Search Results (151)

Background/Objectives: Complex chronic patients represent a heterogeneous and high-risk population, for whom accurate prognostic tools are essential to guide clinical decision-making, optimize resource allocation, and support tailored interventions. The PROFUND index was developed for mortality prediction in polypathological patients, but its performance has not yet been evaluated in an ambulatory integrated care model. Methods: A retrospective observational study was conducted using two cohorts. Cohort H included complex chronic patients admitted to the Internal Medicine Department between March 2023 and February 2024. Cohort A comprised complex chronic patients followed by a multidisciplinary chronic care program between November 2016 and December 2023. PROFUND scores were derived from electronic health records. Discrimination for 12-month mortality was assessed using Kaplan–Meier curves, log-rank tests, and receiver operating characteristic curve analysis. Calibration was evaluated by comparing observed mortality with expected mortality based on the original PROFUND index and improved through intercept and slope recalibration. Results: A total of 660 patients were included in cohort H and 540 in cohort A. One-year mortality was 38.0% and 30.2%, respectively. Discriminatory performance was good in hospitalized patients (AUC 0.760; 95% CI 0.724–0.797) and moderate to good in ambulatory patients (AUC 0.705; 95% CI 0.656–0.754). Calibration analyses demonstrated systematic overestimation of mortality, particularly in the ambulatory cohort and intermediate–high risk strata, while recalibration improved agreement between predicted and observed risks. Conclusions: The PROFUND index provides useful risk stratification for 12-month mortality in CCP across care settings but overestimates absolute risk, particularly in ambulatory case management populations. Local recalibration may improve prognostic accuracy, support individualized care planning, and advance care planning discussions and allocation of multidisciplinary follow-up intensity. Full article

Background: Population ageing has increased the number of older adults living in nursing homes, where loneliness and sleep disturbances are prevalent and negatively affect well-being. Evidence suggests a bidirectional relationship between loneliness and sleep quality, although research in institutionalised populations remains limited. Objectives: This study aimed to characterise the sociodemographic and health profile of nursing home residents in Northern Portugal and examine associations between sleep quality, loneliness, sociodemographic and health variables. Methods: A cross-sectional study was conducted with 157 older adults (≥65 years) across 13 nursing homes. Data were collected using a sociodemographic questionnaire and the Portuguese version of UCLA Loneliness Scale, Pittsburgh Sleep Quality Index and Montreal Cognitive Assessment. Pearson correlations and hierarchical multiple regression analyses were performed. Results: Participants were predominantly female (72.6%), widowed (55.4%), and aged ≥80 years. Most reported chronic conditions (98.7%) and limitations in activities of daily living (75.2%). Age showed modest positive correlations with loneliness. Loneliness dimensions were strongly associated with poorer sleep quality and greater daytime dysfunction. Hierarchical regression revealed that sociodemographic variables explained only a small proportion of variance in sleep quality. The addition of loneliness variables increased explained variance to 38.1%, highlighting loneliness as a key psychosocial predictor. Conclusions: Loneliness significantly influences sleep quality among older adults living in nursing homes. Interventions should integrate strategies to enhance social engagement alongside sleep hygiene measures. Longitudinal studies are recommended to clarify causal pathways. Full article

Background/Objectives: Work–family conflict is a relevant psychosocial factor in nursing and may influence turnover intention. This study analyzed the association between work–family conflict and turnover intention among nursing professionals in Portugal. Methods: A cross-sectional study was conducted between April and July 2025 with 1097 nurses from a local health unit in northern Portugal. Data were collected using a sociodemographic and professional questionnaire, the Work–Family Conflict (WFC) and Family–Work Conflict (FWC) Scale, and the Turnover Intention Scale. Nonparametric tests, Spearman’s correlation, and linear regression models were used. Results: Participants were aged 23–66 years, with a median age of 42 years; most were women (84.0%) and held a bachelor’s degree (85.0%). Mean scores were 24.5 (SD = 7.7) for WFC, 13.2 (SD = 6.6) for FWC, and 34.8 (SD = 15.7) for turnover intention. Both conflict dimensions were positively correlated with turnover intention, with a stronger association for WFC (ρ = 0.347; p < 0.001) than for FWC (ρ = 0.186; p < 0.001). In the fully adjusted regression model, WFC remained positively associated with turnover intention (β = 0.383; SE = 0.062; t = 6.149; p < 0.001), whereas FWC was no longer significant. Adding job satisfaction, perceived work-related stress, and nurse manager support increased explanatory capacity. Conclusions: Work–family conflict, especially work-to-family interference, was associated with nurses’ turnover intention. These findings highlight the need for organizational strategies that reduce work demands, support work–life balance, and address broader occupational and psychosocial conditions. Full article

Objectives: This study aimed to evaluate the relationship between quiet quitting and burnout among nurses, considering the influence of sociodemographic and occupational factors in healthcare settings. Methods: This cross-sectional, observational, and quantitative study was conducted from April to July 2025 in health services in northern Portugal, involving 1097 nurses who completed a questionnaire, the Silent Employment Abandonment Scale, and the Shirom–Melamed Burnout Scale. Descriptive and inferential analyses examined associations between sociodemographic variables, work context, and outcomes. Results: The 1097 participating nurses showed a positive correlation between overall quiet quitting and total burnout across all domains. Burnout remained significantly associated with overall quiet quitting after adjustment, and physical and cognitive fatigue showed the most consistent independent associations across models. The strongest coefficients were observed for the ‘lack of motivation’ dimension. Conclusions: Quiet quitting was consistently associated with burnout among nurses after adjustment for sociodemographic and occupational factors. The pattern of results was stronger for physical and cognitive fatigue and for lack of motivation, supporting the interpretation of quiet quitting as an important correlation of occupational strain in nursing and reinforcing the need for organizational and leadership strategies that reduce fatigue and sustain professional engagement. Full article

Background/Objectives: Professionalism reflects an individual’s connection, identity, and dedication to their profession. In nursing, it is associated with quality of care and professional respect, making its assessment essential for workforce development and management. However, valid and reliable instruments are needed to measure this construct across cultural contexts. Therefore, this study aims to evaluate the validity and reliability of the Portuguese version of the Nurses’ Professionalism Inventory (NPI). Methods: This methodological study used cross-sectional data collected from November 2024 to January 2025 in northern Portugal. Data were gathered from a convenience sample of 684 nurses who completed a sociodemographic questionnaire, the Portuguese NPI, the Conditions of Work Effectiveness Questionnaire II (CWEQ-II), and the Team Psychological Safety (TPS) scale. Confirmatory Factor Analysis (CFA) was conducted. Factor loadings and Average Variance Extracted (AVE) were used to assess validity. Internal consistency was evaluated using Composite Reliability, McDonald’s omega, and Cronbach’s alpha. Convergent validity was examined using Spearman correlations among NPI subscales, CWEQ-II dimensions, and TPS. Results: The Portuguese version of NPI preserved the original five-factor structure. The model showed acceptable fit indices (TLI = 0.90; CFI: 0.91; RMSEA = 0.10; SRMR = 0.08). All items had factor loadings above 0.50, except item 18 (0.42), which did not load significantly on any other factor; therefore, it was removed. This improved the AVE of the Professional Attitude subscale. The overall internal consistency was satisfactory, with all reliability coefficients ranging between 0.73 and 0.99. The correlations among the NPI subscales, CWEQ-II dimensions, and TPS were positive and statistically significant. Conclusions: This study demonstrates adequate measurement properties of the Portuguese version of NPI, supporting its use as a valid and reliable instrument. Full article

Background/Objectives: Evidence-Based Nursing is imperative for high-quality care, but its implementation continues to face the know-do gap. While organizational barriers are often cited, the role of individual competencies, specifically Emotional Competence, in facilitating adoption remains underexplored on a large scale. This study aimed to analyze the association between perceived Emotional Competence, Evidence-Based Nursing adoption, and perceived attitudes and barriers in a nationwide sample of nurses registered with the Portuguese Order of Nurses. Methods: A quantitative, cross-sectional, correlational study was conducted using a non-probabilistic sample of 3014 nurses registered with the Portuguese Order of Nurses. The Clinical Effectiveness and Evidence-Based Practice Questionnaire, the Attitudes and Barriers Questionnaire, and the Emotional Competence Questionnaire were administered. Data were analyzed using bivariate correlations and a multivariable linear regression model. Results: Nurses reported high levels of perceived Emotional Competence (M = 204.7; SD = 20.3). In the multivariable regression model, Emotional Competence remained robustly and independently associated with Evidence-Based Nursing adoption (B = 0.315; p < 0.001), even after adjusting for sociodemographic and professional covariates. The perception of organizational barriers (e.g., time, incentives) did not correlate with adoption (r_s = 0.011; p = 0.54). Conclusions: Perceived Emotional Competence is a significant and independent correlate of Evidence-Based Nursing adoption. The results suggest that developing socio-emotional skills, including emotional regulation, may be a relevant training target to support evidence implementation. Full article

Background/Objectives: This study aimed to analyze the perceptions and experiences of health professionals regarding teamwork as an interprofessional competency within the context of Intensive Care Units (ICUs) in a Brazilian public teaching hospital. Methods: This was a qualitative, exploratory study guided by a constructivist–interpretative perspective. The scenario consisted of Intensive Care Units of a public teaching hospital, which is a reference for emergency care, located in Brazil. Sampling was intentional and involved 29 professionals, most of whom, 25 (86.20%), were females, including nurses, nursing technicians, physicians, physiotherapists, and others. In order to collect data, individual semi-structured face-to-face interviews were conducted in 2025, which were audio-recorded and fully transcribed. The criterion for determining the number of participants was theoretical saturation. Data analysis followed the steps of Braun and Clarke’s thematic analysis, conducted inductively, with peer validation and the use of illustrative quotations to ensure credibility. Results: Five main categories emerged: “Understanding teamwork as an interprofessional competency,” “Factors that facilitate interprofessional teamwork,” “Factors that hinder teamwork,” “Tools used in the ICU to develop interprofessional teamwork” and “Individual actions to develop interprofessional teamwork.” The analysis revealed a central tension: although professionals discursively value interprofessional teamwork, its practical implementation is constrained by organizational and hierarchical barriers. Communication was identified as a transversal axis, functioning at times as a facilitator and at other times as a barrier. Conclusions: This study demonstrates that interprofessionality in Brazilian ICUs cannot be sustained solely through individual initiatives, but requires structured institutional strategies, such as formal collaboration protocols, interprofessional education programs, and a revision of hospital organizational culture. Furthermore, although health professionals value interprofessional teamwork, their practice still faces significant barriers. These findings may support managers’ reflection on the need to implement in-service teaching and learning strategies that facilitate interprofessional teamwork, especially those in high-technology units, thus enhancing collaborative practice in health. Full article

Background/Objectives: Mental health challenges are increasingly prevalent among higher education students, with significant implications for academic success and personal development. Emerging research suggests that critical thinking dispositions may support psychological well-being by enhancing resilience and adaptive coping. This study aimed to investigate the relationship between critical thinking dispositions and psychological well-being and to identify key sociodemographic predictors in this context. Methods: A cross-sectional design was employed from December 2024 to May 2025, recruiting 429 students from Portuguese higher education institutions via convenience sampling. Participants completed validated self-report measures: the Critical Thinking Dispositions Scale (CTDS) and the Psychological Well-Being Scale (PWBS), assessing seven critical thinking dispositions and six well-being dimensions, respectively. Sociodemographic data were also collected. Descriptive statistics, independent t-tests, one-way ANOVA, Pearson correlations, and hierarchical multiple regression were used for data analysis. Results: Students demonstrated moderate to high levels of critical thinking and psychological well-being, with higher scores associated with increased age and academic progression. Significant positive correlations were identified between critical thinking dispositions and all well-being dimensions; personal growth, purpose in life, and autonomy exhibited the strongest associations. Regression analysis revealed that confidence in reasoning, cognitive maturity, and open-mindedness were significant predictors of psychological well-being, explaining 28.7% of the variance. Conversely, inquisitiveness showed a negative association with psychological well-being in the multivariate model, an unexpected finding that warrants cautious interpretation and further investigation. Conclusions: Critical thinking dispositions reflect affective tendencies and habitual ways of engaging with thinking. These dispositions appear to protect psychological well-being in higher education students. Integrating the development of emotional awareness and reflective thinking into curricula may therefore foster resilience and academic success. Further longitudinal research is needed to explore causal mechanisms and intervention efficacy in broader academic contexts. Full article

Research on tannin-based foams has shown promising results. However, all developments in this field have not been addressed from different perspectives, in a systematic way, and with an emphasis on sustainability. This work discusses different formulations, emphasizing their bio-based components and how modifications influence key properties. It examines life cycle assessment (LCA) studies through a sustainability lens and identifies major commercial phenolic products to highlight the practical use of tannin foams for thermal insulation. The type of tannins, as well as their sources, influences the key properties of these foams. The replacement of formaldehyde, a crosslinking agent known for its health risks, is possible, particularly through more sustainable alternatives that allow for foams with better properties than those obtained with formaldehyde. Substitution of diethyl ether with less hazardous alternatives results in foams with improved thermal and mechanical performance. The elimination of the blowing agent—the green alternative—also leads to foams with good performance. The presence of additives (surfactants, plasticizers, and fillers), some of which are sustainable, improves the mechanical properties of the foams. The performance in fire-related applications, already promising, is also enhanced by the presence of additives. An increase in understanding, combined with the sustainable nature of the various alternatives, makes tannin-based foams promising candidates for next-generation insulation and structural materials in construction. Full article

We use the hedonic price model to measure the effect of school quality on apartment rent prices in Porto Alegre, Brazil. A spatial autoregressive regression (SAR) was employed due to the spatial nature of the data. We estimated the effect of school quality on apartment prices for public and private schools separately. The results shed light on the relation between school quality and apartment prices in a Global South context. We showed that both public and private school quality is valued in Porto Alegre house markets, although the effect is quite different for each type of school. For public schools, the major effect comes from the distance of the nearest schools. An increase in test scores by one standard deviation raises apartment rent prices by 2.7% for the whole city. However, this effect is bigger for some submarkets, reaching 11.6% for the distant suburbs. For private schools, the same effect occurs but for a larger distance radius. The same increase in average test score out to a 2 km distance from private schools raised the apartment price by 1.0%. Nevertheless, this effect reaches 6.6% in one specific submarket. 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: Chronic kidney disease and haemodialysis treatment are associated with physiological and functional alterations that compromise postural stability, favouring frailty and the risk of falls. These conditions directly affect the quality of life and autonomy of people undergoing haemodialysis, constituting an important challenge for rehabilitation nursing. In this sense, the aim of this study was to analyse the relationship between falls, frailty and quality of life in people with chronic kidney disease on a regular haemodialysis programme, identifying implications for rehabilitation nursing care. Methods: This was a quantitative, observational and cross-sectional study conducted with 62 participants from a haemodialysis unit in northern Portugal. The Tilburg Frailty Indicator and the Kidney Disease Quality of Life Instrument (KDQOL-SF™ 1.3) were applied. Statistical analysis used parametric and non-parametric tests, considering a significance level of p < 0.05. Results: The prevalence of falls in the year preceding the data collection was 32.2%, and the prevalence of frailty was 40.3%. A significant association was found between frailty and falls (p = 0.038) and between sex and falls (p = 0.002). The dimensions Symptoms/problems and Effects of kidney disease on daily life showed lower scores among participants with falls (p < 0.001). Conclusions: Frailty and poorer illness perception were associated with the occurrence of falls and with lower quality of life. Comprehensive assessment and the implementation of rehabilitation programmes led by specialist nurses in rehabilitation nursing are essential to promote functionality, safety and autonomy in people undergoing haemodialysis. Full article

Background/Objectives: Structural empowerment involves access to opportunities, information, support, and resources within the work environment. These elements are crucial as they foster nurses’ professional growth and autonomy. Given their significance, understanding hospital nurses’ perceptions of structural empowerment is important. Therefore, the aim of this study is to explore hospital nurses’ perceptions of their levels of structural empowerment. Methods: This cross-sectional study included 684 nurses from a Portuguese hospital, conducted between November 2024 and January 2025. The questionnaire collected demographic data and employed the Conditions of Work Effectiveness Questionnaire II. Results: The mean total score for structural empowerment was 18.74 (SD = 3.46), with significant differences found between nurses and specialist nurses, for those with the specialist title (p = 0.0477) and within the professional category (p = 0.0058), as well as between nurses working day shifts and those working day and night shifts (p < 0.0001). Additional significant differences were observed between nurses from the Medicine department (median [Q1–Q3]: 19.25 [17.00–21.50]) and those from the Surgery department (18.17 [16.00–20.25], p = 0.0104), as well as between Generation Z nurses (19.58 [17.33–21.83]) and Generation Y nurses (18.29 [16.25–20.33], p = 0.0018). Conclusions: These results underscore the importance of consistently promoting structural empowerment across the nursing staff, addressing disparities between groups, and improving both professional development and quality of patient care. Full article

Background/Objectives: Evidence-Based Practice (EBP) positively impacts health safety and quality while also empowering nursing as a discipline. A useful strategy for promoting EBP is to build learning paths adapted to the individuality of nurses. These elements establish the framework for effective learning, determining the availability of specific content at certain times and influencing the design of learning objects to ensure optimal efficacy in the teaching-learning process. It is essential to identify effective strategies in evidence-based nursing education to advance EBP and thereby enhance the quality and safety of nursing care. This review aims to summarize the evidence on the effectiveness of learning paths in the acquisition of EBP competencies by nurses. Methods: A systematic review of the literature will be carried out in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness. The results of the review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols (PRISMA-P). The protocol is registered in the PROSPERO database (CRD4202453155). The search will be performed using the EBSCOhost search engine in the following databases: CINAHL Plus, MedicLatina, MEDLINE, Psychology and Behavioral Sciences Collection, Academic Search Complete, eBook Collection, and Education Resources Information Center. The inclusion of studies, data extraction, and analysis will be carried out by two reviewers independently. Disagreements will be resolved by a third reviewer. All studies involving nurses, learning paths, EBP competencies, regardless of geographical area and context, with no time limit or language constraints, will be included. Results: Not applicable; this is a protocol. Findings will be synthesized as specified in the Methods. Conclusions: This review will provide a better understanding of the effectiveness of a learning path in the acquisition of EBP competencies by nurses. It will also assist in the identification of knowledge gaps in the literature and potential areas for future research and development. Full article

Background: Ageing leads to physical, cognitive, and social changes that affect people’s functioning and social participation. Health literacy, sociodemographic, and environmental factors influence health outcomes and access to care. This study aimed to characterize the health and functioning of Portuguese adults aged 65 and over, focusing on sociodemographic factors, health status, lifestyle, fall risk, functional capacity, and social participation, and on comparing rural and urban populations. Materials and Methods: An exploratory, cross-sectional study was conducted using data from older adults who completed the FallSensing screening protocol. Participants were classified by residence type (rural vs. urban), and group comparisons were made. Results: The sample (n = 474) was predominantly female (66.5%) with a mean age of 74.62 (±6.49) years. Rural participants were older (76.87 ± 6.89 vs. 73.50 ± 5.87) and had higher body mass index (BMI) (28.32 ± 4.31 vs. 27.51 ± 4.12), lower educational attainment—for example, 22.9% had no formal education compared to 7.0% of urban participants—and a higher prevalence of hypertension (72.6% vs. 55.4%), whereas urban participants experienced higher rates of osteoporosis (24.4% vs. 14.3%), hearing loss (41.9% vs. 26.9%), and alcohol consumption (12.7% vs. 2.3%) (p ≤ 0.05). Rural residents also demonstrated significantly poorer results for grip strength (21.03 ± 7.36 vs. 23.73 ± 8.61), gait speed (1.17 ± 0.44 vs. 1.45 ± 0.39), and the Timed Up and Go (TUG) test (13.4 ± 10.40 vs. 9.62 ± 4.43), as well as lower exercise self-efficacy (12.83 ± 4.97 vs. 14.28 ± 4.40) (p < 0.001), and more pronounced moderate-to-severe restrictions in social participation (28.0% vs. 15.7%) (p = 0.013). They reported greater use of assistive devices and more severe limitations in social participation. Although falls were reported more often in urban areas, rural residents experienced greater fall frequency. Conclusions: These findings suggest that rural living is associated with lower functional capacity and poorer health, underscoring the need for targeted physiotherapy and primary care strategies in rural settings. Full article