OBJECTIVE: To determine the fit factor and compliance with American Industrial Hygiene Association (AIHA) and Occupational Safety and Health Administration (OSHA) requirements of surgical masks and filtering respirators in male versus female nurses.
METHODS: A case-control gender study performed from 2016 to 2019.
METHODS: A gender and age matched-paired sample of 74 nurses was recruited and divided into men (n = 37) and women (n = 37). FFP3 filtering respirators and surgical masks fit factors were compared between male and female nurses by Mann-Whitney U tests. These measurements were tested to pass or fail according to the OSHA (≥100) and AIHA (≥50) criteria by Fisher exact tests for a 95% confidence interval.
RESULTS: Global fit factor mean (standard deviation) was 2.86 (2.73) and 3.55 (6.34) for male and female nurses wearing surgical masks (p = .180), respectively, and nobody passed neither OSHA nor AIHA criteria (p = 1.00). Nevertheless, global fit factor were 30.82 (28.42) and 49.65 (43.04) for male and female nurses wearing FFP3 respirators, respectively, being significantly lower and worse in male nurses (p = .037). According to OSHA criteria, only 2.70% and 13.51% of male and females nurses, respectively, passed with non-significant difference (p = .199), meanwhile 21.62% and 48.64% of male and female nurses, respectively, passed AIHA criteria showing significant differences (p = .027) wearing FFP3 respirators.
CONCLUSIONS: All male and female nurses wearing surgical masks failed to pass OSHA and AIHA criteria. Global fit factor of the proposed FFP3 filtering respirators was decreased and worse in male than female nurses.
CONCLUSIONS: Our recommendation is to avoid surgical masks use for protective purposes and use the proposed FFP3 filtering respirators among nurses. Each nurse should be fit tested for its own respirator with special caution in male nurses due to their lower fit factor achieved and most of them failed to pass OSHA and AIHA criteria, especially during COVID-19 pandemic.

OBJECTIVE: To describe and explain nurses\' protocol-based care decision-making.
BACKGROUND: Protocol-based care is a strategy to reduce variability in clinical practice. There are no studies looking at protocol-based care decision-making. Understand this process is key to successful implementation.
METHODS: A multiple embedded case study was carried out. Nurses\' protocol-based care decision-making was studied in three inpatient wards (medical, surgical and medical-surgical) of a university hospital in northern Spain. Data collection was performed between 2015 and 2016 including documentary analysis, non-participant observations, participant observations and interviews. Analysis of quantitative data involved descriptive statistics and qualitative data was submitted to Burnard\'s method of content analysis (1996). The data integration comprised the integration of the data set of each case separately and the integration of the findings resulting from the comparison of the cases. The following the thread method of data integration was used for this purpose. The SRQR guideline was used for reporting.
RESULTS: The multiple embedded case study revealed protocol-based care decision-making as a linear and variable process that depends on the context and consists of multiple interrelated elements, among which the risk perception is foremost.
CONCLUSIONS: This study has allowed progress in protocol-based care decision-making characterisation. This knowledge is crucial to support the design of educational and management strategies aimed at implementing protocol-based care.
CONCLUSIONS: Strategies to promote protocol-based care should address the contexts of practice and the ability of professionals\' to accurately assess the degree of risk of clinical activity. Hence, it will promote quality of care, patient safety and efficiency in healthcare cost.

OBJECTIVE: Pressure ulcers (PUs) constitute a health issue that has a high prevalence and incidence rate in acute and long-term care, requiring long-term nursing care for treatment and prevention. Therefore, nurses should have adequate knowledge of the interventions and practices used to prevent PUs.
METHODS: This study employed a descriptive and cross-sectional design to assess the level of nurses\' knowledge concerning preventive interventions for PUs. Based on data found in the literature, researchers developed a 16-question Participant Information Form (including age, gender, level of education, employed ward, and training on PUs) and used this form, along with the Turkish version of the Pressure Ulcer Prevention Knowledge Assessment Instrument (PUPKAI-T), to collect data.
RESULTS: A group of 471 nurses working in two foundation hospitals in 2018 participated in the study by completing a questionnaire. Among the participants, 44.2% worked in surgery, 21.2% in internal medicine, and 34.6% in other wards (such as intensive care, pediatrics, and the operating theater). Most of the nurses(73.5%) held a bachelor\'s degree, and their average work experience was 7.27 ± 7.00 years. It was determined that 69.4% of the nurses had not received in-service training relating to PUs, 55.6% did not attend lectures/conferences or read articles on the prevention of PUs, and 59.7% rated themselves as \"adequate\" in interventions used to prevent PUs. Based on the use of PUPKAI-T, 17 individuals (3.6%) scored equal to or more than the 60% cut-off value, and 454 individuals (96.4%) scored less than 60%. The mean level of knowledge on PUs was calculated as 11.1 ± 2.659 (range: 1-18) out of 26 questions.
CONCLUSIONS: Results of the study showed that the general level of knowledge of nurses in preventing PUs are extremely insufficient. Therefore, various strategies should be developed to increase nurses\' level of knowledge on the etiology and development, classification and observation, and risk assessment of PUs, as well as on nutrition plans and preventive interventions.

This article aims to assist nurses and other health professionals to care for patients who have type 2 respiratory failure as a result of chronic obstructive pulmonary disease, and who require non-invasive ventilation. It outlines findings of a case study that are commonplace in the acute medical setting and aims to highlight important factors that impact on patient care and patient outcome, and to help nursing staff to implement recommended and best practices.

Clinical nurse assessment determines clinical status, status changes, and trends that affect the patient\'s plan of care. With the financial burden of care being a prominent source of patient stress, financial toxicity is a vital component of clinical nurse assessment.
For selected clinical nurse roles, this article provides a foundation for clinical financial toxicity assessment, which is initiated during the patient\'s treatment and continues into survivorship.
With a focus on financial toxicity affecting patients with cancer, this article is an overview of financial toxicity as a part of clinical assessment. It includes an explanation of clinical nurse roles and definitions, assessment as a clinical nurse standard of care, assessment frameworks and components, how clinicians can approach assessment with patients and family members, and implications for clinical practice.
Based on a clinical assessment of financial toxicity risk and status, a clinical nurse who is educated about patient healthcare financial issues can start or continue conversations about financial toxicity, provide and mobilize resources to help address financial burden, and/or refer patients and family members to expert guidance from designated healthcare financial experts when they are available in the healthcare system.

OBJECTIVE: to report the use experience of convergent healthcare research for developing a nursing care protocol.
METHODS: convergent care research developed in university hospital, from July to December 2016, with 27 participants.
RESULTS: the stages of the research and its results are described in the steps: conception, instrumentation, screening and analysis. The end result was the nursing care protocol in day zero of hematopoietic stem cell transplantation.
CONCLUSIONS: convergent care research was an appropriate method for developing the care protocol, and an important contribution to the approximation between theory and practice. The nursing care protocol was the result of this study and confirmed both the purpose of the research as a professional Master\'s in acquiring knowledge aimed at improving professional practice.

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OBJECTIVE: To examine the characteristics of patients that fell and compare them with patients that did not fall and to seek differences between the two groups that might help better predict falls in future patients.
BACKGROUND: It has been estimated that between 700,000 and one million inpatient falls occur yearly in hospitals in the United States, which results in an increase in healthcare costs of over $19 billion dollars per year.
METHODS: This was a case-control study employing a retrospective analysis of inpatient electronic health records. It includes records from 160 patients who experienced a fall after the implementation of the Johns Hopkins Fall Risk Assessment Tool, and 160 records of patient with similar fall risk scores that did not fall.
METHODS: All fall and nonfall patient data for the database were obtained by one research team member, while systematic random selection of nonfall patient records was performed by three research team members as described below. Each patient was assigned a unique study code number which was entered into the research database. The final sample size was 302 patients.
RESULTS: Patients who did not receive lorazepam within 12 hr of the fall risk assessment were less likely to fall than patients who did receive lorazepam. A statistical relationship was also found between toileting at the time of the fall and age.
CONCLUSIONS: Better stratification of patient populations combined with astute nursing awareness may result in a further reduction in falls.
CONCLUSIONS: The results indicate that the nursing assessment with respect to falls is critical to identifying fall-prone individuals who may score as a low-to-moderate fall risk. In addition, the administration of lorazepam should cue the nurse that fall precautions be implemented regardless of scored risk.

Spontaneous newborn skull fracture is rarely cited in nursing literature as a potential outcome of persistent fetal occiput posterior position. Although most newborns seem unaffected by the condition initially, some may show symptoms several hours after the birth, when nursing assessments are less frequent. This case report illustrates delayed newborn symptoms that led to an unexpected diagnosis of spontaneous skull fracture.