to environmental and strategic change. The study contributes to the understanding of how digital leadership and organizational agility jointly support excellence in SMEs. It also offers practical insight for SME leaders seeking to improve organizational performance by combining digital capability with adaptive organizational processes.
Digital leadership; Organizational agility; Organizational excellence; Saudi SMEs; PLS-SEM.
The Determinants of Nursing Continuous Professional Development: A Systematic Review
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt; line-height: 150%; font-family: 'Times New Roman',serif; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; color: black; mso-themecolor: text1; mso-font-kerning: 0pt; mso-ligatures: none; mso-ansi-language: EN-GB; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">Continuous professional development (CPD) is essential for sustaining nursing competence, supporting career progression, and strengthening care quality in health systems characterised by rapid clinical and technological change. Yet nurses’ engagement in CPD remains uneven across settings because participation is shaped by interacting personal, organisational, and contextual determinants. This systematic review synthesises evidence on determinants of nursing CPD, with specific attention to barriers, facilitators, and implementation conditions that influence sustained participation. The review was conducted using a structured systematic design guided by established reporting and evidence-synthesis standards. Across the included studies, nurses consistently recognised CPD as professionally necessary and clinically valuable for updating knowledge, strengthening confidence, and enhancing patient care. However, participation was frequently constrained by time pressure, high workload, staffing shortages, financial costs, scheduling inflexibility, and limited managerial support. Stable facilitators included clear relevance of CPD to practice, supportive leadership, protected learning time, accessible delivery formats (including blended and online approaches), and organisational cultures that value learning. The synthesis further indicates that CPD needs and barriers vary by career stage, with novice and experienced nurses facing different motivational drivers and practical constraints. Overall, the evidence supports a systems perspective in which CPD participation is produced through alignment between individual professional goals and organisational and policy mechanisms that enable equitable access, workload planning, and context-sensitive programme design.
Continuous Professional Development in Nursing: A Concept Analysis
This paper presents a comprehensive concept analysis of Continuous Professional Development (CPD) in nursing, utilizing the systematic framework proposed by Walker and Avant. The proliferation of medical knowledge, technological advancements, and evolving healthcare demands necessitates that nursing professionals engage in ongoing learning to maintain and enhance their competence. Despite its critical importance, the concept of CPD often suffers from definitional ambiguity and varied interpretations across different contexts and regulatory bodies. This analysis aims to clarify the concept of CPD by identifying its defining attributes, antecedents, and consequences, drawing upon contemporary literature from 2021 to 2026. A model case, borderline case, related case, and contrary case are presented to illustrate the concept's application and boundaries. Furthermore, the paper explores empirical referents for measuring CPD, discusses prevalent barriers and enablers to its engagement, and highlights its global perspectives. The findings underscore the multifaceted nature of CPD and its profound implications for nursing practice, patient safety, and professional growth, offering a refined understanding that can inform educational strategies, policy development, and future research in nursing
Team Cohesion Among Nursing; A Systematic Review
This systematic review examines the role of team cohesion among nurses and its influence on professional, organizational, and patient‐related outcomes across healthcare settings. Drawing on evidence from quantitative, qualitative, and mixed-methods studies, the review synthesizes how team cohesion is formed, the conditions that strengthen or weaken it, and the consequences it produces within nursing teams. The findings show that cohesion among nurses is shaped by a combination of interpersonal relationships, leadership practices, psychological safety, work environment, and organizational stability. High levels of cohesion are associated with improved teamwork, stronger job satisfaction, lower burnout and turnover intentions, better communication, and enhanced patient safety and care quality. Conversely, fragmented teams characterized by poor communication, weak leadership, and high staff turnover demonstrate reduced collaboration, higher levels of missed care, and lower performance. The review further indicates that cohesive teams are more resilient during periods of crisis and change, allowing nurses to adapt, support one another, and maintain effective care delivery under pressure. Overall, the evidence positions team cohesion as a central mechanism through which nursing teams achieve both workforce wellbeing and high-quality patient outcomes, highlighting the importance of organizational strategies that foster trust, collaboration, and shared purpose in healthcare environments.
Nursing Team Cohesion: A Concept Analysis Using Walker and Avant’s Method
Nursing team cohesion is increasingly recognized as a critical determinant of communication quality, collaborative decision-making, staff well-being, and patient safety; however, the concept remains insufficiently defined and is often conflated with related constructs, including teamwork, collaboration, and psychological safety. This concept analysis aimed to clarify nursing team cohesion as a distinct construct within nursing science by identifying its defining attributes, antecedents, consequences, empirical referents, and conceptual boundaries. Walker and Avant’s eight-step method guided the analysis, supported by a systematic search of peer-reviewed English-language studies published between 2020 and 2025 in Google Scholar, OpenAlex, and PubMed Central. Using PRISMA 2020 procedures, 28 studies were selected and thematically synthesized. The analysis identified five defining attributes: mutual trust and respect, effective communication, shared goals, interpersonal harmony, and emotional intelligence. Key antecedents included transformational leadership, conflict resolution training, emotional intelligence, and structured team-building initiatives. Consequences were evident at individual, team, and organizational levels, including improved job satisfaction, reduced burnout, enhanced collaboration, greater psychological safety, better patient outcomes, and lower turnover. Empirical referents included the Team Climate Inventory, TeamSTEPPS instruments, and qualitative assessments. Overall, nursing team cohesion emerged as a multidimensional, measurable construct with substantial relevance for leadership, workforce stability, intervention design, and healthcare quality improvement.
Food Safety in Healthcare Institutions; A Systematic Review
Food safety in healthcare institutions constitutes a critical dimension of patient safety because hospitalized populations are disproportionately susceptible to foodborne infections, cross-contamination, and adverse outcomes arising from compromised immunity and clinical vulnerability. This systematic review synthesizes contemporary evidence on the prevalence, determinants, and outcomes of food safety practices in healthcare settings, with particular attention to the effectiveness of Hazard Analysis and Critical Control Point (HACCP) systems, food safety culture, staff training, and emerging digital technologies. Guided by PRISMA 2020, the review examined peer-reviewed studies published between 2020 and 2025 across major academic databases, including empirical and review-based research addressing hospital food hygiene, outbreak prevention, contamination control, and institutional determinants of compliance. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. The evidence indicates that food safety performance in healthcare institutions is shaped by an interaction of behavioral, organizational, and contextual factors. Food handlers’ knowledge, attitudes, and practices consistently emerged as central determinants of hygienic compliance, while leadership commitment, continuous training, inspection frequency, and regulatory enforcement strengthened adherence to established standards. Infrastructure-related conditions, particularly water quality, sanitation, storage capacity, and temperature control, further influenced the success of preventive measures. The review also found that HACCP implementation and structured quality assurance systems were associated with reduced contamination rates and improved operational control, whereas predictive analytics, machine learning, and Industry 4.0 applications enhanced monitoring capability and decision quality. Overall, the findings demonstrate that effective food safety management in healthcare institutions requires more than procedural compliance; it depends on embedding safety within institutional governance, organizational culture, and technological systems. Strengthening staff competence, managerial accountability, regulatory oversight, and digitally enabled monitoring is therefore essential to minimizing hospital-related foodborne risks and protecting patient health.
The Determinants of Digital Health immunization technology; A Systematic Review
Digital health technologies have become central to modern immunization systems, replacing paper-based processes with electronic registries, mobile health applications, interoperable platforms, and digital decision-support tools. While these innovations promise improvements in vaccination coverage, data quality, and program efficiency, their adoption and effectiveness vary widely across health system contexts. Fragmented evidence, diverse technologies, and inconsistent outcomes have made it difficult to understand what truly enables or constrains successful digital immunization implementation. This study therefore aimed to systematically identify and synthesize the key determinants of digital health immunization technology across global settings. A systematic review was conducted following PRISMA 2020 guidelines, drawing on multiple academic databases and applying clear inclusion and exclusion criteria to select empirical studies relevant to digital immunization systems. Thirty peer-reviewed studies were analysed using thematic synthesis to categorize determinants into technological, behavioural, organizational, and contextual domains. The findings reveal that electronic immunization registries, community-based mHealth tools, system interoperability, workforce capacity, governance structures, and digital infrastructure are the most influential determinants of performance. Positive outcomes were most consistently observed in vaccination coverage, timeliness, data reliability, and workflow efficiency, particularly when digital tools were embedded within well-coordinated health systems. The review concludes that digital immunization technologies are most effective when technological innovation is accompanied by strong leadership, sustained investment, user-cantered design, and supportive policy environments, rather than being implemented as isolated technical solutions.
The Professional Autonomy of Nurse Practitioners: A Concept Analysis
Professional autonomy is central to nurse practitioner (NP) practice, yet the concept remains inconsistently defined across regulatory, organizational, and outcome-oriented literature. This paper analyzes professional autonomy of nurse practitioners as a multidimensional construct comprising clinical decision-making authority, independent practice capability, and professional accountability. A structured concept-oriented review of recent peer-reviewed literature published between 2021 and 2025 was used to identify the defining attributes, antecedents, mediating mechanisms, contextual conditions, and consequences associated with the concept. The analysis shows that professional autonomy cannot be reduced to independence alone. Rather, it refers to the legitimate authority to make advanced clinical decisions, enact practice without unnecessary external control, and remain answerable for the quality, safety, ethics, and outcomes of care. Role clarity emerged as the central mediating mechanism because autonomy is translated into advanced nursing practice effectiveness only when responsibilities, jurisdictional boundaries, and expectations are clearly understood by nurse practitioners, physicians, managers, and policymakers. Advanced nursing practice effectiveness was identified as the principal consequence of well-enacted autonomy and was reflected in access, timeliness, continuity, patient outcomes, and service efficiency. Organizational support and regulatory environment were identified as contextual conditions that can either enable or constrain the practical realization of autonomy. The paper contributes a conceptually integrated framework that explains how the internal structure of NP autonomy operates within workplace and policy contexts and identifies key research gaps related to measurement consistency, cross-country comparability, and implementation beyond formal legal authority.