Introduction. Medication adherence plays a critical role in the clinical management of chronic conditions and may significantly influence patients' quality of life (QoL). Understanding this relationship is particularly important in populations with multimorbidity. Focusing on the problem of chronic conditions and multimorbidity in young adults is crucial because they represent the active part of society and chronicity is now public health concern due to the high number of incidence and mortality among this group population. Methods. An extensive literature search was conducted in the PubMed/MEDLINE, Scopus, and Web of Science databases for the period 2014–2024. The search strategy used both Medical Subject Headings (MeSH) and keywords related to medication adherence, quality of life, chronic conditions, and adult populations. Original, full-text articles published in English between 2014 and 2024 were included if they involved adults aged 18–65 with one or more chronic conditions (e.g., diabetes, hypertension, COPD), living in community settings. Eligible studies employed RCTs, cohort, cross-sectional, case-control, qualitative, or mixed-methods designs and reported on both medication adherence and quality of life. Studies were excluded if they focused on psychiatric, oncologic, surgical, transplant, or dialysis populations, hospital-based settings, or lacked relevant adherence and quality of life outcomes. This review is in PROSPERO with code CRD42025641905 Results. Eleven studies were included, cross-sectional, randomized control trial, mixed methods, semi directive interview. Most studies demonstrated a positive association between medication adherence and quality of life, with higher adherence linked to better physical, psychological, and social well-being. Pharmacist-led interventions and digital tools emerged as effective strategies for improving adherence. However, heterogeneity in measurement tools and study populations limited comparability. Discussion. Medication adherence is a key modifiable factor influencing quality of life among individuals with chronic conditions and multimorbidity. Multidimensional adherence-enhancing strategies—including education, patient empowerment, and system-level changes—are essential. Future research should adopt robust methodologies and standardized outcome measures to better inform clinical practice and policy.
Introduction. Optimizing a self-care approach to support health maintenance in patients with aortic valve stenosis (AVS) who require minimally invasive transcatheter aortic valve implantation (TAVI) before and after the procedure could promote faster and more effective recovery. Additionally, this methodology may improve the perceived health-related quality of life (HRQoL) in the patients undergoing treatment, contributing to better overall outcomes through health promotion practices and disease management. This review's primary objective is to investigate self-care's effectiveness in enhancing quality of life. Methods and materials. The literature review protocol follows PRISMA guidelines and uses the PIO framework for search terms. Studies will be identified through significant databases (PubMed, Scopus, CINAHL, Web of Science, and Cochrane Library). Methodological quality and bias risk will be assessed with JBI Critical Appraisal Tools. This review protocol has been registred on PROSPERO (No. CRD420250655531). Results. The emerging findings could potentially contribute to refining current theories on the indications for using self-care interventions to improve the HRQoL of patients undergoing TAVI. Discussion and conclusions. Future implications for research and clinical practice should adopt an increasingly targeted and focused approach in using self-care interventions to enhance the health-related quality of life of patients undergoing TAVI, both in terms of symptom recognition and disease management pre- and post-procedure. This systematic review will comprehensively examine the effects of the implementation of self-care methodologies on improving the quality of life in post-TAVI patients.
Introduction. Stigma affects a large proportion of people with mental health conditions and it can be a potent social stressor, presenting persistent challenges to individuals’ coping abilities. The present study aimed at mapping and exploring the direct experiences of stigma encountered by individuals with mental health conditions. Methods. A scoping review was conducted according to Joanna Briggs Institute guidelines. Searches of PubMed, PsycINFO, EmBASE, and CINAHL led to 18 eligible qualitative studies. Results. Four primary themes emerged: self-stigma, involving the internalization of societal stereotypes; descriptions of social and public stigma; lack of knowledge in mental illnesses’ course; and the consequences of stigma for individuals’ lives. Discussion. Results highlight the deeply negative and exclusionary impact of stigma surrounding mental disorders, outlining its manifestation and repercussions for social life. Future research is needed to identify a direct approach to the issue and to detect the most appropriate approaches in facing it. To help limiting the experience of stigma, healthcare providers should ensure an individualized care relationship, in a secure and empathetic environment filled with elements of understanding, consent and informativeness.
Introduction. Multimorbidity is an increasing global concern, particularly among older populations, affecting 55-98% of those aged ≥ 65 and above. This study aims to provide a comprehensive global overview of research on multimorbidity in older adults. It will assess the quantity and types of studies focused on the prevalence, patterns, determinants, risk factors, and consequences of multimorbidity, while also identifying key research gaps for future studies. Methods. This mapping review study was conducted using the PubMed, Scopus and Web of Science databases in December 2024. Only full-text papers published in English were included. The search terms included ‘aged’, ‘multimorbidity’, ‘multiple chronic conditions’, ‘prevalence’, ‘cost of illness’, ‘social determinants’, ‘risk factors’, and ‘Albania’. After filtering, all results were exported to Rayyan reference management software. Duplicates were removed, and the remaining papers were evaluated for suitability based on their titles and abstracts. Results. After the full text screening the final set for data extraction includes seven observational studies on multimorbidity in older adults. Europe has the highest number of studies, with four, followed by Asia with three studies. Despite this, Asia has a greater coverage of studies on multimorbidity in older populations. North and South America are represented by two studies from each. Six of included studies examine the prevalence of multimorbidity, with four exploring its patterns and consequences, and one investigating its determinants and its risk factors. Discussions. There are notable gaps in research on multimorbidity in older adults, particularly regarding its determinants, and risk factors. No studies on multimorbidity in older adults were found for Africa and Australia in the period 2019-2024.
Introduction. The role of Middle Nurse Managers has become increasingly complex, encompassing responsibilities that range from personnel recruitment to financial and strategic management. Recently, their tasks have become more focused on administrative activities, reducing direct clinical involvement. This evolution can lead to stress and dissatisfaction, requiring a more empathetic and relational management approach to improve work quality. To conduct a preliminary linguistic validation and evaluate the reliability of the Italian version of the "360 Degree Evaluation of the Job-Related Skill Perception of Primary Health Care Nursing Managers" questionnaire. Methods. A translation and cultural adaptation study of the cited questionnaire into Italian was conducted. The goal of the linguistic validation was to produce a translated version that maintained the integrity of the original questionnaire. Results. This preliminary study evaluates the validity of the "360 Degree Evaluation of the Job-Related Skill Perception of Primary health care Nursing Managers" scale among Middle Nurse Managers in Italian hospitals. The scale, consisting of 40 items, assesses skills in communication, leadership, personnel management, financial management, planning and priority setting, and problem-solving. Findings indicate that nurse managers perceive high competencies in communication, leadership, and personnel management, while highlighting gaps in financial management and the implementation of complex plans. Discussion. The study highlights the need for specific, targeted training in financial management to address these gaps. Such training is essential to enhance the competencies of nursing middle managers and support the success of healthcare organizations. Further psychometric validation studies are needed to confirm these preliminary findings.
Introduction. Uganda’s efforts for sharps handling, and their waste management are restrained due to shortage of equipment and supplies resorting to alternatives that may not meet standards. The aim of this study was to provide a current detailed account of the prevalence of sharp injuries, and independent risk factors for these injuries among healthcare workers in a resource limited setting. Methods. A hospital based cross sectional study was conducted among healthcare professionals offering care in a 333-bed capacity tertiary care facility. A self-administered questionnaire was used. Prevalence, and sociodemographic characteristics were determined using descriptive analysis. Univariate and multivariate binary logistic regression analyses were conducted to explore the independent factors associated with risk of sharp injuries. Results. 147 health professionals participated in this study, and majority (57.14%) were females. The median age in years was 38.48 with an interquartile range of (30.87-47.35). The period prevalence of sharps injuries was 40.14% (1 in 3), and health professionals with at least one training in sharp handling, and disposal a year were less likely to have sharps injuries that year (aOR=0.1, 95% CI=0.01-0.48, p=0.006). Work related stress increased the odds of sharps injuries (aOR=4.3, 95% CI=1.2-9.8, p=0.005). Discussion. The overall prevalence of sharp injuries is high. Multidimensional factors including psychological stress, limited flexibility in hospital policies, and less training on sharps handling and disposal every year were associated with sharps injuries. Feasible hospital interventions including simulation-based training, digital education on sharps handling, and disposal should be implemented by hospital administration. While this training on sharps handling, and disposal may be important, its efficacy should be ascertained through repeated studies. Support through allocation of resources, and capacity building from ministry of health, and partners could be of help.
Introduction. Valvular heart disease (VHD) is a growing global health issue, particularly among aging populations. Surgical valve replacement improves survival and cardiac function, yet long-term outcomes rely heavily on patient engagement in self-care. Educational interventions may enhance self-care behaviors and improve clinical and psychosocial outcomes; however, evidence remains fragmented. This systematic review aimed to evaluate the characteristics and effectiveness of educational interventions designed to support self-care in patients following cardiac valve replacement. Methods. Following PRISMA guidelines, a systematic search was conducted in PubMed, Scopus, Web of Science, and CINAHL from databases inception up to February 2024. Only randomized controlled trials (RCTs) assessing educational or behavioral interventions aimed at improving self-care after valve surgery were included. Outcomes were categorized as clinical (e.g., INR stability, complications), behavioral (e.g., medication adherence), or patient-reported (e.g., quality of life). Risk of bias was assessed using the ROB2 tool. Self-care behaviors targeted by interventions were classified according to to Riegel’s Middle Range Theory of Chronic Illness. Results. Six randomized controlled trials involving 537 patients were included in the review. Interventions varied in delivery mode (all face-to-face, some with telephone or digital support), format (individual or group-based), duration, and frequency. All studies targeted self-care monitoring and management, mainly through INR self-monitoring and anticoagulation adherence, while self-care maintenance behaviors such as diet, physical activity, and psychosocial support were less frequently addressed. Interventions improved INR stability, medication adherence, self-efficacy, and psychological well-being, with some evidence for reduced complications and better quality of life. However, reporting was heterogeneous, theoretical frameworks were rarely applied, and cost-effectiveness and long-term sustainability were seldom evaluated. Discussion and conclusion. Self-care interventions after valve replacement surgery appear effective in improving anticoagulation control and enhancing psychosocial outcomes. Yet, most programs focus narrowly on anticoagulation, overlooking lifestyle modification and broader recovery needs. Future studies should adopt standardized, theory-driven, and multidimensional approaches, integrate digital health solutions, and evaluate long-term effectiveness and cost-efficiency to ensure sustainable and equitable self-care support.
Introduction. Generative Artificial Intelligence (AI), specifically through Large Language Models (LLMs), is progressively reshaping clinical documentation, decision support, patient education, and research synthesis in healthcare. Despite significant benefits, these models pose challenges such as inaccuracies (hallucinations) and inherent biases. This paper highlights prompt engineering as an emerging and critical skill for healthcare professionals and demonstrates how structured prompting techniques can improve the reliability, clinical relevance, and ethical compliance of AI-driven applications. Methods. A systematic review of recent literature was conducted to present structured prompt engineering methodologies specifically tailored to healthcare settings. Advanced prompting techniques, including chain-of-thought reasoning, zero-shot and few-shot prompting, and self-consistency strategies, were examined. Results. The proposed structured approach encompasses clear objective definition, precise contextualization, integration of domain-specific knowledge, iterative refinement, and ethical risk mitigation. Practical guidelines are provided for designing prompts suitable for clinical scenarios, such as diagnostic decisions, patient-specific therapeutic protocols, and administrative tasks. Notably, advanced techniques such as chain-of-thought reasoning and self-consistency effectively reduce inaccuracies and enhance clinical decision-making. Discussion and Conclusion. The structured integration of prompt engineering optimizes clinical decision-making and supports adherence to evidence-based practices. Incorporating prompt engineering into healthcare educational programs and fostering interdisciplinary collaboration are crucial for the responsible implementation of generative AI. These advancements have far-reaching implications for improving clinical effectiveness, enhancing patient care quality, and elevating the standards of healthcare education and professional practice.
Introduction. Preventing and controlling Healthcare Associated Infections (HAIs) caused by Multi Drug Resistant Organisms (MDROs) is one of the primary goals in high-risk settings like Intensive Care Units (ICUs). The leadership style of the head nurse can result in a reduction of infection rates, such as bloodstream and urinary tract infections; however, it is unclear how leadership can encourage nurses to adhere to Infection Prevention Control (IPC) programs. This study aims to explore the role of the head nurse in encouraging the clinical care team to adhere to IPC practices for preventing and controlling MDRO infections in the ICU. Methods. In 2024, a single-centre interpretative phenomenological study was conducted following the Consolidated Criteria for Reporting Qualitative (COREQ). Nurses and head nurses from three ICUs were recruited. Data were collected through semi-structured interviews and analysed thematically. Results. Eleven nurses and two head nurses were recruited. The results identified four themes that facilitate the management of HAIs by MDROs: a) awareness of the infection problem, b) head nurse supervision, c) information sharing, and d) distribution of responsibilities. The involvement of leadership and learning through feedback from head nurses are perceived not as barriers but as added value that promotes the dissemination of best practices. Conclusions. Recognising the role of the head nurse in the management of HAIs by MDRO would represent an important driver for change in high-risk infection settings. It would enable healthcare organisations to intervene not only with nurses directly involved in patient care but also with middle managers who implement the hospital's directives and produce nursing sensitive outcomes.
Introduction. Professional values play a crucial role in nursing practice, as they influence nurese’ care quality and ethical decisions. In an evolving educational and healthcare context, it is essential for students to develop and integrate the professional values necessary to effectively address future challenges. This systematic review aims to identify the professional values declared by nursing students during their academic journey. Methods. A comprehensive literature search was carried out for primay quantitative studies published until december 2024 in the databases PubMed/Medline, Embase, CINAHL, Scopus, and yielded 21,071 records. After screening, 29 relevant studies were included in this review. The process of screening, selection and inclusion of articles was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic review was conducted following the JBI Manual for Evidence Synthesis. Methodological quality assessment and methodological quality of the included articles were evaluated. Results. The 29 included studies, comprising 3 cohort studies and 26 cross-sectional studies, reported a low methodological quality assessment, ensuring high reliability of the results. The most frequently cited value was Caring, while Activism and Altruism were also important values for students. Additionally, specific studies highlighted values such as the Principle of Work, respect for Human Dignity, Ethical and Moral aspects, as well as Nursing Professionalism. Discussion. The review provided insight into the fundamental values that define nursing students. Furthermore, it enabled an understanding of the multiple variables that shape professional values, highlighting key factors such as academic education and cultural context. These findings offer a foundation for further exploration of the elements that directly influence the development of professional values.
Introduction. In healthcare system management, managing operating rooms, which are characterized by a significant production focus and a correspondent high level of complexity, is one of the most current issues, to implement more efficient models, based on a balanced use of resources. Operating Room Management is an emerging model based on Operation Management. Although in literature it is easy to find concepts and tools regarding the Operation Management of surgical items, little is known so far about the roles which should apply these principles. The topic is shown in a few articles, many of these marginally related to it, but none derived from primary studies. Methods. To thoroughly explore the topic, the study aimed to investigating whether the Operating Room Manager is a well-known figure, how it is defined by decision-makers with different role, and whether it is considered a resource to be integrated into current surgical paths management systems. Doctors, nurses and other figures, managers involved in the operating theatres were involved. A qualitative content analysis technique was used. This method allows analysis of both the manifest and latent content of interviews, making it suitable for exploring a ‘territory’ that is, to some extent, considered unexplored. Results. Results, obtained from a sample of 11 professional figures, led to the extraction of 6 themes: The dynamism of organizational models and the balance between resources and related risks; Curriculum and complexity: a difficult choice; The role in the management complexity regarding processes and professional figures; Competences: Knowledge of the system (“reading” the processes) and leadership; Teamworking ability; Areas of activity and development: bridge figure with other contexts and “resisting to resistances”. Each theme represents the following areas: Organizational models and Operation Management; curriculum; role; skills and leadership; teamwork; area of development. Discussion and Conclusions. Between the themes emerged from the analysis regarding the role of the Operating Room Manager, the curriculum and the areas of competence and development are fairly well-defined. However, the theme of skills and the role itself struggles to emerge, and a clear profile of the Operating Room Manager should be better defined in future studies.
Severe aortic stenosis is an increasingly prevalent valvular condition due to population aging, associated with debilitating symptoms and high mortality when left untreated. Transcatheter aortic valve implantation (TAVI) has revolutioned the management of aortic valve disease by providing a minimally invasive alternative that reduces hospital stays and enhances clinical outcomes. In this context, the TAVI Nurse Coordinator plays a crucial role in overseeing the entire patient care pathway. This includes conducting comprehensive frailty assessments and educating both patients and caregivers during the preoperative phase, as well as managing postprocedural follow-up - ensuring seamless multidisciplinary coordination and personalized patient care.
Introduction. Case Managers have long been deployed in palliative cancer care, but the heterogeneous nature of this role makes it difficult to gather evidence of its effectiveness and consequently foster standardized implementation by health policies. We explore the models, characteristics, and specific activities that Palliative Care Case Managers perform in oncology. Methods. This scoping review was performed and reported according to the PRISMA-ScR checklist. Seven electronic databases (Cochrane Library, PubMed, Scopus, EMBASE, CINAHL, PsycINFO, and Web of Science) and Google Scholar, were searched for relevant papers until June 2024. Studies were included if they reported Case Management interventions for patients with cancer receiving palliative care. Charted data included study characteristics, Case management activities, Case management models, and intervention delivery. Results. Twelve studies were included. A total of 38 activities emerged from the analysis and five themes were identified across them, including “Information, education and self-management”, “Support and counselling”, “Patient centredness”, “Network”, “Quality of care”. In all studies, the CMs role was performed by a nurse, with a specific experience or training in palliative care or oncology, with multidisciplinary teams acting as support or as possible consultants. Activities were provided by phone, by hospital visits, via homecare visits or a combination of all above models. Only seven studies reported outcome measures related to patient or health care system dimensions, while data regarding case load were reported in four studies. Research gaps include impact and feasibility methodology, informations about referral criteria for case management service, the satisfaction of patients and health care providers with the service, barriers and facilitators, and the investigation of the most suitable professional to perform the case management role. Discussion and Conclusions. It is important to standardize the description of case management activities in the literature and establishing a shared definition of this role in diverse contexts, including its modes of multidisciplinary integration. A standardized reporting framework for studies on this topic is needed to guide future research. Further studies are needed to describe case management activities in palliative care for cancer. This is the first scoping review to systematically explore and summarize Case Management activities and models in Palliative Care for Cancer. These findings will support nursing organizational policies in the design of Case Management services in Cancer Palliative Care, address key issues in case management practice and proposing examples for personalized implementation of this service across clinical contexts. Nursing researchers can foster studies on this topic to improve the body of evidence at our disposal.
Introduction. Contributing factors to the development of malnutrition include the presence of a critical illness. A state of malnutrition is associated with worse outcomes, such as prolonged length of stay and mechanical ventilation, increased risk of contracting infections and developing pressure sores, increased readmission rates, morbidity, and mortality. The aim of the following study is to is to identify predictors of early nutritional risk in critical illness in relation to mNUTRIC, in the first 36 hours of ICU admission. Methods. This is a single-center observational study. The sample consisted of 103 patients admitted to the ICUs of a university hospital in central-southern Italy. The instrument, created on the basis of the literature review, is made of 25 items. A descriptive statistycal analysis was then conducted and the correlation between the items of the instrument and the independent variables were analyzed with Kendall's Tau. Multiple regression analysis was performed, which was evaluated to describe the relationship between the variables, therefore to determine how the various coefficients affect the mNUTRIC variables. Results. The sample had a mean age of 62.25 years, with a mean risk of malnourishment of 3.30 on the mNUTRIC scale. The overall model was statistically significant (F(3, 85) = 31.92, p < 0.001), age showed a significant positive effect (β = 0.485, t = 6.43, p < 0.001) as well as lactates that showed a significant positive effect (β = 0.204, t = 2.73, p = 0.008) and the positive and significant effects of meccanical ventilation and sedation (β = 0.423; t = 5.625; p < 0.001). Discussion. Predictor analysis has succeeded in defining variables that can be considered to improve early metabolic consequences in critically ill patients. Therefore, it is necessary to create rapid and comprehensive tools with specific variables to reduce malnutrition conditions early and activate ad hoc nutritional pathways in critically ill patients.
Introduction. Total artificial heart (TAH) devices are a viable bridge to transplantation in patients with end-stage biventricular heart failure. Among these, the Aeson CARMAT® TAH offers pulsatile flow and biocompatible materials to enhance physiological compatibility and reduce thromboembolic risks. Case Presentation. We describe the case of a 62-year-old male with ischemic cardiomyopathy and NYHA Class IV symptoms, deemed ineligible for immediate heart transplant. The patient underwent Aeson TAH implantation following multidisciplinary evaluation and was admitted to the cardiac surgery intensive care for postoperative management. Clinical Findings. Postoperative care focused on six core areas: (1) hemodynamic monitoring, including continuous tracking of pressures and device-derived values; (2) anticoagulation and bleeding control with INR-based dosing; (3) infection prevention via strict asepsis and respiratory therapy; (4) device monitoring, including waveform interpretation and alarm management; (5) patient and caregiver education on device handling and complication signs; and (6) early mobilization to prevent ICU-related complications and support functional recovery. Discussion. The case highlights the nurse’s central role in managing TAH patients, integrating technical competence with holistic support. Early identification of complications and structured education contributed to a successful recovery and preparation for transplant listing.
Introduction. Central vascular access devices are widely used in oncology settings due to the significant side effects of chemotherapy on blood vessels. Despite the methodological robustness of the literature, the enhanced integration of patients’ perspectives would enrich the evidence on this topic. This study explores oncology patients' experiences with cVADs (PICC and TIVAD), from insertion to daily life management. Methods. We conducted a generic qualitative interview study with thematic analysis. Adult patients with a Peripherally Inserted Central Catheter or a Totally Implantable Venous Access Device receiving oncological treatment at the Oncology Department of the Azienda USL – IRCCS of Reggio Emilia were included, as also those who completed the treatment plan. Results. The emerging themes were categorized into three main areas: (1) catheter implantation, (2) catheter maintenance, and (3) “daily life” with the catheter. Patients reported a high degree of satisfaction with the information and the education received by healthcare professionals: this appeared crucial in reducing anxiety and fear during the device placement and its daily management. However, patient engagement in the device selection appeared less consistent. The devices were well tolerated and had a low impact on their daily activities. All participants perceived the devices as helpful and safe during their care pathway. Discussion. The study confirmed the importance of central venous access devices to minimize patient discomfort during chemotherapy treatment. The competence and empathy of healthcare professionals, along with adequate information and education, contribute to reducing patient’s anxiety. Improving patients’ engagement in the device choice is necessary. Patients reported a positive experience, enabling them to cope with the device, even at home.
Introduction. In the Emergency Department, it is increasingly necessary to be able to find stable venous access when managing acute patients. This study aims to investigate the effectiveness of ultrasound-guided nursing compared to the standard “blind” technique. Methods. A comprehensive literature search was undertaken using PubMed, Cochrane, and EMBASE. The results were then evaluated according to the JBI checklists. Results. 9 studies are considered for this review. This review showed the effectiveness of the ultrasound-guided cannulation procedure (53-91.75%) compared to the standard blind technique. It also indicated a reduction in adverse events, a decrease in the number of attempts needed for successful cannulation (1-2.2 punctures), an increase in success on the first attempt (78.9-83%), greater user satisfaction with the ultrasound-guided technique, and reduced pain perception. Discussions. The effectiveness of the ultrasound-guided cannulation procedure compared to the standard blind technique is aligned with the literature. The innovation of this review is the evaluation of nurse execution, time analysis, user satisfaction, reported pain, and the technique's success.
