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Challenges and Innovations in Nursing Management Within Modern Healthcare Systems
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Challenges and Innovations in Nursing Management Within Modern Healthcare Systems

A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: 10 December 2026 | Viewed by 8717

Editors

Dr. Assunta Guillari

E-Mail Website
Guest Editor
Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
Interests: nurse; gender gap; infection; risk management
Dr. Teresa Rea

E-Mail Website
Guest Editor
Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
Interests: nursing leadership; gender medicine; professional development of nurses; ethics and organizational models in nursing; clinical governance and quality of care
Dr. Vincenza Giordano

E-Mail Website
Guest Editor
Department of Public Health, Federico II University, 80131 Naples, Italy
Interests: nurse; gender gap; cardiovascular disease; acute myocardial infarction; infection

Special Issue Information

Dear Colleagues,

Nursing care represents the foundation of healthcare systems worldwide, encompassing prevention, treatment, rehabilitation, and support across the lifespan. In recent decades, the role of nursing has expanded considerably, integrating scientific evidence, technological innovation, and patient-centered approaches to improve outcomes and ensure safety. At the same time, the complexity of healthcare contexts highlights the need for advanced clinical competencies, interprofessional collaboration, and continuous research to strengthen quality of care.

This Special Issue aims to collect innovative contributions that explore the impact of nursing care in diverse clinical and community settings, aligning with the journal’s scope of advancing healthcare research and practice. By focusing on evidence-based interventions, patient outcomes, and strategies for improving safety and quality, this Special Issue seeks to provide a platform for clinicians, researchers, and educators to share knowledge and best practices.

In this Special Issue, original research articles and reviews are welcome. Research areas may include the following:

  • Evidence-based nursing interventions and clinical outcomes;
  • Nursing care in acute, emergency, and critical settings;
  • Patient safety, quality indicators, and risk management in nursing practice;
  • Education and professional development in nursing;
  • Interprofessional collaboration and models of care;
  • Nursing perspectives in public health and community care.

We look forward to receiving your contributions.

Dr. Assunta Guillari
Dr. Teresa Rea
Dr. Vincenza Giordano
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • evidence-based nursing
  • nursing care
  • cardiovascular disease
  • emergency
  • infection
  • risk management
  • public health
  • acute and critical care nursing
  • patient safety and quality of care
  • nursing education and professional development
  • interprofessional collaboration
  • community and public health nursing

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  • Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
  • Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.
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  • Reprint: MDPI Books provides the opportunity to republish successful Special Issues in book format, both online and in print.

Further information on MDPI's Special Issue policies can be found here.

Published Papers (6 papers)

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Research

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18 pages, 1322 KB  
Article
Knowledge, Attitudes and Perceived Preparedness Regarding Cardiopulmonary Resuscitation and Automated External Defibrillator Use Among Health-Related University Students: A Cross-Sectional Study
by Caterina Mercuri, Giovanni Marasco, Alessandra De Pasquale, Dario Marasciulo, Silvio Simeone and Adele Sarcone
Healthcare 2026, 14(6), 730; https://doi.org/10.3390/healthcare14060730 - 12 Mar 2026
Viewed by 813
Abstract
Background: Early cardiopulmonary resuscitation (CPR) and timely use of automated external defibrillators (AEDs) are critical determinants of survival following out-of-hospital cardiac arrest (OHCA). University students enrolled in healthcare degree programs represent a strategic target population for the dissemination of basic life support and [...] Read more.
Background: Early cardiopulmonary resuscitation (CPR) and timely use of automated external defibrillators (AEDs) are critical determinants of survival following out-of-hospital cardiac arrest (OHCA). University students enrolled in healthcare degree programs represent a strategic target population for the dissemination of basic life support and defibrillation (BLS-D) skills. However, evidence on their level of knowledge, attitudes, and perceived preparedness remains limited in Southern Italy. Methods: A cross-sectional observational study was conducted between mid-December 2025 and 15 January 2026 among undergraduate healthcare students at the Magna Graecia University of Catanzaro (Italy). Data were collected using a structured, self-administered questionnaire assessing socio-demographic characteristics, CPR/AED knowledge, attitudes, and perceived confidence. Composite knowledge scores were calculated and categorized as poor, sufficient, good, or excellent. Statistical analyses included chi-square tests, Cramér’s V, and Spearman’s rank correlation. Results: A total of 604 students were included (mean age 24.4 ± 6.7 years; 69.9% female), of whom 46.4% reported prior BLS-D training. Knowledge levels were heterogeneous: myocardial infarction was widely recognized as a cause of cardiac arrest (81.1%), whereas recognition of non-shockable rhythms, including asystole and pulseless electrical activity, remained low (<25%). Procedural knowledge, particularly regarding the chain of survival and chest compression rate, improved with academic year and prior BLS-D training. Conversely, ventilation skills and correct AED pad placement were consistently inadequate. Attitudes toward CPR were largely positive; however, perceived confidence in performing resuscitation was moderate to low, especially in complex scenarios. More than 80% of students expressed strong interest in further training and supported mandatory BLS-D education. Conclusions: Healthcare students demonstrated favorable attitudes toward CPR but insufficient and uneven knowledge, particularly in rhythm recognition, ventilation, and AED use. Academic progression and structured BLS-D training were associated with improved competencies, although critical gaps persisted. Integrating mandatory, hands-on BLS-D training with regular refresher sessions into healthcare curricula should enhance preparedness and potentially reduce OHCA-related mortality, especially in high-risk regions such as Calabria. Full article
(This article belongs to the Special Issue Challenges and Innovations in Nursing Management Within Modern Healthcare Systems)
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16 pages, 274 KB  
Article
Patient-Reported Self-Care Behaviors, Self-Efficacy, and Their Associated Factors in Men and Women with Coronary Heart Disease
by Gideon Victor, Ercole Vellone and Erika Sivarajan Froelicher
Healthcare 2026, 14(5), 653; https://doi.org/10.3390/healthcare14050653 - 4 Mar 2026
Viewed by 763
Abstract
Background/Objective: Heart disease is the leading cause of death for men and women across most racial and ethnic groups. Effective self-care improves patient outcomes. This study aimed to examine self-care and its associated variables in men and women with coronary heart disease. [...] Read more.
Background/Objective: Heart disease is the leading cause of death for men and women across most racial and ethnic groups. Effective self-care improves patient outcomes. This study aimed to examine self-care and its associated variables in men and women with coronary heart disease. Methods: This cross-sectional survey enrolled patients with coronary heart disease through convenience sampling. Data were collected via in-person interview, including sociodemographic variables (e.g., age and sex) and clinical variables (e.g., comorbidities). We also used the Charlson Comorbidity Index to measure comorbidity; the Patient Health Questionnaire-9 to measure depression; and Generalized Anxiety Disorder-7 to measure anxiety. Self-care was evaluated with the Self-care Coronary Heart Disease Inventory and Self-Care Self-Efficacy Scale. Descriptive and multivariate analyses were performed. This study adhered to the CROSS guidelines. Results: The sample comprised 354 patients (57.6% men and 42.4% women). Self-care monitoring and management scores were inadequate with women. Self-care self-efficacy scores were marginally adequate. Men had worse depression, comorbidities, and smoking, while women had higher anxiety and a sedentary lifestyle. Older age, low education, public transportation use, sedentary lifestyle, comorbidity, anxiety, and depression were associated with worse self-care, whereas being single and ambulance accessibility improved self-care. Conclusions: Self-care monitoring and self-care management scores were inadequate for both sexes. Depression and public transportation use were inversely associated with all self-care domains. Depression and anxiety screening should be included in routine practice. Healthcare providers should enhance self-care education for CHD patients. Interventions must address sedentary lifestyles in women and cigarette smoking in men. Full article
(This article belongs to the Special Issue Challenges and Innovations in Nursing Management Within Modern Healthcare Systems)
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Review

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15 pages, 549 KB  
Review
Nurse Retention in Hospitals: A Multilevel Integrative Review of Organizational Determinants
by Assunta Guillari, Marco Abagnale, Chiara Palazzo, Maria Assunta Fulco, Teresa Rea and Vincenza Giordano
Healthcare 2026, 14(6), 772; https://doi.org/10.3390/healthcare14060772 - 19 Mar 2026
Cited by 1 | Viewed by 1573
Abstract
Background/Objectives: Nurse retention remains a major global challenge for healthcare systems, intensified by workforce aging, rising care complexity, and the long-term impact of the COVID-19 pandemic. Despite extensive research, the evidence on nurse retention remains fragmented and frequently focuses on isolated determinants. [...] Read more.
Background/Objectives: Nurse retention remains a major global challenge for healthcare systems, intensified by workforce aging, rising care complexity, and the long-term impact of the COVID-19 pandemic. Despite extensive research, the evidence on nurse retention remains fragmented and frequently focuses on isolated determinants. This review aimed to synthesize the multifactorial determinants of nurse retention by integrating organizational, relational, and individual perspectives. Methods: An integrative review was conducted following Whittemore and Knafl’s approach and reported according to PRISMA 2020 guidelines where applicable. A systematic search of six databases identified studies published between 2016 and 2026 addressing nurse retention in hospital settings. Included studies underwent methodological quality appraisal using validated tools, and findings were synthesized narratively. Results: Twenty-five articles were included. The analysis revealed differences in perspective between nurse managers and nurses regarding the factors that influence retention. Transformational and participative leadership among nurse managers enhanced staff retention through supportive organizational climates and higher professional commitment. For staff nurses, positive work environments, collegial support, and psychological resources such as self-efficacy and resilience were key predictors of intention to stay. These findings can be interpreted through Herzberg’s Two-Factor Theory, Self-Determination Theory and Theory of Planned Behavior, which collectively highlight how recognition, autonomy, and competence satisfaction drive nurses’ intention to remain in their roles. Conclusions: Nurse retention reflects dynamic, multilevel processes rather than the influence of single determinants. Integrated, theory-informed approaches targeting organizational structures, relational climates, and individual psychological resources are required to strengthen workforce sustainability and support high-quality care delivery. Full article
(This article belongs to the Special Issue Challenges and Innovations in Nursing Management Within Modern Healthcare Systems)
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15 pages, 754 KB  
Review
Evidence on Measures for the Prevention of Pressure Injuries in Mechanically Ventilated Patients in Prone Positioning: A Systematic Review
by Simone Amato, Daniele Napolitano, Alessio Lo Cascio, Elena Conoscenti, Angela Lappa, Emilio D’avino, Mirko Masciullo, Antonello Pucci, Valentina De Bartolo, Claudia Torretta, Lucia Mitello, Anna Rita Marucci and Francesco Gravante
Healthcare 2026, 14(4), 443; https://doi.org/10.3390/healthcare14040443 - 10 Feb 2026
Cited by 1 | Viewed by 2142
Abstract
Background: Therapeutic prone positioning is widely used to improve oxygenation in patients with acute respiratory distress syndrome but is associated with an increased risk of pressure injuries, particularly affecting facial and anterior body regions. Methods: This systematic review was conducted according to PRISMA [...] Read more.
Background: Therapeutic prone positioning is widely used to improve oxygenation in patients with acute respiratory distress syndrome but is associated with an increased risk of pressure injuries, particularly affecting facial and anterior body regions. Methods: This systematic review was conducted according to PRISMA 2020 and Joanna Briggs Institute guidelines and was prospectively registered in PROSPERO (CRD42023442604). PubMed, CINAHL, Web of Science, Scopus, and the Cochrane Library were searched from inception to June 2025, including grey literature. Primary studies involving adult, mechanically ventilated patients undergoing therapeutic prone positioning and evaluating pressure injury prevention strategies were included. Methodological quality was assessed using JBI critical appraisal tools. Owing to clinical and methodological heterogeneity, findings were synthesized using a Synthesis Without Meta-analysis (SWiM) approach. Results: Eight studies with heterogeneous designs were included. Preventive interventions mainly comprised prophylactic dressings, repositioning and support devices, and comprehensive care bundles. Most strategies were associated with a reduction in pressure injury incidence, particularly in facial and anterior anatomical areas. Greater effectiveness was observed when interventions were implemented within structured protocols supported by staff training and multidisciplinary coordination. Conclusions: Preventive strategies appear effective in reducing pressure injuries associated with prone positioning in critically ill patients. The implementation of standardized, bundled prevention protocols may improve patient safety in intensive care settings. Full article
(This article belongs to the Special Issue Challenges and Innovations in Nursing Management Within Modern Healthcare Systems)
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Other

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20 pages, 592 KB  
Systematic Review
Impact of Nurse-Performed Point-of-Care Ultrasound (PoCUS) in Adult Intensive Care: A Systematic Review
by Marco Abagnale, Chiara Palazzo, Nicolò Zampetti, Melania De Filippo, Rita Citarella, Fabio Gennaro Abagnale, Luciano Cecere, Francesco Limonti and Francesco Gravante
Healthcare 2026, 14(10), 1286; https://doi.org/10.3390/healthcare14101286 - 9 May 2026
Viewed by 576
Abstract
Background/Objectives: Point-of-care ultrasound (POCUS) is increasingly used in intensive care units (ICUs) as a rapid bedside diagnostic tool supporting timely clinical assessment. The impact of nurse-performed POCUS on clinical management, procedural performance, and professional practice in adult ICUs has not yet been systematically [...] Read more.
Background/Objectives: Point-of-care ultrasound (POCUS) is increasingly used in intensive care units (ICUs) as a rapid bedside diagnostic tool supporting timely clinical assessment. The impact of nurse-performed POCUS on clinical management, procedural performance, and professional practice in adult ICUs has not yet been systematically synthesized. This review aimed to evaluate the integration of nurse-performed POCUS into nursing care and its effects on technical, decision-making, and professional outcomes. Methods: A systematic review was conducted in accordance with PRISMA 2020 and the JBI Manual for Evidence Synthesis. PubMed, Scopus, CINAHL, and Web of Science were searched without time restrictions. Original studies were included if they involved adult ICU patients and evaluated POCUS performed by nurses, reporting clinical, procedural, or professional outcomes. Methodological quality was assessed using JBI and MMAT checklists according to study design. Results: Eleven studies were included. The results were synthesized into four primary domains: (1) support for the clinical decision-making process, (2) technical performance and procedural outcomes, (3) diagnostic accuracy, and (4) professional autonomy, training, and sustainability of competencies. Nurse-performed POCUS was associated with management changes in 26–67% of assessments and improved first-attempt success in ultrasound-guided peripheral venous access. Diagnostic accuracy was acceptable when supported by structured training, with no reported increase in complications. Conclusions: Nurse-performed POCUS in adult ICUs appears safe and practice-enhancing, supporting decision-making and selected procedural outcomes. Further multi-center controlled studies are required to clarify its impact on major clinical endpoints and long-term outcomes. Full article
(This article belongs to the Special Issue Challenges and Innovations in Nursing Management Within Modern Healthcare Systems)
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20 pages, 434 KB  
Systematic Review
Social Determinants of Health Assessed Among Nurses: A KAP-Oriented Systematic Review Using the Dahlgren-Whitehead Rainbow Model
by Alessandra Improta, Erika Renzi, Nicolò Panattoni, Maila Ruggeri, Marco Di Muzio, Maurizio Marceca, Fabio Fabbian, Azzurra Massimi and Emanuele Di Simone
Healthcare 2026, 14(5), 560; https://doi.org/10.3390/healthcare14050560 - 24 Feb 2026
Cited by 1 | Viewed by 2039
Abstract
Background and Objectives: Social Determinants of Health (SDoH) are factors that can contribute to health inequities. Improving the conditions in which people are born, grow, and live requires collaboration between professionals from different health sectors. Given their health and well-being-focused care, nurses [...] Read more.
Background and Objectives: Social Determinants of Health (SDoH) are factors that can contribute to health inequities. Improving the conditions in which people are born, grow, and live requires collaboration between professionals from different health sectors. Given their health and well-being-focused care, nurses are crucial to promoting health equity in the care they provide. Thus, their knowledge, attitudes, and actions—i.e., practice—(KAP) regarding SDoH could serve as a helpful starting point for promoting care that also focuses on non-medical factors. This study aims to map the SDoH assessed in the literature in relation to nurses’ and nursing students’ KAPs, using the Dahlgren–Whitehead Rainbow Model as a logical framework. Methods: Following PRISMA guidelines, a systematic literature review was conducted using PubMed, Scopus, Web of Science, CINAHL, and PsycINFO. Records published until June 2024 were selected from primary studies involving nurses and nursing students, with no time limits. The assessed determinants were adapted and categorised according to the Rainbow Model Levels. Results: 22 results were eligible. The SDoH (in general), poverty, social justice, social gradient, social inclusion and exclusion, discrimination, diversity, equity and inequality, food insecurity and access to nutritious food, employment status, geographical isolation, healthcare services, housing difficulties, transportation, social support, individual lifestyle factors, and health literacy were assessed on KAPs. Conversely, health equity has been assessed just for knowledge and attitudes. Considering the latter level of the Rainbow Model and the relative categorisation of the results, age, sex, and constitutional factors were not examined in the studies included in this review. Conclusions: This review maps the most and least frequently assessed SDoH in relation to KAP. As nurses are essential to providing care that considers SDoH, improving health outcomes, and addressing health inequities, and advocating for community health, it would be valuable to enhance nursing education from baccalaureate through postgraduate courses. Moreover, a strong relationship with different healthcare professionals is needed. Full article
(This article belongs to the Special Issue Challenges and Innovations in Nursing Management Within Modern Healthcare Systems)
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