Nurs. Rep., Volume 15, Issue 2 (February 2025) – 23 articles

Background/Objectives: The COVID-19 pandemic has adversely impacted the mental health of nurses worldwide. Nurse burnout results from chronic workplace stress and is characterized by exhaustion, negative or cynical feelings about work, and a diminished sense of accomplishment. This can lead to turnover intention. Therefore, psychological capacities, such as psychological flexibility, that could help nurses regulate and minimize the impact should be studied. This study aimed to compare burnout, insomnia and turnover intention among nurses from an Eastern and Western cultural context and to investigate the role of psychological flexibility as a protective factor against mental health and related problems such as insomnia and turnover intention. Methods: Nurses from Hong Kong (n = 158) and Switzerland (n = 294) involved in patient care during the COVID-19 pandemic participated in an online mental health survey. Results: We observed high levels of burnout, subthreshold insomnia and turnover intention in nurses from both Switzerland and Hong Kong, with higher burnout rates among Hong Kong nurses and higher turnover intentions among nurses from Switzerland, and that psychological flexibility is a crucial factor that may protect nurses from burnout and insomnia. Conclusions: The nurses from both regions involved in patient care one year after the onset of the pandemic suffered from poor mental health. Psychological flexibility was identified as a critical factor in improving nurses’ mental health. The results of this study should be incorporated into health promotions for nursing professionals and help develop specific and effective interventions for practical nursing application. Full article

Background/Objectives: Patient and family involvement in bedside handover is a requirement of the national standards on patient safety and quality in Australia. To ensure patient-and-family-centred care, it is essential to understand how patients and families perceive their involvement in nursing bedside handover and what difficulties they face when participating. This study aimed to explore patient and family perceptions of their involvement in nursing bedside handover. Methods: We employed a qualitative descriptive study design with in-depth and semi-structured interviews. Using purposive and convenience sampling, 24 patients and family members were recruited from two adult hospitals in Western Australia between November 2021 and February 2022. The data were thematically analysed. Results: Participants had mixed experiences that overlapped with their individual perceptions, needs, and experiences. Their responses were grouped into three major themes with sub-themes: (1) discovering new nursing care approaches; (2) seeing the value of involvement in bedside handover; and (3) barriers hindering patient and family involvement in bedside handover. The findings revealed that patients and families valued their involvement in nursing bedside handover. However, several factors challenged their participation, including a lack of awareness about their right to participate, the timing of handovers, the nurse’s approach, and fear of asking questions. Conclusions: The findings serve as a guide for evidence-based practice and may significantly influence policy and practice in nursing bedside handover, potentially enhancing patient-and-family-centred care. While considered best practice, the consistent involvement of patients and their families in nursing bedside handover is not routinely achieved and is implemented to varying extents. Full article

Trillium Health Partners (THP) is a hospital network that serves the Mississauga region of Ontario, Canada, and sees nearly 1.7 million patient visits each year. THP is also a provider of highly specialized services to the region and a fully-fledged academic teaching center, with embedded research and innovation. Background/Objectives: Highly trained, skilled, and experienced nurses are foundational to THPs ability to meet the complex care needs of our patients across specialized programs. In 2024, 50% of the nursing workforce at THP was noted to have less than five years of experience. This generation of nurses are reporting high levels of burnout and are at greater risk of leaving the profession. The more experienced nurses are also facing burnout due to the continued pressures and demands in the workplace, having to manage an increasingly complex patient assignment, while providing mentorship to more novice nurses. Based on the existing literature and our collective experience at THP, we have developed the Transition to Independent Practice Support (TIPS) program, a multi-pronged approach to bolster support for our nursing workforce. The TIPS program at THP is designed to address knowledge gaps and enhance clinical competence among new and aspiring nurses. The primary aim of this study is to evaluate the efficacy of the TIPS program in facilitating the transition of novice nurses to independent and competent practitioners, utilizing the Kirkpatrick Model of Evaluation The specific objectives include (a) assessing participants’ reactions to the TIPS program; (b) measuring the increase in nurses’ knowledge and confidence following program participation; (c) evaluating changes in nurses’ behavior and practice post-program; and (d) determining the program’s impact on nurse retention and quality of patient care. Methods: Grounded in Meleis’s Transition Theory, the program combines webinars, simulations, clinical rounding, and mentorship to build resilience, decision-making, and confidence. Evaluative measures, based on the Kirkpatrick Model, assessed participant satisfaction, learning outcomes, behavior changes, and retention. Results: From September 2023 to March 2024, 388 interdisciplinary participants attended the program, including nursing students (56%), registered nurses (24%), registered practical nurses (14%), and aspiring nurses in other interprofessional roles (6%). Participants expressed high satisfaction with the program, achieving a mean reaction score of 4.80 (SD = 0.2921). Ninety-five percent found the sessions relevant, and 98% rated the facilitators as knowledgeable. Self-reported confidence significantly increased across all topics, with overall mean confidence scores rising from 2.94 to 4.52 (p < 0.0001, Cohen’s d = 3.01), demonstrating a strong impact on skill acquisition and application. Behavioral evaluations through simulations, competency checklists, and follow-up touchpoints confirmed improved clinical performance, with participants achieving 100% compliance to nursing skills during simulations and sustained confidence at three-month follow-ups. Since the program’s implementation, nursing turnover rates decreased from 9.52% to 7.7% by March 2024, with 100% of RNs, RPNs and IENs of TIPS participants retained within six months. Conclusions: This paper outlines the TIPS program and the diverse teaching and learning methodologies used in the design and program implementation to ultimately support the transition experience of the new gradate nurse into acute care. Preliminary outcomes are discussed including nursing retention rates, nurses’ knowledge, confidence, and skill levels. Full article

Background: Physical inactivity among older adults persists as one of the global burdens. Older adults’ physical activity (PA) levels decline simultaneously with age, causing health problems and poor outcomes. Immersive interventions, such as mixed reality virtual coaches, are gaining the potential to provide innovative solutions to prevent physical inactivity among older adults. However, an in-depth understanding of older adults’ experience in using virtual-coach-driven physical exercise programs remains unexplored. Purpose: This study explored the experiences of community-dwelling older adults in using a virtual-coach-driven physical exercise program. Design: This study applied a phenomenological design using the qualitative approach to determine the lived experiences of community-dwelling older adults about the mother project, the “Move and Groove for Older Adults Program” (Hataw at Sigla para kay Lolo at Lola), a virtual-coach-driven physical exercise program using MR. A semi-structured interview guide was crafted consisting of three domains (acceptability, barriers, and facilitators), each with two open-ended questions. MAXQDA was used to thematically analyze the qualitative data. Results: Nine key informants shared their experiences with the virtual coach-driven physical exercise program using mixed reality. Four themes were identified describing their experiences with the program: (1) “Looking around”: Exploring MR technology, (2) “Looking after”: Engaging with MR exercise peers, (3) “Looking at”: Examining issues with MR technology devices, and (4) “Looking Ahead”: Envisioning the future of MR exercises. Conclusions: The findings of this study introduced new concepts and challenged old notions regarding older adults’ technological engagement. The virtual-coach-driven physical exercise program enabled the participants to explore the novel methodology, enhance peer relationships, examine potential issues, and envision a future of possibilities using the technology. These outcomes are pertinent for progressing studies, scholars, and technology developers in incorporating MR into gerontechnology for wellness and fullness of life in the aging population. The mother project of this study was retrospectively registered [ID NCT06136468]. Full article

Background/Objectives: School nursing is a nursing practice focused on promoting child health within the school and community environment, integrating healthcare with the educational process. The aim was to explore the experiences of nurses and teachers regarding the implementation of a school nursing pilot programme in primary education in the Canary Islands (Spain). Methods: A phenomenological study was conducted during the 2023/2024 academic year. In-depth interviews were conducted between May and June 2024 until data saturation was achieved. The interviews were transcribed and analysed using descriptive and interpretative thematic analysis. Intentional and co-occurrence coding methods were employed, followed by triangulation using Atlas-Ti software (version 24). Ethical approval was obtained (code: 2023-216-1). Results: A total of 21 informants (7 nurses and 14 teachers) were interviewed. Nurses revealed eight subthemes grouped into two main themes: Role of School Nurses (workload, school nurses’ experiences, career opportunities, and the school nurse profile) and School Nursing Project (suggested improvements, identified weaknesses, time management, and improvement needs). Regarding teachers, six subthemes were identified, also grouped into two main themes: Role of School Nurses (approach to school nursing and the importance of the presence of school nurses) and School Nursing Project (expectations, improving children’s health, school health, and experiences from the pilot programme). Conclusions: The pilot programme has been well received, showing a positive impact on students’ health. While successfully integrating nurses into schools, improvements are needed in working conditions, resource allocation, and specialized training to enhance its effectiveness and sustainability. Strengthening inter-professional collaboration between healthcare and education sectors and involving teachers in planning health activities are essential. Expanding the coverage and ensuring a consistent presence of school nurses would further build trust, improve chronic health management, and promote healthy habits from an early age. This programme illustrates the potential of nurses to transform schools into spaces for comprehensive health promotion. Full article

Background/Objectives: Undergraduate nursing students report encountering significant challenges when they perform preplanning for clinical days. The literature lacks evidence regarding this educational model for clinical training, yet faculty continue to use it despite the evidence that supports it. This study explored undergraduate nursing students’ perceptions of their preclinical training activities. Methods: A quasi-experimental, after-only, nonequivalent control group design was employed at a public nursing school in an urban setting. A total of 110 undergraduate nursing students enrolled in an advanced medical–surgical course. Participants were divided into two groups based on their preparation approach for clinical practice. Data were collected using a paper-and-pencil survey at the end of the course’s clinical rotation. The survey comprised three sections: (1) sociodemographic information, (2) the nursing clinical education tool (NCET) developed for this study, and (3) two open-ended questions focusing on the pros and cons of preplanning and reflective care approaches. The responses were analyzed and compared using a nonparametric two-independent-samples Mann–Whitney U test. Results: The findings indicated that students in eight out of ten nursing clinical education survey categories favored the reflective care approach. No differences were found between groups concerning class grade point average (GPA), the National Council Licensure Examination (NCLEX) passing rate, or standardized tests. Conclusions: The reflective care approach was perceived more favorably than preplanning. Engaging in clinical reasoning strategies requires educators to reconsider how students interact with clinical education. Further research is needed to develop evidence-based methods to enhance the clinical learning experience and promote patient safety. Full article

Background/Objectives: Coping strategies are influenced by sociocultural factors, and an understanding of how the Brief-COPE functions within the Chinese student population is important for its validity and reliability. This study aimed to explore the factor structure of the Brief Coping Orientation to Problems Experienced Inventory (Brief-COPE) in Chinese nursing students. Methods: A cross-sectional study design was adopted. A total of 284 college nursing students, aged 18 years or older, were recruited from a medical university in China using convenience sampling. Exploratory factor analysis (EFA) was conducted to identify the underlying domain structure of the Brief-COPE within those students. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. Results: The Brief-COPE demonstrated robust validity, revealing eight distinct factors: positive reframing coping, avoidant and passive coping, seeking social support, self-blame and emotional distress coping, denial and deflective coping, spirituality and humor coping, avoidance and emotional release coping, and adaptive acceptance with distraction. The scale exhibited good internal consistency, as indicated by a Cronbach’s alpha of 0.759. Conclusions: The Brief-COPE is a valid tool for assessing coping strategies in Chinese nursing students. Nursing educators could benefit from training aimed at enhancing the use of appropriate strategies. Also, culturally tailored interventions, such as peer support groups and mentorship programs, could further promote coping skills and improve the emotional well-being of these students. Full article

Background: Academic integrity is an important component of nursing education, bridging academic ethics with professional practice. This study evaluated the effectiveness of a co-designed Academic Integrity digital serious game in improving nursing students’ self-efficacy related to academic integrity, academic offenses, professionalism, and artificial intelligence use. Methods: A pre-test/post-test design was employed, using a bespoke questionnaire to assess 303 first-year nursing students’ self-efficacy before and after playing the game. The questionnaire covered five subscales: academic integrity standards, academic offenses, professional values, feedback processes, and AI use in academic work. Results: Statistically significant improvements were observed across all subscales following the intervention, indicating enhanced self-efficacy in understanding and applying academic integrity principles, recognizing academic offenses, demonstrating professional behaviors, utilizing feedback, and appropriately using AI in academic contexts. Conclusions: The Academic Integrity digital serious game has the potential to be an effective tool for enhancing nursing students’ self-efficacy in the areas of academic and professional ethics. This approach shows promise for integrating academic integrity-based education in nursing curricula and preparing students for the ethical challenges of modern healthcare practice. This study was not registered. Full article

Background/Objectives: Shift work schedules and mental and physical workloads affect the sleep homeostasis of nurses, increasing the risk of occupational injuries. This study aimed to investigate the relationship between sleep disturbances caused by shift schedules and the occurrence of needlestick and sharps injuries (NSIs) among nurses, considering significant worker and occupational factors. Methods: A total of 348 nurses from five hospitals of Santiago de Guayaquil, Ecuador, participated in this cross-sectional survey. Data on sociodemographic and occupational characteristics, work schedules, and NSI incidents during the previous six months were collected. Emotional status, sleepiness, and insomnia symptoms were assessed using validated questionnaires. Additionally, nurses with night shifts (fixed or rotating) were specifically assessed to estimate the relationship between NSIs and insomnia or sleepiness symptoms related to these types of shift work using logistic regression analyses. Results: Nurses whose schedule included night shifts showed a higher prevalence of NSIs than those with other shifts (33.2% vs. 29.0%; p < 0.05). High levels of depression, anxiety, and stress were associated with having had an NSI in the previous six months. Logistic regression showed that female sex (adjusted odds ratio, aOR 4.62, 95% CI: 1.65–12.97), less experience in the current clinical setting (aOR 3.12, 95% CI: 1.46–6.57), the use of psychotropic drugs (aOR 4.46, 95% CI: 1.51–13.17), and insomnia and sleepiness symptoms due to shift work (aOR 2.61, 95% CI: 1.15–5.91) increased NSI risk among nurses with night shifts. Conclusions: There is an acute need to explore the complex relationship between sleep troubles linked to shift work schedules, occupational factors, and the risk of occupational injuries and propose preventive strategies for enhancing nurses’ sleep health and workplace safety. Full article

Background/Objectives: Previous studies conducted in sub-Saharan African countries have concentrated on examining the challenges of nursing training and the organizational commitment of healthcare professionals, with little attention paid to exploring the mechanisms that contribute to reducing nurses’ job stress. Consequently, the present study addresses a significant gap in the literature by offering an overview of the factors contributing to understanding job stress among nurses in Angola. This study aimed to analyze the direct and indirect relationship between workaholism and job stress with job satisfaction and psychological capital mediating this relationship. Methods: Using the quantitative methodology with a cross-sectional design, a questionnaire was administered to 340 nurses (172 men and 168 women). Results: The results confirmed that workaholism is positively related to job stress and that job satisfaction and psychological capital serially mediate the relationship between workaholism and job stress. Conclusions: These findings highlight the importance of fostering job satisfaction and psychological capital by establishing favorable work environments and promoting nurses’ physical and emotional well-being. In addition, these results may encourage healthcare leaders to create well-designed break areas for nurses to take restorative breaks. Full article

Background/Objectives: Caregivers engage in essential tasks that support patients’ well-being and survival, including administering medications, promoting healthy lifestyle choices, and monitoring and managing symptoms. To date, no valid and reliable instrument is available to assess Caregiver Contribution (CC) to self-care in chronic conditions in middle-income countries such as Albania. Aim: To evaluate the measurement properties (structural and construct validity, internal consistency reliability, stability, and measurement error) of the instrument CC to Self-Care of the Chronic Illness Inventory (CC-SC-CII) in Albanian caregivers caring for elderly people affected by multiple chronic conditions. Methods: A cross-sectional study. We enrolled caregivers of patients with multiple chronic conditions, from August 2020 to April 2021, if they were (a) 18 years of age or older and (b) were identified by the patient as the main unpaid caregiver. Results: Confirmatory factor analysis confirmed the two-factor structure of the CC to Self-Care Maintenance and Management scales and the one-factor structure of the CC to Self-Care Monitoring scale. Reliability estimates were adequate for all (coefficients ranging between 0.827 and 0.961). The construct’s validity was supported. The measurement error was adequate. Conclusions: The Albanian version of the CC to Self-Care of the Chronic Illness Inventory features sound measurement properties and is a valid and reliable instrument for assessing caregiver contribution to patient self-care behaviors in the Albanian population. Full article

Background: Evidence-based practice must be promoted in nursing education to provide quality care. For this, teaching practices that promote its development must be considered. Aim: The aim of this study was to explore a learning experience centered on evidence-based practice through cooperative learning in an online discussion forum with nursing students. Methods: We employed a descriptive qualitative study with the participation of 137 nursing students. A teaching intervention based on cooperative teamwork through an online forum is proposed. The students, through a question, must manage information to provide a reasoned answer. The interactions in the forums were analyzed through qualitative content analysis. Results: Two themes and eight categories emerged: Critical Analysis of the Literature (Computer Literacy, Reliability of the data sources, Level of evidence according to the article design, and Relevance of the research) and Clinical Practice (Patient’s perspective, Professional experience, Quality of care, and Usefulness of EBP). Conclusions: The use of interactive teaching methodologies (cooperative learning and online discussion forums) facilitates the construction of knowledge applied to clinical practice. Students perceive EBP as necessary and useful for optimal care management, and the forums allow for the development of key competencies, such as autonomous learning, teamwork, and critical thinking. Full article

Background/Objectives: Hidradenitis suppurativa (HS) is an under-treated chronic inflammatory disease that affects approximately 0.40–2% of the population. Despite the competences nurses have in wound care, little is known about their management of HS lesions. The objectives of this study were to determine the knowledge and skills of primary care nurses regarding HS as well as to analyse the aspects in which these nurses need to strengthen their competences. Methods: A multicentre exploratory cross-sectional study was carried out in all seven healthcare areas of the Galician Health Service (N-W Spain) during 2021–2022. A questionnaire was developed for the project and subsequently piloted; from it, four dimensions were established. Additionally, sociodemographic data were collected. A total of 211 primary care nurses participated. Results: Both total and dimension scores were lower than 5 out of 10 points. The participants showed more knowledge in the Diagnosis and Clinical Course dimension (M = 4.59 out of 10). An older age correlated with greater knowledge regarding Diagnosis and Clinical Course (rho = 0.196; p = 0.006). Conclusions: These findings highlight the importance of developing evidence-based continuous training in the management and detection of the disease, while reducing the consequences of HS on patients’ quality of life. Full article

Background/Objectives: In recent years, the introduction of specialist nurses, such as donation coordinator nurses, has been proposed as a potentially effective strategy to increase the number of donations and improve the quality of the process. However, experiences in this field are still limited. The aim of this study was to evaluate the impact of the inclusion of this professional in health systems, both in quantitative and qualitative terms. Methods: A scoping review was performed. Studies published from 1990 to 2024 were included regardless of the study design. The bibliographic search was performed on the databases MedLine, Web of Science, Scopus, CINAHL, and PsycInfo and on the search engines EBSCOhost, ProQuest, and Google Scholar. The search strings included keywords such as organ donation, transplant, procurement, and nursing role. The extraction and selection of articles were conducted in accordance with the PRISMA-ScR guidelines and with the methodology of the Joanna Briggs Institute for scoping reviews. The protocol study was prospectively registered with the Open Science Framework database on 3 December 2023, with registration number osf.io/wzxr3. Results: From the included studies, it emerged that the involvement of a nurse coordinator in the donation process is significantly associated with an increase in the number of organ donors and higher rates of family consent to donation. Additionally, the studies highlighted enhanced effectiveness in identifying potential donors and improvements in the training and preparedness of healthcare staff. Conclusions: The nurse coordinator in the donation process can have positive effects both on the management of the process and on the increase in the number of organ and tissue donations. Full article

Background/Objectives: Quiet quitting, defined as employees fulfilling only the minimal requirements of their roles without extra effort or engagement, poses unique challenges in high-stress environments like hospitals where commitment directly impacts patient care. This study investigates the phenomenon of “quiet quitting” within the healthcare sector, with a specific focus on hospital staff in Greece. Methods: A cross-sectional design was employed, surveying 186 healthcare professionals from the General Hospital of Argos using the Questionnaire for Conflicts in Healthcare Organizations and the Quiet Quitting Scale (QQS). Results: Descriptive and inferential statistical analyses revealed that 62% of participants exhibited characteristics of quiet quitting, with “lack of motivation” scoring highest (M = 2.80, SD = 0.987) among QQS subscales. Significant correlations were observed between perceived reward fairness and motivation levels (r = −0.194, p < 0.01) and between management awareness of contributions and both motivation (r = −0.313, p < 0.01) and initiative (r = −0.192, p < 0.01). Logistic regression identified perceptions of management awareness as a key predictor of quiet quitting (p < 0.05). Conclusions: The findings emphasize the critical role of equitable reward systems and managerial recognition in reducing disengagement. Strategies to enhance employee engagement and resolve workplace conflicts are essential for fostering a resilient healthcare workforce. Full article

Background/Objectives: The aim of this study was to describe and examine the relationships among elements of infection prevention practices, the care environment, psychological safety, and safety climate in adult medical surgical units in the wake of the COVID-19 pandemic. Methods: Nurses in adult inpatient medical surgical units in the northeast were surveyed electronically. Each self-rated their infection prevention practices and elements of the care environment in their primary work unit. They were also asked to rate a series of questions regarding how psychologically safe they felt on their units as well as the overall patient safety climate. Results: A total of 259 nurses responded (52% response rate) to the survey. Overall psychological safety was rated neutrally among respondents, with a rating of 3.5 (1 being the lowest and 5 being the highest). Respondents reported better ratings of the safety climate on their unit (4.0) but also identified areas for improvement. Eight of twelve infection prevention practices were correlated with higher safety climate scores and ten were correlated with higher psychological safety scores. Nine of ten environmental factors were correlated with higher safety climate and higher psychological safety scores. Conclusions: Both psychological safety and patient safety climate are related to nurse self-ratings of performance of infection prevention practices. Similarly, the care environment nurses work in has important implications for psychological safety and patient safety. It is essential for nursing leadership to act as a steward in these areas to build a higher quality care environment for nurses and patients alike. Full article

Background/Objectives: Improvements in catheter connection design intended to increase safety have resulted in connections that are difficult to release manually. No medical device exists to safely disconnect catheter connections. Nurses and other users have developed workarounds including use of hemostats, tourniquets, and wrenches. These workarounds are not always successful for performing this task and can break catheters and catheter connections. This study aimed to evaluate a disconnection device to safely disconnect catheter connections. Methods: This is a mixed-methods study using a user-centered design approach with triangulation of quantitative and qualitative data mapped to Valdez’s sociotechnical framework. Nurses (N = 139) from units across two academic medical centers encompassing diverse patient populations engaged in usability testing and surveys. Data about users’ past catheter disconnection experiences and usability of the specialized disconnection device were collected and analyzed. Triangulation of quantitative data and qualitative themes was mapped using Valdez’s socio-technical framework to complement and strengthen the final design generated for nurses’ user requirements. Results: Ninety-five percent of nurses reported previous difficulty with disconnecting luer connections; 93% of those reporting difficulty improvised with readily available medical devices or products to better grip the connected parts. Over 85% of nurses reported positive experiences using the specialized disconnection device; others suggested design improvements for better performance. Conclusions: The nurses who tested the developed disconnection device reported high acceptability, accessibility, ease of use, and improved task performance. Moreover, as workarounds develop at points of practice where no systematic solution exists, aiming product development activities at these points help close gaps in achieving and maintaining patient safety. This study was not registered. Full article

Background/Objectives: The systematic review by Zaher-Sánchez et al. evaluated the effectiveness of pharmacological and non-pharmacological interventions in preventing and managing delirium in elderly patients admitted to intensive care units (ICUs). This commentary discusses its importance, limitations, and dilemmas regarding delirium prevention. Conclusions: The need for effective measures for preventing delirium is imperative, and the findings to date support the benefits of non-pharmacological interventions, but we still do not have a sufficient body of evidence to choose specific interventions. Full article

Background/Objectives: Voluntary Assisted Dying in Australia was first legislated in 2019, with significant concern expressed by palliative care services about the impact on services. We aimed to describe the impact of Voluntary Assisted Dying on community-based palliative care client care. Methods: This study was a retrospective cohort study that compared the characteristics and outcomes of clients who expressed interest in VAD, those who chose voluntary assisted death, and the broader client population of the service. Results: Only 4% of the total client population expressed interest in VAD, and 1% died through VAD. Of the clients who expressed interest in VAD, most had malignancy as their primary diagnosis. The median length of palliative care service for clients who expressed interest in VAD was 101 days, compared to 48 days for all service clients. For 97% of individuals who died from taking the substance, death occurred in their place of choice compared with 71% of all service clients. Of the clients who died through VAD, 88% of these deaths occurred in a community setting compared with 56% of all service clients. Conclusions: Most clients who took the VAD medicine died in their place of choice, which was the community. A review of the length of engagement with the service indicated that a longer length of engagement was illustrated by individuals navigating the VAD process. This study emphasised the value of early referral to community-based palliative care, enabling a focus on quality of life, symptom management, and planning for death. Full article

Background: This study aimed to adapt and validate the Attitudes to Patient Safety Questionnaire (APSQ-III) for Brazilian Portuguese and to compare patient safety attitudes between medical and nursing students. Given the critical role of assessing safety attitudes in shaping future healthcare professionals, this research addresses a significant gap in the Brazilian educational context. Materials and Methods: The cross-cultural adaptation process adhered to the guidelines of for the Process of Cross-Cultural Adaptation of Self-Report Measures, encompassing translation, synthesis, back-translation, and expert committee evaluation. The adapted APSQ-III was administered to a sample of 423 undergraduate students from medicine and nursing courses. Confirmatory factor analysis (CFA) was conducted to verify the factor structure, while reliability was assessed using Cronbach’s alpha, McDonald’s omega, and composite reliability measures. Results: The CFA supported an acceptable fit for the nine-factor model with 26 items, following the exclusion of 4 items (χ²/df = 1.92; CFI = 0.90; TLI = 0.89; RMSEA = 0.05; SRMR = 0.07). Factor loadings ranged from 0.30 to 0.82, with satisfactory reliability indices, except for factors 4 (α = 0.47; ω = 0.48) and 9 (α = 0.54; ω = 0.54). Significant differences were discovered between medical and nursing students in four factors, and gender differences were noted in five items, highlighting the diverse perceptions of patient safety across these groups. Conclusions: The Brazilian version of the APSQ-III demonstrated adequate validity and reliability for seven out of the nine original factors. It is recommended to use the scale with modifications, such as developing a reduced version excluding factors with low reliability, to enhance its applicability. This study contributes to advancing patient safety research and education in Brazil, providing a robust tool for evaluating and improving safety attitudes among healthcare students. Future research should focus on refining the instrument and exploring its application in diverse healthcare educational settings across Brazil. Full article

Background: Atrial fibrillation, the most frequent and prevalent cardiac arrhythmia, often requires external cardioversion to ensure rhythm control. As healthcare professionals, nurses play a key role in autonomous intervention implementation. The aim was to update current evidence on the efficacy of nurse-led external direct current cardioversion. Methods: A systematic review of primary quantitative studies in English or Italian was conducted with no temporal filter. Seven database searches were interrogated. A total of nine articles were included, for which validity was evaluated and analysed. The review was performed using PRISMA guidelines for systematic reviews. Study characteristics were examined to determine if a meta-analysis was possible, and odds ratio was used as the effect size measure. Results: Data analysis led to the development of selected topics. The success rate of nurse-led direct current cardioversion appears to be high, at >80% (eight out of nine studies) in safe conditions. High-level professional training was required of nurses. There seemed to be no clear consensus on the management of anaesthetic aspects and medical support during the procedure. Meta-analyses of three studies found that there was no risk (M1-OR 0.89, CI [0.58, 1.36]; M2-OR 0.90, CI [0.59, 1.37]) difference between nurse-led DCCV and that performed by other clinicians. Few studies reported data on patient satisfaction, cost effectiveness, and waiting time. Conclusions: This review confirms that nurse-led external direct current cardioversion appears to be successful and safe in restoring sinus rhythm. A high level of nurse training and definition of a shared protocol could allow for effective implementation in more countries and settings. Full article

Background: The complex nature of the work–family interaction process means special ethical considerations are required in its study. Symphonology can guide ethical analysis in this area, as it pertains to the study of agreements and the elements necessary to form them. Objective: Our objective was to analyze the ethical considerations involved in the development of research on the work–family interaction process via symphonological bioethical theory. Methods: A scoping review was conducted by consulting the following databases: Web of Science (WoS), SCOPUS, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and Business Source Ultimate. Given the small number of studies identified in the field, we did not discriminate by years of publication and included articles of any design that addressed ethical considerations in research on the work–family interaction process or that were related to the topic, including manuscripts in Spanish, English, and Portuguese. Results: The ethical analysis of research on the work–family interaction process requires us to consider the participant’s multi-role status as a “worker,” including their inherent relationships with their environment, such as colleagues and supervisors, and as a member of a “family” unit. The various factors involved in the work–family interaction “context” must be analyzed within the context of situation, knowledge, and awareness. Based on the review findings, a list of recommendations was developed focused on planning, data collection, and result presentation. Key points include the provision of psychological support when the research involves sensitive data; the notification of authorities upon identifying offenses such as workplace abuse or domestic violence; and ensuring confidentiality of participation. Conclusions: This review provided answers to the proposed objective, concluding that the symphonological nursing bioethics theory, through its conception and statements, guides researchers to make decisions in the context of research development in the work–family interaction process. Full article

Background/Objectives: The uneven distribution of nurses in Albania is a major problem that compromises equitable access to health services. Rural and less developed regions suffer from a chronic shortage of nursing staff, while urban areas attract health professionals. This study aims to quantify the inequalities in the distribution of nurses in Albania, analyzing the nurse-to-population ratio and its impact on the quality of healthcare. The main objective of this study is to examine the distribution of the nursing workforce in Albania and assess regional disparities, using the Gini coefficient and the Human Development Index (HDI) to measure and compare inequalities between regions. Methods: This descriptive–analytical study was conducted in 2024. The data were collected from official sources, including the Albanian Ministry of Health and the World Health Organization (WHO). The Gini coefficient and the Lorenz curve were used to analyze the distribution of nurses in relation to the population and HDI of the different regions. The analysis included data on the number of nurses, population, and regional socioeconomic conditions. Results: The average nurse-to-population ratio in Albania is 28 nurses per 10,000 inhabitants, with significant variations between regions. Tirana has the highest ratio (60 nurses per 10,000 inhabitants), while Kukës and Dibër have the lowest values (10 per 10,000 inhabitants). The calculated Gini coefficient is 0.0228, indicating a very low level of inequality in the distribution of the nursing workforce. Conclusions: Inequalities in the distribution of nurses in Albania require targeted policy interventions. Policies are needed that incentivize health workers to work in less developed regions, through economic incentives, infrastructure improvements, and lifelong learning programs. These interventions are essential to reduce disparities and ensure equitable access to health services across the country. Full article