Background Effective communication is a critical skill for nurses, particularly in palliative care, where emotional and complex patient interactions are common. Training nurses in communication skills may improve both their competence in patient interactions and their ability to manage the emotional demands of end-of-life care. Objective This study aimed to assess the impact of a training program on communication competencies and stress-coping strategies among nurses in two distinct regions, Shymkent and Astana, with a focus on palliative care settings. Methods A descriptive-analytical, cross-sectional study was conducted from January to December 2024 in two palliative care hospitals in Shymkent and Astana, Kazakhstan. Thirty nurses (15 from each hospital) participated. They completed a self-assessment of their communication skills before and after attending a communication skills training seminar, with follow-up assessments after six months. Two instruments were used: the Communicative Competence Scale (CCS) to measure communication skills and the Ways of Coping Questionnaire (WCQ) to assess coping strategies related to stress. Results Before training, nurses in Shymkent demonstrated significantly higher communication competence scores (M = 109.27) compared to those in Astana (M = 98.6). After training, both groups showed improvements in communication skills, with Astana nurses experiencing the most significant increase in their self-assessment scores (M = 106.13). Notably, nurses in Astana showed a marked improvement in coping strategies, including increased seeking of social support and decreased reliance on confrontational and distancing behaviors. Conclusion Communication skills training significantly enhances nurses’ communication competencies and coping strategies, particularly in regions where initial competencies were lower. These improvements may lead to better patient care and increased nurse well-being in palliative care settings. Further integration of communication training in nursing education is recommended. BJMS, Vol. 24 No. 03 July’25 Page : 957-966

Background Clinical decision-making in palliative care is crucial for providing quality care to individuals with life-limiting illnesses. Nurses, as key members of the palliative care team, make critical decisions regarding symptom management, patient comfort, and end-of-life care. In Kazakhstan, where palliative care is still evolving, understanding how nurses make these decisions is essential to improving care quality and informing healthcare policies. Aim This study aimed to explore the clinical decision-making experiences of palliative care nurses in Kazakhstan, focusing on the factors influencing their decisions, the challenges they encounter, the strategies they employ, and how decision-making processes can be improved. Methods A qualitative research design was employed, using semi-structured interviews with 12 palliative care nurses from various healthcare settings across Kazakhstan. Participants were selected through purposive sampling to ensure a diverse representation of experiences from both urban and rural areas. The interviews were transcribed verbatim and analyzed using thematic analysis to identify key patterns and themes related to clinical decision-making. Results The analysis revealed several factors influencing decision-making, including clinical knowledge and experience, patient and family preferences, and systemic factors such as resource constraints. Nurses reported challenges such as cultural reluctance to discuss death, lack of formal palliative care training, and limited access to medications and equipment, particularly in rural areas. To address these challenges, nurses employed strategies like interdisciplinary collaboration, patientcentered care, and a strong desire for ongoing education. Conclusion Clinical decision-making in palliative care nursing in Kazakhstan is shaped by a combination of clinical expertise, cultural dynamics, and systemic limitations. The findings highlight the need for formal education, improved resource availability, and better interdisciplinary collaboration to support nurses in making informed and effective decisions. Enhancing these aspects can significantly improve the quality of palliative care in Kazakhstan, ensuring that decisions align with the values and wishes of patients and their families. BJMS, Vol. 24 No. 03 July’25 Page : 967-974

Municipal solid waste (MSW) generation has increased rapidly due to urbanization, population growth, and changing consumption patterns, creating significant environmental and public health challenges. This review synthesizes current evidence on environmental contamination associated with MSW management and its implications for human health by evaluating recent studies on pollution sources, biomonitoring, and health outcomes. MSW disposal and management activities release particulate matter, heavy metals, volatile organic compounds (VOCs), persistent organic pollutants (POPs), microplastics, pathogens, and landfill leachate, contributing to the contamination of air, soil, and water. Exposure to these contaminants has been associated with respiratory, gastrointestinal and infectious diseases, particularly among waste workers and residents living near waste disposal landfills. Human biomonitoring using blood, urine, hair, and nails provides valuable evidence of internal exposure; however, standardized protocols and longitudinal studies remain limited. Sustainable waste management strategies can reduce environmental pollution and health risks, including source segregation, recycling, resource recovery, engineered sanitary landfills, and advanced leachate treatment. Integrating environmental monitoring, biomonitoring, epidemiological research, and One Health approaches is essential for developing evidence-based policies and promoting sustainable MSW management.