OBJECTIVE:This systematic review aims to assess the prevalence and incidence of pressure injury associated with non-invasive ventilation (NIV) in adult patients treated for acute respiratory failure (ARF). INTRODUCTION:Facial pressure sores are a common complication of NIV, impairing skin integrity, patient comfort, and therapy efficacy. However, the ranges of incidence and prevalence reported in the literature are very wide. ELIGIBILITY CRITERIA:This review will include analytical observational and experimental studies reporting prevalence and/or incidence of pressure sores in adults treated with NIV for hypoxemic or hypercapnic ARF using oronasal, full-face, or hybrid masks. Any study or study arm testing interventions to reduce pressure sores will be excluded. Studies on pediatric patients and adult patients treated with other interfaces (ie, helmets) will also be excluded. METHODS:This systematic review will be conducted in accordance with the JBI and PERSyst methodology for systematic reviews of prevalence and incidence. Searches will be conducted in PubMed, Cochrane Library, Web of Science, Embase, national health-agency surveillance systems, Centers for Disease Control and Prevention data, gray literature, and clinical trial registers to identify unpublished studies. No language limitations will be applied provided an English abstract is available. Two reviewers will independently select studies, and data will be extracted using a customized form. Narrative synthesis will be conducted and, where appropriate, pooled prevalence and incidence proportion will be calculated using the DerSimonian and Laird method. Methodological quality will be assessed using JBI's Critical Appraisal Tool for Prevalence and Incidence Studies. REVIEW REGISTRATION:PROSPERO CRD42024604191.

Aims This study aimed to evaluate the psychometric properties of the Caregiver Preparedness Scale (CPS) in Italian informal caregivers of patients with coronary heart disease (CHD).Methods and results A secondary analysis was conducted using baseline data from the HEARTS-IN-DYADS study. A total of 155 informal caregivers (mean age = 54.1 years, 80% female) completed the CPS and additional validated measures assessing anxiety (Generalized Anxiety Disorder Questionnaire), mutuality (Mutuality Scale), and caregiver self-efficacy (Caregiver Self-efficacy in Contributing to Self-Care Scale). Psychometric evaluation included both classical test theory and item response theory approaches. The CPS demonstrated excellent internal consistency (Omega = 0.94) and a unidimensional factor structure with strong model fit. Item response theory analysis showed high item discrimination and well-spread threshold parameters. One item-related to emergency preparedness-exhibited lower discrimination and information but remained acceptable. Minor violations of local independence were observed in two item pairs, though these are unlikely to affect overall validity. Construct validity was supported by moderate-to-strong correlations with mutuality and self-efficacy and a weak but significant negative correlation with anxiety.Conclusion The CPS is a valid and reliable scale for assessing caregiver preparedness in CHD. Its application may facilitate caregiver assessment and inform supportive interventions. Future studies should explore its responsiveness over time and applicability across diverse caregiving contexts.

OBJECTIVE:This scoping review will map the characteristics of task shifting and task sharing involving nurses. INTRODUCTION:Amid a persistent global shortage of health care professionals, task shifting and task sharing are increasingly adopted to meet health care demands. Nurses form the largest group of skilled health care professionals worldwide, and they are key actors in these phenomena. Task shifting involves transferring tasks from one individual to another, while task sharing refers to collaborative responsibility for a task. Although widely discussed in the literature, some aspects involving nurses have not yet been mapped, such as the settings and characteristics of these practices. ELIGIBILITY CRITERIA:This review will consider evidence sources on task shifting or sharing to or from nurses, involving health care or non-health care professionals. Eligible sources will include primary and secondary studies employing quantitative, qualitative, or mixed methods designs. Dissertations and policy documents will also be considered. Only studies published from 2008 onward will be considered, with no language restrictions applied. METHODS:A comprehensive literature search will be conducted in databases such as PubMed, Embase, CINAHL (EBSCOhost), and ProQuest Dissertations and Theses Global (ProQuest), along with gray literature and the reference lists of relevant studies. Two reviewers will independently screen all records and assess full texts for eligibility. Data extraction will be performed using a structured tool developed and piloted by the reviewers. Results will be mapped and analyzed using descriptive statistics and content analysis. Findings will be presented using tables, charts, and graphs aligned with the review's subquestions. REVIEW REGISTRATION:OSF https://osf.io/w748g.

BACKGROUND:Family involvement in care has been shown to improve patient outcomes and reduce family caregiver burden. However, nurses' attitudes toward family participation vary widely and are influenced by multiple individual and contextual factors. Despite international evidence, there is a lack of data in relation to individual psycho-emotional and organizational predictors across settings. AIM:To assess nurses' attitudes toward involving families in care and individual and organizational factors associated with these attitudes. METHODS:A multicenter cross-sectional study between April 2024 and April 2025 across 16 local health authorities in Northern Italy. A total of 1288 registered nurses completed an anonymous online survey. Data included sociodemographic, professional, psychological (burnout, family functioning, caregiver support), and organizational variables, along with the Families' Importance in Nursing Care - Nurses' Attitudes (FINC-NA) scale. Hierarchical linear regression models were used to explore the role of individual and organizational predictors of attitudes across four FINC-NA subscales. RESULTS:Overall, nurses reported positive attitudes toward family involvement (FINC-NA mean = 100.5). Attitudes were most favorable in pediatric and primary care settings and less so in intensive care. Key individual predictors of positive attitudes included lower depersonalization, higher personal accomplishment, and greater perceived support from caregivers. Burnout, particularly depersonalization and emotional exhaustion, significantly predicted negative perceptions of families as burdens. Shift profile (day-night rotation) and lower private family functioning were also linked to more negative attitudes. Organizational factors, such as the presence of institutional caregiver procedures and unrestricted family access, were associated with more favorable attitudes but did not reduce perception of family as a burden. Notably, traditional variables such as age, gender, education, and work experience showed no influence. CONCLUSION:Nurses' attitudes toward family involvement are shaped by a dynamic interplay of psychological, relational, and organizational factors. Structural policies, while necessary, are insufficient on their own. Promoting family-centered care requires addressing nurses' emotional well-being and supporting relational competencies, particularly in high-stress settings. These findings call for integrated interventions and further longitudinal research to explore how attitudes evolve over time and respond to systemic changes.

BACKGROUND:In primary care (PC), nurses ensure continuity and person-centered care, fostering long-term relationships with patients and caregivers. How mutuality, a relational process closely linked to patient-centered communication, develops in this context remains underexplored. AIMS:To describe the characteristics of mutuality and explore how it develops in the relationships between nurses and care recipients in a PC setting. METHOD:A qualitative descriptive study was conducted in a PC setting. Participants included 14 nurses trained in Family and Community Nursing and 27 care recipients (patients and family caregivers). Data were collected between May and July 2024 through semistructured interviews. A total of 28 interviews were conducted, including both individual and dyadic interviews with patients and caregivers. Data were analyzed using framework analysis, guided by a conceptual framework on mutuality in the nurse-patient relationship. The framework focused on influencing factors, the mutuality process, and outcomes. RESULTS:Findings from 28 interviews revealed that mutuality was influenced by both organizational and personal factors. Nursing care delivery models that ensured continuity of care and nurse autonomy supported trust, stable, and long-term relationships. The process of mutuality unfolded progressively through three dimensions: (1) building and going beyond the formal encounter, (2) being a consistent point of reference, and (3) deciding and sharing care. Mutuality emerged as a co-constructed relationship, shaped by clear communication, trust, and shared responsibilities, with informal caregivers recognized as integral participants. Outcomes included strengthened professional identity and satisfaction for nurses and improved emotional well-being, self-care, and self-efficacy for care recipients. CONCLUSION:In PC, mutuality transforms task-oriented interactions into meaningful, trust-based relationships, enhancing patient-centered communication and shared decision-making. Care continuity and autonomy, combined with investment in relational skills, are essential to sustain mutuality, improve communication, and enhance care quality.

AIM:To estimate the incidence of unplanned transfers to the emergency department among nursing home residents and to identify resident and organizational factors associated with transfer risk. DESIGN:A 12-month prospective multicentre dynamic cohort study. METHODS:The study was conducted in nine nursing homes in a northern Italian region between July 2023 and June 2024. All long-stay residents aged 65 years or older were included and followed for up to 12 months. RESULTS:A total of 643 residents were included; 204 residents experienced at least one unplanned transfer, accounting for 271 events during follow-up. The incidence of first transfers was 4.47 per one hundred resident-months and varied across facilities. At the resident level, recent admission, a higher number of chronic conditions and dependence in eating were associated with a higher likelihood of transfer, whereas female sex was associated with a lower likelihood. At the organizational level, larger bed capacity was associated with a lower risk of transfer. In contrast, the presence of a physician on site and a higher ratio of general practitioners to residents per occupied bed were associated with increased transfer risk. CONCLUSIONS:Unplanned transfers from nursing homes to the emergency department are frequent. Strategies to reduce transfers should address resident vulnerability and organizational characteristics. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE:Nurses should recognize the early period after admission as a critical window for risk stratification and advance care planning and consider how resident vulnerability and organizational characteristics influence transfer patterns. IMPACT:Prospective evidence on unplanned transfers from nursing homes in Europe is limited. Nearly one third of residents experienced at least one transfer, highlighting the importance of addressing multimorbidity, functional dependence and organizational features when planning prevention strategies. REPORTING METHOD:The study adheres to STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

AimTo explore the factors influencing the Family and Community Nurse (FCN) role implementation within the local health authority (LHA) of Biella, Italy.DesignQualitative single embedded case study.MethodsTwenty-two participants (18 FCNs and 4 managers) were interviewed using in-depth semistructured interviews and timeline elicitation. Observational data were recorded in field notes. Data were analyzed using the Framework Analysis approach and organized through the Consolidated Framework for Implementation Research.ResultsAt the outer setting level, alignment with national policy and population needs supported adoption, although public awareness of the role was initially low. Within the inner setting, organizational flexibility enabled role adaptation, especially regarding project participation and time allocation. However, fragmented coordination with existing services and the persistence of task-based workflows limited integration. At the individual level, FCNs expressed strong motivation and professional identification, but also reduced confidence linked to limited preparation for community-based and educational activities. The process was supported by reflective leadership and the progressive tailoring of strategies to local needs and staff competencies.ConclusionImplementing the FCN role is a dynamic process shaped by structural conditions, professional boundaries, and stakeholder engagement. Sustainability requires system-level support, cross-sector collaboration, and a clearly defined scope of practice.ImpactThis study highlights key organizational and contextual conditions required to support the sustainable integration of FCNs. These insights may guide health service managers and policymakers in strengthening community-based care models, improving interprofessional coordination, and investing in role-specific education to meet the needs of aging populations.Reporting MethodThe study adhered to the Standards for Reporting Qualitative Research.Patient or Public ContributionNone.

INTRODUCTION:Historical, geographic, and contextual variation in nursing titles and the multitude of labels for different roles have hindered the creation of a clear map outlining nursing roles in home care settings for older people. OBJECTIVE:This scoping review aimed to explore the literature on nurses' roles in home care for older people. METHODS:A literature search was conducted using Embase, CINAHL, and Medline by two independent reviewers. RESULTS:Out of 1973 references, 14 studies from eight countries were included, primarily from the United Kingdom (n = 6), the United States (n = 2), and Italy (n = 2). Twelve distinct nursing roles were identified, addressing health issues such as cardiovascular disease, mental health disorders, and diabetes. The most frequent nursing activities performed were assessment-related (32%). CONCLUSION:The findings indicate the presence of diverse nursing roles in home care and highlight the significant heterogeneity in nursing activities performed.

AIM:This study explores how nursing students address patients' fundamental needs during their internships, identifying key processes and challenges. BACKGROUND:The Fundamentals of Care framework emphasizes a holistic, person-centered approach to nursing by addressing patients' physical, psychosocial and relational needs. However, its integration into nursing education remains limited, with a stronger focus on technical competencies rather than fundamental care. DESIGN:Qualitative descriptive study. METHODS:The study was conducted within the FoC-Form project in northern Italy. Semi-structured interviews were carried out with first- and second-year nursing students following their internships. Thematic analysis was applied to identify emerging themes and patterns. RESULTS:Four themes emerged: personal resources, care dynamics, contextual features and characteristics of the internship program. Students highlighted the importance of time management, relational aspects and mentoring in delivering fundamental care. Differences between first- and second-year students wereobserved in their clinical reasoning and approach to patient-centered care. Organizational factors such as workload and staffing also influenced their ability to meet fundamental needs. CONCLUSION:This study highlighted the critical role of mentorship and organizational support in fostering the integration of the Fundamentals of Care framework in nursing practice. Findings suggest the need for curriculum enhancements that balance technical training with the relational and holistic aspects of patient care. Nursing leadership should prioritize creating supportive environments that facilitate fundamental care practices.

BACKGROUND:Caregivers of patients hospitalized for coronary heart disease (CHD) are at risk of psychological distress, yet validated instruments for assessing anxiety and depression in this population during the acute phase are lacking. OBJECTIVE:In this study, we aimed to evaluate the psychometric properties of the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) in caregivers of hospitalized CHD patients. METHODS:This secondary analysis used data from 136 informal caregivers enrolled in the Self-Care in Coronary Heart Disease Patient and Caregiver Dyads study. Participants completed the GAD-7, PHQ-9, along with other self-report measures, during patient hospitalization. Item analysis, confirmatory factor analysis (CFA), internal consistency (McDonald's ω and Cronbach's α), convergent validity, and known-groups validity were examined. RESULTS:Mean scores indicated mild anxiety (GAD-7: 6.71, standard deviation [SD] = 6.58) and mild depressive symptoms (PHQ-9: 5.20, SD = 5.68). CFA supported a 2-factor structure (cognitive and somatic symptoms) for both scales, with good model fit and high factor loadings (>0.60). Internal consistency was satisfactory (GAD-7: ω = 0.93, α = 0.92; PHQ-9: ω = 0.89, α = 0.89). Convergent validity was supported by a strong correlation between GAD-7 and PHQ-9 scores (r = 0.72, large effect) and by associations between higher anxiety/depression and lower self-care self-efficacy scores. Known-groups validity was confirmed, with small-to-moderate correlations between female gender and both anxiety and depression. CONCLUSIONS:The GAD-7 and PHQ-9 demonstrated robust psychometric properties in caregivers of hospitalized CHD patients. Both instruments appear suitable for identifying caregivers at risk of anxiety and depression during the acute phase, supporting timely interventions in clinical practice.

Several factors increasing or minimizing the occurrence of Unfinished Nursing Care (UNC) have been documented to date. However, evidence available suggests a sort of stability in the decision-making patterns influencing the occurrence of UNC indicating the need to deepen the underlying criteria also to inform changes in nursing education. A sequential, explanatory, mixed-methods study design was performed including a cross-sectional survey and a qualitative descriptive study. The quantitative phase consisted of a national survey involving 15 hospitals, 110 units, and 1,977 nurses invited to complete the Unfinished Nursing Care Survey (from 1 ‘never’ to 5 ‘always unfinished’). A subsequent qualitative phase involved three focus groups with nurses identified from hospitals with high, medium, and low UNC occurrence. The data integration at the findings level was performed by using the explaining joint technique, where qualitative findings were used to explain the data collected in the quantitative phase. The Good Reporting of a Mixed-Methods Study guideline was followed. A total of 1,400 nurses (70.8

Background/Objectives: The REACtion project was developed to provide nursing care to older adults at home within the primary care setting. The COVID-19 pandemic posed significant challenges to its implementation, acting both as a barrier and an opportunity. Although several studies have explored healthcare innovation during emergencies, there remains a need for strategic insights to guide real-world implementation efforts. This study aims to explore how the COVID-19 pandemic influenced the implementation of the REACtion project and identify the strategies adopted to ensure continuity and effectiveness in achieving its goals despite the challenges posed by the health emergency. Methods: A qualitative descriptive study was conducted. Semi-structured interviews were carried out with nine project stakeholders, including nurses and researchers, between April and May 2023. The interviews were transcribed verbatim, read in-depth, and analyzed using content analysis to identify perceived barriers, facilitators, and strategies adopted during the project. Results: The pandemic shifted priorities from routine care to emergency health activities. Barriers to project implementation included social distancing, disruptions in the decision-making processes, and a general decline in community welfare. Despite these obstacles, the COVID-19 context underscored the central role of Family and Community Nurses in proactive primary care. Stakeholders adopted relationship-based strategies, addressed workforce shortages, and implemented measures to mitigate personal fatigue. Conclusions: The implementation of innovative nursing interventions during emergencies requires adaptability, collaboration, and context-sensitive approaches. Strengthening stakeholder engagement and leveraging professional roles within the community are essential to overcoming barriers and seizing opportunities in crisis contexts.

Background: Nurses report that they often must perform activities outside their area of expertise, referred to as “non-nursing tasks”. The time spent on simple tasks undermines nursing capacity, which is already challenged by the dramatic shortage of nurses. Performing non-nursing tasks affects nurses’ satisfaction and their intention to stay. However, despite their relevance, there is no summary of studies on non-nursing tasks. The aim of this study is to summarize available evidence on characteristics of non-nursing tasks, their antecedents, and consequences, to identify gaps in the existing literature and to make recommendations for management, education, practice, and nursing research. Methods: A scoping review will be conducted using Arksey and O’Malley’s methodological framework. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews, and the Patterns, Advances, Gaps, Evidence for practice and research framework will be used to report and summarize the findings. Results: Findings will provide a map regarding the main patterns of research in this area and the evidence produced to date. Two main lines of findings are expected, namely the conceptual and the empirical. The former may contribute to the understanding of the terminology and concept used so far to clearly express non-nursing tasks; the empirical evidence may shed light on frequencies, instruments, reasons, and effects. Discussion: An analysis of non-nursing tasks will provide healthcare organizations with a conceptual framework of all variations in the phenomenon and will help managers to identify the activities that will fall within this conceptual construct. The establishment of a research strand in this field, based on a science-based review involving international stakeholders, can strengthen global action to prevent the occurrence of non-nursing tasks.

This systematic review aims to evaluate the impact of multimedia education compared to standard approaches for people with central venous access devices for long-term use. We systematically searched PubMed, Embase, and CINAHL Complete until January 2025. Two independent reviewers conducted study selection, data extraction, and risk of bias assessment. Ten studies were identified (832 patients), including six randomized controlled trials and four quasi-experimental studies. Seven multimedia educational programs used asynchronous methods (e.g. pre-recorded videos or presentations), while three employed synchronous approaches (e.g. tele-visits or virtual communities). Five studies assessed short-term knowledge, with two showing significant improvements and three reporting no differences. Skill acquisition improved in two studies. Cumulative catheter complications decreased in two studies, though findings on specific issues were mixed. These findings suggest potential benefits of multimedia education in patient care, but methodological limitations and study variability render the evidence inconclusive, underscoring the need for high-quality research.

Objective:The objective of this review is to identify and map the available evidence on interventions for heart failure dyads through telemedicine.Introduction:Heart failure is a chronic and progressive condition that requires significant lifestyle changes and daily support from informal caregivers. Due to the shared burden of care, the patient-caregiver dyad should be treated as a single unit in the management of the disease. Although telemedicine interventions for dyads are increasing, their application for dyads with heart failure remains largely unexplored, revealing a critical gap in the field.Eligibility criteria:We will include all quantitative, qualitative, and mixed methods studies focusing on adult dyadic interventions for heart failure delivered via telemedicine. Studies involving dyads who do not share the same household will also be considered. Dyadic interventions aim to reduce discrepancies between patients and caregivers in their approach to the disease (dyadic appraisal), foster greater collaboration in planning appropriate responses to the disease (dyadic behavior), and improve the overall health status of both individuals (dyadic health). These interventions can be provided by various health care professionals using any device.Methods:The scoping review will be conducted according to JBI methodology for scoping reviews. We will comprehensively search electronic databases, including PubMed, CINAHL, Web of Science, and Embase. Gray literature will also be considered. Two independent reviewers will screen the studies according to predefined criteria. Data extraction will be performed using a customized tool. Review findings will be analyzed and displayed using charting techniques in table format.Review registration:OSF osf.io/nwafp

AIM:To assess and synthesise evidence on short peripheral intravenous catheter (sPVC) management training programmes and evaluate their effectiveness in reducing early sPVC failure in hospitalised patients. BACKGROUND:Modifiable risk factors, including choice of catheter, site of insertion, early recognition of complications and provider expertise, play a critical role in sPVC failure, highlighting the need for targeted educational programmes to improve provider skills and adherence to evidence-based practices. DESIGN:A systematic review was employed following the PRISMA guidelines. METHODS:A systematic search was conducted across four databases-PubMed, Embase, CINAHL and the Cochrane CENTRAL. Only randomized controlled trials (RCTs) evaluating training programmes for sPVC management in healthcare professionals, with outcomes related to sPVC failure, were included. Risk of bias was assessed using the Cochrane risk-of-bias tool for RCTs. The protocol was registered in PROSPERO (CRD42023444364) and the search covered studies published up to June 20, 2024. RESULTS:The search strategy retrieved 12,253 articles, of which three were included. These reported a significant reduction in sPVC failure in the intervention groups, with reductions ranging from 8 % to 29 %. However, no improvements were found in individual outcomes (occlusion, dislodgment, infiltration, infection). The included studies exhibited substantial heterogeneity in training programme characteristics, including duration, content and delivery methods. CONCLUSION:Structured training programmes can help reduce sPVC failure rates, despite variations in programme implementation. Short- and long-term programmes showed benefits, with long-term training supporting sustained adherence to evidence-based practice despite requiring more resources. A small number of studies prevent definitive conclusions about overall effectiveness.

AIMS: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. DESIGN:Secondary analysis of baseline data from a multi-centre longitudinal study. METHODS: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. RESULTS: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. CONCLUSIONS: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. REPORTING METHOD:We adhered to STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION:Patients and members of the public were not involved in the design, conduct, reporting, or dissemination plans of this research.

This study investigates the psychometric properties of the Mutuality Scale in a sample of patient-caregiver dyads following a recent episode of coronary heart disease. A cross-sectional analysis was conducted. Factorial validity was tested with confirmatory factory analysis. Internal consistency reliability was investigated with the model-based internal consistency reliability index. Pearson's correlation coefficient was used to test convergent validity between mutuality and other theoretical and empirical variables associated with it. We included 150 patient-caregiver dyads (patient: mean age 65 years, 77% males, 71% married; caregiver: mean age 54 years, 21% males, 71% married). The CFA testing the theoretical four-factors (love, shared pleasurable activities, shared values, and reciprocity) of mutuality demonstrated adequate fit to the data in both the patient and caregiver version of the scale. Reliability estimates were adequate for the whole scale (model-based internal consistency index = 0.95). Significant positive correlations were observed between mutuality and self-care behaviors, and caregiver preparedness, supporting convergent validity. The Mutuality Scale demonstrated satisfactory structural and convergent validity and reliability in patient-caregiver dyads after the onset of a coronary heart disease event.

The COVID-19 pandemic significantly impacted emergency department (ED) visits by nursing home (NH) residents, leading to notable shifts in visit rates, characteristics, and outcomes over time. This retrospective study analyzed all-cause ED visits among NH residents aged over 65 at a large Italian hospital from 2019 to 2022. Non-COVID-19 visits declined sharply by 63.8% in 2020 and continued to remain below pre-pandemic levels in the following years. Compared to 2019, the risk of respiratory disease-related visits decreased significantly in 2021 and 2022. Conversely, the risk of mental health-related visits, particularly for neurotic disorders, increased significantly, with a threefold rise in 2021 and a fourfold rise in 2022. Similarly, fracture-related visits nearly doubled in 2021 and remained high in 2022. These findings underscore the pandemic's enduring effects on the health of NH residents and highlight the critical need to strengthen healthcare systems to effectively manage future health crises.

Background Fundamentals of Care (FoC) are often perceived as "invisible" and of lesser clinical relevance, especially among nursing students. Evidence on how to integrate the FoC Framework into undergraduate education and assess its impact remains scarce. Aim To assess the effectiveness of integrating the FoC Framework into a three-year undergraduate nursing curriculum on students’ clinical reasoning, technical and relational competencies and patient-reported experiences of care. Design Multicentric randomized study following first-year students through their third year. Methods The experimental group followed an FoC-informed integrated curriculum; the control group the standard one. Assessments included the Triple Jump test and Objective Structured Clinical Examination. Additional data were collected on patient perception and students’ learning approaches. Results A total of 234 students were enrolled across four universities, with 150 progressing to year two and 79 to year three. The intervention group consistently achieved higher Triple Jump scores in the second and third years (p <.05) and higher Objective Structured Clinical Examination scores across all three years, both pre- and post-placement (p <.05). Relational skills scores were also higher in the third year. No significant differences were found in patient-reported experiences of care or in students’ learning approaches. Conclusions Integration of the FoC Framework into the curriculum enhanced clinical reasoning and improved early technical and relational performance, although these gains were not reflected patient-reported outcomes. Future studies should consider involving the broader healthcare team to support a more effective and sustained transfer of FoC principles into clinical practice.