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Globally, a lower-extremity amputation occurs every 20 s as a complication of a diabetic foot ulcer, underscoring the urgent need for effective preventive strategies. Previous studies have shown that temperature-based foot monitoring can reduce both the incidence and severity of diabetic foot ulcers. However, real-world adherence data for remote temperature monitoring remain limited, particularly in diverse or resource-constrained communities. We conducted a pilot implementation study of 20 adults with diabetes and a history of diabetic foot ulcers to assess adherence to a remote foot temperature monitoring mat within the context of receiving podiatric care. Participants are instructed to stand on the mat for 20 s daily, and data are transmitted wirelessly for remote monitoring. Adherence was defined as use of the mat at least four times a week. Participants demonstrated high adherence to the foot monitoring mat, averaging 6 scans per week, with sustained adherence over the 6-month study period. These findings suggest that high-risk patients with diabetes can reliably engage with the foot temperature monitoring technology, supporting its potential as a management tool to improve outcomes and reduce the burden of diabetic foot ulcer-related complications in high-risk, resource constrained patient populations.
To describe the prevalence and determinants of workplace violence against nurses in the Italian home care setting.
Secondary cross-sectional analysis of data from the multicentre study AIDOMUS-IT.
Nurses employed in home care services provided by Italian Local Health Authorities were interviewed using a variety of instruments. A multivariable binary logistic regression model was performed to model the risk of workplace violence against nurses in the last 12 months. Variables related to violence were selected among sociodemographic characteristics (such as age and gender), work-related factors (including years of experience, team composition, overtime working, previous experience in mental health care, burnout) and organisational elements (including leadership and support, workload, staffing and resources adequacy, and time to reach the patients' homes). Adjusted odds ratios (aOR) were used to present the results.
A total of 3949 nurses participated in the study and 20.49% of them reported to have experienced an episode of violence in the last 12 months. Determinants of higher risk of violence episodes were younger age (aOR = 1.02, p = 0.002), higher workload (aOR = 1.01, p = 0.002), working in a multiprofessional team (aOR = 1.24, p = 0.018), perception of inadequate managerial leadership and support (aOR = 1.38, p = 0.003), and higher burnout levels (aOR = 1.01, p < 0.001).
The prevalence of workplace violence against Italian home care nurses is high. Several modifiable determinants were found to be associated with a higher risk of violence, which can potentially be mitigated with tailored interventions.
Effective preventive strategies must be developed to lessen workplace violence against nurses in the home care setting. These strategies should focus on strengthening nursing managers' leadership and support skills, enhancing team-building strategies, avoiding inadequate workload, monitoring nurses' burnout, estimating optimum staffing levels, and assigning advanced-career nurses to home care services. These measures are imperative to guarantee the quality and safety of home care organisations and to attain favourable outcomes in the provision of care.
This study aimed to explore the prevalence and determinants of workplace violence against nurses in the Italian home care settings. We found that out of the 3949 nurses surveyed, 20% of the sample reported one episode of violence during the last 12 months. Determinants of this violence included younger age, higher workload and burnout, being in a multiprofessional team, and perception of lack of leadership and support by the nurse manager. The results of this study can be used to tailor interventions aimed at mitigating the risk factors of violence, particularly those that can be modified (e.g., workload, burnout, and leadership).
The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
No patient or public contribution.
Chronic diseases are a major global health burden, contributing to morbidity, mortality and healthcare costs. Self-care is essential for effective disease management, with health literacy (HL) and digital health literacy (eHL) playing a role in enabling individuals to engage in health-promoting behaviours. However, the relationship between HL and self-care remains inconclusive, necessitating further investigation to clarify its impact.
To synthesise evidence on the association between HL and self-care in chronic diseases and identify mediating and moderating factors influencing this relationship.
A systematic search was conducted across PubMed, CINAHL, PsycINFO, Embase, Web of Science and Cochrane CENTRAL, supplemented by manual reference checks and author correspondence.
This systematic review and meta-analysis followed PRISMA guidelines, including observational studies and RCTs assessing HL and self-care. Meta-analyses were performed using Fisher's Z transformation. Risk of bias was assessed using ROBINS-E and certainty of evidence was evaluated through GRADE.
A total of 138 studies were included, with 52 meta-analysed. Higher HL was associated with improved self-care behaviours, including medication adherence, disease monitoring and lifestyle modifications across chronic diseases, including type 2 diabetes, heart failure, hypertension, chronic kidney disease, asthma, coronary artery disease, arthritis and COPD. Psychological (self-efficacy, empowerment), cognitive (disease knowledge, decision-making) and social (healthcare communication, social support) factors mediated this relationship, while distress and depression moderated it. Meta-analysis revealed a moderate positive association between HL and self-care (r = 0.29, 95% CI: 0.26–0.31, p < 0.001). Subgroup analyses showed consistent positive effects across conditions. No significant publication bias was detected (Egger's test, p = 0.294). Risk of bias was high in 62 studies, while certainty of evidence ranged from very low to moderate.
HL positively influences self-care in chronic diseases, with its impact shaped by multiple mediators and moderators. Future interventions should integrate tailored education, digital tools and mental health support to enhance HL effectiveness.
PROSPERO (CRD42024488061, registered 20.01.2024).
To classify Italian home care models based on structural characteristics, process factors and stakeholder perceptions.
This is a secondary analysis of the AIDOMUS-IT multicentre cross-sectional study, conducted in Italy between July 2022 and December 2023.
Data were collected via online surveys completed by 33 Local Health Authority Nursing Directors, home care nurses and patients. Hierarchical cluster analysis was used to classify different organisational models based on structural and process-related factors. Nurses' and patients' perceptions of care were described for each identified cluster.
The analysis identified three distinct organisational home care models: The ‘multidisciplinary model’, in which nurses reported high dissatisfaction due to organisational complexity and excessive workloads. In the ‘nurse-centred model’, characterised by publicly employed nurses, strong leadership, and a supportive work environment, patients reported high levels of satisfaction. The ‘performance-based model’, which operated with a lower nurse-to-patient ratio, reduced service hours, and greater reliance on external professionals. Nurses in this model reported high job satisfaction but also a greater intention to leave, while patient satisfaction was lower.
This study underscores the importance of leadership, resource management, and a supportive work environment in influencing both job satisfaction and patient outcomes in home care settings.
Policymakers could use these findings to refine care models and improve service delivery.
Limited research has examined the organisational structures of home care services, which are important for professionals' organisational well-being, patient safety, and quality of care. This study identified three distinct organisational home care models that could be used to refine care approaches and improve service delivery.
This study respects the EQUATOR guideline for observational studies (STROBE).
This study did not include patient or public involvement in its design, conduct, or reporting.
To evaluate the effect of mutuality on self-care in people with CHD and the contribution of their caregivers, and whether such relationships can be mediated by self-efficacy.
Secondary analysis of baseline data from a multi-centre longitudinal study.
Patients at the onset of coronary artery disease who underwent angioplasty, along with their caregivers, were included in the sample. Data from 136 patients and 136 caregivers were used for the analysis. Mutuality between patients and caregivers was measured using the Mutuality Scale. Self-care was measured using the Self-Care of Coronary Heart Disease Index and the Caregiver Contribution to Self-Care of Coronary Heart Disease Index. The actor–partner interdependence mediation models were used to assess the mediating role of self-efficacy for self-care between perceived mutuality and self-care behaviours.
An actor indirect effect was found between patient mutuality and their self-care maintenance, self-care monitoring, and self-care management, through the mediation of their self-efficacy. Caregiver mutuality had a positive indirect effect on their contribution to self-care maintenance, self-care monitoring, and self-care management, through the mediation of their self-efficacy. Caregiver mutuality had a positive indirect effect on patient self-care maintenance and on patient self-care monitoring, through the mediation of patient self-efficacy. All models demonstrated satisfactory fit to the data.
Mutuality between patients and caregivers enhances self-care behaviours in patients with coronary heart disease, and self-efficacy is a crucial mediator in this relationship. Interventions targeting both mutuality and self-efficacy within patient–caregiver dyads may improve self-care outcomes.
We adhered to STROBE guidelines.
Patients and members of the public were not involved in the design, conduct, reporting, or dissemination plans of this research.
Objetivo principal: Interpretar el significado que se le asigna a las estrategias de enseñanza-aprendizaje en el área de salud destinada a personas mayores. Método: Estudio cualitativo de carácter exploratorio. Participaron personas mayores de 60 años y profesionales del área gerontológica con experiencia en la planificación y ejecución de educación en salud. La información fue recolectada a través de entrevista semiestructurada, y los datos fueron analizados a través de análisis de contenido. Resultados principales: Las personas mayores reconocen el realizar talleres y la educación individual como las mejores estrategias para recibir educación. Al triangular la información, los profesionales gerontológicos coinciden con la apreciación positiva de los talleres, pero acompañados de un adecuado diagnóstico participativo y desde la experiencia del participante. Conclusión principal: Los talleres se reconocen como la mejor estrategia de enseñanza-aprendizaje para personas mayores. Esta debe aplicarse considerando un diagnóstico participativo, con la experiencia de la persona mayor y ser mantenido en el tiempo.
Objetivo principal: Analizar la influencia del contacto piel con piel (CPP) en el éxito de la lactancia materna exclusiva (LME) hasta los 6 meses de vida. Metodología: Estudio analítico descriptivo y prospectivo, realizado mediante entrevista directa con 500 puérperas seleccionadas por muestreo de casos consecutivos. Resultados principales: Cuando se realizó el CPP de manera ininterrumpida la LME a los 6 meses de vida fue del 17,40% y la de lactancia artificial del 12,60%. En los casos en que no se realizó, eran mayores las tasas de lactancia artificial (10,80%) frente a las de LME (4,40%). Las variables con mayor influencia en el éxito de la lactancia materna exclusiva a los 6 meses de vida, el tipo de alimentación en hijos anteriores y el tipo de alimentación al alta hospitalaria. Conclusión principal: Se deben evitar rutinas hospitalarias que interrumpan el CPP así como procurar que al alta hospitalaria la LME esté correctamente establecida.
Introducción: Las intervenciones que realizamos a los RN ingresados en nuestra unidad pueden causar dolor y estrés, traduciéndose en signos conductuales y fisiológicos. Método: Se realizó un ensayo clínico controlado aleatorizado en la UCI de neonatos durante un año, el objetivo fue conocer si existen diferencias significativas en cuanto al uso de leche materna vs sacarosa 25% como método analgésico no farmacológico en la realización de procedimientos dolorosos (punción venosa y punción del talón). Se usó para evaluar el dolor la escala de Susan Given Bells (antes y tras 2minutos de nuestra intervención). Material: Se incluyeron los recién nacidos entre 25-40 se-manas de gestación y que no cumpliesen criterios de exclusión. Resultados: Se usó para el análisis estadístico la t-student y el test de chi cuadrado, observando como principal resultado que en la extracción venosa (N=59) es más efectivo el uso de leche materna, sufriendo menor aumento del dolor tras la misma(p<0,029). También se observa relación significativa entre la edad gestacional corregida y el dolor tras la extracción venosa, obteniendo que los recién nacidos > 32 semanas tienen mayor aumento de dolor posterior (p<0,011). En la de punción de talón (N=76), no se hallaron diferencias entre la sacarosa y leche materna, tampoco al analizar otras variables (sexo, edad gestacional, crecimiento intrauterino retardado, llanto o canguro) Conclusiones: Se propone el uso de leche materna como método anal-gésico para el control del dolor en punción de talón y extracción venosa. Ya que demuestra su eficacia y carece de efectos secundarios.
La experiencia de someterse a un procedimiento quirúrgico operativo es una de las más estresantes para el ser humano, debido a que obliga a hacer adaptaciones psicológicas y fisiológicas importantes en el organismo lo que aumenta el riesgo de presentar complicaciones durante el mismo; para disminuir este riesgo se proporciona cuidados de enfermería integrales-holísticos a través de la musicoterapia, la cual es una intervención que disminuye los factores estresores, modifica el entorno y reduce el nivel de estrés fisiológico y psicológico. Este artículo propone especificaciones para la implementación de musicoterapia durante el procedimiento quirúrgico, aun que la Nursing Interventions Clasificación (NIC) ya la incluye, en México aún no se implementa en los quirófanos. Al hacer efectiva la implementación de esta intervención se mejora la calidad de vida de la persona a través de una atención de enfermería de excelencia.
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