Nursing Activities Research Articles

N53 Managing an ever-increasing inflammatory bowel disease helpline service

Abstract Background Inflammatory bowel disease helplines have been initiated by Trusts throughout the country over many years. However many of them are not adequately job planned and have also seen a dramatic rise in calls over the years. Our Trust operates a helpline over 3 acute hospital sites. Previously calls were not accounted for financially and calls not documented in patient notes. Previously all helpline messages were retrieved by one of the clinical nurse specialists which took a considerable amount of nursing time. Methods The nurses on each site all undertake a number of clinical shifts per week answering helpline calls. Previously a list of patients was compiled from patient 1 onwards and staff were unable to prioritise any calls. The consultation is then dictated via a speech recognition system and a letter is generated and sent to the general practitioner. . The time that the call takes is also noted, to enable better job planning. All of the helpline calls are audited and trends and number of calls are analysed. Results We enlisted the support of our IBD coordinator who reviewed the helpline system and looked for improvements. They took over listening to and retrieving all messages left on the answerphone thus saving nursing time. They also changed the reporting system to a tabulated excel spreadsheet which enabled all calls to be effectively triaged and acted on in a timely manner. All calls are then added to a central spreadsheet which then categorises the calls into flare advice, medicines advice, investigation issues, appointment issues, etc. It has also enabled better job planning and it has highlighted the increased number of calls that are taken by the nursing team and that they have been safely managed and accounted for. it has also enabled the team to trend the calls that are taken and the reasons why patients phone our helplines. Conclusion This project has shown a dramatic increase in activity for the IBD nurses. It has also highlighted the financial activity of the service and the contribution this provides to the gastroenterology department. This project has not only saved nursing time that should be spent with patients but ensured that patients are reviewed timely. This audit has since been utilised by the South East IBD Network. This project could not have been a success without the vision of Adam our IBD coordinator and the hard working IBD nurses of East Kent Hospitals University Foundation Trust.

Deciphering the Link Between Diagnosis-Related Group Weight and Nursing Care Complexity in Hospitalized Children: An Observational Study.

The increasing medical and nursing care complexity in hospitalized children represents a significant challenge for healthcare systems. However, the link between these two dimensions remains partially explored. This study aims to decipher the relationship between Diagnosis-Related Group (DRG) weight and nursing care complexity in hospitalized children and to identify the determinants of medical complexity. This retrospective study, conducted in an Italian university hospital, included children aged 2 to 11 years admitted to the hospital in 2022 with a minimum hospital stay of 2 days. Data were gathered from the Neonatal Pediatric Professional Assessment Instrument and the Hospital Discharge Register. DRG weight was used as an indicator of medical complexity, while the number of nursing diagnoses (NDs) documented in the first 24 h from hospital admission and the nursing actions (NAs) recorded during the patient's hospital stay were used to measure nursing care complexity. Correlation analyses were conducted to explore the associations between DRG weight, NDs, and NAs. Stepwise regression was run to identify the key determinants of medical complexity across sociodemographic, clinical, organizational, and nursing variables. Among 914 patients (mean age of 6.11 ± 2.90 years), the median DRG weight was 0.6982 (IQR: 0.5522). Patients had an average of 3.89 ± 2.83 NDs and a median of 17 NAs (IQR: 8). Significant correlations were found between NDs and NAs (rs = 0.507; p < 0.001), as well as between DRG weight and the frequency of NDs (rs = 0.232; p < 0.001) and NAs (rs = 0.184; p < 0.001). Stepwise regression indicated that the number of NAs, surgical DRG, scheduled admissions, and ND frequency were significant determinants of DRG weight (R2 = 0.311; adjusted R2 = 0.308; p < 0.001). In children, DRG weight is also influenced by nursing care complexity, alongside clinical and organizational factors. An integrated approach is essential to enhance pediatric care and patient outcomes.

Enlightening Nursing Care: A Protocol for a Multicenter Observational Study Measuring Nursing Work in Hospital Settings.

Background: Rising costs and demands for improved quality of care present complex challenges for existing healthcare systems. The strain on healthcare resources is exacerbated by the increasing complexity of patient conditions. The Diagnosis-Related Group (DRG) system classifies inpatients according to clinical and treatment criteria, controls healthcare expenditures, and ensures the sustainability of procedures. The cost of nursing care is included in the DRG system in the same way as other fixed costs of hospital care, but the amount of nursing care provided for the same DRG can vary widely. This study, which is based on this protocol, will aim to assess the variability of nursing costs within and across DRGs and to measure how much variability in nursing care is explained by DRGs by comparing nursing care delivery in acute care hospitals with the DRG reimbursement system in Italy. It is necessary to develop a specific protocol to ensure systematic and consistent data collection at the national level. Methods: A multicenter retrospective cross-sectional study will be conducted. A random sample of five public Italian hospitals will be enrolled. Patients included in medical or surgical DRGs, hospitalized and discharged in 2022 will be included. Data will be collected retrospectively from two sources: hospital discharge records and nursing records. Inferential statistics will be used to assess the variability of nursing time and costs across hospitals and DRGs. Nursing costs will be determined by several factors, including time spent on nursing activities and the hourly wages of nursing staff. The time needed to complete each activity will be estimated by a convenience sample of nurses from the hospitals included in this study. The annual salary of nurses will be used to calculate the nursing cost per minute, multipled by the amount of time spent per each nursing activity. The cost per patient per day of hospitalization will be calculated. Conclusions: The results of this study will shed light on the variation in nursing care across different DRGs. This understanding will guide recommendations for optimizing healthcare resource allocation and enhancing the efficiency of the DRG system in Italy.

Determinants of Prolonged Hospitalization in Children and Adolescents: A Retrospective Observational Study.

Ensuring an appropriate length of stay (LOS) is a primary goal for hospitals, as prolonged LOS poses clinical risks and organizational challenges. Children and adolescents are particularly susceptible to prolonged LOS due to frequent hospitalizations and unique vulnerabilities, including developmental disabilities that may necessitate additional care and monitoring. This study aims to describe the LOS of children and adolescent patients and identify the sociodemographic, organizational, clinical, and nursing care factors contributing to prolonged LOS in this population. Observational, retrospective, monocentric study. A sequential sampling approach was used to select the clinical records of 1538 children and adolescent patients admitted to an Italian university hospital in 2022. The study included all children and adolescents aged 3-18 who were hospitalized for a minimum of 2 days. Patients from outpatient units and those with LOS shorter than 2 days were excluded. The Neonatal Pediatric Professional Assessment Instrument (PAIped) and the Hospital Discharge Register were used to collect sociodemographic, organizational, clinical, and nursing care patient data, including nursing diagnoses (NDs) and nursing actions (NAs). A forward stepwise regression approach was used to identify predictors of LOS among the selected variables. A mediation analysis was conducted to explore the role of nursing predictors, identified in the stepwise regression, as mediators between the number of medical diagnoses and LOS. Positive correlations between the number of medical diagnoses, NDs, NAs, and LOS were discovered (rs = 0.262, p = < 0.001; rs = 0.114, p = < 0.001; rs = 0.384, p = < 0.001, respectively). Longer hospital stays were associated with an increased number of medical diagnoses, NDs, and NAs. The number of NAs emerged as an independent predictor of LOS (β = 0.516; p < 0.001). Other significant determinants of LOS included a higher number of NAs and medical diagnoses, the presence of a medical DRG category, increased DRG weight, emergency admissions, residency in rural areas, and older age (F = 122.222, p < 0.001, R2 = 0.361, adjusted R2 = 0.358). The mediation analysis showed that the number of medical diagnoses positively predicted the number of NAs (β = 2.774, p < 0.001), which, in turn, positively affected LOS (β = 0.162, p < 0.001). A significant indirect effect of the number of medical diagnoses on LOS through NAs was observed (β = 0.448, 95% CI [0.34, 0.55]), along with a significant direct effect of medical diagnoses on LOS, even with the mediator in the model (β = 0.633, p < 0.001), indicating partial mediation (F = 321.6892; R2 = 0.295; p < 0.001). These results highlight the influence of medical diagnoses on LOS through the mediating role of NAs. Our study highlights the significant interplay between determinants of LOS in children and adolescent patients, emphasizing the need for targeted interventions, resource planning, and the integration of clinical nursing information systems to enhance care quality and support evidence-based practices. Optimizing resource distribution and implementing specific interventions for patients at risk of prolonged LOS could help mitigate this negative outcome and enhance the quality of care. Incorporating nursing data into DRG systems could improve reimbursement accuracy and benefit the nursing profession, which may result in better patient outcomes and lower hospital expanses.

IMPLEMENTATION OF THE DELEGATION OF MEDICAL AUTHORITY TO NURSING PERSONNEL IN THE SPECIAL CARE UNIT AT RSUD dr. M. YUNUS BENGKULU

According to statutory regulations, nursing personnel are healthcare professionals with dual authority: the authority to perform nursing actions and medical procedures. Medical procedures carried out by nurses are based on delegated authority, either in the form of written delegation or a mandate. The objectives of this study are: (1) To identify and analyze the procedures for delegating medical authority to nursing personnel in the Special Care Unit at Local Government General Hospital (Indonesian - RSUD) dr. M. Yunus Bengkulu, and (2) To identify and analyze the legal accountability of the delegation of medical authority to nursing personnel in the Special Care Unit at RSUD dr. M. Yunus Bengkulu. The findings of this study reveal that the implementation of medical authority delegation to nursing personnel at RSUD dr. M. Yunus Bengkulu lacked the establishment of specific types of healthcare services eligible for delegation, whether by mandate or delegation, from medical to nursing personnel. The delegation of medical authority to nursing personnel was recorded in the patient progress notes integrated by the responsible physician. Keywords: Implementation, the delegation of authority, medical actions.

Can an increase in nursing care complexity raise the risk of intra-hospital and intensive care unit transfers in children? A retrospective observational study

IntroductionIntra-hospital patient transfers (IPTs) and transfers to intensive care units (ICUs) are high-risk events in pediatric care. Nursing care complexity, reflected by nursing diagnoses (NDs) and nursing actions (NAs), may influence the frequency of these transfers. This study explores the association between nursing care complexity and IPTs, including ICU transfers, in hospitalized children. Materials and methodsA retrospective observational study was conducted at a tertiary care university hospital in Italy. Data from 1013 children aged 2 to 12 years were collected from electronic health records. Sociodemographic, clinical, and nursing data, including NDs and NAs, were analyzed. Latent Class Analysis classified nursing care complexity, while backward elimination regression and binary logistic regression identified predictors of IPTs and ICU transfers. ResultsSignificant positive correlations were found between IPTs and both NDs (rs = 0.326, p < 0.001) and NAs (rs = 0.428, p < 0.001). Key predictors of IPTs included Diagnosis Related Groups (DRG) weight, total comorbidities, surgical DRG, the number of medications used, and high nursing care complexity. ICU-transferred patients had significantly higher nursing care complexity (6.54 vs. 3.46 NDs, p < 0.001; 31 vs. 16 NAs, p < 0.001). High nursing care complexity increased the likelihood of ICU transfer by 18 times (OR = 18.413, p < 0.001). ConclusionNursing care complexity strongly influences IPTs and ICU transfers. Close monitoring of patients with high nursing care complexity is essential to anticipate transfers and reduce clinical risks.

Nurses' attitudes, beliefs and knowledge of sleep health in residential aged care: An integrative literature review.

To identify, synthesize and evaluate primary research on registered nurses' (RN) knowledge, attitudes and beliefs about sleep health and sleep health management of older adults living in residential aged care. Integrative review. Medline, Embase and CINAHL databases from inception to September 2023. Databases were searched using a combination of key words, subject heading terms. All abstracts and full-text articles were screened by two researchers. Qualitative synthesis of the included articles was conducted. Inductive content analysis was used to identify themes and analyse data. A total of 923 abstracts were screened resulting in a final yield of 13 articles. Three themes were identified: (i) RN experience with sleep-disturbed residents, (ii) the emotional burden of sleep disturbances on RN and, (iii) organizational barriers to promoting resident's healthy sleep. Inappropriate administration of benzodiazepines and psychotropic drugs to manage residents' sleep disturbances was a major issue and lack of resources in residential aged care to facilitate sleep. There were concerns on nursing activity that disturbed residents' sleep and striking a balance between facilitating sleep and meeting managerial expectations was challenging. This review identified that nurses' decision-making has an integral role in the management of sleep health in residents in aged care. Whilst evidence-based guidelines for managing sleep in residential aged care are available, there is a lack of translation to practice. Understanding RN perspectives is critical to improving sleep health models of care in residential aged care. This review found that RN are attuned to the implications of sleep disturbance in residential aged care but are constrained by current sleep health models of care. Not applicable.

Sleep promotion appearing in nursing documentations – a descriptive study

Sleep is essential for health and well-being. The hospital is a challenging environment for sleeping and inpatients are at risk for insufficient and poor-quality sleep. Nurses have an important role to promote patients’ sleep and well-being. The quality of sleep should be assessed, and the activities taken should be documented accordingly. The aim of this study was to describe nursing activities of sleep promotion according to the nursing documentation. The data were collected from nursing documentations in electronic patient records of 50 + 50 patients in two central hospitals in Finland. The data were analysed using deductive content analysis. According to documentation, nurses promoted patients’ sleep in many ways. They treated sleep-disturbing symptoms, arranged a good sleeping environment and supported patients’ emotional well-being. Nurses also comprehensively observed patients’ sleep and documented it. Many sleep-promoting activities were not done intentionally to promote sleep but are known to be such according to previous studies. Nursing documentation gives a comprehensive picture of sleep promotion as part of nursing care. Sleep is assessed and various activities are in use, although not always intentionally. Nurse managers have an important role ensuring the use of evidence and that nurses have enough knowledge to promote patients’ sleep.

요양병원간호사가 경험한 환자안전사고, 환자안전문화 및 안전간호활동에 대한 연구

This study aimed to analyze patient safety accidents experienced by nurses in long-term care hospitals, and to understand the relationships between these accidents, patient safety culture, and safety nursing activities. A survey was conducted from November 1 to November 30, 2023, involving 234 nurses who had been engaged in nursing duties for more than 6 months at five different long-term care hospitals. The collected data were analyzed using SPSS 29.0 software, employing the chi-square, the t-test, ANOVA, and the Pearson correlation test. The results revealed that 73.5% of participants had experienced a patient safety accident in the past year, with 3.5% of these accidents remaining unreported. The most frequently encountered accident was falls, predominantly occurring in inpatient wards. The accident stage most commonly identified was near misses, and the most common post-accident response was intensive monitoring. Nurses with more experience in terms of age, nursing career, and tenure in long-term care facilities, as well as those involved in accreditation evaluations, reported a higher incidence of patient safety accidents. Nurses with access to patient safety guidelines had higher scores for patient safety culture and safety nursing activities, and those who completed patient safety training had higher scores for patient safety culture. However, no significant relationship was found between the experience of patient safety accidents and both patient safety culture and safety nursing activities. Based on these findings, it is recommended to implement differentiated patient safety training according to nursing experience and to utilize guidelines based on patient safety regulations.

Enlightening Hidden Nursing Care in Nurse-Led Clinics and See & Treat: An Observational Multicenter Protocol Study in Italy.

Background/Objectives: The limited and inconsistent adoption and regulation of nurse-led clinics (NLCs) and "See & Treat" (S&T) services in Italy needs to be explored considering their value towards patients' outcomes acknowledged in the literature. This study aims to explore the phenomenon of hidden nursing activities (HNAs) in these settings, hypothesizing that features and activities performed in these settings are heterogeneous across the country and widely underreported or attributed to other professionals than nurses. HNAs are hypothesized to be associated with a poor work environment climate and nurses' low job satisfaction. Methods: A multicenter, cross-sectional study will be conducted across exclusively nurse-led NLC and S&T services in public health care facilities in Italy. Data collection will involve inputs from organization or nursing managers, coordinators, head nurses, and employed nurses. Information will be gathered on organizational structure, service provision, access modalities, nurses' perceptions of their work environment, and the health care activities performed. Surveys will be distributed online to collect retrospective data in 2023 and via paper to collect 1-month prospective data about services' activities. Expected results: This study is expected to reveal HNAs in NLC and S&T, with implications for policy, resource allocation, reimbursement models, and patient outcomes, ultimately supporting healthcare reforms and enhancing nursing's visibility and impact in Italy. The findings will be essential for guiding health care resource allocation and shaping educational and regulatory policies that recognize and formalize the role of nurses in advanced practice. Policymakers could leverage the findings of this study to promote the development of standardized taxonomies, making nursing contributions more visible and measurable. Ultimately, this research will highlight the value of nursing care in NLC and S&T settings, providing an evidence base to drive policy changes that improve both health care outcomes and resource efficiency. Conclusions: This study lays the groundwork for health care policy reforms by advocating for the recognition, measurement, and funding of nursing contributions, ultimately enhancing patient outcomes and the sustainability of health systems.

Time to care: How a homecare model harnesses nurses' professional ethic and cultivates caring.

A persistent devaluation of care-work, difficult working conditions, and low salaries have led to challenges with staff recruitment and retention in the homecare sector in France. A new homecare organization adopting an innovative organizational model recently experimented an hourly payment method yielding positive outcomes. Using Tronto's caring framework, this paper analyzes the strategies used by the founders as they developed their innovative model and the nursing activities performed during home visits. A longitudinal qualitative study was conducted between 2017 and 2023. Homecare nursing teams were shadowed for 1-2 days per year yielding detailed field notes on caregiving activities, both before and after the new payment method. Secondary data included reports, videos, articles, and unpublished documents found online. While there is no requirement in France to obtain ethical approval in non-interventional research, verbal consent was obtained by all participants prior to their involvement in the study; confidentiality and anonymity were strictly maintained; and pseudonyms were assigned to protect identities. 63 interviews and 185h of shadowing and observations were conducted. Results revealed a virtuous cycle of caring facilitated and encouraged by new incentives that resonated with nurses' professional ethics. The favorable working environment and the hourly payment method enabled nurses to provide caregiving in accordance with their values. As the new hourly payment experiment is scaled-up nationally, it is imperative that it is not isolated from the organizational model. Without the underpinning values and principles, the hourly payment method alone is unlikely to shift the value attributed to caring.

International Council of Nurses 2025 Congress: Nursing power to change the world.

The International Council of Nurses (ICN) 2025 Congress, themed "Nursing Power to Change the World," will convene in Helsinki, Finland, from 9 to 13 June 2025. This landmark event celebrates a century of nursing progress and addresses contemporary challenges in healthcare. The Congress emphasises the pivotal role of nurses in enhancing healthcare equity, accessibility, and outcomes, aligning with global health policy goals such as Universal Health Coverage (UHC). It will feature contributions from key international organisations like the WHO and the International Committee of the Red Cross, highlighting the event's global significance. With over 10000 abstract submissions, the Congress promises a rich scientific programme, fostering knowledge exchange and professional development. Subthemes will explore nursing leadership, healthcare quality, education and the impact of transformative technologies. The Congress will also focus on advocacy, providing a platform for policy discussions on pressing global health issues. Networking opportunities will connect nurses with peers and leaders, promoting collaboration and career advancement. The inclusion of nursing students and early-career professionals underscores the commitment to nurturing the next generation of nurses. The ICN 2025 Congress is a call to action for nurses worldwide to lead transformative change in healthcare, ensuring the profession remains dynamic and influential. Join us in Helsinki to celebrate the power of nursing and explore the many ways in which nurses can lead the change in advancing global health.

A Call to Action for Nurses in Canada to Address Climate-Driven Vector-Borne Diseases

A Call to Action for Nurses in Canada to Address Climate-Driven Vector-Borne Diseases

Based -evidence, an intervention study to improve sleep quality in awake adult ICU patients: a prospective, single-blind, clustered controlled trial

BackgroundEvidence-based guidelines advocate promoting sleep in intensive care unit (ICU) patients, yet many patients experience poor sleep quality. We sought to develop a collaborative evidence-based intervention with healthcare providers and assess whether evidence-based sleep interventions could improve sleep quality in awake adult ICU patients.MethodsWe conducted a prospective, nonrandomized cluster control trial in two intensive care units (ICUs) at a tertiary general teaching hospital in China. Patients aged 18 years or older who stayed in the ICU for one night or more and were conscious were eligible for enrollment. We only blinded the patients, not the outcome assessors. On the basis of evidence-based practice and clinical reality, we developed intervention measures for the intervention group, which mainly included four aspects: reducing environmental noise in the ICU, adjusting nursing actions, modifying nighttime lighting, and other measures. The assessment tools used were wearable actigraphy sleep monitoring devices and the Richards-Campbell Sleep Questionnaire (RCSQ). The primary outcomes were patient sleep quality, including total sleep time, deep sleep time, light sleep time, rapid eye movement (REM) time, number of awakenings, overall sleep score, and patients' self-assessment of their sleep quality that night. The data collected were analyzed via SPSS and Mplus statistical software for between-group analysis, pre-post comparison, profile analysis, and calculation of the intervention effect size.ResultsFrom September 1, 2023, to January 31, 2024, 713 patients underwent eligibility assessment, and ultimately 246 patients were included in the analysis, with 125 in the intervention group and 121 in the control group. Comparative analysis revealed no statistically significant differences in sleep quality between the two groups when the duration in the ICU = 1 night (P > 0.05), with a small intervention effect size. However, the intervention group had higher sleep quality scores (sleep monitoring wristband: 57.74 ± 22.55 > 57.72 ± 19.39; RCSQ questionnaire: 60.58 ± 22.14 > 57.61 ± 24.4) and total sleep time (440.42 ± 262.11 > 420.31 ± 236.89), a lower awakening frequency (3.98 ± 2.69 < 6.09 ± 4.66) and a lower awakening frequency (3.976 ± 2.693 < 6.09 ± 4.664) than did the control group. The sleep quality of patients who stayed in the ICU for > 1 night significantly improved in all the parameters except rapid eye movement time (min) according to the pre-post-test analyses (P < 0.05), with a medium to large intervention effect size and favorable intervention effects.ConclusionEvidence-based interventions significantly improve sleep quality in ICU patients hospitalized for more than one day. However, our results do not support the improvement of sleep quality in patients admitted to the ICU for one day.Clinical trial registration: ChiCTR2300075763, Registered 14 September 2023—Retrospectively registered, https://www.chictr.org.cn/bin/userProject

Carbon monoxide poisoning: assessment and actions for nurses working in service users' homes.

Carbon monoxide is a colourless, tasteless and odourless gas that is a by-product of incomplete combustion of hydrocarbons such as gas or coal. Carbon monoxide poisoning is associated with high levels of mortality and morbidity, although the symptoms of exposure are non-specific and difficult to diagnose. Historically, healthcare professionals who work directly in service users' homes have faced a higher risk of exposure to environments contaminated with carbon monoxide. Despite improved heating engineering and greater protective legislation, there still remains a tangible risk for community nurses and service users, particularly in homes still using open fires, old heating systems and poorly maintained heating appliances. This article provides a scientific summary of carbon monoxide poisoning for nurses working in the community setting. It outlines evidence-based guidance on prevention and initial treatment actions, along with safety instructions to follow in the event of exposure to carbon monoxide.

The influencing factors of pediatric nurses' perception of patient safety culture and partnership with patients' parents on patient safety nursing activities in South Korea: a descriptive study.

This study aimed to identify the effects of pediatric nurses' perception of patient safety culture and their partnership with patients' parents on pediatric patient safety nursing activities. This descriptive study was conducted over a two-month period, from October to November 2022, utilizing self-reported questionnaires. The study included 165 nurses, each having at least 6 months of working experience in wards where children were admitted. These nurses were selected from 13 pediatric specialty hospitals, general hospitals, and university hospitals across seven regions. The data analysis was performed using the SPSS/WIN 26.0 program (IBM Corp.) for descriptive statistics, t-test, One-way ANOVA, Scheffé test, Pearson correlation coefficients, and multiple regression analysis. The average scores for awareness of patient safety culture, partnership with patients' parents, and pediatric patient safety nursing activities were 3.37±0.41, 3.94±0.41, and 4.50±0.38, out of 5 points respectively. The factors influencing pediatric patient safety nursing activities were identified as a partnership with patients' parents (β=.41, p<.001). Among hospital-related characteristics, safety management committee (β=.16, p=.029) and safety management regulations (β=.17, p=.016) were also analyzed as factors influencing patient safety nursing activities. These factors accounted for 29.2% of the explanatory power for pediatric patient safety nursing activities. Based on the above study results, we found that to promote safe nursing activities for pediatric patients, developing and implementing training programs that enhance partnerships with patient's parents was imperative, and establishing work regulations and a safety management committee to systematically manage safety management tasks was deemed important.

Effects of Grit, Patient Safety Competence, and Patient Safety Culture on the Patient Safety Nursing Activities of Nurses in Comprehensive Nursing Service Wards

Purpose : In this study, we aimed to assess the impacts of grit, patient safety competence, and patient safety culture on the patient safety nursing activities of nurses in comprehensive nursing service wards. Methods : Here, a self-reported survey of 179 nurses from three tertiary hospitals was performed. Data from 171 valid responses were analyzed using descriptive statistics, independent t-test, one-way analysis of variance, Pearson’s correlation, and stepwise multiple regression analyses.Results : The key sub-factors influencing the patient safety nursing activities were attitude (β=.30, p ＜.001) and skill (β=.26, p ＜.001) in the patient safety competence factor and safety environment (β=.26, p ＜.001) in the patient safety culture factor. The regression model explained 42.7% of the variance in patient safety nursing activities (F=43.29, p ＜.001). Conclusion : Overall, these findings highlight the importance of improving the nurse attitude and skills related to patient safety as well as the safety environment in hospitals to enhance the patient safety nursing activities in comprehensive nursing service wards. Targeted educational and training programs should be provided along with organizational support to establish a safe and supportive nursing environment in comprehensive nursing service wards.

Integration of Mindfulness Educational Innovation in Nursing Programs.

Purpose: The study's purpose was to assess: (1) Students' perceptions toward mindfulness interventions, and (2) Instructors' perceptions in implementing mindfulness interventions in their classes. Study design: Descriptive study. Methods: A total of 96 students from the second-degree option and BSN programs in the host institution participated in a mindfulness intervention prior to course activities. The four mindfulness interventions utilized in this study included: music, meditation, guided breathing, and positive affirmation. The data were analyzed using descriptive statistics on postintervention surveys. Findings: The mindfulness intervention was overwhelmingly received by the students and faculty as reflected in the result of the confidential postsurveys. The majority of the students and faculty felt that this mindfulness intervention was worth implementing in their course. Conclusion: The mindfulness intervention can promote students' feelings of "at ease" and confidence prior to a nursing course activity.

Development of entrustable professional activities for novice nurses: A modified Delphi study

AimThis study aimed to develop a tailored EPA framework for novice nurses to support their integration and performance in hospital settings. BackgroundNovice nurses often struggle with the transition from education to practice due to the gap between theoretical knowledge and practical skills. EPAs help bridge this gap by defining and assessing key competencies, but a framework specific to novice nurses is needed to address their unique challenges. DesignA modified Delphi method was used. MethodsConducted from October 2023 to March 2024, the study followed a four-stage process: team formation, identification, revision and evaluation of EPAs. Initial EPAs were identified through literature reviews, clinical guidelines and focus groups, then refined using the EQual rubric. Two Delphi rounds were conducted for validation. Experts rated the importance of EPAs in the first round, followed by online discussions, with the second round focusing on dimensions including Focus, Observable, Realistic, Generalizable and Multiple competencies. ResultsThe final framework included 12 EPAs: 1) Manage Admission and Discharge, 2) Provide Basic Care, 3) Collect Specimens, 4) Administer Medications, 5) Perform Non- Medication Therapies, 6) Monitor Conditions, 7) Respond to Emergencies, 8) Educate Patients, 9) Prevent Adverse Events, 10) Conduct Handovers, 11) Document Care and 12) Operate Equipment. ConclusionThis EPA framework integrates theory and practice to improve training and assessment. Future research should focus on its implementation and refinement in diverse clinical settings to ensure broader applicability.

Opportunities for nursing and midwifery research in Bulgaria

Abstract Background The training of nurses and midwives today is at university level and follows established standards. The 2009 Global Standards for the basic nursing and midwifery education of the World Health Organization requires that the curricula should include basic knowledge and skills for scientific research to implement evidence-based health care. In Bulgaria, scientific research among nurses and midwives began in 2000 and has seen more serious development in the last 5 years. Methods A content analysis of normative documents was carried out, to regulate the conduct of scientific studies and the curricula for the two specialties. Results In all documents on the activities of graduate nurses and midwives, activities related to conducting scientific studies are regulated. No mandatory discipline for these competencies is included in the basic education. In Bulgaria, there is a bachelor’s and master’s program only in Health Care Management, in which sociology, statistics, and research methodology are studied. From 2000 to 2016 nurses and midwives defended doctoral dissertations in a program for medical doctors. The first doctoral program for nurses and midwives is from 2016. There are no legal norms for stimulating and provide conducting clinical research, and to ensure evidence-based practice by nurses and midwives. Conclusions The normative regulation of scientific activity among nurses and midwives in Bulgaria corresponds to international and European requirements, but the opportunities for training are limited. The responsibility of nurses and midwives to modern society is to ensure high quality in health care provided by: a. providing opportunities for clinical studies; b. implementation of evidence-based health care and practice; c. developing programs for training for research in health care. Key messages • In Bulgaria, there is a legal norms for conducting nursing research, but not for evidence-based practice. • There is a need for more opportunities to train and encourage clinical nursing research.