Nursing Reports最新文献

Background: The Fundamentals of Care framework emphasizes a patient-centered approach that prioritizes the nurse-patient relationship and care environment to meet patients' basic needs, including oral hygiene. Recognized as crucial for preventing systemic health problems, oral care neglect is a global concern. Studies identify missed oral care as a widespread issue, contributing to significant patient safety risks. This study aimed at measuring missed nursing care occurrence in a Northern Italian university hospital, exploring the association between missed oral care with nursing staff characteristics and oral care policies.

Methods: A single-center cross-sectional study was conducted according to the STROBE guidelines. Data collection was performed in May 2022 using the MISSCARE survey, a self-administered questionnaire sent by email to 473 nurses from all inpatient units. The degree of implementation of oral care policies was obtained by accessing the Facility Score Sheet data at the department level. Descriptive statistics, chi-square tests, and Fisher tests were conducted using SAS 9.4 and R software.

Results: Providing oral care was the third-most missed nursing care after rotating patients every two hours and walking them three times daily. The reasons for missed care included resource shortage and high patient turnover. The Facility Score Sheet data showed a low adoption of oral care policies. No significant associations were found between missed oral care and both nurses' characteristics and oral care policy at the department level.

Conclusions: The study confirms highly missed oral care in acute care settings, emphasizing the urgent need for systemic changes via an evidence-based oral care policy and practice implementation. This study was prospectively registered under protocol 293 CE 050/2022 (8 Aril 2022).

Background: Optimum efficiency and responsiveness to callers of mental health helplines can only be achieved if call priority is accurately identified. Currently, call operators making a triage assessment rely heavily on their clinical judgment and experience. Due to the significant morbidity and mortality associated with mental illness, there is an urgent need to identify callers to helplines who have a high level of distress and need to be seen by a clinician who can offer interventions for treatment. This study delves into the potential of using machine learning (ML) to estimate call priority from the properties of the callers' voices rather than evaluating the spoken words.

Method: Phone callers' speech is first isolated using existing APIs, then features or representations are extracted from the raw speech. These are then fed into a series of deep learning neural networks to classify priority level from the audio representation.

Results: Development of a deep learning neural network architecture that instantly determines positive and negative levels in the input speech segments. A total of 459 call records from a mental health helpline were investigated. The final ML model achieved a balanced accuracy of 92% correct identification of both positive and negative instances of call priority.

Conclusions: The priority level provides an estimate of voice quality in terms of positive or negative demeanor that can be simultaneously displayed using a web interface on a computer or smartphone.

Hormone blockers are defined as substances that suppress the release of sex hormones, thus inhibiting the development of secondary sexual characteristics in teenagers. There is currently an increase in young people seeking healthcare services due to a mismatch between their birth-assigned gender and their perceived or self-identified gender. In early childhood, individuals are not usually affected by their physical appearance. Dysphoria may arise during the initial stages of adolescence and if the self-perceived gender does not align with the external appearance. This may have a negative impact on adolescents' mental health. Could the use of hormone blockers have a positive effect on mental health? The primary objective of this review is to assess whether the use of hormone blockers can have positive effects on the mental health of transgender youth. The review also seeks to evaluate the usage of hormone blockers and the diagnosis of gender dysphoria. A literature search of scientific evidence was conducted across various databases-PUBMED, CUIDEN, ELSEVIER, COCHRANE, DIMENSIONS, SCIELO, PSYCINFO, and CINAHL-alongside a review of the latest publications in high-impact scientific journals and the gray literature. The following terms were used: , , , , , , and . A time period was specified, covering the last ten years (2014-2024). The initial search identified a total of 290 references, which were subsequently narrowed down to 5 studies, with 1 additional study retrieved through other methods. The literature findings are clear. They show that the use of hormone blockers in transgender adolescents can be beneficial, as a reduction in mental health issues was observed during and after their use. Mental healthcare in transgender teenagers is of crucial importance to their physical, psychological, social, and academic spheres. It is also very important for their families. Nurses must be aware of this knowledge to improve the care provided to these individuals and their families during the difficult time surrounding decisions about the use of hormone blockers.

Background: Adolescent eating disorders pose a significant public health challenge and strongly affect both physical and emotional well-being. Early diagnosis is important for improving treatment outcomes, though it remains complex due to multiple influencing factors. The family perspective is essential in this process, as it provides valuable insights into changes in adolescents' habits and emotional health.

Methods: A descriptive qualitative study was conducted between January and February 2023. Interviews were conducted with 12 participants using a phenomenological approach to explore the experiences and perspectives of family members of adolescents with eating disorders.

Results: Four thematic blocks comprising several categories were identified: (T1) diagnosis, (T2) family, (T3) resources, and (T4) treatment. The participants emphasized the need for early intervention and a multidisciplinary approach to the treatment of eating disorders. Family therapy was recognized as vital to treatment, and common dissatisfaction with the public health structure underscores the need for greater investment in research and access to specialists. Mental health nurse practitioners play an important role in providing comprehensive care and support, as well as mental health literacy.

Conclusions: A holistic, patient-centered approach, including family involvement and appropriate support systems, is key to improving the outcomes and quality of life of adolescents undergoing treatment for eating disorders. Improving healthcare resources and addressing the challenges faced by families is essential. In addition, mental health literacy is critical, as it enables families to understand the disease better, make informed decisions, and actively participate in the recovery process, thus contributing to improved therapeutic outcomes and quality of life for patients.

Background: Despite the short- and long-term acknowledged benefits of breastfeeding for mothers and their infants, worldwide rates trail behind international goals. Prior research confirms that breastfeeding is a nurse sensitive indicator and that problems with latching the baby and painful breastfeeding rank high among the reasons given for not continuing to breastfeed. The Lactation Assessment Tool (LAT^TM) was previously evaluated in a study conducted in Latvia by nurse midwives. Use of the LAT to assess breastfeeding and suggesting corrective interventions were shown to decrease pain and promote healing in traumatized nipples. The inter-rater reliability for that study was by test/re-test amongst participating researcher midwives. The aim of the current study is to expand the understanding of LAT inter-rater reliability to include novice and expert assessors.

Methods: A convenience sample of twenty participants, including both novices (nine nursing students) and 11 self-identified experts, assessed four videos of breastfeeding dyads using the assessment tool, the LAT. Novice participants received a 2 h training session before final tool assessment. Each video was viewed three times, with a 3 min pause between viewings. All elements of the LAT that could be visually evaluated were included, with each element appearing in at least two of the videos.

Results: Acceptable internal consistency of the LAT tool was found, with Cronbach's alpha measuring 0.799, 0.740, 0.756 and 0.735 for each video, respectively. The reliability of the novice assessors improved over the course of the four videos, from 0.484 and 0.610 to 0.714 and 0.711. All of the experts had Cronbach's alpha numbers that were acceptable, ranging from 0.769 to 1.00.

Conclusions: Results indicate that experts perform much better using the tool than trained novices. However, the subsequent use of the tool resulted in the last two video assessments having an acceptable measure for the trained novice group. The LAT is a reliable tool for trained novices and experts to assess breastfeeding positioning and latch.

Background/objectives: The use of coercive measures (CMs) and security technologies (STs) in mental healthcare continues to raise ethical and practical concerns, affecting both patient and staff well-being. Mental health nurses (MHNs) and nursing students (NSs) play a key role in the decision-making process regarding these interventions. However, their attitudes, particularly toward STs, remain underexplored in Italy. This study protocol aims to introduce a new conceptual framework and investigate Italian MHNs' and NSs' attitudes toward CMs and STs in mental health settings. Additionally, it will explore the influence of sociodemographic and psychological factors, including stress, anxiety, depression, stigma, and humanization on these attitudes.

Methods: The research will be conducted in two phases. Phase 1 involves a national survey of a convenience sample of MHNs and NSs to assess their attitudes and related factors. Phase 2 includes qualitative interviews with a purposive sample of MHNs and NSs to explore participants' perspectives on STs in more depth. Quantitative data will be analyzed using descriptive and inferential statistics, while qualitative data will be examined through thematic analysis.

Conclusions: This study protocol seeks to enhance our understanding of MHNs' and NSs' attitudes toward the use of CMs and STs in mental health settings, identifying key factors influencing these attitudes. The findings aim to inform policy development, education programs, and clinical practices in both the Italian and international panoramas. Additionally, the proposed conceptual framework could guide future research in this field.

Background/objectives: Caring for patients at the end of life can involve issues that are ethically and legally fraught: withholding or withdrawing artificial nutrition and hydration, pain control that could hasten death, aggressive treatment that is continued when it seems only to be prolonging suffering, patients who request medical assistance in dying, and so forth. Clinicians may find that their deeply held ethical principles conflict with law, institutional policy, or patients' choices. In these situations, they may consider either refusing to participate in procedures that they find morally abhorrent (conscientious refusal) or providing care that they believe to be ethically obligatory despite being contrary to law or policy (conscientious commitment).

Methods: This paper reviews the ethical issues involved.

Results: Each of the usual policies for handling conscientious refusals faces serious challenges.

Conclusions: Healthcare providers who refuse to provide medical services should be expected to explain their reasons, make prompt referrals, and bear some of the resulting costs or burdens.

Background/Objectives: Extensive research has emphasised the persistent challenges and failures in providing hospitalised patients with fundamental evidence-based nursing care, often resulting in grave consequences for patient safety. Recommendations from implementation research indicate that a tailored theory- and research-based implementation strategy targeting contextual determinants can optimise the implementation of evidence-based clinical practice for the benefit of patients. This study evaluated the feasibility of an implementation strategy designed to improve the quality of nursing care by targeting behavioural and environmental barriers in a hospital setting. Methods: Proctor's conceptual model for implementation was applied to evaluate the strategy based on eight outcomes: adoption, acceptability, appropriateness, fidelity, feasibility, penetration, sustainability, and costs. Data collection methods included field observations, informal and focus group interviews, registrations, and audits of electronic patient records. Results: The strategy was adoptive, acceptable, appropriate, and feasible in targeting complex environmental and behavioural determinants (at the individual, team, and management level), enabling successful implementation of fundamental evidence-based nursing care. However, fidelity, feasibility, and sustainability were challenged by competing organisational demands and time constraints. Conclusions: The tailored, multifaceted strategy proved effective in addressing complex environmental and behavioural determinants across multiple levels, facilitating the implementation of fundamental evidence-based nursing care in a clinical practice. Further testing and larger-scale studies is needed to assess the strategy's transferability and its impact on nursing-sensitive patient outcomes in different clinical settings.

Background: Preventing postoperative infection and promoting patient safety are essential responsibilities of the operating room nurse. In some hospitals, splash basins are used to rinse instruments during surgery, although previous studies emphasise the risk of bacterial contamination. A recent systematic review calls for further investigation into surgical teams' use of splash basins. Objectives: Our objective was to investigate bacterial contamination in splash basins and to identify the variables that may have an influence on this contamination. Methods: This prospective observational pilot study involved collecting, cultivating, and analysing water samples obtained from splash basins during operations performed in the thoracic and neurosurgical departments. The ventilation systems, length of surgery, number of instruments in the splash basin, number of persons present in the operating room, frequency of door openings during surgery, and type of bacteria were observed. Results: Bacterial growth was found in 44% of the final water samples: 41% from the thoracic surgical department, which had laminar airflow ventilation systems/unidirectional airflow ventilation, and 47% from the neurosurgical department, which had conventional ventilation systems/turbulent mixing ventilation. However, the binary logistic regression analysis revealed no significant correlation between bacterial growth and the ventilation systems, length of surgery, number of instruments in the splash basin, number of people in the operating room, or frequency of door openings. The most common types of bacteria found were coagulase-negative staphylococci and Micrococcus luteus. Conclusions: Splash basins become contaminated with bacteria during surgery. Therefore, using splash basins with sterile water is not recommended. Further research is needed to determine the best evidence-based practice for rinsing instruments perioperatively.

Background: Ageism refers to the presence of stereotypes, prejudices, and discrimination against older adults based on their age. In healthcare settings it negatively impacts opportunities for treatment, rehabilitation, and cure opportunities. This study aims to assess the presence of ageism among healthcare workers toward older patients and to identify the associated sociodemographic, personal, and work-related factors. Methods: A systematic review of the literature was performed using PubMed, Embase, CINAHL, and Scopus. Studies that assessed the presence of ageism among healthcare professionals through a quantitative or mixed methodology and published between 2014 and 2024 were included. Results: Fifteen articles met the inclusion criteria. Healthcare workers generally exhibited low rates of ageism; however, results varied across studies. Although the available literature is limited, workers with less knowledge about aging and less experience, especially in geriatric units, showed higher ageism scores. Intergenerational contact and a wish to work with older people appeared to be important factors for promoting a positive relationship with older adults. Other sociodemographic and sociocultural factors, such as age and sex, were not related to ageism. Workload and work-related factors, such as stress or lack of personnel, might be associated with ageism, but few studies were found to be available to confirm these results. Conclusions: Ageism scores among professionals were low. Gerontological education and clinical and family experience could help reduce ageist attitudes toward older patients among health professionals.