Search Results (338)

Background/Objectives: Neonatal Intensive Care Units (NICUs) constitute a highly complex clinical environment characterized by patient fragility and frequent ethically sensitive decisions. To date, systematic studies investigating how Italian NICUs address these challenges and what forms of ethics support are effectively available are lacking. The aim of this study is therefore to assess how ethical issues are managed in Italian NICUs, with particular attention to the availability, use, and perceived usefulness of clinical ethics support in everyday practice. Methods: A 25-item questionnaire was developed by adapting an existing tool for investigating clinical ethics activities to the neonatal context. Following expert review by the GIBCE (Gruppo Interdisciplinare di Bioetica Clinica e Consulenza Etica in ambito sanitario), the final instrument covered four areas (general data, experience with ethical dilemmas, tools and procedures, opinions and training needs). A manual web search identified all Italian NICUs and their clinical directors, who were asked to disseminate the survey among staff. Participation was voluntary and anonymous. Data collection was conducted via Google Forms and analyzed through qualitative thematic analysis. Results: A total of 217 questionnaires were collected. The most frequent ethical dilemmas concern quality of life with anticipated multiple or severe disabilities (72.4%) and decisions to withdraw or withhold life-sustaining treatments (64.5%). Major challenges include fear of medico-legal repercussions (57.6%) and communication divergences between physicians and nurses (49.8%). More than half of respondents (52.1%) reported no formal training in clinical ethics, and 68.7% had never developed a Shared Care Plan (Shared Document for healthcare ethics planning) as defined by the Italian Law 219/2017. Conclusions: Findings highlight marked fragmentation in ethical practices across Italian NICUs. On this basis, establishing structured and accessible CEC services could help promote consistency, reinforce shared ethical standards, and support transparent and equitable decision-making in critical neonatal care. Full article

This paper explores recent advancements in end-of-life (EOL) care in Canada, focusing on palliative care (PC) in oncology, advance care planning (ACP), and medical assistance in dying (MAiD). Despite improvements in cancer treatment, cancer remains a leading cause of death in Canada, with patients facing significant physical, psychosocial, and emotional challenges throughout the illness trajectory. Over the past few decades, PC has evolved to address serious illness from diagnosis onward, enhancing symptom management, quality of life, and patient satisfaction, while reducing hospital admissions and unnecessary treatments. However, barriers such as misconceptions about PC, late PC referrals, and limited access to PC, particularly in rural and remote areas, still exist. This perspective paper draws on the authors’ collective clinical and research experience in oncology and PC, complemented by a focused review of key literature. Ongoing education for oncology nurses on EOL care, including on PC, ACP, and MAiD, as well as continued efforts to expand access to PC for all Canadians, are imperative in order to improve the EOL experience for people affected by cancer nationwide. Full article

Objectives: Intensive care units (ICUs) are characterised by high care complexity and nursing workload, which directly affects patient safety and staff sustainability. Latvia faces a chronic shortage of nurses, particularly in intensive care, yet systematic national data on nursing workload have been lacking. This study aimed to quantitatively assess nursing workload in Latvian ICUs using the Nursing Activities Score (NAS) and to evaluate its relationship with staffing adequacy. Methods: A prospective, multicentre observational study was conducted over six months (May–November 2025) in 14 Latvian ICUs representing all three levels of intensive care. Nursing workload was measured using the NAS during each 12 h shift. A total of 28,079 complete NAS observations were analysed using descriptive statistics, inferential tests (t-tests, ANOVA), mixed-effects modelling, regression analysis, and time-series forecasting. Results: The mean NAS was 65.45 (SD = 25.76), equivalent to an average of 15.71 nursing care hours per patient per day. Workload remained similarly high during day and night shifts. Significant differences were observed between ICUs and care levels, with level 2 units showing the highest workload. The average nursing shortage rate was 42.6% and was strongly predicted by NAS values (R² = 0.115), whereas shift type and unit level had minimal explanatory power. Conclusions: ICU nursing workload in Latvia is persistently high and unevenly distributed across units. Staffing levels are not adequately adjusted to actual care demands. Integrating NAS-based workload monitoring into staffing models is essential for evidence-based workforce planning, improving patient safety, and reducing nurse overburdening. Full article

Background/Objectives: Population aging in Europe presents significant healthcare, economic, and social challenges, particularly in the care of individuals with chronic diseases and frailty. Advance Care Planning (ACP) fosters patient autonomy and aligns end-of-life care with individual preferences. This study aimed to evaluate the acceptability and feasibility of an ACP model in nursing homes. Secondary objectives included exploring clinical characteristics of participants and assessing how frailty is associated with residents’ care goals and preferences. Methods: A prospective observational study was conducted among long-term residents of a Spanish nursing home in 2023. ACP was offered to all new permanent residents, with outcomes assessed through quarterly follow-ups. Acceptance rates, care preferences, and resident satisfaction were primary measures. Clinical data, frailty, functional status, cognitive assessments, and nutritional status were analyzed. The model of ACP is structured into three progressive levels: (1) identification of patients’ values, preferences, and global goals of care; (2) decision-making regarding specific clinical interventions in acute situations; and (3) end-of-life care preferences, including preferred place of death, desired companionship, and comfort-focused measures. Results: From 79 new residents admitted, 93.7% accepted ACP. The process required an average of 139 min to complete, distributed over 3–4 sessions. The main documented preferences included do-not-resuscitate orders (CPR) (79%), hospital transfer decisions (50%), and other individualized care choices. When stratified by frailty level, which was categorized as low, moderate, or high—we observed a clear gradient in care preferences. CPR preference increased from 59.3% (Low) to 87.5% (Moderate) and 95.2% (High). Preference to avoid hospital transfer rose from 22.2% to 50.0% and 85.7%, respectively. Avoidance of instrumentalization increased from 56.2% to 85.0% and 95.0%. Conclusions: ACP in nursing homes is highly acceptable and feasible, with benefits in aligning care with patient preferences and enhancing satisfaction. Full article

Background/Objectives: Institutional Special Needs Plans (I-SNPs) are designed to enhance the quality of care for long-term nursing facility (NF) residents. However, utilization patterns vary significantly, and their broader impact remains only partially understood. This rapid review aims to identify, map, and synthesize the existing literature on the use of I-SNPs in nursing homes. Methods: Following Arksey and O’Malley’s framework and PRISMA-ScR guidelines, we conducted a comprehensive search of academic and gray literature using a predefined Boolean string. The extracted data were organized and analyzed thematically. Results: The synthesized literature (n = 12 studies) revealed four primary themes: (1) Market Penetration and Enrollment; (2) Models of Care Application; (3) Impact on Clinical and Financial Outcomes; and (4) Barriers to Utilization. Conclusions: I-SNP utilization represents a shift from fragmented FFS payment models toward integrated managed care within nursing facilities. Evidence shows a reduction in acute care transfers, although findings for other outcomes are mixed, underscoring the need for further research and policy development. Full article

Background: Population ageing and the growing prevalence of chronic diseases, particularly stroke, have negative repercussions on fine motor function, compromising the independence of older adults. The Specialist Nurse in Rehabilitation Nursing plays a central role in functional recovery and in improving quality of life. This study aims to describe the process of developing and validating the design of rehabilitation nursing care for older adults with impaired fine motor function. Methods: This paper is a three-phase methodological study conducted between January and July 2025: (1) initial development of the design of rehabilitation nursing care for older adults with impaired fine motor function; (2) validation of the content of the proposed design, using the modified e-Delphi technique; and (3) development of the final model of the care design. Results: The e-Delphi study, involving a panel of 15 experts, allowed the content validation of the design of rehabilitation nursing care for older adults with impaired fine motor function after two rounds. Following the suggestions, the final care design model, in relation to fine motor function, comprises five steps: (1) collection of relevant data, (2) identification of possible nursing diagnoses, (3) definition of objectives, (4) planning and implementation of interventions, and (5) evaluation of outcomes. As part of step 4, photographic records of exercises focused on the recovery of fine motor function were included. Conclusions: The final model of the design of rehabilitation nursing care for older adults with impaired fine motor function, developed and validated in this study, may serve as a guiding framework in the delivery of specialised care to this population. Full article

Background/Objectives: Conversations about end-of-life care or advance care planning are often difficult and emotionally challenging to initiate. Tailoring messages to the specific audiences can make these sensitive discussions more manageable and effective. The Evidence-based Model for the Transfer and Exchange of Research Knowledge (EMTReK), compromising six core components (message, stakeholders, processes, context, facilitation, and evaluation) offers a structured framework for research dissemination and knowledge transfer in palliative and long-term care settings. Knowledge translation bridges research and practice, with its effectiveness depending on stakeholder engagement, tailored communication, and systematic application of evidence in policy and practice. This study explores stakeholder perspectives on a dementia care intervention, using EMTReK as an analytical framework to examine how knowledge transfer and exchange (KTE) actions were implemented across long-term care settings. Methods: A qualitative analysis was conducted on primary data comprising case narratives from multinational research groups involved in the “Caregiver Decision Support” (mySupport) study (2019–2023). Teams from Canada, the Czech Republic, Ireland, Italy, the Netherlands, and the United Kingdom evaluated the mySupport intervention through interviews, with analysis guided by components of the EMTReK model. Results: Facilitated Family Care Conferences were found to be effective mechanisms for supporting knowledge transfer and intervention uptake in dementia care across nursing homes in Europe and Canada. Despite challenges posed by the COVID-19 pandemic, Family Care Conferences adapted through stakeholder engagement, interactive learning, and innovative communication methods. Using EMTReK as an analytical framework, the research team identified key elements that contributed to successful implementation, including the importance of flexibility to accommodate local contexts. Conclusions: The transnational application of the EMTReK model for advance care planning in long-term dementia care highlights the importance of tailored, culturally relevant knowledge translation strategies, which, despite challenges from the COVID-19 pandemic, were successfully implemented through local adaptations and diverse dissemination methods, emphasising the need for further research on their impact on resident and family outcomes. Full article

Background: Providing complex care and support for people with technology dependence (PwTD) is challenging, even under routine conditions. During disasters, when health and power infrastructure are disrupted, the complex care of PwTD must be maintained under extreme conditions. This research aims to summarize the specific needs of PwTD in disasters and to describe how these needs are addressed in real-life events. Methods: We conducted a scoping review, searching four databases (CINAHL, MEDLINE, PsycInfo, SocINDEX) and the websites of relevant disaster relief organizations. A total of 43 of 2625 screened records were included. Content analysis was used to identify and cluster the needs of PwTD and the response to these needs. Results: Case reports were the most reported types of literature. It was repeatedly stated that PwTD have complex care needs that are often difficult to meet in disaster situations. The review identified three interdependent clusters of needs: clinical and supportive care needs, aids and supply needs, and access needs. The needs of patients and relatives were, as far as the situation allowed, met in accordance with existing plans and guidelines and, where these were found to be inadequate, through creative solutions devised by frontline nurses. Conclusions: We conclude that addressing the complex care needs of PwTD in disasters requires a strategy integrating structural preparedness, professional adaptability, and user participation. Nurses could play a key role in developing and implementing such strategies. This review provides a starting point to develop a more practice-oriented research agenda to achieve inclusive disaster risk management. Full article

Chronic diseases represent one of the most complex, costly, and significant challenges for healthcare systems. The increase in chronic conditions and multimorbidity, together with the growing demand for continuity of care makes the vulnerability of the hospital-to-community transition increasingly evident. This phase is often characterized by delays, fragmented services, and insufficient support for patients and caregivers, leading to higher rates of early readmission and substantial clinical, social, and economic impacts. This paper was developed through a narrative synthesis of international and national literature on continuity of care, integrated models, and nurse-led experiences. Based on this synthesis, an integrated six-phase nursing model is proposed, combining predictive assessment tools and telemedicine to enhance early risk identification, proactive discharge planning, and post-discharge follow-up. Evidence indicates that nurse-led interventions supported by digital solutions can reduce inappropriate hospital days, decrease hospital readmissions, and improve patient and caregiver satisfaction. The integration of predictive tools and telemedicine solutions, coordinated by nurse case managers, represents a promising strategy to strengthen continuity of care and the sustainability of the healthcare system, and the proposed conceptual model highlights practical implications while outlining future research directions for empirical validation and large-scale implementation. Full article

Background: Unsafe care remains a major global health challenge, contributing to millions of preventable deaths and ranking among the top ten causes of mortality and disability worldwide. The World Health Organization’s Global Patient Safety Action Plan 2021–2030 emphasizes the need for strong leadership and system-wide engagement to eliminate avoidable harm. As the largest component of the global healthcare workforce, nurses—especially those in management roles—are essential to achieving these goals. Objective: This narrative review synthesizes global evidence on how nursing management practices, particularly leadership, staffing, and safety culture, influence patient safety outcomes across diverse health systems. Methods: A purposive narrative review was conducted using PubMed, CINAHL, Scopus, and Web of Science databases. Peer-reviewed studies and organizational reports published between 2020 and 2025 were evaluated. A thematic synthesis approach was used to identify patterns related to leadership style, staffing ratios, workplace conditions, and organizational resilience. Quality appraisal followed adapted Critical Appraisal Skills Programme (CASP) and Joanna Briggs Institute (JBI) guidance. Results: A total of 37 peer-reviewed empirical studies were included in the narrative synthesis, along with key global policy and foundational framework documents used to contextualize findings. Evidence consistently demonstrated that transformational leadership, adequate nurse staffing, positive safety culture, and organizational learning structures are strongly associated with improved patient outcomes, reduced errors, and enhanced workforce well-being. Most studies exhibited moderate to high methodological rigor. Conclusions: Nursing management plays a decisive role in advancing global patient safety. Policies that strengthen leadership capacity, ensure safe staffing, promote just culture, and support nurse well-being are critical to achieving WHO’s 2030 safety objectives. Empowering nurse leaders across all regions is essential for building safer, more resilient health systems. Full article

Background: Wireless Vital Parameter Continuous Monitoring (WVPCM) allows the continuous tracking of patient physiological parameters, facilitating the earlier detection of clinical deterioration, especially in low-intensity care settings. The aim of this study is to evaluate the effectiveness of using WVPCM compared to the usual monitoring of critically ill patients hospitalized in Internal Medicine wards. An investigation of the attitude of health professionals towards the use of new technologies in daily practice to improve patient management was also carried out. Methods: The LIght Monitor Study (LIMS) is a prospective, open-label, randomized, multi-center pilot trial comparing WVPCM and conventional nurse monitoring during the first 72 h of hospitalization. A central randomization unit used computer-generated tables to allocate patients to two different types of monitoring. The main outcome was the occurrence of major complications. The study planned to enroll 296 critically ill patients with a Modified Early Warning Score (MEWS) ≥ 3 and/or National Early Warning Score (NEWS) ≥ 5 across two Internal Medicine (IM) Units in Italy. The investigation of the attitude of nurses towards the use of WVPCM was carried out by using a questionnaire and a qualitative survey. Results: Due to the COVID-19 outbreak, the study was interrupted early and only 135 patients (WVPCM = 68; standard care = 67) were randomized. One patient in the control group was excluded from analysis because of drop-out, leaving 134 patients for intention to treat analysis. No statistically significant differences between standard care and WVPCM were observed in terms of major complications (37.5%, vs. 31.2% p = 0.475), in-hospital mortality (17.5% vs. 11.1%, p = 0.309), and median hospital length of stay (9 vs. 10 days, p = 0.463). WVPCM decreased nursing workload compared to the control, as the average time spent by nurses on the detection of vital signs per patient was 0 min per patient per day compared to 24.4 min (p < 0.001) observed in the control group. Twenty-two percent of patients in the WVPCM group (15/68) experienced discomfort with the device, resulting in its removal. The investigation of nurses involved 16 out of 18 people participating in the study. Opinions on the wireless device for patient monitoring were particularly favorable; most of them considered remote monitoring clearly superior to traditional in-person visits and easy to use after a brief practice period. All participants recognized the safety benefits of the system. Conclusions: The reduced sample size of this pilot study does not allow us to draw any conclusions on the superiority of WVPCM compared to standard care in terms of clinical outcomes. However, we observed a positive trend in the reduction of major complications. Full article

Background: Hip fractures in older adults are sentinel events linked to high mortality and functional decline. Few studies have quantified long-term survival probabilities, standardized mortality ratios (SMRs), and risks of new nursing home admission alongside patient-related predictors. Methods: We retrospectively analyzed 355 patients aged ≥ 60 years who underwent hip fracture surgery at a general hospital in Japan (2020–2024). Primary outcomes were mortality and new nursing home admission. Survival probabilities and remaining life expectancy were estimated, and SMRs were calculated using age- and sex-matched national data. Cox regression identified independent predictors. Results: Mean age was 84 years; 76% were female. Mortality probabilities at 1, 2, and 3 years were 23%, 41%, and 60%, respectively; SMRs consistently exceeded 9. Median remaining life expectancy was 260 days. New nursing home admissions occurred in 42%, with cumulative probabilities of 16%, 27%, and 35% at 1, 2, and 3 years, respectively, showing a rapid rise within 9 months. Independent predictors of mortality were delayed surgery, higher Charlson Comorbidity Index, and low Geriatric Nutritional Risk Index. Older age and failure to regain ambulatory ability at 3 months predicted institutionalization. Conclusions: Older adults with hip fractures face persistently high mortality and institutionalization risks, comparable to advanced malignancies or neurodegenerative diseases. Surgical timing, comorbidities, nutrition, and functional recovery critically influence prognosis and should guide perioperative care and discharge planning. Full article

Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that causes severe motor, respiratory and communication impairment and imposes a high psychosocial burden on patients and families. Recent evidence shows that integrated neuropalliative care—early collaboration between neurology and palliative services with community support—improves quality of life and reduces avoidable hospitalisations. Yet there are few descriptions of how such integration is operationalised. Objective: This study examines a Community-Integrated Neuropalliative Pathway (CINP) implemented in the province of Modena (Emilia-Romagna, Italy), analysing how neurology, palliative care and emergency services collaborate to provide continuous, person-centred care for people with ALS. Methods: A single, holistic case study was conducted following Yin’s analytical approach. Data sources included ten semi-structured interviews with neurologists, palliative physicians, nurses, home-care professionals and emergency clinicians; ethnographic observations in the ALS outpatient clinic; relevant organisational documents (the regional Clinical Pathway on ALS); and aggregated quantitative data from the palliative care registry (January 2023–December 2024). Thematic analysis with investigator triangulation was used to explore care integration, advance care planning and emergency coordination. Quantitative data were summarised descriptively. Results: Three interrelated themes were identified: (1) Progressive and flexible integration between neurology and palliative care. Neurologists remained longitudinal reference points while palliative teams were activated in response to evolving needs and became more relevant with the progression of the disease. Regular multidisciplinary meetings and shared discharge planning facilitated coordination. (2) The shared culture of advance care planning. Professionals framed advance care planning (ACP) as a relational, iterative process anchored in therapeutic relationships. Shared care plans, once completed, triggered an electronic Emergency Warning (“warning 118”) procedure that notified the emergency service of patient preferences. (3) The integration of palliative and emergency services. The warning system enabled emergency clinicians to respect care plans and avoid aggressive interventions during crises. Quantitative data on 47 ALS patients followed by territorial palliative services showed that 16 had an active Emergency Warning flag; among these, most died at home or in a hospice rather than in hospital. Conclusions: The Modena CINP exemplifies how a public health system can operationalise early neuropalliative integration and connect hospital, community and emergency services. The qualitative findings illustrate the cultural and organisational shifts required for continuous care, while the quantitative data show that the system is correctly used and that patients with the Emergency Warning activation died mostly at home or in a hospice. Lessons from this analytical case study can inform the development of similar pathways in other regions, although further research is needed to assess outcomes in larger populations and such models need to be adapted to local contexts. Full article

Background/Objectives: Inefficient postoperative handovers contribute to medical malpractice and care discontinuity by omitting critical patient information and compromising patient health. This study aimed to evaluate and compare the quality of postoperative nurse handovers in ORs, PACUs, ICUs, and wards across four hospitals in Jeddah, Saudi Arabia. Methods: A descriptive, cross-sectional, comparative study was conducted among postoperative care nurses across four hospitals in the second health cluster in Jeddah, Saudi Arabia. Data were collected through an online questionnaire to assess handover quality via a Handover Quality Rating Form and sociodemographic information. Data analysis was performed using SPSS v28. Results: Among the 521 nurse participants (84.1% female, M_age = 34.5 years), the overall postoperative handover quality was 76.8%, with handover conduct and quality scoring the highest (27.9 ± 4.8 and 17.7 ± 3.1, respectively). Female nurses demonstrated significantly higher performance in teamwork and handover circumstances, whereas older nurses demonstrated significantly better teamwork, handover conduct, and quality. Saudi and younger nurses experienced significantly higher handover circumstances. Nurses’ educational level and years of experience in the present ward were significantly correlated with handover circumstances, conduct, and quality. Handovers from the theater to recovery resulted in higher average circumstances than those from recovery to the ward. The study setting was significantly associated with handover quality. Conclusions: These findings highlight the importance of local evaluating the handover quality of nurses in various contexts, specifically considering the circumstances, conduct, and teamwork when planning implementation and developing standardized handover protocols for different departments, specialties, and healthcare settings. These results support the development of targeted training programs and unit-specific handover protocols. Full article