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Knowledge, Self-Care and Fragility Fracture Risk: An Exploratory Study Informing the Development of a Complex Nursing Intervention

2026-03-11T21:30:25+00:00

Introduction

Fragility fractures (FF) are a growing public health problem, with 70,700 cases recorded in Portugal in 2019.¹ These fractures are associated with a one-year mortality rate of 25%² and a major economic impact. The management of FF risk comprises multiple interacting components, in which knowledge and the ability to perform self-care activities are key elements.³

Objective

To explore the association between FF risk, osteoporosis knowledge and self-care, and differences across gender and age groups.

Methods

Cross-sectional study, using a convenience sample of individuals aged 50 to 74 years, attending a Family Health Unit, a Public Health Unit and a Blood Collection Center in Lisbon, who were fluent Portuguese speakers and without cognitive impairments. Data collection (August-November 2025) included sociodemographic variables and measures related to the: 10-year fracture risk estimated by FRAX (major osteoporotic fracture: high risk ≥11%, intermediate >7 to <11%, low ≤7%; hip fracture: high ≥3%, intermediate >2 to <3%, low ≤2%); Osteoporosis Knowledge Assessment Tool (OKAT; ranging 0-20); Exercise of Self-Care Agency Scale (ESCA; ranging 0-116). Statistical comparisons were performed using independent samples t-test or one-way ANOVA. An Ethics Committee approved the study (CAML84/25).

Results

Our sample comprised 141 individuals (55.3% women, 61.8y (±7.2), 50.0% holding a higher education degree). Seven women reported history of FF. 24.3% women and 11.3% men were at moderate-to-high 10-year risk of FF. Women had a statistically higher mean OKAT score (8.9±3.4 versus 7.1±3.2; p=0.002). No statistically significant associations were found between self-care ability score and gender, age group, OKAT score, or FF risk category.

Conclusion

One in four women and one in ten men were at moderate-to-high risk of FF, with ~60% demonstrating very limited osteoporosis knowledge. These findings underscore the need for developing a complex intervention aimed at preventing FF through systematic screening and self-care promotion.

Workload and quality of neuroprotective care in neonatal units: Mixed-Design and Multi-Study Protocol

2026-04-06T21:52:56+01:00

Introduction

Preterm newborns are particularly vulnerable, and neuroprotective care centered on the newborn and family is essential to improve development, reduce costs and disease burden, and promote health and well-being (SDG 3). However, such care is often omitted in Neonatal Intensive Care Units (NICU), influenced by factors such as the high workload of nursing staff.

Objective

To assess the relationship between workload and the quality of neuroprotective care in NICUs, as well as to explore the association between this relationship and short- and medium-term child neurodevelopmental indicators.

Methods

PhD study with a mixed-methods, multi-study design. Preliminary studies included six focus groups with content analysis, and a scoping review will be conducted to support the development of a measurement instrument — Neonatal Neuroprotective Interventions Scoring (NeoNIS). The construction of the questionnaire will be based on validated instruments, with previous psychometric studies. The main study will be conducted in six NICUs, with prior submission to ethics committees, informed consent, and participant anonymity ensured.

Results

It is expected to characterize the relationship between the nurses’ total workload and the workload dedicated to neuroprotective care, and to understand how the ratio of these workloads impacts immediate neurodevelopmental outcomes, highlighting the need for policies that ensure quality of care, equity, and health education (SDGs 4 and 10).

Conclusion

The results will contribute to informing policy decisions regarding nursing staffing levels, with an impact on the quality of care, the reduction of inequalities, and the promotion of healthy child development.

Nurses’ Perspectives on Strategies for Parental Involvement in Newborn Pain Management

2026-04-06T21:36:18+01:00

Introduction

Newborns in the Neonatal Intensive Care Unit (NICU) undergo several painful stimuli with their care and treatment, including painful maneuvers, daily. Nurses play a crucial role when applying pain management strategies. Parents, when properly prepared and guided, can effectively apply strategies to reduce newborns’ pain during painful procedures in the NICU, also lowering parental stress and fostering attachment between parents and infants.

This approach aligns with Sustainable Development Goals (SDG) on Promoting Good Health and Well-Being (SDG-3) and Reducing Inequalities (SDG-10) through empowering families in their caregiving roles and helping to integrate newborns into family life, especially those born preterm or with chronic conditions.

Objective

To explore parents’ and expert NICU nurses’ perceptions regarding the strategies that enable parents to collaborate on their newborns’ pain management.

Methods

An exploratory, qualitative, and descriptive study was conducted using online focus group interviews to explore expert NICU nurses' perspectives on nurses’ strategies that involve parents in managing their newborns’ pain.

Results

The study sample was recruited from three Lisbon Metropolitan Region NICUs and consisted of 24 nurses, all NICU experts with over five years of professional experience.

Data analysis is still ongoing, and so far, identified nurses’ opinions regarding newborn pain and nursing strategies to promote parental involvement in newborn pain management are grouped into two categories and five subcategories.

Conclusion

The success of nursing interventions to empower parents in their newborn's pain management depends on factors related to parents, nurses, the organization, and the environment. Parental involvement in newborn pain management promotes Good Health and well-being by improving parental care and reducing their newborns' pain. It also Reduces Inequalities in promoting parent-newborn bonding for newborns who cannot remain in their family environment after birth due to a special clinical condition.

From innovation to ethical impact: a bibliometric mapping of scientific production on Artificial Intelligence, Ethics and Global Health

2026-04-02T22:04:13+01:00

Introduction

The advancement of Artificial Intelligence in healthcare represents a technological revolution with profound ethical and clinical implications. However, the benefits and risks of this progress are not equally distributed, raising questions about bioethical dilemmas and their impact on health and nursing practices. Investigating the global scientific production on Artificial Intelligence, ethics, and health makes it possible to identify established, emerging, and neglected topics that are essential for achieving the Sustainable Development Goals, particularly quality health, innovation, and the reduction of inequalities.

Objective

To map the global scientific production on Artificial Intelligence in healthcare, focusing on ethics, and identifying trends, gaps, and main contributors in the field.

Methods

A bibliometric analysis was conducted using the Scopus, Web of Science, and PubMed databases. The analysis included articles published between January 2015 and May 2025. The data was processed using the Bibliometrix package in R and visualized with Biblioshiny. The analysis covered annual scientific production, thematic trends, the evolution of keywords, collaboration networks, and the impact of the sources.

Results

A total of 1,390 documents were analyzed. Scientific production has grown exponentially since 2020. The thematic analysis showed that "Artificial Intelligence," "Ethics," and "Health" are key topics, while "Bioethics," "Privacy," and "Machine Learning" are fundamental topics that are still underdeveloped. The collaboration map revealed a concentration in North America and Western Europe, highlighting global asymmetries.

Conclusion

There is a strong focus on debates about ethics and Artificial Intelligence, but the development of topics such as bioethics and social justice remains limited. The practice of nursing and health professionals must play a strategic role in building inclusive technological solutions, contributing to the reduction of inequalities and strengthening health systems. Expanding international collaboration and investing in research in the Global South are urgent for digital equity and ethics in health.

Nursing Interventions in the Management of Climate-related Disasters: Documentary Analysis of Emergency Plans

2026-04-02T21:33:09+01:00

Introduction

Extreme weather events reflect climate variability and are influenced by climate change, resulting in high rates of morbidity, mortality, and mental health problems. In this context, health systems require integrated responses throughout the disaster management cycle, and nursing assumes a strategic role, supported by its proximity to communities and skills such as continuous assessment, care coordination, health communication, and psychosocial support. However, evidence on their explicit integration into contingency plans remains limited, especially in island contexts.

Objective

This study aimed to analyse the integration of nursing interventions in emergency plans in the context of climate change.

Methods

This qualitative study applied documentary analysis of three publicly available emergency plans in the Azores that include natural risk scenarios and the organisation of multisectoral responses. Content analysis, which was both inductive and deductive in nature, was conducted using WebQDA®, based on the disaster management cycle and the domains of competence of the International Council of Nurses. Methodological rigor was ensured through in-depth reading of the documents, systematic coding of the data, validation of emerging categories, and maintenance of a transparent record of the analytical process.

Results

The analysis identified nine themes, 22 subthemes, and 133 nursing interventions related to the disaster cycle. There was a predominance in the response and preparation phases, with less representation in mitigation and recovery.

Conclusion

Nursing is present in all phases of disaster management, albeit in a less explicit manner. Strengthening their integration into plans is essential for strengthening the response of health systems to climate change. This study contributes to the consolidation of nursing as a central element in the adaptation of health systems to the emerging climate challenges.

Culturally Sensitive Digital Health Interventions for Informal Caregivers: A Scoping Review Protocol

2026-03-31T20:57:10+01:00

Introduction

The global demographic shift toward an aging population, particularly evident in Europe, has heightened the demand for informal caregivers who support older adults with chronic illnesses and dependencies. Amid increasing cultural diversity due to globalization and migration, there is a critical need for health interventions that are both digitally delivered and culturally sensitive, addressing the unique challenges faced by caregivers from diverse backgrounds.

Objective

This scoping review aims to identify and synthesize evidence on culturally sensitive digital health interventions that enhance the health and well-being of informal caregivers, with a focus on interventions tailored to the cultural and linguistic diversity arising from contemporary demographic trends.

Methods

The review will follow the Cochrane and PRISMA guidelines, employing a comprehensive search strategy across databases including CINAHL, MEDLINE, Nursing & Allied Health Collection, Cochrane Library, MedicLatina, WoS Core Collection, and Scopus. Eligible studies will involve informal caregivers (aged 18+) providing unpaid care to older adults (65+), with interventions delivered via digital platforms (e.g., mobile applications, telehealth, online resources) and explicitly adapted for cultural relevance. Both randomized and non-randomized studies published in English or Portuguese between 2014 and 2025 will be included. Data extraction and quality assessment will be conducted independently by three reviewers, with methodological quality evaluated using ROBVIS and ROBINS-I tools. Quantitative data from randomized controlled trials will be synthesized through meta-analysis, while other study designs will be summarized narratively.

Results

The review will map the landscape of culturally sensitive digital interventions, highlighting their impact on caregiver outcomes such as psychological well-being, self-efficacy, quality of life, and caregiving burden. It will also identify facilitators and barriers to the implementation of culturally responsive digital care.

Conclusion

By mapping evidence on culturally sensitive digital health interventions, this review will inform the development of tailored support strategies for informal caregivers and guide health professionals and policymakers in designing inclusive, effective interventions that address the needs of increasingly diverse populations.

Perspectives of palliative care professionals on an oral hygiene intervention: a qualitative exploratory descriptive study

2026-03-30T21:26:10+01:00

Introduction

Based on previous research a team of nurses, oral hygienist and dentist, designed an oral hygiene care intervention to manage oral symptoms in patients with cancer receiving specialist palliative care. Stakeholder involvement is required to better understand their perspectives on the intervention as well as the context where it will be applied.

Objective

To characterize the perspectives and suggestions of specialist palliative care nurses on the proposed oral hygiene care intervention.

Methods

A qualitative, exploratory, and descriptive study was conducted. Eleven nurses from five palliative care inpatient services in Portugal participated in two synchronous online focus group. Two physicians participated in individual interviews. The interviews were recorded, transcribed, and the generated dataset was subjected to reflexive thematic analysis following a deductive approach.

Results

Three themes were generated from the dataset. Participants consider that the components of the proposed symptom management strategy are adequate to the context and patients that is aimed at. Participants consider that the nurses from their units might adhere to the proposed symptom management strategy. The proposed symptom management strategy might have several possible outcomes, related to the symptom status or indicators sensitive to changes in the symptom status.

Conclusion

Participants considered the proposed oral hygiene care intervention to be adequate for their context of work. Participants recognize the intervention as being evidence based and perceived it as an improvement of current oral hygiene care practices.

Portuguese translation and psychometric testing of the cardiac self-efficacy scale

2026-03-12T21:27:56+00:00

Introduction

Self-efficacy plays a pivotal role in the ongoing management of patients recovering from myocardial infarction.¹ Evaluating patients’ cardiac self-efficacy is essential for healthcare professionals to structure person-centred care interventions that enable individuals to effectively self-manage their condition.²

Objective

To translate and test the psychometric properties of the Portuguese version of Cardiac Self-efficacy Scale (PT-CSE) scale.

Methods

Employing a two-phase methodological design, the research first involved translation and cultural adaptation of the original Cardiac Self-Efficacy scale.³ In Phase I, a forward-backward translation protocol was applied to develop the Portuguese instrument. Phase II focused on evaluating structural, convergent, and discriminant validity as well as internal consistency in a convenience sample of 102 patients diagnosed with myocardial infarction. Exploratory and confirmatory factor analyses were conducted, with full-information maximum likelihood (FIML) employed.

Results

Confirmatory factor analysis supported a multidimensional 13 items scale. The overall internal consistency was good, with subscales also showing strong reliability. Convergent and discriminant validity were established.

Conclusion

The PT-CSE scale has been validated as a reliable and valid measure for assessing cardiac self-efficacy in Portuguese patients following myocardial infarction. The PT-CSE scale offers meaningful insights into patients’ perceptions of their capabilities and beliefs after myocardial infarction. Incorporating self-efficacy assessment can optimize standard treatment by facilitating a more person-centred care practice and promote improved outcomes for patients recovering from myocardial infarction.

Nursing Practice Environment and its impact on Retention and Turnover: Umbrella Review Protocol

2026-02-25T22:21:41+00:00

Introduction

The shortage of nurses constitutes a global challenge with repercussions on care quality, patient safety, and the sustainability of health services. Among the factors influencing retention, the nursing practice environment stands out. It is understood as the set of organizational characteristics that either facilitate or constrain professional practice. Favorable environments are associated with higher satisfaction, better performance, and lower intention to leave, whereas unfavorable environments contribute to turnover, dissatisfaction, and burnout. The COVID-19 pandemic intensified workload, resource shortages, and occupational stress, with significant impacts on professional attrition, making retention an even more pressing, yet imperative, challenge. Despite the extensive scientific literature, a comprehensive synthesis that integrates existing evidence remains lacking. This protocol aims to address that gap by proposing an umbrella review that consolidates current knowledge and supports evidence-based decision-making within organizations.

Objective

To identify systematic reviews of the literature that describe the characteristics of the nursing practice environment which contribute to nurse retention or intention to leave in hospital settings.

Methods

Protocol based on JBI guidelines, including the following databases: JBI, Cochrane, CINAHL, Medline, and Scopus. Two independent reviewers will conduct the selection and appraisal process, with a third reviewer involved in case of disagreement. Methodological quality will be assessed using the JBI Critical Appraisal Checklist and the ROBIS tool. Data will be synthesized narratively. Protocol registration: INPLASY doi 10.37766/inplasy2023.11.0039.

Conclusion

This protocol outlines an umbrella review designed to consolidate and synthesize systematic review evidence on the association between the nursing practice environment and nurse retention, turnover, and turnover intention in hospital settings. The planned synthesis will map the available evidence, highlight potentially modifiable practice environment domains, and inform organizational and policy actions aimed at strengthening workforce stability and quality of care.

Profile of stroke survivors attending a rehabilitation center in Huambo, Angola: a cross sectional observational study

2026-03-11T21:08:35+00:00

Introduction

The continued rise in the global prevalence of cerebrovascular diseases, strongly associated with lifestyle factors, is concerning and substantially affects patients’ quality of life. Despite therapeutic advances, residual sequelae often persist, affecting self-care and functional status and, consequently, quality of life. In Angola, studies assessing the functional and cognitive status of people undergoing post-stroke rehabilitation remain scarce.

Objective

This study aimed to characterize the clinical, functional, and sociodemographic profile of stroke survivors undergoing rehabilitation.

Methods

We conducted a cross-sectional observational study with 230 community-dwelling adults undergoing rehabilitation at a specialized rehabilitation center. Data were collected between May and December 2024. The Barthel Index, the Berg Balance Scale, the Lawton Instrumental Activities of Daily Living (IADL) Scale, and the Six-Item Cognitive Impairment Test (6CIT) were administered. We used χ² tests, ANOVA, or t tests, with α = 0.05.

Results

Participants’ mean age was 56.35±12.77 years; 54.8% were men. Among caregivers, 57.8% were women; 46.1% were aged ≥ 39 years; and 43.5% were participants’ children. Participants with higher Barthel Index and Berg Balance Scale scores attended more rehabilitation sessions. Older participants were more dependent and had a higher risk of falls and cognitive impairment.

Conclusion

The sample shows a high burden of functional dependence and a substantial need for rehabilitation, with strong involvement of family caregivers. The findings support nursing strategies focused on self-care and caregiver education, and prospective studies should examine determinants and the effects of rehabilitation intensity.

Obstetric Nurses' Perception and Assessment of Work-Related Musculoskeletal Disorder Risk: A Mixed-Methods Study

2026-03-09T22:31:37+00:00

Introduction

The occupational health literature documents a high prevalence of work-related musculoskeletal disorders (WMSDs) among healthcare professionals, with nurses consistently identified as the occupational group at greatest risk. The etiology is recognized as multifactorial, combining biomechanical demands (such as patient handling and transfer maneuvers) and psychosocial factors (e.g., work pressure), often exacerbated by organizational constraints including understaffing and inadequate material resources. This synergy of risk factors constitutes a primary determinant of increased absenteeism, premature workforce attrition, and elevated turnover rates. Consequently, systematic ergonomic risk assessment, coupled with critical analysis of high-demand tasks, is imperative to inform evidence-based primary and secondary prevention strategies.

Objective

To analyze obstetric nurses' perceptions of WMSD risks and objectively assess the risk level of postures adopted during clinical practice.

Methods

A convergent mixed-methods study was implemented, integrating Photovoice and ergonomic analysis. Activities perceived as high-risk for WMSDs were photographically documented by obstetric nurses, followed by narrative interviews to extract their risk perceptions. The same photographic corpus was then subjected to objective ergonomic assessment using the REBA (Rapid Entire Body Assessment) tool to determine postural risk levels.

Results

Twenty obstetric nurses participated (95.8% female; mean experience 24.55 years). REBA analysis revealed that 65.3% of postures (10.5% very high risk; 54.8% high risk) required immediate intervention, with no low-risk postures identified. Confined spaces, inadequate equipment, work organization, and job demands were identified as key risks, reflecting nurses' expressed concerns.

Conclusion

The convergence between subjective perception and objective assessment confirms the high-risk nature of obstetric work. These findings underscore the urgent need for targeted ergonomic and organizational interventions to mitigate WMSD risks and confirm obstetric nurses' risk awareness.

Safety in Transition of Care for Critically Ill Patients: Systematic Literature Review Protocol

2026-03-09T22:11:24+00:00

Introduction

The transition of care refers to the process of transferring responsibility and sharing relevant and accurate clinical information regarding a patient’s health status from one healthcare professional to another.¹ Factors such as the lack of standardized procedures, time pressure, clinical complexity of patients, shortages in human resources, and inadequate professional training² have been identified as compromising the safety and effectiveness of care transitions. These factors increase the likelihood of diagnostic and therapeutic errors, with potentially serious consequences for patients, including permanent injury, as well as economic implications for healthcare institutions.³ Such adverse events are more frequently observed during transitions between the emergency department and intensive care units.

Objective

To synthesize the existing scientific evidence on nursing interventions that ensure an effective care transition for critically ill patients.

Methods

This will be a mixed-methods systematic review, following the guidelines of JBI and PRISMA-P. A comprehensive search will be conducted in the following databases: CINAHL, MEDLINE (via PubMed), Scopus, Web of Science, Cochrane, and JBI. Quantitative, qualitative, and mixed-methods studies will be included. The review will consider studies that explore nursing interventions in the care transition of critically ill patients between emergency departments and intensive care units, with a focus on the effectiveness and safety of this transition.

Results

This systematic review is expected to provide a comprehensive overview of the available evidence regarding communication and information transfer among nurses, to identify the methods, techniques, and protocols used to address this issue, as well as the instruments employed to monitor adverse events associated with the care transition process. The findings of this review may help identify practices that contribute to improved continuity of care and patient safety.

Artisanal fishing in the coastal fishing community of Paraná, Brazil: an ethnographic study

2026-03-09T21:57:55+00:00

Introduction

Artisanal fishing is essential for the livelihood and culture of many traditional communities in Brazil and around the world.^1,2 Present in environments such as seas, rivers, lakes, and mangroves, it is estimated that one in every 200 Brazilians is an artisanal fisher, highlighting the importance of this activity in the country.³

Objective

To analyze the behaviors, interactions, and cultural practices involved in artisanal fishing and their relationship with the health-disease process among fishers on an island in the state of Paraná, Brazil.

Methods

This is a qualitative study with an ethnographic approach, conducted on Superagui Island, in the municipality of Guaraqueçaba, Paraná. The research is based on the ethnographic method proposed by Bronislaw Malinowski, using participant observation. The study population consists of local fishers, both men and women, aged 18 or older. Data collection includes participant observation, ethnographic interviews, semi-structured questionnaires, and records such as field diaries, photographs, and audio recordings. Data analysis follows the steps of ethnographic research: preparation, immersion, observation, documentation, and interpretation. The study began in 2024 and is expected to continue until 2027. Data will be analyzed using Microsoft Word, Excel® 2016, and Iramuteq software.

Results

During visits conducted in February and October 2024, it was observed that the main local economic activity is shrimp fishing. The health unit has a physician and a dentist available only once a week, which makes continuous access to healthcare difficult. For emergency care, residents must travel by boat to Guaraqueçaba (approximately 30 to 35 km, with a duration of 50 minutes to 1 hour and 30 minutes) or to Paranaguá (approximately 35 to 46 km, with travel time ranging from 50 minutes to 2 hours and 5 minutes). Travel time varies depending on the type of vessel and sea conditions, and residents face transportation difficulties, such as the absence of water ambulances.

Conclusion

The partial study highlighted vulnerabilities in access to healthcare among artisanal fishers, suggesting the expansion of primary healthcare, culturally sensitive professional training, and specific intersectoral public policies aligned with the Sustainable Development Goals (SDGs), especially SDG 3 – Good Health and Well-Being and SDG 8 – Decent Work and Economic Growth.

Early mobilization in hospitalized patients with pneumonia: a systematic review of effectiveness

2026-03-04T21:10:48+00:00

Introduction

Pneumonia is one of the main causes of hospitalization worldwide, affecting different age groups, with a higher risk for adults/elderly. In addition to representing a significant burden of morbidity and mortality, prolonged hospitalization due to pneumonia is associated with high rates of immobility, with patients remaining up to 95% of the time in bed.^1,2 Low hospital mobility is a preventable risk factor, making the implementation of early mobilization strategies essential for improving health outcomes.

Objective

To identify the available evidence on interventions to implement for early mobilization in adults/elderly hospitalized with pneumonia.

Methods

A systematic review of effectiveness was carried out, following Cochrane guidelines³, to answer the question: "Which interventions ensure early mobilization in adults/elderly hospitalized with pneumonia?". Studies involving adults and elderly hospitalized with pneumonia were included, addressing interventions such as lifting, transferring, ambulation, and early mobilization. The databases consulted included CINAHL, MEDLINE, Scopus, Cochrane Library, CENTRAL, PEDro, OTseeker, and B-On. The protocol was registered in PROSPERO. The risk of bias was assessed with the RoB 2 tool and the quality of evidence with the GRADE approach.

Results

Ten RCTs were analyzed, highlighting that early mobilization requires continuous training of healthcare teams, through in-person and/or online training, practical sessions, and systematic monitoring. The effective implementation of interventions includes detailed initial assessment, progressive mobilization adjusted to the patient's clinical condition, the use of specific exercises, and the application of monitoring scales. The active involvement of patients and families, through education and informative materials, proved to be fundamental for adherence to strategies. Adapting interventions to individual needs, combined with the use of assisted technologies and specialized equipment, favors functional recovery. Continuous monitoring and interdisciplinary meetings are essential to ensure the effectiveness and safety of the implemented interventions.

Conclusion

Early mobilization in patients with pneumonia reduces complications associated with prolonged rest, promotes functional rehabilitation, and improves quality of life. The systematization of these interventions promotes functionality-centered care and contributes to the training of health professionals.

Cultural Competence: promoting quality care and supportive nursing work environments in multicultural units

2026-03-02T15:23:05+00:00

Introduction

The increasing cultural diversity in Portugal challenges healthcare organizations to create positive work environments that both support multicultural teams and address the needs of patients from diverse cultural backgrounds. Evidence suggests that cultural competence is a key factor for promoting supportive nursing work environments and for guiding the planning and delivery of culturally congruent care.

Objective

To analyse the impact of cultural competence on the nursing work environment and its relationship with the delivery of culturally congruent care in a multicultural healthcare organization in Portugal.

Methods

A quantitative, cross-sectional, and descriptive-correlational study was conducted with 155 nurses from a Local Health Unit in the Lisbon region, between February and June 2024. Data were collected using the Cultural Competence Questionnaire for Help Professionals, the NWI-R-PT Nursing Work Index – Revised (Portuguese version), and a single item assessing nurses’ perceptions of the adequacy of the culturally congruent care they provide. Data analysis was performed using descriptive and inferential statistics in SPSS Statistics version 27.

Results

The “Organizational Support” dimension of cultural competence was a significant predictor of a more favourable nursing work environment (β = 0.202; p < 0.001). Furthermore, higher scores in the “Cultural Knowledge” dimension was associated with more positive perceptions of the adequacy of culturally congruent care provided to patients from diverse cultural backgrounds (p < 0.05).

Conclusion

Cultural competence demonstrated a significant impact on the nursing work environment, with the “Organizational Support” dimension emerging as a predictor of more favourable work contexts. A positive relationship was also found between “Cultural Knowledge” and the perceived adequacy of culturally congruent care. These findings indicate that the development of cultural competence, particularly at the organizational and educational levels, constitutes a strategic factor in promoting more positive practice environments and care that is better aligned with patients’ cultural needs.

Co-Design in Social Prescribing Interventions for Older Adults: Insights from a Systematic Review

2026-03-02T15:09:41+00:00

Introduction

Co-design has emerged as a critical strategy in the development of person-centred health interventions. In the context of social prescribing (SP), the involvement of target users and local actors may enhance relevance, acceptability, and long-term impact. Yet, its practical application in SP interventions remains underexplored.

Objective

To analyze the extent and nature of co-design practices in SP interventions for middle-aged and older adults, based on secondary findings from a systematic review.

Methods

This review was conducted in accordance with PRISMA methodological guidelines. The research question guiding the study was: “Are social prescribing interventions effective in promoting quality of life among adults aged 55 years and older?”. Seven databases and repositories were searched using controlled vocabulary (e.g., MeSH) and free-text terms related to social prescribing, quality of life, self-efficacy, social support, and middle-aged or older populations. Search terms were combined using Boolean operators (AND, OR). Language filters were applied (English and Portuguese), and the time frame was limited to January 2016 through December 2024. Eligible study designs included randomized controlled trials (RCTs), quasi-experimental, and observational studies. Grey literature was also considered to reduce publication bias. Inclusion criteria comprised studies involving participants aged ≥55 years, evaluating social prescribing interventions, and reporting at least one of the following outcomes: quality of life, self-efficacy, or social support. Studies without original empirical data, not meeting the age criterion, or not assessing relevant outcomes were excluded. In addition to primary outcomes, data were extracted on the stakeholders involved in co-design strategies, followed by a narrative synthesis of the findings.

Results

Among the seven included studies involving intervention implementation, the degree of co-design varied considerably, five explicitly reported co-design elements. The targeted participants took part in design processes in four studies, primarily through interviews or prototype feedback. Healthcare professionals and community organizations were involved in several cases, although often in supporting roles. Only one study referenced policy-level engagement, and two studies did not report any actors involvement. Overall, there was wide variability in how co-design was conceptualized and implemented, ranging from minimal consultation to structured participatory processes.

Conclusion

Although co-design is increasingly recognized in theory, its integration into SP practice remains inconsistent. Many interventions lack robust mechanisms for engaging older adults and local stakeholders in early development stages. Strengthening participatory methods and fostering multi-actor collaboration could increase intervention alignment with community needs and improve sustainability. These findings underscore the relevance of co-design to the Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 11 (Sustainable Cities and Communities), and SDG 17 (Partnerships for the Goals), by promoting inclusive, place-based, and intersectoral approaches in nursing innovation.

Innovation in the Assessment of Continuing Education in Health: Development of an Instrument in Municipalities of Goiás

2026-02-26T21:01:42+00:00

Introduction

Continuing Health Education (EPS), established by Decree No. 1.996/2007, is an essential strategy for improving the quality of health services and strengthening the collaborative practices among workers, managers, and users. Aligned with contemporary demands, by fostering reflective practices guided by the needs of local communities, EPS can drive significant progress toward the 2030 Sustainable Development Goals (SDG), especially in relation to quality health, reducing inequalities, and promoting a culture of peace, justice, and effective institutions, by consolidating more inclusive, ethical, and integrated learning environments with public policies.

Objective

To develop an EPS evaluation matrix in municipalities in Goiás.

Methods

This methodological study, with a qualitative approach, is part of the research project "Continuing Health Education in Municipalities of the State of Goiás: Participatory Assessment and Intervention," conducted in two phases between May 2018 and March 2022. Focus groups were conducted with 37 workers, managers, and social oversight representatives in four municipalities in Goiás. Data analysis used WebQDA software and the Interpretation of Meanings method.

Results

In the first phase, eight analytical categories were identified, generating 15 questions distributed across the axes of structure, process, and results, composing the initial version of the evaluation matrix. After evaluation and adjustments agreed upon by the participants, the final version with 17 questions was consolidated. The next steps involve applying the matrix in municipal contexts to analyze its practical validity and contribution to EPS management.

Conclusion

The developed matrix is a strategic and participatory tool for evaluating EPS in municipalities in Goiás. Its application can improve the quality of healthcare and strengthen the National EPS Policy, contributing to the achievement of SDG 3, 4, 10, and 16. It is expected that managers and supporters will incorporate the tool into institutional practices, promoting innovation, equity, and continuous improvement in the management and organization of healthcare services.

Networks of knowledge: nursing science and global impact

2026-03-16T21:50:17+00:00