Search Results (9,173)

Background/Objectives: Trauma management in emergency departments (EDs) requires rapid and reliable diagnostic tools. The Focused Assessment with Sonography in Trauma (FAST) is a bedside ultrasound examination used for the early detection of free fluid in the intraperitoneal cavity, pericardium, and pleural spaces. Expanding FAST use to trained emergency nurses may support timely bedside evaluation in high-demand settings. However, data on agreement with physicians remains limited. This study aimed to evaluate the inter-rater agreement between a trained emergency nurse and physicians in performing FAST and to explore the diagnostic accuracy of nurse-performed FAST compared with computed tomography (CT). Methods: A prospective pilot observational agreement study was conducted between October and December 2023 in the ED of a general hospital in Cyprus. FAST examinations were independently performed by a nurse trained in FAST and by physicians from the radiology department. Four anatomical areas were assessed: right upper quadrant (RUQ), left upper quadrant (LUQ), subxiphoid-pericardial area (SUPH), and suprapubic area (BLADDER). Findings were recorded independently to promote blinding. Diagnostic performance of nurse-performed FAST was explored in a subset of patients undergoing CT. Results: The sample included 68 trauma patients, of whom 58 underwent FAST by both the nurse and the radiologists and were included in the inter-rater agreement analysis. Fluid was detected in four patients (6.9%) in the RUQ area and in one patient (1.7%) in both the LUQ and SUPH regions, while no positive findings were recorded in the BLADDER area. Agreement in the RUQ area was 98.3% (Cohen’s kappa = 0.85, p < 0.001) while agreement was observed in all cases in the SUPH region (100%, Cohen’s kappa = 1.00, p < 0.001), although this finding was based on a single positive case. High observed agreement was also noted in LUQ (98.3%) and BLADDER regions; however, Cohen’s kappa could not be reliably estimated in these regions due to limited variability and the very small number of positive cases. In a subgroup of patients who underwent CT (n = 23), as well as in an additional Trauma Team subgroup (n = 10), diagnostic accuracy estimates were 100% for sensitivity and specificity; however, these estimates were based on a very small number of positive cases (only two positive cases in each subgroup) and were associated with wide confidence intervals. Conclusions: This pilot study suggests that, under specific training conditions, a trained emergency nurse may achieve a high level of agreement with physician assessments when performing FAST. The findings regarding diagnostic accuracy are preliminary and should be interpreted with caution due to the small sample size and low number of positive cases. Further studies with larger samples and multiple operators are required to confirm these findings and to evaluate their clinical implications. Future research is also needed to determine whether nurse-performed FAST may contribute to improved patient safety and emergency department workflow. Full article

Background/Objectives: Nursing assessment frameworks play a critical role in guiding holistic patient evaluations, standardizing documentation, and supporting organizational quality and safety initiatives. Among these, Gordon’s Functional Health Patterns (FHPs) offer a comprehensive and widely used framework for nursing assessment. However, no review has synthesized evidence on their association with outcomes. This scoping review aimed to map evidence on the use of FHPs in relation to patient and organizational outcomes, and to examine their integration into electronic health records (EHRs) and the analytical methods employed. Method: A scoping review was conducted following Joanna Briggs Institute methodology and PRISMA-ScR guidelines. PubMed, CINAHL, and Scopus were searched for quantitative primary studies reporting associations between FHPs and outcomes, and the final search was conducted on 22 March 2024. Three reviewers independently screened abstracts and full texts and extracted data. Results: Seven studies met the inclusion criteria. FHPs’ use was associated with improvements in several patient outcomes, including quality of life, psychological well-being, clinical parameters, self-management, dependency level, and functional performance. Organizational outcomes included reduced hospital readmission rates and a positive association between FHP-derived nursing diagnoses and nursing workload. Most studies used standardized nursing terminologies such as NANDA-I, NOC, or NIC, in conjunction with FHPs. Over half of the studies used EHR-based nursing documentation, reflecting increasing digital integration and enabling more structured and interoperable nursing data. Methodological approaches varied widely: most studies used associative analyses, two employed experimental designs, and one investigated the predictive utility of FHP-based assessment data. Conclusions: FHPs provide a structured framework for nursing practice with potential benefits for patient and organizational outcomes. Their increasing integration into EHRs supports standardized documentation and data-driven nursing practice, enhancing assessment quality, diagnostic accuracy, and the availability of structured data for clinical and managerial decision-making in health information systems. Further experimental and longitudinal research is needed to strengthen causal evidence and guide implementation. Full article

Background: Venous catheter placement is the most common invasive procedure performed in hospitals. Despite their widespread use and importance in healthcare, these devices can cause complications such as catheter-associated bloodstream infections (CABSIs). Although several studies have investigated potential risk factors, including sociodemographic, medical history, and clinical variables, the results remain inconsistent and inconclusive. Objectives: The aim of this study was to identify independent risk factors for CABSIs and to develop and validate a predictive model for CABSIs in patients with midline catheters, centrally inserted central catheters (CICCs), and peripherally inserted central catheters (PICCs). Methods: We conducted an observational cohort follow-up study including hospitalized patients with a CICC, PICC, or midline catheter between January 2016 and March 2022. Devices were randomly assigned to derivation (n = 6036) and validation (n = 1549) cohorts. Candidate predictors with p < 0.25 in univariate analysis entered a multivariable logistic regression model, and final variables were selected by backward stepwise regression. Performance in the validation cohort was assessed by calibration and discrimination using the Hosmer–Lemeshow test and AUC. Results: The prevalence of CABSIs in the derivation cohort was 1.8%. Independent risk factors for CABSIs included tracheostomy, a history of bacteremia within 3 months before catheter placement, the presence of a synchronous central catheter, active oncohematological disease, and having received total parenteral nutrition (TPN). The presence of these five variables increased the probability of CABSIs to 42.1%. The final model demonstrated good predictive performance with an area under the curve (AUC) of 0.73 in the derivation cohort and 0.77 in the validation cohort. Decision curve analysis showed that the predictive model offered a greater net clinical benefit than the “treat-all” or “treat-none” strategies among threshold probabilities between 0.5% and 5%. Conclusions: The model can help identify high-risk patients, guide risk-based clinical decisions, reduce unnecessary catheter use, and support infection prevention and antimicrobial stewardship. Full article

Neonatal puppies and kittens face a critical period after birth, during which their health depends heavily on the microorganisms they acquire from their mothers and environment. These microorganisms, known as the gut microbiota, help newborns develop their immune systems, digest nutrients, and protect against disease. This review explores how these microorganisms are transferred from the mother to her offspring before, during, and after birth, including the process of delivery, nursing, and maternal care. It also examines how factors such as birth type, hygiene, feeding, and maternal health can influence the development of these microbial communities. When this process is disrupted, it may lead to health problems such as infections, diarrhea, and immune disorders. Understanding how and when these microbes are passed to newborns, and how to support this process, is essential to improving survival rates and long-term health in puppies and kittens. Full article

Although radiotherapy is a cornerstone in the management of several pediatric malignancies, its administration in children poses unique anesthetic challenges. Unlike adults, pediatric patients, particularly younger children, often require repeated sedation or general anesthesia to ensure immobility and reduce psychological distress during daily treatment sessions that may extend over several weeks. This narrative review summarizes current evidence on anesthetic strategies for children undergoing radiotherapy, focusing on clinical indications, pharmacological approaches, safety considerations, and organizational aspects. We discuss the main sedation and anesthesia techniques used in non-operating room anesthesia (NORA) settings, including deep sedation with midazolam, propofol, ketamine, and dexmedetomidine, as well as general anesthesia with laryngeal mask airway management. Particular attention is given to the cumulative effects of repeated anesthetic exposure, airway management challenges in remote radiation environments, and the risk of respiratory and hemodynamic complications. The review also highlights the importance of individualized, protocol-driven management, rapid recovery strategies, and continuous remote monitoring systems. Non-pharmacological interventions and audiovisual-assisted techniques are also discussed as potential strategies to reduce anesthesia requirements in selected patients. A multidisciplinary approach involving anesthesiologists, radiation oncologists, nurses, psychologists, and technical staff is essential to optimize safety, treatment adherence, and overall quality of care. Tailored anesthetic management, supported by standardized protocols and specialized pediatric expertise, remains crucial to balancing procedural efficacy with short- and long-term safety in this vulnerable population. Full article

Background/Objectives: Limited research has examined the correlates among the lifestyle habits of nursing students, whose suboptimal behaviors may compromise their ability to model and promote healthy lifestyles in future professional practice. This study aimed to assess health-promoting lifestyle behaviors, explore interrelationships among lifestyle domains, and identify key correlates of positive health-promoting lifestyle behaviors to inform the development of targeted interventions. Methods: A cross-sectional study was conducted among 476 undergraduate nursing students in Spain. Data included sociodemographic, academic, and health-related variables, along with Health-Promoting Lifestyle Profile II (HPLP-II) scores. Descriptive statistics, correlations, and hierarchical multivariate logistic regression were used to identify factors associated with positive health-promoting lifestyle behaviors. Results: Overall HPLP-II scores indicated modest health-promoting lifestyle behaviors (adjusted mean 2.62 ± 0.33), with the lowest scores observed for health responsibility (adjusted mean 2.20 ± 0.48) and stress management (adjusted mean 2.33 ± 0.44). Health-related variables showed stronger associations with positive health-promoting lifestyle behaviors than sociodemographic or academic variables (p < 0.001). Significant correlates of positive health-promoting lifestyle behaviors included higher adherence to the Mediterranean diet, greater levels of physical activity, and concurrent employment during studies. Conclusions: Support of nutrition, physical activity, and other health-promoting lifestyle behaviors should be strengthened in nursing curricula and training environments. Educational strategies should move beyond theoretical instruction through student-centered approaches, enhancing self-care and the ability to promote health in future professional practice. Full article

Background: Cultural competence is essential in nursing, enabling the delivery of ethical, patient-centered, and respectful care that respects diverse cultural backgrounds in an increasingly diverse healthcare setting. Improving cultural competence can substantially reduce stereotyping, time pressure, and distress among nurses. Objective: This study aimed to examine the relationship between cultural competence and loneliness among nurses working at a university medical city in Saudi Arabia and to identify associated demographic and psychological factors. Methods: A descriptive cross-sectional study was conducted using a convenience sample of 184 nurses. Data were collected via an online questionnaire that included the Cultural Capacity Scale, the Revised UCLA Loneliness Scale, and the Patient Health Questionnaire-4 between April and May 2024. Descriptive statistics, Spearman’s correlation, and multiple linear regression were used in the data analysis. Result: Findings indicate high cultural competence (mean score: 78.82) but moderate loneliness (mean score: 11.9). Notably, a strong negative correlation exists between cultural competence and feelings of loneliness (r = −0.777) and anxiety/depression (r = −0.818), suggesting that increased cultural competence is associated with lower loneliness and mental health issues. Conclusions: Both cultural knowledge and sensitivity emerged as significant predictors of lower anxiety and depression levels. These findings highlight the association between cultural competence and reduced loneliness and psychological distress among nurses, suggesting the need for targeted training interventions to improve nurses’ well-being and the quality of patient-centered care in culturally diverse healthcare settings. Full article

Objectives: Inappropriate medication use is highly prevalent in nursing home residents and contributes to adverse drug events, falls, and increased healthcare utilization. The Turkish Inappropriate Medication use in oldEr adults (TIME) criteria provide a comprehensive framework for identifying both potentially inappropriate medications and prescribing omissions. We aimed to evaluate the outcomes of a Medication Therapy Management (MTM) intervention by use of TIME criteria among nursing home residents in Türkiye. Methods: This single-arm before–after observational study included 232 adults aged 60–110 years residing in the Bursa Metropolitan Municipality Nursing Home. Medication use patterns were evaluated using the TIME criteria and prescriptions were optimized through a Medication Therapy Management (MTM) intervention. Fall frequency and healthcare utilization outcomes were recorded during the 1 year before and after MTM implementation. Results: Following implementation of the Medication Therapy Management (MTM) approach based on TIME criteria, the median number of medications increased from 5 (IQR: 3–8) to 8 (IQR: 5–10) over one year (p < 0.001). During the post-implementation period, fall frequency, emergency department visits, family medicine visits, and non-geriatric specialist visits were lower compared with the pre-intervention year, whereas hospitalization rates did not significantly change. Conclusions: Among nursing home residents, the total number of medications was higher and fall frequency and selected healthcare utilization measures were lower during the year following implementation of MTM based on TIME criteria. These findings suggest that MTM-guided prescription optimization may be associated with changes in clinical and healthcare utilization outcomes; however, the absence of a control group precludes causal inference, and randomized controlled trials are required to confirm these associations. Full article

Background: Evidence-based practice (EBP) is a cornerstone of high-quality and safe nursing care. However, undergraduate nursing students often experience cognitive, methodological, and contextual barriers to learning and applying EBP. Active teaching strategies, such as the flipped classroom, may support the development of EBP competencies, yet qualitative evidence exploring students’ learning experiences remains limited. Objectives: To explore nursing students’ perceptions and experiences of learning evidence-based practice through a flipped classroom model. Methods: A qualitative descriptive study was conducted at the Faculty of Nursing of the University of Murcia (Spain). Purposeful maximum variation sampling was used to recruit undergraduate nursing students from the second and fourth academic years who had completed an EBP course delivered using a flipped classroom approach supported by an online learning platform. Twenty semi-structured interviews were conducted via videoconference. Data were transcribed verbatim and analyzed using reflexive thematic analysis with independent coding by two researchers and consensus procedures. Ethical approval and confidentiality were ensured. Results: Three main themes were identified: (1) transformation of the meaning of EBP learning and professional role, (2) cognitive and metacognitive processes in EBP learning, and (3) the learning experience as a catalyst for deep learning. Students described a shift from initial fear and perceived difficulty toward recognizing the practical value of EBP, accompanied by increased critical thinking, autonomous learning, and a growing evidence-informed professional identity. The flipped classroom model facilitated engagement and understanding, while the transfer of learning to clinical practice was influenced by contextual facilitators and barriers. Conclusions: Learning EBP through a flipped classroom was experienced as a transformative process that fostered critical thinking, self-regulated learning, and the construction of an evidence-oriented professional identity among nursing students. Strengthening information literacy skills and improving alignment between academic and clinical environments may enhance the sustainable application of EBP in clinical practice. Full article

Background: Although pre-exposure prophylaxis (PrEP) has demonstrated strong clinical efficacy in preventing HIV infection among men who have sex with men (MSM), real-world utilization remains suboptimal. In South Korea, MSM constitute a major population within the domestic HIV epidemic; however, PrEP uptake has not increased pro-portionally to awareness. This discrepancy has been conceptualized as the “awareness–uptake gap,” reflecting multi-level barriers beyond individual knowledge. Purpose: This integrative review aimed to compare PrEP awareness, acceptance, and utilization among MSM populations in South Korea and international settings, and to identify structural, institutional, and psychosocial determinants contributing to the awaness, uptake gap. The study further sought to derive practical implications for nursing practice and health policy. Methods: An integrative literature review was conducted following Whittemore and Knafl’s five-step methodology and reported in line with PRISMA guidance. Electronic searches were performed in PubMed, Google Scholar, RISS, ScienceON, and DBpia for peer-reviewed studies published between 2015 and 2025 in English or Korean. The final search was completed on 31 January 2026. A total of 5952 records were identified, and 187 studies met the inclusion criteria after screening and duplicate removal. Quality appraisal was conducted using AXIS, Newcastle-Ottawa Scale, RoB 2.0, CASP, and MMAT according to study design, and the findings were synthesized within an environmental–structural–individual framework. Results: The included studies consistently showed that awareness of PrEP exceeded actual uptake. Across settings, the awareness–uptake gap was shaped by policy environment, service accessibility, stigma, privacy concerns, economic burden, institutional complexity, and provider preparedness. Comparative evidence from China, Thailand, Belgium and France, Brazil, and West Africa further suggested that awareness alone did not ensure uptake when service pathways were fragmented, culturally unsafe, or poorly understood. Conclusions: Closing the awareness–uptake gap requires integrated policy and practice strategies that extend beyond cost reduction. Strengthening confidentiality systems, simplifying service pathways, and enhancing provider competency—particularly through nurse-centered PrEP navigation and counseling models—may support more sustainable PrEP expansion among MSM populations in global settings. Full article

Background/Objectives: Understanding the genetic basis of food consumption is a key step toward precision nutrition, viewed as a long-term future perspective. This study aimed to investigate genetic variants associated with grapefruit (Citrus paradisi) intake and to evaluate their potential relationship with obesity risk. Methods: A genome-wide association study (GWAS) was conducted on 19,653 European-ancestry participants from two prospective cohorts, the Nurses’ Health Study (NHS) and the Health Professionals Follow-Up Study (HPFS). We employed a functional annotation strategy to select a suggestive locus for follow-up analysis, and computationally derived molecular docking simulations explored a plausible functional link between grapefruit’s bioactive compounds and the candidate gene product. Results: Although falling short of the conventional threshold for genome-wide significance, a suggestive locus was prioritized on chromosome 14, with the lead single nucleotide polymorphism (SNP), rs2124 (p < 5 × 10⁻⁶), located within the metabolic gene ADCK1 (aarF domain containing kinase 1). Molecular docking simulations supported a plausible mechanistic hypothesis, indicating that key bioactive compounds in grapefruit could bind with high affinity to the ADCK1 protein. Consistent with the GWAS finding, individuals with the CC genotype reported lower mean grapefruit intake. This genotype was also associated with other lifestyle factors, notably, lower physical activity in women. In age- and multivariate-adjusted models, the CC genotype was associated with a modestly increased risk of incident obesity in females, but not in males. Conclusions: Our exploratory findings suggest a prioritized candidate locus associated with grapefruit intake, and its link to obesity risk may be mediated by the metabolic gene ADCK1. However, given the lack of genome-wide significance and independent replication, these findings should be considered preliminary and exploratory. These hypothesis-generating results support the integration of genetics and dietary habits, warranting further mechanistic validation. Full article

Pressure injuries remain highly prevalent in hospital and home settings, particularly among elderly patients, intensive care unit patients, and individuals with impaired mobility, generating significant healthcare and economic impacts. Although low-level laser therapy has been explored as an adjunctive therapy to accelerate healing, few validated protocols exist to guide its systematic application in clinical nursing practice. This methodological study aimed to develop and validate a nursing care protocol for low-level laser therapy in stage 1 pressure injuries, conducted in three stages: integrative literature review, protocol development, and content validation using the Delphi technique with specialist nurses selected via the Lattes Platform. Judges evaluated the protocol using a five-point Likert scale, and validity was assessed by the Content Validity Index (CVI) and Cronbach’s alpha, both with minimum acceptable values of 0.80. The integrative review identified four studies supporting low-level laser therapy efficacy, informing the protocol’s technical parameters. Thirty-one specialists participated in the first Delphi round and 25 in the second, achieving a Global CVI of 0.915 and Cronbach’s alpha of 0.91, with all items reaching consensus. The validated protocol demonstrated satisfactory content validity and internal consistency, supporting its clinical applicability and potential to standardize nursing practice and reinforce patient safety. Although the protocol demonstrated satisfactory methodological validity, further clinical studies are needed to assess feasibility, implementation, and effectiveness in routine nursing care. Full article

(1) Background: Nurses are exposed to occupational stressors that may impair their well-being and quality of life. This study examined whether burnout and secondary traumatic stress mediate the relationship between perceived stress and physical and psychological quality of life. (2) Methods: A cross-sectional study included 294 nurses employed at the Clinical Hospital Center Osijek, Croatia. Data were collected using the Perceived Stress Scale (PSS-10), the Burnout and Secondary Traumatic Stress subscales of the Professional Quality of Life Scale (ProQOL-5), and the physical and psychological domains of the WHOQOL-BREF. Pearson correlations and path analysis were used. (3) Results: Perceived stress showed significant negative effects on physical (β = −0.291; p < 0.001) and psychological quality of life (β = −0.217; p < 0.001), and positive effects on burnout (β = 0.230; p < 0.001) and secondary traumatic stress (β = 0.171; p = 0.002). Burnout significantly mediated both relationships, while secondary traumatic stress did not. The model explained 20.8% and 19.3% of variance in physical and psychological quality of life. (4) Conclusions: Burnout represents an important pathway linking perceived stress with poorer quality of life among nurses. Full article

Background: Psychological stress is a common concern among university students, which is also pronounced among nursing students due to the academic and clinical demands of their training. Persistent stress can negatively affect students’ mental well-being, academic performance, and professional development. Social support has been identified as an important protective factor. However, evidence on the relationship between perceived social support and stress among nursing students in Middle Eastern educational contexts remains limited. Methods: A cross-sectional survey was conducted among nursing students. The survey included the Multidimensional Scale of Perceived Social Support (MSPSS) and the 10-item Perceived Stress Scale (PSS-10), along with sociodemographic and academic characteristics. Multivariable linear regression was used to examine the association between perceived social support and perceived stress after adjusting for age group, sex, program type, living arrangement, and employment status. Differences in stress across levels of social support were also examined using analysis of variance (ANOVA). Results: A total of 182 nursing students participated in the study. The mean perceived social support score was 4.95 (SD = 1.42), while the mean perceived stress score was 15.49 (SD = 2.82). We found that higher perceived social support was significantly associated with lower perceived stress (β = −1.9, 95% CI: −3.4 to −0.44), indicating that a one-point increase in the MSPSS score was associated with a 1.9-point decrease in perceived stress. Other sociodemographic factors were not significantly associated with stress. ANOVA indicated significant differences in stress across social support levels (F(2,179) = 6.91, p = 0.001). Conclusions: Perceived social support was significantly associated with lower levels of perceived stress among nursing students. These findings highlight the potential importance of strengthening supportive social environments to promote psychological well-being in nursing education. Full article

Background/Objective: In Spain, 99% of births occur in hospital settings, and planned home birth is neither funded nor regulated by the Public Health System. Despite growing interest in this birth option, qualitative evidence exploring the experiences of women who opt for a planned home birth after a previous hospital birth remains scarce, particularly in contexts where this practice is not integrated into the healthcare system. This study aimed to explore the perceptions and experiences of Spanish women who opted for a planned home birth following a previous hospital birth, focusing on the reasons that motivated this decision and the care received during the process. Methods: A qualitative descriptive design was employed. Semi-structured interviews were conducted between July and December 2025 with 19 women who had experienced a planned home birth in Spain after a previous hospital birth. Data were analysed using inductive thematic analysis following Braun and Clarke’s approach. The study adhered to the Standards for Reporting Qualitative Research (SRQR). Results: Three main themes emerged: (1) motives related to choosing a planned home birth, including negative hospital experiences characterised by loss of autonomy, medicalisation of birth without consent, and fragmented care; (2) seeking a physiological and humanised birth, reflecting women’s desire for empowerment, control, and a transformative experience, alongside barriers such as lack of professional support and financial burden; and (3) the need to increase visibility and establish regulation, highlighting demands for professional training, dissemination strategies, and integration of planned home birth into the Public Health System to ensure equitable access. Conclusions: Women who opted for a planned home birth after a hospital experience reported highly positive and empowering outcomes. However, the absence of regulation, professional support, and public funding creates significant inequalities. Integrating planned home birth into the Public Health System, educating healthcare professionals, and developing strategies to increase the visibility of planned home births are essential to guarantee women’s right to choose where they give birth. Full article