Abstract
This journal issue reports on the effects on our spirits of the increasing stress, complexity, and change that seemingly are coming faster than we as a species can adapt to them. The sources of our articles (Australia, Brazil, Canada, Ecuador, India, Indonesia, Jordan, Palestine, Portugal, South Korea, Turkey, and the US) show that these effects are being felt all over the world. The title of this editorial reflects two concepts presented in this issue: that it is the things we want or need to do in our lives—our activities—that comprise our humanity, and that mental health is a daily continuum, from coping and resilience to significant vulnerability, from psychological pleasure to psychological pain, and from effective performance to struggles with, and sometimes inability to do, the things that help us live in the world. All our articles illustrate in some way these concepts of a continuum of mental health, and of our functioning in the world as its measure.
Keywords
Our overarching theme for Creative Nursing 2025 is Amplifying Seldom-Heard Voices and Dismantling Oppressive Structures. In these dangerous times in our world, our journal's legacy of publishing articles that other journals may avoid is more important than ever. As I have repeatedly said in my own editorials, we don’t seek out controversy, but we welcome it when it comes. This journal issue reports on the effects on our spirits of the increasing stress, complexity, and change that seemingly are coming faster than we as a species can adapt to them. The sources of our articles (Australia, Brazil, Canada, Ecuador, India, Indonesia, Jordan, Palestine, Portugal, South Korea, Turkey, and the US) show that these effects are being felt all over the world.
The title of this editorial reflects two concepts presented in this issue: that it is the things we want or need to do in our lives—our activities—that comprise our humanity, and that mental health is a daily continuum, from coping and resilience to significant vulnerability, from psychological pleasure to psychological pain, and from effective performance to struggles with, and sometimes inability to do, the things that help us live in the world. All our articles illustrate in some way these concepts of a continuum of mental health, and of our functioning in the world as its measure.
From the Guest Co-Editors
Our Guest Co-Editors for this issue are Lori Steffen, an experienced nurse manager and nursing professor who is currently a consultant for people living in group homes and assisted living settings, and Linda Sue Hammonds, a nursing professor at the University of South Alabama, US. The lead articles by these two scholars show the breadth of our discussion of Mental Health in the 21st Century.
Mental Health Then and Now
Lori Steffen's article defines mental illness and details how the understanding of and treatments for it have changed throughout centuries. Mental illness can vary in impact, from no impairment, to mild, moderate, or severe impairment; the National Institute of Mental Health (cited in her article) defines serious mental illness as a mental, behavioral, or emotional disorder resulting in serious functional impairment which substantially interferes with or limits one or more major life activities. Using a broader definition, everyone experiences mental health issues at some point, but when these issues persist or begin to affect daily activities, it becomes mental illness. Situational events may cause short-term mental illness, but for some people, this can progress to chronic, life-altering serious mental illness. Historically, mental illness has been seen as having three distinct etiologies (supernatural, somatogenic, or psychogenic), and treatments, some ineffective and others extremely inhumane, have reflected those changing views. Mental illness has been associated with shame and stigma for generations. More recent advances include effective medications, scientific practices, respectful person-first language, strengthened policies including insurance coverage, access to help, and targeted technology, but “it will take continued effort on many fronts to ensure that humane treatment for mental health issues is accessible to all” (Steffen, 2025).
Mental Health Vulnerabilities and Environmental Justice
Linda Sue Hammonds, Sara Newman, and Melanie Baker report on a collaborative online international learning experience among undergraduate students in a humanities course in scientific inquiry at the Universidad San Francisco de Quito, Ecuador, and Doctor of Nursing Practice students at the University of South Alabama, US, studying mental health vulnerabilities associated with environmental justice issues. Mental health vulnerabilities are situations that are beyond the control of an individual, that may impact their mental health, increasing the severity of symptoms on a continuum. Environmental justice issues can contribute to these vulnerabilities (for example, air pollution; high ambient heat and heat waves; vulnerabilities associated with climate change; activist burnout; and pandemics such as Covid-19). Students identified environmental justice issues and associated mental health vulnerabilities, and developed posters on these topics (Newman et al., 2025).
The Role of Social Media in Adolescent Mental Health
A different kind of vulnerability among adolescents is explored in two articles with contrasting points of view.
Use of Technology to Promote Adolescent Mental Health
Alexandra Ferreira of the Higher School of Health, Fernando Pessoa, in Porto, Portugal, and her colleagues conducted a scoping review of literature that offers insights for health-care professionals, researchers, and technology developers about the use of technology to promote adolescent mental health, such as apps for mood monitoring, online support platforms, computer-based cognitive behavioral therapy programs, and virtual reality interventions for anxiety. The authors conclude that these technologies provide accessible, personalized, stigma-free support for adolescents, enabling early and convenient interventions to address adolescent mental health issues such as anxiety, depression, and stress, while acknowledging concerns including data privacy, security, and the risks of excessive screen time, which may lead to dependency or social isolation. Particularly concerning is the potential for algorithms that amplify harmful content, such as promoting body dysmorphia or reinforcing suicidal thoughts, which can undermine their intended mental health benefits (Ferreira et al., 2025).
The Decline in Adolescent Mental Health
In a narrative review of the same field of literature, Kristin Burgess, a DNP-to-PhD student at the University of Texas at Tyler, US, reports on a significant increase in depression, anxiety, and suicidal thoughts and behaviors in young people ages 13–19 and states that most of the research published from 2016 to 2024 points to social media use as a contributing factor. In many of the articles included in this literature review, depressive symptoms and increased suicide risk often accompany problematic social media use. The author identified themes of negative psychological and physical effects and types of addiction related to social media use, fear of missing out (FOMO), cybervictimization, contagion phenomenon, and low perceived support. There are countless challenges and obstacles to forcing adolescents to change their relationship with social media and screen time. This author recommends further research about FOMO as a newer phenomenon, and education and screening tools related to cyberbullying. The most important recommendation calls for routine annual screening of adolescents between the ages of 12 and 18 for depression and suicide risk (Burgess, 2025).
Mental Health in Educational and Workplace Settings
These articles explore the mental health implications of stressful academic and workplace environments, and the challenges of preparing students to care for vulnerable individuals and populations and to communicate effectively with their colleagues to enhance safe care.
Understanding Imposter Syndrome
Imposter Syndrome (IS) is a psychological pattern in which individuals doubt their accomplishments and talents, and fear being exposed as frauds. Despite evident success, these feelings may lead to an inability to internalize achievements, often resulting in increased levels of stress, anxiety, and depression. This phenomenon, widespread in academic settings, was studied by Noor Qasem and her fellow medical students, and nursing professor Mohammad Alsadi, from Amman, Jordan. Of the 1120 university students who participated, 89% reported moderate, frequent, or intense feelings about IS, with no significant differences based on gender, age, specialty, program level, or grade point average. These authors recommend early detection and screening programs, along with targeted counseling and mentorship, encouraging open discussions about these feelings to empower students to recognize their worth and develop healthier coping strategies (Qasem et al., 2025).
Helping Students Find Their Way in Clinical Placements
Clinical placement experiences can be a time when students feel the impact of intersectional challenges such as regionality, gender, age, first in family to attend university, and low socio-economic status, and is a point in which attrition occurs. The geographical consequences of regional professional experience placement often result in a physical and cognitive disconnect with their university, impeding academic success and diminishing the benefit of the experience. In Australia, many pre-licensure nursing students are mature-aged; studying full-time; live in rural or remote areas; need to work to finance their studies; and hold family carer responsibilities. Keden Montgomery, Monica Davis, and Jessica Biles at Charles Sturt University report on a partnership between the School of Nursing and the Spatial Data Analysis Unit to create a customized, interactive digital map app to support students in professional experience placements. The app provided geographical and visual information about the placement sites and single-click access to information about living accommodations, scholarships, public transport, public libraries, free Wi-Fi locations, mental health support, and First Nation support. Results of participants’ responses suggested that the map app contributed to improving students’ experience of personal, financial, and family stress, and ongoing connection with theoretical learning using technology (Montgomery et al., 2025).
Teaching Equitable Care
Nursing education plays a crucial role in preparing future nurses to deliver competent, respectful care to transgender individuals, who face significant health disparities including barriers to gender-affirming care. Rebekah Almond from the Department of Nursing at Appalachian State University in Boone, North Carolina, US, and her colleagues report on a series of interprofessional unfolding case study modules containing 360-virtual reality and face-to-face simulations, designed to address these health inequities. This multi-modal approach allowed students to experience realistic patient interactions and apply their knowledge in a controlled, low-stakes environment. Students identified benefits of the simulation including hearing first-hand narratives from transgender individuals in the community, increased experience in continuity of care for patients, and exposure to diverse populations prior to entering nursing practice (Almond et al., 2025).
Teaching Safer Communication
In nursing education, teaching clear communication hones critical skills that improve students’ performance and efficacy and allow them to communicate with people from different cultures and backgrounds. Lack of opportunities to practice individual communication with patients and with other health-care providers can be evident in unsafe patient hand-offs, leading nurse educators to integrate alternative teaching strategies into nursing curricula. Simulation-based education is a safe didactic strategy for preparing students for successful transition to clinical practice; it allows learners to practice skills without harm, mimics the reality of a clinical environment, and evaluates clinical skills at different levels of nursing. Nursing professor Samar Thabet Jallad of Al-Quds University in Jerusalem, Palestine, studied the effect of simulation-based learning on communication skills, satisfaction with current learning, and self-confidence in learning among nursing students in the fundamentals of nursing course, using a simulation strategy and SBAR technique following Jeffries's Nursing Education Simulation Model (cited in article). The simulation used several real-life clinical scenarios related to the course; roles included primary nurse, secondary nurse, physician, patient, and family member (Jallad, 2025).
Helping New Employees Build Job Involvement
Individuals who join an organization would like the environment to be predictable, but they typically experience high levels of uncertainty. Lishin Moothery Joshy and Anjali A of SCMS Cochin School of Business in Kerala, India present a model for aiding new employees in adjusting to and becoming involved in their new jobs and work environments. This model, based on Uncertainty Reduction Theory, details the interrelationships among organizational socialization (the process by which newcomers make the transition from being an outsider to being an insider), job characteristics (comprising job demands and job resources), and job involvement (the intensity of a person's psychological identification with the job), with psychological safety (absence of interpersonal fear and confidence that straightforwardness and vulnerability will not have negative consequences) as a mediator. One way of reducing uncertainty is to provide information through organizational channels, mainly social interactions with other organization members. Organizational socialization processes typically target this aspect, facilitating adjustment to the workplace and the job role by reducing anxiety levels (Moothery Joshy & A, 2025).
Promoting Mental Health Through Direct Care
Throughout the lifespan, the stresses and traumatic events surrounding illness and its consequences challenge our ability to maintain our activities of daily living. Often the modalities used to treat these illnesses have their own consequences for the individual's mental health. These articles consider the current and future mental health of premature infants, children forming their first impressions of health care, mothers living with human immunodeficiency virus (HIV), older adults recovering from cardiac surgery, and people of all ages who are coping with mental illness with the help of medications.
Minimizing Procedural Pain for Premature Infants
Pain early in life induces long-term changes in autonomic reactivity and brain development; to minimize short- and long-term negative effects, early and valid detection of pain is as important as pain management. Although pain scales can assess behavioral pain-related responses, few available instruments detect persistent pain or stress in preterm babies, especially facial expressions, which are important communication tools for neonates. Hea Jin Lee of Haeundae Paik Hospital at Inje University in Busan, South Korea, and colleagues Myoung Soo Kim and Mi Lim Chung, compared infants’ pain-related behavioral and physiological responses to and the puncture-related characteristics of two different devices (automated lancets and laser lancets) used for sampling newborn babies’ blood via heelsticks. Use of laser lancets required more sticks than the automated device to obtain the same amount of blood, but penetration was shallower (indicating less trauma to tissues) and there was no significant difference in pain-related responses (Lee et al., 2025).
Addressing Children's Fear Points
The hospital environment can exacerbate fear and stress mechanisms associated with pain, resulting in heightened pain perception and stress due to traumatic memories. Children's fears about hospitals often stem from separation from their parents, an unfamiliar environment, and a perceived loss of autonomy. Nursing professors Suat Tuncay and Abdullah Sarman of Bingöl University in Bingöl, Turkey studied hospital fear points, specific aspects of the hospital experience that can be particularly frightening for children. The survey tools they used are included in the article, in both Turkish and English. In outpatient treatment and emergency department settings, children were afraid of blood drawing, intravenous insertion, injections, and separation from their mothers. In the operating room setting, in addition to painful procedures, children were most afraid of being forced to undergo the procedure, insertion of medications, being in the operating room, being awakened after surgery, and seeing the incision site. In the inpatient ward, children were most afraid of nurses and doctors entering the room. Working collaboratively with hospitalized children, their parents, and the nurses caring for them can enhance the quality of care by addressing the factors that cause fear and anxiety (Tuncay & Sarman, 2025).
Using a Comic Book About Surgery
Perioperative nursing care assesses the needs of people undergoing a surgical procedure, helps them understand the proposed treatment, prepares them for the event, and minimizes the risks associated with the materials and equipment used. In São Paulo, Brazil, nursing student Vanessa Natsumi Mizobata of Botucatu Medical School and her colleagues developed an educational comic book specifically for children having surgery. The story features an 8-year-old boy who has surgery scheduled, and includes a parent, an older brother who has had two surgeries and encourages his younger brother, and a pet. The drawings and text cover a sequence of events and experiences: preoperative period (pediatric ward, fasting, bath, medications), surgical intervention (surgical team, operating room, surgical equipment, post-anesthesia recovery), and postoperative period (dressing, rest, pain), and also present pastime activities. At the end, the child in the book reassures the readers about their own surgery. The article includes samples of the comic book in both Portuguese and English (Mizobata et al., 2025).
Caring for Mothers Living With Human Immunodeficiency Virus
Mothers living with HIV may experience adjustment issues due to their illness progression and the risk of intergenerational transmission of the disease. Existing research has focused on psychological transitions such as child care and breastfeeding and factors such as socio-economic status, stigma, and social support, but not on the lived experiences of these mothers. Understanding these experiences can provide insights into HIV care for specific populations. Nursing professor Yayuk Nuryanti of Politeknik Kesehatan Kementrian Sorong in West Papua, Indonesia, and colleagues Paulina Kombong and Niluh Gede Susantie employed interpretive phenomenological methods to learn about the experiences of mothers living with HIV in West Papua, Indonesia. They identified themes of emotional reaction to the diagnosis, destruction of relationships, treatment burden, emotional coping, motherhood, and uncertainty about their children's future. Almost all participants stated that the virus had a severe impact on their lives, even causing breakups of family relationships. Peer-led support groups may be practical tools for increasing partner communication and antiretroviral therapy uptake and decreasing HIV vertical transmission, especially in low-resource contexts (Nuryanti et al., 2025).
Decreasing Length of Stay in the Intensive Care Unit
Many factors affect patients’ intensive care experiences, especially after surgery. Nursing professors Necibe Dağcan Şahîn at Kutahya Health Sciences University in Kutahya, Turkey, and Gülşah Gürol Arslan of Dokuz Eylul University in İzmir, Turkey studied 200 patients who underwent cardiac surgery, and found that age, gender, length of stay (LOS) in the ICU, and pain scores were significant predictors of the intensive care experience. These authors concluded that holistic care and support for patients in the ICU, taking into account the patient's age, pain intensity, and LOS, can have a positive impact on the intensive care experience and surgical recovery of patients after cardiac surgery (Dağcan Şahîn & Gürol Arslan, 2025).
Increasing Medication Adherence to Support Mental Health Stability
A concerning number of patients either fail to initiate or fail to follow through with their prescriptive treatment plans. A variety of socio-demographic, clinical, and health system elements contribute to medication non-adherence, highlighting the need for personalized interventions to meet individual needs. Family Psychiatric Mental Health Nurse Practitioners Melodie Kabanuk Dohm and Princess Gehyigon-Wallace, and Guest Co-Editor Linda Sue Hammonds report on a quality improvement project (QIP) aimed to increase medication adherence among patients ages 18–65 years at an outpatient mental health clinic in the Midwestern US, using Shared Decision-Making as an intervention, empowering patients to participate actively in treatment decisions through shared responsibility between patients, providers, and health-care systems. The authors used the PDSA cycle, Orem's Self-Care Deficit Nursing Theory, and the Institute of Medicine's Six Domains of Healthcare Quality as theoretical frameworks. This QIP demonstrated an inexpensive and efficient delivery framework that may be easily employed into clinic workflow to improve medication adherence (Kabanuk Dohm et al., 2025).
The Phenomenon of Mental Health
Seeing Beyond Diagnostic Labels
Unearthing the meaning patients attribute to their lived experience is a critical step in optimizing care, granting nurses the opportunity to ascribe meaning in their everyday clinical practice, which in turn can motivate positive patient outcomes. Interpretive phenomenology is a philosophical tradition frequently utilized in nursing and other social science disciplines that is dedicated to the description of lived experience; this philosophy can facilitate an understanding of how things appear in the world in which they exist. Noah Doucette, a nurse in a transplant setting and PhD student in the School of Nursing at Dalhousie University in Halifax, Nova Scotia, Canada, and Jennifer Lane, nursing professor at Dalhousie, recount lessons learned from caring for a patient with a stigmatizing diagnosis of liver cirrhosis. For fear of being labeled as an alcoholic, the patient avoided seeking treatment for coping with a significant loss that preceded 10 years of progressive alcohol misuse. Such a heavily stigmatized diagnosis contains various preunderstandings, often grounded in perceptions that are profoundly influenced by societal stigmatization (e.g., having little social support, lack of willpower to change). Considering statements nurses made about this patient's eligibility for liver transplantation, such as “He just did not know how to cope” and “An alcoholic should not take this organ from someone more deserving,” affirmed the importance of understanding the meaning patients attribute to their diagnosis as a way of transforming the caring art of nursing practice. This patient shared that receiving a functional liver motivated him to seek treatment to deal with his traumatic loss through evidence-based interventions, without reverting to alcohol (Doucette & Lane, 2025).
Choosing a Method of Analysis in Phenomenology Inquiry
In this second in a series of articles in Creative Nursing focusing on qualitative research, nursing professor Ahtisham Younas of Memorial University of Newfoundland and nursing PhD student Shahzad Inayat of the University of Calgary provide researchers with guidance on how to choose among varied phenomenological approaches, including an analytical choice tree with their perspective on the methods of analysis. Phenomenology, a commonly used methodology in health sciences research, addresses the subject of human experience, with the intention of explicating the unique lived experiences of individuals and providing an overall thematic account of lived experiences across cases. Researchers often struggle to understand the difference between lived experience and experience. Philosophers Immanuel Kant, Edmund Husserl, Martin Heidegger, and Hans-Georg Gadamer all wrote in the German language, which has distinct words for experience (Erfahrung), being actively engaged in a task or activity or interaction and gaining knowledge from it as we conceptualize, categorize, and reflect on it; and lived experience (Erlebnis), a tacit or pre-reflective account of one's lifeworld (the everyday concrete and subjectively experienced world) (Younas & Inayat, 2025).
Next: Stories of Indigenous Health
The theme of our upcoming journal issue, Indigenous Voices Sharing Our Stories and Leading Change, continues our legacy of publishing information that the world needs to hear, regardless of forces acting to discount or stifle it. Please watch for these articles as they appear individually Online First and then are gathered into Issue #3, published in August 2025.
