International Journal of Health Supplements
International Journal of Health Supplements (IJHS) is an international scholarly journal dedicated to the publication and long-term preservation of scientific outputs originating from conferences, symposia, and professional meetings across medicine and healthcare. The Journal provides a permanent, citable, and openly accessible platform for conference proceedings, abstract collections, and thematic supplements, supporting the visibility, credibility, and dissemination of scholarly contributions. Through structured editorial review and scientific oversight, developed in collaboration with guest editors and scientific committees, IJHS ensures that published materials meet recognized standards of academic integrity and relevance. Supported by an international and evolving editorial network encompassing expertise in clinical medicine, public health, biomedical sciences, nursing, and healthcare policy, the Journal promotes interdisciplinary exchange and collaboration. By bridging scientific events and academic publishing, International Journal of Health Supplements contributes to preserving the scholarly record of scientific meetings and advancing healthcare knowledge worldwide.
Innovation, Evidence, and Proximity in an Age of Compressed Futures: Oncology Nursing and the AIIAO 2026 Congress
This editorial introduces the AIIAO 2026 Special Issue by framing oncology nursing at the intersection of innovation, evidence, and proximity. It argues that contemporary oncology care is shaped by a compressed tension between scientific progress and constrained health-system capacity. Drawing on the congress theme, the editorial positions nursing proximity, evidence translation, and governed innovation as strategic responses to professional uncertainty and disengagement. The Special Issue is presented as a record of a scientific community answering complexity through research, peer review, and cumulative disciplinary work.
Copyright (c) 2026 Rosario Caruso https://creativecommons.org/licenses/by/4.0
Building the Architecture of Nursing Professional Identity: A Position Paper From Italian Scientific Societies at The Nursing Forum 2026
Introduction. The publication in the Italian Official Gazette (12 May 2026) of the decree activating second-cycle clinical Master’s tracks (primary care; intensive and emergency care; pediatric) has reopened a long-standing question about how specialist practice and advanced practice can be combined in concrete professional exercise. Nursing scientific societies have a stake in this transition as cultural infrastructures that connect education, regulation, the labor market, and health-service implementation. Objective. To develop a shared, policy-oriented position on how nursing scientific societies can contribute to the architecture of professional identity in Italy, using the roundtable discussion held at The Nursing Forum 2026 as the primary deliberative material. Methods. Documentary qualitative analysis of the full roundtable transcript (eight societies plus the chair) combined with reflexive thematic analysis and exploratory lexicometric analysis (word and n-gram frequencies, keyword-in-context, term co-occurrence). The position-development process was iterative, with checkpoint-based validation by the writing group. Findings and position statements. Seven themes were identified, from which nine numbered position statements were derived, addressing professional identity as social mandate; the distinction and connection between specialist and advanced practice; competency frameworks as shared language; validation of specialist education; alignment of the new Master’s degrees with workforce planning, accreditation and contracts; explicit workforce numbers; safe attribution and visibility in information systems; outcomes as the ultimate criterion; and scientific societies as cultural infrastructure. Conclusions. Professional identity should be anchored in nursing’s social mandate and made visible, accountable, and measurable. Scientific societies can connect education, competencies, accreditation, and policy, provided that workforce numbers and contractual recognition are addressed in parallel. This document is a position paper informed by a roundtable discussion; formal multi-society consensus would require the documented endorsement process described herein.
Copyright (c) 2026 Rosario Caruso, Francesca Angelelli, Paola Arcadi, Elena Barnabei, Gianluca Castiello, Bruno Cavaliere, Walter De Caro, Stefano Mancin, Giancarlo Mercurio, Eustachio Parente, Stefano Sironi, Bernardino Tomei, Antonio Vitiello https://creativecommons.org/licenses/by/4.0
Mapping the Scientific Agenda of Italian Oncology Nursing: A Topic Modelling Commentary on AIIAO 2026 Congress Abstracts
Background. Scientific congresses act as observatories of a professional community’s priorities and methods. The abstracts submitted to a national oncology nursing congress form a real-world corpus through which research and practice trajectories can be examined empirically rather than impressionistically. Objective. To identify and interpret the emerging topics within the abstracts included in the AIIAO 2026 Congress proceedings using lexicometric analysis followed by topic modelling, and to discuss their implications for the oncology nursing agenda. Methods. Exploratory, corpus-based text-mining study. The English structured bodies of the 82 included abstracts were preprocessed (lowercasing; removal of punctuation, digits and structural headings; lemmatization; moderate stopword control; n-gram detection). Lexicometric descriptives were computed, and Latent Dirichlet Allocation models were estimated for k = 4-7. The number of topics was selected by combining coherence with the CaoJuan2009, Arun2010 and Deveaud2014 criteria and interpretability, not by automatic optimisation alone. Results. The corpus contained 21,347 running words and 3,568 unique word forms (type-token ratio 0.167; 44.6% hapax). A five-topic solution was selected: care pathways, procedural safety and quality improvement (35.4%); self-management, treatment adherence and nursing surveillance (14.6%); nursing research capacity and symptom-distress measurement (19.5%); professional roles, leadership and organizational/ethical development (17.1%); and palliative and supportive care, quality of life and continuity (13.4%). The latent topics cut across the author-assigned editorial clusters. Conclusions. The topics suggest a maturing research community oriented towards safe, standardized and person-centred care, supported by advanced roles, outcome measurement and digital health. The findings describe the submitted corpus and are not representative of Italian oncology nursing as a whole.
Copyright (c) 2026 Rosario Caruso, Maddalena De Maria, Gianluca Conte, Marco Alfredo Arcidiacono, Serena Caponetti, Gabriele Cremona, Marcella Dabbene, Monica Guberti, Alessio Piredda, Arianna Magon https://creativecommons.org/licenses/by/4.0
Measuring Change: Which Needs Can We No Longer Leave Unanswered?
Copyright (c) 2026 Pasquale Iozzo, Antonino Amato, Gennaro Rocco https://creativecommons.org/licenses/by/4.0
From Discovery to Production: Scientific Research in the Age of Information Overload
*]:pointer-events-auto R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id="request-6a2ebbfe-a4fc-83ed-856b-06040f3a2244-13" data-turn-id-container="request-6a2ebbfe-a4fc-83ed-856b-06040f3a2244-13" data-testid="conversation-turn-38" data-scroll-anchor="false" data-turn="assistant"> The exponential growth of scientific knowledge has transformed research from a discovery-driven endeavor into an increasingly productivity-oriented system. While the unprecedented availability of information creates new opportunities for innovation, it also generates information overload, bibliometric pressure, and a growing fear of missing out among researchers. This commentary reflects on the risks of prioritizing scientific output over intellectual depth and argues for the need to preserve reflection, curiosity, and originality as essential drivers of meaningful scientific progress.
Copyright (c) 2026 Emanuele Buccione https://creativecommons.org/licenses/by/4.0
Beyond Knowledge: Why Nursing Needs Spaces Where Ideas Can Heal
Contemporary healthcare is experiencing an unprecedented expansion of scientific knowledge, technological innovation, and access to information. Yet the accumulation of evidence alone does not necessarily generate transformation. This editorial argues that one of the greatest challenges facing modern healthcare—and nursing in particular—is preserving the capacity to imagine new possibilities for care, education, leadership, and research. Drawing on perspectives from the philosophy of science, nursing theory, professional development, and innovation studies, we propose that imagination should be considered not as an alternative to scientific inquiry, but as one of its essential prerequisites. Many of the most significant advances in healthcare began as ideas that challenged prevailing assumptions before becoming accepted scientific realities. In this context, nursing has a unique responsibility not only to produce knowledge but also to cultivate the intellectual and cultural conditions through which new ideas can emerge. The Nursing Forum was created in response to this need, promoting spaces where research, clinical practice, leadership, education, and innovation can interact and generate new perspectives for the future of care. The concept of Where Ideas Heal reflects the belief that meaningful transformation occurs when evidence encounters vision, curiosity becomes dialogue, and ideas find a place where they can be explored collectively.
Copyright (c) 2026 Hamilton Dollaku, Floriana Pinto, Francesco Limonti, Simone Ghiribelli https://creativecommons.org/licenses/by/4.0
Burden and Self-Care Needs Among Informal Caregivers of Patients With Transthyretin Cardiac Amyloidosis (ATTR-CA): A Qualitative Analysis
Introduction. Transthyretin cardiac amyloidosis (ATTR-CA) is a progressive infiltrative cardiomyopathy increasingly recognized as a cause of heart failure, particularly among older men. Its chronic trajectory necessitates substantial involvement of informal caregivers, with potential consequences for their psychological and physical well-being. Despite the increasing prevalence of ATTR-CA, evidence on caregiving experiences and caregivers’ self-care needs remains scarce. AIM: To explore the caregiving experience of informal caregivers of patients with ATTR-CA, with a specific focus on self-care needs and the impact of caregiving demands on caregiver burden. Methods. A qualitative analysis was conducted within a mixed-methods study, using individual semi-structured interviews conducted to caregivers of patients with ATTR-CA receiving disease-modifying therapies. Results. Preliminary analysis of n = 17 interviews identified multiple dimensions of the caregiving experience, including emotional, physical, and personal life impacts. The findings also highlighted the role of support networks and caregivers’ coping strategies in modulating perceived burden. Discussion. Caregiving for patients with ATTR-CA is associated with a multidimensional burden. These findings emphasize the need for early identification of caregiver burden and the implementation of targeted interventions to support caregivers and their families, alongside the promotion of self-care strategies.
Copyright (c) 2026 Sara Bertilorenzi, Angela Durante, Olena Chubuchna, Michele Emdin, Giuseppe Vergaro https://creativecommons.org/licenses/by/4.0
ECMO in Italy: Early Results of the First National Survey on Organization, Training and Network Integration
Introduction. Extracorporeal membrane oxygenation (ECMO) is a life-supporting system whose outcomes are strongly influenced by organizational factors. Despite recommendations from the Extracorporeal Life Support Organization (ELSO), there is a lack of national guidelines that uniformly define the requirements of the ECMO center. Methods. A national cross-sectional survey was conducted. A questionnaire based on ELSO recommendations was sent to 83 ECMO centers, 64 of which have responded to date. Results. The centers are spread throughout the country, with a concentration in northern Italy. Most provide both veno-venous and veno-arterial ECMO, but with varying activity volumes: 50% perform fewer than 20 procedures per year. A formalized multidisciplinary team is present in 59.4% of centers. ECMO training programs were reported in 57.8% of cases, with limited nursing participation. Organizational gaps include a lack of formal ECMO programs and teams, as well as limited integration into ECMO networks. Discussion. This study is the first attempt to national mapping of the organization of the ECMO center in Italy and revealed significant differences in the organization of the ECMO programs in Italy. Although this variability does not necessarily imply poor clinical quality, it suggests the need for more coordinated and integrated models. The strong interest of centers in the development of ECMO networks indicates a favorable environment to develop a national model.
Copyright (c) 2026 Bianca Bianca Reitano, Angela Durante, Massimo Scolaro https://creativecommons.org/licenses/by/4.0
Quality of Life and Treatment Experience of Experimental CAR-T Cell Therapy in Oncology Adolescents: A Scoping Review
Introduction. Oncology in the Adolescent and Young Adult (AYA) population represents a uniquely complex area of care. While the introduction of experimental treatments, such as Chimeric Antigen Receptor T-cell (CAR-T) therapy, offers significant opportunities for recovery, their inherent complexity and relative uncertainty may negatively impact Quality of Life (QoL) and the patient’s subjective experience. It is, therefore, essential to understand the perspective of adolescents—their feelings and what they seek to communicate regarding the life-altering changes they face. Methods. A literature review was conducted to analyze the scientific evidence regarding quality of life and the treatment experience of CAR-T cell therapy in adolescent oncology patients. The search was performed using the PubMed database, employing a structured combination of keywords to develop the search string. Studies published in English and Italian over the last 10 years were included. Results. The analysis of the eight included articles revealed a scarcity of specific scientific evidence at the intersection of adolescent oncology and experimental therapies, highlighting a significant gap in the literature. QoL appears to be significantly compromised, particularly following treatments such as CAR-T cell therapy, due to both acute and late side effects. Despite an initial decline in QoL related to CAR-T toxicity, many adolescents demonstrate recovery trajectories and improvement over time, with progressive physical, psychological, and relational benefits, also supported by the increasing adaptation of both patients and their caregivers. Furthermore, two studies emphasized the crucial impact of caregiver well-being, whose emotional state and support directly reflect on the quality of life and every aspect of the adolescent patient’s experience. Discussion. In summary, this review underscores that current literature on the QoL of oncology adolescents undergoing experimental therapies is severely limited, necessitating an urgent research focus. It is essential that experimental protocols not only manage physical adverse effects but also integrate robust psychosocial support, extended to caregivers, whose well-being is a crucial determinant of the adolescent patient’s quality of life.
Copyright (c) 2026 Flavia Fiumarella https://creativecommons.org/licenses/by/4.0
Humanization vs Automation: The Impact of Nurse-Led Sensibilization Intervention on Response Rate to Patient-Reported Outcome Measures
Introduction. In chronic diseases such as heart failure, integrating Patient-Reported Outcome Measures (PROMs) is essential to orient care toward patient-perceived value. However, the transition from individual to automated enrollment can lead to a sharp decline in response rates. In our experience, when enrollment was automated using ICD discharge codes, the response rate dropped from 64% to approximately 14%. Methods. In this quality-improvement project, a 4-month sensitization intervention was conducted. Two nurses performed pre-discharge interviews aimed at overcoming barriers by providing technical and informational support to respondents. Response rates were monitored after 7 days(T0) and one month(T1) after discharge. Results. The intervention team reached 19%(42) of the automatically enrolled population (231). The response rate at both T0 and T1 stabilized at 19%, suggesting a direct association with the sensitization activities. During peak sensitization periods, adherence reached 70%, while it was negligible when nurses were absent. Discussion. Early results confirm that automation ensures maximum coverage but cannot guarantee responsiveness or adherence. The nurse’s role appears crucial in transforming PROMs from bureaucratic tasks into decision-making tools. For the model to be sustainable, a greater number of nurses should participate in sensitization activities. In addition, integrating monitoring dashboards could support real-time data oversight.
Copyright (c) 2026 Angelo Fattorusso, Marco Vaselli, Maila Lazzarini, Paola Palumbo, Stefano Dalmiani, Claudio Passino, Angela Durante https://creativecommons.org/licenses/by/4.0
Turnover, Internal Mobility and Nurse Retention
Introduction. Internal turnover among nurses is a relevant organizational phenomenon that has received has been less investigated than external turnover. Requests for internal mobility may represent adaptive responses to organizational and psychosocial risk factors and explicit manifestations of turnover intention. Our aim was to describe voluntary internal mobility flows among hospital nurses. Methods. A retrospective observational study was conducted according to the STROBE Statement. Internal mobility requests submitted between 2017 and 2023 were examined. Administrative data with sociodemographic and professional variables were analyzed. Results. 971 requests by 324 nurses were analyzed. The mean annual rates of explicit turnover intention and internal turnover were 9.1% and 3.3%. Requests mainly involved nurses with intermediate seniority (11-20 years of service) and were concentrated in specific macro-areas, showing non-random mobility patterns. Nurses tended to move within the same macro-area, although some flows toward other macro-areas were observed. A proportion of nurses who requested internal mobility subsequently resigned voluntarily. Discussion. Internal turnover emerges as a complex organizational phenomenon reflecting both occupational strain and professional sustainability strategies. Internal mobility can be interpreted as a proxy of turnover intention and an indicator of organizational performance. Monitoring internal mobility may support nurse management and retention.
Copyright (c) 2026 Chiara Gammarota, Marco Clari, Paola Di Giulio, Mario Paleologo, Valerio Dimonte, Simona Frigerio https://creativecommons.org/licenses/by/4.0
Educational Models and Training Strategies for the Prevention of Healthcare-Associated Infections Among Healthcare Professionals: A Rapid Review
Introduction. Healthcare-associated infections (HAIs) are a global patient safety challenge, increasing morbidity, mortality, and costs. Education and training are pivotal to improve prevention practices, but approaches vary widely across settings. This rapid review identifies educational strategies for HAI prevention and summarizes reported outcomes. Methods. Following PRISMA guidelines, PubMed, CINAHL, and EMBASE were searched for studies published in the last decade. Using the Population (healthcare professionals), Concept (educational or training interventions), and Context (HAI prevention) framework, records were screened independently and synthesized narratively. Results. From 24,915 records, 14 studies were included. Educational interventions included participatory/interprofessional initiatives (n=4; 28.6%), multimodal programs (n=3; 21.4%), digital/e-learning interventions (n=2; 14.3%), gamification and video or simulation training (each n=2; 14.3%), and care bundle education (n=1; 7.1%). Interventions improved hand hygiene compliance and knowledge, with reductions in ventilator-associated pneumonia. High satisfaction was observed; time constraints and resistance to change were common barriers. Discussion. HAI prevention training increasingly incorporates interactive, digital, and behavioral strategies. Multimodal programs appear particularly effective in improving knowledge and practices. Further research is needed to evaluate effectiveness and scalability.
Copyright (c) 2026 Camilla Elena Magi, Martina Roccasecca, Ilaria Saltori, Martina Cavestro, Debora Chillon, Francesca Matteucci, Stefano Deiana, Fabiana Veronese, Khadija El Aoufy, Yari Longobucco, Maria Mongardi https://creativecommons.org/licenses/by/4.0
Empathic AI and Conversational Agents in Clinical Care: Systematic Review of Randomized Controlled Trials
Introduction. This systematic review synthesizes randomized controlled trials (RCTs) published between 2016 and 2026 investigating artificial intelligence systems integrating emotional intelligence or empathic features within clinical decision support and healthcare communication. Methods. PRISMA 2020 guidelines was conducted in PubMed, CINAHL, Scopus, and Embase. Studies were included if they: (1) had a randomized controlled design; (2) involved AI as a clinical decision support or communication tool; (3) incorporated empathy or emotional intelligence components; and (4) reported quantitative outcomes related to decision making, user experience, or communication. Results. Forty-six RCTs were initially identified with inclusion criteria. Studies examined AI applications in mental health support, chronic disease management, and interventions aimed at reducing anxiety and stress. Overall, AI systems demonstrated potential to enhance emotional support, improve adherence to treatment, and promote caring behaviors and patient self-care. In several trials, AI-supported tools improved communication processes and patient engagement in care. Discussion. Evidence from RCTs suggests that AI with empathic or emotional features may support clinical decision processes and improve user experience in healthcare settings. Although promising, the current evidence base remains limited. Further large-scale RCTs with patient-centered outcomes are required to confirm the effectiveness and safety of empathic AI and to guide its integration into clinical practice.
Copyright (c) 2026 Mariana Raluca Doru, Federica Raimondi https://creativecommons.org/licenses/by/4.0
AI-Based Clinical Decision Support Systems in Nursing Practice: A Systematic Review of Clinical Outcomes, Workflow Integration, and Adoption
Introduction. Clinical Decision Support Systems (CDSS) and AI tools are reshaping nursing practice, yet evidence on their impact on clinical outcomes, workflow integration, and adoption remains heterogeneous. This systematic review examines effectiveness and implementation of AI-based CDSS in settings where nurses are primary or co-primary users. Methods. PRISMA 2020; PubMed, CINAHL, Scopus, Embase, (2016–2025). Inclusion: primary studies; AI CDSS; nurses as primary/co-primary users; outcomes: clinical, workflow, adoption. From 980 records: 347 duplicates removed; 403 excluded title/abstract; 207 excluded full-text; 11 included. Quality: RoB2 (RCTs), JBI tools (other designs). Results. Eleven studies (6 RCTs/cluster-RCTs, 3 pre-post, 1 qualitative, 1 experimental simulation); 6 countries; settings: hospital, ED, primary care, mental health, assisted living. CDSS improved clinical outcomes in 8/11 studies: symptom management, hospitalisation reduction, delirium detection, aggression prevention. Nurse-led implementation facilitated workflow integration. Barriers: organisational readiness, training gaps, usability. Discussion. AI-based CDSS demonstrate consistent benefit when nurses are active users. Structured implementation strategies, nurse-led protocols, and usability-centred design are critical for sustainable adoption. Future research should address equity, scalability, and nurse-specific outcome measurement.
Copyright (c) 2026 Federica Raimondi, Mariana Raluca Doru, Rudina Duka https://creativecommons.org/licenses/by/4.0
European Models of Advanced Practice Nursing Autonomy and Their Applicability to Italian IFoC Development: A Comparative Policy Analysis
Introduction. Thirteen European countries have enacted nurse prescribing legislation, 12 nationally. Only 11 of 35 EFN countries have APN frameworks with minimum educational requirements; Italy is not among them. Italy's IFoC operates without prescriptive authority, a national register, or a defined APN legal framework — positioning Italy behind Finland and Norway in APN development. Methods. Comparative policy analysis across PubMed, CINAHL, Overton, EFN repositories (2010–2025). De Raeve et al. (2024) APN typology applied as analytical framework. Countries: UK, Netherlands, Ireland, France, Finland, Norway, Spain, Australia, Italy. Results. UK V300 (>58,000 qualified; full BNF access) documents no prescribing error increase. Netherlands full practice authority improved patient access without adverse events. Finnish NPs report feeling limited by inability to make formal medical diagnosis despite 20 years of APN training. Discussion. Italy's IFoC requires a phased legislative path — device prescribing (2026), supplementary prescribing for chronic conditions (2028), full APN law (2030+) — mirroring EU trajectories with EFN-aligned competency standards and CCNL restructuring.
Copyright (c) 2026 Gianluca Fedelfranco https://creativecommons.org/licenses/by/4.0
Dignity as a Guiding Principle in Nursing Management: A Multicenter Qualitative Study Protocol
Introduction. Dignity represents a fundamental ethical principle of the nursing profession. Although widely considered a guiding value in patient care, its managerial and organizational dimension remains underexplored, particularly in strategic decision-making, human resource management and nursing leadership. Nurse managers plays a key role in translating ethical principles into organizational practices that influence workplace climate, professional well-being, and quality of care. This study aims to explore the meaning attributed to dignity in nursing management and how it shapes decision-making, organizational, and relational practices. Methods. This protocol describes a qualitative, multicenter, non-interventional study that adopts an interpretative phenomenological approach. Nurse managers working in various Italian healthcare organizations will be recruited through a purposive sampling method. Data will be collected through semi-structured interviews aimed at exploring how dignity is perceived and implemented in managerial practice. Interviews will be recorded in audio format, transcribed faithfully, and analyzed using Interpretative Phenomenological Analysis. Results. The study is currently recruiting participants and aims to provide insights into how nursing managers interpret and integrate dignity into leadership practices and organizational processes. Discussion. Understanding dignity as a guiding principle in nursing management can promote the development of leadership models and organizational strategies based on ethical principles, aimed at improving workforce well-being and quality of care.
Copyright (c) 2026 Maria Romilda Filice, Sipontina Rina Zerulo, Federico Ruta, Elena Cocozza, Chiara Maddalo, Davide Ulivieri, Bruno Cavaliere https://creativecommons.org/licenses/by/4.0
The ANCHOR: A New Vision for Nursing in the Italian National Health Service
Introduction. The Italian NHS faces challenges including nursing shortages, high turnover, adverse events, and the need for effective, humanized care. Rethinking nursing’s role is essential to create an attractive environment that values clinical and managerial skills. Integrating the Nursing Minimum Data Set (NMDS) with a conceptual framework inspired by the principles of the Magnet Recognition Program provides tools to improve organizational performance, professional autonomy, and clinical outcomes. Methods. A scoping review of national and international literature on workforce well-being, empowerment, and care quality was conducted. Based on these findings, a pilot model, ANCHOR (Attractive Nursing and Care for Health Outcomes Reform) was designed. Combining transformational leadership, advanced education, vertical (management) and horizontal (clinical roles) professional development, soft skills training (role-playing, peer learning, feedback), adverse event monitoring via NMDS, and staff well-being assessment with validated tools (PES-NWI). Results. The model promotes professional satisfaction, clinical autonomy, empowerment, and well-being, reducing turnover and adverse events. Data standardization supports transparency, identifies critical issues, and facilitates evidence-based management decisions, fostering an innovative and sustainable environment. Discussion. ANCHOR provides an opportunity to redefine nursing in Italy, consolidate a shared professional language, develop a national model of attractiveness, and integrate safety, effectiveness, and sustainability into NHS decision-making.
Copyright (c) 2026 Francesca Micelli https://creativecommons.org/licenses/by/4.0
Immersive Virtual Reality and Educational Escape Rooms in Undergraduate Nursing Education: A Comparative Quasi-Experimental Study on Learning Outcomes and Student Engagement
Introduction. Healthcare professional education requires teaching methodologies capable of integrating theoretical knowledge, practical skills, and decision-making competencies within simulated learning contexts. Serious Games and gamification strategies have established themselves as effective tools for promoting active learning and facilitating the transfer of competencies to clinical practice. The present study evaluates the effectiveness of two innovative interventions: immersive virtual reality (VR) and Educational Escape Rooms (EER), aimed at developing transversal competencies fundamental in high-criticality healthcare settings. Methods. Quasi-experimental pre-post study with an explanatory sequential mixed-methods approach (QUAN → qual), conducted at the Clinical Simulation Centre of Campus Bio-Medico University of Rome, involving two cohorts of nursing students. Primary outcomes include knowledge acquisition and technical-practical competencies; secondary outcomes encompass engagement, perceived clinical self-efficacy, and satisfaction with the educational experience. Results. Both interventions are expected to produce statistically significant improvements in post-intervention scores. For the VR cohort, improvements are anticipated in procedural competencies and a reduction in performance anxiety; for the EER cohort, advances in clinical reasoning and collaborative skills. Qualitative analysis is expected to highlight recurring themes related to intrinsic motivation and transferability of competencies to real clinical contexts. Discussion. The expected findings contribute to the ongoing debate on the effectiveness of innovative methodologies in Italian nursing education. VR proves effective for technical-procedural competencies, while EER targets non-technical skills often neglected in traditional curricula. Despite limitations related to the absence of randomization and the lack of follow-up assessment, the study represents an original contribution to healthcare educational research in the Italian context.
Copyright (c) 2026 Marius Pavel Simion, Gaia Sciotti, Eleonora Tosto, Lanfranco Cortegiani, Marinella Durante, Gabriella Facchinetti https://creativecommons.org/licenses/by/4.0
Synergies for Care: A Mixed-Methods Research on the Integration of Territorial Health and Social Services From the Health Professionals’ Perspective (SYN4CARE)
Introduction. Integrated health and social care is crucial to address ageing populations and rising demand for community-based care. In Italy, fragmented governance and weak coordination between health and social services still limit continuity of care. The SYN4CARE Italian multicentre project, coordinated by the Istituto Superiore di Sanità, investigates professionals’ perceptions and experiences of integrated community-based care by exploring how professionals working in community-based health, social, and socio-health services define integrated care, assess its level of implementation, and identify the main barriers and effective strategies for its application in daily practice across different Italian regions. Methods. SYN4CARE uses a convergent mixed-methods design combining an online questionnaire and focus groups. Around 300 professionals from eight Italian regions complete the survey and 100–160 participate in 16 focus groups. Participants include healthcare and social care professionals with at least two years of community practice. Quantitative data are analysed with descriptive statistics and qualitative data through thematic analysis, then integrated. Results. Professionals are expected to describe integration mainly as a relational and collaborative process. Although some effective local networks exist, integration remains uneven due to resource constraints, limited training, weak digital interoperability and unclear professional roles. Discussion. The project will also develop an Integrated Care Competence Scale to assess professionals’ collaborative and holistic care skills. Findings will support workforce training, organizational improvement and policy strategies to strengthen integrated community care in Italy.
Copyright (c) 2026 Gaia Sciotti, Carlotta Mostarda , Marius Pavel Simion, Yari Longobucco, Sara Dionisi, Jessica Longhini, Valentina Biagioli, Gabriella Facchinetti https://creativecommons.org/licenses/by/4.0
Conceptual Plurality in Transition Programmes for Newly Hired Nurses: An Umbrella Review
Introduction. Despite a growing body of published reviews, nurse transition programmes — encompassing orientation and onboarding initiatives for newly hired staff — have yet to yield fully interpretable evidence, owing to persistent conceptual inconsistency and methodological heterogeneity. Consequently, this study aimed to synthesise and critically examine evidence on nurse transition programmes. Methods. An umbrella review was conducted in accordance with PRISMA 2020 guidelines, searching CINAHL, PubMed, Scopus, Web of Science, and Google Scholar, supplemented by citation tracking. Results. Fourteen reviews (2010–2025) were included. Core programme components comprise one-on-one preceptorship, simulation-based learning, and reflective journaling, with durations ranging from days to twelve months. Professional-level outcomes — notably competence and confidence — were consistently reported, whereas organisational indicators such as retention remain equivocal, and patient-level evidence is largely absent. Discussion. Despite the terminological fragmentation, this review provides a clear focus on programme characteristics and the evaluated outcome. Future evidence should embed these findings within an operational framework to evaluate their impact on professional and organisational context.
Copyright (c) 2026 Marcello Torre, Desiree Lucà, Rosario Caruso, Arrigoni Cristina, Antonio Maria Giuseppe Staffa, Arianna Magon https://creativecommons.org/licenses/by/4.0
From Near Miss to Collective Learning: Team-Based Learning as a Structured Debriefing Tool for Expert Nurses
Introduction. Near misses are intercepted adverse events offering critical opportunities for organizational learning. Although nurses identify approximately 41% of near misses, reporting rates remain low (52.4%) due to fear of consequences, punitive culture, and excessive workload. Structured clinical debriefing is essential to transform these events into shared learning and to support nurses affected by the second victim phenomenon. Methods. A TBL-based debriefing model was designed for teams of 5–7 expert nurses, structured in five phases: (1) pre-session preparation with real clinical cases; (2) individual and team Readiness Assurance Testing (iRAT/tRAT); (3) mini-lecture targeting identified knowledge gaps; (4) application activity (tAPP following the 4S principles), in which teams reconstruct event chronology, identify contributing factors, analyze error-intercepting barriers, process emotional responses, and define corrective actions; (5) structured peer evaluation to foster accountability. Results. The model is expected to promote greater active participation, more effective identification of systemic causes, and reduced psychological impact on second victims, compared to unstructured debriefing. Discussion. Reframing post-event debriefing through TBL logic represents an innovative strategy integrating patient safety, organizational learning, and professional well-being. Empirical validation in high-complexity hospital settings is warranted.
Copyright (c) 2026 Dario Ottobretti, Carlotta Zanetti, Gloria Buconi https://creativecommons.org/licenses/by/4.0
The Italian Centre for Sustainable Healthcare (CSH Italia): Promoting Environmental Sustainability Through Education, Research, and Advocacy
Introduction. Healthcare services contribute to greenhouse gas emissions, resource consumption and waste production. Healthcare professionals, especially nurses, can therefore play a key role in promoting environmentally sustainable practices. In this context, the Italian Centre for Sustainable Healthcare APS (CSH Italia) was established in 2024 to integrate sustainability into healthcare. Its mission is to support the transition toward a system that protects both human health and the environment by encouraging professionals and organizations to adopt sustainable practices. Methods. CSH Italia was founded by an interdisciplinary group of healthcare professionals, mainly nurses, together with engineers and sustainability experts. The association works through three areas: education and training, research and innovation, and advocacy for sustainable healthcare policies. Results. CSH Italia collaborates with the UK Centre for Sustainable Healthcare, adapts Nurse Climate Challenge resources for Italian professionals, and contributes to Green Operating Room recommendations with Choosing Wisely Italia. The association also developed two tools to support sustainability in surgical settings: the Italian Green Theatre Checklist and a questionnaire exploring knowledge and sustainability perception.
Copyright (c) 2026 Federica Pirro, Martina Batino, Elisabetta Mezzalira, Mauro Parozzi, Rachel Clare Stancliffe https://creativecommons.org/licenses/by/4.0
Team-Based Learning for Delirium Prevention and Detection: An Educational Proposal for Expert Nurses
Introduction. Delirium affects 18–35% of hospitalized older adults and remains unrecognized in up to 60% of cases, especially in its hypoactive form. Multicomponent non-pharmacological interventions reduce incidence by 43–53% but require specific staff training. TBL is a structured active-learning strategy, comprising individual and group readiness assurance tests and application exercises, promoting accountability, engagement, collaborative skills, and theory-to-practice transfer. Methods. A pre-post intervention is proposed for experienced nurses in acute medical wards. Three sequential TBL sessions will address: delirium pathophysiology and risk factors, validated screening tools (CAM, CAM-ICU, ICDSC), and non-pharmacological management. Outcomes include knowledge (Delirium Knowledge Questionnaire, pre/post), protocol adherence (audit at 1 and 3 months), and self-efficacy (Likert scale) Results. TBL is hypothesized to improve delirium knowledge, increase screening adherence, and enhance nurses' perceived competence and accountability, outperforming lecture-based training in bedside knowledge transfer. Discussion. TBL is a promising strategy to overcome implementation barriers of delirium protocols by targeting knowledge, attitudes, and team culture simultaneously. The proposal is amenable to empirical evaluation and potential multiprofessional extension.
Copyright (c) 2026 Dario Ottobretti, Gloria Buconi, Carlotta Zanetti https://creativecommons.org/licenses/by/4.0
Meritocracy Perception and Work Disengagement in Italian Nurse Managers: A National Survey Protocol
Introduction. Perceived promotion inequity erodes professional engagement and accelerates attrition. Anti-meritocracy in Italian institutions is empirically documented in academic medicine (Gallina et al., IJEI 2023). FNOPI Study BENE (2023) identifies professional recognition deficit as the third primary retention barrier (65.2% of respondents). Equivalent evidence for Italian nursing leadership is entirely absent. Methods. Cross-sectional national survey protocol (PROSPERO pre-registered). Target: N=350 Italian nurse managers (FNOPI regional networks). Instruments: Organisational Justice Scale (OJS; Colquitt 2001), Utrecht Work Engagement Scale (UWES-9; Schaufeli 2006), and purpose-designed career equity items. Multivariate regression and SEM. Sample size: 80% power, α=0.05, r=0.30 requires N=318. Results. Theoretical model validated by convergent evidence: OJS deficits → reduced organisational identification → reduced UWES-9 → intention to leave (path model). Gallina et al. (2023) demonstrate cooptative promotion as empirically measurable. OECD Health Workforce (2024) confirms recognition as a modifiable retention lever across EU systems. Discussion. This first Italian national study on meritocracy perception in nursing leadership will directly inform transparent promotion criteria frameworks endorsed by the OECD, European Parliament (2025), and FNOPI strategy 2024–2028.
The Perception of Self-Efficacy in Caring Among Home Care Nurses: A Cross-Sectional Study
Introduction. Caring, the essence of nursing, is based on building an authentic relationship between nurses, patients and families (1). In home care, empathy and caring act as gatekeepers to more technical phases (2). This study aims to describe home care nurses' perception of self-efficacy in caring and assess if sociodemographic variables affect it. Methods. A cross-sectional study was conducted among home care nurses in Northern Italy. Participants completed the Italian version of the Caring Efficacy Scale (CES), which includes two domains: Confidence in Caring (CC; range 7–42) and Doubt and Concerns (DC; range 10–60). Sociodemographic variables included age, sex, type of work in the home care setting, years of experience, education, previous work settings, parenting, and caregiving status. Results. 48 nurses were recruited (response rate=50%). Mean CC score was 35.6 (SD=3.6); mean DC score was 21.8 (SD=6.9). Bivariate analyses showed a significant association between CC and years of experience and a borderline association with parental status. Linear regression confirmed a positive correlation between CC and years of experience, and a negative one with the telenursing subgroup of the "type of work in the home care setting" variable. The DC domain appears unrelated to the assessed variables. Discussion. Despite the small sample size, results suggest high confidence and low doubt in caring. The DC domain may be a complex construct linked to psychological and organisational factors.
Copyright (c) 2026 Ilaria Saguatti, Socaina Kahoua, Giovanna D'Iapico, Dalia Caleffi, Domenico Cannizzaro, Ludovica Greco, Fabio Di Cristofaro, Angela Contri, Paola Ferri https://creativecommons.org/licenses/by/4.0
Compassion Fatigue Education in Italian Nursing Curricula: A Systematic Gap Analysis Driven by Patient Safety Evidence
Introduction. Nurse burnout carries measurable patient safety consequences: Li et al. (JAMA Netw Open 2024; 85 studies; N=288,581 nurses) found SMD=−0.58 for missed care and SMD=−0.68 for safety climate. FNOPI Study BENE (2023) documents 60% burnout prevalence in Italian nurses, with 45.2% intending to leave within 12 months. The structural drivers of this crisis are absent from Italian pre-registration nursing curricula. Methods. Phase 1: systematic document review of 34 Italian accredited nursing programme curricula (Ministry of Health registry 2022–2024) for compassion fatigue, organisational recognition, and structural burnout content. Phase 2: focus groups with N=18 newly registered Italian nurses; deductive thematic analysis using Honneth's recognition theory framework. Results. Phase 1 preliminary review of 8 publicly available curricula: empathy-related content present exclusively as generic communication modules (0 curricula included recognition theory or systemic burnout frameworks). Li et al. (2024) demonstrate that systems-level burnout interventions—not individual resilience—drive patient safety improvement. Discussion. Misidentifying burnout as individual failure obscures the organisational recognition deficit as root cause. Italian nursing curricula incorporating Honneth-informed structural frameworks will produce graduates capable of advocating for systemic changes demonstrated by Li et al. (2024) to protect patient safety.
Nurse-Performed Point-of-Care Ultrasound in Critical Care: Implications for Clinical Decision-Making and Advanced Nursing Practice
Introduction. Point-of-care ultrasound (POCUS) is increasingly used in intensive care units (ICUs) as a bedside imaging tool supporting rapid clinical assessment. The extension of ultrasound competencies to nurses reflects the development of advanced roles in critical care. However, the contribution of nurse-performed POCUS to patient assessment and care management remains insufficiently synthesized. Methods. A systematic literature review was conducted following PRISMA 2020 recommendations. PubMed, MEDLINE, Scopus, CINAHL, and Web of Science were searched without time restrictions. Studies involving adult ICU patients in which nurses used POCUS for bedside assessment or procedural guidance were included. Methodological quality was evaluated using Joanna Briggs Institute checklists and the Mixed Methods Appraisal Tool. Results. Eleven studies published between 2018 and 2025 were included. Evidence suggests that nurse-performed POCUS can support bedside clinical reasoning and may lead to management changes. Benefits were mainly reported for ultrasound-guided vascular access and focused bedside assessment. Diagnostic reliability appeared acceptable when supported by structured training. Discussion. Nurse-performed POCUS may represent a useful adjunct to nursing assessment in intensive care, potentially improving bedside evaluation and supporting advanced nursing practice. Further research is needed to clarify its impact on patient outcomes.
Copyright (c) 2026 Marco Abagnale, Francesco Limonti, Luciano Cecere, Chiara Palazzo, Francesco Gravante https://creativecommons.org/licenses/by/4.0
Development and Validation of the Nursing Organizational Well-being Questionnaire (NOW-Q): A Theory-Based Questionnaire to Identify Organizational Well-being Profiles
Introduction. Nurses’ organizational well-being is crucial for workforce stability and care quality. However, existing instruments often assess isolated work environment dimensions, are not grounded in nursing-specific theory, and rarely support person-centered analyses. This study aimed to develop and validate the Nursing Organizational Well-being Questionnaire (NOW_Q). Methods. A two-phase study was conducted following COSMIN guidance. Phase 1 included item generation, expert review, and content validation. Phase 2 was a multicenter cross-sectional study involving 461 nurses from seven Italian hospitals. Construct validity was tested through exploratory and confirmatory factor analyses with cross-validation. Reliability was assessed using ordinal omega, concurrent validity through correlations with a global organizational well-being item, and cluster analysis explored person-centered profiles. Results. The final NOW_Q included 28 items and eight dimensions: emotional demands, work-family conflict, workload, available resources, nurse-nurse relationship, nurse-head nurse relationship, nurse-physician relationship, and autonomy. The final CFA showed good fit (RMSEA = 0.051; CFI = 0.938; TLI = 0.927; SRMR = 0.067). Ordinal omega ranged from 0.75 to 0.87. Three profiles emerged: Nurturing, Observed-Detached, and Withstanding. Discussion. The NOW_Q showed satisfactory psychometric properties and practical utility. As a theory-based, nursing-specific measure, it may support targeted assessment of organizational well-being and identification of distinct nurse profiles to inform interventions in clinical settings.
Copyright (c) 2026 Valerio Della Bella, Jacopo Fiorini, Alessandro Sili https://creativecommons.org/licenses/by/4.0
Dispatcher-Assisted Instructions and Community Engagement: Translating Evidence Into Impact in Out-of-Hospital Cardiac Arrest
Introduction. Early bystander intervention is a key determinant of survival after out-of-hospital cardiac arrest (OHCA). Evidence shows that dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) increases the likelihood that citizens initiate CPR. Translating this evidence into real impact requires integration between dispatch practice, training, and community engagement. Methods. An improvement initiative was implemented in an emergency medical dispatch centre. The project included a structured review of emergency calls to analyse communication dynamics and lay descriptions of cardiac arrest, targeted training for dispatchers on pre-arrival instructions, and analysis of dispatch data. Community engagement activities were also promoted, including dissemination of positive stories involving rescuers and survivors to strengthen public awareness and advocacy. Results. Between 2023 and 2025, dispatcher-assisted instructions for cardiac arrest increased from 180 to 376 cases (+109%). In parallel, patients with return of spontaneous circulation increased: code 2 (medium severity) +119%, and code 3 (critical) +144%. Call analysis improved recognition of cardiac arrest and supported clearer dispatcher communication strategies. Advocacy activities involving survivors and rescuers further reinforced community engagement. Discussion. Integrating dispatcher training, structured call analysis and community advocacy may help translate evidence on DA-CPR into measurable system impact, strengthening early response and supporting improved outcomes in OHCA.
Copyright (c) 2026 Guglielmo Imbriaco, Juliette Masina, Giorgia Ghedini, Gianluca Federiconi, Jihan Kayal, Diana Demaria, Francesco Onofri https://creativecommons.org/licenses/by/4.0
Latent Profiles of Nurses’ Organizational Well-being and Turnover Intention: A Person-Centered Multilevel Multicenter Study
Introduction. Nurses’ organizational well-being is crucial for workforce stability and quality of care. However, most studies use variable-centered approaches that examine isolated workplace factors, overlooking how organizational conditions combine to shape nurses’ experiences. This study adopts a person-centered approach to identify latent nurse profiles and examine whether they differ in turnover intention. Methods. A cross-sectional multicentre multilevel secondary analysis was conducted. Nurses’ perceptions of the work environment were measured using a validated questionnaire grounded in the situational theory of Nursing Organizational Well-being. Latent Profile Analysis with clustering correction for wards identified nurse profiles. Differences in turnover intention across profiles were tested using the BCH method. Results. The study included 2349 nurses from 158 wards across 25 Italian hospitals. Four profiles emerged with distinct configurations of organizational well-being factors. Turnover intention significantly differed across profiles: nurses in the high-strain profile showed the highest intention to leave, whereas more supportive profiles showed lower turnover intention. Discussion. A person-centered approach highlights how combinations of workplace conditions shape distinct nurse experiences and influence turnover intention, supporting the need for targeted organizational strategies to improve nurse retention.