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The effects of increasing dosages of narasin on ruminal fermentation patterns, bacterial community composition, and nutrient digestibility in beef cattle receiving feedlot diets

by Ana Laura Januário Lelis, Leandro Aparecido Ferreira da Silva, Daniel Moretto Casali, Tiago Leiva, Murilo Chuba Rodrigues, José Paulo Roman Barroso, Pedro Veloso Facury Lasmar, Camila Lisboa Tomaz, Anabelle Jorge Barbosa, Camila Cesario Fernandes Sartini, Johnny Maciel de Souza, Danilo Domingues Millen

This study evaluated the effects of increasing narasin doses on ruminal fermentation, nutrient digestibility, ruminal pH stability, papillae histology, and microbial composition in Angus cattle fed feedlot diets. Three rumen-cannulated Angus steers (average body weight: 680 kg) were assigned to a 3 × 3 Latin square design and received diets containing 13, 20, or 27-ppm of narasin. Each experimental period consisted of 14 days of adaptation followed by seven days of sampling. Ruminal degradability was assessed on days 15–17, apparent digestibility on days 15–19, continuous ruminal pH on days 19–20, and samples for short-chain fatty acids (SCFA), microbiota, and ruminal histology were collected on days 20 and 21. Ruminal degradability was not affected by narasin dose. Digestibility of acid detergent fiber (ADF) was significantly influenced, with the greatest values observed at 27-ppm (P = 0.01). Increasing narasin doses improved ruminal pH stability, as indicated by a linear increase in minimum pH (P = 0.01) and a reduction in the duration of pH below 5.6 (P = 0.10). At 13 ppm, SCFA production, particularly acetate and propionate, increased (P P P = 0.02), and butyrate (P P P = 0.03). Narasin supplementation altered ruminal microbial composition, increasing the relative abundance of Lachnospiraceae and Isotricha while reducing lactic acid–producing bacteria. In terms of ruminal morphology, supplementation with 20-ppm of narasin increased the keratin layer thickness of ruminal papillae (P = 0.02), suggesting enhanced epithelial development. Overall, narasin supplementation modulated ruminal function and microbial ecology, with doses between 13 and 20-ppm providing the most favorable balance between fermentative efficiency and ruminal health in feedlot cattle.

Which Aspects of Abortion Care Do Healthcare Practitioners in Britain Think Nurses/Midwives Should Provide? Findings From the SACHA Study

ABSTRACT

Aim

To explore the views of healthcare practitioners in Britain regarding the role of midwives and nurses in the delivery of medical and surgical abortion.

Design

An observational study of the Shaping Abortion for Change study healthcare practitioner survey (2021–2022).

Methods

Relationships between healthcare practitioner type, participant characteristics, knowledge of and attitudes towards abortion, and views about nurses' and midwives' role in abortion care were examined using Pearson's Chi-squared tests of association and multivariable logistic regression.

Results

Amongst 763 participants including doctors, nurses, midwives and pharmacists, 71.6% supported specialist nurses in sexual and reproductive health and abortion clinics and hospitals, expanding their roles to include prescribing abortion medications and surgical abortion methods. Support was lower for midwives (35.8%) and primary care nurses (32.5%). There was considerable support for all nursing and midwifery groups to be involved in adjacent tasks of abortion care. Differences in support by healthcare practitioner type persisted after adjustment for exposure variables.

Conclusion

There is strong support for specialist nurses to expand their role in abortion care. This change could be implemented following clarification of the legal position. Some healthcare practitioner groups are more reluctant to support broader involvement of nurses and midwives in abortion provision.

Implications for the Profession and/or Patient Care

Expanding specialist nurses' role in abortion care could increase service capacity and improve patient access and experience. Understanding and addressing the concerns of healthcare practitioners opposing this change is critical for successful implementation and patient safety.

Impact

This study addresses the potential for nurse and midwife role expansion in abortion care. The findings highlight broad support for specialist nurses whilst identifying barriers to wider role expansion. The research informs policy discussions on workforce optimisation and access to abortion services across Britain.

Reporting Method

This study adheres to the STROBE guidelines for reporting observational studies.

Patient or Public Involvement

In the SACHA study, patient and public involvement was included at all stages to inform study design, recruitment, data collection and analysis.

Assessing Hand Function Post‐Burn: A Systematic Review of Surgical vs. Enzymatic Debridement Using DASH/Quick‐DASH and MHQ Questionnaires

ABSTRACT

Hand burns, although often limited in surface area, have a major impact on function and quality of life. Debridement—surgical or enzymatic—is a key component of treatment, with enzymatic debridement increasingly used for its selectivity and potential to preserve viable dermis. To evaluate and compare the functional outcomes of hand burns treated with surgical versus enzymatic debridement, using the DASH/Quick-DASH and Michigan Hand Questionnaire (MHQ) assessment tools. A systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251034408). Searches were performed in PubMed, Scopus, and Web of Science without date restrictions. Inclusion criteria focused on studies evaluating hand burn function using DASH, Quick-DASH, or MHQ after enzymatic or surgical debridement in patients aged 16 or older. Methodological quality was assessed using the ROBINS-I tool. Of 547 studies identified, 7 met inclusion criteria: 4 surgical and 3 enzymatic. Functional recovery was generally better in cases where enzymatic debridement preserved viable dermis and avoided grafting. DASH and MHQ scores favoured enzymatic approaches, especially when conservative management followed debridement. However, methodological limitations and clinical heterogeneity limited direct comparison. Enzymatic debridement, through preservation of viable dermis and reduced grafting need, appears associated with improved functional outcomes in hand burns. Whilst surgical debridement remains essential for deeper burns, enzymatic methods may offer functional advantages and support early rehabilitation in appropriate cases.

Black Women as Superwomen; Health Disparities and the Cost of Strength: A Discursive Paper

ABSTRACT

Aim

Historically, Black women have been positioned as primary caretakers and problem-solvers, often expected to bear disproportionate responsibility during times of crisis. There is an enduring image of Black women possessing exceptional strength handed down through generations, captured in the sociocultural phenomenon known as the superwoman schema, or SWS. The aim of this discursive review is to explore health disparities among Black women related to the SWS.

Design

A discursive paper.

Methods

A literature search was conducted in PubMed, Scopus and Google Scholar to identify relevant papers published from 2016 to 2025 that addressed health disparities among Black women.

Discussion

Through literature review, we identified three critical areas of health disparities associated with mental health disorders, maternal mortality and breast cancer, reflecting the influence of inequitable practices embedded within healthcare systems and society. Nurses, advanced practice nurses and other healthcare providers must prioritise identifying and addressing barriers that hinder access to quality healthcare for Black women. Many providers remain unaware of how depressive symptoms, chronic stress and social determinants impact maternal, mental and breast health outcomes. Encouraging Black women to prioritise mental health, engage in routine prenatal care and seek early breast cancer screening is critical to improving health outcomes. By understanding the historical, societal, and personal contexts of the SWS, nurses can clarify both its benefits and challenges for Black women.

Targeting Vascular Inflammation In Patients with Community-Acquired Pneumonia (TIN-CAP): protocol for a multicentre, randomised, double-blind, placebo-controlled trial

Por: Stotts · C. · Corrales-Medina · V. F. · deKemp · R. A. · Wells · G. A. · Beanlands · R. · Raggi · P. · Ferrara · G. · Sligl · W. · A Connelly · K. · Paul · N. · Brouwers · M. · Contreras-Dominguez · V. · Yadav · K. · Torres · C. · Tavoosi · A. · Wiefels · C. · Kirpalani · A. · Romsa · J.
Introduction

Inflammation plays a central role in atherosclerosis development and subsequent cardiovascular complications, including heart attack and stroke. Patients with inflammatory conditions such as community-acquired pneumonia (CAP) present with an elevated risk of cardiovascular events, which is likely driven by unresolved systemic inflammation. Targeting this heightened inflammatory burden may present a novel therapeutic strategy to attenuate heart attack risk in CAP survivors. Icosapent ethyl (IPE), an omega-3 fatty acid, demonstrates both pro-resolving and cardioprotective properties. The Targeting Vascular Inflammation In Patients with CAP (TIN-CAP) trial aims to evaluate the efficacy of IPE in mitigating vascular inflammation in CAP survivors.

Methods and analysis

TIN-CAP is a multicentre, randomised, double-blind, placebo-controlled trial. Eligible adults diagnosed with CAP in hospital or the emergency department will complete baseline assessments within 14 days of diagnosis including 18F-fluorodeoxyglucose (FDG) positron emission tomography/CT angiography, bloodwork and quality of life evaluation (EuroQol – 5 Dimensions (EQ-5D)). Participants will then be randomised 1:1 to receive IPE (4 g/day) or placebo for 6 months. Follow-up visits will occur at 30 days (bloodwork and EQ-5D only) and 6 months. The primary endpoint is the change in FDG uptake in the ascending aorta from baseline to 6 months between IPE and placebo groups. Secondary endpoints include FDG uptake in the bone marrow, spleen, lungs and other vasculature, in addition to major adverse cardiac events and quality of life assessments. An initial lead-in cohort of 18 patients will be enrolled to assess recruitment, imaging feasibility and IPE tolerability prior to full trial enrolment. These patients will remain blinded and will be included in the final analysis (Vanguard design).

Ethics and dissemination

The TIN-CAP trial has been approved provincially by the Clinical Trials Ontario Research Ethics Board (approval number: 5045). Participants will provide written informed consent prior to enrolment. Study findings will be disseminated through peer-reviewed publications and conference presentations.

Trial registration number

NCT06710080.

Protocol for a systematic review and meta-analysis of pharmacological and non-pharmacological interventions for chronic pain management in chronic kidney disease

by Chi Peng Chan, Babaniji Omosule, Courtney Lightfoot, Ellesha A. Smith, Ffion Curtis, James O. Burton, Paul Gardner, Sarah Jasat, Sherna F. Adenwalla, Jyoti Baharani, Daniel S. March

Background

Chronic pain affects up to 60% of people with chronic kidney disease (CKD), yet remains under-recognised and under-treated. Pain management in this population is complicated by altered drug pharmacokinetics, polypharmacy, and the potential nephrotoxicity of conventional analgesics. Despite the high prevalence and significant impact on quality of life, evidence-based guidance specific to pain management in CKD remains limited.

Objectives

This systematic review aims to evaluate the effectiveness and safety of both pharmacological and non-pharmacological interventions in reducing chronic pain intensity among people with CKD on dialysis, not on dialysis, and kidney transplant recipients, across all stages of CKD.

Methods

The primary outcome is the effectiveness of interventions in reducing chronic pain intensity as assessed by pain assessment tools. We will conduct a comprehensive search of MEDLINE, Embase, CINAHL, Web of Science, and ClinicalTrials.gov from their inception to the present date to identify studies for chronic pain management in people living with CKD. Study screening will be conducted independently by two reviewers. One reviewer will extract data from each study, with a second reviewer cross-checking for accuracy and completeness. Data will be extracted on study characteristics, participant demographics, intervention components, pain outcomes, and adverse events. The certainty of evidence will be evaluated independently by two reviewers using the GRADE approach. Where applicable, data will be combined in meta-analyses using random-effects models. Additionally, a network meta-analysis will be performed if enough studies are available.

Expected results

This review will synthesise the current evidence for pain management strategies in CKD, by evaluating effectiveness of interventions among people receiving different renal replacement therapy modalities with varying pain and disease phenotypes. Findings will highlight the comparative effectiveness of various interventions while considering their safety profiles specific to the CKD context. The review will identify gaps in the literature and provide recommendations for clinical practice and future research.

Significance

This review seeks to deliver a thorough evaluation of pain management strategies for people living with CKD. This systematic review is supported by the UK Kidney Association (UKKA), and findings will inform the upcoming UKKA guideline on symptoms management in people with CKD, alongside the other symptoms including itch, fatigue, and gastrointestinal symptoms. This review will aid clinicians in making well-informed decisions regarding pain management strategies, ensuring a balance between effectiveness and the specific risks associated with CKD.

Feasibility and efficacy of virtual reality rehabilitation for upper extremity impairment in ischaemic stroke patients: an open-label, parallel-group, randomised controlled trial

Por: Sylaja · P. N. · PR · S. · Paul · R. · Chakravarthy · S. · Sinha · A. · Bapi · R. S. · Kesavadas · C. · Bharath · R. D. · Sarma · P. S. · Elango · S. · Hafsath · S. · Darshini · D. · F · A. J. A. · Dhasan · A. · Sambath · S. · Amal · M. G. · R S · A. · Akhil · S. · Devan · H. S. · Anjana Mad
Objective

The study evaluated the feasibility and efficacy of a non-immersive virtual reality (VR) system on upper extremity (UE) recovery in ischaemic stroke patients in comparison to a conventional physiotherapy.

Design

An open-label, parallel-group, randomised controlled trial randomly assigned the participants to two groups, VR intervention or conventional physiotherapy.

Setting

Two tertiary stroke care centres in South India participated in the study.

Participants

Sixty first-ever ischaemic stroke patients (1–6 months of stroke onset) having spasticity grades of 1 or 1+ as per Modified Ashworth scale and Brunnstrom recovery stages of 3, 4 or 5 in the UE were included in the intention-to-treat analysis.

Intervention

High-intensity non-immersive VR-based comprehensive rehabilitation gaming system with a duration of 12 weeks (3 days/week) was compared with equally intensive conventional physiotherapy.

Primary and secondary outcome measures

The feasibility outcome was the compliance with the treatment. The primary efficacy outcome was the improvement in the motor function assessed by the Fugl-Meyer assessment (FMA) and Wolf motor function test (WMFT). The secondary outcomes included the performance in activities of daily living by the Barthel index (BI) and the quality of life by the 36-item short form health survey (SF-36).

Results

The treatment compliance was similar in two groups (p=0.19). Both groups improved in motor performance, activities of daily living and quality of life. However, there were no significant differences in the FMA (p=0.58), WMFT (functional ability scale, p=0.33; performance time, p=0.44), BI (p=0.84) and SF-36 (physical, p=0.87; mental, p=0.99) scores between the groups.

Conclusions

The non-immersive VR system was feasible, effective and safe; however, it was not found to be superior to conventional physiotherapy. The trial was stopped early and did not reach its proposed sample size and hence, the findings are to be interpreted cautiously.

Trial registration number

Clinical trial registry India: CTRI/2021/11/038339 (https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NTc1OTI=&Enc=&userName=CTRI/2021/11/038339).

Effectiveness of Organisational Strategies for Pressure Injury Prevention and Treatment in Acute Hospital Settings: A Systematic Review

ABSTRACT

Aim

To investigate the effects of organisational interventions on the incidence, healing and management of pressure injuries in adult patients in acute hospital settings.

Design

Systematic review.

Methods

The review included adult patients at risk of or with pre-existing pressure injuries in acute hospital settings, excluding mental health units, emergency departments or operating theatres. Interventions employed in the included studies were categorised using the Cochrane Effective Practice and Organisation of Care taxonomy.

Data Sources

Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid Embase, EBSCO CINAHL Complete and Web of Science Core Collection were searched from 01 January 2012 to 31 December 2023.

Results

Of 8861 records identified, 7 prevention studies met the inclusion criteria. Six studies reported reductions in pressure injury incidence. Included studies employed various combinations of 14 organisational strategies to enhance practices. Educational interventions were utilised in six studies, including educational meetings, materials and outreach visits. Other common strategies included audit and feedback, communities of practice and continuous quality improvement. The interventions targeted patients and clinicians, primarily nurses, with some involving multidisciplinary teams. The focus was on enhancing healthcare practices through systematic approaches and stakeholder engagement.

Conclusions

Organisational strategies targeting both patients and clinicians as part of an intervention bundle may enhance the prevention of pressure injuries in acute hospital settings. Further, high-quality effectiveness–implementation hybrid trials are required to evaluate these strategies.

Implications for the Profession and Patient Care

Organisational factors influence clinicians' ability to implement evidence-based practices. The effectiveness of specific organisational strategies in acute settings is uncertain. Multiple organisational strategies targeting patients and clinicians may improve the implementability of a pressure injury prevention intervention.

Reporting Method

This study adhered to PRISMA guidelines.

Patient or Public Contribution

Neither patients nor the public were directly involved in this study.

Spinal cord perfusion pressure protocol for acute spinal cord injury: Pragmatic implementation and early results at two sites

by John Paul G. Kolcun, Ricky M. Ditzel Jr, Bradley L. Kolb, Ricardo B. V. Fontes, P. B. Raksin

Study design

Retrospective chart review.

Objective

Describe safety/feasibility of implementing a novel clinical protocol for acute spinal cord injury (SCI) management.

Summary of background data

Spinal cord perfusion pressure (SCPP) has emerged as a promising target for the medical management of SCI patients. We report our early experience implementing a pragmatic SCPP-driven clinical protocol to supplant conventional mean arterial pressure (MAP) monitoring in the setting of acute SCI.

Methods

We retrospectively reviewed charts of all SCI patients managed by our SCPP protocol since its adoption at two clinical sites as of 2/1/2023. The SCPP protocol was applied for all adult SCI patients of any injury grade, at any injury level with cord tissue involvement. Intrathecal pressure (ITP) was transduced by lumbar drain (LD). MAP was determined from invasive blood pressure recordings. SCPP was calculated as the difference between MAP and ITP, with an SCPP goal of >65mmHg.

Results

Eighteen patients have been treated since our SCPP protocol was adopted. Patients were predominately male (77.8%); the average age was 52.0 ± 16.2 years. Most injuries involved the cervical segment (72.2%), all of which were manifest clinically as central cord syndrome. The most common presenting injury severity was ASIA Impairment Scale D (44.4%).All patients underwent surgical intervention. There were no complications related to surgery, LD placement, or LD maintenance/ITP transduction during hospitalization. The SCPP protocol was continued for an average 5.2 ± 1.8 days. Eight patients required vasopressor support (44.4%) during that period, for an average 3.1 ± 2.1 days. Five patients underwent therapeutic CSF drainage to augment SCPP (27.8%). All patients maintained an average SCPP above goal for the duration of monitoring.

Conclusions

This study further establishes the safety and feasibility of monitoring SCPP via LD measurement of ITP in acute SCI patients treated by clinical protocol at two clinical sites. There were no complications related to LD placement/maintenance or SCPP monitoring.

Exploring barriers to integrated care for children under 5 living in temporary accommodation: a qualitative study of professionals experiences during the COVID-19 pandemic in England

Por: Pierce · P. A. S. · Svirydzenka · N. · Adil · H. · Allaham · S. · Ankers · M. · Parry · Y. K. · Heys · M. · Ucci · M. · Lakhanpaul · M.
Objectives

This research aims to explore the factors that hinder professionals in delivering integrated care for children under 5 in temporary accommodation (TA) and understand their experiences of collaboration during the pandemic to inform recommendations.

Design

Semistructured qualitative interviews.

Setting

England, UK.

Participants

45 professionals working across health, housing, education and non-profit sectors in England. Purposive and snowball sampling was employed to recruit a representation of key professionals across England. Those not eligible to take part in the study included people who did not work with families and/or children in TA settings.

Outcome measures

To explore cross-sector learnings that are applicable to improving integrated care and to tailor recommendations to the needs of families and children under 5 experiencing homelessness in the UK today.

Results

This study highlights the complex, multilevel barriers that professionals face when delivering integrated care to children under 5 in TA. Findings are organised using a framework that distinguishes between practice-level, organisational and systemic challenges. From siloed working practices and limited training to staffing shortages and restrictive data-sharing policies, these challenges collectively hinder service continuity and collaboration.

Conclusions

Although this project was conducted during the COVID-19 pandemic, the challenges identified reflect deeper, long-standing issues in service delivery. As services continue to recover and prepare for future crises, these insights remain highly relevant and can inform more resilient, integrated recovery plans to support children in TA beyond the pandemic context. Addressing these barriers, through improved collaboration, training and data-sharing, is key to strengthening care for this vulnerable population.

Patient Engagement Interventions to Improve Medication Management of Older Patients Across Transitions of Care: A Mixed Methods Systematic Review

ABSTRACT

Aims

Identify and describe patient engagement interventions used to improve medication management in older adults during transitions of care.

Design

A mixed-methods systematic review.

Methods

A comprehensive search of all study designs was conducted. Studies were categorised using the ladder of patient and family engagement, a framework that positions engagement from low (passive) to high (active partnership) patient engagement.

Data Sources

Six databases were searched from inception to April 2024.

Results

The search yielded 29 reports, with 25 classified as studies. Most interventions (n = 19, 76%) were low-level interventions that comprised informing patients in a passive manner. Interventions that facilitated high-level engagement (n = 6, 24%) where patients were integrated in the decision-making process were associated with consistently improved patient and healthcare long-term outcomes.

Conclusions

While low and high-level engagement interventions were associated with significantly decreased hospital readmission rates, high-level interventions consistently demonstrated positive patient outcomes. Interventions supporting older adults beyond discharge achieved meaningful and lasting patient and healthcare outcomes for older adults.

Implications for the Profession and/or Patient Care

Findings provide clinical reference for designing engagement interventions, highlighting long-term benefits of partnership-based approaches and continuity beyond discharge.

Impact

Engagement in medication management during transitions of care varied significantly. High-level engagement was consistently linked to improved patient and healthcare outcomes but was often resource intensive. This review identifies the need to design balanced interventions that align with the preferences of older adults and real-world contextual healthcare settings.

Reporting Method

PRISMA guidelines.

Patient or Public Contribution

No patient or public contribution.

Protocol Registration

PROSPERO (registration number CRD42024557385).

Medidas más recurrentes para controlar las pestes por el cabildo limeño colonial

El objetivo de este trabajo es identificar algunas de las pestes acaecidas en Lima colonial, y conocer las medidas más recurrentes llevadas a cabo para evitar su ingreso o controlar su propagación. El método fue la búsqueda documental colonial en diferentes repositorios archivísticos, principalmente del Archivo Histórico de Lima Metropolitana y analizar e interpretar estos datos. El resultado confirmó que el cabildo aplicó algunas medidas de salubridad, protección e incluso prácticas religiosas comunes en el Antiguo Régimen español, como la limpieza de las calles y acequias, las cuarentenas de esclavos bozales y las procesiones de imágenes de santos a la catedral.

Parteira à Enfermeira Especialista em Enfermagem Obstétrica

Da Parteira à Enfermeira Especialista em Enfermagem Obstétrica: evolução da formação entre 1836 e 1988

 

Resumo

Contexto: Em Portugal, a escolarização das Parteiras teve início no século XIX, a partir de 1836, altura em que os cursos de partos começaram a ser ministrados nas Faculdades de Medicina, pelos professores da “arte obstétrica”. Desde essa altura e até 1988, ano em que o Ensino de Enfermagem foi integrado no Sistema Nacional do Ensino Superior, esta formação foi palco de uma enorme evolução  que importa explorar, realçando os marcos e os contextos  que mais a caracterizaram: a partir de 1943 os cursos decorreram nas Maternidades Alfredo da Costa, Júlio Dinis e Bissaya Barreto, onde estavam sediadas as delegações do Instituto Maternal, cuja extinção, em 1967, motivou a transição desta formação para as escolas de enfermagem, Calouste Gulbenkian em Lisboa, S. João no Porto e Bissaya Barreto em Coimbra; em 1983 os cursos transitaram para as Escolas de Enfermagem pós-básicas até 1988.

Objetivo: Descrever a evolução da formação das enfermeiras parteiras entre 1836 e 1988 no contexto português, e em especial na cidade do Porto, desde a altura em que se designavam por “Parteiras” até ao momento em que passam a titular-se como “Enfermeiras Especialistas em Enfermagem Obstétrica.

Metodologia: Método histórico, através da revisão da literatura e da análise documental de fontes primárias e da produção legislativa. 

Resultados: Entre 1836 e 1988, a formação das parteiras passou por várias mudanças institucionais e identitárias. Inicialmente, os cursos eram ministrados por médicos nas faculdades de medicina. A partir de 1943, a formação começou a integrar monitoras Enfermeiras Puericultoras ou Enfermeiras Obstetras, na docência. No total formaram-se 892 profissionais no Porto, incluindo cinco homens.

Conclusão: Entre 1836 e 1988, a formação de Parteiras e Enfermeiras Especializadas na área da saúde materno-infantil na cidade do Porto, decorreu em diferentes instituições e sob a influência de reformas sucessivas. Estas reformas elevaram o nível técnico e científico da profissão, contribuindo para fortalecer o reconhecimento social e a valorização profissional das Enfermeiras Especialistas em Enfermagem Obstétrica.

Palavras-chave:

Ensino, Parteira, Enfermeira Parteira, Enfermeira Obstetra, Enfermagem Obstétrica.

Educational Interventions to Enhance Delegation Practices Among Nursing Students and Newly Graduated Nurses: A Scoping Review

ABSTRACT

Aim

To scope international evidence on educational interventions to support delegation practices of nursing students and newly graduated nurses.

Design

A scoping review was undertaken following the Joanna Briggs Institute methodology, reported using the preferred reporting items for systematic reviews and meta-analysis scoping reviews extension (PRISMA-ScR) checklist.

Methods

CINAHL, ProQuest, Medline (Ovid), Scopus, EMBASE, Open grey and grey literature, from January 2014 to September 2024 were searched. Studies in English, empirical, evaluative, and available in full text were included.

Results

Eighteen studies were included in this review. Nine papers were evaluative. Fourteen of the papers were American. Educational interventions included role-play, case scenarios and peer learning. Three studies defined delegation, with four aligned to a delegation framework. Three studies were in clinical settings.

Conclusion

This review highlighted heterogeneity in educational interventions to support delegation practices. Gaps in the evidence base were highlighted, limited interventions in the clinical setting, absence of evidence underpinning educational effectiveness and minimal long-term follow up.

Implications for the Profession

Students and new graduate nurses were able to demonstrate learning after an intervention, highlighting the benefit of case studies, peer learning and simulation. However, the long-term impact is unknown. Interventions need to support theory to practice transition. Professional standards, roles, responsibilities and scope of practice need to be incorporated, and educational interventions should occur more than once to support meaningful and ongoing learning.

Impact

This scoping review highlighted variation in delegation educational interventions for nursing students and new graduate nurses, with limited interventions in the clinical setting. Knowledge acquisition regarding roles and responsibilities was not always evident within interventions. Given the evolving context of healthcare practice, interventions aligned to professional standards necessitate supporting the acquisition of knowledge regarding roles, responsibilities and scope of practice of healthcare workers registered nurses delegate too.

Patient or Public Contribution

No Patient or Public Contribution.

Innovation Competence in Healthcare: Individual, Environmental and Organisational Factors—A Mixed‐Method Systematic Review

ABSTRACT

Aims

To identify healthcare professionals' experiences of innovation competence and the factors associated with it; and to examine the instruments developed to assess innovation competence and its associated factors among healthcare professionals.

Design

A mixed-methods systematic review.

Methods

Researchers independently screened original studies by title and abstract (n = 2996) and then full text (n = 189). Eighteen studies were included: 16 quantitative and two qualitative. Qualitative data were analysed using inductive content analysis, and quantitative data were tabulated and synthesised narratively.

Data Sources

The review followed the Joanna Briggs Institute Mixed Methods Systematic Review methodology. Searches were conducted in Scopus, CINAHL, Ovid Medline, ProQuest, Web of Science, PsycArticles, and Medic. Articles published in English or Finnish with no date restrictions were included. The search covered records from database inception to August 2024.

Results

From qualitative studies, we identified three categories describing experiences of innovation competence: Competences for Innovation in Healthcare, Application and Impact of Innovation in Healthcare, and Challenges and Strategies for Implementing Innovation. Quantitative studies identified three conceptual domains: Individual Capacities in Innovation, Innovation-related Competence Behaviours, and Social and Organisational Enablers. Four categories of factors associated with innovation competence emerged: sociodemographic, career-related, organisational, and academic factors.

Conclusions

Healthcare professionals' innovation competence is a multifaceted construct encompassing individual abilities, behavioural expressions, and social and organisational engagement. A systematic and multilevel approach that targets both personal attributes and organisational enablers is needed to strengthen competence. Enhancing innovation competence can improve the healthcare sector's ability to respond to complex challenges and sustain innovation capacity.

Impact

Findings inform the development of education programmes and leadership strategies to enhance innovation competence among healthcare professionals, supporting innovation implementation in healthcare organisations.

Patient or Public Contribution

No patient or public involvement was included in this study.

Trial Registration

PROSPERO: CRD42024614551

Building and Sustaining Evidence‐Based Practice Through a Scholars Program

ABSTRACT

Background

Integrating evidence-based practice (EBP) into nursing is critical for improving clinical outcomes, yet adoption remains limited due to ongoing individual and organizational barriers.

Purpose

The EBP Scholars Program was developed to overcome barriers and foster a culture of evidence-based nursing practice within a pediatric healthcare system.

Implementation

Launched in 2007 during the organization's Magnet journey, the program is grounded in scientific, educational, and implementation science principles. Selected through a competitive application process, scholars engage in a seven-month structured curriculum grounded in the 8 A's Model of EBP. Learning outcomes are evaluated using pre- and post-program scores on the Evidence-Based Practice Knowledge Assessment Questionnaire (EBP-KAQ).

Outcomes and Impact

The program has enrolled 147 participants and graduated 124. On average, participants increased their EBP knowledge by 15.7%. Scholar-led projects have led to over 40 policy updates, new care guidelines, and measurable quality and safety improvements. Graduates have produced 43 posters, 18 podium presentations, and 9 peer-reviewed publications.

Linking Evidence to Action

The EBP Scholars Program offers a scalable model for embedding EBP in healthcare. Through strategic leadership, interdisciplinary collaboration, and structured mentorship, it has advanced evidence-based care, professional development, and a culture of continuous improvement.

Nurses' Perceptions of Fundamental Care in Preventing Venous Ulcer Recurrence: A Qualitative Focus Group Study

ABSTRACT

Venous ulcers are the most prevalent among those affecting the lower limbs, with high economic and quality of life impact. Due to the chronicity of venous disease, healing and recurrence cycles are common. Patient adherence to self-care activities to prevent recurrence is very low, so it is crucial to reflect on nurses' experiences with this phenomenon. A qualitative and descriptive study was developed to analyse nurses' perceptions about preventing venous ulcer recurrence. According to the inclusion criteria, focus groups with nurses were implemented. Three focus groups were conducted through the Colibri platform, ensuring all ethical assumptions. Content analysis was performed according to thematic criteria, using the WebQda software. Three main themes emerged: integration of care, context of care, and relationship. The participants emphasised the importance of holistic assessment and the establishment of common goals to promote adherence to fundamental recurrence prevention care. Understanding and respecting individual values, empathy and active listening, considering the established relationship, anticipating the person's needs, and trust are essential to overcoming barriers to implementing recurrence prevention care and to its continuity. Taking these aspects into consideration implies that the professional is part of the process of preventing the recurrence of venous ulcers.

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