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- Scoping review on the consequences of falls in women during the PerinatalperiodPublication . Risso, Sandra; Soares, Tânia; Sá, Luis Octávio de; Miranda, Luis; Rosado, Rita; Deus, Sílvia; Marques-Vieira, CristinaObjective: To identify consequences of falls in women during the perinatal period. Data sources: Academic Search Complete (EBSCO), CINAHL Ultimate (EBSCO), MEDLINE Ultimate (EBSCO), Cochrane Central Register of Controlled Trials (EBSCO), Cochrane Clinical Answers (EBSCO), Cochrane Database of Systematic Reviews (EBSCO), Cochrane Methodology Register (EBSCO), MedicLatina (EBSCO), Repositórios Científicos de Acesso Aberto de Portugal (RCAAP), SciELO, Scopus, and Web of Science. Study selection: We included quantitative or qualitative primary studies, literature reviews, systematic reviews, expert opinion papers, organizational guidelines, and conference abstracts regarding consequences of falls in women during the perinatal period, in any context of care, that were published until November 11, 2024, in English, French, Portuguese, and Spanish. Data extraction: We extracted the following data from the included reports: author(s), year, country, aim, study design, type of report, sample size, setting, types and consequences of falls, prevalence, and risk factors for falls. Data synthesis: From a total of 33 articles, 27 were related to the consequences of falls during pregnancy, 3 were related to consequences of falls during both pregnancy and the postpartum period, 2 were related to consequences of falls during the perinatal period in which one does not identify the specific stage, and 1 was related to the postpartum period. We did not identify any reports of falls during childbirth. Injuries were common consequences of falls among women during the perinatal period, and the severity of falls varied from minor to severe. Obstetric injuries were severe and unique to pregnant women. Conclusion: Pregnant women sustain varied injuries after falls and often need health care. Further research is warranted regarding the consequences of falls during childbirth and the postpartum period.
- Culturally competent nursing care as a promoter of parental empowerment in neonatal unit: A scoping reviewPublication . Guarda-Rodrigues, Joana; Dias, Mariana Prosperi Ferreira Calado; Fatela, Maria Matilde Rodrigues; Jeremias, Cristina Rosa; Negreiro, Miguel Pereira Gonçalves; Sousa, Odete Lemos eProblem In neonatal units, a significant number of newborns and their respective parents and families are hospitalized, each with culturally distinct practices and perspectives that require specialized knowledge. However, the literature lacks comprehensive evidence depicting culturally competent nursing care that concurrently promotes parental empowerment in the neonatal units. Eligibility criteria The review was conducted following the methodology recommended by the Joanna Briggs Institute and in accordance with the Preferred Reporting Items for Systematic Reviews - Scoping Reviews (PRISMA-ScR) guidelines. Searches were performed on MedLine, CINAHL, Psychology and Behavioral Science Collection, MedicLatina, Scopus, Web of Science, the Scientific Open Access Repository of Portugal (RCAAP), Mednar, and Google Scholar. Study eligibility criteria were defined based on the PCC mnemonic. Sample A total of 608 records were identified for title and abstract screening, with 30 selected for full-text review. Ten studies met the inclusion criteria. Results The studies, published between 2002 and 2023, focused on the following cultures: Lumbee, Chinese, Jewish, Ghanaian, Nigerian, Ugandan, Mexican, Taiwanese, Iranian, and Aboriginal. Culturally competent nursing care promoting parental empowerment is categorized into: the relationship between parents and healthcare professionals, the care process, alignment of needs with community resources, alignment of needs with healthcare, and receiving information and emotional support. Conclusions Culturally competent care, rooted in family-centered care, promotes parental empowerment, which can consequently translate into improved quality of nursing care.
- Trends in delivery hospitalizations and the impact of ICD-9-CM to ICD-10-CM-PCS transition in Portugal between 2010 and 2018Publication . Camarinha, Catarina de Paraíso; Oliveira, Maria Miguel Gomes; Elias, Cecília; Nobre, Miguel de Araújo; Nicolau, Leonor Bacelar Costa; Furtado, Cristina; Costa, Andreia Silva da; Nogueira, Paulo Jorge da SilvaBackground: Hospital discharge data are essential for maternal health surveillance, clinical research, and healthcare resource allocation. In 2017, Portuguese hospitals transitioned from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to the International Classification of Diseases, 10th edition, Clinical Modification and Procedure Coding System (ICD-10-CM/PCS), impacting the recording of delivery hospitalizations. This study examines trends in delivery hospitalizations from 2010 to 2018 and assesses the impact of the ICD-10-CM/PCS transition. Methods: We conducted a register-based observational cross-sectional analysis using data from the National Hospital Discharge Database, covering delivery hospitalizations in public hospitals from January 1, 2010, to December 31, 2018. Delivery episodes were identified using diagnosis codes, normal delivery codes, diagnosis-related group (DRG) codes, and procedure codes. Statistical analyses included descriptive statistics, interrupted time series with segmented regression, and Prophet forecasting models to evaluate trends and the impact of the coding transition. Results: A total of 673,978 delivery hospitalizations were recorded. The transition from ICD-9-CM to ICD-10-CM/PCS in 2017 had minimal overall impact on delivery trends. DRG codes consistently identified the majority of delivery episodes, with outcome of delivery codes and selected procedure codes showing varying trends. An increase in episodes identified by normal delivery codes and a significant decrease in episodes identified by procedure codes was observed immediately after the ICD-10 transition (p < 0.001). The Prophet model indicated improved forecast accuracy for procedure codes when including the ICD-10 transition variable. Conclusion: The transition to ICD-10-CM/PCS had a limited impact on overall delivery hospitalization trends but significantly affected procedure coding. These findings underscore the importance of considering coding system changes in healthcare data analyses. Further research should incorporate private hospital data and continuously monitor coding practices to ensure reliable health data for research and policy-making.
- Learning to assess the fall risk in clinical nursing education: an interpretative study.Publication . Pedrosa, Ana Rita; Dixe, Maria dos Anjos; Sousa, Luís; Ferreira, Rogério; Marques-Vieira, Cristina; Marques, Andréa; Baixinho, Cristina LavaredaBackground: Falls are a complex problem for the health and quality of life of older persons. Risk assessment is important for identifying people at risk and planning preventive measures. Few studies have focused on how health professionals learn to assess this risk. Objective: The aim of this study was to explore how nursing undergraduate students learn to assess fall risk in older adults/people during their hospital-based clinical practice. Methods: This qualitative study was conducted within an interpretive paradigm. The focus group was selected as the method to address the research question: How do nursing students learn to assess of fall risk in the older population during clinical practice? The participants were students enrolled in a Bachelor of Nursing program. To support data organization and enhance analytic rigor, qualitative data analysis software (WebQDA®) was employed. Results: Fifteen students participated in two focus groups. The analysis identified three main categories: (i) risk factors assessed; (ii) risk assessment; and (iii) learning to manage fall risk in clinical practice. Students reported that nursing supervisors primarily emphasized physical factors, mobility, and cognitive status. The findings also highlighted a gap between the assessment and the implementation of individualized interventions, as well as the difficulty in converting records into preventive actions and risk management. Conclusions: Nursing students learn to assess fall risk primarily through observation of clinical practices and the influence of supervisors, although they do not always understand the instrumental basis or the correlation between risk and intervention. The results indicate the need to strengthen the training of professionals and students.
- Technological nursing interventions on nutritional status of middle-aged and older adults undergoing hemodialysis: A systematic reviewPublication . Pernas, Amélia; Pires, Sara; Gomes, Idalina; Fonseca, César; Ramos, AnaObjective: Malnutrition is common in hemodialysis patients, increasing mortality and significantly impacting quality of life. This study aimed to identify technological nursing interventions that promote self-care and improve the nutritional status of middle-aged and older adults undergoing hemodialysis. Methods: A systematic literature review was conducted in accordance with the Joanna Briggs Institute (JBI) and PRISMA guidelines. Searches were conducted in Medline, CINAHL, the Cochrane Library, Scopus, Web of Science, and grey literature. Studies published between 2018 and 2024, involving patients aged 40 years or more undergoing regular hemodialysis, and available in Portuguese, English, or Spanish, were included. JBI's critical appraisal tools were used to conduct a rigorous analysis and methodological quality assessment of the articles. Results: Out of a total of 738 articles, 10 were included for analysis. Five key dimensions of technology-driven self-care interventions were established. 1) Mobile applications and digital platforms with features like nutritional databases, food logging, and personalized feedback; 2) E-learning and virtual education using social media and chat-based communication; 3) Telenursing employing a hybrid follow-up model of face-to-face, telephone, and SMS contact; 4) Educational strategies focused on nutritional status, utilizing methods such as teach-back and pictorial learning within a multidisciplinary team; and 5) Comprehensive assessment tools evaluating treatment adherence (hemodialysis, medication, diet, fluid) and laboratory markers. Significant improvements were reported across several outcomes: eight studies showed enhanced biochemical markers (e.g., phosphorus, sodium, potassium, calcium, iron, albumin, urea, and hemoglobin) and nutritional status, three demonstrated increased self-efficacy, and two reported improved quality of life. Conclusion: Integrating technology and face-to-face education enhances nutritional status, highlighting the importance of comprehensive strategies to improve treatment adherence and prevent malnutrition in hemodialysis patients.
- Adherence to peripheral venous catheters’ guidelines by emergency nurses: A systematic reviewPublication . Teixeira, Joana; Bastos, Celeste; Pinto, Maria do RosárioBackground: Peripheral intravenous catheters are widely used in emergency departments for intravenous treatment. However, peripheral intravenous catheter practices supported by the latest evidence remain suboptimal, negatively affecting patient outcomes. Objective: To identify the determinants influencing adherence to peripheral intravenous catheter guidelines in the emergency department (the insertion technique, maintenance protocols, and timely removal) and to analyse strategies for improving adherence. Methods: A systematic review was conducted from August to September 2025, in the Cochrane Central Register of Controlled Trials, CINAHL Complete, MEDLINE Complete databases (via EBSCOhost), and SCOPUS and included eligible papers published from 2018, according to eligibility criteria: studies involving emergency department nurses or clinicians, focusing on peripheral intravenous catheter adherence determinants and related strategies. This approach followed the methodological guidelines of the Joanna Briggs Institute and the PRISMA Statement reporting guidelines for Systematic Reviews. Results: The six studies included in this review identified individual, organisational, and clinical decision-making determinants that influence emergency nurses' adherence to peripheral intravenous catheter infection prevention guidelines, including limited knowledge, training gaps, lack of institutional support, and inconsistent practices. Effective strategies included ongoing education, ultrasound-guided training, the involvement of vascular access teams, and quality improvement approaches like the Plan-Do-Study-Act cycle. Conclusions: This review identified key determinants and strategies that influence and enhance emergency nurses' adherence to infection prevention guidelines for peripheral intravenous catheter care. The importance of integrating technical training with supportive environments and effective clinical leadership is emphasised throughout multimodal intervention programs. Future interventions should prioritise team empowerment, alignment with institutional goals, and promoting nurses' motivation and self-efficacy, ideally through participatory approaches.
- Effective nursing interventions for infection prevention and control in acute and critically ill patients with a peripherally inserted venous catheter: an umbrella reviewPublication . Costa, José; Teixeira, Joana; Sousa, Eliana; Pinto, Maria do RosárioIntroduction: Infections related to peripherally inserted venous catheters are among the most serious and frequent complications in acute and critical care. If unaddressed, these infections markedly escalate morbidity, mortality, and healthcare expenditures. Objective: To synthesize scientific evidence about effective nursing interventions that prevent and control infections in acute and critically ill patients with peripherally inserted venous catheters. Methods: This umbrella review followed Joanna Briggs Institute guidelines and the PRISMA statement for reporting systematic reviews. A systematic search was carried out in CINAHL, MEDLINE, JBI Evidence Synthesis, Cochrane Database of Systematic Reviews, Web of Science, and SCOPUS. Rayyan software supported study extraction and selection. Each study was assessed for methodological quality, grade of recommendation, and level of evidence. Results: Six systematic reviews were included, allowing the identification of nursing-led interventions that demonstrably reduce catheter-related infection. Evidence supports infection risk reduction through chlorhexidine gluconate for skin preparation, insertion and maintenance bundles, and strategies to support bundle implementation. Additional effective interventions include in-line filters, limiting device dwell time, minimizing continuous antibiotic infusions, and avoiding using Teflon cannulas, instead of polyethylene or Vialon cannulas. For patients with peripherally inserted central catheters (PICCs), quantified grip exercises improved circulation and reduced infection and thrombosis risk. Integrated short peripheral catheters were associated with significantly fewer complications than non-integrated ones. Conclusions: Nurses are pivotal in preventing peripherally inserted venous catheter-related infection through specific evidence-based interventions. Nurse leaders should also prioritize selecting lower-risk devices to enhance patient outcomes and reduce complications.
- The effectiveness of family participation interventions for the prevention of delirium in intensive care units: A systematic reviewPublication . Vitorino, Marli Lopo; Henriques, Adriana; Melo, Graça; Henriques, Helga RafaelAim: To review the effect of family participation interventions in preventing delirium in Intensive Care Units (ICU). Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the "Synthesis Without Meta-analysis" guidelines. The search was performed using the MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, Web of Science, Scopus, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov databases in April 2024. Eligibility criteria included patients admitted to Intensive Care Units, aged 18 or older exposed to risk factors for delirium, and with family members present; studies about family intervention to prevent delirium, that considered family as a partner in care and included interventions; studies that quantitatively assessed the effect of measures on the incidence and duration of delirium; interventional studies. Two authors independently applied these criteria using the Rayyan® application, assessing study quality with Critical Appraisal Skills Programme tools. Results: Fourteen studies were included, involving 33,232 patients. A meta-analysis was not feasible due to the highly heterogeneous results, but we concluded that the family participation interventions for delirium prevention were grouped into single-component and multi-component interventions. The single-component interventions, such as familiar voice messages, flexible visitation, and family presence, showed a favorable response in reducing delirium. The multicomponent interventions suggesting a positive effect included family visitation with professional-guided orientation; familiar voice messages for reorientation, newspaper reading, and nighttime eye patch use; sensory stimulation program; the ABCDEF bundle; the DyDel program; family education, emotional support, orientation training, cognitive stimulation, and ICU life care participation. Conclusions: Several family participation interventions, both single-component and multicomponent, have shown positive effects on outcomes in preventing delirium in ICU patients, particularly in reducing its incidence and duration.
- Contributions of mindfulness in high-risk pregnancy: a mixed methods systematic reviewPublication . Dutra, Irina Neves; Seixinho, Sandra; Baixinho, Cristina; Presado, Maria Helena; García-Fernández, RubénIntroduction Experiencing a high-risk pregnancy entails pathological situations with repercussions that can interfere with maternal-fetal well-being and increase maternal anxiety. Mindfulness emerges as one of the techniques used to improve the quality of care in the transition period resulting from pregnancy, which, through meditative practice, seeks to understand observation and the nature of the lived experience, resulting in a progressive state of clarity and awareness. Objective This review assessed the contributions of applying mindfulness in high-risk pregnancies. The review considered experimental, quasi-experimental studies, randomized controlled trials and non-randomized controlled trials. Observational studies were also considered. Evidence published in the last 5 years was considered. Methods This systematic review was conducted in accordance with the Joanna Briggs Institute methodology for systematic reviews of mixed methods using a convergent integrated approach to synthesis and integration. We searched for published and unpublished English, Portuguese and Spanish-language studies and grey literature. CINAHL Ultimate, MEDLINE (via Pubmed), Web of Science, Academic Search Complete, EBSCO Host Open Dissertations and Open Access Theses and Dissertations were searched in April–May 2024. Two authors screened titles and abstracts before full-text screening and data extraction. Two authors reviewed the extracted data. Results Ten articles were included in the review: 5 randomized controlled trials, 3 quasi-experimental studies and 2 mixed-methods studies. 9 studies measured the effectiveness of the application of mindfulness-based interventions on high-risk pregnant women and 1 assessed the acceptance of mindfulness intervention. Six studies measured the effects of the application of mindfulness in high-risk pregnant women in depressive symptoms, two reported the outcomes in stress, five on anxiety, two on psychological well-being, one on gestational weight gain, one in prenatal attachment and another in sleep quality. Conclusions Long term reduction of depressive symptoms, anxiety and stress and increased psychological well-being are contributions of mindfulness on high-risk pregnant women. The existing evidence on other contributions of the application of mindfulness is limited, further research being necessary.
- Falls efficacy scale - Formal caregivers: Adaptation and validation in Portuguese nursing homesPublication . Baixinho, Cristina Lavareda; Marques-Vieira, Cristina; Sousa, Luís; Abrantes, António; Conceiçao, Nuno; Martins, Amaro; Henriques, Maria Adriana; Dixe, Maria dos AnjosThe literature review shows that the fear of falling is present in older persons', but also in their careers and influences the performance of activities of daily living. The objective of this methodological study was to adapt and validate the Falls Efficacy Scale - Formal Caregivers. The development of the examined scale was based on the Falls Efficacy Scale - International, which was adapted for assessing the fear of falling in formal caregivers. The instrument was filled out by 319 formal caregivers of older people living in 11 Portuguese nursing homes for older people. Their average age was 46.8 ± 10.7 years, they had been working in this role for 13.4 ± 8.2 years, and 67.7 % of them attended vocational training in the workplace after being employed at the nursing home. Falls Efficacy Scale - Formal Caregivers, which contains 16 items, showed good internal consistency (α = 0.848). These items were organized into 3 factors after exploratory and confirmatory factor analysis (lesser physical effort activities; intermediate physical effort activities, carried out in safe conditions; and intermediate physical effort activities, carried out in less safe conditions), with adequate convergent validity.