Nurs. Rep., Volume 15, Issue 3 (March 2025) – 41 articles

Patient and Public Involvement and Engagement (PPIE, alternatively referred to as public involvement (PI), public and patient involvement (PPI), or consumer and community involvement and engagement (CCIE)), refers to research being conducted ‘with’ or ‘by’ members of the public rather than ‘to’, ‘about’, or ‘for’ them [...] Full article

Background: Health-related programs frequently integrate interprofessional education (IPE) into their training. The COVID-19 pandemic transitioned many IPE programs online, making it essential to assess student expectations and perceived learning outcomes across virtual simulations and in-person settings. Methods: This qualitative study compared student expectations and self-reported outcomes across in-person and virtual case scenarios at a Texas health science center. Responses to open-ended questions from two data collection periods were analyzed using inductive coding and thematic analysis. Results: Students from nursing, medicine, dentistry, public health, and informatics participated in each group. Three major themes emerged from this study: communication, teamwork, and role identification, with self-development and professionalism as major subthemes. For communication, students often described a desire for increased simulations to “practice with interprofessional communication”. Teamwork was the second theme identified, with students discussing the significance of effective teamwork, such as, “It is a good practice to work together, listen to each other, and achieve a common goal of patients getting better”. Additionally, students expressed a desire to better understand the roles of other healthcare professionals across different settings. Conclusions: Realistic IPE simulations may help students build confidence in their team roles while understanding other health professions. To strengthen curriculum design, faculty should include student expectations and perceived outcomes from IPE activities. A limitation of this study is the reliance on self-reported data, which may introduce response bias and the potential variability in student experiences. Full article

Background: Patient-centered communication is a critical process in high-quality healthcare that emphasizes the reciprocal sharing of information between providers and patients to ensure care aligns with the patient’s needs, preferences, and personal values. A significant challenge arises from the healthcare provider’s time constraints during clinical encounters and the lack of adequate training on how to adopt a patient-centered communication style that addresses patient concerns, making it difficult to foster an environment conducive to shared decision making. These issues are further exacerbated by cultural and language barriers, along with low levels of health literacy and social determinants of health (SDoHs), which complicate efforts to deliver patient-centered care. Objective: This study examined quality criteria for patient–provider communication (PPC) and their associations with sociodemographic characteristics and SDoHs on housing, transportation, and food insecurity. Methods: This retrospective cross-sectional study analyzed data from the 2022 Health Information National Trends Survey (HINTS-6) national dataset. Associations between PPC and sociodemographic variables were tested using the chi-squared test. Binary logistic regression was carried out to examine the association between three PPC criteria and each of the sociodemographic characteristics and patient comfort in disclosing information on SDoHs. Results: Bivariate analyses showed statistically significant associations for age, occupation status, marital status, Hispanic origin, and race across all three PPC criteria. Significant associations were reported for education and income for the two criteria related to being given the chance to ask questions and being involved in healthcare decisions. Finally, significant associations were reported for all PPC criteria and patient comfort levels in discussing SDoHs. Conclusions: Findings from this paper provide insight for enhancing the quality of PCC in underserved populations, particularly when it comes to informing the design of evidence-based cervical cancer screening interventions which are culturally centered around the patients’ needs and that integrate PPC as a foundational component. Full article

This study explores the curriculum of Nursing Bachelor’s degrees across 15 European countries, aiming to describe nursing course curricula and admission requirements and to identify differences and similarities in the implementation of the Bologna Process. The research employs a qualitative and documentary methodology, analyzing curricula from selected higher education institutions involved in the Erasmus+ “Innovative Skills for Nurses” project. The findings reveal variations in the duration of training, with some countries adopting 3-year (180 ECTS) programs, while others require 4-year (240 ECTS) programs. Furthermore, discrepancies were found in the balance between theoretical and clinical education, as well as the availability of optional subjects. Countries with longer training programs tend to offer more consolidated practices and greater alignment with Bologna’s principles, fostering better professional outcomes. The study highlights the challenges posed by non-standardized training durations and their impact on mobility and employability of nursing professionals. These findings may inform future discussions on harmonizing nursing education across Europe to ensure consistency in quality and professional competencies. Full article

Background: Pressure injuries are an ongoing problem commonly managed with the prescription of pressure mattresses. There is conflicting research about the comparable effectiveness of the two types of pressure mattresses, active and reactive. This, coupled with technological advances and an updated understanding of pressure aetiology, means decision-making when prescribing pressure mattresses is complicated. Objective/Design: A pragmatic approach was used to design an equivalence randomised-controlled trial investigating the comparative effectiveness of active and reactive pressure mattresses in a community setting from a wound healing perspective as well as from a user acceptability perspective. Methods: Participants with an existing pressure injury were provided with an active or reactive mattress for wound healing, with wound stages assessed using photography. Usual clinical care was provided based on the protocols of the health care service, including nursing and occupational therapy input. Participants were monitored for the healing of their existing pressure injuries, using the Revised Photographic Wound Assessment Tool. User acceptability feedback was provided through surveys, including impact on comfort, pain levels and bed mobility. An equivalence design was used for data analysis to determine if the surfaces were comparable. Results: Twelve participants completed the study, which found that people on active mattresses healed 11.71 days (95% CI −55.97–31.78 days) quicker than people on reactive mattresses; however, the small sample size meant that a definitive determination could not be made. Users found bed mobility more challenging, and pain levels decreased, regardless of mattress type. Conclusions: A pragmatic methodology is imperative for research in this field due to the complexity of pressure injury healing. Researchers exploring multi-faceted conditions should consider a pragmatic design to ensure transferability of results to the clinical setting. The results from this study were inconclusive when determining the equivalence of active and reactive mattresses due to the small sample size. When choosing a mattress, prescribers need to consider user preferences and mattress features to ensure user acceptability. Full article

Background/Objectives: Arterial hypertension (HT) is a leading modifiable risk factor for cardiovascular diseases, often contributing to prolonged lengths of hospital stay (LOHS), which place significant strain on healthcare systems. This study aimed to analyze the factors associated with prolonged lengths of hospital stay in patients with HT, focusing on key biochemical and clinical predictors. Methods: This retrospective study included 356 adult patients hospitalized in the Cardiology Department of the University Hospital in Wroclaw, Poland, between January 2017 and June 2021. Data collected included demographic characteristics, body mass index (BMI), comorbidities, and laboratory parameters. Logistic regression models were used to identify predictors of prolonged LOHS, defined as four or more days, and to evaluate interactions between variables. Results: Lower levels of low-density lipoprotein cholesterol (LDL-c) and elevated concentrations of high-sensitivity C-reactive protein (hsCRP) were identified as significant predictors of prolonged LOHS, with each 1 mg/dL decrease in LDL-c increasing the odds of prolonged LOHS by 1.21% (p < 0.001) and each 1 mg/L increase in hsCRP raising the odds by 3.80% (p = 0.004). An interaction between sex and heart failure (HF) was also observed. Female patients with HF had 3.995-fold higher odds of prolonged LOHS compared to females without HF (p < 0.001), while no significant difference was found among male patients with or without HF (p = 0.890). Conclusions: The predictors of prolonged LOHS in patients with HT include lower levels of LDL-c, elevated hsCRP, and the interaction between sex and heart failure (HF). Specifically, female patients with HF demonstrated significantly higher odds of prolonged LOHS compared to females without HF, while this relationship was not observed in male patients. Full article

Background: The psychological well-being of university students significantly impacts their academic performance and future professional preparation. The aim of this study is to analyze the relationships between perceived stress, self-esteem, and learning strategies in university students enrolled in Nursing and Obstretics degree programs, in order to understand the impact of psychological well-being on their study abilities. Method: This study is observational cross-sectional, using non-probabilistic convenience sampling. The study involved students enrolled in Nursing and Obstetrics courses at the University of Salerno. A standardized self-reported questionnaire will be used. Results: 331 students (82.75%) participated voluntarily. Correlations show significant relationships consistent with psychological literature. Higher self-esteem correlates with lower perceived stress (r = −0.325, p < 0.01), better information elaboration (r = 0.156, p < 0.01), and higher metacognitive awareness (r = 0.123, p < 0.05), but negatively with organizational strategies (r = −0.150, p < 0.01) and self-evaluation frequency (r = −0.153, p < 0.01). Perceived stress correlates positively with organizational strategies (r = 0.180, p < 0.01) and self-evaluation frequency (r = 0.178, p < 0.01), suggesting stress may drive compensatory strategies. Multiple regression analyses showed that self-esteem was a significant positive predictor of information elaboration strategies (β = 0.49, p = 0.05). Both self-esteem (β = −0.52, p = 0.01) and perceived stress (β = −0.74, p = 0.01) were significant negative predictors of structured learning strategies, suggesting that higher levels of stress and self-esteem are associated with a reduced use of planned organizational approaches. The models explained a substantial proportion of variance, with adjusted R² values of 0.52 for elaboration and 0.63 for strategy components. Conclusions: These results emphasize the need for interventions to enhance learning strategies and stress management among students. Full article

Background: This case report describes the rare coexistence of cervical cancer with pregnancy, a challenging scenario requiring careful balance between maternal treatment and fetal safety. In Poland, cervical cancer remains a significant health issue, highlighting the need for effective multidisciplinary strategies. Methods: This case report was prepared based on CARE guidelines for medical case reporting. The patient was observed by a clinical psycho-oncologist–midwife and a psychologist (also specializing in clinical psycho-oncology) from the start of oncological treatment until delivery and early postpartum. During pregnancy, the pregnant woman was asked three times (at the 23rd, 32nd, and 38th weeks of pregnancy) to complete questionnaires: a self-report questionnaire collecting sociodemographic data, clinical information, and perception of causes and effects of fatigue, the Chalder Fatigue Questionnaire (CHFQ-PL), the Fatigue Management Barriers Questionnaire (FMBQ), the Multidimensional Social Support Scale (MSPSS), and the Walsh Family Resilience Questionnaire (WFRQ-PL). Results: The patient, a 37-year-old woman in her second pregnancy, presented with cervical cancer diagnosed in the first trimester. Major concerns included fatigue, emotional distress, and treatment-related uncertainties. Throughout the pregnancy, she underwent four chemotherapy cycles and participated in psycho-oncological assessments to monitor fatigue, which increased as treatment progressed and affected daily functioning and emotional well-being. To enable the early continuation of oncology treatment, the pregnancy was electively terminated by cesarean section at 37+5 weeks, resulting in the good condition of the infant and a stable maternal postpartum condition, though anemia and emotional concerns required further management. Conclusions: As research on fatigue in pregnant oncology patients is limited, this case underscores the value of structured psycho-oncological support to enhance care and outcomes for both mother and child. Full article

Objective: It is well established that having a stoma can negatively impact health-related quality of life (HRQoL), but there is a paucity of research describing the natural history of certain complications associated with living with a stoma, such as leakage and peristomal skin complications (PSCs), and whether these affect QoL within the first year of stoma surgery. The objective of this study was to investigate the pattern of such complications and impact on QoL in individuals who had stoma surgery within the preceding year. Methods: A cross-sectional study was conducted at three hospital sites in the United Kingdom to evaluate the burden of disease in those who had undergone intestinal stoma formation surgery within the preceding year. The study consisted of a one-to-one consultation with a study nurse and the completion of an online questionnaire by the patient (ISRCTN-registry: 23080097). The nurse-led interview directly evaluated peristomal skin health, whilst the online questionnaire evaluated the impact of leakage (using the Ostomy Leak Impact tool), generic mental well-being (by WHO-5) and wider HRQoL (by EQ-5D-5L). Results: A total of 114 individuals with an intestinal stoma completed the evaluations. The participants had a mean age of 55.8 years (range 18–87 years) and 58% were male. Forty-three percent of the participants had experienced leakage of stomal effluent outside the baseplate (e.g., onto clothes) in the preceding two weeks and 85% suffered from PSCs ranging from mild (35%), to moderate (18%), and severe (32%). Leakage and PSCs were associated with lower mental well-being and HRQoL (p < 0.05). Leakage events, HRQoL, mental well-being and peristomal skin health were similar for individuals across different timepoints from the time of surgery within the first year. Conclusions: This study reported a high disease burden in people with a new intestinal stoma. Experiencing frequent leakage incidents and/or living with severe PSCs were associated with reduced HRQoL and mental well-being. Full article

High blood pressure in older adults poses significant risks, including cardiovascular disease, stroke, and renal failure; yet, its management is often overlooked. Nurse-led personalised interventions provide essential guidance, helping patients adhere to treatment plans and adopt lifestyle changes, improving outcomes and quality of life. A scoping review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR). Six electronic databases were searched systematically (CINAHL, MEDLINE, PsycINFO, EMBASE, Web of Science, and Scopus). Five research studies were included in this review, from five countries (India, Korea, China, Turkey and Thailand). Primary data were synthesised using descriptive and thematic analysis methodology. The five main themes from this review relate to nurse-led empowerment strategies for hypertension management, variability in blood pressure outcomes, the importance of tailored education and counselling, the role of regular follow-ups and support, and environmental support. Overall, nurse-led personalised interventions improve blood pressure management and patient engagement in older adults, highlighting the need for research into their long-term effectiveness and broader applicability. Full article

Background: Unfulfillment of maternity rights in healthcare is a global problem associated with abuse, neglect and discrimination, known as obstetrics and gynecology (OB/GYN) vulnerability. Women’s perceptions of their experience are a keystone to improving maternity healthcare. The aim of this study was to evaluate the women’s perceptions of the vulnerability of maternity rights and the associated risk and protective factors. Methods: This study was carried out by qualitative techniques based on the analysis of a semi-structured interview applied to six women in the postpartum period with pregnancy assistance and birth in Spain and Colombia between February and August of 2024. A triangulation analysis was performed about the perceptions of the concept, experiences and risk and protective factors of OB/GYN vulnerability. The free-access ATLAS.ti software was used. Results: OB/GYN vulnerability is generally perceived by women with a psychological impact. Women think that their own factors (emotion management, social support, attitude to change and beliefs), health professional factors (burnout, empathy and social skills) and health institution factors (workload, centralization in technical and protocols, humanization, quality and access to recourses) have an influence to modulate the vulnerability of rights in maternity healthcare. Conclusions: It is necessary for health systems to move from a protocol-centered to a person-centered model, particularly in maternity healthcare. This model should include the biopsychosocial needs of women and allow for their participation. Health institutions need to evaluate their processes and minimize burnout in health professionals. In addition, there are factors affecting OB/GYN vulnerability not only in childbirth but also during pregnancy and postpartum. Full article

Background/Objectives: One of the risk groups during the COVID-19 pandemic was people with predominantly antibody deficiencies (PADs) that have a compromised immune system. In the absence of evidence and clinical experience, there were challenges for patients in their daily life and for staff in counseling during this time. Therefore, the aim of this study was to explore the experiences of PAD patients and nurses during the COVID-19 pandemic. Methods: Focus group interviews with patients (n = 12) and nurses (n = 12) were performed separately, which were then analyzed using content analysis. Results: The daily life of PAD patients was affected during the pandemic, with concerns about becoming seriously ill. Social isolation and adherence to recommendations by the majority of the Swedish population resulted in patients feeling infectiously healthier during this period. The rapid transition of specialist care to telemedicine care encounters was an important measure taken to address patients’ concerns and questions according to both patients and nurses. In addition, patients expressed a need for a coordinated care plan to facilitate access to integrated care. Conclusions: The high level of trust for authorities in Sweden was related to the high compliance with the recommendations, which reduced the spread of the infection. The role of specialized care is an important support for PAD patients, which was particularly evident during the pandemic. Information transfer to a specific risk group, such as people with PADs, is important and can usefully be coordinated by their specialist clinic. Telemedicine meetings are an important complement for people with PADs and need to be further elaborated. Also, there is a need to clarify how to better coordinate primary and specialized care. Full article

Background: The term “medical mistrust” has increased in literary usage within the last ten years, but the term has not yet been fully conceptualized. This article analyzes the usage of the term “medical mistrust” in the extant literature in order to articulate its antecedents, attributes, and consequences. The aim of this article is to provide a preliminary conceptual definition and conceptual figure for medical mistrust. Methods: Walker and Avant’s method of conceptual analysis was used to extract concept attributes, antecedents, and consequences and define empirical referents. The databases PubMed, CINAHL, Scopus, and PSYCinfo and the Google search engine were used. Results: Medical mistrust is a social determinant of health fueled by a fear of harm and exploitation and is experienced at both the interpersonal, intergenerational, and institutional levels, reinforced by structural racism and systemic inequalities. Medical mistrust is antedated by historical trauma, socioeconomic disparities, medical gaslighting, traumatic medical experiences, maladaptive health beliefs and behaviors, and individual minority identities and is transmitted intergenerationally and culturally. The consequences of medical mistrust include the underutilization of health services, delays in diagnosis and care, poor treatment adherence, poor health outcomes, negative psychological effects, and an increase in the uptake of medical misinformation and maladaptive health behaviors. Conclusions: The findings of this concept analysis have important implications for healthcare providers, healthcare systems, and researchers, as well as healthcare policy makers. Full article

Background: Assertiveness in nursing is crucial to improving communication, reducing interpersonal tensions, and improving healthcare outcomes. Objective: The objective of this systematic review was to identify and synthesize the literature on assertiveness in nursing, focusing on nurses’ perspectives regarding its role, influencing factors, challenges, and impact within complex healthcare settings. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. An integrated mixed methods approach was used to capture the multifaceted nature of assertiveness in nursing. The evaluation covered both qualitative and quantitative investigations, concentrating on quantitative publications between 2018 and 2024 and qualitative publications without a time limit. Diverse methodologies were incorporated using the SPIDER framework. A comprehensive electronic search was conducted across six databases: PubMed, Medline, CINAHL, PsychInfo, Wiley Online Library, and Web of Science. Ultimately, 15 research papers were included in the review out of 9490 publications that were initially identified. Included studies were critically appraised using the Critical Appraisal Skills Program (CASP) and the Joanna Briggs Institute Critical Appraisal checklists. Results: A total of 9490 studies were identified, of which 15 (eight quantitative and seven qualitative) were included in this review. The review and subsequent analysis revealed five major themes: (1) facilitators of assertiveness; (2) barriers to assertiveness; (3) assertiveness training; (4) interaction with other staff; and (5) patient relationships. Conclusions: Assertiveness is essential for proficient nursing practice, especially in complex healthcare environments. It facilitates improved communication, alleviates stress, and augments patient care. Future research should explore the long-term benefits of assertiveness training and its influence across various cultural settings. Full article

Background/Objectives: Nurse practitioners (NPs) play a pivotal role in delivering medical care, leveraging their specialized training and broader range of authorities than registered nurses, as approved by the Ministry of Health. Since 2009, Israel has expanded NP training to include diverse specialties such as palliative care, geriatrics, diabetes, surgery, and health policy. Introducing a new professional role into the health system is a complex, resource-intensive process that requires collaboration across stakeholders. Globally, NPs are recognized for preventing hospitalizations and achieving improved care outcomes, with high patient satisfaction. However, in Israel, NPs’ perceptions of their role and contributions remain underexplored. This study aims to assess NPs’ role perception, contributions to the health system, and attitudes toward their professional development in palliative and geriatric care. Methods: The mixed-methods study included 26 in-depth interviews with palliative and geriatric NPs and an online survey of 89 NPs (29 in geriatrics and 60 in palliative care). Results: Most NPs are women (84%), Israeli natives (69%), and Jewish (64%). More than half (53%) have 1–4 years of experience as practitioners, and 71% are employed full time. Regarding their work environment, the NPs feel that their supervisors and patients are appreciative of their work and that they are considered professional authorities. The qualitative findings also point to several challenges in their work: (1) The NPs’ status vis-à-vis medical staff and patients is insufficiently established; (2) the NPs lack practical and theoretical learning over time; (3) there is a shortage of positions; and (4) there is a sense of high work and emotional load and difficulty in implementing palliative care within the health system. With regard to their training, 58% of NPs were satisfied with the course, while 71% felt it lacked content. Looking forward, 76% of the NPs believed that over the next five years, the NP role would expand significantly, and 88% would recommend that other nurses become NPs. Conclusions: To maximize NPs’ potential, the study recommends clarifying their role, expanding authorities, aligning training with professional demands, and fostering trust between NPs and the medical establishment. Branding efforts and emotional support for NPs, especially in palliative care, are essential to enhance their integration and effectiveness in the health system. Full article

Background/Objective: Ageing favours the onset of cardiovascular diseases, frailty, and risk of falls. In the hospital setting, 47.7% of patients may be frail, and the incidence of falls may be as high as five per thousand. This study seeks to determine the relationship between frailty, risk of falls, and length of hospital stays in hospitalised older adults with heart disease. Methods: An observational study was conducted of a cohort of patients aged ≥60 years admitted to a cardiology unit (2022–2024). Frailty was assessed using Fried’s phenotype, risk of falls using the J.H. Downton scale, and level of dependency using the Barthel index. Clinical variables, anthropometric measurements, and length of stay were analysed. Statistical analysis: quantitative variables were expressed as means and standard deviations, and categorical variables as frequencies. Associations were analysed using Student’s t-tests, chi-squared tests, and Kruskal–Wallis tests for comparisons of three or more groups. Relationships between frailty, risk of falls, and other variables were examined using univariate binary logistic regression, with a 95% confidence interval and statistical significance set at p < 0.05. Results: A total of 144 patients were recruited (mean age = 73.08 years [SD = 7.95]) (women = 33.30%). Frailty was associated with waist circumference in men (p = 0.01) and diastolic blood pressure in women (p = 0.05). Frailty was further linked to Downton scores (odds ratio [OR] = 1.565; 95% CI: 1.156–2.120; p = 0.004), age (OR = 1.114; 95% CI: 1.058–1.173; p = 0.000), Barthel index (OR = 0.902; 95% CI: 0.854–0.953; p = 0.000), and length of stay (OR = 1.101; 95% CI: 1.021–1.186; p = 0.012). Conclusions: Frailty appears to be related to Downton scores and impacts the length of hospital stays in older adults hospitalised with cardiac conditions. Full article

Objective: This study aimed to estimate the Greek population’s maternal dietary intake, physical activity status, and body composition during pregnancy. Research method: Forty-nine women during pregnancy, with a mean age of 31.08 ± 4.90 years old, were asked to fill in the Pregnancy Physical Activity Questionnaire (PPAQ) to assess their physical activity levels, the Food Frequency Questionnaire (FFQ) to assess the maternal dietary intake, and a Bioelectrical Impedance Analysis (BIA) to evaluate different body composition indices. Results: Variance analysis showed that the pregnancy trimester’s effect on various indices of BIA was statistically significant. Moreover, the results showed that pregnant women consume a median of 2135 kcal and 2012.10 mL of water per day, regardless of their trimester. The Pearson correlation analysis unveiled a significant positive correlation between energy (r = 0.795, p < 0.001), water (r = 0.759, p < 0.001), fat (r = 0.535, p = 0.029), and dietary fibers (r = 0.310, p < 0.001) with pregnancy trimester. According to the PPAQ in women, categorized based on their pregnancy trimester, the results showed that women in the third trimester were statistically more sedentary than those in the second and first trimesters, respectively. Lastly, multiple regression analysis showed that pregnancy trimester (p = 0.005), employment status (p = 0.040), economic status (p = 0.037), and higher BMI (p = 0.013), BFMI (p = 0.017), and FFMI (p = 0.024) values had a significant contribution to the model. Conclusions: Pregnancy trimester has a significant impact on different indices of BIA and nutrients based on the FFQ, while physical activity levels decrease dramatically during pregnancy. Full article

Background/Objectives: Hospital bed shortage is a widespread issue affecting healthcare systems globally, often exacerbated by bed-blocking, a phenomenon where patients remain hospitalized longer than medically necessary due to discharge delays. The aim of this study was to evaluate the prevalence of patients with bed-blocker status admitted to the internal medicine wards. Methods: This cross-sectional study was conducted at an academic tertiary-level hospital in Milan (Italy) from 1 January to 31 December 2023. All adult patients identified as ready for discharge by the bed management service, but whose actual discharge was delayed by more than 24 h, were included. Clinical data were retrieved from electronic medical and nursing records. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results: Out of 2480 admissions to the internal medicine wards, 147 patients (5.9%) experienced delayed discharge. The median hospital length of stay was 22 days (IQR: 15.0–33.0); the median duration of appropriate stay was 6 days (IQR: 2.0–13.0), and the median length of delayed stay was 14 days (IQR: 7.0–21.0). Waiting for transfer to lower-intensity care facilities was the primary cause of delayed discharge. Complications during delayed stays included delirium (31.3%) and hospital-acquired infections (35.4%), particularly urinary tract infections (17.7%). Logistic regression identified older age (≥75 years), extended hospital length of stay, emergency admissions, and discharge to long-term care as independent predictors of bed-blocker status. Conclusions: This study highlights delayed discharges as a significant issue in internal medicine wards, driven by advanced age, caregiver absence, and high dependency in activities of daily living. Full article

Background/Objectives: Historically, male nurses were predominant in mental health settings due to their perceived physical strength and ability to manage violent patients. However, societal changes and the evolution of nursing education have led to a decline in male participation. This study aims to explore the characteristics, qualities, and attributes of male mental health nurses, while aiming to identify factors that attract and retain, as well as that deter, men in this field, to inform male recruitment and retention strategies to grow the mental health nursing workforce. Methods: A scoping review was conducted across six databases, including PubMed, MEDLINE, Web of Science, Scopus, CINAHL, PsycINFO, and ProQuest. The focus was on studies from 1970 to 2024. Screening and selection of studies were based on eligibility criteria. Narrative synthesis was conducted, and the study follows the PRISMA for Scoping Reviews checklist. Results: Limited research exists on male mental health nurses. The data highlight the unique contributions of male nurses, including their resilience, teamwork, and emotional competence. They also identify challenges such as workplace violence, stigma, and lack of career development opportunities. The literature suggests that targeted recruitment strategies and supportive work environments are essential to increase the number of male mental health nurses and address the nursing shortage in this specialty. Positive academic experiences and professional development opportunities are crucial for retaining male nurses. Conclusions: Addressing stigma associated with mental health nursing is needed, starting with a positive public health education campaign. Addressing workplace violence needs to stem from improved organisational procedures that promote the safety and wellbeing of nurses and clients, combined with de-escalation education and training; mentoring are vital to improving attraction, job satisfaction, and the retention of male nurses. By understanding these factors, health care organisations can better support male mental health nurses and enhance the overall quality of mental health care. Full article

Background/Objectives: When experiencing a variety of negative family events, families that, as a whole, have high family resilience maintain and improve family functioning. It is important, therefore, for nursing professionals to be able to assess families lacking in family resilience in order to prevent, reduce, or ameliorate family symptoms (such as family-perceived problems, issues, difficulties, or suffering). The purpose of this study was to clarify how family resilience works. Methods: Family resilience is defined based on the Concentric Sphere Family Environment Theory (CSFET) as when a family becomes aware of family symptoms on its own, and its power to autonomously and actively improve its own family functions. The contents of 22 family nursing cases from 16 qualitative studies on family resilience and the results of 28 semi-structured interviews with 28 parenting-age families in Japan were qualitatively categorized using the triangulation method, and then directed content analysis was conducted based on the CSFET. Results: A total of 157 labels, with a total of 23 categories and 47 subcategories, were found to relate to family resilience, such as “can utilize relatives”, “family members can communicate with members of other families”, “family members can share information”, “all family members can communicate with one another”, “all family members can cooperate with one another”, and “can share time with family”. Conclusions: From these, a variety of diverse aspects contributing to a family’s resilience, including family member interactions, entire family interactions, use of social resources, and religious and spiritual support, were indicated. Full article

Background: Attracting and retaining sufficient numbers of nurses is an international challenge. The group most difficult to retain are newly qualified nurses within their first five years of practice or earlier. A recent US study reported that approximately 25 percent of nurses leave within the first year of graduation. Health organisations play a crucial role in providing workplace cultures where nurses feel empowered and can thrive. Research needs to focus on improving organisational culture, yet most approaches to supporting and retaining nurses have used top–down, management-designed interventions. This article describes a collaborative international programme of research. Methods: This innovative international theory-driven multi-site action research programme adopts a longitudinal co-design approach based on principles of appreciative inquiry to develop and implement organisational support for newly qualified nurses. It integrates the Institute for Health Improvement (IHI) Framework for Improving Joy at Work and the Thriving at Work model, both focused on improving the well-being of the healthcare workforce and health service outcomes. Each year, a new group of nurses during their first-year orientation is invited to participate. Over five years, each cohort will then participate in an annual survey, focus groups, and co-design meetings with nurse leaders/managers, generating new solutions developed through open dialogue for subsequent testing driven by these key stakeholders. Expected outcomes: This research will generate a new co-design management model to improve systems of support that may assist nurse retention and thriving that can be shared with other nursing organisations. It will provide an understanding of the effectiveness of current support for nurses by their employers from the perspective of those nurses whilst providing evidence about what extra support nurses would like from their employers. Conclusions: This international research programme gives agency to nurses and organisational nurse leaders/managers to co-design interventions for building positive work environments where early-career nurses can thrive. This programme will capture what works, where, how, and with whom, ultimately benefiting both individual nurses and the overall effectiveness and sustainability of healthcare systems. Full article

In previous studies exploring continuous glucose monitoring (CGM), there has been a limited focus on how CGM influences key behavioral outcomes such as self-efficacy, health behaviors, and medication adherence. Background/Objectives: The aim of this study was to assess the impact of combining self-regulation health education with CGM on medication adherence, diabetes self-efficacy, diabetes health behaviors, and glucose control in individuals with diabetes. Methods: A randomized controlled study, reported following the CONSORT 2010 reporting guidelines. Individuals with diabetes volunteered to participate and were randomly allocated into two groups: the CGM group (n = 34) and the control group (n = 34). The CGM group received real-time CGM devices and education on self-regulation theory to enable them to self-adjust health promotion strategies and behaviors, while the control group received routine diabetes health education focusing on self-monitoring of blood glucose. Outcome measures included medication adherence, diabetes self-efficacy, diabetes health behaviors, and glucose control. Results: The CGM group demonstrated consistent diabetes self-efficacy, significant improvements in diabetes health behaviors, and a reduction in HbA1c levels over time. However, no significant differences in outcomes were observed between the CGM group and the control group. Conclusions: The use of continuous glucose monitoring (CGM) provides continuous, real-time glucose data. When combined with self-regulation education, it may help provide personalized insights into how specific foods, activities, medications, and stress levels affect blood glucose levels. This allows individuals with diabetes to make personalized adjustments to their lifestyle and treatment plans to optimize their blood sugar control. Full article

Background/Objectives: Universities, particularly in nursing education, have evolved to incorporate University Social Responsibility (USR) into their curricula, emphasizing ethical, social, and sustainable competencies, which align with the Sustainable Development Goals (SDGs) to enhance healthcare and education. The study examines socially responsible behaviors, ethical competencies, and sustainability values among nursing students in private universities in Santiago, Chile, and their relation to sociodemographic variables. Methods: The study measures social responsibility in nursing students at private universities, accredited and co-financed by the State in Santiago, Chile, using the ICOSORE-U questionnaire, with statistical analyses such as EFA and CFA to validate the scale and evaluate correlations with sociodemographic variables. Results: The study validated the ICOSORE-U-10 scale for social responsibility in Chilean nursing students through both exploratory and confirmatory factor analysis. The results revealed a two-factor structure and an acceptable internal reliability (α = 0.841), with no significant differences related to sociodemographic variables. The findings confirmed that socially responsible behaviors are positively correlated with the development of ethical competencies and sustainability among these students. Conclusions: the socially responsible behaviors of nursing students are mainly determined by their orientation towards University Social Responsibility (USR) and not by sociodemographic variables. This orientation favors the development of ethical and professional competencies, improving their ability to address social and ethical challenges in the health field. Integrating the principles of USR in university education is key to training professionals committed to social justice, equity and sustainability in health care. Full article

Background: Burnout is an important psychological condition that affects the work performance of nurses. It occurs under long-term psychological or emotional stress associated with the work of a nurse. As a result, symptoms such as emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA) may be experienced. The purpose of this study was to determine the syndrome of “burnout” using three subscales—emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA)—among nurses providing round-the-clock nursing care in multidisciplinary hospitals in the Republic of Kazakhstan. Methods: A cross-sectional study was conducted among nurses in the Republic of Kazakhstan working in round-the-clock care. In total, 284 respondents participated in the online survey. The Maslach Burnout Inventory for Medical Personnel (MBI-HSS-MP) was used for collecting data. Results: The results demonstrated that burnout occurred among 61.97% of hospital nurses in the Republic of Kazakhstan. EE was identified among 29.23% of the respondents, DP in 60.92% of the respondents, and PA in 38.73%. Burnout, according to these indicators, occurred in 25.7% (EE), 19.37% (DP), and 12.68% (PA) of nurses. The level of burnout was higher among young nursing specialists and more frequent in the southern region of the Republic of Kazakhstan. Conclusions: This study revealed a high level of burnout among nurses providing round-the-clock care in multidisciplinary hospital settings. These findings have implications for further research into the impact of burnout on nurses’ work and for developing interventions to reduce potential risks to nursing staff health and improving the quality of nursing care. Full article

Purpose: This article focuses on identifying cognitive behavioral (CB) techniques that can help nurse supervisors more effectively navigate interpersonal challenges, reduce workplace stress, improve team cohesion, and, ultimately, enhance overall organizational performance and staff well-being. Approach: Through a comprehensive review of leadership literature and clinical management practices, we determined that CB techniques could be integrated into nursing management. Two hypothetical scenarios within this context are offered, where CB techniques can enhance nursing leadership effectiveness. Conclusions and Recommendations: CB techniques offer a humanistic approach to nursing leadership through: (1) providing tools for leaders to reframe challenges and frustrations, particularly in resource-limited settings; (2) offering stress-management strategies for nursing leaders; and (3) enhancing communication skills, self-awareness, and team motivation. These applications can potentially improve both staff and management satisfaction, ultimately improving patient care quality. Healthcare organizations should consider incorporating CB techniques into their leadership development programs. We suggest practical ways to implement these techniques in daily nursing management, emphasizing the importance of creating supportive and safe work environments and provide recommendations for future research. This perspective extends the cognitive behavioral approach beyond its traditional therapeutic context into nursing leadership, providing a novel theoretical framework for understanding and enhancing leadership development in healthcare settings. Full article

Objectives: Based on social cognitive theory, this study aims to explore the associated factors of and whether and how health information literacy was correlated to health behavior and glycemic control among individuals with type 2 diabetes and metabolic syndrome. Methods: Following convenient sampling, this cross-sectional, correlational study was conducted among 225 patients with type 2 diabetes and metabolic syndrome from an outpatient clinic in a suburban area of Beijing, China. Hierarchical multiple regression and mediation analysis were performed to explore the effect of health information literacy on self-management practice and hemoglobin A1c in this sample. The STROBE guidelines for cross-sectional studies were followed. Results: The findings showed incompetent health information literacy, inadequate self-management behavior, and suboptimal glycemic control in a sample of patients with type 2 diabetes and metabolic syndrome. Based on social cognitive theory, the results of regression analysis indicated that self-management attitude, health problem-solving, and chronic illness resources were correlated with self-management practice, and health problem-solving and health information evaluation were correlated with hemoglobin A1c. Mediation analysis revealed that self-management attitude, health problem-solving, and chronic disease resources fully mediated the effect of health information literacy on self-management practice. There was an indirect effect of health information literacy on hemoglobin A1c through health problem-solving. Conclusions: The findings demonstrated that health information literacy has significant indirect and direct effects on self-management behavior and glycemic control through self-management attitude, health problem-solving, and chronic disease resources in a sample of patients with type 2 diabetes and metabolic syndrome. Full article

Background/Objectives: Sarcopenic obesity (SO) is a clinical condition in which there is an excess of fat mass and a loss of muscle mass, strength, and function. Its prevalence increases with age, particularly in adults over 65 years old. However, debate persists on the definition and assessment of SO. The purpose of this review is to examine the impact of resistance training on older adults with sarcopenic obesity. Methods: This review included studies investigating the effects of resistance training interventions in older adults with SO. A comprehensive literature search was conducted across six databases (PubMed, SCOPUS, Cochrane Library, Embase, EBSCO, and Web of Science), yielding 1882 articles. The risk of bias in the included studies was assessed using the PEDro scale and the GRADE system. Results: Eleven randomized clinical trials were analyzed qualitatively and nine were analyzed quantitatively. The meta-analysis demonstrated that exercise interventions revealed the positive effects of exercise mainly on physical performance ([SMD] = 0.36, [95% CI] = 0.03, 0.69, p = 0.003) and body composition ([SMD] = 0.35, [95% CI] = 0.12, 0.57, p = 0.003), with no significant differences in biomarkers ([SMD] = 0.1, [95% CI] = −0.28, 0.49, p = 0.52). Conclusions: Resistance training benefits older adults with SO, improving body composition and physical function, whereas there were no significant differences in blood biomarkers. The present review highlights the limitations of the existing evidence base. Many included studies exhibited methodological shortcomings, necessitating the cautious interpretation of findings. Future research should prioritize rigorous study designs, including larger sample sizes and extended follow-up periods, to enhance the precision and generalizability of results. Full article

Background/Objective: In nursing practice, differences have been noted between the shared habitus acquired during academic training and professional practices within healthcare systems. In this context, nurses tend to experience an impact on their autonomy due to the ways in which their professional habitus has been established, which, in some way, alters the cultural capital acquired during their academic training. The objective of this study was to identify factors that facilitate and/or limit autonomy in nursing practice based on professional habitus. Method: This research was conducted using a hermeneutic qualitative study framed within a critical approach that incorporated Bourdieu’s theory of fields (habitus, field, and capital). This study included 11 registered nurses working in hospital settings, 17 nursing students, and six university professors. Data collection included 34 sociodemographic forms, 34 individual semi-structured interviews, and five focus group discussions conducted with an interview guide. The collected data were analyzed using an interpretative hermeneutic approach, integrating grounded theory and Bourdieu’s theory of fields, focusing on the concepts of habitus, field, and capital. Results: This study identified a central theme—clarification of the nurse’s role (professional habitus)—alongside three subthemes: (1) strengthening the nursing identity (identity habitus), (2) optimizing nursing education (optimization habitus), and (3) reinforcing professional credibility (validation habitus). Autonomy was found to be influenced by hierarchical structures, power relations, and institutional constraints within the healthcare social field, which led to limitations in the accumulation of nurses’ symbolic capital. Conclusions: The professional habitus of nurses is shaped by various elements within the healthcare social field. This field is constrained by hierarchical structures and factors such as subordination to the hegemonic biomedical discourse and the medical profession, limited recognition of humanized care, institutional restrictions on acknowledging the nursing process, and a lack of solidarity and leadership. These constraints ultimately hinder the accumulation of symbolic and social capital in nursing, leading to a loss of autonomy and hindering professional development. Full article

Background: Seasonal influenza currently remains a major public health concern for the community and, in particular, the health care worker (HCW). According to the World Health Organization, HCWs are among the high-risk categories for which vaccination is recommended, due to the derived absenteeism, productivity loss, and high probability of transmitting the disease to vulnerable individuals or patients. Therefore, an HCW vaccination policy should be adopted by every health care provider. There is growing evidence that a time effect of the vaccination event is probable, which may influence vaccine effectiveness. We designed and conducted an observational study to investigate the time to anti-influenza vaccination event of different categories of HCWs belonging to different occupational settings in a tertiary hospital during three seasons in order to retrieve some insight about HCW prioritization when designing vaccination campaigns. Materials and Methods: We retrospectively analyzed the results of two HCW anti-influenza vaccination campaigns (2022 and 2023) to assess any difference regarding job typology and unit typology (critical care, surgical, medical, service). We first fitted a classic Cox proportional hazard model and then an AI random forest model to assess variable importance. We used R, RStudio, and the survex package. Results: Overall, other HCWs reported a lower vaccination rate compared to nurses (HR 0.77; 95%CI 0.62–0.97), and service unit personnel appeared to more likely be vaccinated (HR 1.42; 95%CI 1.01–1.99) compared to those belonging to the critical care units. As expected, older workers tended to be vaccinated more frequently (HR 1.70 for the (46, 65] category compared to the younger one; 95%CI 1.39–2.09). The variable importance analysis showed consistent superiority of the ward typology and age category variables with respect to time. During the entire timeline, the ward typology appeared to be more important than the HCW typology. Conclusions: Our results suggest a prioritization policy based firstly on the unit typology followed by the job typology for HCW anti-influenza campaigns. Full article

Background: After childbirth, sexual activity and sexual desire decrease significantly. In recent years, postpartum sexual health has been a common concern that is often not discussed in antenatal postpartum care and has received little attention from either clinicians or researchers. This lack of attention is concerning, and thus, the aim of this study was to investigate associated factors with postpartum sexual function during the puerperium period, with the hope of sparking a change in this trend. Methods: Three hundred and thirty-six women participated in the study. They were asked to complete two questionnaires: a general questionnaire regarding demographic and other personal information about the postpartum period and the Female Sexual Functioning Index (FSFI). Results: The results showed that women scored an average of 20.8 points on the FSFI, and thus, their level of sexual functioning was characterized as moderate. Factors such as older age, lack of partner support, and negative body image appeared to influence scores on the FSFI scale. Conclusions: In conclusion, our research underscores the need for further investigation into the challenges women face during the puerperium period, which may negatively influence sexual health and functioning. Full article