Search Results (321)

Background: Mega-events like the FIFA World Cup (FWC) present unique and substantial challenges for individuals in recovery from substance use disorders (SUDs), primarily by increasing the risk of relapse. We employed a qualitative design using reflexive thematic analysis to explore the behavior of patients with SUDs during the 2022 FWC and to evaluate institutional strategies for mitigating related risks. Methods: We purposively sampled 32 participants who were present at the Naufar Center during the 2022 FWC: (i) thirteen adult patients with SUDs who were receiving treatment, and (ii) nineteen healthcare practitioners. Semi-structured patient interviews were conducted, and focus group discussions were held with a multidisciplinary team, including psychologists, nurses, and physicians. Individuals’ experiences regarding patterns in substance use behavior, environmental triggers, and the effects of institutional interventions were examined. Thematic analysis was employed to identify patterns, risks, and effective strategies. Results: Most patients maintained abstinence and only had cravings for alcohol. Triggers included public celebrations, emotional excitement, and the increased availability of addictive substances. Psychologists and physicians reported signs of behavioral destabilization; nurses observed some behavioral changes and noted logistical challenges. The participants acknowledged the supportive measures provided by Naufar, including the accessibility of clinical services, individualized therapy, social and recreational programming, and protective fan zones, which enabled them to participate in various activities during the event. Conclusions: The 2022 FWC created considerable psychological and environmental triggers for high exposure to alcohol and other substances. The supportive structured activities and tailored interventions were helpful in mitigating the risk of relapse, maintaining treatment engagement and ensuring recovery. Further research is required to explore the implications for recovery-oriented practices during culturally and socially high-risk events. Full article

Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality globally, with low-resource settings, including Ethiopia facing challenges due to limited early diagnostic services. AI-powered electrocardiography (ECG) interpretation has the potential to improve diagnostic accuracy, decentralize care, and support timely clinical decisions, but evidence on healthcare providers’ perspectives and adoption determinants is limited. This exploratory descriptive qualitative study employed 31 in-depth interviews with healthcare providers. Healthcare providers (cardiologists, internists, cardiac and critical care nurses, critical care specialists, and general practitioners) were purposively selected through maximum variation sampling from ten hospitals in four regions of Ethiopia. Data were transcribed verbatim, coded inductively, and analyzed thematically. The data analysis identified six themes: perceived benefit of AI-powered ECG interpretation CDSS, trust development, workflow integration, ethical concerns, functionality, and adoption determinants. Participants emphasized AI’s potential to enhance accessibility, consistency, and diagnostic accuracy while reducing subjectivity and unnecessary referrals. Acceptance relied on high accuracy, reliable data, and rigorous validation, with the technology seen as supportive rather than replacing clinicians. Material resources, human resource readiness, and leadership engagement were key factors for adoption. Recommendations included phased implementation, continuous training, and model expansion to ensure sustainability and clinical utility. The AI-powered ECG interpretation CDSS was viewed as a valuable adjunct for strengthening cardiovascular care in Ethiopia, highlighting the need for context-sensitive strategies, ethical safeguards, and multi-level system readiness for successful adoption. Full article

Background/Objectives: Although prescribing physical activity (PA) is a well-established preventive strategy in primary health care (PHC), its ethical implications remain under-researched. This study examines how general practitioners (GPs) and nurses experience, interpret, and manage ethical tensions in PAP. Methods: A qualitative study was conducted with 28 PHC professionals (13 GPs, 15 nurses) from rural and urban centers in Toledo, Spain (M = 18.4 years of experience). Data were collected through semi-structured interviews and analyzed using reflexive thematic analysis. Beauchamp and Childress’ four-principles framework was applied abductively to synthesize ethical conflicts and coping strategies. Results: Two main themes emerged: (1) Ethical conflicts in PAP, characterized by tensions between autonomy and paternalism, and the challenge of balancing beneficence with non-maleficence under institutional pressures; and (2) Professional coping strategies, where clinicians used relational care, individualized tailoring, and interprofessional collaboration to mitigate moral distress. Results indicated that clinical codes, such as “unrealistic goals” or “institutional pressure,” often overlapped across multiple ethical principles, necessitating a nuanced, multi-dimensional approach to counseling. Conclusions: PAP is not a neutral clinical task but an ethically grounded practice constrained by structural and organizational factors. To move toward safe and equitable health promotion, PAP must be conceptualized as a relational intervention. We propose an Ethical Reflective Tool and a conceptual framework to support clinical reflection, enhance professional accountability, and guide policy-level support for preventive care in PHC. Full article

Background: Mental health needs are rising globally, while workforce shortages constrain access to timely care. Israel launched formal training for Psychiatric–Mental Health Nurse Practitioners (PMHNPs) in 2023 as part of broader efforts to strengthen the public mental health system. This narrative review provides a focused synthesis of international and Israeli literature on PMHNP roles, models of practice, outcomes, and implementation considerations relevant to the Israeli context. Methods: We conducted a narrative, non-systematic literature review of international and Israeli literature on Psychiatric–Mental Health Nurse Practitioners (PMHNPs). Searches were conducted in PubMed/MEDLINE, CINAHL, PsycINFO, and Scopus (January 2000–December 2024), alongside targeted policy and regulatory documents. Eligible sources addressed NP/PMHNP roles, scope of practice, clinical and service outcomes, implementation processes, workforce implications, or policy considerations in high-income health systems. Findings were synthesized thematically. Results: Across the reviewed literature, particularly in primary care and community-based settings, PMHNP/NP-delivered care was generally associated with comparable outcomes on selected quality and safety indicators, alongside improved accessibility, continuity, and high patient satisfaction. Successful implementation depended on regulatory clarity, organizational readiness, interprofessional collaboration, and the development of a clear professional identity. In Israel, the role is emerging within a cautious regulatory framework and may face early barriers related to role ambiguity, variable organizational support, and limited stakeholder awareness. Conclusions: PMHNP implementation may offer an important strategy for strengthening mental health service capacity in Israel. However, the extent of its contribution will depend on regulatory clarity, organizational support, implementation quality, and future empirical evaluation in the Israeli context. Full article

Ongoing health system reforms in Kazakhstan have transformed the working environment of primary health care (PHC) staff and may increase workload and psychosocial stress. This study aimed to assess perceived stress among PHC workers in Almaty and its associations with socio-demographic characteristics and health-related behaviors. A cross-sectional survey was conducted in October–November 2023 across all 36 state-funded PHC facilities in Almaty. General practitioners (GPs) and family nurses employed in these facilities were invited to participate. In total, 1484 respondents completed a standardized questionnaire in Kazakh or Russian administered electronically via Google Forms. Perceived stress was assessed using PSS-10, physical activity using IPAQ-SF, alcohol consumption using AUDIT-C, and tobacco use through items aligned with STEPS/GATS. Statistical analyses were performed using SAS. Associations between variables were evaluated using χ² and Fisher’s exact tests, and multivariable logistic regression models were applied. Statistical significance was set at p < 0.05. Higher stress levels were more common among GPs than nurses (OR = 2.58; p < 0.0001) and less common in younger workers (18–29 vs. 50–59: OR = 0.504; p = 0.017) and alcohol abstainers (OR = 0.587; p = 0.0004). Kazakh ethnicity showed a borderline protective association (OR = 0.472; p = 0.057), while physical activity was not a significant predictor. Perceived stress is highly prevalent in Almaty PHC and disproportionately affects GPs; younger age and alcohol abstinence are protective. The findings support prioritizing organizational measures to reduce role-related burden and maladaptive coping behaviors. Full article

Infection prevention and control remains an essential component of effective healthcare delivery and disease prevention. This study aimed to explore healthcare workers’ perspectives on factors influencing compliance with infection prevention and control practices in Katavi Regional Referral Hospital, Tanzania. With a qualitative approach, we aimed to enable a broader narrative, gain a more detailed understanding of IPC practices, and identify experiences that may be overlooked in a forced-choice questionnaire. A cross-sectional design using a phenomenological approach was employed. An interview guide was used to collect data from 19 participants (five doctors, four nurses, four laboratory practitioners, and six from administration positions; ward in-charges, quality improvement officers and administrative officers) between 24 July 2025, and 23 August 2025. Among participants, nine were the key informants, and 10 were involved in in-depth interviews. Thematic analysis revealed that the availability of IPC supplies, desire for personal and patient protection, high patient volume, awareness of IPC protocols, institutional support, supportive supervision, and HCWs’ attitudes towards IPC activities were factors influencing IPC compliance. Strengthening structured supervision, ensuring a constant supply of IPC materials, and investing in continuous IPC capacity building may be an important approach in enhancing compliance with IPC practices and reducing hospital-associated infection risk in Katavi Regional Referral Hospital and similar resource-limited healthcare settings. Full article

Background/Objectives: To determine the effects of a subconcussive head injury on adolescent student academic achievement assessed by grade point average (GPA). Methods: The study utilised an experimental (subconcussive head injury, n = 45) and a matched pair control group (n = 45). Data were collated at baseline (i.e., the term prior to sustaining a subconcussive head injury) and the term the subconcussive head injury occurred. Subconcussive head injuries were preliminarily assessed onsite by a registered nurse and diagnosed by a general practitioner using established protocol. The average subconcussive head injury occurred 26.93 ± 15.22 days prior to the exam period, which is when all graded assessments/examinations occurred. All participants (N = 90) were adolescent males (age: 14.04 ± 1.48 years) in grades 7–12 (grade: 8.62 ± 1.51). An independent t-test was used to test for potential between group differences at baseline. Separate dependent t-tests were used to test for the effects of a subconcussive head injury on GPA in the experimental group and the effects of time on GPA in the control group. Standardised Cohen’s d with 95% confidence intervals were used to quantify the meaningfulness of the potential between or within group differences. Results: Non-meaningful, non-significant differences were revealed for all variables between the experimental and control group at baseline. A subconcussive head injury resulted in a meaningful and significant decrease in GPA (d = −0.417, 95% CI = −0.720 to −0.110, small, p = 0.008); while a non-meaningful, non-significant increase in GPA occurred in the matched pair control group (d = 0.037, 95% CI = −0.256 to 0.329, trivial, p = 0.808). Conclusions: Our findings provide initial evidence suggesting the need for return to learn protocols to consider subconcussive head injuries. Full article

The COVID-19 pandemic caused major disruption to healthcare education worldwide, forcing rapid transitions to online learning, interruptions to clinical placements, and heightened uncertainty that profoundly influenced student experiences. Given that academic motivation is a key determinant of learning quality, persistence, and professional identity, this review sought to consolidate global evidence on how the pandemic affected healthcare students’ motivation to study. A systematic search of peer-reviewed literature was conducted following PRISMA-ScR guidelines, identifying studies across medicine, nursing, and allied health programs that reported on changes in motivation and the factors shaping these trajectories. Extracted data were synthesized narratively, with attention to emerging themes such as stress, anxiety, burnout, resilience, gender differences, and the role of professional identity formation. Findings revealed substantial variability: while many students reported reduced motivation due to social isolation, technological barriers, and limited clinical exposure, others described increased drive linked to professional responsibility, adaptability, and resilience. Evidence also indicated gendered differences in motivational patterns, with female students more likely to report stress-related declines. Overall, the pandemic exposed both vulnerabilities and strengths in healthcare student motivation, pointing to the value of educational strategies that promote motivation, resilience, and professional identity development among future practitioners. Full article

Medication adherence following myocardial infarction (MI) is essential for effective secondary prevention, yet adherence rates remain suboptimal. Healthcare professionals (HCPs) are central to promoting adherence through clinical decision-making, patient education, and ongoing behavioural support. Understanding how HCPs perceive and experience the factors’ influencing adherence is key to developing effective, context-specific interventions. This study explored HCPs’ perspectives on medication adherence post-MI and identified behavioural determinants influencing medication management across the care pathway. A qualitative descriptive study was conducted using semi-structured interviews with HCPs in the southwest of Ireland. Participants included hospital pharmacists, community pharmacists, general practitioners (GPs), cardiologists, and nurses, recruited through purposive, convenience, and snowball sampling. Interviews were recorded, transcribed verbatim, and analysed using directed content analysis guided by the Theoretical Domains Framework (TDF). Twelve HCPs (eight female) were interviewed between December 2024 and May 2025, including four pharmacists, two GPs, three cardiologists and three nurses. Interviews lasted 30–50 min (mean 41 min). Analysis identified 15 facilitators, 13 barriers, and 7 dual-role determinants across 10 TDF domains. Novel contributions include demonstrating how HCPs’ real-world experiences contextualise adherence issues in the distinct post-MI setting characterised by abrupt care transitions, polypharmacy, and emotional vulnerability and identifying where HCPs feel most constrained and where their expertise could directly inform targeted intervention design. HCPs’ insights reveal complex, context-specific behavioural determinants influencing post-MI medication adherence and highlight the need for multidisciplinary, tailored, and system-level solutions. Enhancing collaboration, supporting patient-centred communication, and addressing resource barriers could empower HCPs to deliver more effective, personalised adherence support and inform the development of targeted intervention strategies. Full article

Background: Digital transformation in healthcare has advanced rapidly in hospitals and primary care, while long-term care facilities have often lagged behind. In nursing homes, nurses play a central role in coordinating care and accessing medical expertise, yet digital tools to support these tasks remain inconsistently implemented. The CareConnect study, funded under the German Model Program for Telecare (§ 125a SGB XI), aimed to develop and implement a multiprofessional telecare system tailored to nursing home care. Objective: This implementation study examined the feasibility, acceptability, and early adoption of a multiprofessional telecare system in nursing homes, focusing on implementation processes, contextual influences, and facilitators and barriers to integration into routine nursing workflows. Methods: A participatory implementation design was employed over 15 months (June 2024–August 2025), involving a university hospital, two nursing homes (NHs), and four medical practices in an urban region in Germany. The telecare intervention consisted of scheduled video-based teleconsultations and interdisciplinary case discussions supported by diagnostic devices (e.g., otoscopes, dermatoscopes, ECGs). The implementation strategy followed the Standards for Reporting Implementation Studies (StaRI) and was informed by the Consolidated Framework for Implementation Research (CFIR). Data sources included telecare documentation, nurse surveys, researcher observations, and structured feedback discussions. Quantitative and qualitative data were analyzed descriptively and triangulated to assess implementation outcomes and mechanisms. Results: A total of 152 documented telecare contacts were conducted with 69 participating residents. Most interactions occurred with general practitioners (48.7%) and dermatologists (23%). Across all contacts, in 79% of cases, there was no need for an in-person visit or transportation. Physicians rated most cases as suitable for digital management, as indicated by a mean of 4.09 (SD = 1.00) on a 5-point Likert scale. Nurses reported improved communication, time savings, and enhanced technical and diagnostic skills. Key challenges included delayed technical integration, interoperability issues, and varying interpretations of data protection requirements across facilities. Conclusions: This pilot study suggests that telecare can be feasibly introduced and accepted in nursing home settings when implemented through context-sensitive, participatory strategies. Implementation science approaches are essential for understanding how telecare can be sustainably embedded into routine nursing home practice. Full article

Contemporary medical practitioners increasingly recognize the critical impact of healing-environment design on patients’ recovery, positioning it as a pivotal consideration in healthcare facility planning. While existing research has predominantly focused on enhancing the functionality and efficiency of healthcare environments, it has often overlooked the significance of individual patient needs and their distinct experiences. This paper aims to utilize the principles of epidemiology and empirical analysis to explore the application and research trends of the patient-centered care (PCC) concept in healthcare facility design, to promote interdisciplinary collaboration and achieve customized healthcare environments. Based on bibliometric analysis and key literature review methods, this paper systematically examines and interprets the research development trends of PCC in healing environment design, integrating both macro and micro perspectives, and reveals how design factors in therapeutic environments support the realization of PCC principles, thereby improving patients’ rehabilitation experiences and health outcomes. The results indicate that current research on PCC is trending towards increasingly diversified integration via high-frequency keywords such as recovery, healing environment, and evidence-based design, highlighting the shift from functional optimization to emotional care, technological integration, and nature-based interactions in design. Notably, patient-centered care has become a consensus and core integrating concept in this field. This paper not only reveals the key role of healing environments in constructing PCC practice pathways but also provides theoretical support and strategic reference for the planning of healthcare spaces and the collaborative design of nursing processes, and demonstrates that healing environments have evolved from passive spaces into active rehabilitation mediums through interdisciplinary collaboration, thereby facilitating the implementation of the patient-centered healthcare philosophy. Full article

Background: Narrative Medicine (NM) has emerged as a strategy to support reflective clinical practice and emotional resilience among nurses. This study examined relationships between NM practices and well-being among registered nurses (RNs) and nurse practitioners (NPs). Methods: A national sample of RNs and NPs was recruited using snowball sampling. Participants completed a NM practice survey and the Mayo Clinic Well-Being Index (WBI) survey. Data were analyzed using descriptive statistics and Pearson correlation coefficients. Results: A total of 3167 responses were analyzed (1934 RNs and 1233 NPs). Among RNs, strong statistically significant correlations were found between NM practices and well-being scores (p < 0.001). Among NPs, moderate correlations appeared in select NM practice dimensions (p < 0.05). Conclusions: Engagement in narrative Medicine practices is associated with improved well-being among nurses and nurse practitioners. NM may present a promising strategy to reduce burnout and strengthen professional resilience. Full article

Background/Objectives: The iBreast Exam (iBE) electronically palpates the breast to identify possible abnormalities. The purpose of this study was to assess iBE feasibility and compare it to Clinical Breast Exam (CBE) for breast lesion detection. Methods: Prospective evaluation of 300 asymptomatic women, ≥18 years old, with CBE, iBE, and mammography was performed. Sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) of iBE and CBE for detecting suspicious breast lesions were calculated using breast imaging as the reference standard. For women with one year follow up, the sensitivity, specificity, PPV, and NPV for cancer detection were calculated. Results: 300 women (mean age 58.9 years) underwent CBE, iBE, and mammography. In 2/300 (0.7%), CBE was positive; in 1/300 (0.3%), iBE was positive; and in 24/300 (8%), screening mammograms were positive. Nine had suspicious imaging findings with biopsy (three malignant and six benign). Of three cancers, all visualized mammographically, CBE and iBE detected an ipsilateral breast abnormality in one woman and missed two cancers (<2 cm). Sensitivity, specificity, NPV, and PPV of iBE and CBE were similar, with no statistically significant difference in NPV or PPV for detection of suspicious breast findings or breast cancer (p > 0.05). Conclusions: Mammography detected all breast cancers in our cohort and remains the standard of care. iBE is feasible to perform. Our pilot data demonstrates iBE performed similarly to CBE by trained nurse practitioners. Given our small study population, further investigation is warranted into the potential use of iBE where trained healthcare practitioners are not readily available. Full article

Background/Objectives: Postoperative Delirium (POD) is a frequent complication in older patients undergoing elective surgery. Although multicomponent interventions are effective, deficits in interdisciplinary communication and intersectoral collaboration persist. This study developed and evaluated the “Geriatric Delirium Pass (GeDePa)”, a paper-based tool to systematically document risk factors for POD across care settings. Methods: A multi-method design was applied, comprising (i) a structured literature review, (ii) semi-structured expert interviews, and (iii) a standardized online survey utilizing the RAND/UCLA Appropriateness Method (RAM). A total of 21 healthcare professionals (general practitioners, geriatricians, anaesthetists, surgeons, and nurses) were recruited from Salzburg, Austria, and South Tyrol, Italy (2023–2024). Results: Healthcare professionals confirmed the GeDePa’s practical applicability for early POD risk detection across care settings. The expert rating using the RAM Disagreement Index (DI) method deemed all 45 risk factors as sufficiently relevant and, with the exemption of two risk factors (alcohol use, intraoperative complications), feasible. A detailed analysis provided a more differentiated picture, with full consensus reached for only 18 items. Several factors with uncertain consensus (e.g., cognitive impairment and polypharmacy) were retained based on strong evidence in the literature. Others were excluded despite high ratings if they were considered redundant or impractical (e.g., detailed intraoperative complications). In total, 38 of the 45 risk factors were retained. Conclusions: The GeDePa is a feasible and relevant tool for structured delirium risk assessment and enhancing interdisciplinary communication between primary and hospital care. The finalized German and Italian versions are now available and will undergo further testing and implementation in clinical practice. Full article

Background: Rural healthcare providers encounter multifaceted barriers including geographic isolation, resource limitations, and provider shortages that impede optimal patient care delivery. The Barriers Experienced in Providing Healthcare Instrument (BTCPI) was designed to assess provider challenges; however, concerns regarding its psychometric properties necessitated comprehensive validation. The primary purpose of the study was to evaluate the structural validity of the instrument using confirmatory factor analysis with a sample of Idaho healthcare professionals. Because the model failed to meet criteria, the study identified a more parsimonious model that then underwent multi-group invariance testing. Methods: A survey consisting of a modified Barriers to Providing Optimal Healthcare instrument and a demographic questionnaire was distributed to Idaho healthcare providers across 22 clinical sites in the state. The structural validity of the modified 41-item, 9-factor instrument was assessed using confirmatory factor analysis (CFA), exploratory structural equation modeling (ESEM), and exploratory factor analysis (EFA). Multi-group invariance testing was also conducted to assess measurement equivalence across provider profession, practice setting (rural vs. urban), and years of experience. Results: A total of 373 healthcare providers completed the survey and were used for analysis. The proposed BTCPI model did not meet model fit criteria. An ESEM analysis was conducted and identified a 9-factor, 14-item model. However, due to fit concerns, an exploratory factor analysis was subsequently conducted and identified the 4-factor, 12-item (BPOC-12) that also met invariance criteria across groups. A group mean and variance differences were found between nurses and primary care providers as well as between rural and urban practitioners on several barrier factors. Conclusions: The BTCPI did not meet model fit criteria. Subsequent model refinement resulted in the BPOC-12, which had preliminary psychometric validity. Although the refined model offered a more condensed and preliminarily valid psychometric framework, future research should be done to assess this model. Future research should also collect responses from different healthcare professions to enhance its applicability. Full article