This paper introduces the Societal Health & Nursing Framework as a sociologically informed approach that expands nursing's focus from individual patients and families to the broader societal conditions influencing health and illness. Grounded in sociology, public health ethics, social determinants of health, intersectionality, and socioecological models, the framework offers nurses a shared language and structure to address upstream drivers of health inequities. Nursing practice is increasingly shaped by social, political, and economic forces that extend beyond individual clinical encounters. Although the International Council of Nurses Code of Ethics affirms nurses' responsibility to promote human rights, health equity, and social justice, these ethical commitments are not consistently translated into everyday practice or education. By situating health within cultural and structural contexts, the Societal Health & Nursing Framework provides a unified vocabulary and conceptual foundation to promote holistic, culturally responsive care and strengthens nursing's role in advocacy, policy engagement, and global citizenship. Integrating this framework into nursing education and practice reinforces nursing's social mandate to advance health equity and societal well-being.

This commentary critiques the growing use of the term "equity-deserving" in health equity literature, academic institutions, and policy research. The term was originally intended to frame equity as a right rather than a request. However, we argue that "equity-deserving" is a conceptually flawed term that reinforces a charity-based model of social justice by positioning institutions as benevolent givers and marginalized groups as passive receivers. This, in turn, results in obscuring the structural causes of inequality, risking the creation of meritocratic gatekeeping in clinical care and jeopardizing the validity of health equity research through the use of monolithic, performative labels.

Background: The education of preceptors, who support novice nurses in adapting to the workplace and developing their practical skills, is an important topic. Lack of preceptor preparation is an issue. Purpose: Investigate the specific content of preceptors' metacognition in novice nurse instruction. Methods: A qualitative descriptive design involving semi-structured interviews with 15 preceptors at four hospitals in Japan. Preceptors were asked to explain their own behaviors, thoughts, and feelings in a typical instructional episode. A verbatim transcription was analyzed by qualitative content analysis. Results: Three categories were identified from the preceptors' responses: Monitoring of Instruction, Regulation of Instruction, and Self-Assessment. All preceptors described using metacognition. Conclusions: Metacognition is useful for improving preceptors' instructional approaches and for their own development. In order to ensure good instruction of novice nurses, preceptors should consider themselves and their instruction abilities objectively before, during, and after the instruction process, and adapt to the situation. These findings provide important insights for preceptor development programs internationally.

This fourth issue of Creative Nursing 2025 focuses on people with disabilities (another example of seldom-heard voices), those who are or want to be nurses and those for whom nurses care. Ableism in nursing education has kept out generations of people with disabilities, and our profession is the poorer for it. In this journal issue we hear the voices of content experts about structures and processes needed to enact true inclusion of people with disabilities (including accommodations, communication, leadership, design, technology, advocacy, and policy work), and personal accounts of student learners and professional nurses living with disabilities visible or invisible that have a direct impact on their practice. We hear about varying degrees of inclusion extended to people with achondroplasia, d/Deaf and hard-of-hearing college students, children with profound intellectual and multiple disabilities and their families, and people coping with laryngeal dystonia, sudden blindness, and preparation for discharge to home after a stroke. An article in our series on methodology focuses on qualitative description, in which researchers recruit participants with diverse experiences or who can provide detailed information regarding the phenomenon under study. And we present three recently published articles of general interest, all related either to nursing education or innovations in practice.

Background:The care of children with Profound Intellectual and Multiple Disabilities (PIMD) often relies heavily on parents, and their care practices can be difficult for professionals to fully understand or replicate. Purpose: This study aims to clarify the foundation of care practices among parents of children with PIMD. Methods: Five mothers were interviewed using unstructured interviews, and the data were analyzed using a phenomenological approach. Conclusions: Mothers emphasized the importance of fostering children's sense of self-determination through sincere and attentive care. They also expressed concerns that nurses' excessive focus on medical expertise could lead to losing sight of the child as a person and reducing care to the application of knowledge. This study highlights the lack of a universal definition of care for children with PIMD. Implications for Practice: Nurses need to take more account of the fact that care for children with PIMD is deeply personalized, and that based on mothers' experiences, care itself constitutes an important form of tacit knowledge. These insights should be applied to everyday practice and emphasized in the training process.

Background: A health-care workforce that mirrors the identities of patients is critical for achieving positive outcomes. To support a highly qualified and diverse nursing workforce, the Caring for Our Own Program (CO-OP) aims to increase the enrollment and retention of Indigenous students in nursing programs. Poor retention rates for Tribal-college transfer students (35.9%) presented a barrier to success for students best placed to enhance the nursing workforce in Tribal communities. Methods: CO-OP piloted the Success Academy, a pre-entry immersion program for Tribal college transfer students, ahead of four consecutive semesters. This four-week immersion featured a holistic hybrid format to improve sense of place, financial security, academic readiness, and social connection. Results: Thirty students participated ahead of beginning upper division coursework. Twenty have progressed without delays, including seven who graduated on time and are pursuing licensure. Five participants were delayed by one semester to repeat one or more courses, one was delayed by two semesters, and four stepped away. Conclusion: Success Academy had a demonstrable long-term impact to improve college access and success for Indigenous nursing candidates most ideally placed to make lasting change on Indigenous health in the Western U.S.

In Fall 2024, the University of Calgary Faculty of Nursing launched its inaugural Indigenous health course within the new Bachelor of Science in Nursing curriculum. Rather than simply providing a stand-alone course, this first-year course provides the foundation for ongoing learning and transformation needed to prepare nursing students to provide culturally safe care to Indigenous peoples. In this article, we will share the curriculum design process and implementation of the first iterations of the course. We will highlight the long-standing relationships and trust built over years that made it possible for a group of women (a Mi'kmaw/Irish/English settler scholar, a Scottish/German settler nurse scholar, and a Lakota/Dakota Elder, and scholar) to work together from course design to implementation and validation. Through the embodied practice of "first voice" as eloquently articulated in the epilogue by Graveline, we are leading change through stories of lived experiences that enable us to forefront Indigenous ways of knowing, being, doing, and connecting from our unique locations.

Aim: This study aimed to explore the experiences and perceptions of patients in a rehabilitation center who had experienced a stroke, regarding their concerns about discharge and life after stroke. Methods: A qualitative descriptive design was used and unstructured interviews were conducted with 100 patients with stroke. Reflexive thematic analysis was employed to identify recurring patterns and themes in the data, ensuring an in-depth understanding of the participants' experiences. Results: Three themes were generated from the analysis: (a) general post-hospitalization concerns, (b) concerns regarding the ability to handle activities of daily living, and (c) post-discharge aspirations and goals. Conclusions: This study sheds light on the diverse perspectives of patients with stroke regarding discharge from rehabilitation centers. A person-centered approach for patients with stroke is an important step for coordinating discharge planning. Developing a personalized care plan for meeting patients' needs is critical to address fundamental care issues.

Collaboration and intercultural interaction and engagement are relevant to all aspects of higher education including distance/remote/virtual courses. Collaborative Online International Learning (COIL) experiences connect students in different countries and provide them with meaningful and significant opportunities for global and intercultural exposure. Such an educational environment enhances students' cultural awareness and knowledge, and guides their personal, relational, and professional actions. Accordingly, engagement in COIL experiences can increase students' understanding of and ability to respond to significant global health-care issues both locally and internationally and to recognize their impact on mental health, and can lead to reflection and awareness that will endure beyond students' individual class experiences. One of these urgent issues is mental health vulnerabilities associated with environmental justice issues. This article describes participation in an international collaborative experience between the Universidad San Francisco de Quito, Ecuador, and the College of Nursing at the University of South Alabama, USA.

Organizational socialization (OS) is a critical process that all employees go through. In addition to the job characteristics, the efficiency and effectiveness of the OS process impact the individual's ability to adjust and be involved in the job. This study proposes and tests a new model in which psychological safety mediated the effects of OS and job characteristics on the job involvement of 313 newly recruited health-care professionals' working in 10 private hospitals in South India. Researchers used Uncertainty Reduction Theory to explain the relationship between the variables under study. The results indicate that newcomers' job involvement is predicted positively by OS and job characteristics, and that psychological safety mediates these relationships. These findings as well as their implications in the health-care professional arena are discussed within the Eastern cultural contexts of organizational behavior research.