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- 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.
- Comparative Analysis of Pressure Platform and Insole Devices for Plantar Pressure AssessmentPublication . Amaro, Catarina M.; Paulino, Maria F.; Valvez, Sara; Roseiro, Luis; Castro, Maria António; Amaro, Ana M.Foot plantar pressure refers to the pressure or force that the foot generates in contact with the ground, varying across different regions of the foot. This parameter is essential in static and dynamic analyses to access accurate diagnoses, study the human body biomechanics, create functional footwear designs, aid in rehabilitation and physiotherapy, and prevent injuries in athletes during sports practice. This study presents an experimental comparison between two different plantar pressure measurement devices, Pedar® (sensorized insoles) and Physiosensing® (pressure platform). The devices were selected based on their capacity to measure contact area and peak pressure points. Results showed that Physiosensing® provided a more uniform measurement of the contact area, proving its efficiency for weight distribution and stability analysis applications, particularly in posture assessment and balance studies. The Pedar® system showed higher capacity in peak pressure point detection. Therefore, the insole system is more suitable for applications requiring precise high-pressure zone localization. Comparative analysis highlights the strengths and limitations of each device and offers insights regarding its optimal usage in clinical, sports, and research settings.
- Leadership Development in Undergraduate Nursing Students: A Scoping ReviewPublication . Costa, Patrícia; Pereira de Sousa, Joana; Nascimento, Tiago; Cruchinho, Paulo; Nunes, Elisabete; Gaspar, Filomena; Lucas, PedroBackground: Leadership is present at all levels of nursing and is essential to ensure the continuous improvement of nursing practice environments and the quality of the care provided to patients. This reality, coupled with the growing complexity of today’s health contexts, emphasises the importance of promoting the development of leadership skills in undergraduate nursing students, thus training nurses who are capable of acting as leaders and agents of change. To this end, a scoping review was carried out to map the available scientific evidence on the development of leadership in undergraduate nursing students. Methods: The scoping review was conducted according to two systematic review guidelines. The searches were conducted across a total of five databases for published studies and two databases for the unpublished/grey literature. The data extraction and analysis were performed by two reviewers, who independently screened and extracted data from the selected studies. Results: This review included 25 articles, and four thematic categories were identified—students’ perceptions of leadership; strategies to train leaders in nursing; the evaluation of leadership development; and conceptual models and curricula. The main conclusions highlight the need to reformulate existing curricula, the importance of integrating student-centred pedagogical approaches to promote leadership development, the impact that evaluating leadership development has on the whole process, contributing to the construction of an identity as a leader, and the need for it to be done in a structured and progressive way. Conclusions: The teaching of leadership should be promoted from the beginning of training, in a transversal, continuous, consistent, sustained, and articulated way, incorporating different disciplines, because only in this way will it be possible to train competent nurse leaders who are capable of acting in today’s complex and dynamic health contexts.
- Racial and Socioeconomic Disparity in Breast Cancer Mortality: A Systematic Review and Meta-AnalysisPublication . Ribeiro, Helena Fiats; Pelloso, Fernando Castilho; Fonseca, Beatriz Sousa da; Camparoto, Camila Wohlenberg; Carvalho, Maria Dalva de Barros; Marques, Vlaudimir Dias; Bitencourt, Mariá Romanio; Stevanato, Kely Paviani; Borba, Pedro Beraldo; Borghesan, Deise Helena Pelloso; Egger, Paulo Acácio; Alarcão, Ana Carolina Jacinto; Cuman, Roberto Kenji Nakamura; Huber, Isabella Morais Tavares; Consolaro, Márcia Edilaine Lopes; Pujals, Constanza; Laranjeira, Carlos; Pedroso, Raíssa Bocchi; Pelloso, Sandra MarisaBackground/Objectives: Breast cancer is one of the leading causes of female mortality worldwide, but significant racial and socioeconomic disparities persist in disease outcomes. This review aimed to analyze racial and socioeconomic inequalities in mortality and survival from breast cancer, identifying the impact of social risk factors on access to diagnosis and treatment. Methods: A systematic literature review and meta-analysis was performed following PRISMA guidelines. Eighteen studies published between 2014 and 2024 were included, with 11 contributing to the meta-analysis. Random-effect models were used to assess correlations between socioeconomic status, race, and clinical outcomes, including heterogeneity and publication bias analyses. Results: The strongest associations were observed between income, race, and breast cancer survival, with survival significantly worse among Black women and low-income populations (p < 0.001). Income also showed a strong positive correlation with clinical outcomes. In contrast, the overall effect on mortality was not statistically significant (p = 0.290), likely due to high heterogeneity across studies (I2 = 100%). These findings suggest that structural disparities in access to healthcare and early detection substantially affect survival rates. Conclusions: Racial and socioeconomic disparities in breast cancer outcomes remain critical public health challenges. Targeted policies to expand early diagnosis and ensure equitable access to effective treatment are essential to reduce these disparities and improve survival in underserved populations.
- Perceptions and Practices of Interdisciplinary Action in an Intra-Hospital Support Team for Palliative Care: A Qualitative StudyPublication . Cruz, Célio; Querido, Ana; Pedrosa, VandaBackground: The quality of palliative care (PC) services is closely linked to the effectiveness of interdisciplinary collaboration. A coordinated approach among professionals from different fields fosters holistic, person-centered care, ensuring comprehensive support for patients with complex conditions and their families. In hospital settings, In-Hospital Palliative Care Support Teams (EIHSCPs) play a key role in delivering specialized care, enhancing interdepartmental communication, training other healthcare professionals, and optimizing resources. Strong leadership by PC specialists, combined with effective team management, contributes to symptom relief, improved quality of life, and cost reduction. However, interdisciplinary collaboration presents challenges, including competing priorities, resource constraints, and communication barriers. Despite its recognized benefits, research on its implementation in PC, particularly in Portugal, remains scarce. Objective: This study explores the perspectives and practices of professionals within an EIHSCP, examining team dynamics, interprofessional collaboration, and key facilitators and barriers. Methods: Twelve semi-structured interviews were conducted with physicians, nurses, psychologists, and social workers from the EIHSCP in the Médio Tejo region. Data were analyzed using Braun and Clarke’s reflexive thematic analysis. Results: The interview findings were organized into three themes: (1) Social Representations and Interdisciplinary Practice; (2) Competencies for Interdisciplinary Practice; and (3) Challenges in Interdisciplinary Practice. Participants consistently highlighted that interdisciplinary collaboration enhances communication between services and improves care quality. While teamwork is central, patient- and family-centered care remains the priority. Key competencies include empathy, ethics, active listening, and cultural sensitivity, alongside structural and procedural elements such as team meetings, integrated communication, and clear referral criteria. Continuous education and professional development are essential. Challenges primarily stem from limited human and material resources, staff workload and stress, communication gaps between hospital and community teams, and insufficient institutional recognition. Suggested improvements focus on investing in ongoing training, strengthening communication and inter-institutional collaboration, and revising the organizational model of PC within Portugal’s National Health Service. Conclusions: Interdisciplinary collaboration in PC is fundamental for holistic, patient-centered care but is hindered by structural and organizational barriers.
- Effectiveness of Nursing Interventions on Preventing the Risk of Infection in Adult Inpatients: Protocol for a Systematic ReviewPublication . Todo Bom, Luís Filipe Pereira; Mata, Ema Soraia Fazenda; Cunha, Helena Margarida Pereira; Marquês, Maria do Céu Mendes Pinto; Dixe, Maria dos AnjosBackground/Objectives: Healthcare-associated infections (HAIs) are a major global public health concern, significantly impacting patient safety and healthcare quality. These infections are associated with high morbidity and mortality rates, prolonged hospital stays, and increased healthcare costs. Nurses play a critical role in infection prevention, implementing evidence-based interventions to reduce infection risks. This systematic review aims to identify and synthesize the most effective nursing interventions to prevent HAIs in hospitalized adults, analyzing their variability across different clinical settings and populations. Methods: This systematic review follows the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness and is reported according to PRISMA guidelines. The protocol is registered in the PROSPERO database (CRD42024582820). This review includes randomized controlled trials, quasi-experimental studies, and observational studies (cohort, case-control, and cross-sectional) assessing the effectiveness of nursing interventions in reducing HAIs. A comprehensive search is conducted in the PubMed, CINAHL, Scopus, Web of Science, and Cochrane databases. Study selection, data extraction, and quality assessment are performed by two independent reviewers, with disagreements resolved by a third reviewer. Results: The primary outcomes include reductions in HAI incidence rate, increased adherence to preventive interventions, decreased hospital length of stay, reduced readmission rates due to infections, and overall patient safety improvements. A meta-analysis is conducted when feasible; otherwise, results are synthesized narratively. Conclusions: The findings of this review contribute to the standardization of evidence-based nursing practices for HAI prevention, promoting safer healthcare environments. By identifying the most effective interventions, this study aims to support healthcare professionals and policymakers in implementing targeted infection control strategies.