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- 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.
- Respiratory telerehabilitation: user experience and satisfaction with the programPublication . Reis, Neuza; Costa Dias, Maria José; Sousa, Luís; Oliveira, João; Rico, Miguel Toscano; Baixinho, Cristina Lavareda; Henriques, Maria AdrianaBackground The rise of telehealth in geriatric care is an inexorable movement toward adapting to global digitalization trends, in terms of both technology and implementation experiences, with clear gains for health systems and citizens. A literature review shows that the older population, with lower levels of digital literacy, faces specific challenges with this type of service. The aim of this study was to understand the way older people with Chronic Obstructive Pulmonary Disease or long COVID perceive the implementation of telerehabilitation programs to meet their healthcare needs. Methods A qualitative study was conducted using semi-structured interviews to answer the research question: How do older people perceive telerehabilitation programs? The study participants were 17 people aged ≥ 65 years old who had completed a respiratory telerehabilitation program at a Portuguese hospital. The interviews were submitted to content analysis using WebQDA® qualitative data analysis software. Results The study participants had an average age of 70.94 ± 7.44 years old. The content of the interviews with these older people points to easy adaptation to the telerehabilitation program. Three categories and their respectives subcategories emerged from the content analysis: (1) access and continuity of care (access, continuity of care, and self-management); (2) presence (communication with the team and maintaining relationships); and (3) experience in the program (comfort, advantages, and difficulties). Conclusions This study allows for an understanding of how older people perceive participation in telerehabilitation programs, what they value, and the difficulties they experience. It makes it possible to make recommendations for clinic practice and research into this emerging area of health care.
- Technology-mediated training programs for school health teams on special health care needs: a scoping reviewPublication . Pires, Maria do Céu Coelho Monteiro; Barbieri-Figueiredo, Maria do Céu Aguiar; Cardoso, Daniela Filipa Batista; Duque, Filipa Margarida; Tricas-Sauras, Maria Sandra; Prosen, Mirko; Menino, Eva Guilherme; Sousa, Paulino Artur Ferreira deObjective: To map technology-mediated training programs for school health teams thataddress special health needs in the school environment and to identify their characteristics.Method: The review followed the JBI methodology. Eight databases were searched forpublished and gray literature. Studies published in Portuguese, English or Spanish since2000 were included to capture emerging training programs. Results: Of the 1,106 studiesidentified, 29 were reviewed in full and eight were included in the final analysis. All studieswere carried out in the United States of America. Program topics included chronic healthconditions such as diabetes, asthma, procedures, as well as emergency situations, all aimed atschool nurses and based on a conceptual or pedagogical framework. The programs includedthematic modules of various lengths and offered online and hybrid training through variousdigital educational resources. Conclusions: Programs focused on chronic health conditionsand assessed professionals' knowledge, skill development, self-efficacy, and confidence; fewstudies provided a detailed exploration of the underlying pedagogical models and did notuse formative assessment.
- 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.
- 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.
- 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.
- 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.
- Physiotherapy Intervention for Promoting Comfort in Palliative Care Patients: A Focus Group StudyPublication . Domingos, Daniela Filipa dos Santos; Querido, Ana; Pedrosa, VandaBackground/Objectives: Population aging and the rise in chronic diseases challenge healthcare systems to adopt person-centered approaches, especially in palliative care (PC), where symptom management remains limited. Physiotherapy plays a key role in alleviating discomfort but faces inconsistent integration in Portugal due to lack of recognition. Variations in intervention methods hinder uniform care delivery, limiting timely patient access to comfort-focused treatments and knowledge. This study aims to deepen the understanding of physiotherapy’s role in Portuguese PC to improve its integration into teams and enhance patient access to comfort care. Methods: This study used a descriptive qualitative approach with online focus groups (FG), guided by Krueger and Casey’s methodology and adhering to the COREQ checklist. A non-probabilistic convenience sample of physiotherapists working in palliative care across mainland Portugal and the islands was selected based on inclusion criteria. Three FGs were planned with up to ten participants each. However, due to availability and attendance issues, only 15 physiotherapists participated: 5 in FG1 (in-hospital PC units), 6 in FG2 (inpatient units), and 4 in FG3, the minimum appropriate number from community-based units. Results: Physiotherapy plays a crucial yet underrecognized role in PC, emphasizing the need for its full integration into care teams rather than reliance on late, on-call referrals. Techniques such as positioning, mobilization, pain and dyspnea relief, adapted exercises, massage, music therapy, and emotional support are employed. Conventional physiotherapy tools are used and personalized according to the patient’s context, duration, setting, dosage, and individual needs. Conclusions: Physiotherapy should be recognized as a fundamental part of PC, contributing not only to the prolongation of life but also to ensuring comfort and dignity for patients and their families. To achieve this, its role within multidisciplinary teams must be strengthened and supported by regulations that guarantee access and the formal integration of physiotherapists. However, a significant gap remains in patients’ regular access to comfort-focused interventions at the appropriate time, perhaps due to the considerable variation in physiotherapy practices depending on the patient and care setting, which presents a challenge for knowledge development both in Portugal and globally.
- The Practices of Portuguese Primary Health Care Professionals in Palliative Care Access and Referral: A Focus Group StudyPublication . Barreto, Camila; Silva, Marcelle Miranda da; Fernandes, Ana Fátima Carvalho; Yanez, Romel Jonathan Velasco; Laranjeira, CarlosBackground/Objectives: The prevalence of people with incurable and progressive diseases in primary health care is high. Family doctors and nurses must be active agents in the early identification of palliative needs and the implementation of palliative approaches in cases of low to intermediate complexity. While there is a need for early referral of more complex palliative care (PC) cases to specialized teams, primary health care (PHC) professionals lack the confidence or skill to describe their role. This study sought to explore and describe (a) the practices of PHC professionals regarding their PC provision; (b) the barriers regarding access and referral of patients to specialized PC services; and (c) the strategies used or recommended to mitigate difficulties in accessing and referring to specialized PC. Methods: A descriptive qualitative study was carried out, using five focus groups conducted with nursing and medical staff at three local health units in the central region of Portugal. Semi-structured interviews were conducted, and then recorded, transcribed, and analyzed through a thematic analysis approach. The reporting of this research follows the COREQ checklist. Results: In total, 34 PHC professionals participated in this study. The majority of participants were women (n = 26) and family doctors (n = 24). Their mean age was 43.8 ± 11.9 (range: 29 to 65 years). The findings were organized into three core themes: (1) the contours of palliative action developed by PHC teams; (2) barriers to access and safe transition between PHC and specialized PC; and (3) ways to mitigate difficulties in accessing and referring to specialized PC. Conclusions: Our findings highlight the fundamental role of PHC professionals in providing primary PC, and in identifying PC needs and referring patients to PC early on, while exposing the systemic and interpersonal challenges that hinder these processes. To overcome these challenges, it is essential to invest in the development of integrated care models that promote practical, low-bureaucratic referral processes and capture the human resources necessary for the adequate follow-up of users.
- Spatial Distribution and Post-COVID-19 Health Complications in Older People: A Brazilian Cohort StudyPublication . de Brito, Franciele Aline Machado; Laranjeira, Carlos; Rossoni, Stéfane Lele; Ali, Amira Mohammed; Salci, Maria Aparecida; Carreira, LígiaBackground/Objectives: In the aftermath of the COVID-19 pandemic, individuals infected with SARS-CoV-2 have progressively displayed a range of symptoms linked to protracted COVID during the post-acute phase of illness. Concurrently, in several nations globally, the phenomenon of population aging has been intensifying. In this scenario, the aged population has become both vulnerable and high-risk during the acute phase of COVID-19, and faces significant dangers associated with long-COVID. This study seeks to analyze the incidence and spatial distribution of health complications in older people affected by COVID-19, in the first year of the pandemic (2020), in the State of Paraná, as well as to identify the factors associated with the development of cardiovascular, neurological, respiratory, and metabolic diseases. Method: An observational and retrospective study was carried out in the Brazilian state of Paraná. Participants were randomly selected from two databases. A total of 893 older people (≥60 years) participated in the study 12 months after acute COVID-19 infection. Telephone questionnaires were applied between March and December 2021. The Moran index test, logistic regression, and Poisson models were used to analyze the data. Results: In terms of age, most participants (66%) were between 60 and 69 years old, 25.8% were between 70 and 79 years old, and 8.2% were 80 years old or older. Most participants were female (51.2%), white (98.1%), had a partner (69.8%), and had been hospitalized due to COVID-19 (59.3%). Cardiovascular diseases were the most frequent in the population (39.5%), followed by metabolic diseases (27.3%). The long-term use of medication was associated with the development of metabolic diseases (aOR = 9.8), cardiovascular diseases (aOR = 6.6), and diseases in multiple organic systems (aOR = 3.2); living alone was associated with neurological diseases (aOR = 2.5), and the age group of 80 years or older (aOR = 2.4) was associated with cardiovascular events. The spatial distribution showed that complications in body groups are distributed randomly among the health regions of the state, with no influence from neighboring locations. Conclusions: Post-COVID-19 health complications are more frequent in older adults who have comorbidities and long-term medication use. Therefore, long-term monitoring of these individuals and investment in public policies for rehabilitation and prevention of complications are necessary.