Nursing Reports

Background/Objectives: Peristomal skin complications (PSCs) are common among patients with ostomies, significantly impacting quality of life and increasing healthcare utilization. This study aimed to evaluate the effects of the Dermamecum protocol, a risk-stratified educational intervention, on the prevention of PSCs, self-care improvements, health-related quality of life (HRQoL), and patient satisfaction over a 90-day follow-up period. Methods: This prospective cohort study included 305 patients stratified into three risk-based groups (green, yellow, and red paths) according to the Dermamecum protocol. Primary outcomes included PSC rates at 30, 60, and 90 days. Secondary outcomes included self-care scores, HRQoL, and patient satisfaction. Comparative analyses and trend assessments were performed across groups and time points. Temporal trends in PSCs were analyzed using Poisson regression. Results: Early PSC rates were 8.5% at 30 days, with late complications at 7.9% and 6.2% at 60 and 90 days, respectively. No significant differences in PSC rates were observed between paths. Self-care scores improved over time, with stability across groups and domains. HRQoL remained stable, with minor fluctuations in physical and mental components. Patient satisfaction was high across all paths. Poisson regression identified significant temporal trends in PSC rates, with higher risks at 30, 60, and 90 days compared to baseline. Age, BMI, and path assignment (lower risk for the green path) were significant predictors of PSCs. Conclusions: The Dermamecum protocol effectively maintained low PSC rates, supported self-care, and sustained HRQoL and patient satisfaction. These findings highlight the value of risk-stratified, patient-centered interventions in ostomy care. Further studies are needed to validate these results and explore long-term outcomes. Full article

Background/Objectives: The REACtion project was developed to provide nursing care to older adults at home within the primary care setting. The COVID-19 pandemic posed significant challenges to its implementation, acting both as a barrier and an opportunity. Although several studies have explored healthcare innovation during emergencies, there remains a need for strategic insights to guide real-world implementation efforts. This study aims to explore how the COVID-19 pandemic influenced the implementation of the REACtion project and identify the strategies adopted to ensure continuity and effectiveness in achieving its goals despite the challenges posed by the health emergency. Methods: A qualitative descriptive study was conducted. Semi-structured interviews were carried out with nine project stakeholders, including nurses and researchers, between April and May 2023. The interviews were transcribed verbatim, read in-depth, and analyzed using content analysis to identify perceived barriers, facilitators, and strategies adopted during the project. Results: The pandemic shifted priorities from routine care to emergency health activities. Barriers to project implementation included social distancing, disruptions in the decision-making processes, and a general decline in community welfare. Despite these obstacles, the COVID-19 context underscored the central role of Family and Community Nurses in proactive primary care. Stakeholders adopted relationship-based strategies, addressed workforce shortages, and implemented measures to mitigate personal fatigue. Conclusions: The implementation of innovative nursing interventions during emergencies requires adaptability, collaboration, and context-sensitive approaches. Strengthening stakeholder engagement and leveraging professional roles within the community are essential to overcoming barriers and seizing opportunities in crisis contexts. Full article

Background: Vascular access in emergency departments (ED) is challenging for patients with difficult venous access (DIVA), causing delays and discomfort. Ultrasound-guided techniques may offer improved outcomes, making it crucial to assess their benefits, risks, and the effectiveness of validated identification systems. Objectives: To contribute new evidence regarding the effectiveness of validated tools for identifying DIVA and to assess the clinical benefits of ultrasound-guided vascular access in emergency care, and to assess their utility in arterial puncture for arterial blood gas sampling, from now on ABG, within the ED. Methods: This study follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines for protocol development and the Consolidated Standards of Reporting Trials (CONSORT) guidelines for the conduct and reporting of the randomized clinical trial (RCT). The trial will be conducted in Spain throughout 2025. The study population will consist of 114 subjects with difficult intravenous access (DIVA), identified using the DIVA scale for individuals under 14 years of age and the A-DICAVE scale for adults, along with 80 subjects from the general surgical area (GSA). Participants will be randomly assigned, in a 1:1 ratio, to either the Control Group (CG) (traditional technique) or the Experimental Group (EG) (ultrasound-guided technique). Data collected will include sociodemographic characteristics, procedure-related variables (e.g., time required, human resources, and materials used), as well as pain levels, assessed using validated scales (EVA, FLACC, PAINAD), and overall satisfaction from both patients and healthcare professionals. Ethical approval has been obtained, and the trial will be registered as an RCT through an official clinical trial registry before recruitment begins. Results: Expected results suggest ultrasound guidance will significantly improve first-attempt success rates, reduce procedural time, enhance patient comfort, and optimize resource utilization compared to traditional techniques. Conclusions: The integration of ultrasound-guided vascular access into routine emergency protocols could enhance patient safety, satisfaction, and procedural efficiency in emergency care settings. Full article

Background/Objectives: Home non-invasive ventilation use is the primary treatment for improving respiratory function in people with chronic hypercapnic respiratory failure. Non-invasive ventilation has also been studied to understand users’ perspectives. However, no studies have been conducted on how users adapt to non-invasive ventilation in their homes from the early phase of their diagnosis as a long-term utility. Methods: The study employed a descriptive qualitative design guided by Roy’s adaptation model. A purposive sample was used. People with chronic hypercapnic respiratory failure who had used NIV at home for a minimum of six months would be eligible. They were interviewed at a sleep and assisted ventilation centre. Their interviews were audio recorded before proceeding with transcription. Each transcript was thematically analysed. Results: Twenty participants were included in the study, from which six themes emerged. They experienced a common transition, from denying the need for non-invasive ventilation to integrating them into their daily lives at home. Throughout this process, they had emotional turmoil, faced difficulties in keeping their masks on, and improved sleep quality. They also adjusted their social interactions before fully accepting the use of non-invasive ventilation. Their coping strategies in their role functions at home and social interaction were also narrated. Their family members were pivotal in their adaptation period. Conclusions: Gaining insight into individuals’ adaptation experiences can facilitate early identification of potential challenges faced by new users of non-invasive ventilation. This study calls for healthcare professionals to assess users’ understanding of long-term commitment and their living conditions early for a successful NIV adaptation. Full article

Background: Critical thinking is fundamental for registered nurses (RNs) when making clinical decisions, which impact patient outcomes. This review aimed to identify studies on critical thinking and clinical decision making among nurses in clinical practice and synthesize their findings based on the regional area, observed findings, and predictive factors, and to assess the measurement tools used. Methods: A comprehensive search of the PubMed, Web of Science, CINAHL, and SCOPUS databases up to December 2024 was conducted in accordance with the PRISMA guidelines. The Newcastle–Ottawa Scale was used to assess the quality of included studies. Studies with similarly themed components were grouped for narrative synthesis. A meta-analysis of random-effects model calculations was performed. Results: This review included forty studies (twenty-four on CT, twelve on CDM, four on both) from various WHO regions, revealing diverse findings on observed skills. Ten CT and four CDM measurement tools were identified. Many studies also explored individual and group-level predictive factors for these skills. Meta-analyses of four common tools (CCTDI, NCT4P, CDMNS, and NDMI) showed significant heterogeneity, with statistically significant pooled mean scores. Conclusions: The synthesis highlights the global research on nurses’ critical thinking and clinical decision making, including the exploration of various predictive factors. However, the significant heterogeneity in the findings from meta-analyses of commonly used measurement tools underscores a need for more standardized measurement and analytical approaches, such as multilevel modeling, to better account for the hierarchical nature of potential predictive factors (individual and group levels), which would allow for more reliable comparisons and stronger conclusions in this field. Full article

Background/Objectives: Academic engagement (AE) and work engagement (WE) are important indicators of performance and well-being in educational and occupational settings. Although these constructs are well researched independently, few studies have examined them concurrently among individuals navigating both academic and professional demands. Nursing students who are simultaneously employed as nurses represent a unique and under-researched population in this context. Understanding how personality traits influence both AE and WE in this dual-role group may offer insights relevant for academic success and well-being in healthcare settings. Methods: The sample consisted of 230 nursing students from a public university in Croatia who were also working as nurses. This study employed a repeated cross-sectional descriptive predictive research design (2022–2025). The participants completed questionnaires (UWES-9, UWES-S-9, and IPIP-15) during their university lectures. Results: The analysis yielded two personality clusters (adaptive—lower levels of neuroticism and higher levels of the other personality traits and maladaptive—the opposite). The participants in the adaptive cluster had higher levels of WE and AE. Regression analysis revealed that conscientiousness was a significant predictor for WE and AE, whereas agreeableness was a significant predictor for only WE. Conclusions: The findings highlight the importance of personality traits when addressing AE and WE, and fostering traits such as conscientiousness and agreeableness may enhance positive work and academic outcomes. Personality traits showed similar patterns of association with both AE and WE, indicating that dispositional factors may play a more crucial role in WE and AE than external influences. Full article

Background and Objectives: Medication errors are a critical issue in healthcare systems worldwide, contributing to significant patient harm, with studies indicating that medication-related incidents are among the most common causes of adverse events in medical practice. There are between 80 and 200 steps in providing a single patient with a single dose of drugs, with five stages, including prescription, preparation, dispensation, administration and monitoring. This study aims to describe and validate the MAEs (Medication Administration Error Scale) tool, which investigates the most common causes of medication errors in medication administration. Materials and Methods: Independent translators translated the original version of the scale using language verification. The agreed-upon version of the translation was then assessed by a team of nurses, specialists in anaesthetic and intensive care nursing, in terms of understanding the translated content. After introducing changes resulting from linguistic and organisational differences, a survey questionnaire was prepared and used in the pilot study. Eighty-six respondents participated in the pilot study via the Office 365 platform and the Forms programme. The research was led by nurses who work in highly specialised units. The reliability of the translated version of the questionnaire was examined by calculating the Cronbach’s alpha coefficient. Results: The tool’s internal consistency across ranges was within acceptable limits. For part A (questions 1–29), it was 0.93; for part B (questions 30–45), it was 0.94. In part C, regarding the percentages of the type of error occurring in a given medical facility, Cronbach’s alpha coefficient was 0.97. When the factor loadings of the items were evaluated, they were determined to be in the range of 0.602–0.783. In this context, the factor loading levels of the items in the 5-factor model were high and sufficient. Conclusions: The statistical analyses suggest that the Polish version of the Medication Administration Error Survey demonstrates satisfactory reliability and is a promising tool for assessing the cause of medication administration errors. Full article

Background/Objectives: Mental health literacy (MHL) plays a crucial role in transitional processes, influencing, for example, students’ adaptation to higher education and, later, their transition into the workforce. This study assesses MHL about depression among first- and fourth-year nursing students and identifies which MHL components and related variables are associated with a higher likelihood of being in either academic year. Methods: A cross-sectional descriptive correlational study was conducted with 478 nursing students (59.4% first-year students; 40.6% fourth-year students), predominantly female (82.2%), with a mean age of 20.41 years (SD = 4.71) and a median age of 19.0 years. Results: The results revealed a low level of recognition of depression and knowledge of mental health first aid (MHFA) strategies, including health literacy. Students tended not to hold beliefs based on myths and stereotypes about mental illness and individuals with mental illness and did not have highly stigmatizing views. MHL varied by year of study, with fourth-year students having more adequate MHL levels. Conclusions: These findings highlight the need to integrate MHL as a key element of academic success. Health education initiatives that promote mental health, prevention, and MHFA training may serve as effective strategies to enhance MHL among nursing students. Full article

Background: The healthcare sector is under increasing pressure due to an ageing population, rising multimorbidity, and a projected global workforce shortage of 10 million by 2030. It is becoming increasingly apparent that addressing these challenges requires more than simply increasing workforce numbers—it necessitates a shift towards innovative practices in healthcare education. Higher education (HE) plays a crucial role in preparing future healthcare professionals, yet embedding innovation within HE presents challenges such as resistance to change, resource limitations, and difficulties in interdisciplinary collaboration. This review explores the barriers and opportunities associated with fostering innovation in HE health programmes. Methods: This narrative review explored the recent literature on innovation in healthcare HE, examining national policies, institutional strategies, and emerging technological advancements. It describes the impact of digital learning tools, simulation-based education, artificial intelligence (AI), and interprofessional education (IPE) on student learning outcomes and workforce preparedness. Results: Findings suggest that while digitalisation and AI-driven innovations offer opportunities to enhance HE health programmes, their effectiveness is dependent on appropriate pedagogical integration and resource. Challenges include upskilling workforce to new more modern methods, ensuring equitable access to digital resources, and maintaining a balance between technological innovation and traditional face-to-face learning. Conclusions: To embed innovation effectively within healthcare HE, institutions may need to prioritise interdisciplinary collaboration, entrepreneurial thinking, and sustainable funding models. While technology is key to modernising education, it should be implemented alongside evidence-based pedagogical strategies to ensure meaningful learning outcomes and long-term workforce preparedness. Full article

Background/Objective: Needlestick injuries (NSIs) are a significant source of bloodborne infections among nurses. This study aimed to assess the prevalence, contributing factors, and awareness of post-exposure prophylaxis (PEP) among Estonian nurses. Methods: This prospective cross-sectional study was conducted using an electronic questionnaire in September 2024. Results: The majority of the 211 nurses participating in this study were females aged 21 to 75 years. Notably, 57.1% (n = 109, aged 43.9 ± 12.2) had experienced an NSI in the past decade. Most injuries occurred during sharps’ disposal (33%) and with syringe needles (72%). Among those injured, 84% washed the area with water and soap, 80% used alcohol-based disinfectants, and 69% reported the incident. However, 20.6% did not report due to perceived insignificance or lack of follow-up actions. Additionally, 14.7% were unaware of the reporting requirement, and 8.8% did not know who to report to. Conclusions: Improved training and reporting practices are essential to reduce NSIs among nurses. Full article

Background: Weight bias in healthcare can affect the quality of care and create health disparities. In nursing, the presence of weight-biassed attitudes influences the therapeutic relationship and clinical decision-making. However, in Spain, research on this phenomenon remains scarce, hindering the development of strategies to mitigate its impact. Objectives: This study aimed to assess the methodological feasibility of a study on weight bias in nursing, and to explore nurses’ attitudes towards being overweight and obesity and their association with sociodemographic and body image variables. Methods: A cross-sectional, quantitative pilot study was conducted with 22 primary care nurses. The Anti-Fat Attitudes (AFA) and Beliefs About Obese Persons (BAOP) scales, previously validated in Spanish-speaking populations, were applied. Response distribution, the internal consistency of the instruments, and the relationship between variables were analysed. Results: Difficulties were identified in the recruitment of participants and the reliability of certain items of the questionnaire, as well as in the internal consistency of the scales. A trend towards moderate weight-biassed attitudes was observed in the sample, with the highest scores in the AFA’s “Willpower” subscale. The BAOP scale showed a significant negative correlation with the AFA (r = −0.55, p = 0.009), indicating that a lower attribution of obesity to individual control is associated with less discriminatory attitudes. Conclusions: This pilot study helped identify methodological improvements and confirmed the presence of weight bias in nursing. It is recommended that the sample be expanded and the measuring instruments refined before performing the full study. Full article

Objective: To explore the feasibility and acceptability of using an evidence-based Tai Chi intervention to manage the fatigue–sleep disturbance–depression symptom cluster (FSDSC) in female breast cancer patients. Methods: This study reported the feasibility outcomes of a pilot randomized controlled trial (RCT), along with a nested qualitative process evaluation. Seventy-two female breast cancer patients experiencing the FSDSC were randomized into either a Tai Chi group or a control group. The Tai Chi group received an eight-week Tai Chi intervention consisting of two one-hour sessions per week, along with routine care, while the control group received routine care only. The feasibility and acceptability of the study procedure and Tai Chi intervention protocol were assessed by measuring recruitment, referral, retention and drop-out rates, questionnaire completion rates (including the Brief Fatigue Inventory [BFI], Pittsburgh Sleep Quality Index [PSQI], Hospital Anxiety and Depression Scale-Depression [HADS-D], and Functional Assessment of Cancer Therapy-Breast [FACT-B]), intervention adherence, and safety outcomes. The nested qualitative process evaluation consisted of semi-structured interviews conducted among 22 participants to further explore their experiences of participating in this study and practicing Tai Chi. Descriptive data analysis was employed to present the feasibility and acceptability outcomes. Content analysis was employed to analyze the data from the qualitative process evaluation. Results: A total of 72 breast cancer patients were successfully recruited over six months, with a recruitment rate of 79.1%, retention rate of 95.8%, and dropout rate of 4.2%. No missing data was found in the BFI, PSQI, or HADS-D. However, a notable number of missing values were found in the FACT-B, particularly for items related to sexual satisfaction. The Tai Chi intervention demonstrated a high level of feasibility, with an average adherence rate of 86.8%. Only eight participants reported minor discomforts, such as minor musculoskeletal discomfort and dizziness, but they were transient and manageable after stopping Tai Chi practice. Semi-structured interviews with 22 participants highlighted that Tai Chi was experienced to be generally convenient, energy-saving, and low intensity for FSDSC management. Participants also felt that the study questionnaires were comprehensible and straightforward. Many interviewees from the Tai Chi group reported perceiving favorable effects on FSDSC management, as well as overall functional health and well-being. Conclusions: The evidence-based Tai Chi intervention proved feasible, safe, and convenient as a non-pharmacological intervention for managing FSDSC in breast cancer patients. Future large-scale studies are needed to evaluate Tai Chi’s definite effects on improving FSDSC among breast cancer patients. Full article

Background/Objectives: Lower limb amputation profoundly affects individuals and their family caregivers, particularly during home transition after hospital discharge. Understanding the needs, challenges, and emotions during this period is essential for designing effective family centered empowerment interventions. This study aimed to explore the lived experiences of amputees and their caregivers, identify their needs and challenges, and identify strategies to foster empowerment, resilience, and adaptation after amputation. Methods: This qualitative, descriptive-exploratory study involved semi-structured interviews with 37 dyads, each comprising an amputee who has undergone major dysvascular lower limb amputation and their primary caregiver, who provided home care. The participants attended follow-up consultations post-amputation. Data were collected over a 13-month period and analyzed using qualitative content analysis based on Bardin’s methodology, with support from ATLAS.ti 23.3.4 software for coding and data organization. Results: Four categories emerged: (i) difficulties faced, including loss of autonomy, mobility challenges, architectural barriers, and emotional strain; (ii) home discharge, emphasizing functional training for amputees and caregivers and the need for community support; (iii) impact of amputation, highlighting acceptance difficulties, psychological distress, social isolation, and lifestyle changes; and (iv) empowerment strategies, focusing on psychological support, skills training, assistive devices, and coordinated care. Tailored interventions such as peer support, home adaptations, and multidisciplinary care are essential for resilience, independence, and improved quality of life. Conclusions: Family centered empowerment strategies are vital for improving the outcomes of amputees and caregivers. Interventions that prioritize caregiver education, psychological support, and enhanced accessibility promote resilience, autonomy, and quality of life. These findings highlight the need for integrated hospital-to-community programs. Full article

Background/Objective: Part of the workload of ambulance service involves patients with low-acuity health events that do not require the specific resources provided by ambulance services or emergency departments (EDs). The problem of inappropriateness is also present in Italy. However, research is limited to the perspective of triage nurses only, excluding patients and emergency medical service (EMS) staff. This study aims to identify the presence of inappropriate ambulance use in the study context by comparing patients’ perception of emergency with appropriateness perspectives of both triage nurses and emergency service staff. Methods: A cross-sectional study involving 109 patients transported by ambulance was performed between January and March 2020. Questionnaires were distributed to patients, EMS staff, and triage nurses operating in the chief town and hinterland of a region of Italy. Results: Non-penetrating trauma was the most frequent cause for calling an ambulance. Patients referred that activation of the service was necessary, while triage nurses and EMS technicians were in line in believing the non-urgency of the call due to non-emergent health conditions. Conclusions: Although we cannot conclude that citizens use the emergency system inappropriately, the results of this study make us think about the need to implement educational interventions that increase citizens’ knowledge of how the service works and the territorial services available. Full article

Background: Research in the intensive care unit (ICU), which involves critically ill patients, families and healthcare professionals, poses significant ethical challenges. The aim of this PRISMA-guided systematic review is to identify major challenges for research ethics in the ICU. Methods: Pubmed and Scopus databases were searched in November-December 2024 for papers discussing theoretical concepts or specific aspects related to ethical issues in ICU research, retaining 70 papers on ICU research challenges, difficulties or controversies. Results: A total of 10 papers described general concepts related to research ethics in the ICU, 16 studies focused on the methodology or some of the study steps, and 6 papers focused on ICU trials, while 38 studies focused on special patient categories or special situations of critical patients. None of the included papers addressed all of the issues we identified regarding the ethical challenges. Conclusions: ICU research is challenging from a moral point of view. Significant ethical difficulties arise during the design and implementation phases, hampering the study's exactness. Being a vulnerable population with limited decision-making capacity and research-associated risks, alternative consent methods need to be considered. This systematic review provides a checklist of aspects that could generate ethical dilemmas and might constitute a starting point in the conduct of research studies, preventing unethical research. Full article

Objective: To synthesize and analyze the prevalence, composition, longitudinal stability, and predictors of cancer symptom clusters in children and adolescents undergoing chemotherapy. Method: A systematic literature review was conducted in accordance with the PRISMA 2020 guidelines. Evidence was sourced from MEDLINE/PubMed, Cochrane Library, Embase, PsycINFO, and Web of Science, as well as clinical trial registries (Clinical Trials WHO-ICTRP) and gray literature. The search was performed in February 2025, with no restrictions on publication date or language. Two independent reviewers screened and selected the studies. The methodological quality of the included studies was assessed using design-specific tools, and the findings were synthesized narratively. Results: A total of 6221 records were identified, with 12 studies meeting the inclusion criteria. These studies were published between 2010 and 2024 in the United States, Brazil, China, and Turkey. Cancer symptom clusters in children and adolescents followed well-defined patterns, with the gastrointestinal, emotional, fatigue-related, somatic, and self-image clusters being the most prevalent. Conclusions: Early identification of these cancer symptom clusters is essential for guiding interprofessional teams in delivering personalized, evidence-based care to children and adolescents with cancer and their families. Full article

Objectives: The objectives of this study were to determine the suitability of the low-fidelity/low-cost simulator “Salvando a Rosita^®” in the acquisition of “hands-only CPR” skills by adult nursing degree students. Methods: A quasi-experimental quantitative study was carried out with a single experimental group that included 89 nursing degree students; it was conducted in November and December 2024 at the National University of Trujillo, Peru. Results: The STAI-TA score was 17.30, and the STAI-SA score was 37.00 points. Women showed a greater level of SA (p = 0.002). The required effort was described by women as being high and by men as light (p < 0.001). The compression rate was 125.7, and the percentage of compressions with an adequate depth was 89.6%. Overweight/obese individuals achieved more correct compressions (p < 0.01). The attitudes toward alerting emergency services, remaining calm while a person is in cardiac arrest, applying the CPR sequence automatically, and performing CCs were better after receiving training. The majority considered the “Salvando a Rosita^®” simulator to be useful for teaching “hands-only CPR” to students in the first cycles of a nursing degree. Conclusions: The “Salvando a Rosita^®” simulator was found to be an appropriate tool for teaching “hands-only CPR” to students in either the first cycles of health sciences or in other related professions. Full article

Background/Objectives: Satisfaction among undergraduate nursing students plays a crucial role in student retention, helping to mitigate nursing shortages in the workforce, reduce academic costs, and uphold universities’ reputations. The Nursing Student Satisfaction Scale (NSSS) measures three theoretical domains: Professional Social Interaction, Curriculum and Teaching, and Learning Environment. Although the NSSS has demonstrated reliability and validity with respect to American nursing students, its psychometric properties have not been tested on a population of Italian nursing students. Therefore, this study aimed to determine the reliability and validity of the NSSS in regard to Italian nursing students. Methods: A multicenter observational study was conducted on undergraduate nursing students in Central Italy. A confirmatory approach was used to assess structural validity. The construct validity, internal consistency, test–retest reliability, and responsiveness to change of the NSSS were evaluated using correlation analyses, reliability coefficients, and measurement error determination. Results: Confirmatory factor analysis supported the three-factor first-order structure of the NSSS as well as the presence of a single second-order factor. Reliability was adequate for all the coefficients computed (with values ranging from 0.924 to 0.974). Construct validity was supported. The measurement error was adequate. Conclusions: The NSSS exhibited robust measurement properties, confirming its validity and reliability as an instrument for assessing nursing student satisfaction in the Italian context. Furthermore, our results indicate that, after the translation and cultural adaptation of the scale, the construct of nursing student satisfaction remains consistent with the theoretical model. Full article