Nurs. Rep., Volume 15, Issue 1 (January 2025) – 29 articles

Background/Objectives: Decreased well-being may be a precursor to mental health challenges. Mental health visits for 5–11-year-old children increased by 24% from 2019 to 2020. COVID-19 led to record high levels of anxiety and depression in young children. This highlights the need for early identification and intervention of decreased well-being to prevent progression to potential mental health issues. The purpose of our research was to develop the Pediatric Well-Being Picture Scale© (PWBPS©), the first picture-based screening tool for ages 8–11 years, accessible to children regardless of their literacy, language skill, and developmental levels, allowing for quick screening for early referral and intervention. Methods: The mixed-methods research design included focus groups and one-on-one interviews for content and face validity, test/retest reliability, convergent validity, and exploratory factor analysis. Subjects were recruited from public elementary schools. Results: The numbers of participating subjects were as follows: N = 17 for focus groups; N = 12 for one-on-one interviews; N = 50 for test/retest reliability; and N = 237 for convergent validity. Thematic analysis resulted in a 10-item, 3-point picture-based Likert scale. The test/retest reliability demonstrated strong correlations, with an ICC of 0.823 (95% CI [0.690, 0.905]). The Cronbach’s alpha for all the administrations was 0.74, 0.74, 0.84, and 0.89. The convergent validity demonstrated correlation with the validated KIDSCREEN-10. The Spearman’s correlation was 0.64 (95% CI as [0.55, 0.71]). The cutoff for the PWBPS© was 18.5, which correlated to a score of 22 on the KIDSCREEN-10. All the items loaded on one component. Conclusions: These findings demonstrate that the PWBPS© is valid and reliable, allowing for quick and accurate assessments of children’s well-being and allowing for early intervention, which is key to reducing the negative effects of poor mental well-being. Full article

Background: Mothers and their newborns experiencing caesarean birth often receive delayed or interrupted skin-to-skin care (SSC) despite the intervention being well recognised as beneficial to both mother and baby, with no associated risk for increased morbidity or mortality. Maternal birth satisfaction is recognised as an indicator of quality maternity care; however, most of the research has focused on early intraoperative SSC initiation and breastfeeding outcomes. Objectives: To collate and synthesise evidence for maternal satisfaction of intraoperative and early postpartum SSC during and immediately following caesarean birth. To identify timelines of implementation, barriers, and facilitators of SSC. Methods: An integrative review was conducted guided by the 5-stage Wittemore and Knalf’s framework. Four electronic databases (CINAHL, Medline, PsycINFO, Web of Science) were searched. Key terms were ‘Caesarean birth’, ‘skin-to-skin care’, ‘maternal satisfaction’. Studies published from 2014 to 5 September 2024 in English language were included. A hand search of potential inclusion articles was also searched to undertake a comprehensive review. The JBI critical appraisal checklist was used to assess the quality of inclusion studies. Results: 17 studies met the selection criteria and were included in this review. Intraoperative and early SSC during caesarean birth is associated with positive maternal birth satisfaction and contributes to improved birth experience for mothers with no negative implications. Conclusions: Increased access to intraoperative SSC will likely contribute to increased maternal satisfaction and positive birthing experience. Compliance with policy recommendations regarding SSC may improve with access to a flow chart tool identifying expectations of women’s intraoperative and postoperative care for caesarean birth. Full article

Background: Ukrainian refugees fleeing the conflict between Russia and Ukraine may face significant challenges to their physical, psycho-emotional, social, and spiritual wellbeing. Aim: To identify the health needs of Ukrainian refugees seen in primary care facilities in Tenerife, Canary Islands, Spain. Methods: A mixed-methods design was employed. Quantitative data were obtained through a descriptive analysis of health records, while qualitative data were collected via focus group interviews and thematic analysis of testimonies. Results: The sample comprised 59 individuals (45.4% of all patients seen). Eight participants from five family groups took part in the focus group. The typical profile of a Ukrainian refugee in the Canary Islands is female (79.7%), relatively young, with a high socio-cultural background, generally in good health, travelling alone or with her minor children. The main reasons for consultation were routine health check-ups and control blood tests. The NANDA-I nursing diagnoses indicated a need for psycho-emotional care, with the most prevalent being Risk for Relocation Stress Syndrome (27.1%); Interrupted Family Processes, Disturbed sleep pattern, Risk for Impaired Resilience (13.6% each); and Anxiety (11.9%). Participants rated the healthcare system positively, but language barriers and long waiting times for access to specific services were noted as limitations. The primary social demands include seeking employment, learning the language, and increasing support groups among Ukrainians themselves. Conclusions: This study underscores the need for a tailored approach to refugee care, considering their unique circumstances and needs. Early provision of information about available healthcare services and protocols can facilitate access, manage expectations, and aid decision-making. Full article

Background/Objectives: Team-based learning is an educational strategy that promotes active learning and student engagement through structured team activities. It contrasts with traditional teaching models by emphasizing student preparation and collaboration. The TBL-SAI is a reliable and valid instrument designed to evaluate students’ attitudes towards TBL, assessing dimensions such as accountability, preference for lecture or team-based learning, and satisfaction with TBL. Validating the TBL-SAI in different languages ensures its applicability and accuracy in diverse educational contexts, supporting the global adoption of TBL methodologies. Thus far, no Italian validation of this tool has been performed. The aim of this study is to validate the Italian version of the Team-Based Learning Student Assessment Instrument (TBL-SAI) among nursing students. Methods: A methodological-driven translation process and a cross-sectional study design were used. The study was conducted from November 2022 to March 2023 and involved 202 nursing students from the University of Modena and Reggio Emilia (Italy). Convenience sampling was employed to recruit participants who had experienced at least one TBL session during the academic year 2022/2023. The validation process included translation, back-translation, and expert panel review, followed by a pilot test to ensure clarity and comprehension. Data were collected using the self-administered TBL-SAI. The responses were analyzed using Exploratory Structural Equation Modeling (ESEM) to assess the scale’s validity and McDonald’s ω to evaluate internal consistency. Results: The ESEM results supported the validity of the Italian TBL-SAI, maintaining the factor structure proposed in the original instrument. The model fit indices indicated a good fit (χ²(318) = 384.097, p = 0.0065; RMSEA = 0.032; CFI = 0.974; TLI = 0.957). McDonald’s ω values exceeded 0.70 for all factors, confirming adequate internal consistency. Conclusions: This study successfully validated the Italian version of the TBL-SAI, demonstrating its reliability and validity for assessing perceptions of TBL among Italian undergraduate nursing students. However, future studies should employ Confirmatory Factor Analysis to further test the proposed factor structure and explore the instrument’s applicability in various educational settings. The validated TBL-SAI is recommended for use in evaluating students’ attitudes towards TBL, providing actionable feedback for educators to improve teaching methods and integrate TBL methodologies effectively. Full article

Introduction: Mass media play a crucial role not only in informing the public but also in shaping public perception, educating, and enhancing the visibility of various professions, including nursing. Despite being the most populous healthcare profession, nursing remains underrepresented in media coverage. This imbalance affects the social status of the nursing profession and its public perception. Methods: This cross-sectional study utilized a validated questionnaire with high internal reliability (Cronbach’s alpha coefficients) to assess nurses’ perceptions of the media’s role in society and the nursing profession. Data were collected from 203 participants using an online survey employing the snowball sampling method. Statistical analyses included Welch ANOVA, t-tests, and hierarchical regression to predict the importance of media education. Results: Participants demonstrated positive perceptions of the media’s societal influence but identified a lack of adequate representation of nurses. Younger nurses and those with higher education levels emphasized the need for media education. Regression analysis revealed that perceptions of the media’s power and self-assessed media competencies were significant predictors of valuing media education. Conclusions: The findings highlight the need for integrating media literacy training into nursing education to enhance professional visibility and public engagement. This can empower nurses to actively contribute to shaping their professional image and addressing public misconceptions. Future research should expand the sample size and explore diverse healthcare settings to validate these findings. Full article

Background/Objectives: In Portugal, evidence regarding the mental health of institutionalized older people is limited, leaving this area poorly described and the mental health needs of this population largely unknown. This research aims to describe the mental health of older persons residing in nursing homes in Northern Portugal. Methods: A cross-sectional study will be conducted. We estimate that 567 participants will be recruited through convenience sampling. Potential participants must live in nursing homes in Northern Portugal, be aged 65 years or older, and exhibit cognitive impairment at an initial or intermediate stage. Ten web survey questionnaires will be administered to the participants, including one sociodemographic and health questionnaire and nine mental health assessment instruments evaluating fear of falling; sleep quality; frailty; anxiety, depression, and stress; loneliness and social isolation; risk of acute confusion; cognition; emotional literacy; and perceived hope. Data will be analyzed by employing descriptive, cluster, inferential, and bivariate analyses, with multiple regression models included. The study and the research protocol were submitted to and approved by the Ethics Committee of a major public university in Northern Portugal (CEICVS 007/2025). Expected Results: This is a pioneering study in Portugal, representing the first attempt to assess the mental health of older nursing home residents. Our study will enhance the understanding of the mental and multifactorial health needs of this population through a comprehensive description of their mental health, and sociodemographic and health characteristics. Full article

Background/Objectives: Despite the availability of screening services, the rate of diabetic retinopathy (DR) screening continues to be suboptimal in Australia, necessitating improvement. However, improving DR screening rates requires a more comprehensive understanding of the factors influencing adherence to the screening recommendations. This study aimed to explore the factors that influence adherence to DR screening among people with diabetes attending a community screening clinic in Australia. Methods: This qualitative study included purposively patients with diabetes recruited from a nurse-led community screening clinic in Australia. Semi-structured interviews were conducted to explore barriers and enablers impacting patient adherence to DR screening recommendations. The interview data were analyzed thematically using NVivo based on the socio-ecological model, with salience identified by the frequency of the theme. Results: A total of 22 participants completed the interview, including 10 females with a mean age of 60 ± 16.2 years. The interviews identified several factors that improved adherence to DR screening guidelines, including (a) knowledge of the connection between DR and diabetes and the importance of the screening, (b) the care provider’s recommendations, and (c) pre-booked appointments and automatic invitations. Beyond these factors, clinic staff interactions, family support, fear of vision loss, flexible clinic hours, and transportation accessibility also facilitate DR screening adherence. Conclusions: The present study identified key multi-level factors influencing adherence to DR screening. While these findings from a single clinic provide valuable insights to inform screening strategies, larger multi-center studies are needed to validate their broader applicability across diverse healthcare settings and populations. Full article

Background/Objectives: Adolescents with type 1 diabetes face complex challenges associated with the disease, underscoring the importance of developing self-management skills. This study examined participants’ perspectives on a type 1 diabetes self-management education program. Methods: Focus group interviews were conducted with 32 adolescents with type 1 diabetes who participated in the program and six expert patients. Both thematic analysis and content analysis were conducted using NVIVO software, version 1.6.1. Results: Two dimensions emerged: expert patient roles and program evaluation. Expert patient roles were viewed positively, with an emphasis on responsibility, sharing experiences, and being a role model. Program evaluation emphasized peer-to-peer sharing and educational sessions, with increased knowledge of the disease and management strategies. Expert patients also benefited from the program by developing a sense of responsibility, serving as role models for adolescents, and improving their disease self-management. Conclusions: The adolescents emphasized that the program was a learning tool and the expert patient’s view of their role emerges, highlighting modelling as a facilitator of learning and of the responsibility and commitment of the mentors. This study reinforces the benefits of peer-to-peer interaction in a camp setting, including rich experiences. Full article

Background/Objectives: Being a healthcare professional often involves exposure to complex situations that can contribute to the development of psychological problems. Evidence suggests that both mental and physical health are crucial for the well-being of these professionals, which in turn influences the quality of care they provide to patients. The main aim of this study was to examine the association between adaptive and maladaptive forms of humor and psychopathological disorders among healthcare workers. Methods: A cross-sectional and descriptive correlational design was employed. The participants consisted of 250 healthcare professionals at a general hospital. Humor styles and the presence of psychological and psychosomatic symptoms were assessed. Data were collected using the Humor Styles Questionnaire (HSQ), the Short Checklist of Symptoms (LSB-50), and sociodemographic information. Spearman correlation analysis and linear regression analysis were conducted. Results: Healthcare professionals were more inclined to use affiliative and self-enhancing humor styles compared to self-defeating and aggressive humor. Affiliative and self-enhancing humor styles were negatively correlated with psychological symptoms, whereas aggressive humor and, to a lesser extent, self-defeating humor styles showed a significantly positive correlation with most psychological symptoms. Regression analysis revealed that positive humor styles negatively predicted all severity indices of the LSB-50. In contrast, negative humor styles, particularly self-defeating humor, positively predicted the severity indices. Being female, working night shifts, and having temporary contracts were positive predictors of most global indices of the LSB-50. Conclusions: This study highlights the importance of considering different types of humor as a potential strategy for improving the mental health of healthcare professionals, as well as the influence of other independent variables related to their personal and work environment. Positive humor styles, specifically affiliative and self-enhancing humor, are associated with a lower prevalence of psychological symptoms among healthcare professionals. Negative humor styles are correlated with a higher prevalence of these symptoms. Full article

Background/Objectives: Parkinson’s disease (PD) is a complex neurodegenerative disorder that presents significant challenges for care home residents and staff. This scoping review aimed to synthesize evidence on PD education and training available to care home staff, examine existing programs and their effectiveness, and identify gaps in current educational approaches. Methods: A scoping review (ScR) was conducted and guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for ScR (PRISMA-ScR) checklist. A comprehensive search of six electronic databases was conducted in September 2024. Studies focusing on PD education and training for care home staff were included. Data extraction and quality appraisal were performed, followed by thematic analysis to identify key patterns and themes. Results: Seven studies met the inclusion criteria. The thematic analysis revealed four main themes: improvements in PD knowledge and confidence, improvements in care practices and outcomes, the need for increased specialist education, and the incorporation of communication training. Educational interventions led to significant improvements in staff knowledge, confidence, and care practices. However, these studies also highlighted a critical need for more specialized PD training among care home staff. Conclusions: This review provides evidence of promise regarding the potential impact of PD-specific education on care home staff knowledge and practices. Future research should focus on developing and evaluating comprehensive, tailored educational programs to enhance the quality of care for people with PD in care home settings. Full article

Background/Objectives: The nursing work environment, encompassing accessible resources and established processes, might affect nurses’ professional behavior. Our aim was to examine the effect of nurses’ work environments on quiet quitting and work engagement among nurses. Methods: We performed a cross-sectional study with nurses in Greece. We used the “Practice Environment Scale-5” to measure nurses’ work environments, the “Quiet Quitting Scale” to measure quiet quitting, and the “Utrecht Work Engagement Scale-3” to measure work engagement among nurses. We developed multivariable regression models adjusted for gender, age, understaffed wards, shift work, and work experience. Results: The study population included 425 nurses. The mean age of the nurses was 41.1 years. After controlling for confounders, we found that lower nurse participation in hospital affairs, less collegial nurse–physician relationships, worse nursing foundations for quality of care, and lower levels of nurse manager ability, leadership, and support were associated with higher levels of quiet quitting among nurses. Moreover, our multivariable analysis identified a positive association between nurse manager ability, leadership, and support, collegial nurse–physician relationships, nursing foundations for quality of care, and work engagement among nurses. Conclusions: Our findings highlight the poor work environment, elevated levels of quiet quitting, and moderate work engagement among nurses. Moreover, we found that a poor nurses’ work environment was associated with higher levels of quiet quitting. Moreover, our findings showed that nurses’ work environments had a positive impact on work engagement. The ongoing endeavor to enhance all aspects of nurses’ working conditions by healthcare organization administrations is essential for optimizing nurses’ performance, facilitating organizational operations, and ensuring service quality. Full article

Background: Complexity of care, adequate staffing levels, and workflow are key factors affecting nurses’ workloads. There remain notable gaps in the current evidence regarding clinical complexity classification and related staffing adjustment, limiting the capacity for optimal staffing practices. This study aimed to adapt and validate the Winnipeg Surgical Complex Assessment of Neonatal Nursing Needs Tool (WANNNT-SC) for an Italian context to allow the assessment of newborns admitted to NICUs. Methods: This was a validation study. Results: To evaluate the reliability of the tool among different professionals, a correlation test was performed using Pearson’s correlation, which revealed a strong correlation (r = 0.967, p = 0.01). In the test–retest phase, there was a significant correlation (r = 0.910 and p = 0.01). Using an analysis of variance, we found that the higher the I-WANNNT-SC score was, the higher the predicted death rate (F = 13.05 and p < 0.001). Conclusions: The Italian Winnipeg Surgical Complex Assessment of Neonatal Nursing Needs Tool represents the first tool available for an Italian context that aims to measure the nursing workload in neonatal intensive care. It could allow adjustments in nursing staffing based on NICU activities and patient needs. This study was prospectively approved by the local Ethics Committee “Palermo 1” (Protocol CI-NICU-00). Full article

Objective: The objective of this study is to identify, examine, and map the literature on infection prevention and control (IPAC) education and training for visitors to long-term care (LTC) homes. Introduction: Visitor restrictions during infectious outbreaks in LTC homes aim to reduce virus transmission to vulnerable residents. The COVID-19 pandemic highlighted the negative impacts of such restrictions, prompting the need for IPAC education for visitors. Inclusion Criteria: This review includes research, narrative papers, and grey literature on IPAC education and training for LTC visitors. It focuses on intentional education aimed at preventing infection transmission. Studies not involving visitors or offered in other settings were excluded. Methods: Following the JBI methodology for scoping reviews, bibliographic databases (CINAHL, Embase, AgeLine, Medline, and ERIC) were searched from 1990 to present in English or French. Data were extracted by two reviewers, focusing on the educational content, delivery mode, frequency, timing, and qualifications of educators. A narrative summary and descriptive statistics were produced. Results: The 26 included documents contained guidelines, policies, educational resources, and opinion papers. Pre-2020, healthcare workers were responsible for educating visitors. Post-2020, more detailed recommendations emerged on the frequency, content, and delivery methods. Key topics included hand hygiene (92.3%), respiratory hygiene (80.8%), and PPE use (73.1%). Conclusions: IPAC education and training for LTC visitors is essential for safe visitation. Future research should evaluate the effectiveness of these educational interventions. Full article

The aim of this scoping review was to map intervention programmes for first-episode psychosis by identifying their characteristics, participants, and specific contexts of implementation. It seems reasonable to suggest that early intervention may be beneficial in improving recovery outcomes and reducing the duration of untreated psychosis (DUP). Despite the expansion of these programmes, there are still some significant variations and barriers to access that need to be addressed. In line with the Joanna Briggs Institute (JBI) methodology and the Participants, Concept, and Context (PCC) framework, this review encompasses studies focusing on individuals grappling with early-stage psychosis and their caregivers across a range of settings, including hospital and community environments. The review identified 47 studies from 2002 to 2023, which revealed a great deal of diversity in programme characteristics and implementation contexts. This reflects a global perspective. The results showed that there is a great deal of variety in the characteristics of the programmes, with interventions ranging from single-component strategies, such as cognitive–behavioural therapy (CBT) and cognitive remediation therapy (CRT), to multicomponent programmes that integrate a number of different approaches, including psychosocial, pharmacological, and family-focused strategies. The objectives included attempts to improve cognitive functioning; enhance coping skills; reduce caregiver burden; and address symptoms such as anxiety, depression, and hallucinations. It is notable that there was considerable variation in the frequency, duration, and follow-up periods of the interventions, with some lasting just three sessions over one month and others spanning five years and 48 sessions. The majority of the programmes were delivered in community or outpatient settings, although there were also examples of hospital- and home-based interventions. These findings highlight the value of early interventions and provide a useful resource for adapting programmes to different social and cultural contexts. It would be beneficial for future research to explore how these interventions can be tailored to diverse settings. Full article

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