Search Results (2,077)

Background: Population ageing has increased the number of older adults living in nursing homes, where loneliness and sleep disturbances are prevalent and negatively affect well-being. Evidence suggests a bidirectional relationship between loneliness and sleep quality, although research in institutionalised populations remains limited. Objectives: This study aimed to characterise the sociodemographic and health profile of nursing home residents in Northern Portugal and examine associations between sleep quality, loneliness, sociodemographic and health variables. Methods: A cross-sectional study was conducted with 157 older adults (≥65 years) across 13 nursing homes. Data were collected using a sociodemographic questionnaire and the Portuguese version of UCLA Loneliness Scale, Pittsburgh Sleep Quality Index and Montreal Cognitive Assessment. Pearson correlations and hierarchical multiple regression analyses were performed. Results: Participants were predominantly female (72.6%), widowed (55.4%), and aged ≥80 years. Most reported chronic conditions (98.7%) and limitations in activities of daily living (75.2%). Age showed modest positive correlations with loneliness. Loneliness dimensions were strongly associated with poorer sleep quality and greater daytime dysfunction. Hierarchical regression revealed that sociodemographic variables explained only a small proportion of variance in sleep quality. The addition of loneliness variables increased explained variance to 38.1%, highlighting loneliness as a key psychosocial predictor. Conclusions: Loneliness significantly influences sleep quality among older adults living in nursing homes. Interventions should integrate strategies to enhance social engagement alongside sleep hygiene measures. Longitudinal studies are recommended to clarify causal pathways. Full article

Autobiographical memory plays a central role in identity continuity, narrative functioning, and psychological well-being in later life. In nursing home residents, however, reduced environmental stimulation, cognitive vulnerability, and limited opportunities for self-expression may compromise autobiographical engagement. Music, as an emotionally salient and personally meaningful cue, may facilitate memory retrieval through affective and self-referential mechanisms. This exploratory pilot study examined whether personalized music listening influences the productivity and linguistic features of autobiographical narration in nursing home residents. Eleven older adults completed one baseline autobiographical recall session without music and three weekly music-assisted sessions focused on different life periods. Narratives were transcribed and analyzed using LIWC-22. Within-subject differences were tested with Wilcoxon signed-rank analyses. In addition, an exploratory qualitative paper-and-pencil analysis was conducted to identify recurrent narrative and experiential patterns in the music-assisted accounts. Music-assisted recall was associated with higher total word count compared with baseline, although this difference should be interpreted cautiously given the asymmetry between the single-session baseline and the three-session post-intervention format. No significant changes emerged in positive or negative emotion words. Qualitative observations of the music-assisted narratives highlighted recurrent features including vivid autobiographical scenes, references to meaningful social identities and former life roles, and emotionally salient communication. These preliminary findings suggest that personalized music may support autobiographical recall by increasing verbal output during narration and by facilitating meaningful self-expression and relational communication in later life. Larger controlled studies are needed to clarify its role in supporting autobiographical narrative processes in nursing home older adults. Full article

Background and Clinical Significance: Kinesio tape (KT) has gained popularity as an adjunctive approach for treating edema during the rehabilitation phase, following traumatic events, as well as for managing edema in breast cancer patients. Its goal is to reduce swelling and improve mobility in the affected extremity; however, its use in critically ill patients remains limited. To our knowledge, this is the first report of its application in this population. Case presentation: This case series involved three patients in the Intensive Care Unit (ICU) who presented with lower extremity edema. One patient developed a cerebrovascular event secondary to moderate traumatic brain injury and two patients experienced sepsis. KT was applied, and extremity circumference, Godet sign, and Stemmer sign were assessed. The bandage was reapplied every 24 h over a 5-day period, with daily evaluations performed by the same nursing staff to ensure measurement consistency. All three patients exhibited a reduction in extremity circumference, along with improvement or resolution of the Godet and Stemmer signs. No adverse effects associated with KT were observed. Conclusions: Our results suggest that KT may be a beneficial adjunctive therapy for edema reduction in ICU patients. Larger-scale studies are needed to confirm its clinical value. Full article

Introduction: Wounds increase the risk of hospitalization in home health (HH) settings by up to 52%. They also consume a notable portion of HH budgets due to frequent nursing visits for wound assessment and care. To address these challenges, a U.S.-based HH enterprise adopted a Digital Wound Care Solution (DWCS) to enhance wound management and operational efficiency. This study examines the impact of integrating the DWCS into practice, focusing on clinical and operational indicators and potential cost savings. Methods: This study employed a quasi-experimental pre–post design to evaluate the impact of the DWCS on clinical and operational outcomes. Data were extracted from the DWCS and EMR databases, encompassing pre-adoption (2022) and post-adoption (2023) periods. The analysis included wound data from 16,276 patients in 2023 and 19,252 patients in 2022, covering an 8-month period (March–October) across 11 branches. The key performance indicators included skilled nursing (SN) visits per episode (VPE), time to complete SN visits, hospitalization rates, and staff optimization. Results: The adoption of the DWCS was associated with clinical and operational improvements. SN VPE decreased by 7.5%, resulting in an estimated annual savings of $1.3 million. A directional change in wound-related hospitalization rates was observed at 30 days (20.7% to 20.3%) and 60 days (32.4% to 31.5%); however, these changes did not reach statistical significance and should be interpreted as trends. The projected prevention of 200 hospitalizations with estimated annual cost savings of $3.4 million to the health system represents modeled projections based on observed directional trends rather than realized savings. A 1.9% shift in staff roles increased the utilization of licensed practical nurses with no adverse indicators identified within the scope of this analysis, saving $112,748 annually. Conclusions: The adoption of the DWCS was associated with fewer and shorter SN visits and a shift toward more LPN utilization, with anticipated reductions in costs Wound-related admissions showed downward trends but did not reach statistically significant levels. This pre–post design precludes causal attribution, and findings should be interpreted as associations rather than definitive effects of the intervention. These findings support further investigation of wound care models integrating AI within a value-based home health setting. Full article

Background: The nursing profession is recognized as a high-risk occupation, with the emotional toll on healthcare workers reaching a critical point. A complex interplay of anger and cynicism, often stemming from systemic pressures and chronic moral injury, seems to increasingly affect nurses’ professional and personal lives. This psychological strain does not end when the shift ends; rather, it often manifests as insomnia and nightmare distress, creating a vicious cycle of exhaustion and emotional instability. This article explores how anger, cynical distrust, nightmare distress and insomnia are interrelated and jeopardize the well-being of nursing staff and what these “invisible” symptoms reveal about the current state of healthcare by confirming their prevalence rates. Methods: This cross-sectional study was conducted online in October 2025 and included 441 hospital nurses who completed the Dimensions of Anger Reactions-5 (DAR-5), the 8-item Cynical Distrust scale (CDS-8), the Nightmare Distress Questionnaire (NDQ) and the Athens Insomnia Scale (AIS). Results: The prevalence rates of anger, nightmare distress and insomnia were 41.5%, 6.6%, and 62.1%, respectively. Based on the CDS-8 scores, a notable proportion (20.9%) of nurses fell within the highest quartile of CDS-8 scores (CDS-8 > 29), indicating relatively elevated cynical distrust within this sample; this threshold is sample-derived and does not correspond to a validated clinical cut-off. Hierarchical multiple regression analysis indicated that the DAR-5 explained 22.1% of the variance in AIS, while an additional 10.2% was explained by NDQ and another 1.5% by the CDS-8. Both cynical distrust and nightmare distress displayed a chain mediation pattern in the association between anger and insomnia; however, given the cross-sectional design, the temporal order of these variables cannot be confirmed. Conclusions: Anger exhibited significant direct and indirect associations with insomnia, with cynical distrust and nightmare distress acting as serial mediators in this cross-sectional model. Findings from this cross-sectional study tentatively suggest that future intervention efforts targeting insomnia in nurses might benefit from addressing anger alongside nightmare distress and cynical attitudes; however, experimental studies are needed to confirm whether such interventions would be effective. Full article

Background: Transitioning from hospital to home presents substantial challenges for patients with chronic obstructive pulmonary disease (COPD), often leading to difficulties maintaining self-management, functional independence, and psychological well-being after discharge. Although transitional care programs are increasingly implemented, their effects on multidimensional patient-centered outcomes remain insufficiently examined. This study aimed to evaluate the effectiveness of a nurse-coordinated transitional care service for patients with COPD during the transition from hospital to home and to examine its broader implications for improving continuity of care and patient-centered outcomes within the healthcare system. Methods: This randomized controlled trial was conducted in three university hospitals in South Korea between November 2022 and December 2024. A total of 465 patients were randomly assigned to either a nurse-coordinated transitional care intervention group or a usual care group. The intervention included structured self-management education during hospitalization, post-discharge home visits, and follow-up telephone consultations during the first month after discharge. Outcomes were assessed at baseline, 1 month, and 3 months. Statistical analyses included linear mixed-effects models for continuous outcomes and chi-square tests and independent t-tests for group comparisons. Results: Patients in the Transitional Care Group (TCG) showed marked improvements: disease awareness increased from 27.9% to 94.3% (vs. 35.7% in the Usual Care Group [UCG], RR = 2.64, 95% CI: 2.19–3.18, p < 0.001) and exercise adherence to 76.3% (vs. 43.0%, RR = 1.78, 95% CI: 1.49–2.11, p < 0.001). After adjusting for age, cognitive function declined in both groups but showed significantly smaller decreases in the TCG than in the UCG at 3 months (mean difference = −0.92, p < 0.001), and IADL demonstrated significantly better preservation in the TCG (mean difference = −1.77, p < 0.001). Self-efficacy declined in both groups but remained significantly higher in the TCG (mean difference = 2.65, p < 0.001). Anxiety and depression were significantly reduced in the TCG compared with the UCG (anxiety: −1.45, p < 0.001; depression: −2.72, p < 0.001). After adjusting for age, discharge preparedness and post-discharge management capacity were significantly higher in the TCG than in the UCG (adjusted mean differences = 3.25 and 4.93, respectively; both p < 0.001). Conclusions: These findings indicate that nurse-coordinated transitional care enhances patients’ self-management capacity and improves patient-centered outcomes during the transition from hospital to home. Full article

Background: Human papillomavirus (HPV) is a serious infection which is primarily transmitted through sexual intercourse. Almost 100% of cervical cancers are caused by HPV. Limited awareness of HPV leads to delayed cancer diagnoses, significantly increasing mortality and morbidity rates. Aim: The purpose of this study was to develop strategies to increase awareness of human papillomavirus screening and vaccination among women in Limpopo Province, South Africa. Setting: This study was carried out in the Vhembe District of the Thulamela Municipality of Limpopo Province. Methods: The E-Delphi method was used, and the researcher used a quantitative approach. A total population of 15 nursing managers was part of the study. Questionnaires were used to collect data. Data were analysed using the statistical package for the social sciences version 26. Results: In Round 1, 8 (53.3%) of the 15 participants strongly supported the strategy of updating women with the most recently revised HPV screening guidelines. In Round 2, consensus was achieved, with 14 (93.3%) of the participants strongly agreeing that the development of teaching programmes in healthcare facilities is necessary. This indicates a strong convergence of expert opinion on the importance of structured educational interventions to support the implementation of the strategy. The consensus in this study was defined as ≥70% agreement between participants on each item. Conclusions: The lack of awareness of HPV is concerning because early detection and treatment can prevent serious health problems. The study used the E-Delphi method to assess the effectiveness of strategies to increase awareness of HPV screening and vaccination in women. Contribution: Health policy initiatives may improve public awareness of HPV and vaccination, especially by focusing on educating nurses, which could improve women’s awareness and encourage HPV screening and vaccination. Full article

Background/Objectives: Nursing organizational well-being has important implications for nurses, patients, and healthcare organizations. From a nursing-specific perspective, it arises from the balance between nursing demands and nursing resources in the work environment. However, most available instruments are not grounded in explicit nursing theory and do not allow the identification of well-being profiles through person-centered approaches. This study aimed to develop and evaluate the psychometric properties of the Nursing Organizational Well-being Questionnaire (NOW_Q). Methods: Following COSMIN guidelines, a two-phase design was adopted. Phase 1 involved item generation and expert evaluation, resulting in a 28-item instrument rated on a 5-point frequency scale. Phase 2 consisted of a multicenter cross-sectional study. Construct validity was examined through exploratory and confirmatory factor analyses using cross-validation. Reliability was assessed using ordinal omega coefficients, concurrent validity through associations with a global organizational well-being item, and cluster analysis to explore practical utility. Results: Findings (n = 461 nurses; 7 hospitals) supported an eight-dimension structure: workload, emotional demands, work–family conflict, autonomy, available resources, nurse–nurse relationship, nurse–head nurse relationship, and nurse–physician relationship. The confirmatory model showed good fit (RMSEA = 0.051; CFI = 0.938; TLI = 0.927; SRMR = 0.067), and all dimensions demonstrated satisfactory internal consistency (ordinal omega = 0.75–0.87). Significant associations with global organizational well-being were observed. Three distinct profiles emerged (Nurturing, Observed-Detached, and Withstanding), reflecting different configurations of nursing demands and resources. Conclusions: The NOW_Q is a theory-based, nursing-specific instrument with satisfactory psychometric properties and practical utility for identifying organizational well-being profiles and supporting targeted interventions in clinical settings. Full article

As the population ages and new therapies become available, general practitioners will have a significant role in the early detection, diagnosis, and management of dementia. However, both in Australia and globally, dementia remains under-recognised and under-diagnosed in primary care. The aim of this study is to develop a complex intervention, informed by behaviour change theory, to improve rates of dementia diagnoses in Australian primary care. Co-design participants included GPs, general practice nurses, practice managers and reception staff. A program logic model was used to describe the essential activities and mechanisms of the intervention. Six behaviour changes—education, training, enablement, modelling, persuasion, and environmental restructuring—were identified to address the identified barriers to dementia diagnosis in primary care. The intervention comprises seven activities—peer-led online dementia education and training, geriatrician ‘drop-in’ online support sessions, quality improvement in dementia care sessions, stand-alone videos, auditing and benchmarking, a dementia risk alert tool and a set of dementia diagnosis and management decision-making resources. Using behaviour change theory can assist in the development of complex interventions aimed at changing clinical practice and may assist in their evaluation. Full article

Background: Sleep disturbances are linked to adverse outcomes in postpartum women. While behavioral interventions can potentially improve sleep, research in this area during the postpartum period is limited. This study aims to evaluate the effect of a behavioral education program on sleep quality among postpartum women. Methods: A quasi-experimental design with a pretest–posttest approach was employed, including a control group for comparative analysis. The research was conducted at the Maternal and Child Health Center in Egypt, focusing on the sleep disturbances experienced by postpartum women. The study involved 280 postpartum women (140 in the study group and 140 in the control group) who had given birth within the last two months. Results: Post-intervention, the study group demonstrated significant improvements in all components of sleep quality, with p-values < 0.001. Conversely, the control group experienced a deterioration in sleep quality, with 77.9% reporting poor sleep quality post-intervention. Conclusion: The behavioral education program significantly enhanced sleep quality among postpartum women, suggesting that such interventions should be integrated into maternal healthcare practices to improve postpartum sleep management. Full article

Background: Infants discharged home from a neonatal intensive care unit (NICU) often have multiple ongoing medical needs. The Coached, Coordinated, Enhanced Neonatal Transition (CCENT) program provides nurse navigator-led support for caregivers of high-risk infants through their first year after transitioning from the NICU to home. The objective was to compare health care resource use and costs between CCENT and standard care control groups post-discharge. Methods: Resource use and costs were collected at 4 months and 12 months post-discharge from families enrolled in the CCENT randomized controlled trial across Canada. Infant healthcare utilization and parent mental health service use and costs were analyzed from public health care system and family payer perspectives and were compared statistically between groups and within groups over time. Results: A total of 97 and 105 infants were randomized to the intervention and control groups, respectively. Significant reductions in use of medications and equipment were observed over time in both groups while use of allied health professionals decreased and emergency department (ED) visits increased for CCENT. Annual total healthcare costs per child to the public payer were $4135 (95% CI $2825, $5709) for the CCENT group and $4578 (95% CI $2246, $8356) for controls. The cost of delivering CCENT was $669 per family (SD $362). The average annual out-of-pocket cost per family was $724 (95% CI $467, $1024) for CCENT and $728 (95% CI $479, $1007) for controls. Conclusions: This study indicates the importance of considering patterns of healthcare utilization, program costs and costs to families when implementing NICU to home care interventions. Excluding the cost of a nurse navigator, costs to the healthcare system were not increased in the intervention group. Such a program may help families access appropriate care. Full article

Background: Contemporary pediatric oncology confronts medical staff with challenges that are not only clinical but also ethical and existential in nature. The aim of this study was to identify the cognitive and affective factors associated with medical professionals’ attitudes toward fertility preservation procedures (oncofertility) in pediatric patients. In particular, the association of “existential vacuum” (lack of life goals, sense of meaninglessness), value systems, and religiosity on the level of competence and emotional acceptance of these procedures was examined. Methods: A cross-sectional observational study was conducted between January and September 2024 in pediatric oncology centers in Poland (Gdańsk, Lublin, Łódź, and Poznań). The study group consisted of 62 medical professionals (62.9% physicians and 37.1% nurses) selected using purposive sampling. The research protocol included an Author-Designed Questionnaire, the Scheler Value Scale (SVS), the Life Attitude Profile—Revised (LAP-R), and the Centrality of Religiosity Scale (CRS-15). Statistical analyses comprised Pearson’s r correlations, multiple regression analysis, and cluster analysis using the k-means method. Results: Participants demonstrated a moderate level of substantive competence in oncofertility (M = 2.31 on a 5-point scale). Regression analysis revealed that “existential vacuum” was the strongest negative predictor of competence (B = −0.34; p = 0.001), which was found to be a significant negative correlate of professional development in this area. In the affective domain, a pronounced normative conflict was observed: religiosity was negatively correlated with emotional acceptance of the procedures (r = −0.42; p < 0.001), indicating tension between medical imperatives and worldview-based beliefs. At the same time, the regression model showed that internalized religiosity and moral values might theoretically function as an “axiological buffer”; however, due to the severe psychometric limitations of the emotional acceptance measure (α = 0.268), these affective associations are highly tentative and unstable. Alternative measurement strategies are required to validate this hypothesis. Exploratory cluster analysis suggested the potential existence of two professional profiles: “Axiologically Integrated” staff members and a larger group of “Existential Skeptics”, who exhibited higher “existential vacuum” and lower psychosocial resources. Conclusions: Viewed through a dual-process interpretative lens, a theoretical phenomenon of cognitive–affective dissociation was explored. The highly tentative data suggest that “existential vacuum” might represent a hypothesized barrier to competence acquisition. Furthermore, findings regarding the affective domain—limited by the low reliability of the emotional measure—suggest religiosity could act as a potential source of normative tension. These exploratory profiles serve as hypotheses for future intervention designs rather than definitive clinical mechanisms. Full article

This study aimed to explore and describe the barriers to Antiretroviral Therapy (ART) adherence among children in Ekurhuleni, Gauteng. A quantitative, cross-sectional design using a survey method was employed. Convenience sampling was used to recruit 157 parents, guardians, and caregivers (PGCs) who consented to participate in the study. Data was collected using self-report questionnaires and analysed using descriptive statistics and frequency distributions. The study was not designed or statistically powered to formally test associations between variables; therefore, only descriptive statistical analyses were conducted. The reliability and validity of the instrument were ensured, and ethical clearance was obtained from the relevant authorities prior to data collection. The study was conducted in accordance with established ethical principles and in compliance with the Declaration of Helsinki. The findings revealed that there were multiple barriers to children’s adherence to ART. Approximately one-third of PGCs reported being fully informed about the importance of ART adherence, while the majority indicated being only partially informed. Missed doses emerged as a significant challenge, with a substantial proportion reporting missed medication on one or more days, and only 31.2% administering ART consistently on time. Difficulties in understanding blood test results were also reported. In addition, a notable proportion of PGCs admitted to missing clinic appointments. These findings emphasize the need for strengthened caregiver education, ongoing support, and tailored interventions directed at primary health care nurses to promote consistent ART adherence among children. Full article

Background: Poor or rapid growth velocity in early childhood can have negative long-term health consequences. Early identification of children at risk of growth problems facilitates timely intervention to change growth trajectories and health parameters, but barriers exist to routine screening in primary care. Methods: Experts from general practice, primary care nursing, pediatrics, dietetics, and academic research convened to develop a practical algorithm to support routine growth screening and intervention in children aged 1 to 5 years in primary care. Results: Using a single initial measurement of weight and height in conjunction with risk factor assessment, the algorithm presented here identifies children at risk of poor or rapid growth velocity and provides guidance for intervention and follow-up frameworks. Conclusions: This tool helps to define children in the community setting who are at risk of poor or rapid growth velocity and supports primary care providers in promoting healthy growth trajectories through timely intervention and continued routine growth monitoring. Full article

The current study aimed to investigate complex links among a large set of anxiety-related variables and identify targets for well-being interventions in a large sample of male and female vocational education training students. In total, 28 psychological constructs, such as self-esteem, parental pressure and dissatisfaction and motivation, were assessed in four groups of VET students (mode age: 16). The sample included 3069 females in ASSP schools (nursing and caring); 2108 females and 1772 males in Commerce schools (sales and management); and 2262 males in MELEC schools (electricity and maintenance). We used Gaussian Graphical models (GGMs) that allow for building sparse models of links among multiple variables and detecting targets for interventions via the identification of the most central nodes. We showed gender differences in absolute means for some variables (higher self-esteem and math grades in males; higher anxiety and error sensitivity, but stronger endorsement of mastery approach achievement goals in females), as well as in network structure. GGMs suggested that the key nodes were self-reported math competence for females in the ASSP group, self-regulation for females in Commerce, and mastery approach goals for males in both MELEC and Commerce groups, and that these should be differentially targeted by educational interventions in these populations. Full article