Search Results (370)

Background: Pediatric oropharyngeal dysphagia screening protocols remain limited in acute and critical care settings due to the lack of psychometrically valid and reliable tools. Objectives: The eDelphi methodology was employed to establish content validity for the Children’s Oral Feeding Screener (COFS), a novel, nurse-led oropharyngeal dysphagia screening tool for hospitalized children in acute and critical care (0–16 years). Methods: The two-round eDelphi study was completed using Qualtrics^®. A multidisciplinary, international steering-group guided tool conceptualization, elements for rating in the eDelphi, and oversaw consensus decisions. Experienced speech pathologists in pediatric acute and/or critical care were invited as panelists and rated tool content regarding (a) clinical presentations requiring immediate referral for dysphagia assessment; (b) oral trial component/s; and (c) signs observed during oral trials suggesting dysphagia. Items were rated on a 10-point Likert scale, and panelists could give open-ended feedback. Items not reaching pre-defined consensus (>75%) were re-presented in round two. Results: Fifty panelists participated in round one and 41 in round two, primarily from Australia (n = 19; 46%) and the United Kingdom (n = 13; 34%). Half (n = 22; 54%) had >10 years’ experience. Based on consensus scores, panelists’ qualitative feedback, and steering group decision, final items included eight clinical presentations, three oral trial elements (cup, bottle, breastfeeding) with three associated oral trial protocols, and fourteen signs suggestive of dysphagia. Other feedback led to changes to headings and the format of the COFS layout. Conclusions: Content validity for items in the three components of the COFS was established. Further work is now required to explore other psychometric properties (construct validity, sensitivity/specificity, and feasibility) in clinical settings. Full article

Background: The implementation of shared governance within the nursing practice results in heightened satisfaction among nurses and enhances the quality of care provided. Shared governance fosters collaborative and proactive relationships among nurses and healthcare providers, while also cultivating a sense of confidence among nurses. However, evidence suggests that a lack of awareness, reliance on traditional governance, and inadequate shared governance structures among nurses continue to exist at the unit-based council (UBC) level, including those in the Kingdom of Saudi Arabia (KSA). Purpose: The present study aimed to assess the extent of clinical nurses’ perceptions concerning shared governance at the UBC level, and to examine the variations and relationships in their perceptions based on demographic and work-related characteristics. It further explored the demographic and work-related factors that affect the overall perceptions of shared governance among clinical nurses. Methods: This quantitative study utilized a cross-sectional design and was carried out in three governmental hospitals in the KSA. The sample comprised 669 nurses, who were selected using a convenience sampling method. The Index of Professional Nursing Governance (IPNG) tool was utilized for data collection conducted between February 2025 and April 2025. Descriptive statistics alongside the t-test and analysis of variance (ANOVA), Pearson-r correlation coefficient, and multiple linear regression were utilized for data analysis. Significant findings were drawn when p ≤ 0.05. Results: The average perception of shared governance among clinical nurses at the UBC level was 180.42 out of 430, suggesting that decision-making occurs collaboratively between nurses and management. Significant differences in the average level of clinical nurses’ perceptions of shared governance were noted in relation to their educational qualifications (F = 5.015, p = 0.001) and nursing units (F = 4.157, p = 0.010). The hospital in which clinical nurses were employed (r = 0.098, p = 0.037) and nursing units (r = 0.087, p = 0.020) exhibited significant correlations with their overall shared professional governance. Furthermore, the hospital where clinical nurses were employed (β = 0.406, p = 0.001, 95% confidence interval [CI] = 0.166, 0.646) and nursing units (β = 0.326, p = 0.038, 95% CI = 0.018, 0.314) served as predictors of their overall professional shared governance. Conclusions: Clinical nurses in this study showed an initial or relatively low level of shared governance at the UBC level. The overall finding highlights a critical need for nursing managers and leaders to enhance the level of professional shared governance among clinical nurses, which may result in improved nurse retention and overall quality of nursing care. It is crucial to consider clinical nurses’ educational qualifications and working environment at the UBC level when aiming to enhance their level of professional shared governance. Full article

Background/Objectives: Inefficient postoperative handovers contribute to medical malpractice and care discontinuity by omitting critical patient information and compromising patient health. This study aimed to evaluate and compare the quality of postoperative nurse handovers in ORs, PACUs, ICUs, and wards across four hospitals in Jeddah, Saudi Arabia. Methods: A descriptive, cross-sectional, comparative study was conducted among postoperative care nurses across four hospitals in the second health cluster in Jeddah, Saudi Arabia. Data were collected through an online questionnaire to assess handover quality via a Handover Quality Rating Form and sociodemographic information. Data analysis was performed using SPSS v28. Results: Among the 521 nurse participants (84.1% female, M_age = 34.5 years), the overall postoperative handover quality was 76.8%, with handover conduct and quality scoring the highest (27.9 ± 4.8 and 17.7 ± 3.1, respectively). Female nurses demonstrated significantly higher performance in teamwork and handover circumstances, whereas older nurses demonstrated significantly better teamwork, handover conduct, and quality. Saudi and younger nurses experienced significantly higher handover circumstances. Nurses’ educational level and years of experience in the present ward were significantly correlated with handover circumstances, conduct, and quality. Handovers from the theater to recovery resulted in higher average circumstances than those from recovery to the ward. The study setting was significantly associated with handover quality. Conclusions: These findings highlight the importance of local evaluating the handover quality of nurses in various contexts, specifically considering the circumstances, conduct, and teamwork when planning implementation and developing standardized handover protocols for different departments, specialties, and healthcare settings. These results support the development of targeted training programs and unit-specific handover protocols. Full article

Background/Objective: This review explored the literature on Missed Nursing Care (MNC) in inpatient oncology settings to gain insights on how to enhance the quality of nursing care for hospitalized patients with cancer and survivors. The aim was to identify the common MNC and the factors associated with MNC in inpatient oncology units. Methods: A scoping review approach was used, in which a five-stage methodological framework informed the process. Five databases were searched for relevant studies (EMBASE, Medline, SCOPUS, CINAHL, and PsycINFO) published from January 2013 to June 2025. Other search methods were conducted using Google Scholar, Trove, and ProQuest Dissertations for records focusing on the topic. The review included qualitative and quantitative articles. Thomas and Harden’s three-step method for thematic synthesis was followed to summarize data into themes. Results: Fifteen studies were selected and included in the scoping review. Three themes were generated: the commonly MNC; reasons for MNC; and factors associated with MNC. The common categories of MNC were related to basic patient care, documentation, and communication with patients or family members. The common factors associated with MNC were job satisfaction, patient load, and staffing adequacy. Conclusions: MNC is common in inpatient oncology settings and presents a key challenge to the safety of cancer patients and their health outcomes. Efforts to curtail MNC, such as integration of evidence-based policies, clinical guidelines, and standards in oncology nursing care, are needed. Interventional studies are needed to provide insight into effective remedies to the factors that fuel MNC, such as staffing, work overload, communication, work environment, and nurses’ skills. Studies from pediatric oncology settings, Africa, and other resource-limited settings where the future global burden of cancer will be highest are also needed. Full article

Background/Objectives: In Ontario, approximately 8% (11,000) of infants are born preterm (22–<37 weeks gestation) each year. Many of these infants are cared for in a Level II Neonatal Intensive Care Unit (NICU). Family Integrated Care (FICare), an innovative model of care, aims to facilitate the involvement of parents in the care of their infants in NICUs. The aim of this study was to gain a better understanding of the general and specific needs of Level II NICUs in Ontario prior to implementation of FICare. Methods: Using a cross-sectional study design, two surveys (leadership and site resources) were developed using the Consolidated Framework for Implementation Science Research’s innovation, inner setting, and outer setting constructs and distributed to Level II NICUs medical and nursing leaders. Results: The surveys were sent to 44 Level II NICUs in Ontario, of which 24 hospitals (55%) responded. Key facilitators to implementation of FICare in Level II hospitals in Ontario were leadership interest, availability of staff and parent volunteers, and existing policies to support implementation. The identified barriers were lack of financial resources for new initiatives, skepticism in FICare’s ability to save costs, need for tailored implementation due to variability in NICU characteristics, and the lack of environmental support for prolonged parental presence. Conclusions: This study has confirmed the interest of many Ontario level II NICUs in implementing FICare and variability in their readiness for implementation based on the identified facilitators and barriers. Full article

Background/Objectives: Falls are a leading cause of hospitalization, injury, and healthcare spending among older adults. Surveillance data on local falls, especially for those associated with Alzheimer’s disease and related dementias (ADRD), are limited. We conducted a surveillance analysis to describe fall-related hospitalizations and their associations with ADRD in Los Angeles County (LAC). Methods: We analyzed countywide hospital discharge data for LAC residents aged 50+ from 2016–2022 (n = 3,520,927) to assess differences in fall-related hospitalizations by ADRD status and demographic characteristics. We used multivariable logistic regression to identify predictors of fall status and multinomial regression to examine associations between ADRD status and discharge disposition. Results: Of all hospitalizations, 6.8% were fall-related. Individuals hospitalized for falls had longer stays, higher charges, and were more frequently female, older, and White. Fall frequency peaks consistently occurred during winter months, with higher seasonal variation among those without ADRD. After adjustment, ADRD diagnosis was associated with increased odds of fall-related hospitalization (AOR = 1.14) and non-routine discharge, including transfer to a short-term hospital (AOR = 1.35), skilled nursing or other care facilities (AOR = 1.88), and home health care (AOR = 1.23). Conclusions: This study provides one of the most comprehensive local assessments of fall-related hospitalization among older adults in the United States. The findings highlight the increased risk and care complexity among patients with ADRD. As results are descriptive and reflect cross-sectional surveillance, temporality and causality cannot be inferred. Nevertheless, the findings underscore the need for better surveillance and integrated fall prevention, discharge planning, and post-hospital support strategies tailored to individuals with ADRD. Full article

Background/Objective: Transformational leadership (TL) by nurse managers is a modifiable organizational factor consistently linked to improved staff outcomes. However, evidence from the Arab Gulf region, particularly the Kingdom of Saudi Arabia (KSA), is limited. This study aimed to assess the relationship between nurse managers’ TL and staff nurses’ intent to stay and determine which TL dimensions predict intent to stay. Methods: A cross-sectional online survey was conducted among staff nurses at a three-hospital academic medical city in Riyadh, KSA. A total of 523 eligible respondents successfully completed the survey, utilizing probabilistic cluster sampling to guarantee representation from various nursing units within the medical city. Nurse managers’ TL was assessed across five dimensions by using the multifactor leadership questionnaire, and staff nurses’ intention to stay was measured using intent to stay scale. Descriptive statistics summarized the respondents’ demographic profile, nurse managers’ TL and staff nurses’ intent to stay. Normality was evaluated using Shapiro–Wilk and Kolmogorov–Smirnov tests. Relationships were examined using Spearman’s rank correlation, and multivariable ridge regression modeled the predictive contributions of the overall TL and its five dimensions to intent to stay. Results were considered significant if p < 0.05. Results: Nurse managers’ TL exhibited a positive association with staff nurses’ intention to stay in their current positions (r = 0.22, p < 0.001). Moreover, every dimension of TL demonstrated a strong positive relationship with the intent to stay (all p-values < 0.001). Multivariable ridge regression analysis revealed that the overall TL was a significant predictor of the intent to stay (β = 0.13, p < 0.001). Conclusions: The findings corroborate prior evidence linking TL to retention intentions. This underscores the practical salience of leadership competencies and attributes of nursing leaders, particularly TL, which recognizes the individual needs of staff nurses. This recognition subsequently fosters retention intentions, cultivates supportive nursing work environment, and enhances overall organizational success. Full article

Background: Recovery is an emerging approach. In Chile, attempts are being made to introduce the Recovery Model with specific guidelines for the care of people diagnosed with Severe Mental Disorders. The participation of nurses in this process is peripheral to the biomedical model. Objectives: To explore the participation of nurses in the recovery process of people hospitalised in Psychiatric Intensive Care between 2023 and 2024. Methods: Qualitative research, collective-case multisite study design in four hospitals. With the approval of four ethics committees, 18 nurses who signed informed consent were interviewed. Rapid qualitative analysis was performed. Results: Nursing care is mainly related to the caregiving, educational, and management roles. Recovery is associated with clinical improvement, and different components are identified, such as family and social support, the ability to resume control of one’s life, the existence of a future life plan, and the ability to manage one’s own illness. Conclusions: The results are consistent with elements described in contemporary approaches to recovery, incorporating autonomy, confidence in the person’s abilities, and shared decision-making. However, they are still far from modern approaches to personal and non-clinical recovery. Nursing needs to redirect its efforts toward recovery with a paradigm shift toward a model in which the person affected by a mental health condition is the protagonist of their own health process. Full article

Background/Objectives: Prolonged hospitalization of clinically stable preterm infants may lead to nosocomial infections, interfere with breastfeeding, and hinder parent-infant bonding. We evaluated the impact of an early discharge program with hospital-at-home (HaH) on hospital stay and clinical outcomes among preterm infants. Methods: A retrospective case–control study was conducted in a tertiary neonatal unit (Spain). Fifty infants managed with HaH (2016–2020) were compared with ninety-six controls receiving conventional in-hospital care. Baseline characteristics, growth, and clinical events up to 12 months were collected. Analyses included bivariate comparisons and multiple linear regression for length of stay, adjusted for gestational age, birth weight, sex, and parental factors. Results: Baseline characteristics were comparable between groups. Discharge weight was lower in HaH infants (1865 vs. 2130 g; p < 0.001), but no differences were observed at 6 or 12 months. Length of stay was shorter in HaH infants (26.3 vs. 33.8 days; p = 0.081), and the multivariable model showed an independent 5.5-day reduction (β −5.53; 95% CI −10.96 to −0.11; p = 0.046). Exclusive breastfeeding was more frequent (74% vs. 59%; p = 0.08) and significantly longer in HaH infants (141.9 vs. 81.1 days; p = 0.024). No increases were found in complications at discharge, emergency visits (28% vs. 32%; p = 0.7), or readmissions (18% vs. 31%; p = 0.2). Conclusions: Among clinically stable preterm infants, early discharge with HaH was associated with a shorter hospital stay and longer exclusive breastfeeding duration, without evidence of increased morbidity or healthcare use; however, causal inference cannot be established due to the observational design. These findings support the implementation of nurse-led HaH programs as a safe, family-centered strategy for neonatal care. Full article

Background: Modern healthcare environments expose staff to various occupational stressors, with noise being among the most common and harmful stressors. In intensive care units (ICUs), both patients and nurses are frequently exposed to unsafe noise levels, which can adversely affect well-being, recovery, and work performance. Objective: This study aimed to identify sources of noise and their adverse effects from the perspective of ICU nurses, and to examine associations between noise perception, demographic and job-related variables, and outcomes across four domains: subjective, emotional, physiological, and work performance. Methods: A cross-sectional study was conducted from February to September 2023 among 100 ICU nurses employed in three Croatian hospitals: Zagreb, Pula and Slavonski Brod. Data were collected using a validated three-part questionnaire and analyzed with descriptive and inferential statistics. Results: Nurses reported that monitor and ventilator alarms were the most prominent sources of internal noise. Noise perception within and outside ICUs differed significantly depending on the type of institution, ICU, and number of beds (p < 0.05). Significant relationships were found between noise exposure and outcomes across all four domains. Conclusions: Noise in ICUs poses a health risk to both patients and nurses, impairing well-being and work performance. Implementing effective noise reduction strategies should be prioritized in critical care settings. Full article

Background: The COVID-19 pandemic posed a severe psychological burden on healthcare professionals worldwide, yet little evidence exists from North African low- and middle-income countries. Objective: This study assessed levels of perceived stress and burnout among Moroccan healthcare workers and explored associated occupational risk factors, based on retrospective data collected in 2022. Methods: A cross-sectional survey was conducted among 200 physicians and nurses (n = 200) from five public hospitals in Meknes. Validated instruments, the Perceived Stress Scale (PSS-14) and the Maslach Burnout Inventory (MBI-HSS), were used. Descriptive statistics, chi-square tests with Cramér’s V, and ordinal logistic regression analyses were performed using IBM SPSS Statistics version 26. Results: High proportions of healthcare professionals reported elevated stress and clinical burnout. Occupational risk factors such as working in intensive care or COVID-19 units, on-call shift schedules, and sleep disturbances were strongly associated with adverse outcomes. Conclusions: Moroccan healthcare professionals experienced persistent psychological strain during and after the pandemic. The novelty of this study lies in documenting post-pandemic data from 2022 in a North African setting, providing timely evidence of long-term impacts. These findings underscore the urgent need for organizational reforms and targeted psychological support programs to protect the mental health of healthcare workers in future health crises. Full article

Background: Methicillin-resistant Staphylococcus aureus (MRSA) colonization is a risk factor for potential staphylococcal infection and outbreaks. Although it is recommended to obtain a swab culture to detect nasal colonization its necessity in low-prevalence countries is debated. The aim of this study was to determine the prevalence of MRSA nasal colonization, the rate of invasive infection development, and the risk factors for invasive infections in patients admitted to the intensive care unit. Materials and Methods: This retrospective study included patients who were followed up in one of the adult intensive care units at Kayseri City Training and Research Hospital between 1 January 2019 and 31 December 2024 (6 years) and from whom a culture was taken at the time of hospital admission to detect MRSA colonization in the nose. MRSA carriers were examined for the development of any invasive infection caused by MRSA within 28 days of their relevant admission. Results: Over a total period of six years, nasal swab samples were collected from 22,913 patients, and MRSA colonization was detected in 939 (4.0%). Of the patients with MRSA colonization, 32 (3.4%) were excluded from the analysis because they already had invasive MRSA infection. Additionally, 431 patients (45.8%) were excluded from the analysis because they were discharged or died within the first seven days of their admission. Consequently, invasive MRSA infection developed within 28 days in 29 of the 476 patients with MRSA colonization (6.0%). Patients who developed invasive infection had a higher rate of chronic renal failure (p < 0.001), hemodialysis (p < 0.001), central venous catheter (p = 0.028), staying in nursing home (p = 0.001), and a history of hospitalization within the last 90 days (p = 0.015). In the multivariable regression analysis, routine hemodialysis (OR: 5.216, p = 0.015), nursing home stay (OR: 3.668, p = 0.014), and a history of hospitalization within the last 90 days (OR: 2.458, p = 0.028) were found to be risk factors for developing invasive infection. The most common invasive infections were ventilator-associated pneumonia (n = 9), surgical site infection (n = 7), and catheter-related bloodstream infection (n = 6). All 29 strains were susceptible to vancomycin, linezolid, and daptomycin, while one strain was resistant to teicoplanin (3.5%). Conclusions: MRSA colonization has been detected in 4% of patients admitted to the intensive care unit. Screening should be performed because MRSA colonization may be a risk factor for invasive infections; however, screening all patients would be prohibitively expensive and labor-intensive. Instead, it may be more appropriate to identify risk factors and then screen select patients. Full article

Background: Nursing interventions are important in improving patient outcomes, especially in acute care units where patients encounter severe and complicated health problems. However, multiple barriers can hinder the accurate assessment of the effectiveness of such interventions. Aim: The aim of this study was to explore the barriers to evaluating the impact of nursing interventions on patient outcomes in acute care settings. Methods: This study employed a qualitative exploratory research design. This study was carried out in the acute care departments of a governmental tertiary hospital in the Western Region, Saudi Arabia. A purposive sample of 20 nurses was considered. Data were collected using a semi-structured interview guide. Thematic analysis was employed for data analysis. Results: The thematic analysis results identified five major themes: a lack of a standardised evaluation tool, time constraints, resource limitations, patient variability, and a lack of interdisciplinary collaboration. Conclusions: The results reveal that there are obstacles to evaluating nursing interventions in acute care. Such obstacles hinder the introduction of evidence-based changes in nursing practice and, consequently, affect the quality of care provided to patients. Healthcare settings should therefore focus on addressing the identified barriers and enabling nurses to effectively evaluate their care interventions. Full article

Background: Climate change increasingly threatens global health, with adolescents among the most vulnerable. Hospitals are major emitters of greenhouse gases, making carbon reduction in healthcare a pressing challenge. Nurses play central roles in implementing sustainability, while adolescents can contribute to long-term resilience. Methods: A scoping review of peer-reviewed articles (1990–2023) and World Bank datasets was conducted. Comparative analysis focused on Norway and South Korea, with the United States and Australia reviewed narratively. Inclusion criteria targeted studies on hospital-based carbon reduction and youth/nurse engagement; unrelated studies were excluded. Results: Three domains emerged: (1) governance approaches—Norway applied top-down integrated monitoring, while Korea showed fragmented progress, especially in private hospitals; (2) roles of adolescents and nurses—nurses led quality improvement in energy efficiency and waste reduction, while adolescents contributed through school–hospital partnerships and youth initiatives; and (3) barriers and enablers—key barriers included limited youth decision-making and lack of councils, while enablers included certification frameworks and WHO guidelines. Conclusions: Nurses and adolescents are complementary partners in sustainable healthcare. Establishing hospital green teams, integrating climate literacy into curricula, and fostering government–healthcare–education partnerships can reduce emissions and strengthen climate-resilient health systems. Full article

Objectives: The aim of this study was to establish a structural model that could explain and predict factors influencing health-related quality of life (HRQoL) in high-risk pregnant women. Methods: This study adopted a structural equation model based on the HRQoL model. Data were collected from 200 high-risk pregnant women hospitalized in a maternal-fetal intensive care unit. Structured questionnaires measured antenatal depression, marital intimacy, fetal attachment, self-care behavior, perceived health status, and HRQoL. All data were collected simultaneously during a single point in participants’ hospitalization. Results: Among the factors, antenatal depression showed the greatest influence on HRQoL (β = −0.27, p < 0.001), followed by marital intimacy (β = 0.26, p < 0.001), fetal attachment (β = 0.25, p < 0.001), perceived health status (β = 0.14, p = 0.005), and self-care behavior (β = 0.12, p = 0.037), with an explanatory power of 73.4%. Conclusions: To improve the HRQoL of high-risk pregnant women, psychological nursing intervention strategies are needed to reduce antenatal depression. It is necessary to provide education that encourages self-care behavior. Furthermore, the findings indicate that strategic nursing interventions are necessary to enhance marital intimacy, fetal attachment, and perceived health status. As a theoretical basis, this study will contribute to the preparation of basic data that will improve the HRQoL of pregnant women at high risk. Full article