Search Results (245)

Hospitals are complex institutions where clinical, social, and cultural practices intersect. In Ghanaian hospitals, interactions are shaped by multilingual communication, professional hierarchies, cultural norms, and community expectations. Drawing on five months of ethnographic fieldwork, this study examines coordination of care in a Ghanaian hospital to understand how boundaries (i.e., professional hierarchies, communication barriers, community accountabilities), ruling relations, and power dynamics influence care. Institutional ethnography (IE) was implemented. Participants were purposively sampled, and data were collected through participant observation, documentary materials, and interviews with nurses (n = 11), patients (n = 21), and caregivers (n = 11). Thematic and IE analyses trace how boundaries and professional hierarchies, informal economies, and multilayered surveillance (“medical,” “social,” and “community” gazes) organize care work through institutional texts and how nurses, patients, and caregivers access or deliver care. The findings showed that boundaries at the Yendi Hospital were simultaneously rigid and negotiable, with informal economic activities compensating for institutional resource constraints. Communication work was central to navigating linguistic and cultural diversity, while surveillance from within and beyond the hospital-shaped behaviour and accountability. These everyday practices revealed how institutional texts and societal forces co-produce the conditions of care, with implications for teamwork, patient–provider relationships, and hospital governance. Full article

Background/Objectives: Therapeutic adherence remains a critical challenge in the management of chronic conditions, yet most research has focused on pharmacological adherence from the perspective of physicians and pharmacists. The views of non-physician healthcare professionals—particularly physiotherapists, podiatrists, psychologists, and nurses—remain underrepresented. This study aims to explore how these four healthcare disciplines perceive the factors influencing therapeutic adherence, the strategies they use to support it, and how they address patient resilience in clinical practice. Methods: An exploratory qualitative study was conducted using semi-structured interviews with 32 healthcare professionals (8 per discipline) recruited through purposive sampling across diverse care settings across Spain. Data were analyzed using reflexive thematic analysis following a hybrid deductive–inductive approach. Quality criteria were applied in accordance with the standards proposed by Lincoln and Guba. Results: Three thematic domains emerged. Patient-related factors, especially motivation, health literacy, illness beliefs, and socioeconomic constraints, emerged as central determinants across all disciplines. Health system barriers, particularly limited consultation time and fragmented continuity of care, also constituted significant barriers. Discipline-specific strategies ranged from the teach-back technique and customized visual aids in nursing and podiatry to functional goal-setting and group-based dynamics in physiotherapy and expectation-setting and digital follow-up in psychology. Resilience was consistently described as a key mediating factor enabling patients to sustain adherence despite adversity. Conclusions: Therapeutic adherence is a multifactorial and discipline-sensitive phenomenon. The complementary strategies identified across professions support the value of coordinated interdisciplinary approaches. Resilience-informed interventions and profession-specific adherence training represent promising directions for improving clinical practice and professional education. Full article

Background/Objectives: The support of healthcare professionals can affect the improvement of cancer survivors’ self-management ability. Community nurses in charge of primary health care can play a positive role in the management of cancer survivors because they meet with cancer survivors in various areas and have basic knowledge of oncology. This study aimed to assess the educational needs and analyze the priorities of a cancer survivor nursing care education program for community nurses. Methods: An online survey was conducted on 164 nurses working in public health centers in South Korea from 5 February to 24 February 2024. A 25-item questionnaire was used to measure community nurses’ perceived knowledge and perceived importance of cancer survivor care. The educational needs analysis was conducted using the Borich needs assessment and the Locus for Focus model. Results: The highest priority content areas were as follows: economic support and related insurance systems, second primary cancer screening, physical rehabilitation after cancer treatment, diet and nutrition, complications of cancer treatment, returning to work, physical and mental problems of a cancer patient’s family, and providing training materials and information on cancer. Conclusions: The results suggest that community nurses’ educational needs extend beyond direct clinical care to include care coordination and resource-linkage roles. Because these priorities were based on nurses’ perceived educational needs rather than needs grounded in clinical practice, future educational programs should be developed to address these needs while also strengthening community nurses’ clinical reasoning competencies. Full article

Background: Bronchiectasis is a chronic respiratory condition characterised by irreversible airway dilation and recurrent infections, resulting in significant symptom burden and frequent healthcare utilisation. Although nurses are central to chronic respiratory disease management, their specific roles and responsibilities in outpatient bronchiectasis care remain poorly defined. Understanding these roles is imperative to support workforce planning, optimise multi-disciplinary collaboration, and improve patient outcomes. Aim: This scoping review aimed to map and synthesise existing evidence on the roles and responsibilities of nurses involved in the outpatient management of adults with non-cystic fibrosis bronchiectasis. Methods: A scoping review was conducted. Six databases were systematically searched (MEDLINE, CINAHL Complete, Central, Web of Science, and ProQuest Dissertations and Theses Citation Index). Records describing nursing roles, responsibilities, or models of care within outpatient bronchiectasis settings were included (any design). Data was analysed descriptively and thematically. Results: Five studies and two international clinical practice guidelines published between 2002 and 2025 were included. Nurses were shown to play roles across five key domains: 1. clinical assessment and monitoring, 2. self-management support and patient education, 3. care co-ordination and multi-disciplinary collaboration, 4. patient advocacy and communication, and 5. leadership and service development. Evidence on measurable outcomes and standardised role definitions remains limited. Conclusions: This review mapped five domains within which nurses may contribute to outpatient bronchiectasis care; however, most identified roles and responsibilities were derived from multi-disciplinary recommendations rather than explicit descriptions of nursing practice. Further research is required to better define nursing roles and responsibilities and evaluate nurse-led models of care in bronchiectasis outpatient care settings. Full article

Objective: This study seeks to synthesize the experiences, challenges, and core competency requirements of nurse managers caring for patients with emerging infectious diseases to inform targeted training and strengthen emergency response systems. Background: The frequent emergence of emerging infectious diseases has placed unprecedented strain on global public health systems, with nurse managers playing a pivotal role in coordinating and sustaining outbreak responses. Methods: A literature search was conducted across PubMed, CINAHL (EBSCO), Embase, Web of Science, Scopus, CNKI, and other databases. Qualitative studies were screened and assessed using the JBI appraisal tool. Thirteen studies were included and meta-synthesized. Thematic synthesis was used to synthesize the findings. Results: Four main themes emerged: multidimensional experiences of nurse managers, dual pressures from resource shortages and environmental constraints, core competency requirements, and the need for organizational and system support. Discussion: Outbreaks intensified physical and mental strain, increased burnout and turnover, yet also fostered professional growth. Systemic support, flexible staffing, digital training, and inclusive governance are needed to ensure well-being, care resilience, and leadership retention. Conclusion: This study outlines challenges and competencies of nurse managers during health crises, underscoring the need for comprehensive support to guide specialized training and improve public health preparedness. Full article

Background/Objectives: Acute ischemic stroke (AIS) care depends on rapid, coordinated workflows. This study compared two real-world in-hospital stroke models—a neurohospitalist-led model and a stroke practitioner-led multidisciplinary model—in terms of time metrics, radiological outcomes, and 3-month clinical outcomes in patients undergoing reperfusion therapy. Methods: This retrospective, single-center cohort study evaluated patients across two sequential workflow periods. In the practitioner-led model, trained non-neurologist clinicians coordinated care with a stroke nurse under neurologist supervision. Time metrics included door-to-needle time (DNT) and door-to-puncture time (DPT). Clinical outcomes included intensive care unit (ICU) transfer and 3-month functional outcomes assessed by the modified Rankin Scale (mRS). Multivariable logistic regression analyses were performed to explore variables associated with achievement of DNT < 60 min and ICU transfer. Results: A total of 573 patients were included (284 neurohospitalist-led, 289 practitioner-led). Baseline NIHSS scores were similar between groups. Among patients receiving intravenous thrombolysis, the proportion achieving DNT < 60 min did not differ significantly between periods (77.9% vs. 72.5%, p = 0.124), while mean DNT and DPT were comparable. Early radiological outcomes at 24 h were similar between groups. ICU transfer rates were significantly lower in the practitioner-led period (17.6% vs. 28.2%, p = 0.002). In multivariable analyses, the stroke practitioner-led period was not independently associated with achieving DNT < 60 min among thrombolysed patients, but remained independently associated with a lower likelihood of ICU transfer. Three-month mRS outcomes did not differ significantly. Conclusions: A structured, practitioner-led multidisciplinary workflow was associated with lower ICU transfer rates, while no statistically significant differences were detected in DNT target achievement among thrombolysed patients, safety outcomes, or functional outcomes compared with the neurohospitalist-led period. The observed associations between workflow organization and ICU utilization highlight the potential importance of system-level factors in AIS care delivery. Full article

Background: Liver cancer is a major public health problem in Thailand due to its high incidence and mortality. Although hepatectomy is a potentially curative treatment, it is a complex procedure with a high risk of postoperative complications, necessitating a structured and systematic approach to care. Objectives: This study aimed to develop a clinical practice guideline (CPG) for patients with liver cancer undergoing hepatectomy and to evaluate the feasibility of its implementation in relation to outcomes for healthcare providers, the organization, and patients. Methods: This implementation research was conducted in three phases: (1) an evidence-triggered phase, (2) an evidence-supported phase, and (3) an evidence-observed phase. The CPG covered five stages of care: preoperative, intraoperative, postoperative, discharge planning, and post-discharge follow-up. It was implemented through a multidisciplinary approach, with an advanced practice nurse (APN) facilitating adherence to Enhanced Recovery After Surgery (ERAS) components. Data were analyzed using descriptive statistics. Results: Healthcare personnel demonstrated high adherence to the CPG and reported high feasibility of implementation. After implementation, favorable trends were observed in postoperative complications, length of hospital stay, hospitalization costs, and patient satisfaction compared with the historical pre-implementation period. The CPG also appeared to support clearer care standards and multidisciplinary coordination. Conclusions: The developed CPG was feasible and contextually appropriate for ERAS-based hepatectomy care in this setting. Preliminary findings suggest favorable trends in care processes and selected outcomes. Larger controlled studies with longer follow-up are needed to determine effectiveness and sustainability. Full article

Background/Objectives: Registered nurse (RN) prescribing is increasingly discussed as a strategy to improve primary-care access, medication follow-up, chronic disease management, and service responsiveness. The available evidence, however, does not directly test a single coordinated RN prescriber–family physician/nurse practitioner (FP/NP) model. This integrative review synthesized heterogeneous evidence relevant to how RN prescribing may be organized within team-based primary care. Methods: A structured integrative review approach was used to map evidence from nurse and non-medical prescribing, RN-led primary care, nurse–physician substitution, interprofessional collaboration, chronic disease medication titration, patient-experience, and implementation research. Searches completed on 30 March 2026 included PubMed/MEDLINE, PubMed Central, the Cochrane Library search interface, publisher full-text platforms, targeted scholarly searches, citation chasing, and Canadian regulatory/professional sources. Methodological quality was appraised using AMSTAR 2- and CASP-informed criteria, and the strength of interpretation was assessed narratively. No meta-analysis was performed because of substantial heterogeneity and the risk of double-counting primary studies included in prior evidence syntheses. Results: A total of 286 records were identified. After de-duplication, screening, and eligibility assessment, 37 peer-reviewed records were included: 30 review-level or evidence-synthesis records and 7 primary, mixed-methods, or patient-experience studies. Four official regulatory/professional sources were retained separately for context. Nurse and non-medical prescribing were generally associated with comparable or favourable outcomes for blood pressure, glycated hemoglobin, low-density lipoprotein cholesterol, medication adherence, patient satisfaction, and selected access outcomes in defined contexts. Direct evidence for the exact RN prescriber–FP/NP configuration remains limited. Conclusions: Current evidence is consistent with a coordinated RN prescribing model embedded within primary-care teams, but does not establish causal superiority of this configuration over other models. Coordinated RN prescribing should therefore be understood as an evidence-informed and testable implementation model requiring prospective evaluation, particularly for diagnostic safety, adverse events, continuity, workload, cost, and patient-level outcomes. Full article

Background: Perceived inequity in work allocation has well-documented consequences for nurse job satisfaction, organizational commitment, and patient safety. Despite this recognition, empirical research examining how nurses in Middle Eastern healthcare contexts conceptualize allocation justice remains limited. This qualitative study explored Saudi registered nurses’ perceptions of work allocation justice, identified the organizational factors shaping those perceptions, and examined their implications for nurse well-being and quality of care. Methods: A qualitative design employing reflexive thematic analysis was used, grounded in constructivism. Semi-structured individual interviews were conducted with 17 purposively sampled registered nurses from three Riyadh-based healthcare facilities. Credibility was established through data, method, and analyst triangulation; peer debriefing; and member checking (12 of the 17 participants were purposively selected for member checking to represent the full range of experiences; 11 of those 12 confirmed thematic plausibility). Thematic saturation was reached at interview 13. Results: Six interconnected themes emerged: (1) Understanding Work Justice; (2) Personal Experiences; (3) Influencing Factors; (4) Psychological and Professional Impacts; (5) Institutional and Administrative Support; and (6) Future Perspectives. Participants define fairness as contextual equity and relational respect rather than simple numerical equality. Inequities were driven by staffing constraints, leadership styles, and policy gaps, leading to burnout and reduced organizational commitment. Conclusions: Saudi nurses experience meaningful allocation inequities arising from structural constraints, leadership variability, and the absence of written allocation policies. Addressing these inequities requires coordinated action on policy transparency, objective criteria, and psychologically safe communication channels. These findings provide contextually grounded, evidence-informed guidance for developing equitable nursing work environments that support workforce retention and patient safety. Full article

Background/Objectives: Artificial Intelligence (AI) integration in healthcare promises improved diagnostic accuracy, patient safety, and operational efficiency. However, AI acceptance among healthcare workers remains limited due to knowledge gaps, risk concerns, and governance challenges, particularly in developing countries like Saudi Arabia, where rapid healthcare modernization faces unique infrastructure, organizational, and cultural challenges. This research investigates the factors influencing AI acceptance among medical practitioners, nurses, administrators, and students in Saudi Arabian hospitals to identify key determinants and barriers to adoption. Methods: This cross-sectional study employed an extended Unified Theory of Acceptance and Use of Technology (UTAUT) framework integrated with ethical considerations from the Model for Ethical Assessment and Analysis of AI in Medicine (MEAAM). A structured bilingual questionnaire was administered to 119 healthcare professionals and students across Saudi Arabia, measuring constructs including Awareness and Knowledge, Performance Expectancy, Effort Expectancy, Facilitating Conditions, Social Influence, Trust, Perceived Risk, Ethical Governance, and Price Value. Partial Least Squares Structural Equation Modeling (PLS-SEM) was employed for quantitative analysis, supplemented by thematic analysis of open-ended qualitative responses. Results: The PLS-SEM analysis explained 59.8% of variance in behavioral intention to adopt AI (R² = 0.598). Awareness and Knowledge emerged as the strongest predictor (β = +0.505, p < 0.001), followed by Performance Expectancy (β = +0.229, p < 0.05) and Social Influence (β = +0.123). Perceived Risk functioned as the primary barrier (β = −0.185, p < 0.05). Qualitative findings identified infrastructure gaps, regulatory ambiguities, and training deficiencies as major implementation barriers, while emphasizing opportunities in diagnostic accuracy and remote monitoring. Conclusions: AI acceptance in Saudi healthcare is primarily driven by knowledge, with perceived usefulness and peer support as secondary facilitators, while safety and accountability concerns remain substantial obstacles. Successful AI integration requires coordinated efforts in education, transparent governance frameworks, and institutional support. This study contributes theoretically by validating extended UTAUT in a non-Western healthcare context and practically by providing evidence-based strategies for sustainable AI adoption that enhance healthcare quality while respecting professional roles and ethical principles. Full article

Introduction: Inequities in access to medicines persist for asylum seekers, refugees, and undocumented migrants in Europe. For vaccines, access gaps not only exist for these groups in childhood routine immunization, but also for life-course and catch-up vaccinations. As part of a broader project examining access to medicines and vaccines for migrants across all stages of the migration cycle, this scoping review synthesizes evidence on the determinants of access to vaccines. Methods: We conducted a scoping review across PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews, Scopus, and grey literature sources, covering the period 2000–2024. Sources were eligible if they addressed access to vaccines among migrants. We examined access to vaccines along the life course, and across phases of the migratory cycle, including departure, transit, reception and settlement, and return or deportation. Results: A total of 47 research studies and grey literature reports were included. Most studies focused on migrants in reception and settlement (destination) settings, with only twelve sources addressing other phases of the migratory cycle. Across European countries, migrants were frequently reported to have lower uptake of routine vaccines (e.g., measles–mumps–rubella (MMR), polio, diphtheria–tetanus–pertussis (DTP), and human papillomavirus (HPV)) and COVID-19 vaccines than host populations. The most frequently reported barriers were related to migrants’ legal status, administrative requirements, and lack of documentation, alongside poor affordability of vaccination, limited awareness of their rights, and mistrust in the health system. Conclusions: Health systems need to adopt innovative approaches to expand vaccine access for migrant populations. Further, protecting confidentiality is essential for building trust and reducing ethical and legal risks. Flexible and coordinated vaccination strategies are required to address migrants’ mobility across the different migration stages and settings. Our findings appeal for sustained improvements in access to vaccines among migrants in Europe, contingent on strong policy commitments to equity, data protection, and the adoption of life-course and catch-up vaccination strategies. Full article

Background/Objectives: Population aging has increased the demand for comprehensive and coordinated care for older adults, placing primary health care (PHC) nurses at the forefront of comprehensive geriatric assessment (CGA) implementation. However, limited evidence exists regarding nurses’ experiences and educational needs related to CGA across different European healthcare contexts. This study aimed to explore the experiences, perceived challenges, and educational needs of PHC nurses regarding the implementation of CGA in five European countries. Methods: A qualitative study design was employed using five focus groups, one in each participating country: Greece, Iceland, Finland, Estonia, and Latvia. A total of 29 PHC nurses participated in semi-structured interviews. Data were analyzed using reflexive thematic analysis. Results: Three overarching themes and nine subthemes were identified in relation to good practices in CGA: (1) embracing the complexity of holistic assessment; (2) balancing consistency with flexibility in clinical practice; and (3) advancing professional expertise through structured learning. Participants highlighted the importance of standardized assessment tools and effective multidisciplinary collaboration. At the same time, they reported significant gaps in formal education, limited organizational resources, and insufficient training in cultural competence, which hinder consistent CGA implementation. Conclusions: PHC nurses recognize the value of a holistic and structured approach to CGA but require clearer educational pathways and evidence-based training to address the complex needs of older adults. Strengthening curricula that emphasize interprofessional collaboration, practical competencies, and contextual adaptability may support more effective and sustainable implementation of CGA in primary care settings across Europe. Full article

Background/Objectives: Survivors of sexual violence and domestic violence/intimate partner violence (IPV) often require support beyond the immediate emergency encounter; however, post-acute care remains inconsistently defined, unevenly organised or conceptualised, and fragmented across service systems. This scoping review mapped international post-acute follow-up, care, assistance, and support pathways, with particular attention to organisational models, continuity mechanisms, loss to follow-up after first access, and implications for the Italian context. Methods: We conducted an international health-services scoping review of post-acute follow-up, care, assistance, and support interventions for survivors of sexual violence and domestic violence/IPV. Searches were performed in PubMed/MEDLINE, Scopus, Web of Science Core Collection, Embase, APA PsycINFO via EBSCOhost, and CINAHL via EBSCOhost. Eligible studies were published from 2013 onward and had to describe an identifiable post-acute component beyond the initial emergency, forensic, or first-contact phase. The review followed a Population–Concept–Context framework and was reported in accordance with PRISMA-ScR. Results: Forty-four studies were included in the core synthesis, comprising 16 studies on sexual violence/sexual assault, 27 on domestic violence/IPV, and one mixed domestic, family, and sexual violence outreach model. The sexual violence literature clustered around early trauma-focused interventions, sexual assault care centre pathways, medical follow-up, follow-up attendance, and digital continuity tools. The IPV literature was broader and included psychotherapy, advocacy and case-management models, housing-first and trauma-informed stabilisation approaches, nurse-led and clinic-based services, outreach and safety-contact programmes, digital interventions, and programmes for system-involved survivors. Across both fields, the pathways most consistently described as supporting continuity combined structured re-contact, coordinated support, and multi-component responses over time. Conclusions: The mapped literature supports conceptualising post-acute responses to sexual violence and domestic violence/IPV as continuity pathways that extend beyond first contact and link healthcare, psychological, advocacy, and social supports. Systems may be better positioned to support continuity when they provide structured follow-up, warm handoffs, coordinated navigation, and context-sensitive recovery models. These findings point to provisional, evidence-informed organisational questions for strengthening post-acute pathways, including in Italy, particularly around structured re-contact, warm handoffs, survivor navigation, and integration between healthcare, anti-violence, psychological, and territorial social-support services. Full article

Background: Multiple sclerosis (MS) is a condition that requires long-term, multidisciplinary management. The growing digital transformation in healthcare has highlighted the central role of nurses in supporting key aspects such as patient self-management, continuity of (at home) care, and patient empowerment. However, evidence on nurse-led digital interventions in MS remains fragmented. Objective: To map the available literature on nurse-led digital interventions in MS, focusing on the role of nurses, clinical outcomes, and research gaps. Methods: The review was conducted using the methodological framework of the Joanna Briggs Institute (JBI) and the PRISMA-ScR checklist. A systematic search was performed in PubMed, Scopus, Web of Science, and CINAHL. Studies were included if they described digital or telehealth interventions led or coordinated by nurses in patients with MS. Results: A total of 12 studies published between 2015 and 2025 met the inclusion criteria. Four main thematic areas were identified: (1) telenursing and empowerment-based interventions; (2) mobile and web-based patient self-management programs; (3) digital systems for monitoring and integrated care pathways; and (4) digital interventions targeting symptom management and psychosocial outcomes. Across the studies, nurse-led digital interventions were associated with improvements in self-management, treatment adherence, self-efficacy, and health-promoting behaviors. Positive effects were also reported on clinical outcomes such as fatigue, sleep quality, and balance, as well as on psychosocial variables including quality of life, coping strategies, and emotional well-being. Furthermore, the identified systems, in general, contributed to enhanced continuity of care, patient engagement, and organizational efficiency. Conclusions: Nurse-led digital interventions represent a promising approach in the management of patients with multiple sclerosis, supporting both clinical and psychosocial outcomes while enhancing continuity of care. However, the current evidence base remains limited by small sample sizes, heterogeneity of interventions, and short follow-up periods. Future research should prioritize multicenter randomized studies with larger samples and long-term follow-up to strengthen the evidence. Additionally, the integration of digital interventions into routine clinical practice, along with targeted training for nurses, is essential to ensure sustainability, accessibility, and equitable implementation. Further studies should also explore cost-effectiveness and the impact on caregivers and long-term quality of life. Full article

Background: Pediatric emergencies are high-risk clinical situations requiring timely, accurate, and coordinated interventions. Nurses play a pivotal role in early recognition and management of acute pediatric conditions; however, the rarity and complexity of these events often limit clinical exposure and preparedness. Continuous professional education is therefore essential to ensure patient safety and high-quality care. Objective: This systematic review aimed to synthesize evidence on innovative continuing education strategies for nurses involved in pediatric emergency care, with a primary focus on studies evaluating educational effectiveness and a secondary contextual focus on studies describing training needs, perceived barriers, preparedness, and implementation conditions. Methods: The review was conducted according to PRISMA guidelines. The protocol was registered in PROSPERO (ID CRD420251120993). A comprehensive search of PubMed, CINAHL Complete, Scopus, and the Cochrane Library identified studies published between 2015 and August 2025. Primary intervention studies were used to assess educational effectiveness, whereas descriptive, observational, qualitative, and review-based evidence was retained as contextual evidence. Methodological quality was assessed using Joanna Briggs Institute (JBI) tools. Results: Forty-nine studies met the inclusion criteria, including randomized controlled trials, quasi-experimental studies, observational and cohort studies, and integrative or narrative reviews. Educational interventions mainly involved simulation-based training, blended learning, telesimulation, digital education, and structured training programs. Intervention studies suggested improvements in knowledge, technical skills, self-efficacy, and team performance, while contextual studies highlighted training needs, perceived barriers, preparedness, and implementation challenges. However, the evidence was limited by methodological heterogeneity, frequent reliance on self-reported outcomes, and limited long-term follow-up. Conclusions: Simulation-based, blended, and telesimulation-based educational strategies may be associated with short-term improvements in nurses’ preparedness and educational outcomes in pediatric emergency care. However, conclusions regarding effectiveness should be interpreted cautiously because of methodological heterogeneity, reliance on subjective outcomes, and limited evidence on long-term clinical and patient-safety outcomes. Full article