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- Burnout protective patterns among oncology nurses: a cross-sectional study using machine learning analysisPublication . Rocha, Ana; Costeira, Cristina; Barbosa, Raul; Gonçalves, Florbela; Castelo-Branco, Miguel; Viana, Joaquim; Gaudêncio, Margarida; Ventura, FilipaBackground Oncology nurses face unique and intense demands due to the nature of their work, caring for patients with life-threatening illnesses. The emergence of professional burnout among these nurses is influenced by several factors, highlighting the importance of identifying protective and risk factors to mitigate its impact. This study aims to identify burnout profiles and protective socio-demographic and work-related patterns associated with reduced burnout among oncology nurses. Methods A cross-sectional study was conducted with 150 oncology nurses at a specialized hospital exclusively dedicated to adult oncology treatment in Portugal. Data collection included a self-administered questionnaire incorporating the validated Portuguese version of Maslach Burnout Inventory (MBI). Statistical analyses were performed using SPSS and machine learning tools, specifically KMeans clustering and Random Forest algorithms. Results Six protective patterns against burnout were identified, characterized by conditions of permanent contracts, work-life balance, and supportive work environments. Moreover, factors such as holding management roles and being a parent of two or more children might even be protective in some circumstances, suggesting a nuanced relation between personal and professional factors. Machine learning analyses made apparent the unpredictability of burnout and highlighted the critical role of protective factors in mitigating its impact. Conclusions This study underscores the importance of resilience-building strategies and promoting protective factors, such as job stability, learned experience, and adequate rest, to reduce burnout risk among oncology nurses. Future research should validate these findings through hypothesis-driven analyses to inform targeted and context-specific burnout prevention programs.
- A Complex Intervention to Minimize Medication Error by Nurses in Intensive Care: A Case StudyPublication . Coelho, Fábio; Furtado, Luís; Tavares, Márcio; Pereira, Joana SousaBackground/Objectives: Medication errors are the most frequent and critical issues in healthcare settings, often leading to worsened clinical outcomes, increased treatment costs, extended hospital stays, and heightened mortality and morbidity rates. These errors are particularly prevalent in intensive care units (ICUs), where the complexity and critical nature of the care elevate the risks. Nurses play a pivotal role in preventing medication errors and require strategies and methods to enhance patient safety. This study aims to develop a comprehensive and evidence-based intervention to minimize medication errors by nurses in ICUs. Methods: This qualitative case study forms a part of a broader research project that commenced with a scoping review. Building on the review findings, a complex intervention was designed to address nurses’ medication errors. A focus group of experts was conducted to validate the intervention designed, evaluating its contextual feasibility and relevance. Results: This study led to the development of a complex intervention whose relevance lies in its potential implementation within the studied context. The resulting intervention was structured around four main components—educational interventions, verification and safety methods, organizational and functional modifications, and an error reporting system—meticulously designed to leverage the ICU’s existing resources. Conclusions: In conclusion, the proposed intervention has the potential to positively impact healthcare quality by reducing errors and promoting a culture of safety. Furthermore, this study’s findings provide a relevant foundation for future research and practical applications, driving advancements in healthcare service excellence.
- Curae de Mim (Care for Me): A Personalized Alzheimer’s Care Nursing Intervention for Informal CaregiversPublication . Afonso, Catarina Inês Costa; Madeira, Ana Spínola; Reis, Alcinda; Gomes, JoãoBackground: Informal caregivers of individuals with Alzheimer’s disease often experience high levels of emotional, physical, and psychological burden. Personalized nursing interventions are essential to support these caregivers and promote their well-being. Objectives: The objective of this study was to implement and evaluate a personalized psychoeducational intervention—Curae de Mim (Care for Me)—designed to reduce caregivers’ burden and enhance the emotional resilience among informal caregivers for people with Alzheimer’s disease. Methods: A mixed-methods study was conducted with 14 informal caregivers in a Portuguese community healthcare setting. The intervention consisted of six weekly group sessions guided by a mental health nurse, using cognitive–behavioral and recovery-oriented approaches. Results: After the intervention, the caregivers’ burden scores decreased significantly. The mean burden score dropped from 78 to 50. The thematic analysis revealed two key outcomes: emotional empowerment through peer interactions and reframing of the caregiver’s role through knowledge and self-care. Conclusions: This program proved effective in reducing caregivers’ burden and promoting adaptive coping. The integration of narrative reflection and specialized nursing care contributed to improved mental health outcomes.
- O efeito do jogo na promoção do equilíbrio e na prevenção do risco de quedas em pessoas idosasPublication . Neves Rosa, Marlene Cristina; Brites, Cátia; Tarrafa, Inês; Viamonte, Miguel; Oliveira, Patrícia; Silva, CândidaIntrodução: O jogo analógico dirigido a pessoas idosas com alterações de equilíbrio e risco de queda demonstrou alguns potenciais resultados, contudo os estudos são escassos. Objetivo: O presente estudo pretendeu testar o potencial de um jogo analógico na melhoria do equilíbrio e diminuição do risco de quedas, bem como caracterizar o desempenho dos participantes no jogo e a sua relação com as variáveis de equilíbrio e risco de queda. Metodologia: Foram analisados dados recolhidos em três momentos: inicial (T0); após 6 semanas de intervenção com jogo (T1) e final (T2), após 6 semanas sem intervenção com jogo. Foram calculadas correlações entre o desempenho no jogo nas diferentes grelhas (S, M e L) e os indicadores de equilíbrio (Teste de Levantar e Ir (TUG) e teste Tinetti); estes testes foram comparados entre os períodos com e sem o jogo. Resultados: Dez pessoas idosas (87,60±7,25 anos; 8 mulheres) participaram no estudo, melhorando significativamente os valores de TUG apenas entre T0-T1 (p=0,002). Os valores do teste de Tinetti melhoraram significativamente nos dois períodos de intervenção (p=0,001; p=0,006). O desempenho na grelha L demonstrou correlação com o teste Tinetti (T0 - ρ = -0,664; p = 0,036) e com o TUG apenas na 2ª tentativa (T0; r = 0,680; p = 0,030*). Conclusão: Existe potencial benefício do jogo analógico na melhoria do risco de queda (TUG) na pessoa idosa institucionalizada. O jogo implementado, no seu nível mais exigente (grelha L), parece adequar-se ao contexto de reabilitação, promovendo aprendizagem ao longo do tempo.
- Efficacy and safety of pharmacological treatments in inclusion body myositis: a systematic reviewPublication . Santos, Eduardo José Ferreira; Farisogullari, Bayram; Yapp, Nicholas; Townsley, Hermaleigh; Sousa, Pedro; Machado, Pedro; Combe, BernardObjective: To identify the best evidence on the efficacy of treatment interventions for inclusion body myositis (IBM) and to describe their safety. Methods: Systematic review of randomised controlled trials (RCTs) of pharmacological treatments of adults with IBM, conducted according to the Cochrane Handbook, updating a previous Cochrane review. The search strategy was run on Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE and EMBASE, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. Assessment of risk of bias, data extraction and synthesis were performed independently by two reviewers. Data pooled in statistical meta-analyses, if possible. Results: From a total of 487 records, 48 were selected for full-text review, 14 fulfilled the inclusion criteria, but only 2 RCTs were included in meta-analyses due to clinical heterogeneity (different drug interventions or dosages). Treatments included various immunosuppressive and immunomodulatory agents, alongside interventions modulating muscle growth and protein homoeostasis. Efficacy was assessed across multiple outcomes, namely muscle strength, physical function, mobility and muscle trophicity. Trials of methotrexate (MTX), intravenous immunoglobulin, interferon beta-1a and MTX, MTX and anti-T-lymphocyte immunoglobulin, oxandrolone, MTX and azathioprine, bimagrumab, arimoclomol, and sirolimus provided low-quality to high-quality evidence of having no effect on the progression of IBM. Conclusions: Drug interventions for IBM were not effective for most of the outcomes of interest. We observed inconsistency of outcome measures across trials. More RCTs are needed, of adequate size and duration, and using a standardised set of outcome measures.
- Lived Experiences of Physiotherapists in Caring for People with Advanced Amyotrophic Lateral Sclerosis in Portugal: A Phenomenological StudyPublication . Monteiro, Andreia; Ali, Amira Mohammed; Laranjeira, CarlosAmyotrophic lateral sclerosis (ALS) is a disease that has a multidimensional impact on a person’s life, with symptoms associated with a significant loss of autonomy. Specialized palliative care (PC) should be provided early and throughout the course of the disease. Indeed, physiotherapists should be understood as integral members of the multidisciplinary team in PC, in the care and improvement of the quality of life of these people. This study aimed to describe the lived experience of physiotherapists in the context of intervention in people with advanced ALS and their families. Descriptive phenomenology was employed as a framework for conducting semi-structured interviews to reveal experiences. Sixteen physiotherapists who performed interventions on at least one person with advanced ALS in the last 2 years were included in the study. The study involved conducting semi-structured individual interviews, through the Zoom® videoconferencing platform (version 6.4.3). Data were analyzed according to Giorgi’s five-stage approach and managed using webQDA software (Version 3.0, University of Aveiro, Aveiro, Portugal). The COREQ checklist was applied in the study. Participants were mostly female (n = 12) and aged between 26 and 55 years (M = 36.81; SD = 6.75). Four constituents were identified: (1) undulating course of a complex disease; (2) barriers to person-centered care; (3) enablers of person-centered care; (4) transition between curative and palliative care. The findings illustrate the multidimensional impact of the disease trajectory on the person and their family. This study highlights the need to invest in specialized training for physiotherapists, contributing to a person-centered PC practice with an impact on promoting comfort and quality of life.
- Loneliness among dementia caregivers: evaluation of the psychometric properties and cutoff score of the Three-item UCLA Loneliness ScalePublication . Ali, Amira Mohammed; Al-Dossary, Saeed A.; Laranjeira, Carlos; Selim, Abeer; Hallit, Souheil; Alkhamees, Abdulmajeed A.; Aljubilah, Aljawharah Fahad; Aljaberi, Musheer A.; Alzeiby, Ebtesam Abdullah; Pakai, Annamaria; Khatatbeh, HaithamIntroduction: Dementia is a chronic progressive syndrome, with an entire loss of function in the late stages. The care of this demanding condition is primarily provided by family members, who often suffer from chronic burnout, distress, and loneliness. This instrumental study aimed to examine the factor structure, reliability, convergent validity, criterion validity, and cutoff scores of a short loneliness measure: the Three-Item version of the University of California, Los Angeles, Loneliness Scale (UCLALS3) in a convenience sample of dementia family caregivers (N = 571, mean age = 53 ±12 years, 81.6% females). Methods: Exploratory and confirmatory factor analyses were used to examine the structure of the UCLALS3 while receiver-operating characteristic (ROC) curve, including caregiving burden and emotional distress as outcomes, was used to examine its cutoff. Results: One factor accounted for 79.0% of the variance in the UCLALS3; it was perfectly invariant across genders but variant at the metric level across countries. The scale had adequate internal consistency (alpha = 0.87), high item-total correlations (0.69 - 0.79), reduced alpha if item deleted (0.77 - 0.86), and strong positive correlations with caregiving burden and psychological distress scores (r = 0.57 & 0.74, p values = 0.01). Percentile scores and the ROC curve suggested two cutoffs (≥6 and ≥6.5), which classified 59.3 and 59.4% of the participants as having higher levels of loneliness-comparable to global levels of loneliness among informal caregivers. The Mann-Whitney test revealed significantly high levels of caregiving burden and distress in caregivers scoring ≥6.5 on the UCLALS3. Conclusion: The UCLALS3 is a valid short scale; its cutoff ≥6.5 may flag major clinically relevant symptoms in dementia caregivers, highlighting the need for tailored interventions that boost caregivers' individual perception of social relationships. More investigations are needed to confirm UCLALS3 invariance across countries.
- Loss and Grief Among Bereaved Family Members During COVID-19 in Brazil: A Grounded Theory AnalysisPublication . Lima, Paola Kallyanna Guarneri Carvalho de; Laranjeira, Carlos; Carreira, Lígia; Baldissera, Vanessa Denardi Antoniassi; Meireles, Viviani Camboin; Baccon, Wanessa Cristina; Dias, Lashayane Eohanne; Ali, Amira Mohammed; Mello, Fernanda Fontes; Tostes, Maria Fernanda do Prado; Salci, Maria AparecidaThe COVID-19 pandemic has resulted in countless losses around the world, profoundly affecting the lives of many people, especially those who faced the death of family members, bringing several negative repercussions to these families and constraining the experience of grief. This study aimed to understand the experience of loss and grief among bereaved individuals who lost family members during the COVID-19 pandemic. This qualitative study was guided by Charmaz’s constructivist grounded theory as a methodological framework. The study adhered to the Criteria for REporting Qualitative research (COREQ) checklist. Data collection took place between May and November 2023 through telephone interviews that were audio-recorded and later transcribed in full. The purposive sample consisted of 21 bereaved family members who had lost their loved ones during the COVID-19 pandemic. Participants were mainly female (n = 16) with a mean age of 55.5 (SD = 16.2). The loss of their family members occurred 12 to 24 months before data collection. The following central phenomenon was identified through the analytical process: “Family experience of loss and grief: between the unspoken goodbye and post-loss adjustment”. This was anchored in the following three categories: (1) Anguish and fear of the unknown; (2) Death by COVID-19—communication of death and lack of goodbyes; and (3) (Re)construction of meaning—support networks and the grieving process. Our findings recommend that policymakers allocate additional resources to grief support services to better prepare for future pandemic events. Furthermore, it is necessary to invest in the implementation of relevant training programs for healthcare professionals, with a family centered approach.
- Multidrug resistance assessment of indoor air in Portuguese long-term and acute healthcare settingsPublication . Santos-Marques, C.; Teixeira, C.; Pinheiro, R.; Brück, W. M.; Pereira, Sónia Gonçalves; dos Santos Marques, Catarina; Silva Teixeira, Camila; Pinheiro, Rafael; Gonçalves Pereira, SóniaBackground: Knowledge about air as a pool of pathogens and multidrug resistance (MDR) in healthcare units apart from hospitals is scarce. Aim: To investigate these features in a Portuguese long-term healthcare unit (LTHU) and a central hospital (CH). Methods: Air samples were collected and their microbial load (bacteria and fungi) determined. Bacterial isolates were randomly selected for further characterization, particularly identification by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry, antimicrobial susceptibility testing, and polymerase chain reaction screening of extended-spectrum b-lactamases, carbapenemase genes and mecA gene, with RAPD profile assessment of positive results of the latter. Findings: A total of 192 samples were collected (LTHU: 86; CH: 106). LTHU showed a statistically significantly higher bacterial load. CH bacteria and fungi loads in inpatient sites were statistically significantly lower than in outpatients or non-patient sites. A total of 164 bacterial isolates were identified (MALDI-TOF: 78; presumptively: 86), the majority belonging to Staphylococcus genus (LTHU: 42; CH: 57). The highest antimicrobial resistance rate was to erythromycin and vancomycin the least, in both settings. Eighteen isolates (11%) were classified as MDR (LTHU: 9; CH: 9), with 7 MDR Staphylococcus isolates (LTHU: 4; CH: 3) presenting mecA. Nine non-MDR Staphylococcus (LTHU: 5; CH: 4) also presented mecA. Conclusion: The current study highlights that healthcare unit indoor air can be an important pool of MDR pathogens and antimicrobial resistance genes. Also, LTHUs appear to have poorer air quality than hospitals, as well as supportive areas compared to curative care areas. This may suggest possible yet unknown routes of infection that need to be explored.
- Navigational health literacy and health service use among higher education students in Alentejo, Portugal - A cross-sectional studyPublication . Rosário, Jorge; Dias, Sara Simões; Dias, Sónia; Pedro, Ana Rita; Paulo AlexandreIntroduction The navigational health literacy of higher education students is fundamental to effective health management and successful health navigation, thereby improving health outcomes and overall well-being. Assessing the general and navigational health literacy levels of these students is crucial for developing targeted interventions and facilitating informed decision-making on health-related issues. This study aimed to identify the levels of general and navigational health literacy, characterise access to and utilisation of healthcare services, and analyse the differences between the mean general and navigational health literacy indices and determinants among higher education students in the Alentejo region of southern Portugal. Methodology A descriptive and cross-sectional study was conducted between 25 May and 12 September 2023 with 1979 higher education students. An online structured questionnaire comprising the Portuguese version of the European Health Literacy Survey Questionnaire – 16 items (HLS-EU-PT-Q16) and the Navigational Health Literacy Scale (HLS19-NAV), both from the European Consortium, was used. Sociodemographic data, presence of chronic disease, perceived health status, perceived availability of money for expenses, and healthcare access and utilisation variables were included. The study data were analysed using independent samples t-test, one-way ANOVA, and post hoc Bonferroni test, followed by multiple linear regression analyses at a significance level of 0.05. Multiple linear regression analysis was performed to identify factors associated with both general and navigational health literacy. The study protocol was approved by the ethics committee of the University of Évora, and all participants provided written informed consent. Results Most students (86.8%) exhibited limited general health literacy, while 13.2% demonstrated adequate health literacy. Inadequate navigational health literacy was observed in 73.4% of students. Students with lower mean general and navigational health literacy were more likely to have utilised health services. Students with chronic conditions, recent use of urgent or emergency services, and difficulties in accessing healthcare had lower health literacy. Conversely, those enrolled in health-related courses, those with good financial resources and those who had not used health services during their course had higher health literacy. In addition, lower navigational health literacy was found among displaced students, those with chronic conditions and those who had recently consulted a doctor. Higher navigational health literacy was associated with enrolment in health-related courses and adequate general health literacy. Conclusion The findings highlight the significant influence of demographic and academic factors on general and navigational health literacy among higher education students. The prevalence of limited general and navigational health literacy underscores a significant challenge for students, institutions, and health policy makers. Effective health literacy interventions should take these factors into account. Future research should examine longitudinal changes in health literacy and evaluate the impact of targeted educational programmes.