Search Results (1,977)

Background/Objectives: The COVID-19 pandemic exerted unprecedented pressure on healthcare professionals and systems worldwide. To manage this increased demand, hospitals extended working hours, resulting in increased strain on workers and impacting their professional well-being. Simultaneously, the numerous deaths due to illness meant that healthcare professionals did not have sufficient time to process grief, which may have led to unresolved grief and other mental health problems. The aim of this study was to understand the experiences of loss and grief and their repercussions on Brazilian healthcare professionals working on the front lines during the COVID-19 pandemic. Methods: This qualitative study followed Charmaz’s constructivist grounded theory. The study used the COREQ checklist. Between August 2024 and January 2025, 24 healthcare professionals who worked on the front lines during the COVID-19 pandemic were interviewed via telephone. Participants were primarily female (n = 14) with a mean age of 42 years (SD = 9.13). Interviews were audio-recorded and transcribed. Results: The core phenomenon that emerged from the analytical process is “between exhaustion and resilience in a war-like scenario: challenges and opportunities in the care provided by frontline professionals during the COVID-19 pandemic”. This main axis was anchored in three categories: (1) adversities imposed by COVID-19 on the functioning of health services; (2) witnessing sudden deaths and the physical absence of families; (3) reconstruction of meanings and personal and professional growth. Conclusions: The experience of grief was intensified by the peculiarities permeating the death process in the pandemic context and the modification of farewell moments. The study exposes a need for training programs focused on medical, nursing, psychological, and other areas of care education that involve not only understanding clinical issues but also recognizing loss and grief as an integral part of care processes. Importantly, legislators should allocate additional resources to services that provide psychological support to healthcare professionals, in order to promote their adaptive coping. Full article

Background: Erectile dysfunction (ED) is a common complication of type 2 diabetes and obesity and significantly affects patients’ quality of life. Nursing care for patients with metabolic multimorbidity requires a holistic, structured approach. The International Classification for Nursing Practice (ICNP^®) enables standardized formulation of nursing diagnoses, interventions, and outcomes and supports structured and individualized ICNP^®-based care planning. Aim: This study aimed to develop and present an ICNP^®-based nursing care plan for a patient with erectile dysfunction associated with type 2 diabetes and obesity and to demonstrate the applicability of ICNP^® in holistic nursing management of chronic disease. Methods: A descriptive single-case study was conducted in 2025 in a cardiology ward in Poland. Data were collected using a nursing interview, observation, medical documentation analysis, and standardized tools (IIEF-5, SF-36v2). Based on a comprehensive assessment of physical, psychological, and social status, nursing diagnoses, interventions, and expected outcomes were formulated according to ICNP^® terminology. Results: The patient presented with poorly controlled diabetes, class I obesity, moderate erectile dysfunction, reduced testosterone levels, and decreased quality of life, particularly in psychosocial domains. Key ICNP^® nursing diagnoses included erectile dysfunction, deficient knowledge, obesity, disturbed psychological status, impaired endocrine function, impaired cardiovascular function, and impaired adaptation. Individualized ICNP^®-based interventions focused on metabolic control, lifestyle modification, sexual health support, education, and psychosocial support. Implementation of the care plan was associated with improvements in health behaviors, disease knowledge, and psychological well-being. Conclusions: ICNP^® provides a useful framework for structured and comprehensive nursing care in patients with diabetes-related erectile dysfunction and multimorbidity. Case-based ICNP^® care planning supports holistic management, interdisciplinary collaboration, and quality improvement in chronic disease nursing. Full article

Cognitive load theory-informed curriculum design in health sciences education refers to the purposeful organisation of teaching strategies and learning materials based on the principles of Cognitive Load Theory (CLT), a framework developed by John Sweller in the late 1980s. CLT is grounded in cognitive psychology and recognises that the working memory has a limited capacity for processing new information. It identifies three types of cognitive load: intrinsic load, which refers to the inherent complexity of the material being learned; extraneous load, which results from ineffective instructional design or irrelevant information; and germane load, which reflects the mental effort directed toward understanding, integrating, and organising information into long-term memory. In health sciences education, students frequently engage with tasks that require the simultaneous processing of multiple interacting elements, placing high demands on working memory at specific points in time. This includes foundational biomedical sciences such as anatomy, physiology, and pathophysiology extending to applied clinical skills, diagnostic reasoning under uncertainty, health service management within complex systems, and ethically grounded decision-making. Without thoughtful instructional design, learners may be overwhelmed by excessive information and cognitive demands, which can hinder understanding, retention, and performance. Applying CLT-informed strategies, educators can reduce unnecessary cognitive burden, sequence learning activities to align with learners’ cognitive capacity, and promote deeper learning. This approach supports more effective knowledge acquisition and transfer and is particularly valuable in content dense academic environments such as medicine, nursing, allied health education, public health and health service management education. Therefore, integrating CLT-informed principles into curriculum design can help optimise learning experiences and support the development of competent health professionals. Full article

Background: This study develops a transparent, decision-focused framework that integrates the World Health Organization’s defined daily dose (DDD) standard with the planned-backorder economic order quantity (EOQ) model to manage nursing and pharmacy workflows within a unified economic and operational scale. Method: Demand was expressed in DDD per year, and process-based costs were monetized according to National Health Service (NHS) workflow steps, where the holding cost was computed as H = r × cu and the delay cost B was derived from the target fill rate via a closed-form shadow-price relationship. The model was calibrated for a typical NHS acute-care hospital with 600 beds (D ≈ 130,305 DDD/year). Results: Calibration resulted in an ideal order quantity of 7554 DDD, an inter-order interval of 21 days, and a minimum annual total cost of £451. In the national conceptual scenario, the fill rate is about 99.4%, and the minimum annual total cost is £26,366. At this optimum, cost components are symmetrically balanced, with order cost and combined holding–delay cost contributing equally. Conclusions: This repeatable framework, based on the DDD scale, enhances management visibility regarding the cost–service balance, thereby confirming the policy’s robustness. Full article

Background: Tuberculosis (TB) remains a major public health challenge globally, particularly in high-burden countries such as South Africa. Treatment interruption is a critical barrier to effective TB control, contributing to poor treatment outcomes, increased risk of multidrug-resistant tuberculosis (MDR-TB), and continued community transmission. Understanding the determinants of treatment interruption in rural healthcare settings is essential for strengthening TB programme implementation. Methods: This qualitative study explored the factors influencing TB treatment interruption from the perspectives of professional nurses working in primary healthcare facilities in the Nyandeni Subdistrict, Eastern Cape, South Africa. Semi-structured interviews were conducted with nurses involved in TB programme implementation. Data were analysed using thematic analysis following the six-phase approach described by Braun and Clarke. Descriptive statistical analyses were also used to summarize participant characteristics, including age and years of nursing experience. Conceptual frameworks were developed to illustrate the multilevel determinants of TB treatment interruption. Results: Participants had a mean age of 40.6 years and an average of 14.2 years of nursing experience, reflecting a workforce with substantial clinical exposure to TB management. Thematic analysis identified multiple interconnected determinants of treatment interruption. Key barriers included poverty, food insecurity, transport costs, long distances to healthcare facilities, limited family support, and challenges related to patient tracing. These factors interact across structural, community, health system, and interpersonal levels to influence patient adherence behaviour. Conceptual models developed from the findings illustrate the complex pathways through which these determinants contribute to treatment interruption and programme-level consequences such as reduced treatment success and increased risk of MDR-TB. Conclusions: TB treatment interruption in rural settings is driven by multilevel socioeconomic and health system determinants rather than individual patient behaviour alone. Strengthening community health worker programmes, improving patient tracing systems, addressing socioeconomic barriers, and enhancing community-based support mechanisms are essential for improving treatment adherence. Integrated, multisectoral interventions are required to strengthen TB programme outcomes in rural high-burden settings. Full article

Transgenerationality refers to the psychological and behavioral elements transmitted across generations. It is intrinsically linked to unelaborated content—such as trauma, grief, secrets, conflicts, and shame—operating through implicit and partially unconscious pathways that manifest in individual behavior. In the context of nursing, transgenerationality explores how nursing care is influenced by these dynamics and how the concept can be utilized to achieve superior health-related outcomes, such as facilitating more effective healthcare transitions. Specifically, it examines how experiences, vulnerabilities, resilience factors, and health-related patterns transmitted across generations affect overall health. As a humanistic profession rooted in person-centered care, nursing must remain cognizant of the impact of this concept on healthcare. This is particularly relevant in clinical settings where nurses are pivotal practitioners, such as mental health, health literacy, chronic disease management, and healthcare transitions. Healthcare transitions represent critical periods in a person’s life, and nurses are present across all contexts to facilitate these shifts. A primary example is the transition from hospital to home, which illustrates the importance of understanding transgenerationality within the roles of both patients and caregivers. Understanding how this concept impacts healthcare allows for the perception of transition as a holistic process. Awareness of these transgenerational operations leads to more personalized care, fostering healthier and more seamless healthcare transitions. The general purpose of this paper is to define and operationalize the concept of transgenerationality within nursing care, emphasizing its critical role in achieving better health outcomes, particularly during hospital-to-home transitions. Full article

Buildings represent 40% of the European Union’s energy consumption and 36% of its greenhouse gas emissions. Nursing homes are among the buildings that consume the most energy. The objective of this study was to make predictive models of Energy Consumption, Energy Costs, and CO₂ Emissions in nursing homes using different variables. To do this, data from 20 public nursing homes located in Extremadura (Spain) during the 2019–2023 period were analyzed. All the buildings were built or renovated between 1995 and 2009; the useful area and the number of residents were in the range of 1332–10,880 m² and 24–254 residents. A statistical analysis was performed using multivariable linear regression. During the research, equations that allow for the estimation of the annual Energy Consumption, Energy Costs and CO₂ Emissions of nursing homes, according to the useful area and number of residents, were found. The R_adj² was 0.9710, 0.9744 and 0.9742, respectively. The quality of the models obtained was contrasted using the mean absolute error (MAE), the relative error (RE) and the root mean square error (RMSE), together with the assessment of multicollinearity through the Variance Inflation Factor (VIF). The findings of this study may prove beneficial for stakeholders within the elder care sector. Full article

Background/Objectives: Effective information seeking is essential for new graduate nurses’ adaptation to the workplace. The objective of this study was to identify how nurse managers and senior nurses support new graduate nurses’ information seeking and the expectations underlying such support. Methods: Nurse managers and senior nurses from Japanese hospitals participated in semi-structured interviews. Data were analyzed using qualitative content analysis by coding meaningful units, grouping similar codes into subcategories, and organizing them into broader categories. Ethical approval was obtained from the research ethics committee of the first author’s institution, and written informed consent was obtained from all participants. Results: Participants included twelve nurse managers from five hospitals and fourteen senior nurses from three hospitals. The nurse managers had an average of 7.4 years of supervisory experience, and the senior nurses had an average of 14.2 years of clinical experience. Participants expected new graduate nurses to demonstrate appropriate attitudes toward seeking information, engage in proactive communication to express their needs or uncertainties, take initiative in seeking and obtaining information, and build relationships with senior nurses that would facilitate information seeking. To support these expectations, participants adopted approaches that encouraged information seeking, proactively provided necessary information, and promoted information sharing among peers. Nurse managers also sought to create a work environment in which all staff members collectively nurtured new graduate nurses. Conclusions: To facilitate information seeking among new graduate nurses, nurse managers and senior nurses need to foster a supportive work environment. They also need to recognize the information content, sources, tactics, and timing appropriate for new graduate nurses. Full article

Background/Objectives: Patient satisfaction and supportive care are key quality indicators in certified Head and Neck Cancer Centers (HNCC). We assessed patient-reported experiences across diagnostic staging and surgical treatment pathways, focusing on discharge management and supportive service integration. Materials and Methods: In this prospective cross-sectional study, 84 inpatients were surveyed at the time of hospital discharge after diagnostic tumor staging (n = 45) or surgical treatment (n = 39) at a German tertiary HNCC. Phase-specific standardized questionnaires with five-point Likert scales were analyzed using Pearson’s chi-square and Fisher’s exact tests. Associations of sex and treatment intensity with satisfaction and supportive care utilization were explored descriptively and in an exploratory manner. Results: Overall ratings were high across both cohorts for admission processes, inpatient organization and medical and nursing care, with no statistically significant between-group differences (p > 0.05). Information regarding diagnostic and perioperative procedures was rated very positively in both groups. Discharge-related items were generally favorable. However, patients who underwent surgery reported greater uncertainty and lower reported utilization of formal discharge management. This difference did not reach statistical significance (p = 0.0559) and should therefore be interpreted as a non-significant trend toward less positive evaluation compared with diagnostic patients. Supportive services were rated predominantly good to very good by users (>95% positive ratings). Utilization differed by treatment intensity: Speech therapy was more frequent in operative patients (p < 0.001) and social work counseling was offered and utilized more often in patients undergoing extensive surgery (p = 0.042 and p = 0.027, respectively). Overall dissatisfaction was strongly associated with perceived deficiencies in information on diagnostic procedures and tumor-related counseling (both p < 0.001), whereas waiting time for surgery was not associated with negative overall ratings. Conclusions: Patient satisfaction was consistently high across diagnostic and surgical pathways. Adequate, transparent and repeated information, particularly on diagnostics and tumor counseling, was strongly associated with higher overall satisfaction, whereas objective timing metrics were not associated with negative ratings. Discharge management may represent a sensitive transition point, particularly after extensive surgery and may therefore be a relevant target for further optimization and proactive integration of supportive care services. Sex-specific findings were limited and should be interpreted cautiously due to small subgroup sizes. Full article

Background/Aim: Cardiovascular disease (CVD) represents a relevant global public health challenge with dyslipidemia as a major modifiable cardiovascular risk factor (CVRF). Recent advances have introduced injectable lipid-lowering therapies (LLT). Their clinical effectiveness in real-world practice seems to depend not only on pharmacological efficacy but also on patients’ acceptance, adherence, and persistence, influenced directly by perceived barriers and facilitators. The main objective of this scoping review is to map the barriers and facilitators related to the use of novel injectable LLTs among adult patients with dyslipidemia or CVD. Methods: This review was conducted in accordance with JBI methodology and reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for scoping reviews (PRISMA-ScR); pre-registration on Open Science Framework (OSF) was performed. A search was conducted in MEDLINE from PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL) from EBSCOhost, and Google Scholar up to June 2025. Eligible studies included qualitative, quantitative, mixed-methods, and review papers involving adult patients with dyslipidemia who reported experiences, perceptions or challenges related to the use of injectable LLT in any healthcare or community setting worldwide. Two reviewers independently screened studies, selected and extracted data. Results: Out of 665 records identified, 7 studies met the inclusion criteria. Patients’ adherence to injectable LLTs is shaped by psychological fears, prior negative experiences, and perceived efficacy. Satisfaction increases when patients feel supported and informed. Convenience, self-administration, and motivational meaning facilitate persistence. Organizational support and economic accessibility further influence uptake, highlighting that adherence depends on both patient experience and structural factors. Conclusions: Patient acceptance and persistence with injectable LLT depends on a complex interplay of emotional, clinical, organizational and economic factors, beyond pharmacological efficacy alone. Fear of injections, previous statin-related experiences, administrative complexity, and high costs remain major barriers, while shared decision-making, trust in healthcare providers, perceived efficacy, regimen convenience, and supportive structures act as strong facilitators. Addressing these challenges requires multidimensional and multidisciplinary strategies for policy makers and clinical managers. Full article

The cessation of recurrent anthropogenic activities can promote vegetation succession. In this paper, we report a case study of passive restoration of the herbaceous plant vegetation associated with cork oaks carried out by citizens in collaboration with local farmers in a suburban area of Rome (Italy). A sampling design has been carried out in two comparable patches using replicated plots: (i) a first patch corresponding to the passive restored area, evolving from an uncultivated field towards a cork oak forest, where the mowing activity was stopped in 2017, and (ii) a second patch corresponding to an uncultivated land periodically mowed as a control. We recorded 24 plant species in the restored patch and 9 in the control patch. The Shannon-Wiener diversity index was significantly higher in the restored patch when compared to the control. Whittaker diagrams, graphically representing evenness, showed significant differences among plotted values. The Chao 2 richness estimators evidence the differences between patches (52.17 species vs. 9), graphically observed in the sample rarefaction curves. An analysis in the 2017–2025 period showed a substantial increase in NDVI values in the restored patch (from 0.18 in 2017 to 0.28 in 2025; approximately +54% relative to 2017; mean NDVI increased from 0.181 in 2017 to 0.29 in 2025), indicating an increase in cover/biomass associated with the post-2017 restoration of the area. Suspending mowing, both humidity (due to the reduction in grass cover) and nutrients increase, and the pH is reduced (Ellenberg indices): it is possible that the young oak trees are comparatively more effective cation exchangers. Therefore, only a few years after mowing was suspended, we observed a marked recovery not only of the dominant cork oak component but also of the herbaceous species (Vulpio-Dasypyretum villosi association). Even young, isolated cork oak trees can act as nurse plants (or keystone structures), supporting many species and creating microhabitats for shade-tolerant plants. This passive restoration began when local citizens and a school asked landowners to stop mowing in an area where cork oaks were naturally regenerating, making it an example of autonomous citizen-led environmental management. Full article

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

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