Search Results (1,078)

The global Black Lives Matter movement and COVID-19 pandemic drew attention to the urgency of addressing entrenched structural dynamics such as racialization, gender, and colonization shaping health inequities for diverse racialized people. Canadian community-based research with racialized immigrant women recognized the need to enhance service provider capacity using a strengths-based activism approach to support client health and wellbeing. In this study, we aimed to understand the impacts of this mental health promotion practice on service providers and strategies to support them. Through purposeful convenience sampling, three focus groups were completed with 19 service providers working in settlement and mental health services in Toronto, Canada. Participants represented varied ethnicities and work experiences; most self-identified as female and racialized, with experiences living as immigrant women in Canada. Postcolonial feminist and critical mental health promotion analysis illuminated organizational and structural dynamics contributing to burnout and vicarious trauma that necessitate a focus on trauma- and violence-informed care. Transformative narratives reflected service provider resilience and activism, which aligned with and challenged mainstream biomedical approaches to mental health promotion. Implications include employing a postcolonial feminist lens to identify meaningful and comprehensive anti-oppression strategies that take colonialism, racialization, gender, and ableism and their intersections into account to decolonize nursing practices. Promoting health equity for diverse racialized women necessitates focused attention and multilevel anti-oppression strategies aligned with critical mental health promotion practices. Full article

Background/Objectives: Pressure injuries are a significant concern among older adults, particularly in community-based long-term care settings where prolonged immobility is prevalent. This study aimed to identify factors influencing sacral interface pressure in community-dwelling older adults, with an emphasis on support surface usage and clinical risk indicators. Methods: A total of 210 participants aged 65 years and older, all receiving long-term care services in South Korea, were enrolled in this study. Sacral interface pressure was measured in the supine position using a portable pressure mapping device (Palm Q7). General characteristics, Braden Scale scores, Huhn Scale scores, and mattress usage were assessed. Data were analyzed using descriptive statistics, t-tests, chi-square tests, and logistic regression. Results: Mattress non-use was identified as the strongest predictor of elevated sacral interface pressure (OR = 6.71, p < 0.001), followed by Braden Scale scores indicating moderate risk (OR = 4.8, p = 0.006). Huhn Scale scores were not significantly associated with interface pressure. These results suggest that support surface quality and skin condition have a stronger impact on interface pressure than mobility-related risk factors. Conclusions: The findings highlight the importance of providing high-quality pressure-relieving mattresses and implementing standardized nursing assessments to reduce the risk of pressure injuries. Integrating smart technologies and expanding access to advanced support surfaces may aid in developing tailored preventive strategies for vulnerable older adults. Full article

This study aims to understand the meaning nursing professionals attribute to their lived experiences of providing humanized care within a public hospital setting. Grounded in Jean Watson’s theory of human caring, the research adopts a qualitative, descriptive phenomenological design to capture the perceptions and emotions of nurses regarding humanized care. Data were collected through semi-structured interviews with nine experienced nurses, selected through purposive sampling. The interviews, conducted virtually between July and December 2024, were analyzed using Colaizzi’s method and supported by Atlas.ti software. Four main thematic categories emerged: institutional health policies, professional image and identity, strengths and challenges in care, and essential competencies for humanized care. The findings highlight the critical role of empathy, cultural sensitivity, ethical commitment, and emotional presence in delivering compassionate care. Participants emphasized that, beyond clinical procedures, humanized care requires relational and contextual sensitivity, often hindered by institutional limitations and excessive administrative burdens. The study concludes that nursing professionals are key agents in promoting ethical, empathetic, and culturally respectful practices that humanize health services. These insights offer valuable contributions for designing policies and training strategies aimed at strengthening humanized care as a cornerstone of quality healthcare systems. Full article

Early rehabilitation is essential for restoring functional recovery in patients with stroke, particularly during the early phase of post-acute care (PAC), or the subacute stage. We aimed to evaluate the effectiveness of a 7-week PAC rehabilitation program in improving muscle strength, physical performance, and functional recovery. A total of 219 inpatients with stroke in the subacute stage were initially recruited from the PAC ward of a regional teaching hospital in Northern Taiwan, with 79 eligible patients—within 1 month of an acute stroke—included in the analysis. The program was delivered 5 days per week, with 3–4 sessions daily (20–30 min each, up to 120 min daily), comprising physical, occupational, and speech–language therapies. Sociodemographic data, muscle strength, physical performance (Berg Balance Scale [BBS], gait speed, and 6-minute walk test [6MWT]), and functional recovery (modified Rankin Scale [mRS], Barthel Index [BI], Instrumental Activities of Daily Living [IADL], and Fugl–Meyer assessment: sensory and upper extremity) were collected at baseline, 3 weeks, and 7 weeks. Generalized estimating equations analyzed program effectiveness. Among the 56 patients (70.9%) who completed the program, significant improvements were observed in the muscle strength of both the affected upper (B = 0.93, p < 0.001) and lower limbs (B = 0.88, p < 0.001), as well as in their corresponding unaffected limbs; in physical performance, including balance (BBS score: B = 9.70, p = 0.003) and gait speed (B = 0.23, p = 0.024); and in functional recovery, including BI (B = 19.5, p < 0.001), IADL (B = 1.48, p < 0.001), and mRS (B = −0.13, p = 0.028). These findings highlight the 7-week PAC rehabilitation program as an effective strategy during the critical recovery phase for patients with stroke. Full article

Background/Objectives: Accurately assessing the independence level of older adults using useful assessment tools is an important step toward providing them with the necessary care while preserving their dignity. These tools allow older adults to receive effective, personalized home care, which improves their quality of life. This study aimed to clarify the current prevalence of severe and complete functional dependence and associated factors among Kazakhstan’s older adults aged >60 years. Methods: This cross-sectional study was conducted in several polyclinics and geriatric service care centers in two cities of Kazakhstan from March to May 2024. Functional status was assessed by the Barthel Index. We combined the selection into two categories: total dependency and severe dependency in the category “dependent”, and moderate dependency, slight dependency, and total independence in the category “active patients”. Results: Among the 642 older people in this study, 43.3% were dependent patients, and 56.7% were active patients. The odds of severe and total functional dependence are significantly higher for frail participants (adjusted odds ratio (AOR) = 2.96, 95% confidence interval (CI) [1.70, 5.16], p < 0.001) compared to those that are not frail; eleven times higher for those at home (AOR =11.90, 95% CI [5.77, 24.55], p < 0.001) than those in nursing homes; two times higher for participants with sarcopenia (AOR =2.61, 95% CI [1.49, 4.55], p < 0.001) compared to those with no sarcopenia; and three times higher for participants with high risk of fracture (AOR =3.30, 95% CI [1.94, 5.61], p < 0.001) compared to those with low risk. The odds of having severe and total functional dependence are significantly higher for participants with low dynamometry (AOR =1.05, 95% CI [1.03, 1.07], p < 0.001) compared to those with normal dynamometry. Conclusions: Old age, low dynamometry (for men ≤ 29 kg, for women ≤ 17 kg), frailty, being at home, high risk of fracture and osteoporosis, and sarcopenia were associated with increased risk of severe and total functional dependence. Full article

Background: Automated surgical navigation can be separated into three stages: (1) organ identification and localization, (2) identification of the organs requiring further surgery, and (3) automated planning of the operation path and steps. With its ideal visual and operating system, the da Vinci surgical system provides a promising platform for automated surgical navigation. This study focuses on the first step in automated surgical navigation by identifying organs in gynecological surgery. Methods: Due to the difficulty of collecting da Vinci gynecological endoscopy data, we propose DeepVinci, a novel end-to-end high-performance encoder–decoder network based on convolutional neural networks (CNNs) for pixel-level organ semantic segmentation. Specifically, to overcome the drawback of a limited field of view, we incorporate a densely multi-scale pyramid module and feature fusion module, which can also enhance the global context information. In addition, the system integrates an edge supervision network to refine the segmented results on the decoding side. Results: Experimental results show that DeepVinci can achieve state-of-the-art accuracy, obtaining dice similarity coefficient and mean pixel accuracy values of 0.684 and 0.700, respectively. Conclusions: The proposed DeepVinci network presents a practical and competitive semantic segmentation solution for da Vinci gynecological surgery. Full article

Background: Nemaline myopathy is a rare congenital neuromuscular disease associated with progressive weakness and frequent respiratory complications. In emergency situations, families often serve as the first and only responders. The aim of this study is to explore how parents in Spain care for children with nemaline myopathy during emergency situations, focusing on the clinical responses performed at home and the organizational challenges encountered when interacting with healthcare systems. Methods: A qualitative phenomenological study was conducted with 17 parents from 10 families belonging to the Asociación Yo Nemalínica. Semi-structured interviews were performed via video calls, transcribed verbatim, and analyzed using Giorgi’s descriptive method and ATLAS.ti software (version 24). Methodological rigor was ensured through triangulation, reflexivity, and member validation. Results: Four themes were identified. First, families were described as acting under extreme pressure and in isolation during acute home emergencies, often providing cardiopulmonary resuscitation and respiratory support without professional backup. Second, families managed ambiguous signs of deterioration using clinical judgment and home monitoring tools, often preventing fatal outcomes. Third, parents frequently assumed guiding roles in emergency departments due to a lack of clinician familiarity with the disease, leading to delays or errors. Finally, the transition to the Pediatric Intensive Care Unit was marked by emotional distress and rapid decision-making, with families often participating in critical choices about invasive procedures. These findings underscore the complex, multidisciplinary nature of caregiving. Conclusions: Parents play an active clinical role during emergencies and episodes of deterioration. Their lived experience should be formally integrated into emergency protocols and the continuity of care strategies to improve safety and outcomes. Full article

In recent studies, public health has been considered a key stakeholder in climate mitigation and adaptation in cities since they are more exposed to the impact of climate change. Nurses represent a vast majority of public health professionals, playing a key role in health promotion that allows them to influence individuals, families, and communities in adopting healthier behaviours and decarbonized lifestyles. Therefore, the purpose of this study is to map the existing evidence on nursing interventions, which are being led or implemented to reduce the health risks related to climate change in urban areas. The present review follows the JBI methodological framework, including a search on PubMed, MEDLINE complete, CINAHL Complete, Scopus, Web of Science, SciELO (Scientific Electronic Library Online), BASE (Bielefeld Academic Search Engine), and RCAAP. Hand searched references were also considered, including quantitative, qualitative, and mixed-methods studies between January 2014 and October 2024, for a more contemporary perspective. A three-step search strategy and data extraction tool were used by two independent reviewers. Twenty-seven studies in English and Portuguese were eligible for inclusion, all targeting a population of professionals with nursing-related roles: two case studies, one Delphi panel, one descriptive study, one historical research paper, two using a methodological design format, four narrative reviews, one observational study, nine review articles, three scoping reviews, and three systematic reviews. Eight categories of nursing interventions that contribute to decarbonized lifestyles, reducing health risks in relation to climate change, were acknowledged. Nurses play a key role in empowering individuals, families, and communities, promoting climate awareness and literacy, supporting health policy change, advocating for the most vulnerable and engaging in environmental activism, using evidence-based research, and taking advantage of marketing strategies and social media. Full article

Background: Psychological problems post-stroke can negatively impact stroke survivors. Although general psychological services exist (e.g., NHS Talking Therapies), access remains limited, particularly for individuals with post-stroke communication and cognitive impairments. Stroke service staff report low confidence in managing psychological distress. This study is the first to explore the barriers and facilitators to implementing a novel intervention package comprising a cross-service care pathway and staff training to enhance post-stroke psychological provision. Methods: Staff from stroke and mental health services in four UK regions, recruited through purposive sampling to ensure diversity of services and professional roles, participated in semi-structured interviews or focus groups, guided by the Theoretical Domains Framework (TDF), before and after implementation of the intervention package. Pre-implementation interviews/groups identified anticipated barriers and facilitators to implementation and training needs, informing the development of site-specific intervention packages; post-implementation interviews/groups explored experienced barriers, facilitators and perceptions of the intervention. Interviews underwent thematic analysis using the TDF. Results: Fifty-five staff participated pre-implementation and seventeen post-implementation, representing stroke (e.g., nurse, physiotherapist, consultant) and psychology (e.g., counsellor, psychological therapist) roles across acute, rehabilitation, community, and voluntary services. Challenges anticipated pre-implementation included: limited specialist post-stroke psychological support; low staff confidence; and fragmented service pathways. Post-implementation findings indicated increased staff knowledge and confidence, enhanced screening and referral processes, and stronger inter-service collaboration. Implementation success varied across sites (with some sites showing greater ownership and sustainability of the intervention) and across staff roles (with therapy staff more likely than nursing staff to have received training). Conclusions: Effective implementation of an intervention package to increase psychological provision post-stroke requires staff engagement at all levels across all services. Staff investment influenced ownership of the intervention package, beliefs about priorities and overall enhancement of service capability. Full article

Background: Medication adherence is essential for managing chronic conditions, while non-adherence remains a widespread issue, leading to poorer health outcomes and higher healthcare costs. This study aimed to identify key adherence barriers, explore their relationship with patient satisfaction, and assess their impact on overall well-being among ambulatory patients in Albania. Methods: A cross-sectional study was conducted in three public urban health centers in Vlora, Albania, between November 2024 and January 2025. A total of 80 ambulatory patients were recruited using convenience sampling. Data were collected through face-to-face interviews using validated questionnaires, including the Adherence Barriers Questionnaire (ABQ), the Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ), and the Patient Health Questionnaire (PHQ-9) for depression screening. Results: The study included 80 ambulatory patients (mean age 66.7 years; 48.7% female), predominantly diagnosed with diabetes (42.5%) and rheumatic diseases (36.3%). All participants reported at least one adherence barrier, with 92.5% experiencing multiple barriers. The most common were financial burden (91.3%) and fear of side effects (77.5%). A significant positive correlation was found between adherence barriers and depression severity (ρ = 0.518, p < 0.0001), while patient satisfaction did not significantly influence adherence barriers (ρ = −0.217, p = 0.053) or depression severity (ρ = −0.004, p = 0.969). Multiple regression analysis showed that higher depression severity (p = 0.0049) was significantly associated with greater adherence barriers, while postgraduate education was associated with fewer barriers (p = 0.0175). Conclusions: Financial burden, fear of side effects, and psychological distress are key barriers to adherence among Albanian ambulatory patients. Although there are limitations inherent to the cross-sectional design and modest sample size, our findings highlight the potential benefit of routine mental health screening, targeted financial support, and improved patient education on medication management within primary care. These insights may help inform future research and interventions aimed at enhancing adherence and overall well-being. Patient satisfaction did not significantly impact adherence or depression. Targeted interventions focusing on financial support, mental health care, and patient education are needed to improve adherence and patient well-being. These findings underscore the need for integrated mental health and adherence support strategies within routine primary care services. Full article

Background and aims: Rheumatic diseases are chronic, progressive conditions associated with severe pain, joint damage, disability, and even death. Healthcare interventions play a critical role in symptom management, patient education, and adherence to treatment plans. This study evaluates the role of healthcare interventions in the management of patients with rheumatic diseases, focusing on pain management, functional rehabilitation, patient education, and multidisciplinary collaboration. In addition, barriers to optimal care and potential solutions, including digital health technologies, are explored. Materials and methods: We conducted a narrative review of the scientific literature. Studies published between 2014 and 2025 were selected from PubMed, Scopus, Web of Science, Elsevier, Springer, Frontiers, and Wiley Online Library. Key areas of review included nurse-led pain management, education programs, and the impact of interdisciplinary care on patient outcomes. Results: Nursing interventions significantly improve pain control, treatment adherence, and self-management skills in patients with rheumatic diseases. Multidisciplinary approaches improve functional rehabilitation and increase quality of life in patients with rheumatic conditions. However, barriers such as insufficient health care resources, lack of patient awareness, and disparities in the availability of services hinder effective care delivery. Conclusions: A structured, multidisciplinary approach integrating healthcare interventions, digital health solutions, and patient-centered education is essential to optimize the management of rheumatic diseases. Future research should focus on improving access to non-pharmacological therapies and standardizing healthcare protocols for better patient outcomes. Full article

Objectives: This study aims to explore the experiences of bereaved family members during and after the loss of a relative in an intensive care unit (ICU) during the COVID-19 pandemic-related visitation restrictions, as well as to assess their perceptions of a nurse-led bereavement support programme. Methods: Ten participants with a relative who had died in an ICU were recruited in September 2020 during a follow-up bereavement meeting at a tertiary cardiac centre in Switzerland. Descriptive qualitative research was conducted. Face-to-face nurse-led follow-up bereavement meetings, adapted to the pandemic circumstances and conducted as semi-structured interviews, were analysed by a thematic analysis. Findings: Fifteen sub-themes and three main categories were identified. The motivation behind the family members’ participation in the meetings was to ask and learn about their experiences regarding the death of their relative during this abnormal time. The reactions to the meetings varied among the families. Many expressed that the experience of bereavement was particularly challenging and painful, and that the absence of a final farewell to their loved one, as well as the impossibility of having a formally held funeral, made the deaths harder to accept. The families appreciated the interview as it gave them clarification, information, and an awareness of the facts and the care provided, and for several of them it was also a chance to share their emotions and express any difficulties they might have encountered both during and after the patient’s death. Conclusion: The COVID-19 pandemic’s restrictions had a profound impact on families who lost a loved one in an ICU. The nurse-led bereavement support service responded to the needs of grieving families, providing valuable emotional and practical support and re-establishing a healthy relationship between the families and the caregivers that was hindered by pandemic restrictions. The study also shows that a nurse-led bereavement support service can be a valuable component of family-centred care. Full article

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, with rural populations experiencing higher prevalence and worse outcomes. This paper explores the transformative potential of nurse-led palliative care models in addressing the unique challenges faced by rural patients with COPD and their informal caregivers and synthesizes current evidence on nurse-led palliative care interventions, highlighting their impact on symptom management, advance care planning, and psychosocial support. Methods: This is a comprehensive synthesis of nurse-led palliative care programs, focusing on home-based care, telehealth, community outreach, and primary care integration. Results: Nurse-led interventions significantly improve patient satisfaction, reduce symptom burden, and enhance the likelihood of advance care planning discussions. Home-based care models and telehealth are particularly effective in rural settings, offering accessible and continuous support. Conclusions: Nurses have a critical role in bridging the palliative care gap for rural patients with COPD and their informal caregivers. Expanding nurse-led palliative care services can improve quality of life, reduce healthcare utilization, and promote health equity. Future research should focus on long-term outcomes, cost-effectiveness, and strategies for scaling nurse-led palliative care programs in rural contexts. Full article

This study presents the findings of an academic extension project focused on promoting oral health and diagnosing oral lesions in institutionalized elderly individuals. The project involved visits by students and faculty to two nursing homes in southern Brazil. Data collection included extraoral and intraoral clinical examinations and educational activities such as lectures and the distribution of printed materials on oral and denture hygiene. According to caregiving staff, oral hygiene, including denture cleaning, was generally performed once daily during morning showers. A total of 118 older adults (68 males and 50 females; mean age 76.1 ± 8.6 years) were examined. Forty-nine used dentures, of whom only 24 (49%) reported satisfaction with their prostheses. In total, 42 oral lesions were identified, mainly angular cheilitis (8), inflammatory fibrous hyperplasia (7), irritation fibroma (7), frictional hyperkeratosis (7), prosthetic stomatitis (5), actinic cheilitis (3), traumatic ulcers (3), and leukoplakia (2). Educational sessions also targeted caregivers, offering practical guidance for improving hygiene practices. The results underscore the need for better oral care and improved access to dental services for institutionalized elderly populations. Academic extension activities play a valuable role in health promotion and in training future professionals in elderly care. Full article

Objectives: While pre-screening triage (PST) enhances healthcare efficiency in emergency and pediatric settings, its application in dental healthcare remains undervalued. This novel study implemented PST in dental services, identifying determinants of physician–patient dissatisfaction to optimize triage systems and promote dental health outcomes. Methods: A cross-sectional survey (July–September 2024) recruited 113 physicians and 206 patients via convenience sampling. Dissatisfaction levels were quantified using validated questionnaires and analyzed through t-tests, ANOVA, and regression models. Results: In total, 37.17% of physicians with prior PST experience demonstrated significantly higher dissatisfaction scores (37.67 ± 9.08 vs. 32.51 ± 10.08, p = 0.006). Multivariate analysis revealed that experienced physicians rated PST services 5.63 points higher than less experienced counterparts (95% CI: 0.75–10.51). Dental patients expressed dissatisfaction with nurse attitudes (β = 1.04, 95% CI: 0.07–2.01) and triage process inefficiencies. Conclusions: Key dissatisfaction drivers include a lack of physician PST exposure and nurse–patient interaction quality in dental settings. These findings advocate for the development of a specialized triage system to enhance clinical workflow efficiency and service effectiveness in dental healthcare. Full article