Search Results (282)

Background: Automated discharge instructions are increasingly used to support post-discharge communication, patient education, and nursing follow-up, yet the current state remains unidentified. This systematic review explores the types of automated discharge instructions used and their effectiveness in enhancing patient engagement and reducing readmission, emergency department visits and reoperation rates. Methods: A systematic search was conducted on 15 April 2025, using Embase, PubMed, Scopus, Web of Science, and CINAHL, following PRISMA guidelines. Inclusion criteria required peer-reviewed original research evaluating the utilization of automated patient discharge instructions following hospital admission or surgical stay. Exclusion criteria included correspondence, reviews, educational materials, not peer-reviewed, retracted reports, not retrievable, and no English translation. Risk of bias was assessed independently using NIH, JBI, ROB-2, and ROBINS-I tools. Two investigators independently conducted the screening, extraction, and synthesis of results using Endnote and Microsoft Excel. Results: Of the 1252 records identified, 13 studies were selected for analysis. There was a total of 34,386 patients across a diverse range of healthcare settings and clinical contexts. The average sample size per study was approximately 4912, with study samples ranging from 16 to 13,188 patients. The modalities of discharge instructions included automated phone calls (23.1%) and/or text messages (53.8%), as well as printed out auto-generated summaries (15.4%). Patient engagement was generally high, with automated phone calls showing the most consistent interaction, with completion rates ranging from 44% to 56%, often prompting clinical follow-up. SMS tools demonstrated strong scalability and response rates up to 87%. Two studies reported on hospital readmission outcomes and only a single study reported on emergency department revisit rates, while none assessed reoperation outcomes. Among those reporting readmission, automated phone calls and SMS were associated with lower or proxy-reduced readmission rates. Included studies had low to moderate levels of bias. Conclusions: While evidence on clinical outcomes such as readmissions, emergency department revisits, and reoperations remains limited and inconclusive, automated discharge tools—particularly phone calls and SMS—consistently demonstrated high patient engagement. Automated discharge tools show promise for supporting transitional care, discharge education, and post-discharge monitoring, highlighting the future role of automated tools in nursing workflows to support follow-up, escalation, and continuity of care. Full article

Introduction: Fever is one of the most common reasons for Paediatric Emergency Department (PED) visits, often driven by parental anxiety and misconceptions about fever management. This study aimed to evaluate the knowledge, attitudes, and practices of parents regarding childhood fever to identify gaps and guide targeted educational interventions. Understanding parental behaviors is crucial for improving care outcomes and reducing unnecessary PED utilization. Methods: This study is a descriptive cross-sectional study. The sample of this study consists of a total of 440 parents of children admitted to the Paediatric Emergency Department (PED) with complaints of fever. Convenience sampling was used to select the participants. Data were collected using a questionnaire covering sociodemographics, a form surveying the parents’ fever knowledge and attitude, and the validated parents’ fever management scale (Turkish version). The data were analyzed using the SPSS 22.0 statistical program. Results: Most parents (95.5%) reported prior experience with childhood fever, yet 54.1% lacked a regular physician. Common fever detection methods included tactile assessment (56.4%) and thermometers (27.3%). Parental concern arose at 39 °C (48.6%). Cold applications (41.6%) and antipyretics (21.1%) were frequent interventions. The mean PFMS-TR score was high (34.97 ± 4.27), indicating elevated caregiver burden. Scores varied significantly by the child’s age (higher for infants, p = 0.044) and maternal education (higher for educated mothers, p = 0.008). Satisfaction with healthcare staff correlated with higher scores (p = 0.024). Negative correlations emerged between parental age, number of children, and fever management scores (p < 0.05). Conclusions: Parents exhibited high interventionist behaviors and persistent knowledge gaps, underscoring the need for targeted education programs. Educational programs targeting fever management, tailored to parental demographics and misconceptions, are essential. Healthcare providers, particularly pediatric nurses, should prioritize clear communication and evidence-based guidance to empower parents and reduce unnecessary healthcare burdens. Future research should expand to diverse geographic and cultural settings to enhance generalizability. Full article

The rise in ICU survival rates has introduced new challenges related to the long-term effects of intensive care, known as Post-Intensive Care Syndrome (PICS). Nurses play a key role in these clinics; however, the nature and outcomes of their interventions remain insufficiently understood. Objectives: This review aims to identify nursing interventions for PICS in follow-up clinics. Methods: Using the JBI scoping review methodology, we searched PubMed, Web of Science and CINAHL (via EBSCOhost) in March 2025, and examined grey literature in RCAAP and Open Dissertations (through B-ON). Inclusion criteria, based on JBI’s PCC (Population, Concept, Context), focused on nursing interventions for PICS for patients and families in follow-up. Studies involving children, adolescents, pregnant women, and those receiving end-of-life care were excluded. Results: Encompassing studies from 2005 to 2022 across multiple countries, this review highlights nursing interventions for post-ICU recovery. A total of 394 articles that met our search criteria were found, resulting from searches in the mentioned databases. These were initially exported to Rayyan, and 115 duplicates were removed. The 21 articles that met our inclusion criteria were fully analyzed, and those that effectively answered our questions and met our inclusion criteria were selected. In the end, 9 articles were selected, to which, after an individual analysis of their bibliographic references, 3 more were added, totaling 12 articles submitted to the final analysis. Conclusions: For patients, interventions ranged from debriefing, PICS symptom evaluation, ICU re-visits, health education, cognitive–behavioral therapy and support groups, complemented by home-based physical rehabilitation and virtual reality. Family-focused interventions centered on appointment involvement, educational sessions, patient diary review, and emotional support. These assessments and interventions address the consequences of ICU admission, with the goal of facilitating physical, mental, and emotional rehabilitation of ICU survivors. This review emphasizes the critical role of follow-up consultations in the recovery of both patients and families. A comprehensive assessment using PICS scales and the integration of families into care plans are crucial for optimizing intervention outcomes. Implications for Clinical Practice: The development of evidence-based guidelines for implementation of follow-up clinics for SPICI appointments is necessary. Full article

Frailty is a multidomain reduction in physiologic reserve that impacts recovery and can contribute to poor outcomes following trauma beyond what chronological age, comorbidities, or injury severity predicts. In geriatric trauma patients, a large proportion are frail or prefrail on initial encounter in the emergency department, and because there are opportunities for actionable management plans, major trauma guidelines endorse systematic screening integrated into coordinated geriatric trauma care. We reviewed the literature and identified practical instruments used in the acute trauma setting for risk stratification. Additionally, we highlight the feasibility of using these instruments, as some can be completed via patient report, proxy input, or chart review when cognition, language, or caregiver availability limits history-taking. Implementation efforts succeed when shared mental models are leveraged and screening is embedded in the electronic health record system, linked to order sets and trigger-based pathways that offer downstream goal-directed care management, such as early mobility, delirium prevention, nutrition, medication review, and comprehensive geriatric assessment. Additionally, we highlight the importance of initiating early goals-of-care discussions and coordinating care with palliative care services. Resource-limited systems can preserve the same architecture by using nurse-led or allied staff-led screening, tele-geriatric consultation, and virtual interdisciplinary huddles. Lastly, we expand upon opportunities for longitudinal post-discharge follow-up. We describe how targeted initiatives translate research into practice, improve outcomes, and support longitudinal reassessment through in-person and telehealth follow-up visits. Full article

Background/Objectives: This study examined the reasons and sociodemographic drivers behind delays in seeking medical care among participants in the All of Us Research Program. Methods: A cross-sectional study was conducted using data collected between 2018 and 2024. The primary outcome was the prevalence of reasons for delayed medical care (DMC). Descriptive statistics were used to calculate the prevalence of the various reported reasons for delayed medical care. Binary logistic regression was applied to examine the association between sociodemographic characteristics and each reported reason for delayed medical care. Results: Out of a total of 633,000 All of Us participants, 300,820 participants had complete data on the healthcare utilization and access survey and were eligible for final analysis. The most common reported reasons for DMC were out-of-pocket expenses (16.68%), nervousness about seeing a provider (14.18%), and inability to get time off work (11.04%). Females had significantly higher odds of DMC due to out-of-pocket costs (OR = 1.31, 95% CI: 1.28–1.33). Black (OR = 0.81, 95% CI: 0.78–0.84) and Asian (OR = 0.94, 95% CI: 0.89–0.99) individuals had lower odds of DMC due to out-of-pocket costs. Married individuals had more than twice the odds of DMC due to childcare responsibilities (OR = 2.45, 95% CI: 2.33–2.56). Conclusions: A significant proportion of participants reported DMC due to various reasons, with financial, medical visit anxiety, and work-related reasons being the most common. These findings highlight actionable intervention targets, including nurse-led cost navigation and financial counseling, flexible scheduling/telehealth to reduce work-related delays, and patient-centered communication and outreach strategies to reduce visit-related anxiety and support caregiving and transportation needs. Full article

Background: Behavioural cues observed during emergency department (ED) triage may provide additional information on patient acuity. We conducted an exploratory pilot study to investigate whether mobile phone use observed during ED triage was associated with hospital admission. Methods: We performed a retrospective, single-centre study including all adult ED attendances between 1 January 2019 and 30 June 2025. Demographics, triage category, mobile phone use documented by nursing staff during waiting time, and hospital admission were extracted from the electronic health record. The primary outcome was hospital admission, with a secondary analysis restricted to low-priority triage categories. Results: Among 423,267 ED visits, the overall admission rate was 20.9%. Mobile phone use was documented in 171 patients (0.04%), of whom 4.7% were admitted (p < 0.001). In low-priority patients (n = 336,160), admission was 4.5% among those using a phone compared with 13.2% overall (p = 0.001). Conclusions: Mobile phone use observed during ED triage was associated with lower hospital admission rates and may represent a simple behavioural adjunct to conventional triage assessment. Full article

Background/Objectives: The 2024 Noto Peninsula earthquake in Japan severely affected community care for persons with psychiatric disabilities. This study analyzed the difficulties and adaptive coping strategies of psychiatric visiting nurses (PVN) to inform disaster mental health practice. Methods: A qualitative, descriptive design was used. Semi-structured interviews were conducted with six PVN, and the data were analyzed thematically. Results: Key findings indicated two main challenges: a system-level paralysis of care owing to infrastructure collapse and the ethical dilemmas experienced by the role of PVN as “dual victims.” In response, nurses leveraged pre-existing therapeutic relationships to ensure care continuity and acted as essential liaisons to external teams. The study also documented substantial and unexpected patient resilience. Conclusions: Based on the findings, this study’s primary contribution is a recommendation to reframe disaster policy by shifting focus from merely deploying external aid to empowering existing, trusted community care networks and adopting a strengths-based model for mental health support. Full article

Background: Digital transformation in healthcare has advanced rapidly in hospitals and primary care, while long-term care facilities have often lagged behind. In nursing homes, nurses play a central role in coordinating care and accessing medical expertise, yet digital tools to support these tasks remain inconsistently implemented. The CareConnect study, funded under the German Model Program for Telecare (§ 125a SGB XI), aimed to develop and implement a multiprofessional telecare system tailored to nursing home care. Objective: This implementation study examined the feasibility, acceptability, and early adoption of a multiprofessional telecare system in nursing homes, focusing on implementation processes, contextual influences, and facilitators and barriers to integration into routine nursing workflows. Methods: A participatory implementation design was employed over 15 months (June 2024–August 2025), involving a university hospital, two nursing homes (NHs), and four medical practices in an urban region in Germany. The telecare intervention consisted of scheduled video-based teleconsultations and interdisciplinary case discussions supported by diagnostic devices (e.g., otoscopes, dermatoscopes, ECGs). The implementation strategy followed the Standards for Reporting Implementation Studies (StaRI) and was informed by the Consolidated Framework for Implementation Research (CFIR). Data sources included telecare documentation, nurse surveys, researcher observations, and structured feedback discussions. Quantitative and qualitative data were analyzed descriptively and triangulated to assess implementation outcomes and mechanisms. Results: A total of 152 documented telecare contacts were conducted with 69 participating residents. Most interactions occurred with general practitioners (48.7%) and dermatologists (23%). Across all contacts, in 79% of cases, there was no need for an in-person visit or transportation. Physicians rated most cases as suitable for digital management, as indicated by a mean of 4.09 (SD = 1.00) on a 5-point Likert scale. Nurses reported improved communication, time savings, and enhanced technical and diagnostic skills. Key challenges included delayed technical integration, interoperability issues, and varying interpretations of data protection requirements across facilities. Conclusions: This pilot study suggests that telecare can be feasibly introduced and accepted in nursing home settings when implemented through context-sensitive, participatory strategies. Implementation science approaches are essential for understanding how telecare can be sustainably embedded into routine nursing home practice. Full article

Nail clipping can cause fear, anxiety, and stress (FAS) in dogs and cats and possibly long-term aversion to veterinary care. We conducted an anonymous, online, mixed-methods survey to characterise the knowledge, attitudes, and practices of Australian veterinary nurses, technicians, and other veterinary staff regarding nail clipping in dogs and cats. Among 242 valid responses, 71.9% (n = 174/242) performed nail clipping multiple times per week. Dogs (72.4%, n = 165/228) and cats (59%, n = 134/227) frequently displayed FAS (score > 2/5) during nail clipping. Most respondents (79.8%, n = 193/242) reported being injured while performing nail clipping. Respondents reporting a negative attitude towards nail clipping were 5.5 times (95% CI = 1.7–17.8) more likely to report being injured during a nail clip compared to those with a positive attitude. Respondents reported feeling pressure to persevere with nail clipping when it was unnecessary or when animals exhibited severe FAS. Where used, pre-visit pharmaceuticals and sedation were reported to effectively reduce FAS (dog: p = 0.015; cat: p = 0.152), along with non-pharmaceutical interventions such as gentle handling and counter-conditioning. Respondents perceived nail-clipping to be a difficult, undervalued task. Increased training of veterinary team members regarding nail clipping could improve animal welfare and the safety of veterinary team members. Full article

Public health restrictions during COVID-19 disproportionately affected older adults, especially those in long-term care (LTC) and their families. Family caregivers (FCs) are essential care partners in LTC settings, yet pandemic policies largely excluded them, creating emotional and systemic consequences. This study explored FCs’ experiences of visitation restrictions in British Columbia, Canada, using an arts-based qualitative approach within a larger mixed-methods project. Eight FCs participated in completing a total of twelve artworks, including photographs, collages, and creative writing that reflected their experiences. Virtual talking circles were used to facilitate the sharing and description of their experiences. Findings revealed three interconnected theme categories with eleven sub-themes. These themes suggest a plausible pathway: infection-control rules may lead to caregiver exclusion, disrupting relational continuity and oversight and contributing to distress and task-centered care. While context-specific and exploratory, results underscore the need for trauma-informed, family-inclusive policies and cultural safety in LTC. Arts-based research methods provided a powerful lens for capturing emotional realities often missed by conventional research. Full article

Introduction: Palliative needs assessment and referral to advanced palliative care resources are fundamental aspects of complex chronic patients’ care. Primary care Nurse Case Managers play a key role in the care of these patients. Objective: We aimed to describe the experiences of primary care Nurse Case Managers in palliative care needs identification and complex chronic patients’ referral to advanced palliative care resources. Method: This is a qualitative descriptive study with a phenomenological approach. Semi-structured online interviews were conducted with primary care Nurse Case Managers. A thematic analysis was performed using ATLAS.ti software. Results: 20 nurses participated, 16 of whom were women, with a mean age of 52.3 years and an average of 15.9 years of experience in primary care. Regarding “Palliative care Needs Assessment”, four sub-themes have been identified: “What do you understand?”, “How do you assess?”, “Difficulties” and “Alternatives” to current palliative care needs assessment. For the “Palliative Care Referral” theme four sub-themes have been identified: “Criteria”, “Tools”, “Difficulties” and “Alternatives” for referral. Discussion: Palliative needs are identified in patients with incurable diseases when there are no curative treatment options and when quality of life must be prioritized. Symptoms, general condition, progression, and comorbidity are assessed. Open interviews and home visits are essential for assessing the social and family context and the home resources available. Barriers identified include the conspiracy of silence, limited training in non-oncological palliative care, and a lack of staff and caregiver’s understanding of illness situation. The presence of difficult symptoms and a limited life expectancy were identified as key criteria for referral to palliative care. The physician’s assessment, the family’s request, and consultation with specialized teams play a key role in prognosis. Barriers include late referrals, lack of a palliative background, inequity in access to resources, and low visibility of the palliative care needs of non-cancer patients. Conclusions: Significant challenges remain in identifying palliative needs and referral to specialized resources, highlighting the need to optimize resources, strengthen professional training, and improve coordination between levels of care to ensure quality palliative care. Full article

Background: Due to the lack of curative treatments for inflammatory bowel disease (IBD), patients need lifelong follow-up care. Telehealth offers a valuable solution to balance routine visits with necessary monitoring. Objectives: To map what is known about the benefits and barriers encountered by nurses in their use of telehealth for the follow-up care of patients with IBD. Methods: Following the methodology from the Joanna Briggs Institute, we conducted a scoping review across four electronic databases from June 2024 to September 2025. Key search terms included “inflammatory bowel disease,” “nurse experience,” and “telehealth.” A content analysis was employed to summarize the key findings. Results: We screened 1551 records, ultimately including four original research articles from four countries. Benefits identified were as follows: (1) the vital contributions of IBD telenursing in empowering patients by bridging health literacy and self-care skills; (2) optimal use of staffing time supports patient-centred care; and (3) ease of use. Barriers included the following: (1) increased workload and task imbalances; (2) the need for customized interventions; (3) technical issues and concerns regarding the security of digital systems; (4) telehealth as a supplementary option or a standard procedure; and (5) concerns related to the patient–nurse relationship. Conclusions: Nurses view telehealth as a promising approach that enhances patients’ health literacy and self-care skills and improves patient outcomes through effective monitoring. To fully realize telehealth’s potential, implementing strategies like triage protocols, algorithmic alerts, electronic health record integration, and comprehensive nurse training to enhance patient care and engagement may be beneficial. This scoping review highlights the need for more research on nurses’ experiences with telehealth in IBD due to limited publications. Full article

Background/Objectives: This study explores the perceptions, experiences, and expectations of pediatric healthcare professionals regarding the implementation of virtual visits (VVs) in routine pediatric practice. Methods: Using the Consolidated Framework for Implementation Research (CFIR) to analyze individual, organizational, and contextual factors influencing the adoption of pediatric virtual visits, we conducted a descriptive cross-sectional survey distributed nationwide among pediatricians, pediatric nurses, and residents. Results: A total of 308 Spanish healthcare professionals correctly completed the REDCap survey and were included in the analysis. The mean age was 44.3 years, and respondents represented both hospital-based (55.8%) and primary care professionals (44.2%). Overall, 74.8% had previous experience with telephone consultations, while only 11% had performed virtual visits. Most professionals believed VVs could be useful in primary care (81.3%) and hospital out-patient settings (73.9%), especially for follow-up appointments, communication of test results, and chronic-care monitoring. VVs were perceived as more appropriate for older children and adolescents than for infants. Major concerns included poor internet connection (52.6%), and data security (37.4%); however, a particularly relevant finding was the low confidence in using digital tools, particularly among older professionals. Comparative analyses by age and workplace setting identified differences in interest, perceived barriers, and access to technical resources. Hospital-based clinicians reported greater interest in adopting VVs and better access to technological resources compared with primary care professionals. The professionals’ age was inversely associated with interest in VVs. Notably, 72.6% of respondents expressed interest in receiving specific VV training, and nearly 90% believed virtual visits should be offered in their workplace. Conclusions: These findings show a high overall acceptance of VVs but also underline persistent barriers related to infrastructure, digital literacy, and clinical applicability in younger children. Addressing these obstacles through training, improved equipment, and clear clinical protocols will be essential for the successful implementation of pediatric VV programs. Full article

Background/Objectives: The implementation of advanced practice nursing in Kazakhstan is aimed at improving the accessibility and quality of primary healthcare. One of the key indicators of the effectiveness of this model is patient satisfaction, which reflects the perceived quality of care and directly influences treatment adherence. The aim of the study was to assess patient satisfaction with nurse-led consultations in primary healthcare institutions in Kazakhstan. Methods: A cross-sectional study was conducted using a questionnaire developed on the basis of Karin Bergman’s instrument and adapted to the Kazakhstani context. A total of 621 patients who attended independent nursing consultations in polyclinics in Aktobe, Almaty, Astana, and the village of Merke participated in the survey. Descriptive statistics and Pearson’s χ² test were applied, with statistical significance set at p < 0.05. Results: The majority of respondents were women, with a median age of 61 years. Awareness of independent consultations was higher among patients who regularly visited nurses (97.1% vs. 86.9%; p < 0.006). High satisfaction levels were associated with service accessibility, quality of examination, and clarity of recommendations. Among regular visitors, 99.2% reported satisfaction with the nurse’s work, and 76.6% rated the service as “excellent”. In contrast, patients with irregular visits more often reported dissatisfaction due to insufficient attention and limited knowledge of nurses. Conclusions: The findings confirm a high level of patient satisfaction with advanced practice nursing services and highlight the importance of this model in strengthening primary healthcare in Kazakhstan. Full article

Background: Referrals to the Stroke prevention clinic with incomplete preliminary investigations decrease clinic capacity due to additional workload and the need for multiple follow-ups. We aimed to improve the efficacy of the initial visit by increasing the completion rate of vascular imaging in a quality improvement (QI) project. Methods: This is a quasi-experimental study with three phases: Phase 1: Surveillance; Phase 2: Stakeholder feedback-informed intervention development (physicians and clinic staff); and Phase 3: Intervention. Interventions included a new standardized specific physician triage form listing required investigations (brain imaging, vascular imaging, cardiac tracing), and a nurse-led pre-visit via telephone. The primary outcome measure was the completion of vascular imaging by the time of visit, assessed using multivariable logistic regression adjusted for age (in years), sex, and triage category. Results: The study’s inclusion criteria were met by 397 patients, with a mean age of 67.7 ± 13.2 years; 47.8% were female, and 62.9% (250) were diagnosed with vascular events. An increase in vascular imaging before the initial visit was observed in Phase 3 (148/199, 75.5%) compared to Phase 1 (121/198, 61.1%), with an adjusted Odds ratio of 1.77 (95% CI 1.2–2.8; p = 0.01). A trend toward fewer follow-up visits was observed in Phase 3 (23.1%) compared with Phase 1 (31.8%; p = 0.052). Conclusions: Implementing a standardized triage process and a nurse-led pre-visit may improve completion of vascular imaging before patients visit the stroke prevention clinic. Further QI studies are required to improve the completion rate of rhythm monitoring in this patient group to enable early detection and management of atrial fibrillation. Full article