BACKGROUND: An evidence and consensus-based instrument is needed to classify central venous access device-associated skin impairments.
OBJECTIVE: The aim of this study was to design and evaluate the central venous access device-associated skin impairment classification tool.
METHODS: A two-phase modified Delphi study.
METHODS: This two-phase study consisted of a literature review, followed by the development and validation of a classification instrument, by experts in the fields of central venous access devices and wound management (Phase 1). The instrument was tested (Phase 2) using 38 clinical photographs of a range of relevant skin impairments by the same expert panel. The expert panel consisted of registered nurses who were clinical researchers (n = 4) and clinical experts (n = 3) with an average of 24 years of nursing and research experience and 11 years of experience in wound management. Measures to assess preliminary content validity and inter-rater reliability were used.
RESULTS: The instrument consists of five overarching aetiological classifications, including contact dermatitis, mechanical injury, infection, pressure injury and complex clinical presentation, with 14 associated subcategory diagnoses (e.g., allergic dermatitis, skin tear and local infection), with definitions and signs and symptoms. High agreement was achieved for preliminary scale content validity and item content validity (I-CVI = 1). Inter-rater reliability of aetiologies was high. The overall inter-rater reliability of individual definitions and signs and symptoms had excellent agreement.
CONCLUSIONS: The development and preliminary validation of this classification tool provide a common language to guide the classification and assessment of central venous access device-associated skin impairment.
CONCLUSIONS: The comprehensive and validated classification tool will promote accurate identification of central venous access device-associated skin impairment by establishing a common language for healthcare providers. The availability of this tool can reduce clinical uncertainty, instances of misdiagnosis and the potential for mismanagement. Consequently, it will play a pivotal role in guiding clinical decision-making, ultimately enhancing the quality of treatment and improving patient outcomes.
UNASSIGNED: The Guidance on Conducting and Reporting Delphi Studies (CREDES) was adhered to.
UNASSIGNED: No patient or public contribution.

BACKGROUND: The study underscores the crucial yet often neglected issue of sexual dysfunction in haemodialysis patients. Despite nephrology nurses\'close relationships with patients, there is a significant communication gap on this topic. In China, limited research highlights the need for further study.
OBJECTIVE: To describe the perspectives of Chinese nephrology nurses on discussing sexual dysfunction with patients receiving haemodialysis.
METHODS: A qualitative descriptive study.
METHODS: Ten Chinese nephrology nurses from a tertiary public hospital in Guizhou province, China.
METHODS: Semistructured interviews were conducted using an interview guide. Qualitative content analysis approach was utilised in analysis.
RESULTS: There were five themes described: (1) lack of training in sexual education, as nephrology nurses described never being trained to manage patients\' sexual health issues; (2) discomfort when discussing sexual topics, Chinese nephrology nurses found the topic of sexual dysfunction embarrassing and avoided discussing it; (3) sexual dysfunction viewed as a nonurgent topic, nephrology nurses prioritise physical health to aid patient survival; (4) belief in physicians as ultimate care advisors, nephrology nurses believed that doctors should handle discussions on sexually related topics; and (5) lack of a suitable environment for discussing sexual dysfunction, nephrology nurses viewed sex as a private matter, inappropriate for discussion in a public unit.
CONCLUSIONS: The study identifies barriers to discussing sexual dysfunction in healthcare, including provider knowledge deficits, discomfort and lack of supportive environments. It recommends specialised training and conducive settings to improve communication in renal care. Future research should evaluate the effectiveness of these interventions.

Background: Despite American Society of Clinical Oncology and Children\'s Oncology Group recommendations, the rate of sperm-banking for newly diagnosed adolescent and young adult males with cancer remains between 18% and 35%. The purpose of this study was to examine recent literature regarding decision-making and fertility preservation prior to the initiation of therapy for adolescents and young adults diagnosed with cancer. Method: A search of multiple online databases was undertaken for peer-reviewed studies between the years of 2010 and 2022. The databases CINAHL, PubMed, PsycInfo, Scopus, Google Scholar, and forward citation search was employed using the same Boolean search phrases in each database. Some 402 articles were then screened for relevance by title, abstract, and full review based on inclusion/exclusion criteria for synthesis. Results: Ten articles met criteria to be included in this review. Three themes were identified as impacting the decision to cryopreserve sperm prior to the initiation of therapy. Provider recommendation, parent recommendation, and referral for fertility specialist consult emerged as statistically significant factors in the decision to attempt sperm banking. Discussion: While the most significant factor impacting the decision to preserve fertility, parents reported they were more likely to recommend this to their child if they received clear recommendations from the medical team. Pediatric oncology physicians and nurses are in a unique position to positively impact quality of life and psychosocial outcomes in survivors of pediatric cancer by providing up-to-date evidence-based information, risk assessment, recommendations, and/or referral to fertility preservation specialists to families and patients.

To evaluate the effect of mobile app-based educational information on anxiety, distress, and quality of life in patients with breast cancer (BC).
This mobile app was designed to assist patients before and after BC surgery. This randomized controlled study was conducted between April and August 2021. The intervention group (n = 42) received routine care and access to the mobile app for one month, while the control group (n = 40) received only routine care. Data were collected using questionnaires one week before and three weeks after surgery.
The patients in the intervention group, after using the mobile app, had significantly lower anxiety and distress levels than those in the control group (p<0.05). However, there was no difference between the two groups regarding overall quality of life and subscale mean scores (p>0.05).
These findings suggest that using informative mobile apps starting before surgery can effectively reduce anxiety and distress in the early periods after surgery. Although the impact on overall quality of life was insignificant, such interventions may have long-term positive effects on quality of life.

OBJECTIVE: Minimizing delays in delivering nursing care is paramount for enhancing the overall quality of care. Certain bottleneck variables restrict the workflow of nurses, resulting in extended shift times. This study is designed to pinpoint and analyze the principal factors contributing to bottleneck issues in nursing workflow, to direct improvement endeavors. This study seeks to provide insights into the key variables contributing to nurses\' extended shift times, with the ultimate goal of prioritizing efforts for improvement.
METHODS: A descriptive multicenter cross-sectional study was conducted. A scale was developed for this study by the authors after conducting a literature review, subsequently validated, and its reliability was assessed.
RESULTS: Among the 31 bottleneck variables, 29 were retained under three persistent bottleneck factors: (1) Nurse staffing- This pertains to the availability of sufficient nursing staff at all times across the continuum of care; (2) Working environment and quality of care-This refers to the availability of necessary skills and resources for nurses to perform their duties effectively and; (3) Medical devices- This factor concerns the availability of fully functional medical devices required for providing care.
CONCLUSIONS: Efforts aimed at enhancing the overall healthcare system should concentrate on addressing persistent bottleneck factors. This may involve the implementation of a healthcare workforce management system, the establishment of standards for a conducive and supportive working environment, and the utilization of a standardized system for the management of medical equipment. The outcomes of this study can be utilized by nurses and policymakers to devise comprehensive strategies for improvement.

BACKGROUND: Technological advancements have extended the lifespan of individuals with congenital heart disease (CHD), but physical and mental health issues can affect their life and job satisfaction.
OBJECTIVE: This study examined whether grit can protect full-time employed adults with CHD from depression by exploring its mediating role between depressive symptoms and life or job satisfaction.
METHODS: A cross-sectional design involved 181 adults with CHD assessed using the Patient Health Questionnaire, Grit-10, Satisfaction with Life Scale, and Basic Psychological Need Satisfaction at Work Scale. Data analysis was conducted with SPSS and Smart PLS software for partial least squares structural equation modeling, adhering to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
RESULTS: Indicated that depressive symptoms were negatively correlated with grit, life satisfaction, and job satisfaction, while grit was positively correlated with both satisfaction measures. Grit partially mediated the relationship between depressive symptoms and life/job satisfaction, accounting for 30.70 % and 29.11 % of the variance, respectively.
CONCLUSIONS: Grit significantly mitigates the negative impact of depressive symptoms on life and job satisfaction in full-time employed adults with CHD. Nurses should identify signs of depression in adults with CHD and evaluate their grit levels. Interventions to increase grit and reduce depressive symptoms could enhance life and job satisfaction.

OBJECTIVE: To determine the effect of virtual reality glasses intervention on pain, vital signs, and patient satisfaction of hemodialysis patients undergoing AVF catheter puncture.
METHODS: Randomized controlled study.
METHODS: The study was conducted in 60 patients receiving dialysis treatment in the HD unit of a public hospital in Turkey. The data were collected via the \"Patient Identification Form\", \"Visual Analog Scale/VAS\" and \"Hemodynamics Variables Inspection Form\". The patients in the experiment group watched videos through the virtual reality glasses for totally 5 minutes in average, 2 minutes before the AVF cannulation process and 3 minutes during the process. No intervention was applied to the patients in the control group other than the normal nursing interventions in the HD unit.
RESULTS: In the intra-group comparisons, the 2nd and 3rd measurement average pain level scores of the patients with in the experimental group were determined to be statistically significantly lower compared to their 1st measurement (p < 0.05); the 3rd measurement average pain level scores of the control group were determined to be statistically significantly lower compared to their 1st and 2nd measurements (p < 0.05).
CONCLUSIONS: It was determined that the virtual reality glasses decreased the pain that emerges during the AVF cannulation process and increased the patient satisfaction level. It is suggested that the virtual reality glasses should be used by the nurses in the HD unit since it is easily applicable in coping with pain in the patients and since it is an invasive method.

BACKGROUND: Nursing students\' learning during clinical practice is largely influenced by the quality of the guidance they receive from their nurse preceptors. Students that have attended placement in nursing home settings have called for more time with nurse preceptors and an opportunity for more help from the nurses for reflection and developing critical thinking skills. To strengthen students\' guidance and assessment and enhance students\' learning in the practice setting, it has also been recommended to improve the collaboration between faculties and nurse preceptors.
OBJECTIVE: This study explores first-year nursing students\' experiences of using the Technology-Optimized Practice Process in Nursing (TOPP-N) application in 4 nursing homes in Norway. TOPP-N was developed to support guidance and assessment in clinical practice in nursing education.
METHODS: Four focus groups were conducted with 19 nursing students from 2 university campuses in Norway. The data collection and directed content analysis were based on DeLone and McLean\'s information system success model.
RESULTS: Some participants had difficulties learning to use the TOPP-N tool, particularly those who had not attended the 1-hour digital course. Furthermore, participants remarked that the content of the TOPP-N guidance module could be better adjusted to the current clinical placement, level of education, and individual achievements to be more usable. Despite this, most participants liked the TOPP-N application\'s concept. Using the TOPP-N mobile app for guidance and assessment was found to be very flexible. The frequency and ways of using the application varied among the participants. Most participants perceived that the use of TOPP-N facilitated awareness of learning objectives and enabled continuous reflection and feedback from nurse preceptors. However, the findings indicate that the TOPP-N application\'s perceived usefulness was highly dependent on the preparedness and use of the app among nurse preceptors (or absence thereof).
CONCLUSIONS: This study offers information about critical success factors perceived by nursing students related to the use of the TOPP-N application. To develop similar learning management systems that are usable and efficient, developers should focus on personalizing the content, clarifying procedures for use, and enhancing the training and motivation of users, that is, students, nurse preceptors, and educators.

OBJECTIVE: The aim of this study is to explore the feasibility of using machine learning approaches to objectively differentiate the mobilization patterns, measured via accelerometer sensors, of patients pre- and post-intervention.
METHODS: The intervention tested the implementation of a Frailty Care Bundle to improve mobilization, nutrition and cognition in older orthopedic patients. The study recruited 120 participants, a sub-group analysis was undertaken on 113 patients with accelerometer data (57 pre-intervention and 56 post-intervention), the median age was 78 years and the majority were female. Physical activity data from an ankle-worn accelerometer (StepWatch 4) was collected for each patient during their hospital stay. These data contained daily aggregated gait variables. Data preprocessing included the standardization of step counts and feature computation. Subsequently, a binary classification model was trained. A systematic hyperparameter optimization approach was applied, and feature selection was performed. Two classifier models, logistic regression and Random Forest, were investigated and Shapley values were used to explain model predictions.
RESULTS: The Random Forest classifier demonstrated an average balanced accuracy of 82.3% (± 1.7%) during training and 74.7% (± 8.2%) for the test set. In comparison, the logistic regression classifier achieved a training accuracy of 79.7% (± 1.9%) and a test accuracy of 77.6% (± 5.5%). The logistic regression model demonstrated less overfitting compared to the Random Forest model and better performance on the hold-out test set. Stride length was consistently chosen as a key feature in all iterations for both models, along with features related to stride velocity, gait speed, and Lyapunov exponent, indicating their significance in the classification.
CONCLUSIONS: The best performing classifier was able to distinguish between patients pre- and post-intervention with greater than 75% accuracy. The intervention showed a correlation with higher gait speed and reduced stride length. However, the question of whether these alterations are part of an adaptive process that leads to improved outcomes over time remains.

This study was aimed at determining the spiritual care and comfort needs of patients having undergone open-heart surgery. This cross-sectional descriptive study was conducted with 147 patients in the Cardiovascular Surgery Intensive Care Unit of a training and research hospital in Izmir, a province in western Turkey, between May 1, 2022 and November 1, 2022. The comfort level of the patients who had undergone open-heart surgery was moderate, and the levels of their spiritual care needs were high. A statistically significant relationship was found between the patients\' Perianesthesia Comfort Scale total score and the Spiritual Care Needs Inventory (p < 0.05). We concluded that the patients\' comfort levels decreased as their spiritual care needs increased. We recommend authors to conduct studies in the future which should include different sample groups and compare the data obtained before and after the surgery.