Search Results (1,548)

Background/Objectives: Patient- and family-initiated abuse of nurses is widely recognized as workplace violence, but it also raises a distinct professional-regulatory question: when may a nurse end or restrict an established therapeutic relationship without creating an allegation of abandonment or discriminatory denial of care? This perspective focuses on Alberta and examines whether the province’s nursing regulator provides a comprehensive, nurse-specific, all-registrant standard comparable in clarity to Alberta’s physician standard. The concern is not the absence of every form of protection but the absence of a clearly defined regulatory pathway for all Alberta RNs and NPs. Methods: Publicly available legal, occupational health and safety, regulatory, legal-risk and scholarly materials were purposively selected where they addressed relationship termination, discontinuing or declining care, workplace violence, immediate safety risk, abandonment, documentation, continuity of care or patient safeguards. Results: The College of Physicians and Surgeons of Alberta standard provides a clearly defined regulatory pathway, including immediate discharge where a patient poses a safety risk, is abusive or fails to respect professional boundaries. Alberta nursing materials contain important elements but do not yet constitute a dedicated Alberta RN/NP standard applicable across office-based, community, virtual, home care and independent nursing practice. Interprovincial nursing standards demonstrate feasibility, operational detail, emerging professional consensus and potential templates for policy transfer; however, they do not bind the CRNA or create an Alberta regulatory benchmark for complaint review. Conclusions: Alberta should adopt a nurse-specific standard for ending or restricting abusive patient- and family-initiated relationships. Such a standard should include ordinary and urgent safety pathways, prohibited grounds, documentation requirements, continuity safeguards, employer integration and practical templates. Nurse protection and patient protection are mutually reinforcing regulatory objectives. Full article

Background/objectives: To describe and compare Korean AYAs’ and parental perspectives on the family environment in terms of agreement and significant differences and examine which variables were associated with AYAs’ symptom distress. Sample and setting: Self-report data were collected from a total sample of 113 AYAs, recruited from a pediatric-oncology outpatient clinic at a university-affiliated hospital and community group in South Korea. Because each study aim required different data sources, different analytic samples were used. Specifically, 54 AYA–parent dyads were included for Aim 1, whereas self-report data from 111 AYAs with complete data were used for Aim 2. Methods and variables: This subgroup analysis used a quantitative–descriptive, cross-sectional design. AYAs’ and parent perceptions of the family environment (family cohesion and adaptability, family strength, and social support from family) and AYAs’ symptom distress were collected using reliable and validated self-report questionnaires and analyzed using descriptive and inferential statistics. Results: AYAs and their parents showed low (family support) to moderate agreement (family strength, family cohesion, and adaptability) on perceptions of family environment (ICC = 0.374–0.612). AYAs reported significantly lower perceptions of family support than their parents, with a small to moderate effect (p < 0.001, d = 0.48). All family environment variables were correlated with AYAs’ symptom distress (p < 0.05). Among these variables, AYAs’ perceived family strength emerged as the only family environment variable significantly associated with their symptom distress (F = 14.309, p < 0.001, R² = 0.359, R²adj = 0.334), which was stronger during treatment. Conclusions: AYAs’ perceived family strength should be routinely assessed, especially during cancer treatment. Additional nursing interventions focusing on enhancing AYAs’ families as a support group are needed. Full article

Background: Medication errors remain a major threat to patient safety in acute care settings worldwide and are associated with preventable morbidity, mortality, and increased healthcare costs. Nurses play a critical role in identifying, intercepting, and preventing medication-related harm. However, limited qualitative evidence has explored nurses’ perspectives on medication safety within the Saudi Arabian healthcare context. This study explored nurses’ experiences of medication safety, perceived systemic challenges, and strategies for error prevention in Saudi hospitals. Methods: A qualitative descriptive design was employed. Fourteen (n = 14) nurses from two major referral hospitals in Saudi Arabia participated in semi-structured face-to-face interviews. Interviews were audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke’s six-phase thematic analysis framework. Results: Five overarching themes were identified: (1) Communication gaps; (2) Medication processes; (3) Technology and safety; (4) Workload and staffing; and (5) Staff competence. Participants described how communication failures, staffing pressures, workflow interruptions, and documentation ambiguities compromised medication safety. While barcode systems and EHRs were perceived as valuable safeguards, participants emphasized that their effectiveness depended on staff vigilance, adequate training, and supportive workplace cultures. Conclusions: Medication safety is a dynamic socio-technical process shaped by communication, competence, staffing capacity, and human interaction with technology. Improving safety requires integrated organizational strategies that combine workforce investment, structured communication practices, continuous professional education, and non-punitive incident reporting cultures. These findings provide practical insights for healthcare leaders seeking to strengthen medication safety systems in Saudi Arabia and comparable settings. Full article

Background/Objectives: Medical social work is performed in hospital teams, but evidence remains limited on how medical social workers’ perceived communication and cooperation with physicians and nurses are associated with occupational outcomes. Methods: Using the medical social work module of the China Social Work Longitudinal Survey 2019 (CSWLS2019), this cross-sectional study examined job satisfaction, personal accomplishment, self-rated service quality, and emotional exhaustion. We constructed a four-item communication-and-cooperation index and estimated ordinary least squares (OLS) models with HC3 heteroskedasticity-robust standard errors and city fixed effects. Robustness and exploratory supplementary checks assessed sample definition, alternative specifications, single-item ordered logit models, decomposed components, moderation, and a supplementary seemingly unrelated regression (SUR) system. Results: The index was positively associated with job satisfaction (b = 0.260, p = 0.0010), personal accomplishment (b = 0.416, p = 0.0335), and self-rated service quality (b = 0.151, p = 0.0275). Its association with emotional exhaustion was negative but not statistically significant in the main model (b = −0.186, p = 0.1207), although it became significant in the stricter sample. Decomposed and moderation models provided limited evidence for stable component-specific or moderation patterns. Conclusions: The findings should be interpreted as exploratory associational evidence rather than causal effects. Perceived communication and cooperation with physicians and nurses appear more consistently linked to favorable occupational evaluations than to emotional exhaustion among medical social workers in China. Full article

This study assessed community process and empowerment in a Primary Healthcare Island Unit in the Azores to support the implementation of Epidemiological Surveillance of Nursing Diagnoses (ESND), focusing on three priority areas: tobacco use, drug dependence, and adolescent decision-making related to sexuality and life planning. Strengthening the visibility of nursing-sensitive phenomena requires integrating nursing diagnoses into epidemiological surveillance systems. A multimethod descriptive study was conducted between September and November 2025, combining document analysis, a community empowerment assessment, and a structured questionnaire. The total population included 328 nurses, with 172 participants (response rate: 52.4%) using a non-probabilistic sampling approach. Data were analyzed using descriptive statistics (frequencies, percentages, means, and standard deviations). Priority nursing foci were identified according to the ICNP^® 2019 classification: tobacco use, drug dependence, and decision-making process related to sexuality and life planning. Results showed that all three dimensions of the MAIEC were weak: community leadership was limited, particularly in knowledge indicators; participation was constrained by unclear organizational structures and insufficient communication; and coping capacity was insufficient due to limited training and experience. Empowerment assessment confirmed structural weaknesses in leadership, organizational support, and resource mobilization. Overall, the community process and empowerment profile indicate that the conditions required to sustain ESND are not yet sufficiently developed. Strengthening leadership, improving communication, and expanding training in ESND and ICNP^® documentation are essential to support nurse-centered surveillance and enhance the visibility of nursing contributions to population health. Full article

Background/Objectives: Chronic diseases account for 74% of global deaths, with multimorbidity (existence of more than one chronic condition) increasing disability risk and treatment burden, leading to poor adherence, disease progression, and reduced quality of life. Nursing-led proactive care models that focus on patient engagement, education, and self-care can help mitigate these challenges. The study aims to evaluate the effectiveness of a nurse-led proactive health intervention in improving care for individuals with chronic diseases in general practice. Methods: A quasi-experimental pre–post study will be conducted in a Community Health Home in Northern Italy. Family and community nurses will deliver the intervention, which includes assessments, educational sessions, and follow-ups for patients aged 65+ with at least one chronic condition. Recruitment will occur over three months. Results: Primary outcomes include emergency department visits and hospitalizations, while secondary outcomes focus on medication adherence, self-care, and service utilization. Data will be collected at 6 and 12 months, and statistical analysis will use descriptive methods and generalized estimating equations (GEEs). Conclusions: This study will improve the understanding of the value of nurse-led proactive intervention, filling the gap in the literature by testing evidence-based approaches on a realistic frail population. Moreover, delivering a complex but structured intervention will provide evidence for future interventions to reduce treatment burden and improve health outcomes. Full article

Background/Objectives: Health literacy (HL) is recognized as an important social determinant of health. It supports healthy behaviors and effective health management throughout one’s life. For children and adolescents, developing HL influences their well-being, development, and ability to make informed health decisions. Nurses are strategically positioned to promote HL from an early age. To our knowledge, no prior synthesis has specifically examined nurse-led HL interventions targeting pediatric populations, highlighting the originality and relevance of this scoping review. The purpose of this review was to map and characterize nursing interventions aimed at improving HL outcomes in children and adolescents. Methods: A scoping review was conducted according to the Joanna Briggs Institute methodology, using a three-step search strategy, and reported in accordance with the PRISMA-ScR guidelines. Searches were conducted in MEDLINE, CINAHL, Scopus, Web of Science, and ProQuest with no date restriction, including studies published in Portuguese, English, or Spanish. Studies involving children and adolescents (ages 0–18) in any healthcare or community setting were eligible. Data on intervention characteristics and HL outcomes were extracted and analyzed descriptively, and no critical appraisal of the included sources was conducted. Results: A total of 44 studies were included. Interventions were predominantly school-based and focused on adolescents (n = 26), with a clear gap in early childhood (n = 2). Studies of early childhood primarily used storytelling and reading activities, whereas interventions targeting older children and adolescents more often employed participatory educational strategies, group-based approaches and digital platforms. The most frequently addressed topics were chronic disease management (n = 12), mental health (n = 7), and nutrition (n = 5). HL domains mainly focused on healthcare and health promotion, with fewer studies addressing disease prevention. Most interventions were conducted in school settings (n = 24), highlighting this context over those in primary care, community, and hospital settings. Conclusions: The results revealed nursing interventions used to promote HL, particularly in the management of chronic diseases, mental health and nutrition. However, the existing body of research is still limited. Key gaps include the absence of standardized measurement tools and the scarcity of longitudinal studies evaluating long-term outcomes. These limitations constrain the comparability and generalizability of findings, highlighting the necessity of more rigorous, methodologically robust research to support evidence-based practices. This scoping review comprehensively maps nurse-led interventions that promote HL among children and adolescents, identifying key priorities to guide future research in this area. Full article

Background: This study examined how clinical nurses’ communication competence, grit, and leader–member exchange (LMX) contribute to nursing performance, aiming to identify key predictors to support workforce development and organizational policy planning. Methods: This study was conducted as a descriptive correlation study targeting 190 clinical nurses working at a general hospital in S City. Data were collected through a self-report questionnaire and analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficient, and hierarchical regression analysis using the IBM SPSS/WIN 25.0 program. Results: On a 5-point scale, the mean score of nursing performance was 4.05. Communication skills (β = 0.52, p < 0.001), grit (β = 0.23, p = 0.002), and clinical experience (β = 0.18, p = 0.022) significantly affected nursing work performance, with communication skills having the greatest effect. This model explained 47.3% of the nursing performance. Conclusions: To improve the nursing performance of nurses, strengthening communication skills and grit, supporting professional development, and recognizing clinical experience are crucial. These findings suggest that integrating such programs into ward nurse training may contribute to improved nursing performance and organizational effectiveness. To develop these competencies and evaluate their effectiveness, follow-up research is continuously needed. Full article

Background: Cardiac telemetry monitoring represents an important aspect of in-hospital patient safety in both telemetry and critical care settings. Despite technological advancements, telemetry effectiveness may be diminished due to systemic failures including operational processes, instructional policies, and human factors. Alarm fatigue, recognized by the Joint Commission as a leading contributor to serious patient harm, lies at the forefront of these failures. Objective: This narrative review utilized and synthesized sources indexed through PubMed, PubMed Central, MEDLINE, Web of Science, Google Scholar, Directory of Open Access Journals (DOAJ), and Scopus to illustrate the factors involved in hospital related monitoring failures. We purport that alarm fatigue and telemetry monitoring failures are the result of complex systemic failures comprising technological and human failures. Through this narrative, we propose an evidence-based framework known as the Safer Telemetry Architecture (STA) to pinpoint redundancies and promote closed-loop communication regarding alarm management. Conclusions: Monitored in-hospital environments represent a key area of preventable morbidity and mortality due to systemic design flaws. Our STA framework addresses such flaws via improvements in nurse-driven protocols, alarm routing, mandatory coverage standards for backup, and increased performance auditing. Systemic improvements via such a framework may represent an important institutional strategy for hospitals with cardiac monitoring, but requires further prospective validation. Managing redundancies in alerts and sounds, improving backup and nursing telemetry protocols, and promoting closed or continuous loops targeting alarm response times and telemetry utilization are key to effectively improving patient safety. Full article

Background and Objectives: Anxiety can influence the intensity of postoperative pain, anesthesia and the need for analgesia. Likewise, proper anxiety management can reduce hospital stays. Therefore, it is important to review the actions of nursing professionals and estimate the effect size of nursing interventions to reduce anxiety in pre- and postsurgical processes. Therefore, the objective of this study was to analyze the effectiveness of preoperative motivational interviews by nursing to reduce pre- and postoperative anxiety and postoperative pain after surgery. Materials and Methods: A systematic review was carried out according to the PRISMA guidelines, with a record in PROSPERO using DeCS and Boolean operators OR and AND to increase the specificity of the search. In the EBSCOhost, Pubmed, Cochrane Library and Scopus databases, 104 studies were obtained. Patients ≥ 18 years of age with scheduled surgeries, communication skills, clinical trials or quasi-experimental studies were included. The risk of bias 2 (RoB2) tool was used to assess the risk of bias in the studies. A random effects meta-analysis was performed to analyze pre- and postoperative anxiety and postoperative pain. Results: A total of 6 studies were included (4 clinical trials and 2 quasi-experimental studies). All the studies analyzed preoperative anxiety, which was significantly lower (SMD = −1.53; 95% CI: −4.01 to −0.95; I² = 40%). Postoperative pain (SMD = −0.74; 95% CI: −0.94 to −0.54; I² = 35%) and postoperative anxiety (SMD = −0.48; 95% CI: −0.78 to −0.19; I² = 0%) also decreased. Conclusions: Motivational interviews by nurses may help provide clearer information and emotional support and allow patients to express doubts, reducing their fear of anesthesia, pain and the recovery process. Emotional control improved adaptation to the surgical environment, reducing postoperative pain. With respect to implications for clinical practice, it is necessary to use the same scales to measure anxiety to better compare the studies. Full article

Background/Aims: The increasing complexity of disasters requires effective integration of nurses into Civil Defense (CD) systems. Despite their crucial role, the competencies needed to operate within these multi-agency frameworks remain fragmented and insufficiently defined. The main aim of the study was to map nursing competencies for disaster response within the CD context, identifying essential skills, contextual variations, and barriers to application. Methods: A scoping review was conducted following the JBI methodology and reported according to PRISMA-ScR guidelines. Major databases (PubMed, CINAHL, Scopus, Embase) were searched without time limits, resulting in the inclusion of 27 studies published between 2011 and 2025. Results: 12 core competency domains were identified. Clinical care was the most cited competency (70% of studies), followed by communication (63%), leadership (60%), triage (48%), and psychosocial support (48%). The lack of specific training emerged as the primary individual barrier (44%), while the absence of standardized curricula was the leading systemic obstacle (41%). Competency requirements varied significantly based on the hazard type and organizational setting. Conclusions: Disaster nursing is emerging as an essential specialized field in response to the increasing frequency of climate-related events and global conflicts. There is an urgent need to move beyond purely clinical training to integrate “organizational literacy” and psychological resilience, harmonizing educational pathways with national CD policies and competency-based disaster preparedness programs. Full article

Background/Objectives: Community hospitals can be a valuable and cost-effective resource for elderly people, especially in rural areas. Their aim is to promote self-reliance, prevent unnecessary hospital admissions, and facilitate rapid recovery after acute illness. The widespread adoption of intermediate care facilities helps alleviate hospital overcrowding by preventing clinical deterioration through advanced and continuous nursing care. An intermediate care unit was established in a rural area of central Italy. This study aims to describe the impact of a community hospital on patients’ functional status from admission to discharge, describing a real-life model. Methods: This single-center descriptive study examines trends in the quality of care provided. Data were retrieved from anonymized electronic clinical records. Statistical analyses were performed using descriptive statistics, paired t-tests, and Pearson correlation coefficients. Results: A total of 532 residents (mean age 80.7 ± 13.2 years; 61% female) were admitted to the community hospital between January 2022 and September 2025. The mean length of stay was 15.2 ± 7.6 days, with a mean improvement in Modified Barthel Index score of 5.24 ± 7.95 (p < 0.05). Most patients (81.8%) were discharged home, while 6.0% required hospitalization. No readmissions were recorded in 2025. Clinical risk events occurred only in 1.2% of the total. Nursing specialization increased during the study period, correlating with improved patient outcomes (R = 0.88). Conclusions: This descriptive cross-sectional study in a rural nurse-led intermediate care unit found relatively short lengths of stay, high rates of home discharges and modest, but statistically significant, improvements in functional autonomy. Full article

Background: Culturally and Racially Marginalised (CaRM) communities in Australia encounter subtle and covert forms of prejudice, commonly referred to as “new racism”. Within healthcare settings, these experiences can shape trust, engagement, and patterns of help-seeking. Mental health nurses are often the first point of contact in care delivery, and their ability to recognise, respond to, and mitigate the impacts of new racism is critical for fostering therapeutic relationships and supporting equitable access. Understanding how CaRM communities perceive the conditions that influence their mental health service use is fundamental for informing more equitable and culturally responsive care. Objective: This study explored the viewpoints of CaRM community members regarding the factors they consider important for addressing new racism in healthcare systems and supporting engagement with mental health services. Design: Q methodology was used to identify statistically derived viewpoints that reflect shared viewpoints about the conditions perceived as critical for addressing the impacts of new racism on mental health service use. Setting: Participants were recruited from culturally and linguistically diverse communities across Australia through community settings, social media, and professional networks. Participants: Thirty-five individuals from CaRM backgrounds completed the Q-sort. Methods: This Q methodology consisted of five steps: (1) set up of the Q-sorting instrument, (2) selection of participants, (3) data collection, (4) factor analysis, and (5) factor interpretation. Results: Three distinct viewpoints were identified: (1) raising awareness of mental health issues within CaRM communities (community-focused), (2) providing visible anti-racism and culturally safe services (service-focused), and (3) recognising and formally addressing new racism within healthcare systems (policy-focused). Conclusions: This study offers the first empirically derived, community-informed set of viewpoints on addressing new racism in Australian mental healthcare. While exploratory, the findings highlight multi-level considerations that are potentially relevant to mental health nursing practice, and may be useful to inform future research, policy development, and service redesign aimed at strengthening cultural responsiveness and equity in mental health systems. Full article

The emergence and increasing use of artificial intelligence (AI) in healthcare have paved the way for highly personalized and time-saving approaches in the field of precision medicine. It can be applied to determine a prognosis, diagnosis, and recommended treatment, and may also be used for patient monitoring. As AI applications become more widely available, reliable and easy to use, they are rapidly reshaping the traditional roles of professionals and patients in the therapeutic relationship. On the positive side, professionals may have more time to communicate with patients and provide individualized care, whereas patients may become more empowered and autonomous due to AI-facilitated personalized information and monitoring. On the negative side, AI applications threaten to reduce the role of professionals to a mediating one in clinical decision-making, provide patients with misinformation, and lead to misunderstandings that hinder patients’ autonomy. In this narrative review, we examine the main ethical issues related to the AI-induced shift in roles in the therapeutic relationship, within four inter-related themes: the validity of claims that algorithms outperform humans in certain tasks; the ways in which AI saves time for health professionals but also takes time to properly explain and implement; the issues of trust and accountability, especially if AI suggestions lead to patient harm; and what AI’s alleged cost-effectiveness means for professionals’ employment and remuneration. Across the three roles, we find a common pattern: AI tends to absorb the technical and data-processing parts of clinical work while leaving its relational core to humans. Physicians move toward oversight and interpretation, nurses retain the attentiveness and responsiveness that define care, and patients gain tools for self-management that can widen autonomy or, left unguided, erode it. Whether the overall effect is benign depends less on the technology than on how outperformance is evidenced, how the freed time is used, how trust and accountability are anchored in people, and how cost pressures are managed. The article concludes with some suggestions for prudent use of AI in healthcare, indicating the appropriate measures that can be used to harness the power of AI without damaging the traditional cornerstones of the therapeutic relationship. Full article

Background: Catheter-associated urinary tract infection (CAUTI) remains a major healthcare-associated infection, particularly in intensive care units (ICUs). Nurse-driven urinary catheter removal protocols can reduce catheter duration and improve patient safety; however, their implementation remains inconsistent. This study explored barriers and facilitators influencing the implementation of nurse-driven CAUTI prevention protocols in Saudi ICUs. Methods: A qualitative study guided by the Consolidated Framework for Implementation Research was conducted in two tertiary hospitals in Riyadh, Saudi Arabia. A purposive sample of 23 ICU nurses, infection control nurses, and nurse managers participated in semi-structured interviews. Data were analyzed using Braun and Clarke’s thematic analysis approach, supported by NVivo. Results: Two overarching themes emerged. Facilitators included interprofessional communication and shared decision-making, clinical experience, and professional commitment. Barriers included workload and staffing pressures, physician dominance and nurse hesitation, knowledge deficits and poor adherence to guidelines, inconsistent documentation, and reduced awareness of catheter presence. Implementation was influenced by interconnected individual, organizational, and cognitive factors. Conclusions: Implementation of nurse-driven CAUTI prevention protocols is shaped by both enabling and limiting factors. Strengthening interprofessional collaboration, supporting nurse autonomy, improving documentation, and providing ongoing education may enhance protocol uptake and sustainability, ultimately improving patient safety. Full article