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Profiling Healthcare Professionals' Digital Health Competence and Associated Factors: A Cross‐Sectional Study

ABSTRACT

Aim

To assess healthcare professionals' digital health competence and its associated factors.

Design

Cross-sectional study.

Methods

The study was conducted from October 2023 to April 2024 among healthcare professionals in Italy, using convenience and snowball sampling. The questionnaire included four sections assessing: (i) socio-demographic and work-related characteristics; (ii) use of digital solutions as part of work and in free time, and communication channels to counsel clients in work; and DigiHealthCom and DigiComInf instruments including measurements of (iii) digital health competence and (iv) managerial, organisational and collegiality factors. K-means cluster analysis was employed to identify clusters of digital health competence; descriptive statistics to summarise characteristics and ANOVA and Chi-square tests to assess cluster differences.

Results

Among 301 healthcare professionals, the majority were nurses (n = 287, 95.3%). Three clusters were identified: cluster 1 showing the lowest, cluster 2 moderate and cluster 3 the highest digital health competence. Most participants (n = 193, 64.1%) belonged to cluster 3. Despite their proficiency, clusters 2 and 3 scored significantly lower on ethical competence. Least digitally competent professionals had significantly higher work experience, while the most competent reported stronger support from management, organisation, and colleagues. Communication channels for counselling clients and digital device use, both at work and during free time, were predominantly traditional technologies.

Conclusion

Educational programmes and organisational policies prioritising digital health competence development are needed to advance digital transition and equity in the healthcare workforce.

Implications for the Profession

Greater emphasis should be placed on the ethical aspects, with interventions tailored to healthcare professionals' digital health competence. Training and policies involving managers and colleagues, such as mentoring and distributed leadership, could help bridge the digital divide. Alongside traditional devices, the adoption of advanced technologies should be promoted.

Reporting Method

This study adheres to the STROBE checklist.

Patient or Public Contribution

None.

Validity and Reliability of the Self‐Care of Chronic Illness Inventory and Self‐Care Self‐Efficacy Scale in Patients Living With Cancer

ABSTRACT

Aim

This study aimed to test the psychometric properties of the Self-Care of Chronic Illness Inventory and the Self-Care Self-Efficacy scale in patients with cancer.

Design

A multisite cross-sectional validation study was conducted.

Methods

Between November 2022 and July 2023, a convenience sample of 318 patients with cancer were enrolled in five Italian inpatient and outpatient facilities. Confirmatory factor analysis was performed on the three scales of the Self-Care of Chronic Illness Inventory and the Self-Care Self-Efficacy scale. Internal consistency was tested using Cronbach's alpha for unidimensional scales and McDonald's Omega for multidimensional scales. Construct validity was assessed with the global health status by Pearson's correlation. The COnsensus-based Standards for the selection of health Measurement INstruments reporting guidelines were followed for the reporting process.

Results

Three hundred fourteen patients were included (median age: 55.5 years; male: 53.82%). Confirmatory factor analysis showed supportive fit indices for the three Self-Care of Chronic Illness Inventory scales (CFI: 0.977–1.000; SRMR: 0.004–0.78) and the Self-Care Self-Efficacy scale (CFI: 1.000; SRMR: 0.014). All scales demonstrated adequate internal consistency (0.89–0.99) and test–retest reliability (0.85–0.95). Construct validity was confirmed through correlations between Self-Care Self-Efficacy, each Self-Care of Chronic Illness Inventory scale, and global health status.

Conclusion

The Self-Care of Chronic Illness Inventory and Self-Care Self-Efficacy scales demonstrated excellent psychometric qualities and construct validity when administered to patients with cancer. Future research should explore self-care behaviours across different diseases and cultural contexts.

Implications For the Profession

These tools can help develop targeted educational programs, improving patient outcomes.

Impact

Currently, there is a lack of knowledge regarding self-care behaviours in patients with cancer. These tools enable healthcare professionals to identify patient needs, design personalised interventions, and monitor their effectiveness over time.

Patient or Public Contribution

No patient or public contribution.

Design, 3D printing, and preclinical validation of an extraglottic ramp to facilitate blind orotracheal intubation in emergency airway management

by Jorman H. Tejada-Perdomo, Valentina Gutierrez-Perdomo, Juana V. Agudelo-Castro, Jorge A. Pérez-Gamboa, Alejandro Weinstein, Sebastián San Martín, Rodrigo Salas, Jorge A. Ramos-Castaneda

The use of devices that facilitate rapid airway isolation is essential when managing critical patients in emergencies. In recent years, additive manufacturing has emerged as an innovative, versatile, and accessible technology for developing medical devices. This study presents the design, development, and validation of an extraglottic medical device created using computer-aided design tools and stereolithographic 3D printing to facilitate blind intubation by first responders. The device was iteratively modeled and fabricated with biocompatible materials; validation in airway simulators and human cadaveric specimens assessed dimensions, friction, intubation technique, and learning curve, and ease of use was rated with a Likert scale. Ten iterations led to a final design with low friction and minimal cervical manipulation; ramp angle, cup geometry, and distal tip were optimized for tube passage, and BioMed Flex 80A showed high strength and anatomical compatibility. The final version is a safe, reusable, and functional alternative for airway management and blind orotracheal intubation, particularly in emergencies and resource-limited settings; clinical validation in live patients is still needed.

Move to improve: protocol for a single-arm, pragmatic feasibility trial of an individualised physical activity programme for children with chronic conditions

Por: Sivaramakrishnan · H. · Finlay-Jones · A. · Valentine · J. · Wood · F. M. · Naylor · L. H. · Haustead · L. · Davey · E. · Reid · S. · Shetty · V. B. · Graciet · J. · OMeara · D. · Robertson · A. · Davis · E. · Move to Improve Author Group · Elliott · Walwyn · Gottardo · Martin · Long
Introduction

Physical activity improves physical and psychosocial outcomes in healthy children and in children with a range of chronic health conditions. Unfortunately, children with chronic health conditions have lower levels of physical activity compared to their healthy peers due to multiple restrictions in physical activities and therefore tend to have lower levels of physical activity compared with their peers. This paper describes the protocol for Move to Improve, a pragmatic trial of an individualised physical activity intervention for children with chronic health conditions.

Methods and analysis

Using the RE-AIM framework, this study aims to test the feasibility of Move to Improve, an 8-week hospital-based individualised physical activity intervention. We will recruit 100 children aged 5–17 years who are diagnosed with type 1 diabetes, cancer, postburn injuries and cerebral palsy to a single-arm, pragmatic feasibility trial. The primary outcomes (objective moderate to vigorous physical activity, quality of life and goal attainment) and secondary outcomes (including aerobic capacity, body composition, motor function, grip strength and psychosocial outcomes) will be assessed at baseline, post intervention and at 6-month and 12-month follow-ups. We will conduct semistructured interviews with participants and their primary caregiver at a 2-month follow-up to capture aspects of feasibility. Quantitative data will be reported descriptively, and qualitative data will be analysed using thematic analysis. Data gathered from this study will inform service decision-making and future trials.

Ethics and dissemination

The study has received ethics approval from the Government of Western Australia Child and Adolescent Health Service Human Research Ethics Committee (RGS6677). Findings of this research will be communicated to the public through peer-reviewed publications, conference presentations, reports, infographics and information sheets. Modifications to the protocol will be outlined in the trial registry and journal publications. Authorship will be in accordance with the International Committee of Medical Journal Editors.

Trial registration number

Australian and New Zealand Clinical Trials Registry Number: ACTRN12624000836538.

NuPOWER (Nuwiq for Perioperative management Of patients With haemophilia A on Emicizumab Regular prophylaxis): protocol for an open-label, single-arm, multicentre study

Por: Srivastava · A. · Kanny · A. · Langer · F. · Kubicek-Hofmann · C. · Alvarez Roman · M. T. · Nunez Vazquez · R. · Boban · A. · Dejanova-Ilijevska · V. · Miljic · P. · Garcia · J. · Halimeh · S. · Drillaud · N. · Valentin · J.-B. · Mancuso · M. E. · Castaman · G. · Santoro · R. C. · Leht
Introduction

Despite the known haemostatic action of emicizumab (Hemlibra) in haemophilia A patients, its role in the prevention and control of bleeding in high-demand haemostatic situations, such as major surgery, remains to be determined. Patients receiving regular emicizumab prophylaxis often require concomitant factor VIII (FVIII) therapy during major surgery to prevent uncontrolled bleeding and to promote postoperative healing. However, there are limited prospective surgical data relating to concomitant FVIII and emicizumab use. Simoctocog alfa (Nuwiq) is a B-domain deleted recombinant FVIII produced in a human cell line without chemical modification or protein fusion with proven efficacy as surgical prophylaxis in adult and paediatric patients. The Nuwiq for Perioperative management Of patients With haemophilia A on Emicizumab Regular prophylaxis (NuPOWER) study aims to examine perioperative efficacy and safety of simoctocog alfa in haemophilia A patients on emicizumab prophylaxis undergoing major surgery.

Methods and analysis

NuPOWER is a prospective, open-label, single-arm, multicentre study that will be conducted at approximately 15 centres worldwide. Up to 28 male patients ≥12 years with severe haemophilia A and no FVIII inhibitors will be recruited. All patients must be receiving regular emicizumab prophylaxis and scheduled to undergo a major surgical procedure during which concomitant simoctocog alfa will be administered. The primary endpoint is the overall haemostatic efficacy of simoctocog alfa, adjudicated by an independent data monitoring committee using a pre-defined algorithm, and will consider intraoperative and postoperative efficacy assessments by the surgeon and investigator, respectively. Secondary endpoints include intraoperative haemostatic efficacy, postoperative haemostatic efficacy, number of allogeneic blood products transfused, perioperative FVIII plasma levels (as measured by FVIII activity) and thrombin generation, and safety parameters. In the era of non-factor therapy, NuPOWER will generate valuable prospective data on concomitant use of simoctocog alfa and emicizumab prophylaxis in patients with severe haemophilia A undergoing major surgery.

Ethics and dissemination

Ethical approval has been received from institutional review boards/independent ethics committees, and the study will be conducted in compliance with the Declaration of Helsinki. This work will be disseminated by publication of peer-reviewed manuscripts and presentations at scientific meetings.

Trial registration number

CT EU 2022-502060-21-00; NCT05935358.

Global prioritised indicators for measuring WHOs quality-of-care standards for small and/or sick newborns in health facilities: development, global consultation and expert consensus

Por: Day · L. T. · Vaz · L. M. E. · Semrau · K. E. A. · Moxon · S. · Niermeyer · S. · Khadka · N. · Chitashvili · T. · Valentine · G. C. · Drake · M. · Ehret · D. E. Y. · Sheffel · A. · Sacks · E. · Greenspan · L. · Shaver · T. R. · Kak · L. · Hailegebriel · T. D. · Gupta · G. · Hill · K. · Jac
Objectives

The aim of this study was to prioritise a set of indicators to measure World Health Organization (WHO) quality-of-care standards for small and/or sick newborns (SSNB) in health facilities. The hypothesis is that monitoring prioritised indicators can support accountability mechanisms, assess and drive progress, and compare performance in quality-of-care (QoC) at subnational levels.

Design

Prospective, iterative, deductive, stepwise process to prioritise a list of QoC indicators organised around the WHO Standards for improving the QoC for small and sick newborns in health facilities. A technical working group (TWG) used an iterative four-step deductive process: (1) articulation of conceptual framework and method for indicator development; (2) comprehensive review of existing global SSNB-relevant indicators; (3) development of indicator selection criteria; and (4) selection of indicators through consultations with a wide range of stakeholders at country, regional and global levels.

Setting

The indicators are prioritised for inpatient newborn care (typically called level 2 and 3 care) in high mortality/morbidity settings, where most preventable poor neonatal outcomes occur.

Participants

The TWG included 24 technical experts and leaders in SSNB QoC programming selected by WHO. Global perspectives were synthesised from an online survey of 172 respondents who represented different countries and levels of the health system, and a wide range of perspectives, including ministries of health, research institutions, technical and implementing partners, health workers and independent experts.

Results

The 30 prioritised SSNB QoC indicators include 27 with metadata and 3 requiring further development; together, they cover all eight standard domains of the WHO quality framework. Among the established indicators, 10 were adopted from existing indicators and 17 adapted. The list contains a balance of indicators measuring inputs (n=6), processes (n=12) and outcome/impact (n=9).

Conclusions

The prioritised SSNB QoC indicators can be used at health facility, subnational and national levels, depending on the maturity of a country’s health information system. Their use in implementation, research and evaluation across diverse contexts has the potential to help drive action to improve quality of SSNB care. WHO and others could use this list for further prioritisation of a core set.

Older Adults' Self‐Care and Family Caregiver Contribution in Multiple Chronic Conditions: A Dyadic Qualitative Study

ABSTRACT

Aims

To explore how older adult-family caregiver dyads jointly manage multiple chronic conditions. Specifically, it investigates how dyads (i) prioritise chronic diseases, (ii) make and negotiate decisions related to self-care and (iii) define and distribute self-care tasks and caregiver contributions.

Design

A qualitative descriptive study using dyadic data collection and analysis.

Methods

Semi-structured interviews were conducted separately with chronically ill older adults and their family caregivers between July and December 2024. A hybrid inductive-deductive content analysis was applied. Dyadic analysis compared intra-dyad perspectives to identify patterns of agreement and disagreement.

Results

Thirty-four dyads (n = 68 participants) were interviewed. Older adults had a mean age of 80.09 years (SD = 6.95) and were affected by a median of four chronic conditions. Family caregivers had a mean age of 51.71 years (SD = 14.59), with most being the older adults' children (66.67%) and women (82.35%). Five categories, comprising 25 subcategories, were derived from the data. Disease prioritisation varied within dyads: older adults often focused on conditions with the most disabling symptoms, while caregivers emphasised those with higher risks of complication. Decision-making roles ranged from older adult-led to caregiver-led to shared. Care organisation followed three models: collaborative, older adult-directed, or caregiver-directed. Challenges in managing diseases included treatment adherence, care coordination, emotional burden and addressing multiple symptoms simultaneously. Role distribution in disease management and decision-making was complex and occasionally misaligned, sometimes resulting in conflict. Collaborative dyads reported greater adaptability and balance, while incongruent dyads experienced relational and organisational strain.

Conclusion

Managing multiple chronic conditions in older adults is a relational process shaped by interpersonal dynamics and shared responsibilities with family caregivers. Recognising dyadic relational patterns is essential for designing targeted educational interventions. Nurses should incorporate dyadic assessments into routine care to improve outcomes for older adults and reduce caregiver burden.

Implications for the Profession and/or Patient Care

This study highlights the importance of viewing chronic disease management as a dyadic process, rather than an individual task, involving both the older adult and the family caregiver. Tailored strategies that account for the relational dynamics within dyads, such as decision-making roles and care task distribution, are essential for effective chronic disease management.

Reporting Method

Consolidated criteria for reporting qualitative studies (COREQ).

Patient or Public Contribution

None.

Head-to-head comparison of the RMI and ADNEX models to estimate the risk of ovarian malignancy: a systematic review and meta-analysis of external validation studies

Por: Barrenada · L. · Ledger · A. · Kotlarz · A. · Dhiman · P. · Collins · G. S. · Wynants · L. · Verbakel · J. Y. J. · Valentin · L. · Timmerman · D. · Van Calster · B.
Objectives

Assessment of Different NEoplasias in the adneXa (ADNEX) and Risk of Malignancy Index (RMI) are models that estimate the risk of malignancy in ovarian masses based on clinical and ultrasound information. The aim is to perform a meta-analysis of studies that compared the performance of the two models in the same patients (‘head-to-head comparison’).

Design

Systematic review and meta-analysis.

Data sources

Systematic literature search from publication of ADNEX model (15/10/2014) up to 31/07/2024 in Embase, Web of Science, Scopus, Medline (via PubMed) and EuropePMC.

Eligibility criteria for selecting studies

We included all studies that externally validated the performance of ADNEX (with or without CA125) and RMI on the same data.

Data extraction and synthesis

Two independent reviewers extracted data using a standardised extraction sheet. We assessed risk of bias using PROBAST. We performed random effects meta-analysis of the area under the receiver operating characteristic curve (AUC), sensitivity, specificity and clinical utility (net benefit, relative utility and probability of being useful in a hypothetical new centre) at thresholds commonly used clinically (10% risk of malignancy for ADNEX, 200 for RMI).

Results

We included 11 studies comprising 8271 tumours. Most studies were at high risk of bias. The summary AUC to distinguish benign from malignant tumours in operated patients for ADNEX with CA125 was 0.92 (95% CI 0.90 to 0.94) and for RMI it was 0.85 (0.81 to 0.89). Sensitivity and specificity for ADNEX with CA125 were 0.93 (0.90 to 0.96) and 0.77 (0.71 to 0.81) and for RMI, they were 0.61 (0.56 to 0.67) and 0.92 (0.89 to 0.94). The probability of the test being useful in a hypothetical new centre in operated patients was 96% for ADNEX with CA125 and 15% for RMI at the selected thresholds.

Conclusions

ADNEX has better discrimination and clinical utility than RMI.

Impact of Traumatic Stress on Nurses' Work Ability, Job Satisfaction, Turnover and Intention to Leave: A Cross‐Sectional Study

ABSTRACT

Aims

This study aimed to explore the direct and indirect effects of secondary traumatic stress (STS) on nurses' perceived work ability and the effect of these two variables on job satisfaction, organisational turnover intention and intention to leave the nursing profession.

Design

A cross-sectional study was conducted from June to November 2023.

Method

Data were collected by sending an online survey to a convenience sample of nurses. Instruments for data collection included a 37-item questionnaire divided into three sections: (i) socio-demographics, job satisfaction, organisational turnover intention, and intention to leave the profession; (ii) perceived work ability assessed through the Work Ability Index (WAI); (iii) STS measured with the Secondary Traumatic Stress Scale.

Results

Two hundred seventy-one nurses completed the questionnaire. STS negatively and statistically impacted on WAI, and it was a direct determinant of intention to leave the nursing profession. WAI showed a direct, positive and significant impact on job satisfaction and it was a significant partial mediator in the relationship between STS and job satisfaction. Job satisfaction mediated between WAI, the intention to leave the nursing profession, and the organisational turnover intention.

Conclusion

STS negatively impacted nurses' work ability, influencing their job satisfaction through the mediation of WAI, whereas job satisfaction independently affected nurses' organisational turnover intention. Moreover, STS was a positive and direct determinant of the intention to leave the nursing profession.

Impact

Nurses, as helping professionals, are exposed to extreme stressful events resulting from the traumatic experiences of patients. STS in nurses can lead to emotional exhaustion, turnover intention, job dissatisfaction and reduced work ability. The findings from this study offer insights that can help shape organisational health policies aimed at reducing STS, preserving nurses' work ability, enhancing job satisfaction and mitigating turnover intentions within and outside the nursing profession.

Reporting Method

This study followed the STROBE checklist guidelines for cross-sectional studies.

Patient or Public Contribution

No Patient or Public Contribution.

Quality of life after pulmonary embolism: psychometric validation of the Danish electronic version of the PEmb-QoL questionnaire

Por: Lindegaard · S. F. · Valentin · J. B. · Rolving · N. · Ingemann-Molden · S. · Hojen · A. A.
Objective

Patient-reported outcome measures are essential for assessing health-related quality of life (HRQoL) in both research and clinical practice. The Pulmonary Embolism Quality of Life (PEmb-QoL) questionnaire is a disease-specific instrument designed to measure HRQoL in patients with pulmonary embolism (PE). This study aimed to evaluate the psychometric properties of the Danish electronic version of the PEmb-QoL questionnaire.

Design

Psychometric validation study.

Setting

Eligible patients received a digital mail 6 months after their diagnosis, with an invitation to complete an online questionnaire. A subset of patients completed a second time 7–10 days following the initial completion.

Participants

Adult patients diagnosed with PE in Denmark between March 2022 and May 2023 were included in the study.

Main outcome measure

The main outcome measure was the PEmb-QoL summary score. Validation procedures included assessments of targeting, internal reliability (IR), test–retest reliability, differential item functioning (DIF) and concurrent validity.

Results

The study included 1017 patients. The Danish PEmb-QoL demonstrated robust IR (IR=0.95 for the total score) and adequate test–retest reliability for most domains (relative G-coefficients>0.7). However, DIF analysis revealed subgroup differences for some items, particularly those related to daily activity limitations and pain. Targeting analysis indicated moderate alignment between latent score distributions and item response distributions, with ceiling effects noted in several domains. The PEmb-QoL exhibited strong correlations with the Post-Venous Thromboembolism Functional Status Scale (r=0.82) and EuroQol-5 Domain (r=0.73), and moderate correlations with Generalised Anxiety Disorder Questionnaire (r=0.47) and Patient Health Questionnaire (r=0.57), confirming its concurrent validity.

Conclusion

While some items in the PEmb-QoL instrument performed inadequately on DIF and targeting, the expected overall score and the concurrent validity did not seem to be compromised by these issues. Thus, it is likely that a reduced version of the electronic Danish PEmb-QoL will possess suitable psychometric properties for measuring HRQoL in patients with PE.

Digital Health Literacy in Patients With Hypertension: A Cross‐Sectional Study

ABSTRACT

Aim

To assess Digital Health Literacy (DHL) levels among hypertensive patients.

Design

Cross-sectional study.

Methods

The study, conducted from March to August 2024 among hypertensive patients using convenience sampling, employed a 35-item questionnaire assessing: (I) sociodemographic; (II) physical activity, dietary habits, antihypertensive pharmacological treatment and medical history; (III) online health-related information knowledge and confidence; (IV) DHL, through the HLS19-DIGI questionnaire with subscales on: (i) dealing with digital health information (HL-DIGI), (ii) interaction with digital resources (HL-DIGI-INT), (iii) frequency of digital device use for health (HL-DIGI-DD).

Results

Among 311 participants (mean age 63.9 years, SD = 14.8), 42.1% completed high school, 25.4% held a bachelor's degree and 22.8% were physically inactive. While 49.8% were aware of online health-related information, 28.9% were uncertain and 47.6% lacked confidence in using it for health decisions. On average, participants showed a problematic level of DHL in HL-DIGI, a sufficient level in HL-DIGI-INT, and used digital health devices just over once a week. Older age emerged as a predictor of higher online health-related knowledge and DHL, while higher education level predicted higher knowledge, confidence and DHL. Physical inactivity was associated with lower online health-related information knowledge and confidence.

Conclusions

These findings point to the need to design proactive strategies and implement targeted training and educational interventions to improve DHL in hypertensive patients.

Implications for the Profession and/or Patient Care

Enhancing DHL levels through targeted interventions in patient care allows patients to effectively benefit from digital healthcare, achieve positive health outcomes and reduce disparities in care pathways.

Reporting Method

This study adhered to the STROBE checklist for reporting.

Patient or Public Contribution

Patients were involved as the study population.

Protocol Registration

Local Ethical Committee of the University Hospital Company of the Marche Region, Italy (protocol: 2023/279, date: 28/09/2023).

The Illness Experience of Nurses Who Become Patients: A Phenomenological Study

ABSTRACT

Aim

To explore the phenomenon of nurse–patient's illness experience.

Design

A multicentre phenomenological qualitative study was conducted in Italy.

Methods

A convenience sample of nurses with an acute illness experience, requiring at least one hospitalisation of ≥ 3 days, was enrolled. Semi-structured interviews were conducted. Data were transcribed verbatim and analysed according to Giorgi's descriptive method. Ethics committee approval was obtained for this study. The COnsolidated criteria for REporting Qualitative research checklist guided the study reporting.

Results

Eleven interviews were conducted from August 2022 to July 2023. The essential structure ‘being on the other side of the fence’ and six common themes, ‘role reversal’, ‘expanded awareness’, ‘professional identity’, ‘emotional swing’, ‘having experienced it on their own skin’ and ‘reframing the healthcare context’, were identified. Nurses' awareness of the healthcare system and pathways related to their professional background at the onset of their illness experience turns into an expanded awareness of the illness experience in itself, having it ‘lived on their own skin’. When nurses return from the ‘other side of the fence’ to their professional role this new awareness triggers a more compassionate and cognizant relationship with patients and colleagues.

Conclusion

This study highlights the lived experience of nurses who became patients, showing characterising elements of ‘being on the other side of the fence’ and the potential of this experience for expanding nurses' awareness of other patients' experiences under their care.

Implications for the Profession and/or Patient Care

Nurse–patients' illness experience may be instrumental to reinforce nurses' awareness, empathy and any positive attitude or practice devised to improve patient's illness experiences and patient centred care in hospitals.

Patient or Public Contribution

Nurses participated as interview respondents.

Validity and Reliability of the Self‐Care of Chronic Illness Inventory in Patients Living With Inflammatory Bowel Disease

ABSTRACT

Aim

To test the psychometric properties of the Self-Care of Chronic Illness Inventory (SC-CII) in patients living with inflammatory bowel disease (IBD).

Design

A cross-sectional, multicenter study.

Methods

A total of 452 IBD patients were recruited from nine centres across Italy. Participants completed the SC-CII, the Self-Care Self-Efficacy Scale (SCSES), and a sociodemographic questionnaire. Structural validity was assessed using confirmatory factor analysis (CFA). Reliability was evaluated with Cronbach's alpha and McDonald's Omega. Construct validity was determined through correlations between SC-CII and SCSES scores.

Results

CFA confirmed the SC-CII's structural validity, demonstrating its multidimensional self-care maintenance, self-care monitoring, and self-care management structure. Reliability scores were satisfactory, with robust internal consistency. Significant positive correlations between SC-CII and SCSES scores confirmed its construct validity.

Conclusion

The SC-CII is a valid and reliable tool for assessing self-care behaviours in IBD patients. Its application in clinical and research settings can facilitate the evaluation of self-care practices, supporting the development of targeted interventions to improve patient outcomes.

Implications for the Profession and/or Patient Care

The SC-CII helps identify self-care deficits in IBD patients, enabling tailored interventions for better patient-centred care.

Impact

The study addressed the need for validated tools to assess self-care in IBD patients, crucial for managing conditions like IBD. The SC-CII proved valid and reliable, with CFA confirming its structure and correlations with self-efficacy supporting validity. It offers a robust tool to assess and promote self-care behaviours.

Reporting Method

The STROBE checklist ensured accurate and comprehensive reporting.

Patient or Public Contribution

IBD patients helped align the SC-CII with their experiences, ensuring its relevance.

Trial Registration

ClinicalTrials.gov identifier: NCT06015789

Development and Validation of the Family and Community Nursing Advanced Practice Scale

ABSTRACT

Aim

To develop and test a Family and Community Nursing—Advanced Practice Scale.

Design

A cross-sectional and methodological scale validation design, following classical test theory.

Methods

Three phases, the first of which involved scale development, including item generation. Phase two assessed the content validity index. The third phase involved a cross-sectional survey to establish construct validity, content validity, internal consistency reliability, and exploratory factor analysis.

Results

The Family and Community Nursing Advanced Practice Scale has good construct validity, with the final scale consisting of 5 domains and 27 items. This was confirmed by both the exploratory and confirmatory factor analysis. The Cronbach's Alpha is very good, suggesting that the scale is reliable. When comparing family practice advanced practice nurses with those working in the community, the results show that scores are similar except for clinical reasoning and health promotion, which consistently showed statistically significant higher scores among the family practice nurses. While community nurses scored higher on items in the leading practice domain reflecting their role in a wider team of nurses.

Conclusion

This study developed and psychometrically tested the Family and Community Nursing—Advanced Practice Scale. The scale has good reliability, and analysis of the construct validity reveals five domains of advanced practice among this practitioner group.

Implications for the Profession

The study suggests that advanced practice nurses working in community roles perform similar activities to those working in family practice in the United Kingdom. However, activity related to research was less evident.

Impact

The study examined the scope of the advanced practice nurse role in family and community nursing. The study illustrated practice across five domains: clinical care, leading practice, clinical reasoning, health promotion, and ethics. The family practice and wider community roles were largely homogenous, with only two items showing a statistically significant difference in scores.

Reporting Method

STROBE guidelines for cross-sectional studies.

Patient or Public Contribution

No patient or public contribution.

Psychological and Social Factors Associated With Reporting Post‐COVID Symptoms Among German Healthcare Workers: A Cross‐Sectional Study

ABSTRACT

Background

Health care workers (HCW) with post-COVID condition (PCC) are frequently reported to suffer from mental health impairment. Given HCW above-average risk for mental health, research is necessary and risk factors need to be assessed.

Aim

To compare mental health and health of German HCW with and without PCC and to identify associated psychological and social factors.

Design

Cross-sectional study.

Method

Overall, 2816 German HCW participated (332 reported PCC). Measures were post-COVID condition symptom sum score (PCSS), symptoms of depression (Patient Health Questionnaire-2), anxiety (Generalised Anxiety Disorder-2) and post-traumatic stress disorder (PTSD) symptoms (Impact of Event Scale-6), work–family conflict (Work–Family Conflict Scale), social support (ENRICHD Social Support Inventory), sense of coherence (Sense Of Coherence-3 Scale) and working conditions. Group differences of HCW with and without PCC were investigated. Multiple linear regression analysis was performed for HCW with PCC. PCSS was the dependent variable. Independent variables were a.m. measures and age, gender, occupational group and migration background.

Results

HCW with PCC exhibited higher values, with medium effect sizes, for symptoms of depression, anxiety and PTSD. Small effect sizes were observed for work–family conflict, social support, sense of coherence and working conditions. Higher PCSS scores were associated with higher depression, anxiety, PTSD and work–family conflict levels, lower social support and sense of coherence and migration background. Being a physician was associated with lower PCSS.

Conclusion

Lower mental health, social factors and resources may play a role in reporting severe post-COVID symptoms. Further research is necessary to investigate these interactions using the biopsychosocial theory.

Implication for the Profession

This study can help to understand PCC in HCW to design adjusted treatments and protect HCW from PCC and minimise their risk of PCC.

Reporting Method

This study complies with the Journal article reporting standards for quantitative research in psychology: The APA Publications and Communications Board task force report (Data S1).

Public Contribution

Caregivers are the sample group.

The Relationship Between Nurses' Digital Health Literacy and Their Educational Levels, Professional Roles, and Digital Attitudes: A Cluster Analysis Based on a Cross‐Sectional Study

ABSTRACT

Aim

The current study aimed to identify digital health literacy levels among nurses with respect to their education, role and attitude towards digital technologies.

Design

Cross-sectional study.

Methods

Through convenience sampling, all Registered Nurses, managers/leaders and nurse researchers employed in Hospitals, University Hospitals and Districts were recruited and surveyed using an online questionnaire. The data collection tool assessed: (I) demographics, (II) Digital Health Literacy (DHL) with the Health Literacy Survey19 Digital (HLS19-DIGI) instrument including DHL dealing with digital health information (HL-DIGI), interaction with digital resources for health (HL-DIGI-INT) and use of digital devices for health (HL-DIGI-DD); (III) attitudes on the use of digital technologies in clinical practice. The multiple correspondence analysis was applied to identify three clusters for the education/professional role (A, B, C) and three for digital technologies' use (1, 2, 3). The one-way nonparametric analysis of variance (Kruskal–Wallis test) was applied to compare HL-DIGI, HL-DIGI-INT and the HL-DIGI-DD scores among clusters.

Results

Among 551 participants, the median scores of the HL-DIGI, the HL-DIGI-INT and the HL-DIGI-DD questionnaires were 70.2, 72 and 2.00, respectively. The distribution in the clusters ‘educational/professional role’ was A, (58.8%); B, (16.5%); and C, (24.7%). Nurses in a managerial or coordinator role and with a postgraduate degree used digital resources with greater frequency. The distribution in the clusters ‘use of digital technologies’ was: 1, (54.6%); 2, (12.2%); and 3, (33.2%). The HL-DIGI-DD and HL-DIGI scores of clusters 1, 2 and 3 differed significantly.

Conclusion

DHL among nurses is strongly influenced by the education level, professional role, habits and attitude towards digital technologies. Nurses with coordinator roles used digital technologies with greater frequency and had a higher level of DHL.

Reporting Method

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were used for reporting.

Patient or Public Contribution

No Patient or Public Contribution.

Trial Registration: Local Ethical Committee of the Polyclinic of Bari (code: DHL7454, date: 21/09/22)

Violence Against Nurses During Care: A Systematic Review

ABSTRACT

Aims

To analyse and synthesise knowledge on workplace violence perpetrated by patients and caregivers against nurses, its consequences and strategies to prevent this phenomenon.

Design

A systematic review of the literature was conducted following the method of the Center for Reviews and Determination and reported in accordance with the PRISMA checklist. A pre-defined protocol was designed (PROSPERO ID: CRD42023432271).

Methods

Three researchers screened eligible studies independently. The Joanna Briggs Institute Critical Appraisal for Analytical Cross-Sectional Studies was used to assess the risk of bias within the studies included.

Data Sources

Quantitative primary studies published between January 2012 and June 2023 were included through specific research strings used in the CINHAL, Scopus, PubMed and PsychInfo databases.

Results

A total of 15 studies were selected, the majority of which were cross-sectional and observational. The consequences related to events of verbal and physical violence were highlighted, ranging from the psychological to the physical effects on nurses' mental health, for example, gastrointestinal symptoms, headache and sleep problems. Four studies analysed the strategies used to cope with such violence.

Conclusion

The results showed that aggression on the part of patients affects nurses' health adversely on both a personal and a work level, and makes it necessary to pay more attention to the phenomenon and to find strategies to reduce the incidents, such as developing policies to safeguard the professionals' physical and mental health.

Implications for the Profession and/or Patient Care

Nurses and nursing managers should be aware of violence and its consequences on the victims' health. Therefore, it is essential for nursing managers to develop effective policies to reduce violence and its consequences.

Using interoperable nursing care data to improve outcomes for multiple traumas patients with Impaired Physical Mobility

Abstract

Aim(s)

To demonstrate how interoperable nursing care data can be used by nurses to create a more holistic understanding of the healthcare needs of multiple traumas patients with Impaired Physical Mobility. By proposing and validating linkages for the nursing diagnosis of Impaired Physical Mobility in multiple trauma patients by mapping to the Nursing Outcomes Classification (NOC) and Nursing Interventions Classification (NIC) equivalent terms using free-text nursing documentation.

Design

A descriptive cross-sectional design, combining quantitative analysis of interoperable data sets and the Kappa's coefficient score with qualitative insights from cross-mapping methodology and nursing professionals' consensus.

Methods

Cross-mapping methodology was conducted in a Brazilian Level 1 Trauma Center using de-identified records of adult patients with a confirmed medical diagnosis of multiple traumas and Impaired Physical Mobility (a nursing diagnosis). The hospital nursing free-text records were mapped to NANDA-I, NIC, NOC and NNN linkages were identified. The data records were retrieved for admissions from September to October 2020 and involved medical and nursing records. Three expert nurses evaluated the cross-mapping and linkage results using a 4-point Likert-type scale and Kappa's coefficient.

Results

The de-identified records of 44 patients were evaluated and then were mapped to three NOCs related to nurses care planning: (0001) Endurance; (0204) Immobility Consequences: Physiological, and (0208) Mobility and 13 interventions and 32 interrelated activities: (6486) Environmental Management: Safety; (0840) Positioning; (3200) Aspiration Precautions; (1400) Pain Management; (0940) Traction/Immobilization Care; (3540) Pressure Ulcer Prevention; (3584) Skincare: Topical Treatment; (1100) Nutrition Management; (3660) Wound Care; (1804) Self-Care Assistance: Toileting; (1801) Self-Care Assistance: Bathing/Hygiene; (4130) Fluid Monitoring; and (4200) Intravenous Therapy. The final version of the constructed NNN Linkages identified 37 NOCs and 41 NICs.

Conclusion

These valid NNN linkages for patients with multiple traumas can serve as a valuable resource that enables nurses, who face multiple time constraints, to make informed decisions efficiently. This approach of using evidence-based linkages like the one developed in this research holds high potential for improving patient's safety and outcomes.

No Patient or Public Contribution

In this study, there was no direct involvement of patients, service users, caregivers or public members in the design, conduct, analysis and interpretation of data or preparation of the manuscript. The study focused solely on analysing existing de-identified medical and nursing records to propose and validate linkages for nursing diagnoses.

Intervenciones de enfermería a Recién Nacido Extremadamente Prematuro con Síndrome de Distrés Respiratorio

Introducción: La prematuridad y el bajo peso al nacer son factores predictivos asociados a la morbilidad y la mortalidad neonatal y, por lo tanto, dan lugar a complicaciones como el Síndrome de Dificultad Respiratoria (SDR), que es la principal complicación de los recién naci-dos que ingresan en la Unidad de Cuidados Intensivos Neonatales (UCIN). Objetivo: implementar cuidados integrales de enfermería especializados e individualizados al recién nacido extremadamente prematuro basados en recomendaciones de evidencia científica e intervenciones NIC. Presentamos la valoración integral de una persona recién nacida de 23 SDG con un peso de 500 g. más SDR remitidos desde un hospital comunitario básico a un hospital de tercer nivel de atención, donde se aplica el proceso de enfermería. Métodos: Se seleccionó un paciente a conveniencia de la UCIN, aplicando la metodología del proceso de enfermería, la evaluación integral a tra-vés de los 13 dominios de la NANDA, los datos se obtuvieron del expediente clínico, la entrevista con la madre y el examen físico del recién nacido Se identifican las principales respuestas humanas para analizar datos objetivos y subjetivos, se hacen juicios clínicos para implementar planes de atención bajo recomendaciones de guías de práctica clínica e intervenciones de NIC. Resultados: Se implementa-ron cinco planes de atención con diagnóstico priorizado de enfermería, cuatro reales y uno en riesgo, se identificaron los dominios más alterados: nutrición, eliminación/intercambio, crecimiento/desarrollo y seguridad/protección. Conclusiones: se realizaron intervenciones independientes e interdependientes observando mejoría en los dominios alterados, sin embargo, el recién nacido se mantuvo en una incubadora y permaneció en la UCIN para seguir los planes terapéuticos especializados, Esto implica que la UCIN debe contar con personal multidisciplinario altamente capacitado con conocimientos actualizados en atención neonatal.

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