Nursing Reports

Background/Objectives: Parents who accompany their children with a complex chronic illness until their death experience a unique situation, with vulnerabilities, specific needs and enormous suffering. The aim of the study was to describe the lived experience of parents who accompanied their children with a complex chronic illness until their death, in a paediatric palliative care setting. Methods: We opted for a qualitative methodology, with a descriptive phenomenological orientation. Phenomenological interviews were carried out with nine intentionally selected mothers, with the support of a paediatric palliative care hospital team. The procedural phases of van Kaam’s method, modified by Moustakas, were used to analyse the data. Results: An understanding of the essential structure of the phenomenon is revealed in a description made up of three essential themes: ‘facing the harbinger of illness’; ‘living (together) with a sick child’; and ‘starting again without ever forgetting: living with an absent child’, the latter being the subject of this article. Conclusions: The participants attribute a self-transforming meaning to their lived experience of accompanying their children. Nurses will be able to access the lived experience of these mothers and improve their intervention in the process of their children’s illness, as well as in their bereavement process. There are also contributions to research and teaching in palliative care in the area of child and paediatric health. Full article

(1) The question addressed in this study is what kinds of stereotypes and biases of gender in nursing exist in Tanzania. This study aimed to investigate gender stereotypes and bias among healthcare providers and non-healthcare providers. (2) Methods: Qualitative descriptive design and data were collected from the Dar es Salaam region of Tanzania through a Focus Group Discussion approach. The qualitative content analysis was used to obtain themes the following themes. (3) Results: Three themes and eighteen subthemes emerged from this study. The first theme is role distribution based on nurse gender, its impact, and mitigating approaches for biased role distribution; the second theme is the different ways of addressing challenges in gender in nursing diversity; and the third theme is gender in nursing biases at the training institutions. (4) Conclusions: The bias and stereotypes about gender in nursing still exist in clinical areas and training institutions. Exercising professionalism in both settings remains a vital aspect of reducing bias. Moreover, role distribution should not be dominated by social roles of men and women in the community but rather should be based on competence and individual abilities. Full article

Background/Objectives: Climate change adversely affects some of the fundamental determinants of health, and children are the population group most vulnerable to exposure to environmental risk factors. The main objective of this study was to validate in the Portuguese context three scales to assess attitudes, knowledge, and skills on children’s environmental health. Methods: A cross-sectional observational study was developed to translate, adapt, and validate the questionnaire consisting of the following three scales: Attitude Scale (SANS_2), knowledge scale (ChEHK-Q), and skills scale (ChEHS-Q). This was carried out in two phases: the translation and adaptation process and the validation process using classical measure theory and item response theory with undergraduate nursing students. Results: We obtained a valid and reliable questionnaire to measure children’s environmental health competence consisting of an attitude scale (α = 0.84), a knowledge scale (Infit = 0.98, Outfit = 0.97, item reliability = 0.98, and people reliability = 0.75), and a skills scale (Infit = 1.00, Outfit = 0.99, item reliability = 0.82, and people reliability = 0.88). The mean score on the attitude scale was 28.15 (5–35) ± 4.61; 14.92 (0–26) ± 4.51 on the knowledge scale; and 42.51 (24–60) ± 6.41 on the skills scale. Conclusions: We found that most Portuguese undergraduate nursing students have very good pro-environmental attitudes and good knowledge and skills in dealing with children’s environmental health. The questionnaire obtained in this study will be useful for comparative studies with other countries and for evaluating the effectiveness of educational interventions. Full article

Background: Medication errors cause adverse events; however, studies have yet to examine medication errors related to nursing hours while considering ward characteristics in Japan. Purpose: This study investigated medication errors caused by nurses to quantitatively assess ward activity as busyness in nursing duties. Methods: This study considered patients hospitalized in the general wards of 10 National Hospital Organization institutions between April 2019 and March 2020. The study data were obtained from the Diagnosis Procedure Combination system, incident report system, and reports on nurse staffing and work hours. Data for 27,629 ward days with 88,475 patients were analyzed. Multivariate analysis was performed to determine the impact of factors on medication errors. Results: The mean patient age was 71.43 years (SD = 15.08). The medication error rate in nursing wards was 13.71%. The mean nursing time per patient during day shift was 1.95 h (SD = 0.58) in the non-medication error group and 2.06 h (SD = 0.58) in the medication error group (p < 0.01). The nursing time per patient in the medication error group compared to that in the non-medication error group had an odds ratio of 1.31 (p < 0.01) during day shifts. Conclusions/Implications for practice: Contrary to evidence, the results showed that medication errors caused by nurses related to increased nurse time with patients during day shifts. Further investigation is needed on the relationship of busyness with nursing duties to ensure an adequate nurse–patient ratio, nursing time, and improved patient safety. Full article

Background/Objectives: Interventional radiology (IR) utilizing X-rays can lead to occupational radiation exposure, posing health risks for medical personnel in the field. We previously conducted a survey on the occupational radiation exposure of IR nurses in three designated emergency hospitals in Japan. Our findings indicated that a hospital with 214 beds showed a higher lens-equivalent dose than hospitals with 678 and 1182 beds because the distance between the X-ray irradiation field and the IR nurse’s position of the hospital with 214 beds was shorter than those of 678 and 1182 beds. Based on these observations, we hypothesized that the number of hospital beds affects the distance between the X-ray irradiation field and the IR nurse’s position. Methods: To verify this hypothesis, we conducted a more extensive online questionnaire survey, focusing exclusively on hospitals that perform cardiovascular IR. Results: We analyzed data from 78 facilities. The results of this study confirmed our earlier findings, showing that both the number of physicians performing IR procedures and the distance from the X-ray irradiation field to the IR nurse’s position are influenced by the number of hospital beds. Additionally, factors such as the type of hospital, emergency medical system, annual number of IR sessions, location of medical equipment, and the positioning of IR nurses appear to be associated with the number of hospital beds. Conclusions: Understanding these relationships could enable the development of individualized and prioritized radiation exposure reduction measures for IR nurses in high-risk settings, provided that comprehensive occupational radiation risk assessments for cardiovascular IR consider the number of hospital beds and related factors. This study was not registered. Full article

Background: Nursing relies on the development of caring attributes to uphold exceptional standards of care. While small-group work is a common practice in nursing education, its pivotal role in nurturing these attributes often remains underexplored. Aim: This study explored how caring attributes emerge in small-group settings from the perspectives of nursing students and educators. Methods: This qualitative study conducted semi-structured group interviews separately for students and educators. Thirteen nursing students and ten educators at a professional educational institution were interviewed. Results: Through the interviews, four key sets of caring attributes nurtured through small-group work were identified: interpersonal communication with respect; compassion and empathy; competence and confidence; and accountability to commitment. These findings, based on the perspectives of students and educators, underscore the essential role of caring in nursing. They emphasize how collaborative group work can serve as a catalyst for the development of these vital attributes through meaningful interpersonal interactions. Notably, the cultivation of respectful communication skills among students emerged as pivotal for enriching interactions with healthcare professionals, patients, and families, ultimately enhancing the quality of care provided. By providing a platform for interactive learning and continual practice, small-group work facilitates the internalization of these caring attributes, nurturing nursing professionalism over the course of students’ careers. Conclusions: This study offers invaluable insights into the profound impact of small-group work in fostering caring attributes and propelling advancements in nursing education and practice. By enhancing the development of these attributes, small-group work contributes to the delivery of compassionate and high-quality patient care. Full article

Background/Objectives: Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) present significant challenges in modern healthcare, leading to increased morbidity, mortality, and healthcare costs. Examination gloves play a critical role in infection prevention by serving as a barrier to reduce the risk of cross-contamination between healthcare workers and patients. This manuscript aims to provide consensus-based guidelines for the optimal selection, use, and disposal of examination gloves in healthcare settings, addressing both infection prevention and environmental sustainability. Methods: The guidelines were developed using a multi-stage Delphi process involving healthcare experts from various disciplines. Recommendations were structured to ensure compliance with international regulations and sustainability frameworks aligned with the One Health approach and Sustainable Development Goals (SDGs). Results: Key recommendations emphasize selecting gloves based on clinical needs and compliance with EN 455 standards. Sterile gloves are recommended for surgical and invasive procedures, while non-sterile gloves are suitable for routine care involving contact with blood and other body fluids or contaminated surfaces. Proper practices include performing hand hygiene before and after glove use, avoiding glove reuse, and training healthcare providers on donning and removal techniques to minimize cross-contamination. Disposal protocols should follow local clinical waste management regulations, promoting sustainability through recyclable or biodegradable materials whenever feasible. Conclusions: These consensus-based guidelines aim to enhance infection control, improve the safety of patients and healthcare workers, and minimize environmental impact. By adhering to these evidence-based practices, grounded in European regulations, healthcare settings can establish safe and sustainable glove management systems that serve as a model for global practices. Full article

Introduction: Pregnant women’s experiences and concerns regarding childbirth are complex, necessitating a multidimensional and personalized approach in maternal care. This study explores the psychological and emotional factors influencing pregnant women’s decisions regarding their mode of delivery. The results will provide valuable insights for the development of educational and counseling strategies designed to support pregnant women in making informed and conscious decisions about their childbirth. Material and method: This cross-sectional study aimed to develop and validate a questionnaire exploring the psychological dimensions of childbirth. Factor analysis was employed to assess emotional perceptions, perceived medical risks, and the impact of cesarean section on pregnant women. The questionnaire was distributed online via Google Forms, using social networks like Facebook and Instagram to ensure rapid and broad accessibility. The questionnaire was available for seven months, from January to July 2023. Results: McDonald’s ω, Cronbach’s α, average inter-item correlation, and total item correlations were calculated to assess the consistency of the questionnaire items in measuring the same construct. The three-factor model emerged as the primary structure based on exploratory and confirmatory factor analyses (EFA and CFA). The first profile, centered on the psychological and emotional benefits of vaginal birth, highlights the importance of the natural birth experience for the mother’s psychological well-being. The second profile addresses concerns about medical risks and the need for interventions. The third profile focuses on perceptions and concerns related to the intelligence and adaptability of children born by cesarean section and the effects of anesthesia. Conclusions: Each profile reflects different strategies for seeking control and security amid childbirth uncertainties. These include emphasizing the psychological benefits of vaginal birth, addressing medical risks, and focusing on the impact of interventions on child development. Understanding these variables is essential for providing appropriate counseling and psychosocial support, thereby optimizing the birth experience and promoting the health of both mother and child. The integration of multi-factor and single-factor models in the questionnaire analysis serves complementary purposes, providing distinct yet interrelated insights into the instrument’s structure and validity. Full article

Background: As part of simulation-based learning, it is well known that debriefing plays a crucial role; ineffective debriefing can lead to a reiteration of errors in decision-making and a poor understanding of one’s limitations, compromising the learner’s psychological safety and making future simulated learning experiences less effective. In Italy, although simulation has been used in nursing education for more than 20 years, there is a general lack of data regarding the elements of debriefing. Methods: An exploratory, cross-sectional, multicenter nationwide study was conducted to identify current debriefing practices in Italian simulation-based nursing education. A non-probability sample of all directors of the Italian Bachelor school of Nursing and the directors of simulation centers on Italian national territory was surveyed with an online questionnaire. Results: Fifty-four nursing degree programs and 11 simulation centers participated in the survey. Significant differences were found between debriefing practices used by simulation centers and those used by the Bachelor School of Nursing. Specifically, differences concerned the training of debriefers, the knowledge of a debriefing framework, the use of different rooms for debriefing and the time spent on this activity. Conclusions: There is an emerging need for a harmonization process in Italian nursing education debriefing practices that would align the current reality with the best practices of the literature. Full article

Background/Objectives: Although delirium is common during critical illness, standard-of-care detection and prevention practices in real-world intensive care unit (ICU) settings remain inconsistent, often due to a lack of provider education. Despite availability for over 20 years of validated delirium screening tools such as the Confusion Assessment Method in the ICU (CAM-ICU), feasible and rigorous educational efforts continue to be needed to address persistent delirium standard-of-care practice gaps. Methods: Spanning an 8-month quality improvement project period, our single-ICU interdisciplinary effort involved delivery of CAM-ICU pocket cards to bedside nurses, and lectures by experienced champions that included a live delirium detection demonstration using the CAM-ICU, and a comprehensive discussion of evidence-based delirium prevention strategies (e.g., benzodiazepine avoidance). Subsequent engagement by health system leadership motivated the development of an electronic health record dataset to evaluate unit-level outcomes, including CAM-ICU documentation and benzodiazepine administration. Results: Using a dataset that spanned 9 pre- and 37 post-project months and included 3612 patients, 4470 admissions, and 33,913 patient days, we observed that delirium education was followed by a dramatic rise in CAM-ICU documentation, from <1% for daytime and nighttime shifts to peaks of 73% and 71%, respectively (p < 0.0001 for trend), and a fall in the proportion of mechanically ventilated patients ever receiving benzodiazepine infusions (69% to 41%; p < 0.0001). Conclusions: An interdisciplinary delirium project comprising rigorous lectures on standard-of-care practices can yield significant improvements in documentation and sedative administration. This approach can help ICUs jumpstart efforts to build awareness and address longstanding gaps in standard-of-care delirium practices. Full article

Background/Objectives: The health of migrant populations is strongly influenced by social, cultural, and environmental factors. Promoting health literacy (HL) is essential to empower these populations and reduce health inequalities. We aimed to assess the perceptions and behaviors of migrants residing in a neighborhood within a municipality in the Metropolitan Area of Lisbon regarding health risks arising from environmental conditions, as well as to determine their level of health literacy. Methods: Our cross-sectional, descriptive, exploratory study used the Health Literacy Questionnaire. This study was conducted with ethical approval including a sample of 101 participants. We performed descriptive and inferential statistical analyses using the Statistical Package for the Social Sciences (SPSS) version 29. Results: Most participants were from Portuguese-speaking countries and reported issues with indoor humidity and inadequate thermal comfort in both hot and cold conditions. The primary environmental issues identified included stagnant water, organic waste, and deficient electrical networks. Conclusions: The results revealed precarious housing conditions and inadequate support infrastructure, posing significant environmental health risks. Data revealed low levels of health literacy across most domains assessed. Full article

Background: In the last decades, there has been a growing demand for outpatient services; understanding the factors influencing patient satisfaction is critical for improving healthcare quality. Objectives: This study evaluates patient satisfaction with nursing care and examines how satisfaction varies based on socio-demographic factors in ambulatory settings across five healthcare centers in the municipality of Vlora, Albania. Methods: In this cross-sectional study, a total of 246 patients were surveyed using the Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ), adapted for outpatient contexts, after assessing its validity and reliability. The mean age of the sample was 63.9 ± 13.1 years old with a range of 21 to 94 years, and 47.2% were aged between 50 and 69 years. Results: The results indicate that the overall satisfaction level was fair, with a mean PSNCQQ score of 2.55 on a five-point scale. Socio-demographic factors, such as age, gender, education, and socio-economic status, significantly impacted patient satisfaction. Younger patients (aged 20–49), females, and those with a higher education and socio-economic status reported higher satisfaction. Medical history also played a role, with patients attending general check-ups showing greater satisfaction compared to those with chronic conditions. Older patients tend to report a lower level of satisfaction with the care provided compared to younger patients. Conclusions: Communication and nurse–patient interactions emerged as key areas for improvement, particularly in outpatient settings where care is episodic. These findings suggest that personalized care, improved communication, and greater attention to socio-demographic and medical factors can enhance patient satisfaction in ambulatory care settings. Full article

Background: Individuals with severe mental illness live, on average, up to 30 years less than the general population, with cardiovascular disease being the leading cause of death. Metabolic syndrome (MetS) plays a significant role in this, making it crucial to manage this issue in individuals with psychosis at the onset of the illness. The approach to managing this issue has evolved from a focus on calorie counting to a deeper understanding of hormone function, particularly the role of insulin resistance in MetS. Therefore, incorporating this perspective into mental health nursing consultations with individuals experiencing psychosis is of great interest. Methods: In accordance with the SPIRIT guidelines, an open randomized clinical trial is proposed, involving patients from a first-episode psychosis program. Results: The primary outcome will be significant weight loss (≥5%). Secondary outcomes will include changes in metabolic parameters, psychopathological status, quality of life, and physical activity. Participants will be assigned to two groups: one group will attend a series of six previously manualized nursing consultations, while the other will continue with their usual treatment. Results will be evaluated at six months and one year. Conclusions: This study will determine whether a mental health nursing consultation based on the carbohydrate–insulin model of obesity is effective in reducing weight and the risk of MetS in individuals with early-onset psychosis. This study was retrospectively registered on Clinical Trials—NCT06650943. Full article

Background: Promoting physical activity among people living with dementia is critical to maximise physical, cognitive and social benefits; yet the lack of knowledge, skills and confidence among health professionals, informal care partners and people with dementia deters participation. As the initial phase of a larger feasibility study, co-design was employed to develop a new model of community care, ‘Changing the Focus’, to facilitate the physical activity participation of older people living with mild dementia. Methods: Co-design methodology was utilised with nine stakeholders (with experience in referring to or providing physical activity programs and/or contributing to policy and program planning) over three workshops plus individual interviews with four care partners of people with dementia. Insights were gathered on the physical activity for people with mild dementia, referral pathways were explored and ‘personas’ were developed and refined. Materials and resources to support exercise providers and referrers to work effectively with people with mild dementia were finalised. Results: Three ‘personas’ emerged from the co-design sessions, aligned with stages of behaviour change: (1) hesitant to engage; (2) preparing to engage; and (3) actively engaged. Referral pathway discussions identified challenges related to limited resources, limited knowledge, access constraints and individual factors. Opportunities were classified as using champions, streamlining processes, recognising triggers for disengagement, influencing beliefs and attitudes, and means of communication. Conclusion: This study captured the views of physical activity referrers and providers and informal care partners in an inclusive and iterative manner. The use of co-design ensured a robust approach to facilitating participation in formal and informal physical activity options for people living with mild dementia. This study has provided the necessary framework from which to develop and test training and resources for the next stage of intervention (a feasibility trial) to improve physical activity participation for people with dementia. Full article

Background: Anxiety in simulations can be influenced by various factors that either motivate or immobilize students. Understanding simulation anxiety is crucial for educators to design appropriately challenging scenarios without overwhelming students. No instruments have yet been tested to differentiate between debilitating and facilitating anxiety within nursing simulations. Methods: A quantitative repeated measures design was used to examine students’ baseline and pre-simulation anxiety with 90 pre-licensure junior level nursing students. The Achievement Anxiety Test (AAT) was administered to differentiate levels of debilitating and facilitating anxiety. Results: The revised AAT demonstrated preliminary validity and reliability for measuring debilitating and facilitating anxiety when used in nursing simulation. Linear regression showed only debilitating anxiety significantly predicted pre-simulation state anxiety. Baseline anxiety has a significant impact on students, increasing debilitating anxiety in simulated settings. Conclusions: To ensure success in practice settings, it is important to address students baseline anxiety to support a successful transition into practice. This study was prospectively determined to be exempt with the University’s Institutional Review Board on 6 December 2022 and was not prospectively registered in a formal registry. Full article

Background: The Fundamentals of Care framework emphasizes a patient-centered approach that prioritizes the nurse–patient relationship and care environment to meet patients’ basic needs, including oral hygiene. Recognized as crucial for preventing systemic health problems, oral care neglect is a global concern. Studies identify missed oral care as a widespread issue, contributing to significant patient safety risks. This study aimed at measuring missed nursing care occurrence in a Northern Italian university hospital, exploring the association between missed oral care with nursing staff characteristics and oral care policies. Methods: A single-center cross-sectional study was conducted according to the STROBE guidelines. Data collection was performed in May 2022 using the MISSCARE survey, a self-administered questionnaire sent by email to 473 nurses from all inpatient units. The degree of implementation of oral care policies was obtained by accessing the Facility Score Sheet data at the department level. Descriptive statistics, chi-square tests, and Fisher tests were conducted using SAS 9.4 and R software. Results: Providing oral care was the third-most missed nursing care after rotating patients every two hours and walking them three times daily. The reasons for missed care included resource shortage and high patient turnover. The Facility Score Sheet data showed a low adoption of oral care policies. No significant associations were found between missed oral care and both nurses’ characteristics and oral care policy at the department level. Conclusions: The study confirms highly missed oral care in acute care settings, emphasizing the urgent need for systemic changes via an evidence-based oral care policy and practice implementation. This study was prospectively registered under protocol 293 CE 050/2022 (8 Aril 2022). Full article

Objective: This systematic review aimed to identify the most prevalent conflict management styles and strategies employed by nurses in clinical settings and to examine the factors associated with their selection. Methods: A comprehensive literature search was conducted following the PRISMA guidelines. Databases searched included PUBMED, CINAHL, Medline, and ProQuest, focusing on articles published between 2014 and 2024. Inclusion criteria were primary data studies involving nurses, published in English. The search strategy utilized Boolean operators to combine keywords related to nursing, conflict management, and healthcare settings. A total of 174 articles were initially identified, with 22 meeting the inclusion criteria after screening. The quality of the included studies was assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument Critical Appraisal Checklist. The results were synthesized using content analysis. Results: The main findings from the 22 articles reviewed indicate that accommodation and collaboration/integration are the most common conflict management styles and strategies among nurses, with compromising also frequently employed. Factors such as age, experience, educational level, and workplace culture significantly influence the choice of conflict management strategies. Discussion: Nurses employ a variety of conflict management strategies depending on the context, individual preferences, and situational factors. Effective conflict resolution is closely linked to collaboration and communication, with proactive strategies being more effective in preventing conflicts. The findings underscore the need for tailored conflict management training to enhance job satisfaction and work relations in nursing environments. We acknowledge several limitations that may affect the interpretation and generalizability of our findings such as the diversity of the tools and the methodologies used by the included studies. Full article

Background: Optimum efficiency and responsiveness to callers of mental health helplines can only be achieved if call priority is accurately identified. Currently, call operators making a triage assessment rely heavily on their clinical judgment and experience. Due to the significant morbidity and mortality associated with mental illness, there is an urgent need to identify callers to helplines who have a high level of distress and need to be seen by a clinician who can offer interventions for treatment. This study delves into the potential of using machine learning (ML) to estimate call priority from the properties of the callers’ voices rather than evaluating the spoken words. Method: Phone callers’ speech is first isolated using existing APIs, then features or representations are extracted from the raw speech. These are then fed into a series of deep learning neural networks to classify priority level from the audio representation. Results: Development of a deep learning neural network architecture that instantly determines positive and negative levels in the input speech segments. A total of 459 call records from a mental health helpline were investigated. The final ML model achieved a balanced accuracy of 92% correct identification of both positive and negative instances of call priority. Conclusions: The priority level provides an estimate of voice quality in terms of positive or negative demeanor that can be simultaneously displayed using a web interface on a computer or smartphone. Full article

Background: Adolescent eating disorders pose a significant public health challenge and strongly affect both physical and emotional well-being. Early diagnosis is important for improving treatment outcomes, though it remains complex due to multiple influencing factors. The family perspective is essential in this process, as it provides valuable insights into changes in adolescents’ habits and emotional health. Methods: A descriptive qualitative study was conducted between January and February 2023. Interviews were conducted with 12 participants using a phenomenological approach to explore the experiences and perspectives of family members of adolescents with eating disorders. Results: Four thematic blocks comprising several categories were identified: (T1) diagnosis, (T2) family, (T3) resources, and (T4) treatment. The participants emphasized the need for early intervention and a multidisciplinary approach to the treatment of eating disorders. Family therapy was recognized as vital to treatment, and common dissatisfaction with the public health structure underscores the need for greater investment in research and access to specialists. Mental health nurse practitioners play an important role in providing comprehensive care and support, as well as mental health literacy. Conclusions: A holistic, patient-centered approach, including family involvement and appropriate support systems, is key to improving the outcomes and quality of life of adolescents undergoing treatment for eating disorders. Improving healthcare resources and addressing the challenges faced by families is essential. In addition, mental health literacy is critical, as it enables families to understand the disease better, make informed decisions, and actively participate in the recovery process, thus contributing to improved therapeutic outcomes and quality of life for patients. Full article