Nursing Reports最新文献

Background/Objectives: Japan introduced a certification system for Advanced Practice Nursing Workforce (APNW) in 1996. The Japanese Nursing Association formally certified two types of the APNW: Certified Nurses (CNs) and Certified Nurse Specialists (CNSs). Little is known about the geographic distribution of CNs and CNSs. Methods: We conducted an ecological panel analysis using prefecture-level data from 1996 to 2022. To assess the degree of inequality of CN and CNS among prefectures, we calculated the Gini overall coefficients, as well as those by categories of CN and CNS, number of hospitals, number of hospital doctors, and hospital nurses. Using data available from 2000 to 2017, we examined factors associated with CN and CNS density through fixed-effects panel data analyses of log-transformed overall and category-specific densities. Results: During the study period, the number of CNs and CNSs consistently increased, and geographic disparities in their distribution decreased until around 2010. After 2010, however, geographic disparities in prefectures with persistently low CN and CNS densities persisted without significant change. For overall CN and CNS density, significant associations were observed with population aging, per capita income, hospital density, hospital doctor density, hospital nurse density, and study year, whereas hospital nurse wages showed a positive but not statistically significant association. When stratified by clinical category, the directions of associations for several regional factors varied; however, hospital nurse density and hospital nurse wages tended to be positively associated with CN and CNS density in most categories. Conclusions: This study highlighted the need for targeted strategies to increase CN and CNS numbers specifically in prefectures with persistently low densities, tailored to each clinical category.

Background: Teamwork and effective communication are widely recognized as essential pillars for the safety and quality of healthcare. However, in Portugal, no validated instrument had previously been available to assess healthcare professionals' attitudes toward teamwork. This study aimed to translate, culturally adapt, and validate the TeamSTEPPS^® Teamwork Attitudes Questionnaire (T-TAQ) for the Portuguese context, resulting in the Portuguese version of the instrument. Methods: A methodological study with a quantitative approach was developed. The translation and cultural adaptation process followed internationally recognized guidelines. The sample consisted of 162 healthcare professionals (136 nurses and 26 physicians) from a hospital in Lisbon. Exploratory and confirmatory factor analysis techniques were used to assess construct validity. The internal consistency of the scale was analyzed using Cronbach's alpha coefficient. Results: The Portuguese version comprises 30 items distributed across five dimensions: Effective Leadership Support, Team Functional Performance, Teamwork Coordination, Willingness to Engage in Teamwork, and Team Functioning Supervision. The scale demonstrated a total explained variance of 53.9% and an overall internal consistency coefficient (α) of 0.86, indicating good reliability. Confirmatory factor analysis supported the five-factor structure of the scale (χ²/df = 1.461; CFI = 0.900; GFI = 0.821; RMSEA = 0.054; MECVI = 4.731). Conclusions: The T-TAQ-PT proved to be a valid, reliable, and robust instrument for assessing healthcare professionals' individual attitudes toward teamwork, contributing to the development of research and clinical practice in the Portuguese context.

Background/Objectives: Medication incidents remain a significant concern in hospital settings. Integrated medication systems, regarding organized processes, policies, technologies and professional practices are designed to enhance patient safety; however, their safety performance is still suboptimal. The use of valid and reliable instruments to assess hospital medication system safety can be a valuable resource for health care management. The aim of this study was to describe the development and psychometric validation of the Hospital Medication System Safety Assessment Questionnaire (HMSSA-Q) for assessing the safety of hospital medication systems and its processes in Portugal. Methods: The HMSSA-Q was developed through a literature review and two rounds of expert panel consultation. Following consensus, a pilot methodological study was conducted in 95 Portuguese hospitals. Construct validity was assessed using principal component factor analysis, and reliability was evaluated through internal consistency (Cronbach's alpha). Results: The instrument is theoretically structured into five predefined domains/subscales: Organizational Environment, Safe Medication Prescribing, Safe Medication in Hospital Pharmacy, Safe Medication Preparation and Administration, and Information and Patient Education. Principal component analyses performed separately for each domain supported their internal structure. The overall scale showed excellent internal consistency (Cronbach's α = 0.97), with Cronbach's alpha values for the domains ranging from 0.86 to 0.94. Conclusions: The HMSSA-Q is a valid and reliable instrument for assessing the safety of hospital medication systems and has the potential to serve as an innovative management tool for improving patient safety.

Background/Objectives: The aim of this study was to evaluate the research competencies of pediatric nurses and to assess the psychometric properties of the Research Competencies Assessment Instrument for Nurses (RCAIN) in Greece. Methods: A cross-sectional study was conducted in December 2023 via a convenience population-based sample of 106 registered pediatric nurses. Eligible participants owned a diploma, bachelor's, or graduate degree in nursing and had completed at least two years of professional service. Research competencies were estimated through the RCAIN, a standardized instrument previously validated in the Greek language. Results: The findings revealed moderate levels of research-related knowledge (mean score: 26.92/40), skills (mean score: 22.17/30), and application of research in clinical practice (mean score: 14.89/25). Higher educational attainment and participation in scientific activities were positively associated with research competency scores. The RCAIN showed high internal consistency across subscales (Cronbach's α: knowledge = 0.914, skills = 0.905, application = 0.935), supporting its reliability in this population. Conclusions: Pediatric nurses showed moderate research competencies, underscoring the need for direct educational and institutional strategies to foster research capacity and evidence-based practice in pediatric nursing settings.

Background: Music therapy is a non-pharmacological psychosocial intervention that is increasingly recognised for its role in supporting older adults in acute hospital settings. Engagement with music, whether through passive listening, preferred recorded music, live music, or creative music therapy, has been linked to improvements in behavioural, cognitive, and emotional outcomes during episodes of delirium. Although there are reviews on non-pharmacological approaches to delirium, few have focused specifically on music therapy within acute hospital environments. Methods: This scoping review examined the evidence relating to music-based interventions for older adults who are experiencing delirium or who are at risk of delirium in acute care settings. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA ScR). Four electronic databases were searched systematically, namely, CINAHL, Medline, PsycINFO and Embase. Results: Seven primary research studies published between 2004 and 2024 met the inclusion criteria. A narrative synthesis approach was used to summarise the data. Three themes were identified. The first relates to the extent to which music therapy may reduce the incidence or severity of delirium or other related behaviours in acute hospital settings. The second relates to the potential for music-based interventions to support clinical practice by improving interaction between patients and staff and reducing distress during recovery and enhancing physical recovery. The third relates to the impact of music therapy on emotional regulation, engagement, cooperation with care, and overall patient experience. Conclusion: Music therapy shows promise as a person-centred, safe, and low-cost intervention that may enhance wellbeing and support delirium care for older adults in acute hospital settings. Further high-quality studies are needed to strengthen the evidence base and guide practice.

Background: Patient-centered care (PCC) is a cornerstone of quality, yet its translation into managerial decision-making remains underexplored. Middle nurse managers (MNMs) play a pivotal role in enabling patient-centeredness, but their perspectives on PCC decisions are rarely investigated. Aim: This study explored MNMs' perceptions of what constitutes a patient-centered decision in hospital settings and identified the essential dimensions underpinning such decisions. Methods: A qualitative descriptive design was adopted using semi-structured interviews. Thirty-eight MNMs from three hospitals in central Italy were included. Data were analyzed using Elo and Kyngäs' content analysis approach. Results: Two overarching themes emerged as central to patient-centered managerial decision-making (PCMDM): "Meaning and definition of PCMDM," and "Influencing dimensions of PCMDM". MNMs described PCMDM as an evolving and adaptable process shaped by patient needs and organizational constraints and unfolding across distinct phases. Key influencing dimensions included the manager's role, organizational environment, human resource management and knowledge of the patient. Conclusions: PCMDM is a continuous, ethical, and reflective process mediated by MNMs, who reconcile institutional priorities, team dynamics, and patient needs to create conditions for high-quality PCC. Implications for Practice: Strengthening PCMDM requires coordinated action aimed at equipping nurse managers with advanced leadership capabilities, building organizational structures that sustain patient-centered decisions, and empowering patients to actively co-shape the care process.

Background: Integrating palliative care (PC) into primary health care (PHC) is essential for achieving Universal Health Coverage and reducing avoidable suffering. Despite global progress in PC development, the extent to which PC is effectively embedded within PHC systems remains unclear, particularly in low- and middle-income countries. Colombia illustrates this gap, with an advanced legal framework but persistent territorial inequities. This study explored how national experts conceptualize PC integration into PHC to inform the development of context-sensitive indicators. Methods: A directed thematic analysis was conducted using qualitative comments from a modified Delphi process (pre-Delphi, Round 1, Round 2). Coding was guided by the WHO model for PC development and the WHO-UNICEF Operational Framework for PHC, combining deductive and inductive approaches to identify recurrent themes. Results: A total of 230 qualitative comments from experts in PC, PHC, and public health were analyzed. Experts described integration as the alignment of policy, education, service delivery, and community participation within PHC structures. They emphasized that laws and training programs alone are insufficient; integration depends on implementation capacity, equitable access, and locally responsive systems. Rural areas were identified as facing the greatest barriers, including limited trained staff, restricted medicine availability, and weak referral pathways. Conclusions: Experts understood PC integration into PHC as a dynamic and ethical process linking system design with human experience. Strengthening equity, workforce preparation, and community engagement is essential to translate policy into practice and to develop meaningful indicators for health system improvement.

Background: Rotating and night-including shifts disrupt circadian alignment, impair sleep, and may reduce nurses' physiological recovery. Objectives: This study aimed (1) to compare sleep quality and physical well-being across four shift schedules among hospital nurses and (2) to examine whether the association between rotating shifts and physical well-being was statistically consistent with an indirect association via sleep quality. Methods: In this cross-sectional study, 173 nurses from a tertiary hospital in Zagreb, Croatia, completed validated measures of sleep quality and physical well-being. Four shift patterns were analyzed-fixed morning, morning-afternoon, extended 12-h, and rotating three-shift-using Welch ANOVA and regression models. A bootstrapped mediation analysis (10,000 resamples; BCa method), interpreted as a statistical decomposition, estimated an indirect association consistent with sleep quality. Results: Rotating-shift nurses reported the poorest sleep (PSQI = 10.2 ± 2.6; p = 0.003). Physical well-being did not differ significantly across shift types (p = 0.08), although rotating-shift nurses had the lowest mean physical scores (24.3 ± 4.4). The rotating-shift subgroup was small (n = 16), limiting precision. The mediation analysis was statistically consistent with an indirect association between rotating shifts and physical well-being via sleep quality (ACME = -1.85, 95% CI -3.05 to -0.88; p < 0.001), while the proportion of the total association was imprecisely estimated. Conclusions: In this single-site cross-sectional sample, rotating night shifts were associated with poorer sleep and, on average, lower physical well-being; patterns were statistically consistent with an indirect association via sleep quality. Because exposure, mediator, and outcome were measured concurrently, these findings are hypothesis-generating and do not establish causality.

Background: Treatment nonadherence in oncology is common. Surveys often miss why patients do not follow recommendations. We synthesised Natural Language Processing (NLP) studies, mainly sentiment analysis, of patient-generated content (social media, forums, blogs, review sites, and survey free text) to identify communication and relationship factors linked to nonadherence and concordance. Methods: We conducted a scoping review (PRISMA-ScR). Searches of PubMed, CINAHL, and Scopus from 2013 to 15 June 2024 identified eligible studies. We included 25 studies. Data were charted by source, cancer type, NLP technique, and adherence/concordance indicators, then synthesised via discourse analysis and narrative synthesis. Results: Four themes emerged: (1) unmet emotional needs; (2) suboptimal information and communication; (3) unclear concordance within person-centred care; and (4) misinformation dynamics and perceived clinician bias. Sentiment analysis helped identify emotions and information gaps that surveys often miss. Conclusions: Patient-voice data suggest practical actions for nursing, including routine distress screening, teach-back, misinformation countermeasures, and explicit concordance checks to improve adherence and shared decision making. Registration: Not registered.

Background: Intravenous catheterization is a common nursing procedure, although it is invasive and may cause pain and stress. Non-pharmacological interventions such as cryotherapy and thermotherapy have been explored, but practical and effective options remain limited. Purpose: This study aimed to evaluate the effects of cryotherapy and thermotherapy using the Enhanced Thermoelectric Element Tourniquet (E-TEET) a device equipped with a temperature-controlled plate and wireless charging on pain, stress, and patient satisfaction during intravenous catheterization. Methods: A randomized controlled trial was conducted involving 128 adult inpatients scheduled for preoperative intravenous catheterization. Participants were randomly assigned to one of four groups: cryotherapy (n = 31), thermotherapy (n = 31), control (E-TEET without temperature, n = 33), or comparison (latex tourniquet, n = 33). Pain and stress levels were measured using- the Numeric Rating Scale (NRS), along with pulse rate and oxygen saturation. Post-procedure satisfaction was also evaluated. Results: No significant differences were observed among the groups in terms of pain, pulse rate, or oxygen saturation. However, the cryotherapy group exhibited significantly lower stress levels and higher satisfaction compared to the comparison group (p < 0.05). Furthermore, Healthcare provider Satisfaction was significantly higher in the cryotherapy group than in the control group (p < 0.05). Conclusions: Cryotherapy using the E-TEE Tourniquet effectively reduced stress and improved satisfaction during intravenous catheterization, supporting its use as a feasible non-pharmacological intervention. Further studies are needed to standardize intervention parameters and validate findings across populations.