Search Results (212)

Background/Objectives: Members of the LGBTQ+ community often have poorer health outcomes and less access to health services than cisgender and heterosexual populations, and many healthcare professionals remain insufficiently aware of the barriers faced by these patients. Community nurses, given their skills and competencies, can help patients overcome barriers and achieve greater inclusion. The aim of this project is to identify the barriers and facilitators detected by the primary care nursing team of the Málaga-Valle del Guadalhorce Health District (MVGHD) when providing holistic care to LGBTQ+ individuals. Methods: A sequential explanatory mixed-methods design (DEXPLIS) will be employed to robustly combine a quantitative baseline of professional attitudes with an in-depth qualitative exploration of institutional discourses. Phase I consists of a pilot cross-sectional study with cluster allocation of questionnaire versions in which primary healthcare nursing staff in the MVGHD will complete the validated Sexuality Attitudes and Beliefs Survey (SABS) with one group completing a version framed around LGBTQ+ patients and the other around the general population. Phase II consists of a qualitative descriptive study based on discourse analysis (DA) using in-depth semi-structured interviews, analyzed with ATLAS.ti 23. Conclusions: This study protocol is expected to provide an empirical framework to identify potential institutional barriers and attitudinal biases in nursing care, highlighting the potential need for targeted training programmes in sexual and reproductive health. The resulting protocol aims to contribute to health equity by offering practical resources to optimize ongoing clinical education in primary care settings. Full article

Background: Patients with cystic fibrosis frequently require repeated courses of intravenous antibiotic therapy, resulting in cumulative vascular injury, progressive depletion of peripheral venous access, and increasing complexity in long-term vascular access management. Integrating structured vascular access planning into multidisciplinary care pathways has become increasingly important for preserving venous capital, optimising vascular access decision-making, and ensuring continuity of care. Objective: To describe the development and implementation of an Advanced Practice Nursing-led multidisciplinary vascular access care pathway for patients with cystic fibrosis requiring prolonged intravenous therapy. Methods: A practice-based descriptive analysis of a multidisciplinary vascular access pathway was conducted, incorporating ultrasound vascular assessment, structured clinical decision-making, and coordinated care across the Emergency Department, Cystic Fibrosis Unit, Vascular Access and Infusion Team, Hospital Pharmacy Service, and Hospital-at-Home Programme. An illustrative patient example was used to demonstrate pathway implementation in routine clinical practice. Results: Pathway implementation illustrated the feasibility of integrating ultrasound-guided vascular assessment, evidence-informed selection of vascular access devices, and coordinated home-based intravenous therapy within a multidisciplinary care model. Ultrasound-guided vascular assessment identified a suitable upper-arm basilic vein despite severe peripheral venous depletion. An Advanced Practice Nurse successfully performed ultrasound-guided midline catheter insertion, achieving first-attempt cannulation and no immediate complications. The illustrative patient completed four weeks of home-based intravenous antibiotic therapy without observed catheter-related infection, thrombosis, occlusion, catheter dysfunction, or unplanned hospital readmissions. The patient reported satisfaction with the treatment experience and the ability to maintain daily activities throughout treatment. Conclusions: This study describes and clinically contextualises an APN-led multidisciplinary vascular access care pathway for patients with cystic fibrosis requiring prolonged intravenous therapy. The illustrative patient demonstrated the feasibility of applying the pathway in routine clinical practice. Further prospective multicentre studies are required to evaluate its effectiveness, safety, reproducibility, and broader applicability. Full article

Objectives: To describe and compare decadal antibiotic prescribing patterns and trends by diagnosis groups among ophthalmology inpatients at two private-sector hospitals in Central India. Methods: This observational surveillance study was conducted prospectively for a decade in the ophthalmology inpatient departments of a teaching hospital (TH) and a non-teaching hospital (NTH). Patient-level data on demographics, diagnoses, and antibiotic prescriptions were collected by nurses using a standardised form. Antibiotic utilisation was analysed using WHO’s Anatomical Therapeutic Chemical (ATC) codes and Defined Daily Doses (DDDs), as well as AWaRe groups (Access, Watch, Reserve). Diagnoses were classified into infectious and non-infectious categories, and surgical and non-surgical groups. Prescribing trends were analysed using descriptive statistics and linear regression models. Results: Of 7561 patients (TH: 7305; NTH: 256), antibiotics were prescribed to almost all inpatients (TH: 99%; NTH: 90%). Fluoroquinolones were the most prescribed (TH: 94%; NTH: 71%), predominantly by the oral route (73%). Access-group antibiotics were considerably under-prescribed relative to WHO targets (TH: 3%; NTH: 4%). Watch-group antibiotics comprised 97% (TH) and 96% (NTH) of all prescribed antibiotics, and their prescribing increased significantly over 10 years (p < 0.05). Conclusions: Watch-group fluoroquinolones dominated antibiotic prescribing at both hospitals and increased over the study period. Access-group antibiotics were substantially underutilised. These findings highlight an urgent need for context-specific antibiotic prescribing guidelines and stewardship programmes in ophthalmology settings in LMICs. Full article

Purpose: Breast cancer has been recognised as a chronic condition, with survivors experiencing long-term physical and psychosocial effects following treatment. Supporting breast cancer survivors to self-manage their health can optimise health-related quality of life and reduce symptom burden. Self-management education (SME) has been advocated at the policy and programme level in Australian primary care, but its uptake is often limited. This study explores healthcare professionals’ (HCPs) experiences and perceptions of SME in primary care, aiming to identify factors influencing its implementation and to support survivorship care for breast cancer survivors in Australia. Methods: A qualitative descriptive approach was adopted involving in-depth semi-structured interviews. Convenience sampling was used to recruit HCPs across the three primary care clinics in the Greater Brisbane area. The interviews were conducted based on an interview guide. Each interview was audio-recorded and transcribed verbatim. Descriptive content analysis was used to analyse the data. Results: Fourteen participants were interviewed across three primary care settings, including five general practitioners and nine registered nurses. Three categories were synthesised from the data: (1) Meaning and role of SM/SME; (2) Suboptimal SME in current practice; (3) Perceived factors impacting SME delivery in practice. Each category had two to six subcategories for the participants. Conclusions: The findings highlighted the importance and perceived benefits of SME for breast cancer survivors and HCPs in Australian primary care. However, the integration of SME into primary care remained suboptimal due to a combination of systemic, organisational, and healthcare provider factors. Evidence-based resources, particularly guidelines and training, are essential to equip HCPs to effectively integrate SME into routine care for breast cancer survivors. Full article

Background: Implanted port catheters are widely used in oncology care to provide reliable long-term venous access. Safe management of these devices requires adequate nursing knowledge to prevent complications such as catheter dysfunction, infection, and chemotherapy extravasation. Despite their clinical importance, previous studies have demonstrated considerable deficiencies in nurses’ knowledge regarding implanted port catheter care. This study aimed to evaluate the short-term effect of a structured educational intervention on nurses’ knowledge of implanted port catheter management. Methods: A single-group pre–post quasi-experimental study was conducted in a public hospital in Istanbul, Türkiye, in July 2025. One hundred and one registered nurses completed the pre-test, and 73 participants who completed both assessments were included in the paired analysis. Participants attended a standardized evidence-based educational session covering port catheter insertion, maintenance, complication prevention, and extravasation management. Knowledge was assessed immediately before and after the intervention using a 20-item Port Catheter Knowledge Assessment Form. Data were analysed using the Wilcoxon signed-rank test and McNemar test. Results: The mean knowledge score increased significantly from 9.72 ± 6.14 before the intervention to 15.12 ± 1.97 after the intervention (p < 0.001), representing a large effect size (rank-biserial correlation = 0.883). Statistically significant improvements were observed in 15 of the 20 knowledge items following the educational intervention (p < 0.05). Conclusions: The educational intervention was associated with significant short-term improvements in nurses’ knowledge of implanted port catheter management. These findings support the value of structured educational programmes for improving knowledge; however, further studies are needed to determine whether these gains are sustained over time and translate into improvements in clinical practice and patient outcomes. Full article

Background/Objectives: Chronic heart failure (CHF) is a leading cause of global morbidity and mortality, particularly among older adults, significantly impacting their quality of life and imposing a substantial economic burden. While pharmacological and surgical treatments remain essential, non-pharmacological interventions led by nurses are gaining prominence due to their comprehensive approach and biopsychosocial impact. The objective of this study was to synthesise and integrate such interventions for community-dwelling older adults with CHF. Methods: An integrative review was conducted in accordance with the Joanna Briggs Institute protocols and the PRISMA statement, utilising a systematic search across databases including PubMed and Cochrane. Qualitative, quantitative, and mixed-methods studies evaluating non-pharmacological interventions in the home setting were included, whilst those targeting non-specific populations were excluded. Following a rigorous screening process, 12 studies were selected, and their methodological quality was appraised based on study design. Results: The 12 included studies involved a total of 2466 participants and addressed interventions across the domains of education, physical activity, telehealth, and nutrition, with programme durations ranging from 4 weeks to 16 months. Notable improvements were observed in physical capacity, cognitive function, quality of life, and self-care capabilities, alongside potential reductions in hospitalisations reported in some studies. However, considerable methodological variability was identified across the literature. Conclusions: This review synthesises non-pharmacological nursing interventions for older adults with CHF, demonstrating varied benefits across multiple biopsychosocial domains. The findings emphasise the critical need for further research to evaluate the economic viability of these programmes and to adapt interventions to enhance the delivery of community-based care. Full article

Background/Objectives: This study aims to describe the experiences of healthcare professionals collaborating with Intercultural Mediators (IMs) in the care relationships with migrant patients. Methods: This study is a qualitative descriptive study. A total of 13 healthcare professionals (9 nurses and 4 physicians) working in two public hospitals in Italy participated in face-to-face semi-structured interviews between June and July 2024. Interviews were audio-recorded, transcribed verbatim and analyzed using inductive qualitative content analysis. Results: Three main categories emerged: (1) the experience of healthcare professionals in the relationship with migrant patients; (2) the linguistic and intercultural mediator as a supportive relational role; and (3) limitations in language and intercultural mediation. Participants described difficulties in mutual understanding due to cultural and linguistic barriers and emphasized the central role of the mediator as a bridge between diverse cultural worlds. IMs were described as essential in promoting trust, improving therapeutic adherence, and supporting culturally sensitive communication. However, organizational challenges included limited availability of IMs, poor integration into clinical teams, and the lack of structured, continuous support system. Conclusions: IMs are perceived as key actors in facilitating communication, trust, and therapeutic adherence with migrant patients. Yet their integration within healthcare teams remains underutilized due to organizational barriers. The findings inform managers and policymakers about the necessity of structurally integrating IMs within clinical teams and implementing intercultural competence programmes to ensure equitable and culturally sensitive care for migrant patients. Full article

Background: Performing and maintaining high-altitude cardiopulmonary resuscitation (CPR) could pose a significant physical challenge for rescuers. The objective of this study is to analyse the effects of reducing the oxygen fraction at altitudes of 3000 m and 5000 m above sea level (asl), with and without conditioning to hypoxia, on the quality of resuscitation performed in adults. Methods: An analytical before–after study in which 56 students with a Degree in Nursing between 18 and 30 years old perform 10 min of resuscitation on a mannequin at different altitudes (670, 3000 and 5000 m asl) will be carried out. Subsequently completing an intermittent hypoxia conditioning programme, the participants will perform the resuscitation manoeuvres at previously referenced altitudes. Sociodemographics, CPR quality, self-perception CPR, adequate anthropometric data, physical condition, blood tests, oxygenation in muscular tissue, biceps, brachii and erector spinae, subjective perception of effort, anxiety levels and quality of resuscitation will be measured in all participants at different altitudes. Discussion: Although CPR is a submaximal effort manoeuvre, it is subject to being performed by anyone without motor disabilities. Our study will also provide evidence as to whether this characteristic continues to hold true in a hostile environment such as medium and high altitudes. Our study aims to demonstrate that the improvement in physical performance and recovery capacity induced by intermittent hypoxia conditioning programmes increases the quality of CPR in prolonged cardiac arrests and in adverse conditions, such as at high altitudes. The proposed study will contribute as a novelty to the estimation of the influence of high altitudes and conditioning on performing basic CPR manoeuvres. If the hypothesis turns out to be true, recommendations about the practice of moderate-intensity physical exercise could be incorporated into the CPR guidelines as one of the important aspects in the training of rescuers to conduct CPR. Full article

Background/Objectives: Nursing home (NH) residents who become acutely unwell may frequently be conveyed to emergency departments (EDs). However, at least half of such low-acuity visits could be avoided. Telehealth-supported acute care programmes may potentially reduce unnecessary ED attendances and subsequent hospital utilization. This study aimed to describe a telehealth-based acute care programme for NH residents and to explore a pragmatic method for estimating potential inpatient bed-day savings using publicly available diagnosis-related group (DRG)-based average-length-of-stay (ALOS) data. Methods: A telehealth-based programme was implemented at Sengkang General Hospital (SKH) to support NH staff in the management of acutely unwell residents. NH residents were prospectively tracked for ED non-attendance within 14 days following teleconsultation. Potential inpatient bed-day savings were estimated by mapping teleconsultation diagnoses to relevant DRGs and referencing Singapore Ministry of Health Hospital Bill Size and Fee Benchmarks. Institution-specific and nationally derived ALOS estimates were compared using exploratory Bland–Altman agreement analysis. Results: Over two financial year periods, seven NHs participated in the programme. A total of 726 teleconsultations were conducted, of which 424 encounters were successfully managed within NHs without ED attendance within 14 days (ED non-attendance rate being 58.4%). Using DRG-based estimation, the projected inpatient bed-day savings for FY2023 were 694.31 days using institution-specific ALOS and 805.42 days using nationally derived ALOS estimates. Exploratory Bland–Altman analysis across 34 mapped diagnostic categories demonstrated a mean bias of 0.098 days (approximately 2.4 h), with 95% limits of agreement ranging from −1.31 to +1.51 days. Conclusions: The acute care programme may reduce ED attendances and hospitalizations among NH residents. Publicly available national DRG-based ALOS data may provide a pragmatic approach for estimating the potential inpatient hospital bed-day savings when institution-specific data are unavailable. Full article

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

Burnout among intensive care unit (ICU) nurses is an escalating occupational health concern due to the high psychological and physical demands of critical care, with implications for staff well-being, patient safety, and healthcare quality. Despite its importance, limited evidence exists on burnout among ICU nurses in Saudi Arabian tertiary hospitals. This study investigated the prevalence of burnout, associated factors, and potential interventions to reduce stigma and support mental health among ICU nurses at a tertiary healthcare setting, Saudi Arabia. A quantitative cross-sectional design was employed using the Maslach Burnout Inventory–Human Services Survey (MBI-HSS). Simple random sampling selected 250 registered ICU nurses with at least six months of experience. Data was analysed using SPSS v30 with descriptive statistics, and chi-square tests at a significance level of p < 0.05. Findings indicated a high prevalence of burnout, with 52% of nurses reporting elevated emotional exhaustion. Burnout was significantly associated with overtime hours (χ² = 29.155, df = 12, p = 0.015), nurse-to-patient ratios (χ² = 36.170, df = 20, p = 0.015), shift patterns (day: χ² = 4.931, df = 8, p = 0.765; night: χ² = 263 4.226, df = 8, p = 0.836; rotating: χ² = 3.739, df = 4, p = 0.442), living arrangements ((χ² = 13.153, df = 16, p = 0.662), and perceived impact on patient outcomes. Participants identified mental health education, anonymous support programmes, psychological check-ins, and leadership encouragement as helpful coping strategies. The study concludes that burnout among ICU nurses is influenced by workload, work schedules, and organisational support, underscoring the need for systemic interventions to enhance nurse well-being and sustain healthcare quality. Full article

Background/Objectives: Blood donation knowledge is increasingly recognised as a relevant construct in health education research due to its role in supporting voluntary donation and informing evidence-based strategies that promote preventive behaviours and civic engagement. This study aimed to develop and validate the Spanish version of the Blood Donation Knowledge Questionnaire (BDKQ22-Spain) through university–school partnerships. The BDKQ22-Spain consists of 22 multiple-choice items, each with a single correct answer, designed to assess knowledge about blood donation. Methods: Psychometric evaluation was conducted within a quasi-experimental study involving 228 responses from individuals aged 17 to 51 years (M = 24.12, SD = 7.75), comprising high school and university students enrolled in health and education programmes. Results: Factor analysis supported a two-factor structure for the BDKQ22-Spain, confirming its construct validity and reliability (KR-20 = 0.85) for measuring blood donation knowledge in Spanish. The results identified higher levels of knowledge among women, nursing students, and individuals with previous blood donation experience, while lower scores were observed among minors, future teachers, and therapy students. However, both minors and future teachers showed significant improvements following the intervention, reaching levels comparable to those of nursing students. These findings highlight specific knowledge gaps across sociodemographic and academic groups. Conclusions: The BDKQ22-Spain represents a valid and reliable tool for assessing blood donation knowledge, supporting its use in health and education settings to guide future research and targeted educational strategies. Full article

Background: The expansion of telenursing in primary care requires undergraduate nursing programmes to prepare students for clinical decision making in virtual care. However, evidence on educational interventions integrating clinical reasoning with managing uncertainty, anxiety, and self-confidence in telenursing remains limited. Objective: This study aims to assess changes in nursing students’ self-confidence and anxiety related to clinical decision making following a simulation-based video consultation intervention, and to explore their satisfaction and perceived learning regarding this educational experience. Methods: A quasi-experimental pretest–post-test study with a comparison group was conducted at two public universities during the 2024–2025 academic year. Undergraduate nursing students (N = 115) were included. The intervention consisted of theoretical training on video consultations, complemented by structured simulated consultations based on primary care scenarios. The control group received no intervention. Outcomes were assessed before and after, with self-confidence and anxiety measured using the Nursing Anxiety and Self-Confidence with Clinical Decision Making (NASC-CDM^©) scale. Satisfaction and perceived learning were evaluated in the intervention group using the Student Satisfaction and Self-Confidence in Learning Scale. Results: At baseline, students had high digital competence but limited preparedness for telenursing, with heterogeneous self-confidence and moderate anxiety in virtual decision making. After the intervention, the intervention group showed significant increases in self-confidence and reductions in anxiety, particularly in global clinical judgement and autonomous decision making. Students reported high satisfaction and perceived learning. Conclusions: Simulation-based video consultations may improve nursing students’ self-confidence and reduce anxiety in virtual care decision making, suggesting a potentially valuable strategy for integrating psychoeducational dimensions into nursing curricula on digital health. 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: Oral health is integral to the overall well-being and quality of life of older adults. For institutionalized older residents who depend on staff for daily care, the knowledge, attitudes, and practices (KAP) of healthcare providers directly influence oral health outcomes. This study aimed to assess oral care KAP among healthcare providers in Macao’s residential care facilities and to examine the relationships between KAP and personal characteristics. Methods: A cross-sectional study was conducted from September to December 2023 using a structured KAP questionnaire. Data were collected from 225 healthcare providers across four nursing homes in Macao. Results: Significant positive correlations were found among KAP (Spearman’s γ = 0.293–0.419; p < 0.001). Mean scores were 15.60 (SD = 2.27)/19 for knowledge, 52.13 (SD = 5.75)/65 for attitudes, and 45.87 (SD = 5.93)/55 for practices. Denture care was the major knowledge deficit. Knowledge was associated with age 18–20 (p = 0.002), age 31–40 (p = 0.015), and university education (p = 0.003). Attitudes were associated with age 18–20 (p = 0.002), female gender (p = 0.005), and primary education (p = 0.044). Practice was associated with training programme attendance (p = 0.006) and female gender (p = 0.016). All associations involving the age 18–20 subgroup (n = 3) and male gender (n = 16) should be interpreted with caution due to very small sample sizes. Conclusions: Oral care KAP among HAs and PCWs in Macao’s residential care homes are positively but modestly correlated. Most providers acquired knowledge through induction training with verified competency outcomes and personal experience. These findings highlight the need for structured, repeatable training and suggest that Macao’s data can contribute to international efforts to improve oral care in institutionalized aging populations. Future research should employ longitudinal or observational designs and include all elderly care facilities in Macao. Full article