Improving alarm management to reduce alarm fatigue in critical care: a mixed-methods study.

Experienced nurses' perceptions of essential nursing care in the emergency department - A focus group study.

This study aimed to describe the competence profiles, practices, job satisfaction, and interprofessional collaboration among nurses working in Italian anticoagulation clinics (ACs) affiliated with the Italian federation of centres for the surveillance of anticoagulant therapy (FCSA). Data were collected via a web survey from December 2023 to May 2024. The information was condensed into two stochastic components using the t-distributed stochastic neighbour embedding (t-SNE) algorithm as part of the hierarchical clustering procedure, revealing two distinct clusters labelled "substandard profile" (n = 21 nurses) and "proficient profile" (n = 38 nurses). Results indicated significant variability in nursing practices, with differences in educational activities, self-reported competence, and levels of interprofessional collaboration between the two clusters. The findings underscore the importance of tailored interventions to enhance nursing practices, nursing education, and interprofessional collaboration within ACs. Future corroboration of the emerging results is warranted with longitudinal studies.

Background: Oral health (OH) is integral to general health, well-being, and quality of life; however, in long-term care (LTC) settings, it is often neglected due to residents’ functional limitations, high care dependency, and the prioritization of underlying medical conditions by healthcare staff. Previous studies have highlighted this issue and identified multiple barriers to OH promotion in institutional settings. Objectives: To assess OH practices among nurses (NUR) and nursing assistants (NA) in LTC units and to identify barriers compromising effective oral care delivery. Methods: An observational, cross-sectional, descriptive study was conducted across five LTC facilities in Porto, Portugal. A structured survey was administered to 145 healthcare workers out of a total of 259 eligible participants, yielding a response rate of 55.98%. Data were collected via Google Forms and analyzed using IBM SPSS Statistics v.26. Descriptive statistics, analysis of variance, the Mann–Whitney U test, and Chi-square tests were applied, with a significance level of 0.05. Results: The main primary barriers to OH promotion included poor patient cooperation (74.6%), lack of dentists (74.6%), insufficient material (62.7%), limited time (45.8%) and inadequate staffing (40.7%). Chlorhexidine (94.50%) and oral sponges (70%) were the most frequently used resources, whereas other methods were underutilized. No statistically significant differences were observed between professional groups, irrespective of prior training. Although 48.5% of NUR and 51.5% of NA reported not perceiving barriers, substantial gaps in practice were identified. Only 1.9% of untrained NA reported consulting evidence-based scientific sources, compared with 44.7% of untrained NUR. Conclusions: Despite limited perceived barriers, significant deficiencies in OH practices persist in LTC settings, highlighting the need for structured, interdisciplinary training programs to improve oral care delivery.

BackgroundNeedle-stick and sharps injuries (NSSIs) are major occupational hazards faced by healthcare employees (HCEs) worldwide.ObjectivesThis study aimed to assess trends of NSSIs among HCEs and their exposure to other infected body fluids, as well as to determine their risk factors.MethodsThis retrospective observational study involved secondary data of NSSIs collected from January 2016 to June 2023.ResultsThere was a constant decline in the number of NSSI incidents over the time, except in 2021. Among the 334 HCEs with a history of exposure, 129 (38.6%) were staff nurses. Most HCEs [274 (82.0%)] developed a prick from the injector needle, and the majority (39.4%) received a prick on the fingers of the left hand. The majority (24.1%) were exposed to NSSIs and infectious body fluids while handling/discarding biomedical wastes (BMWs). Delays in screening and initiation of postexposure prophylaxis (>24h) were observed among 10.3% and 15.1% of HCEs, respectively. There were significantly more NSSIs than other forms of occupational exposure during the COVID-19 period (p = 0.046) and among HCEs aged 18-25years (p = 0.033). Females were more prone to exposure while handling/discarding BMWs (p = 0.0001).ConclusionTraining, particularly among junior HCEs, is needed to prevent NSSIs and exposure to infectious body fluids.

Assessment of Factors Influencing Staff Nurses’ Participation in Continuing Professional Development Programs in a Military Hospital

Abstract Background: Nurses spend substantial time with patients and their families as part of routine clinical care, including monitoring vital signs, administering medications, providing health education, and offering emotional support. This sustained, trust-based interaction positions nurses uniquely to influence patient engagement beyond clinical outcomes, including participation in voluntary activities such as small-value charitable donations. Aims and Objectives: To enhance voluntary crowd-sourced funding through hospital donation boxes by actively involving nursing staff using Action Research. Methods: An Action Research study was conducted in the inpatient areas of a super-speciality tertiary care public hospital. Eight nurses participated actively under the leadership of a senior hospital administrator and a postgraduate resident. The study followed a five-step Action Research cycle: practice, reflection, research, planning, and action. Participating nurses maintained reflective notes in English to identify reasons for low donation uptake and propose feasible improvement strategies. The team leader synthesised these insights, designed interventions, implemented selected measures, and facilitated group discussions to assess progress and outcomes. Results: In August 2016, donation box collections totalled INR 294,397 from 23 boxes located across general wards, private wards, and outside the Neonatal Intensive Care Unit, yielding a baseline monthly average of INR 2,559.97 over 115 months. Four months after implementation of nurse-led interventions, the average monthly collection increased to INR 10,095.25, representing a fourfold rise. Conclusion: Active nurse involvement significantly improved donation outcomes. Leadership in Action Research functioned primarily as facilitation. Improved location, visibility, accessibility, and regular opening of donation boxes were key contributors to enhanced fund collection.

Implementing a Fall Risk Protocol in an Ambulatory Surgery Setting.

Ethical climate as a dominant predictor of family-centered care: A comparative study of pediatric nurses in Egypt and Saudi Arabia.

Nursing workforce characteristics, such as staffing and specialized training, are integral to the delivery of high-quality patient care in the intensive care unit (ICU). Nurse staffing is defined as the number of nurses per patient but also skill-mix (combination of registered nurses and other nursing support staff) and expertise of available nurses for the specific patient population each shift. When nurse staffing is suboptimal the risk of adverse patient outcomes and patient mortality increases. In addition, existing research has established the importance of staffing ICUs with interprofessional teams-registered nurses (RNs), physicians, and respiratory therapists (RTs). Yet, shifting characteristics of the nursing workforce- such high turnover and a more novice workforce- are still under studied and may impact the interprofessional team and its ability to collaborate effectively. This study is an analysis of previously collected qualitative data from 9 ICUs within a single academic medical system in the US. Participants (RNs, physicians, RTs, and other ICU providers) working in study ICUs across 4 hospitals were purposively sampled and interviewed individually. Thematic analysis was used to analyze interview transcripts; 2 researchers coded each transcript independently. Consensus on any coding disagreement was reached through discussions at research team meetings. Once all data was coded, the team iteratively reviewed the data and codes and generated themes that focused on the primary research question of this analysis: how nursing workforce characteristics influence the interprofessional team. Our final sample included RNs (n = 11), RTs (n = 4), physicians (n = 4), and a dietician (n = 1). Three interconnected themes were identified in the analysis: (1) The effects of a transition to a more novice nursing workforce in ICUs extends beyond nurse staffing to the interprofessional team and their ability to provide care; (2) Staffing decisions do not incorporate interprofessional team needs, leading to decreased collaboration and disruptions in patient care; and (3) Adequate nurse staffing and additional support can balance increased burden on the interprofessional team. These themes highlight how nurse workforce characteristics can influence the interprofessional team in adult ICUs in a post-COVID era. Characteristics of the nursing workforce, such as nurse experience and expertise, have downstream effects on interprofessional team members and their ability to deliver care in the ICU. A multi-pronged approach, which includes adequate support staff for nursing, increased retention of experienced ICU nurses, and improving communication across professions, is vital to improve interprofessional team collaboration and allow ICU teams to provide the best care possible to their patients.

Implementation of a risk factor-based pressure injury prevention protocol in a long-term care facility: a quality improvement project.

Nursing’s Digital Identity: Leveraging Unique Nurse Identifiers and Artificial Intelligence-Based Tools to Transform Hospital Nurse Staffing Models

The predictive power of job content, subjective workload, and job burnout on cognitive failures in nurses working in emergency departments.

To evaluate the value of machine learning in assessing intraoperative blood loss by comparing associated outcomes with those of the gold standard. Intraoperative bleeding is a leading cause of death in surgical patients and may be preventable through early and accurate assessment of blood loss. Machine learning models are used for measuring intraoperative hemorrhage with conventional assessment methods. However, outcome metrics vary across studies. A systematic review and meta-analysis. Data were retrieved from Web of Science, PubMed, Embase, Cochrane Library, and CINAHL, with searches conducted through August 18, 2025. Twelve studies were included. The pooled correlation coefficient between machine learning models and the gold standard for assessing intraoperative blood loss was high. Machine learning models demonstrate high accuracy and reliability in assessing intraoperative blood loss. Heterogeneity was high, likely attributable to differences in publication year, country, study subjects, sample type, and modeling method. Models should be promoted for clinical use to improve blood loss assessment accuracy and to potentially reduce perioperative risk. Novel machine learning models could enhance the accuracy and applicability of existing models, providing nursing staff with a more efficient tool for assessing blood loss. This will optimize the nursing decision-making process, reduce adverse events caused by underestimating or overestimating blood loss, and improve patient safety. We provide a reference for exploring the application of artificial intelligence in other nursing fields, promoting interdisciplinary research and driving continuous innovation and progress in nursing.

In fragile healthcare systems such as Palestine's, nursing leadership is critical for patient safety, yet its nature and influence remain poorly understood. This study aimed to analyze the forms and extent of nursing leadership authority-both formal and informal-and its impact on patient safety in Palestinian hospitals. A mixed-methods, convergent cross-sectional design was employed across three governmental hospitals in the West Bank. Data were collected via surveys (n=123 nurses), semi-structured interviews (n=15 nursing leaders), and document analysis. Quantitative data were analyzed using descriptive statistics, multiple regression, and mediation analysis; qualitative data were analyzed thematically. Nursing leaders possessed moderate to high operational authority (e.g., clinical supervision, staff scheduling) but were systematically excluded from strategic and financial decisions. Regression analysis revealed that strategic authority (β = 0.52, p < .001) was a stronger predictor of safety adherence than operational authority. Informal strategies (e.g., persuasion, coalition-building) mediated the relationship between low formal authority and safety compliance. Document analysis confirmed a formal gap in governance structures, and qualitative findings highlighted a "Vicious Cycle of Disempowerment" rooted in hierarchical, physician-dominated cultures and resource constraints. Strategic disempowerment of nursing leaders creates an unsustainable reliance on informal influence, which carries high emotional labor and systemic fragility. To sustainably improve patient safety, structural reforms-such as establishing executive nursing roles (e.g., Chief Nursing Officers) and integrating nursing leadership into hospital governance-are urgently needed in Palestine and similar constrained settings.

The American Nurses Credentialing Center (ANCC) Magnet Recognition Program® is an international designation awarded to healthcare organizations that demonstrate excellence in nursing practice and outcomes (nursing, organizational, and patient). This article is a perspectives piece that juxtaposes the viewpoints of a chief nursing officer and a Magnet program director. It synthesizes whether Magnet designation functions primarily as an organizational differentiator or a catalyst for internal improvement. The analysis is based on a narrative synthesis of peer‑reviewed studies, professional standards, and relevant industry reports published between 2020 and 2025.

Peripheral vascular access device (PVAD) insertion is a frequent and critical procedure in hospitalized patients; yet success rates vary and complications are commonplace. Ultrasound (US) guidance can improve outcomes in difficult venous access (DIVA), but adoption and training among bedside clinicians remain inconsistent. We surveyed clinicians to assess current practices, training, and confidence in PVAD placement, including the use of US. Between July 9 and September 2, 2025, a total of 321 completed surveys were analyzed. Respondents included bedside clinicians (n = 247) and non-bedside clinicians (n = 74). Survey items captured demographics, clinical roles, PVAD practices, US availability, training, and self-reported confidence. Among respondents, vascular access nurses (55.5%) and staff nurses (21.5%) predominated, with most working in medical/surgical units (72.6%). Frequent encounters with patients requiring >2 PVAD attempts were reported by 38.9%. Most respondents reported policies or informal norms mandating multiple insertion attempts before escalation, with two attempts most common (59.5%). US was available in 83.0% of units, but staff nurses had lower access (59.4% vs 92.1% for vascular access nurses) and lower personal use (37.7% vs 90.4%). Confidence in US-guided insertion was markedly lower among staff nurses (26.1% very confident) versus vascular access nurses (85.4%), as was formal training (23.2% vs 47.2%). Despite widespread US availability, many staff nurses lack access, training, and confidence in US-guided PVAD placement. Policies emphasizing multiple insertion attempts before escalation persist, and potentially contribute to patient harm. Structured, competency-based training programs are needed to improve skill acquisition, procedural success, and patient outcomes across bedside clinicians.

Abstract: BACKGROUND: Sleep issues are a critical public health issue, especially for nurses facing long hours, irregular shifts and high stress. Poor sleep quality impacts their well-being and patient care. Work stress disrupts sleep, affecting cognitive and emotional health. Addressing this issue is vital for nurse’s health and their job satisfaction. AIM: This study aimed to assess sleep quality, work stress, and subjective well-being among staff nurses in a selected tertiary care hospital in Assam. METHODOLOGY: The study employed nonexperimental, quantitative study used a descriptive design at a tertiary care hospital in the year 2024. Using purposive sampling, data were collected from 100 staff nurses meeting the inclusion criteria. Tools included a sociodemographic pro forma, Pittsburgh Sleep Quality Index, Perceived Stress Scale-10, and subjective well-being inventory, administered individually by the investigator. RESULTS: The study found that 71% of nurses had poor sleep quality, and 80% experienced moderate stress. A significant correlation was found between sleep quality and stress ( r = 0.358, P &lt; 0.01). The presence of a caregiver for a sick family member had a significant impact on sleep quality (χ 2 = 4.740, P = 0.043). CONCLUSION: The study highlights the significant impact of work stress and poor sleep quality on nurses’ well-being. It underscores the importance of providing institutional support to address these challenges. Interventions that promote better sleep hygiene, stress management, and supportive work environments are essential, particularly for nurses balancing caregiving roles at home, to improve both their well-being and the quality of patient care.

A chest wall defect after resection of a recurrent desmoid tumor of the right breast was reconstructed with a TRAM flap over a Gore-Tex graft. The tumor had involved 2 ribs, and the wide resection included 5 ribs with a portion of the lateral sternum. After the wide resection to effectively manage this aggressive, invasive lesion from the anterior chest of a 42-year-old woman, a 2-mm Gore-Tex graft was directly sewn in place to bridge the defect. A TRAM flap based on the left rectus abdominis muscle was delivered to the right chest to close the defect. The TRAM flap was initially well perfused and adequately reconstructed the chest wall defect. A clinical exam 6 hours after surgery found the flap pink, warm, and healthy. Within 18 hours of surgery, venous congestion of the distal TRAM flap was observed. Because of scarring from previous chest surgery and tightness of the flap, flap adjustment or advancement was not possible. Leech therapy was employed over 4 days. Twenty-six leeches alleviated the venous congestion and produced a persistent oozing that facilitated blood flow and oxygen delivery through hemodilution. The hospital had no established protocol for leech therapy, so there was resistance from the medical and nursing staff. The leeches were kept in the author's home refrigerator and personally driven to the hospital for each application over the 4 days. The leech therapy salvaged the congested flap, and the reconstruction successfully protected the heart and lungs. Radical resection of a desmoid tumor was the preferred management in 1993. The application of leeches to a myo-cutaneous flap was a novel approach. The leech therapy proved effective in reducing congestion and salvaging the TRAM flap reconstruction. Hemodilution was induced, which helped with tissue perfusion. Chest reconstruction continued in stages and included a solid silicone pectoralis implant inserted to add a rigid, more protective cover of the heart and lungs. Breast reconstruction with bilateral silicone gel implants produced a result acceptable to the patient. The desmoid tumor has not recurred.

Cultural diversity has increased in the NHS in England with the recruitment of internationally educated healthcare professionals, especially nurses. Internationally educated nurses (IENs) face challenges in progression and achieving their aspirations. It is important to develop strategies that support this group of staff to realise their ambitions and attain job satisfaction. A questionnaire delivered to all band 5 staff nurses in an NHS organisation identified that nurses educated in the UK faced similar challenges relating to career progression and also require support. A pilot Leadership Enhancement and Development programme was developed in partnership with a local college and was open to applications from all band 5 registered nurses. This strategy contrasted with national recommendation that support developing leadership programmes specifically for IENs. The pilot was successful in improving leadership skills and acting as an agent of socialisation. This article reflects on results from the staff survey and pilot participant evaluations to share learning and recommendations for the provision of future leadership programmes.