Search Results (169)

Background/Objectives: Children in paediatric palliative care often face school attendance barriers due to complex health needs. This study describes post-training perceptions of a training program by a pediatric hospice team to prepare school care assistants to safely include children with complex conditions, focusing on procedural skills, knowledge of the child, and family partnership. Methods: Care assistants who completed a structured course at the Paediatric Palliative Care Centre, University Hospital of Padua (2023–2024), were surveyed immediately after training. The program combined classroom instruction with hands-on simulation using high-fidelity mannequins and standard devices, including suction, pulse oximetry, ventilation, enteral feeding, and tracheostomy care. It also covered modules on urgent and emergency management, as well as family communication. An anonymous online questionnaire gathered socio-demographic data, prior training, clinical tasks performed, self-efficacy levels, and open-ended feedback. Quantitative results were analyzed descriptively, while qualitative comments were subjected to thematic analysis. Results: Of 130 invited assistants, 105 participated (81%). Participants reported strong perceived confidence: 85% selected the upper end of the 5-point scale (“very” or “extremely”) for routine-management ability, and 60% selected these same response options for emergency-management ability. In the most severe events recalled, 60.5% of incidents were resolved autonomously, 7.6% involved contacting emergency services, and 3.8% involved community or hospice nurses. Seventy-five percent judged the course comprehensive; thematic analysis of 102 comments identified satisfaction, requests for regular refreshers, stronger practical components, and requests for targeted topics. Conclusions: Immediately after the session, participants tended to select the upper end of the self-assurance item for both routine and emergency tasks. Combining core emergency procedures with personalized, child-specific modules and family-partnership training may support safety, trust, and inclusion. Regular refreshers and skills checks are advised. Full article

Background: Treatment nonadherence in oncology is common. Surveys often miss why patients do not follow recommendations. We synthesised Natural Language Processing (NLP) studies, mainly sentiment analysis, of patient-generated content (social media, forums, blogs, review sites, and survey free text) to identify communication and relationship factors linked to nonadherence and concordance. Methods: We conducted a scoping review (PRISMA-ScR). Searches of PubMed, CINAHL, and Scopus from 2013 to 15 June 2024 identified eligible studies. We included 25 studies. Data were charted by source, cancer type, NLP technique, and adherence/concordance indicators, then synthesised via discourse analysis and narrative synthesis. Results: Four themes emerged: (1) unmet emotional needs; (2) suboptimal information and communication; (3) unclear concordance within person-centred care; and (4) misinformation dynamics and perceived clinician bias. Sentiment analysis helped identify emotions and information gaps that surveys often miss. Conclusions: Patient-voice data suggest practical actions for nursing, including routine distress screening, teach-back, misinformation countermeasures, and explicit concordance checks to improve adherence and shared decision making. Registration: Not registered. Full article

Background: Effectively managing pain in adults remains challenging, particularly in individuals with cognitive impairment or communication difficulties. Digital technologies, including artificial intelligence (AI)-enabled facial recognition and mobile applications, are emerging as innovative tools to improve the objectivity and consistency of pain evaluation. This scoping review aimed to map the current evidence on digital pain-assessment tools used with adult and older populations, focusing on validity, reliability, usability, and contributions to person-centred care. Methods: The review followed the Joanna Briggs Institute methodology and Arksey and O’Malley framework and was reported in accordance with PRISMA-ScR guidelines. Systematic searches were conducted in PubMed, CINAHL Complete, Medline (ALL), and PsycINFO for English-language studies published from 2010 onwards. Eligible studies included adults (≥18 years) using digital tools for pain assessment. Data extraction and synthesis were performed using Covidence, and findings were analyzed thematically. Results: Of 1160 records screened, ten studies met inclusion criteria. Most research was quantitative and conducted in high-income clinical settings. Five tools were identified: ePAT/PainChek^®, Painimation, PainCAS, Pain Clinical Assessment System, and Active Appearance Model. Four key themes emerged: (1) Validity and Reliability of Digital Pain Assessment Tools; (2) Comprehensive Pain Evaluation Across Contexts (Rest vs. Movement); (3) Usability and Integration into Clinical Practice; (4) Enabling Person-Centred Pain Management and Future Directions. Conclusions: Emerging evidence suggests that facial-recognition-based digital pain-assessment tools may demonstrate acceptable psychometric performance and usability within dementia care settings in high-income countries. However, evidence relating to broader adult populations, diverse care contexts, and low-resource settings remains limited, highlighting important gaps for future research. Full article

Background/Objectives: Inborn errors of metabolism (IEM) are chronic, life-threatening genetic disorders with a significant cumulative prevalence worldwide. Advances in early diagnosis and treatment have significantly increased life expectancy, underscoring the need for specialised adult care units and the establishment of structured transition programmes from paediatric to adult services. We hereby present a functional transition model for IEM patients and share our implementation experience. Methods: Initiated in 2012, the partnership between the paediatric Hospital Sant Joan de Déu (HSJD) and the adult-care centre at Hospital Clinic of Barcelona (HCB) culminated in 2019 with the transference of the first IEM patients under the structured A10! Programme. This model is structured around the transition units of paediatric and adult centres to guarantee communication and functional management. Regular monthly meetings at each centre and joint quarterly sessions allowed for protocol harmonisation and personalised care planning. Coordinated engagement of the multidisciplinary health care teams with patients and families smoothed the transfer process. Results: Between 2019 and 2024, 94 IEM patients were successfully transferred. Diagnoses included intermediary metabolism defects (71.23%), lipid metabolism and transport disorders (4.25%), heterocyclic compound metabolism (2.12%), complex molecules and organelle dysfunction (6.37%), cofactor and mineral metabolism (2.12%), signalling defects (5.31%), and unclassified cases (8.51% of rare disorders, maybe non-IEM). Transition formats included 21 in-person joint visits in HSJD, 37 remote transitions during the COVID-19 pandemic, and 36 streamlined transfers via standardised protocols. Sessions, trainings, and meetings allowed the exchange of patients’ needs and protocols. Conclusions: The successful transference of IEM patients requires structured programmes with interdisciplinary paediatric and adult teams, joining efforts with the patient, families, and caregivers. Communication between paediatric and adult transition units is essential to promote continuity of care and patient empowerment. While constantly updated, this model has proven effective, gaining positive evaluations from healthcare professionals and patients alike, representing a scalable framework for lifelong management of IEM in adult care settings. Full article

This study explores the dynamics of engaged spiritualities within contemporary Buddhist communities in Italy. By employing an ethnographic approach, the research examines how physical space fosters spiritual experiences, facilitates social interactions, and serves as a site for personal and collective transformation. The study integrates insights from religious studies, anthropology, and neuroscience to analyse the cognitive and emotional effects of meditation while also engaging with Foucault’s theories on power and space to understand Buddhist centres as structured environments that shape individual and collective subjectivities. The research highlights how engaged Buddhism in Italy adapts traditional practices to contemporary challenges, particularly in response to mental health concerns among university students. Through participant observation and interviews conducted during mindfulness and contemplative education programmes, the study demonstrates how meditation contributes to psychological well-being, emotional regulation, and social connection. This analysis aligns with theoretical discussions on the conceptualisation of spirituality in modern societies, illustrating how engaged spiritualities manifest in secular and pluralistic contexts. The findings suggest that Buddhist spaces in Italy function not only as sites of religious practice but also as transformative environments where power relations are renegotiated, identity is reconstructed, and alternative ways of living emerge. The study further explores how scientific advancements in neuroscience inform spiritual practices, shedding light on the reciprocal relationship between spiritual yearning and scientific inquiry. Finally, the research contributes to the debate on the future of engaged spiritualities in the face of global crises. It argues that while Buddhist communities in Italy preserve traditional wisdom, they also actively shape new forms of spiritual engagement that respond to contemporary social, political, and environmental challenges. This work situates engaged Buddhism as a key player in fostering alternative models of coexistence, well-being, and ethical responsibility in the modern world. 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

Community-based organisations (CBOs) play a crucial role supporting clients during emergencies yet often lack adequate preparation. This study examined how Australian CBOs perceived and enacted dual responsibilities: ensuring service continuity during emergencies and facilitating person-centred preparedness for high-risk populations. A national cross-sectional online survey of community-based health and social care organisations was conducted between December 2021 and April 2022, employing strategic outreach and snowball sampling. Among 244 respondents, disability services (69%) and housing and homelessness services (27%) were the most common providers. Many organisations showed strong emergency preparedness, including comprehensive insurance, staff empowerment, and adaptive service delivery. Barriers to business continuity plans (BCPs) included resource constraints and limited emergency information access. Organisations with established networks and collaborations with emergency services demonstrated greater capacity for sustained service delivery (p < 0.001). Logistic regression analysis revealed local networking with emergency service agencies was positively associated with CBOs’ ability to support client preparedness (p < 0.001), while lack of tools (p = 0.007) and training (p = 0.037) limited capacity to facilitate person-centred emergency planning for high-risk populations. Embedding business continuity planning within operations and strengthening cross-sector collaboration can enable CBOs to fulfil their aforementioned dual responsibilities, while advancing sustainable organisational resilience and inclusive disaster risk reduction. Full article

Background/Objective: The incidence of diabetic foot complications has been increasing in South Africa. While foot screening at the primary healthcare level is crucial for preventing these complications, the growing number of cases in hospitals indicates that persons with diabetes are not undergoing routine screening in primary healthcare settings. Method: This cross-sectional descriptive observational study was conducted at five community healthcare centres, one in each municipality in Gauteng. Participants included persons with diabetes who presented at these facilities for their routine diabetes care. Data were collected, which included patient demographics, a history of screening, risk factors for diabetic foot, and an assessment of diabetic foot was conducted for each participant. Results: A total of 597 diabetic patients volunteered for this study. Only 10% (n = 60) had received a diabetic foot assessment. No patient had been risk-stratified; the results showed that 30% (n = 178) were very low risk and 17% (101) were at high risk. Active ulcers were recorded in 19% (116), and 18% (106) were in remission. Neuropathy was recorded in 33% (197), peripheral arterial disease in 22% (131), and a history of amputation was recorded in 17% (103). Conclusions: Implementing routine diabetic foot assessment and risk stratification at the PHC level could be key in preventing diabetic-related complications. Full article

Wildfires are a source of air pollution, which impacts air quality in proximity to and at great distances from fires. Wildfire smoke exposure is seasonal and episodic, with exposure levels and durations that can vary considerably. Exposure to wildfire smoke is associated with numerous health effects, including an increased risk of mortality and exacerbation of respiratory diseases. In Canada, the health risks of wildfire smoke are communicated to the public via air quality (AQ) alerts, when levels of wildfire smoke are currently or are forecasted to be relatively high, posing a risk to the general population. To better understand the population at risk due to wildfire smoke, a population-based exposure metric was developed based on geolocated AQ alerts and population data. This metric, measured in person-days, quantifies the number of people at risk of experiencing adverse health effects of wildfire smoke during a given time period. Data from the 2023 wildfire season were used to evaluate the metric. The greatest numbers of person-days were associated with population centres and regions that experienced periods of prolonged, intense smoke exposure. For example, Toronto, a large population centre, had 12 days with AQ alerts issued, corresponding to 33.5 M person-days. This approach could be expanded to other environmental or extreme weather conditions. Full article

Background: Structured patient education (SPE) is a critical component of diabetes management, with the potential to reduce its physical, social, and economic burden. National and international guidelines emphasise the importance of raising awareness and equipping individuals with the knowledge and skills necessary for effective self-management. In the UK, practice nurses are central to this effort, playing a key role in identifying at-risk individuals and facilitating referrals to diabetes education programmes. However, non-attendance at these programmes remains a persistent challenge, undermining the impact of policy initiatives and service provision. Aim of the study: This study aimed to explore practice nurses’ perspectives on the factors contributing to non-attendance at diabetes education centres and to identify potential strategies to improve uptake. Methods: A qualitative approach was employed, involving semi-structured face-to-face interviews with eight practice nurses across six general practice (GP) surgeries in Southeast England. Data were analysed thematically to uncover key patterns and insights. Results: Findings reveal that barriers to attendance are multifaceted, encompassing personal, social, and systemic factors. These include limited patient understanding of the benefits of education, cultural and language differences, scheduling conflicts, and perceived relevance of the programmes. Conclusions: The results highlight the need for a coordinated, patient-centred approach that addresses these challenges through improved communication, flexibility in programme delivery, and enhanced interprofessional collaboration. Full article

Theatre-based methodologies are increasingly recognized as complementary approaches that can enhance nurses’ empathy, communication, critical thinking, and person-centred care, all essential for managing chronic illnesses. This scoping review aimed to map and synthesize evidence on the application of theatre in continuing nursing education. A systematic literature search was conducted across five databases (PubMed, CINAHL, PsycINFO, Scopus, and Education Source) for publications in English and Italian up to 30 December 2024, supplemented by grey literature from ProQuest and reference screening via Google Scholar. Twenty-one studies met the inclusion criteria, identifying two main theatre methodologies, Forum Theatre and Drama, with four variations. These interactive methods were reported to foster reflective practice, enhance person-centred care, and improve interprofessional collaboration. Positive outcomes included improved nurse–patient relationships, quality of care, emotional engagement, cultural competence, teamwork, conflict management, and acceptance of diversity. Key facilitators were institutional support and active participation, while barriers included resistance to change and limited resources. These findings indicate that theatre-based education can serve as an effective complementary strategy to cultivate empathy, creativity, and reflective skills in continuing nursing education, supporting the development of holistic and patient-centred care practices. Further research is needed to explore the sustainability of acquired competencies in clinical practice. Full article

Background: International and national policies increasingly call for person-centred approaches in disability services, yet little is known about how support intensity needs influence the allocation of resources for individuals with intellectual and developmental disabilities (IDDs). In Italy, where integrated socio-health systems operate within a human rights framework, this quantitative study investigates how individual and contextual factors shape resource use in individualized support planning. Methods: We analyzed data from 1152 adults with IDDs enrolled in 23 service centres across 13 Italian regions. Case managers developed Individualized Support Plans (ISPs) informed by the Supports Intensity Scale and socio-ecological variables. Resource use was measured as weekly counts of adaptive skills training, community participation supports, habilitation services, prosthetics, and assistive technologies. We applied multivariate count models (Sarmanov–Lee) to capture the interdependence across support types. Results: Findings show that gender and level of intellectual functioning did not significantly affect resource allocation. However, individuals with the highest support intensity needs often received fewer supports, particularly in adaptive skills and community participation. Residential settings were associated with higher levels of support provision compared to family or independent living. Assistive technologies and prosthetics were linked with more comprehensive support packages. Conclusions: While person-centred planning frameworks are being implemented, systemic inequities remain, with those at the highest levels of need at risk of receiving fewer enabling supports. Multivariate modelling provides a robust tool for understanding resource use and highlights the importance of equity-focused planning. These findings support policy and practice reforms that operationalize human rights principles and align with the UNCRPD, ensuring more inclusive and responsive systems of support. Full article

Background: Conflicts are an inevitable part of interpersonal relationships, and personality traits influence how they are resolved. In the nursing work environment, conflicts often arise from poor communication and stress, negatively impacting nurses’ well-being and quality of care. The “Big Five” personality model highlights how traits such as extraversion, agreeableness, and emotional stability shape conflict approaches. Understanding these traits aids in developing effective conflict management strategies. This study investigates intragroup conflicts among nurses by identifying their types and examining how sociodemographic factors and personality traits predict their occurrence. The aim is to provide insights that support targeted interventions and improve team dynamics in nursing practice. Methods: The study was conducted as a cross-sectional analysis within the University Hospital Centre Osijek from March to August 2024, involving nurses and technicians. Data was collected using structured questionnaires with clearly defined inclusion and exclusion criteria. The questionnaire included the Process Conflict Scale, the Big Five Inventory, and a Demographic questionnaire. Appropriate statistical analyses were conducted, including descriptive statistics, normality testing with the Kolmogorov–Smirnov test, non-parametric Spearman and Point-Biserial correlations, and linear regression to examine predictors of intragroup conflicts. All assumptions for regression were met, with significance set at p < 0.05, and analyses were performed using JASP software version 0.17.2.1. Results: The research reveals significant differences among various types of team conflicts, where personality traits such as neuroticism increase, while conscientiousness decreases conflicts. The professional competence of respondents also positively correlates with logistical conflicts, and personality explains the variance in conflicts among nurses. Conclusions: Intragroup conflicts among nurses, particularly task-related, stem from communication issues and high care standards. Neuroticism negatively affects team dynamics, while conscientiousness can reduce conflicts but may also lead to disagreements if expectations are unmet. Education on conflict management and clearly defined roles can improve teamwork and quality of care. Full article

Purpose: Decentralized hearing care models facilitated by community health workers (CHWs) can improve access to care in low-income settings. Preset hearing aids, which offer user-selectable pre-developed amplification programs, may support such models, but little is known about their real-world use and alignment with clinical recommendations. Method: This longitudinal study formed part of a feasibility project implementing the World Health Organization’s (WHO’s) hearing aid service delivery approach in three low-income South African communities. Adults (≥18 years) with confirmed moderate-to-severe bilateral hearing loss were fitted with preset hearing aids by trained CHWs. Devices offered four preset amplification programs. Participant-driven selections were recorded at four distinct time points: fitting and follow-ups at 2 weeks, 2 months, and 6 months post-fitting. Results: In total, 36 participants (mean age = 76 years, SD = 8.9, range 50–96) were fitted with devices. Although over half (right: 52.8%, left: 58.3%) presented with high-frequency loss, only 34% initially selected the corresponding program. Most participants (80.6%, n = 29) changed their selections at least once over the six months. Significant associations between hearing loss configuration and selection occurred at some time points only in the left ear, but agreement with clinically recommended programs declined from 42% at baseline to 28% at six months. Conclusions: CHW-facilitated hearing aid delivery supports user autonomy in low-resource settings. However, frequent changes and divergence from clinically recommended programs suggest reliance on user-driven trial-and-error adjustments rather than audiometric fit, which may limit long-term benefit. Ongoing, person-centred guidance is needed for the effective use of preset hearing aids. Full article

The healthcare needs of refugees and people seeking asylum are often broad and complex, with a higher burden of communicable diseases. There are limited data describing migrants’ experiences of accessing healthcare in Ireland. This cross-sectional study describes the experiences of migrants accessing healthcare services through an Irish Infectious Diseases clinic. Individuals attending the infectious diseases services in our hospital who had migrated to Ireland were included. Data were collected via a questionnaire, focusing on factors that may limit access to care, including communication, accessibility, cost, and stigmatisation. Seventy-six patients participated in this study. N = 20 (26%) of patients reported a commuting time of more than two hours to attend our clinic. N = 11 (15%) had experienced being unable to access healthcare in Ireland due to cost. Trust in healthcare providers was high (88%), and patient-reported satisfaction with communication was high (>90%). Persons living in direct provision services were more likely to report issues around privacy and less likely to have registered with a general practitioner. Accessibility and privacy were among the biggest challenges faced by migrants attending infectious diseases services at our centre, while communication and trust in healthcare providers were identified as areas of strength. Considering the burden of infectious diseases in migrant populations, and the challenges that certain migrant populations face in accessing healthcare, it is important to identify potential barriers to accessing care in order to ensure equitable, effective care. This study seeks to identify and describe the challenges that migrants face when accessing care through an Irish infectious diseases clinic. The results can help inform service provision and allocation of resources at a local level, while also identifying an area for further research regarding the barriers to accessing care faced by migrant communities in Ireland. Full article