Search Results (250)

Background/Objectives: Self-care is a cornerstone of healthy aging and chronic disease management; however, evidence on the most effective intervention models for improving quality of life in older adults with chronic non-communicable diseases (NCDs) remains fragmented. This review aimed to evaluate the effectiveness of self-care interventions in promoting quality of life and health outcomes in older adults with NCDs. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251040613). Randomized and non-randomized clinical trials published between 2019 and 2024 were retrieved from Scopus, Web of Science, and EBSCOhost. Eligible studies included adults aged ≥60 years with NCDs receiving self-care interventions. Data extraction and risk of bias assessment were independently performed using Joanna Briggs Institute tools. Results: Twenty-nine studies involving 7241 older adults were included. Self-care interventions comprised nurse-led educational programs, digital health strategies, community- and peer-based approaches, and person-centered care models. Multicomponent and continuous interventions demonstrated consistent improvements in physical and psychological domains of quality of life, self-efficacy, autonomy, symptom management, and treatment adherence. Digital interventions enhanced monitoring and engagement, although their effectiveness varied according to sensory and health literacy limitations. Conclusions: Structured, person-centered, and nurse-led self-care interventions are effective in improving quality of life and autonomy among older adults with NCDs. These findings support their integration into primary and community-based care, reinforcing their relevance for clinical practice, care planning, and the development of assistive and educational strategies in aging care. Full article

Background: Globally, stroke is a significant health problem and is considered one of the leading causes of mortality and permanent disability worldwide. Nurses are key stakeholders and integral members of the stroke care team, contributing to every stage of care. Objective: This study aimed to assess the effects of a nurse-led stroke training program on the knowledge, attitudes, and practices of registered nurses working in Berea primary health care facilities, Lesotho, before and after an educational intervention. Methods: To evaluate the effectiveness of the nurse-led intervention, this study used a pre-experimental one-group pretest–posttest design. Participants completed a structured questionnaire before the intervention to assess their baseline knowledge, attitudes, and practices related to stroke. Following the intervention, which consisted of educational sessions led by trained nurses, the same questionnaire was administered again to measure changes in participants’ knowledge, attitudes, and practices. Paired t-tests compared results. Results: A total of 34 registered nurses from 18 primary healthcare facilities participated in this pre- and post-intervention questionnaire study. When comparing knowledge, attitudes, and practices related to stroke before and after the educational intervention, the increase in correct response rates was statistically significant (p < 0.001). The training evaluation received positive feedback from the participants. Conclusions: Structured nurse-led educational interventions enhance nurses’ knowledge, attitudes, and practices in stroke care, leading to improved patient outcomes and stronger community-based prevention. These findings highlight the need to integrate continuous stroke education into nursing policies and primary health care practice. Full article

Background/Objectives: Self-care is central to chronic illness management and is particularly relevant in osteoporosis to prevent complications and improve quality of life. Grounded in Riegel’s middle-range theory of self-care of chronic illness, the study sought to understand the contextual, emotional, and structural influences shaping self-care in people living with osteoporosis. Aim: The aim of this study was to explore patient-reported barriers and facilitators to self-care behaviors among individuals living with osteoporosis. Methods: A qualitative descriptive design was conducted using in-depth, semi-structured interviews with 20 patients with osteoporosis recruited via convenience sampling. Data were coded deductively and analyzed using Mayring’s qualitative content analysis with a deductive approach. Results: Participants identified several factors related to both barriers and facilitators of self-care behaviors. Four barrier sub-themes emerged: ineffective coping strategies, difficulties in osteoporosis management, inadequate physical activity, and ineffective self-efficacy. Six facilitator sub-themes were identified: self-care management strategies, osteoporosis management after a fracture, osteoporosis control, osteoporosis treatment, exercise, and confidence in one’s ability. Main barriers included fear of falling, ineffective self-efficacy, and poor care continuity, whereas key facilitators included support networks, motivation, and tailored care. Conclusions: Self-care behaviors in individuals with osteoporosis are influenced by emotional, contextual, and structural factors. Person-centered interventions integrating emotional and educational components may strengthen patients’ engagement and enhance self-care behaviors in osteoporosis. Identifying barriers and facilitators enables nurses to design empathetic, tailored strategies that enhance empowerment and disease management. Understanding these factors can improve autonomy for patients and adherence, promoting long-term health outcomes across clinical and community settings. Full article

Background/Objectives: Multidisciplinary hybrid educational programs combined with continuous glucose monitoring may contribute to improved self-management in adults with type 1 diabetes mellitus (T1DM); however, real-world evidence remains limited. This study assessed the effects of an educational intervention integrated with continuous glucose monitoring on glycemic control and patient-reported outcomes in adults with T1DM. Methods: We conducted a single-group quasi-experimental study including 210 adults with T1DM from a public hospital. The nurse-led hybrid intervention consisted of a 2-h in-person group educational session followed by an individual telematic follow-up session. All participants used continuous glucose monitoring. The primary outcome was the change in HbA1c at 9 months. Secondary outcomes included continuous glucose monitoring metrics, diabetes-related quality of life, treatment satisfaction, and hypoglycemia awareness. Results: HbA1c showed a statistically significant but modest reduction from 7.70 ± 1.10% to 7.45 ± 0.91% following the intervention (p = 0.003). No statistically significant changes were observed in continuous glucose monitoring metrics, including time in range, time below and above range, mean glucose, glycemic variability, or sensor wear time. In terms of emotional well-being, treatment satisfaction increased significantly (8.17 ± 7.86 vs. 12.73 ± 5.49; p < 0.001), and the Clarke score showed a statistically significant but modest decrease (2.49 ± 1.90 vs. 2.12 ± 1.88; p = 0.017). Although the overall quality of life score did not change significantly, statistically significant differences were observed in several subscales, including satisfaction, impact, and diabetes-related concern. Conclusions: A multidisciplinary hybrid educational intervention integrated with continuous glucose monitoring was associated with modest improvements in HbA1c and statistically significant, though limited, enhancements in quality of life, treatment satisfaction, and hypoglycemia awareness in adults with T1DM. These findings suggest that similar educational models may have a supportive role in routine care. Full article

This paper explores recent advancements in end-of-life (EOL) care in Canada, focusing on palliative care (PC) in oncology, advance care planning (ACP), and medical assistance in dying (MAiD). Despite improvements in cancer treatment, cancer remains a leading cause of death in Canada, with patients facing significant physical, psychosocial, and emotional challenges throughout the illness trajectory. Over the past few decades, PC has evolved to address serious illness from diagnosis onward, enhancing symptom management, quality of life, and patient satisfaction, while reducing hospital admissions and unnecessary treatments. However, barriers such as misconceptions about PC, late PC referrals, and limited access to PC, particularly in rural and remote areas, still exist. This perspective paper draws on the authors’ collective clinical and research experience in oncology and PC, complemented by a focused review of key literature. Ongoing education for oncology nurses on EOL care, including on PC, ACP, and MAiD, as well as continued efforts to expand access to PC for all Canadians, are imperative in order to improve the EOL experience for people affected by cancer nationwide. Full article

Sexual and gender minority (SGM) people report considerable dissatisfaction with health services compared to heterosexual and/or cisgender people, with health professionals highlighting insufficient training. Teaching about the health of SGM people is not mandated in UK health professionals’ educational curricula. A review of published and unpublished surveys and of UK training courses evaluating LGBTQ+ content, in the UK and Ireland, examining the teaching of the health of SGM people to health professionals was conducted. Fifteen surveys from the perspectives of educators and students were compared and contrasted. Surveys were found from educators from undergraduate medicine, nursing and midwifery, and pharmacy schools, from students at dental, medical, and pharmacy schools, and from qualified doctors and paramedics. Students and clinical staff perceived that they have insufficient training in SGM health, although there is a contradiction in the perception of teaching amount between students and educational staff. Two curriculum reviews of Royal College postgraduate medical training showed either no or very few requirements on SGM health. Although some courses make considerable efforts to fully incorporate SGM health into mandatory curricula appropriately, professionals mention insufficient training. Until curriculum setters mandate SGM health, patient complaints will continue. Full article

Heart failure (HF) and chronic kidney disease (CKD) are prevalent conditions in older adults, often coexisting and significantly increasing the risk of hospitalization, cardiovascular events, and mortality. Traditional hospital-based care, while essential for acute management, is often insufficient to ensure continuity of care and optimal long-term outcomes. Home-based care, although promising for improving quality of life and reducing hospital-acquired complications, faces challenges related to treatment adherence, monitoring, and caregiver support. Recent evidence highlights the potential of multidisciplinary, patient-centered care models integrating physicians, nurses, pharmacists, and family caregivers. Technological innovations, including telemedicine, remote monitoring, mobile health applications, and artificial intelligence, have shown efficacy in early detection of clinical deterioration, improving adherence, and reducing cardiovascular events in HF and CKD patients. Structured patient education, caregiver training, and proactive follow-up are key elements to optimize transitions from hospital to home and to improve long-term outcomes, including reduced rehospitalizations and better quality of life. Future care strategies should focus on personalized, integrated approaches that combine technology, education, and multidisciplinary collaboration to address the complex needs of HF and CKD patients, while mitigating healthcare costs and enhancing overall patient well-being. Full article

Objectives: This study aimed to identify the factors influencing person-centered care (PCC) among nurses working at long-term care hospitals for patients with dementia and to propose strategies for strengthening their capacity to provide PCC. Methods: Guided by the ecological model, this descriptive study examined the effects of personal factors (self-compassion and the burden of behavioral and psychological symptoms of dementia [BPSD]), interpersonal factors (communication behavior), and organizational factors (nursing work environment) on PCC. Participants were 152 nurses who had worked for more than two months at four long-term care hospitals in Seoul and Gyeonggi Province, South Korea. Data were collected between 8 January and 4 February 2024, and analyzed using SPSS version 23.0. Results: Hierarchical multiple regression analysis showed that the strongest predictors of PCC were the nursing work environment (β = 0.36, p < 0.001), having received dementia-related education twice (β = 0.26, p = 0.008), self-compassion (β = 0.23, p = 0.017), having received dementia-related education three or more times (β = 0.22, p = 0.036), and communication behavior (β = 0.20, p = 0.026). The final model (Model 3) explained 41.5% of the variance in PCC (adjusted R² = 0.415, F = 5.70, p < 0.001). Conclusions: To strengthen PCC among nurses in long-term care hospitals, comprehensive efforts to improve the nursing work environment are essential. Institutional support should particularly focus on securing sufficient nursing staff and ensuring adequate material resources. In addition, continuous dementia-related education and training programs that foster self-compassion and communication skills among nurses are recommended. Full article

Chronic kidney disease (CKD) affects nearly 850 million people worldwide, and most patients with kidney failure are treated with kidney replacement therapy. Despite technological progress, venous congestion remains a major determinant of morbidity and mortality, and is often underdetected by conventional tools such as clinical evaluation, weight changes, blood pressure measurement, or bioimpedance. Point-of-care ultrasonography (PoCUS) has transformed this diagnostic landscape by providing real-time, physiology-based insights into both left- and right-sided filling pressures. In dialysis care, multiple or confluent B-lines and subtle pleural irregularities suggest elevated pulmonary capillary wedge pressure, while a dilated inferior vena cava (IVC) with reduced collapsibility and increased portal vein pulsatility indicate elevated right atrial pressures. Integrating these sonographic findings into a multiparametric assessment that also includes clinical assessment, bioimpedance, and biosensor feedback enhances diagnostic sensitivity and refines fluid management. Advanced practice nurses (APNs) trained in PoCUS can perform focused examinations of the lungs, IVC, portal venous system, arteriovenous access, and skeletal muscle, translating ultrasound findings into physiological interpretations that guide individualized ultrafiltration strategies and patient care. Nutritional ultrasound (NUS) further complements congestion assessment by quantifying muscle mass and quality, linking nutritional reserve and functional status with hemodynamic tolerance. The implementation of structured education, competency-based training, and standardized scanning protocols allows nurses to incorporate these techniques safely and reproducibly into daily dialysis workflows. By integrating PoCUS and NUS within interdisciplinary decision-making, nursing practice evolves from procedural to diagnostic, supporting early identification of congestion, protection of vascular access, and detection of malnutrition. This multiparametric, physiology-guided approach exemplifies the concept of precision nursing, where patient evaluation becomes continuous, individualized, and grounded in real-time pathophysiological insight. Full article

Background/Objectives: Assisted suicide and suicide prevention remain subjects of intense societal, political, and professional-ethical debate in Germany. Nurses working in residential and home-based long-term care (LTC) play a pivotal role in responding to requests for assisted suicide and in supporting suicide prevention. While international research has explored diverse ethical perspectives and challenges related to these issues, little is known about how LTC nurses in Germany experience and navigate them. This study examines German LTC nurses’ ethical perspectives on assisted suicide and suicide prevention and explores the associated ethical challenges. Methods: A qualitative design employing both in-person and online focus groups was used. Data were analyzed following Mayring’s qualitative content analysis. Results: Twelve focus groups with a total of 96 nurses working in residential and home-based LTC were conducted between February and September 2025. Findings show that nurses perceive assisted suicide and suicide prevention as ethically complex and emotionally demanding. Three overarching themes emerged: (1) Intuitive and Emotional Reactions, (2) Ethical Perception and Ethical Reflection, and (3) Ethical Challenges. Conclusions: This study offers new insights into the diverse ethical perspectives of German LTC nurses on assisted suicide and suicide prevention. It extends existing knowledge through its explicit focus on the ethical issues and implications involved, both in residential and home-based LTC. The ethical challenges identified may enhance understanding of the factors underlying the development of moral distress in Germany and other countries where assisted suicide is a legal option. To help nurses navigate these ethically demanding situations, strategies at multiple levels are required. These include continuous ethics education, an open ethical culture, role definitions and clear professional guidance, alongside societal support for equitable access to general healthcare and suicide prevention services. Full article

Background/Objectives: Clinical instruction and mentorship are essential components of nursing education and early professional development. In Greece, while nursing curricula align with EU directives mandating both theoretical and clinical training, significant gaps persist in the quality, coordination, and legislative support of mentorship. This work aims to (i) synthesise evidence on clinical instruction and mentorship in Greece and draw on selected European examples to provide contextual insight, and (ii) integrate national stakeholder perspectives to generate actionable recommendations for a Greek clinical mentorship framework. Methods: A narrative literature review was conducted, identifying 19 eligible articles examining mentorship, clinical instruction and preceptorship in European and Greek contexts. In addition, a national stakeholder focus group with 25 participants, including representatives from academia, healthcare institutions, regulatory bodies, and nursing associations, was held in Athens in 2024. Data from both sources were thematically analysed and integrated to identify gaps, best practices, and context-specific recommendations. Results: Findings revealed inconsistent collaboration between universities and clinical institutions, limited training and recognition for clinical instructors, and the absence of a unified national framework. Stakeholders highlighted structural barriers to clinical mentoring such as understaffing and lack of policy support and expressed strong interest in a mentorship reform. Comparative analysis with European models demonstrated feasible pathways for Greece, including structured training, certification, and non-financial incentives. During the national stakeholder focus group, a dual-pathway mentorship system tailored for nursing students and newly hired nurses was most recommended to ensure both continuity and quality in professional development of nurses. Conclusions: Despite alignment with EU directives, Greece lacks an integrated national mentorship framework that ensures consistent clinical learning and supports workforce development. Two priority policy actions emerge from this work: (1) establishing a legally supported national certification and training system for clinical mentorship, and (2) educational structures in the clinical setting to improve educational quality, workforce retention and patient care outcomes. Full article

Background/Objectives: The institution of the nursing assistant (NA) profile in Italy, established by the Decree 28 February 2025 responds to the chronic shortage of healthcare personnel, especially in nursing. This figure, non-healthcare but trained to perform basic healthcare tasks, aims to support nurses and ensure continuity of care, especially in community and long-term care settings, through further nursing activities delegation. The model aligns with international practices, emphasizing delegation within multiprofessional teams, based on formalized protocols and continuous on-site training, within standardized, low-discretion contexts. The delegation of health activities, however, presents legal and medico-legal challenges regarding scope of practice and supervision. Methods: The aim of this paper is critically discussing delegation of health activities to non-healthcare providers and the related issues of liability in team-based delivery of care, considering the specific regulatory setting of health providers in Italy. Results: Critical activities such as nutrition and hydration, in particular artificially, and drug administration highlight the limits of delegation and the ongoing need for professional nurse oversight. In pre-hospital emergency care, standardized, protocol-based systems and simulation-based training successfully integrate non-healthcare personnel within the health team. Conversely, chronic and long-term care remain fragmented, lacking organizational maturity, regular supervision, and uniform regulation. Conclusions: The decree represents a step toward structured team-based care, but its success depends on robust governance, protocol clarity, organizational guidelines, and sustained practice-based education to prevent unsafe delegation and unauthorized practice. Full article

Background/Objectives: This study explored end-of-life care stress, attitudes toward end-of-life care, and end-of-life care performance as predictors of job satisfaction among hospital nurses. Methods: A descriptive cross-sectional design was employed to assess job satisfaction among nurses with end-of-life care experience in tertiary and general hospitals in South Korea. A convenience sample of 215 nurses was recruited. Eligibility criteria included at least 3 months of experience as a direct care nurse and having provided care to terminally ill patients at least once. Data were collected through an online survey. The study variables included end-of-life care stress, attitudes toward end-of-life care, end-of-life care performance, and job satisfaction. Data were analyzed using descriptive statistics, ANOVA, Pearson correlation coefficients, and hierarchical regression analysis. Results: Attitudes toward end-of-life care (β = 0.277, p < 0.001) and end-of-life care performance (β = 0.339, p < 0.001) were significant predictors of job satisfaction, with being enrolled in a master’s nursing program (β = 0.228, p < 0.001) also contributing positively. End-of-life care stress showed no direct association with job satisfaction. The final model explained 29.4% of the variance in job satisfaction (adjusted R² = 0.294). Conclusions: End-of-life care performance was the strongest predictor of job satisfaction, suggesting that nurses’ perceived competence enhances professional fulfillment. Positive attitudes toward end-of-life care further strengthen satisfaction. Continuous education and supportive organizational environments are essential to enhance nurses’ competence, attitudes toward end-of-life care, and quality of end-of-life care. Full article

Background: The implementation of shared governance within the nursing practice results in heightened satisfaction among nurses and enhances the quality of care provided. Shared governance fosters collaborative and proactive relationships among nurses and healthcare providers, while also cultivating a sense of confidence among nurses. However, evidence suggests that a lack of awareness, reliance on traditional governance, and inadequate shared governance structures among nurses continue to exist at the unit-based council (UBC) level, including those in the Kingdom of Saudi Arabia (KSA). Purpose: The present study aimed to assess the extent of clinical nurses’ perceptions concerning shared governance at the UBC level, and to examine the variations and relationships in their perceptions based on demographic and work-related characteristics. It further explored the demographic and work-related factors that affect the overall perceptions of shared governance among clinical nurses. Methods: This quantitative study utilized a cross-sectional design and was carried out in three governmental hospitals in the KSA. The sample comprised 669 nurses, who were selected using a convenience sampling method. The Index of Professional Nursing Governance (IPNG) tool was utilized for data collection conducted between February 2025 and April 2025. Descriptive statistics alongside the t-test and analysis of variance (ANOVA), Pearson-r correlation coefficient, and multiple linear regression were utilized for data analysis. Significant findings were drawn when p ≤ 0.05. Results: The average perception of shared governance among clinical nurses at the UBC level was 180.42 out of 430, suggesting that decision-making occurs collaboratively between nurses and management. Significant differences in the average level of clinical nurses’ perceptions of shared governance were noted in relation to their educational qualifications (F = 5.015, p = 0.001) and nursing units (F = 4.157, p = 0.010). The hospital in which clinical nurses were employed (r = 0.098, p = 0.037) and nursing units (r = 0.087, p = 0.020) exhibited significant correlations with their overall shared professional governance. Furthermore, the hospital where clinical nurses were employed (β = 0.406, p = 0.001, 95% confidence interval [CI] = 0.166, 0.646) and nursing units (β = 0.326, p = 0.038, 95% CI = 0.018, 0.314) served as predictors of their overall professional shared governance. Conclusions: Clinical nurses in this study showed an initial or relatively low level of shared governance at the UBC level. The overall finding highlights a critical need for nursing managers and leaders to enhance the level of professional shared governance among clinical nurses, which may result in improved nurse retention and overall quality of nursing care. It is crucial to consider clinical nurses’ educational qualifications and working environment at the UBC level when aiming to enhance their level of professional shared governance. Full article

Background/Objectives: The COVID-19 pandemic accelerated the shift toward community- and home-based care models. Within this transformation, Family and Community Nurses (FCNs) have become key in bridging hospital and primary care, supporting continuity, self-care, and quality of life (QoL). Despite increasing recognition, evidence on FCN-led interventions remains fragmented. This systematic review and meta-analysis aimed to synthesize evidence on the impact of FCN interventions on QoL and clinical outcomes in post-COVID and people living with chronic conditions managed in community and home settings. Methods: Following PRISMA 2020 guidelines, we searched PubMed, Scopus, CINAHL, PsycINFO, Embase, and Cochrane Library (January 2020–November 2024). Eligible studies were randomized controlled trials evaluating FCN-led interventions. Primary outcomes were QoL (measured with validated tools) and glycemic control (HbA1c). Secondary outcomes included hospital readmissions, anxiety, depression, and self-care abilities. Risk of bias was assessed using the Cochrane RoB2 tool for randomized controlled trials. Random-effects meta-analyses were performed, with heterogeneity evaluated by I². The protocol was prospectively registered in PROSPERO (CRD42024567890) before data extraction. Results: Seventy-one studies (n = 19,390) were included. Interventions comprised home visits, telehealth, patient education, and case management. Pooled analyses demonstrated significant improvement in QoL (SMD 0.34, 95% CI 0.18–0.50) and reduction in HbA1c (−0.47%, 95% CI −0.69 to −0.25). FCN interventions also reduced hospital readmissions (RR 0.74, 95% CI 0.62–0.89) and improved mental health outcomes. Most studies were judged at low to moderate risk of bias. Conclusions: FCN-led interventions significantly enhance QoL, mental health, and clinical outcomes while reducing hospital readmissions. These findings highlight the strategic importance of integrating FCNs into community-based healthcare models. Full article