Search Results (704)

The nurse rostering problem (NRP) has attracted significant research interest in recent decades due to both its practical relevance and computational complexity. While the branch-and-price algorithm has demonstrated effectiveness in solving NRPs, its column generation component frequently produces weak lower bounds for some problem instances, which consequently degrades overall computational performance. To strengthen the lower bound quality, we propose three classes of cutting planes derived from the column generation master problem formulation: SRCs, CG rank-1 cuts, and {0, ½}-cuts. For each cut type, the separation approaches enhanced with acceleration strategies are described. These cuts are typically classified as non-robust, meaning each cut added to the master problem requires introducing a new resource in the pricing subproblem’s labeling algorithm. We therefore developed problem-specific methods to update these resources and integrate them into the NRP dominance rules. Computational experiments were conducted on benchmark instances from two international nurse rostering competitions (INRC-I and INRC-II). The results indicate that SRCs are highly effective for two challenging INRC-I instances, including one where a tighter lower bound was identified. In contrast, the {0, ½}-cuts yield the strongest performance for most selected INRC-II instances. These findings demonstrate that the cutting plane method can be used to improve lower bounds for NRPs, and that the effectiveness of different cut types in improving lower bounds is closely tied to the problem formulation. Full article

Background and Objectives: Early identification of patients at risk of clinical deterioration is essential for optimizing therapeutic management and improving outcomes in general medicine wards. The National Early Warning Score 2 (NEWS2) is a validated tool for predicting patient worsening but integrating it with additional clinical and demographic data can enhance its predictive accuracy and support timely clinical decisions. Material and methods: In this retrospective cohort study, 2108 patients admitted to the general medicine department of the University Hospital of Siena were analyzed. Logistic regression models incorporating NEWS2 alongside key clinical variables—including age, presence of central venous catheter (CVC), and functional status measured by the Barthel Index—were developed to predict high clinical risk (HCR) and mortality. Model performance was assessed using the area under the ROC curve (AUC). Results: High clinical risk status developed in 29% of patients. Older age, presence of CVC, lower Barthel Index, and higher NEWS2 scores were significantly associated with both HCR and mortality. The integrated predictive model demonstrated good accuracy, with an AUC of 0.798 for HCR and 0.716 for mortality prediction. Conclusions: This study suggests that NEWS2, when combined with additional patient-specific variables from the electronic health record, can become a more sophisticated tool for early risk stratification. Such a tool has the potential to support timely clinical intervention and optimized therapeutic management, potentially contributing to improved patient outcomes. While the model may indirectly support nurse workload balancing by identifying patients requiring intensified care, its ultimate impact on patient outcomes requires confirmation through prospective studies. Full article

Background: The Healthy, Hunger-Free Kids Act requires access to free drinking water in public school cafeterias during meal times. Previous studies suggest that increasing access to water in schools can increase its consumption among students, potentially reducing their intake of sugar-sweetened beverages. The current study provides a descriptive assessment of water availability, delivery methods, and quality in 96 public schools across four New Jersey school districts. Methods: As part of the New Jersey Child Health Study, we administered an online and paper survey to school nurses at 96 schools to evaluate the availability, delivery, and quality of water in the school cafeteria during lunchtime. Univariate and bivariate statistics were used to analyze the data. Results: In school year 2019–20, 83 (86.5%) schools reported providing free drinking water in the cafeteria during lunch. The most common source of water was water fountains, available in 64 schools (66.7%). Issues related to water quality, specifically cleanliness, temperature, pressure, and taste, were present in 20–30% of schools. Conclusions: While most schools surveyed provide access to clean, free drinking water, students in some schools still lack free access to drinking water during school meals, which may affect overall water consumption among students. Full article

Violence against nurses in the workplace is a worldwide concern. The high prevalence of these events has negative impacts on professionals, including stress, abandonment of the workplace, and post-traumatic stress syndrome. It is a frequent problem for nurses. As awareness of this problem increases, strategies for prevention and management of aggression and violence have evolved. This study aims to identify strategies, both institutional and personal, to address violence against nurses in the workplace. Methods: A scoping review was conducted with the PRISMA approach, using New Rayyan platform and CEMB for the evaluation of methodological quality. We included all research that studied strategies against workplace violence for nurses in hospitals in Spanish or English published between 2019 and 2024. Results: Among the 28 analyzed full-text studies, two central categories emerged with respect to addressing violence against nurses before (prevention), during (mitigation), and after (response) such events: (1) training and nurses’ action strategies and (2) practical implementation tools. Institutional leadership supporting a zero-tolerance culture; training and resources for early identification of risks; and mitigation strategies with strong emphasis on de-escalation of potential violence, building personal resilience, and support from security personnel are among the effective strategies. Conclusions: Strategies for preventing and handling workplace violence are multidimensional. Leadership engagement, addressing gender biases, conflict management training, resilience building, and security can reduce violence against nurses and its sequelae. It is essential to generate practical knowledge that is easy to apply in healthcare settings. More research is needed, especially in Latin America. Full article

Background/Objective: Penicillin allergy labels (PALs) contribute to broad-spectrum antibiotic use. Thorough documentation can help prescribers identify and remove unnecessary PALs. We aimed to improve documentation of PALs in three pediatric urgent care (PUC) clinics, using a nurse-initiated quality improvement (QI) approach. Methods: QI interventions included a survey to assess prescriber and nurse confidence, an online educational module, and an algorithm to aid in clarifying PALs. We measured the percentage of PALs with a clarified reaction severity as our primary outcome using annotated control charts. Descriptive and inferential statistics evaluated survey responses between nurses and prescribers. Results: Clarified PAL reaction severity had a sustained upward shift from 58.5% to 63.3% following implementation of our interventions. Of 129 nurses and prescribers, 87 (67.4%) respondents completed the survey. Prescribers and nurses reported feeling knowledgeable about PALs but experienced different challenges to clarifying PAL documentation. Prescribers reported time pressures as a barrier to PAL clarification more often than nurses (IQR [3, 4], p = 0.001). Nurses reported higher confidence in ability to document a PAL compared to prescribers (IQR [3.25, 5], p = 0.010). Respondents requested family education and practice guidance to aid PAL clarification. No consistent differences were noted in PAL documentation by sociodemographic characteristics. Conclusions: The nurse-initiated QI approach demonstrated improved PAL documentation in PUCs. Engaging nurses in antibiotic stewardship initiatives can provide new perspectives and broaden the approach to intervention design and implementation. Future efforts should focus on improving electronic health record and interprofessional workflow processes to build on these improvements. Full article

Background/Objectives: Heart failure with preserved ejection fraction (HFpEF) has increased in prevalence as the population ages and associated comorbidities increase. Remote ischemic preconditioning (RIPC) has been shown to provide protection against ischemic injury to the heart and other organs. Therefore, the aim of this project will be to analyse the effectiveness of RIPC in terms of arterial stiffness, endothelial function, diastolic function, and exercise capacity in patients with HFpEF. Methods: The PIRIC-FEp study will be a parallel, randomised controlled trial with two groups conducted at the Faculty of Nursing in Cuenca, University of Castilla-La Mancha. Individuals who are diagnosed with HFpEF and are older than 40 years, with a left ventricular ejection fraction ≥50% and a sedentary lifestyle, will be included. The exclusion criteria will include, among others, patients with noncardiac causes of heart failure symptoms, significant pulmonary disease, diabetes, peripheral vascular disease, or myocardial infarction within the previous three months. A sample size of 48 patients was estimated, with 24 for each group. Participants will be randomly allocated (1:1) to either the RIPC intervention group or the control group to evaluate the effects on arterial stiffness, endothelial function, diastolic function, and exercise capacity. Assessments will be conducted at baseline and after a three-month follow-up period. Results: The findings will be published in a peer-reviewed journal article. Conclusions: This study is important for daily clinical practice because it provides a new approach for the treatment of HFpEF patients via RIPC. Full article

Introduction: The increasing cultural diversity of patients poses new challenges for nurses. Cultural competence, especially knowledge of the cultural determinants of health and illness, is an important element of professionalism in nursing care. The aim of this study was to analyse nurses’ self-assessment of cultural knowledge, with a focus on the six dimensions of the Giger and Davidhizar model, prior to formal training in this area. Methods: A triangulation method combining qualitative and quantitative analysis was used. The analysis included 353 statements from 36 master’s student nurses. Data were coded according to six cultural phenomena: biological factors, communication, space, time, social structure, and environmental control. Content analysis, ANOVA, Spearman’s rank correlation, and cluster analysis (k-means) were conducted. Results: The most frequently identified that categories were environmental control (34%), communication (20%), and social structure (16%). Significant knowledge gaps were identified in the areas of non-verbal communication, biological differences, and understanding space in a cultural context. Three cultural knowledge profiles of the female participants were distinguished: pragmatic, socio-reflective, and critical–experiential. Conclusions: The cultural knowledge of the participants was fragmented and simplified. The results indicate the need to personalise cultural learning and to take into account nurses’ level of readiness and experience profile. The study highlights the importance of the systematic development of reflective and contextual cultural knowledge as a foundation for competent care. Full article

Alfalfa (Medicago sativa) persists for several years but must be rotated to another crop before replanting. Kura clover (T. ambiguum M. Bieb) is a perennial legume that can persist indefinitely without replanting; however, establishment is slow, which limits economic returns during the process. Two studies, each with four randomized complete blocks, were planted in two consecutive years at New Mexico State University’s Rex E. Kirksey Agricultural Science Center at Tucumcari, NM, USA, as the first known assessment evaluating alfalfa as an economic nurse crop during kura clover establishment using various kura clover–alfalfa drilled and broadcast planting arrangements. Irrigation termination due to drought limited yield measurements to three years after seeding. In that time, kura clover–alfalfa mixtures generally yielded equally to monoculture alfalfa, except for alternate row planting. After 5 years, the alfalfa stand percentage remained >80%, except for the alternate row treatment (69% stand). Kura clover monocultures attained about 40% stand, and the mixtures had a <25% stand. Alfalfa may persist for more than 5 years before relinquishing dominance to kura clover in mixtures, but the alfalfa would continue to provide economic returns as kura clover continues stand development with minimal production, but develops its root system to maximize production when released from the alfalfa nurse crop. Full article

Background/Objectives: This retrospective multicenter study, conducted within the ORCHESTRA Project, investigated SARS-CoV-2 reinfections among 5777 healthcare workers (HCWs) from four University Hospitals (Modena, Verona, Padova and Trieste) in northern Italy, aiming to assess the risk of reinfection and its determinants, comparing the clinical characteristics of reinfections with those of first infections, and examining the impact of preventive measures and vaccination strategies. Methods: HCWs completed an online questionnaire between June and August 2022. The survey collected demographic, occupational, and clinical data, including information on first infections and reinfections. Statistical analyses were performed using SPSS 28.0, through bivariate and multivariate approaches. Results: Response rates were 41.8% for Modena, 39.5% for Verona, 17.9% for Padova, and 17.4% for Trieste. Among the respondents, 4.8% (n = 276) experienced 2 infections and 0.5% (n = 27) reported 3 infections, out of a total of 330 reinfection cases. Additionally, 43.0% (n = 2787) reported only one infection, while 51.5% were never infected. Reinfection rates increased across five study phases (based on the epidemiological context), likely due to the emergence of new SARS-CoV-2 variants. A booster vaccine dose significantly reduced reinfection risk. Higher reinfection risk was found among HCWs aged ≤30 years, those with chronic respiratory diseases, and those working in COVID-19 wards, particularly nurses and allied health professionals. Reinfections were associated with a lower frequency of symptoms both during the period of swab positivity and after a negative swab, as well as with a shorter duration of swab positivity. No significant differences in symptom duration were found between first infections and reinfections. Conclusions: Despite its limitations, the online questionnaire proved a useful tool. Natural infection and vaccination reduced both reinfection risk and symptom severity. Prior infections should be considered in planning vaccination schedules and prioritizing HCWs. Full article

This paper aims to discuss the transition of new graduate nurses into the workforce, the preparation provided to equip them through the novice–beginner stage, and the theory–practice conundrum. Background: In Australia, new graduate transition programs have been in existence since the 1990s. While there is widespread acknowledgment that this period is pivotal for new graduate nurses entering the profession, there is a lack of consensus on the definition of best practice to achieve optimal preparation for new graduate nurses transitioning into the workforce. Methods: This discussion paper integrates the nursing literature on this topic with the extensive professional experiences of the authors, who are currently working as clinicians in metropolitan hospitals and hold academic positions at universities. Their insights are informed by the literature sourced from peer-reviewed English language journals, including reviews, empirical studies, and national and international reports. Discussion: Recruiting and retaining nurses presents a multifaceted challenge that requires the development of effective tools and strategies to build a sustainable workforce. Both the literature and the authors’ experiences highlight several key factors influencing the preparedness of new graduates. These factors include workplace culture, the demands placed on new graduates, and the support, education, and training they receive. The perspectives shared in this article offer valuable discussion points that can deepen our understanding of the current issues and contribute to the development of more effective solutions. Full article

Background: Early identification of sepsis is critical for improving outcomes, particularly in low-resource emergency settings. In Thai community hospitals, where physicians may not always be available, triage is often nurse-led. Selecting accurate and practical sepsis screening tools is essential not only for timely clinical decision-making but also for timely diagnosis and promoting appropriate antibiotic use. Methods: This cross-sectional study analyzed 475 adult patients with suspected sepsis who presented to the emergency department of a Thai community hospital, using retrospective data from January 2021 to December 2022. Six screening tools were evaluated: Systemic Inflammatory Response Syndrome (SIRS), Quick Sequential Organ Failure Assessment (qSOFA), Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), National Early Warning Score version 2 (NEWS2), and Search Out Severity (SOS). Diagnostic accuracy was assessed using International Classification of Diseases, Tenth Revision (ICD-10) codes as the reference standard. Performance metrics included sensitivity, specificity, predictive values, likelihood ratios, and the area under the receiver operating characteristic (AUROC) curve, all reported with 95% confidence intervals. Results: SIRS had the highest sensitivity (84%), while qSOFA demonstrated the highest specificity (91%). NEWS2, NEWS, and MEWS showed moderate and balanced diagnostic accuracy. SOS also demonstrated moderate accuracy. Conclusions: A two-step screening approach—using SIRS for initial triage followed by NEWS2 for confirmation—is recommended. This strategy enhances nurse-led screening and optimizes limited resources in emergency care. Early sepsis detection through accurate screening tools constitutes a feasible public health intervention to support appropriate antibiotic use and mitigate antimicrobial resistance, especially in resource-limited community hospital settings. Full article

Background: Pressure ulcers (PUs) remain a prevalent complication in intensive care unit (ICU) settings, especially among immobilized patients. The impact of structured, nursing-led mobilization protocols on PU prevention and recovery remains underexplored. Objective: To evaluate the impact of nursing-led mobilization protocols on the incidence and progression of PUs in critically ill patients. Methods: In this retrospective observational cohort study, 188 ICU patients were admitted during one of two consecutive periods of care: conventional care (6-hourly repositioning) and an advanced nursing-led protocol (3-hourly repositioning with support surfaces and specialized nurse training), which replaced conventional care as standard in our institution. The primary outcome included new PU development for patients with no pre-existing ulcers or worsening/non-progression of pre-existing ulcers at discharge; ICU mortality was evaluated as a secondary outcome. Results: Among patients without pre-existing ulcers (n = 155), new PU incidence did not significantly differ between groups, even after adjusting for SOFA score (OR 0.40, 95% CI: 0.05 TO 3.17; p = 0.374). However, in patients with pre-existing ulcers (n = 33), the advanced care group showed improvement (53.3% versus 0% in the conventional group, OR 0.07, 95% CI: 0.01–0.64; p = 0.012); this effect was independent of initial SOFA score. Mortality was associated with the SOFA score, but not with the type of care. Conclusions: While advanced nursing-led mobilization did not reduce PU incidence, it significantly improved existing ulcer outcomes. Findings support the integration of structured protocols for high-risk ICU patients, especially those with existing ulcers. Full article

The prevalence of cancer is rising both in Canada and across the world, with approximately 35 million new cases predicted by 2050. Cancer immunotherapy is a form of treatment that harnesses the body’s immune system to fight cancer cells, increasing life expectancy beyond what traditional treatments offer. Immunotherapy may cause immune-related adverse events that differ from the toxicities of traditional treatments. While these events can be detrimental to health, it is critical that they are caught early. This perspective paper examines the evolving role of oncology nurses within the cancer care continuum in caring for patients receiving cancer immunotherapy, specifically immune checkpoint inhibitors. Oncology nurses provide care in many areas, specifically in educating patients on the early detection of side effects to prevent negative outcomes, assessing and monitoring patient symptoms through a variety of means, including nurse-led clinics, and providing support to patients undergoing therapy. This work helps identify gaps in the literature. Future research is required for advancing cancer immunotherapies and better detecting early signs of side effects for nurses practicing in different settings, ensuring timely care. Full article

Background/Objectives: The role of the primary health care nurse has evolved since the Spanish Ministry of Health officially established the professional profile of the nurse specialist in Primary Health Care in 2005. Despite the potential benefits of this new professional profile in the population’s health, their actual scope of practice is still unknown and still largely underutilized. This study aimed to explore demands and expectations of adult primary health care service users regarding the role of the nurse specialist in primary health care. Methods: A nationwide cross-sectional study consisted of a computer-assisted telephone survey to a random sample of 1200 adults living in Spain. A self-developed 19-item instrument assessed population’s perception of the role of the nurse specialist in primary health care. Descriptive, bivariate and logistic regression models explored associations between sociodemographic characteristics with perception of the nurse specialist role. Results: Most participants (82.3%) would choose a nurse specialist in primary health care and consider that the nurse specialist in primary health care should expand their scope of practice requesting diagnostic test (70%) and prescribing medications for chronic diseases (63.8%). Conclusions: Results show a population’s positive perception towards expanding the scope of practice of the nurse specialist in primary health care in the Spanish healthcare system. Primary health care models should acknowledge the potential of expanding the competencies of this professional profile. Full article

Technological advancement has radically transformed higher education, requiring faculty members to continually adapt to new tools and teaching methods. In this context, the phenomenon of fear of missing out (FoMO) has gained relevance, often manifesting through a range of negative emotional states, including technostress—stress associated with the use of technology. Objectives: This study aimed to map the available scientific evidence on technostress among nursing faculty in higher education, through a scoping review conducted according to the methodology proposed by the Joanna Briggs Institute (JBI). Methods: The literature search was performed across eight databases, including Medline (via PubMed), CINAHL Complete, Scopus, and the Teacher Reference Center. Results: Of the 266 studies identified, only 3 met the inclusion criteria. Conclusions: Findings reveal varying levels of technostress among nursing educators, with higher levels observed among older faculty members, frequently associated with limited technical and administrative support. Although the direct impact on job satisfaction was not significant, the anxiety induced by intensive technology use and the perceived necessity for constant professional updating—often driven by FoMO—was shown to affect daily academic life, highlighting the need for effective coping strategies. Understanding technostress within the context of nursing education is essential for addressing the challenges of pedagogical modernization. This review supports the need for future institutional interventions aimed at preventing technostress and fostering a more balanced, reflective, and sustainable relationship with technology in academic settings. Full article