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Digitalization is not fully implemented in clinical practice, and several factors have been identified as possible barriers, including the competencies of health care professionals. However, no summary of the available evidence has been provided to date to depict digital health competencies that have been investigated among health care professionals, the tools used in assessing such competencies, and the effective interventions to improve them. This review aims to summarize digital health competencies investigated to date and the tools used to assess them among health care professionals. A systematic review based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was performed. The MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Scopus databases were accessed up to September 4, 2021. Studies assessing digital health competencies with quantitative designs, targeting health care professionals, and written in English were included. The methodological quality of included studies was evaluated using the Joanna Briggs Institute tools. A total of 26 studies, published from 1999 to 2021, met the inclusion criteria, and the majority were cross sectional in design, while only 2 were experimental study designs. Most studies were assessed with moderate to low methodological quality; 4 categories and 9 subcategories of investigated digital health competencies have been identified. The most investigated category was \"Self-rated competencies,\" followed by \"Psychological and emotional aspects toward digital technologies,\" \"Use of digital technologies,\" and \"Knowledge about digital technologies.\" In 35% (9/26) of the studies, a previously validated tool was used to measure the competencies assessed, while others developed ad hoc questionnaires. Mainly descriptive studies with issues regarding methodology quality have been produced to date investigating 4 main categories of digital health competencies mostly with nonvalidated tools. Competencies investigated might be considered while designing curricula for undergraduate, postgraduate, and continuing education processes, whereas the methodological lacks detected might be addressed with future research. There is a need to expand research on psychological and emotional elements and the ability to use digital technology to self-learn and teach others. PROSPERO International Prospective Register of Systematic Reviews CRD42021282775; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282775.

[This corrects the article DOI: 10.2196/36414.].

Background Unfinished Nursing Care (UNC) concept, that express the condition when nurses are forced to delay or omit required nursing care, has been largely investigated as tasks left undone, missed care, and implicit rationing of nursing care. However, no summary of the available evidence regarding UNC antecedents has been published. The aim of this study is to identify and summarise antecedents of UNC as documented in primary studies to date. Methods A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. MEDLINE, CINAHL, SCOPUS, and PROSPERO databases were searched for quantitative studies reporting the relationships between antecedents and UNC published after 2004 up to 21 January 2020. The reference lists of secondary studies have been scrutinised to identify additional studies. Two reviewers independently identified studies and evaluated them for their eligibility and disagreements were resolved by the research team. The quality appraisal was based on the Joanna Briggs Institute Critical Appraisal tools, according to the study designs. A data extraction grid was piloted and then used to extract data. The antecedents that emerged were thematically categorised with an inductive approach. Results Fifty-eight studies were included; among them, 54 were cross-sectional, three were cohort studies, and one was a quasi-experimental study. They were conducted mainly in the United States and in hospital settings. The UNC antecedents have been investigated to date at the (a) unit (e.g., workloads, non-nursing tasks), (b) nurse (e.g., age, gender), and (c) patient levels (clinical instability). Conclusions At the unit level, it is highly recommended to provide an adequate staff level, strategies to deal with unpredictable workloads, and to promote good practice environments to reduce or minimise UNC. By contrast, at the nurse and patient levels, there were no clear trends regarding modifiable factors that could decrease the occurrence of UNC. The map of antecedents that emerged can be used to design interventional studies aimed at changing research from merely descriptive to that which evaluates the effectiveness of interventions.

Background Primary care serves as the initial point of healthcare contact; however, the shortage of general practitioners can threaten equitable access to primary care, necessitating innovative models. In a district in the north of Italy, an alternative primary care model, as a primary care center (PCC), has been established to care for citizens unattached to a general practitioner. We aimed to explore the users’ experience with the novel alternative primary care model. Methods We conducted a qualitative study using a grounded theory approach. We interviewed a total of 33 participants, including 25 patients and eight informal caregivers. Results Findings suggest a core concept of the “Patient experience process at the PCC as a dynamic and interconnected journey” that unfolds in three interconnected themes, starting from “Living the care pathway at the PCC “, progressing to “Evaluating the care pathway at the PCC”, and concluding with “Drawing conclusion on the PCC”. Patients transitioned through these phases as they interact with healthcare professionals, reflect on the quality of care, and make informed decisions regarding their preferences. Findings indicate that the transition from a general practitioner to the PCC is often marked by uncertainty and frustration, primarily due to the lack of structured handovers and clear service explanations. However, effective communication, proactive follow-up, and home visits by healthcare professionals significantly enhance patient satisfaction and trust in the PCC model. Nurses emerge as central figures in ensuring continuity of care and holistic support, while multidisciplinary collaboration fosters comprehensive and personalized care. Patients critically assess their care experiences, weighing the benefits of PCC services against their previous GP experiences. While many patients appreciate the structured and multidisciplinary nature of PCC care, some still prefer a dedicated GP for continuity and familiarity. Digital health solutions, including telehealth and remote monitoring, are recognized as useful additions but require careful integration to avoid reducing human interaction and address potential barriers for older people needing support from informal caregivers. Conclusion Our study underscores the importance of effective communication, proactive follow-up, multidisciplinary care, and continuity of care to ensure a positive user experience satisfaction when delivering primary care to patients unattached to a GP through a new alternative primary care model.

The nursing role significantly changed following reforms in the nurse training process. Nowadays, nurses are increasingly trained to promote and improve the quality of clinical practice and to provide support in the assistance of patients and communities. Opportunities and threats are emerging as a consequence of the introduction of new disruptive technologies in public health, which requires the health care staff to develop new digital skills. The aim of this paper is to review and define the role of nurses and the skills they are asked to master in terms of new methodological approaches and digital knowledge in a continuously evolving health care scenario that relies increasingly more on technology and digital solutions. This scoping review was conducted using a thematic summary of previous studies. Authors collected publications through a cross-database search (PubMed, Web of Science, Google Scholar) related to new telemedicine approaches impacting the nurses' role, considering the time span of 2011-2021 and therefore including experiences and publications related to the first phase of the COVID-19 pandemic. The assessment was completed between April and July 2021. After a cross-database search, authors reviewed a selection of 60 studies. The results obtained were organized into 5 emerging macro areas: (1) leadership (nurses are expected to show leadership capabilities when introducing new technologies in health care practices, considering their pivotal role in coordinating various professional figures and the patient), (2) soft skills (new communication skills, adaptiveness, and problem solving are needed to adapt the interaction to the level of digital skills and digital knowledge of the patient), (3) training (specific subjects need to be added to nursing training to boost the adoption of new communication and technological skills, enabling health care professionals to largely and effectively use new digital tools), (4) remote management of COVID-19 or chronic patients during the pandemic (a role that has proved to be fundamental is the community and family nurse and health care systems are adopting novel assistance models to support patients at home and to enable decentralization of services from hospitals to the territory), and (5) management of interpersonal relationships with patients through telemedicine (a person-centered approach with an open and sensitive attitude seems to be even more important in the framework of telemedicine where a face-to-face session is not possible and therefore nonverbal indicators are more problematic to be noticed). Further advancing nurses' readiness in adopting telemedicine requires an integrated approach, including combination of technical knowledge, management abilities, soft skills, and communication skills. This scoping review provides a wide-ranging and general-albeit valuable-starting point to identify these core competences and better understand their implications in terms of present and future health care professionals' roles.

Background Several systematic reviews (SRs), with and without meta-analyses, have investigated the use of wearable devices to improve physical activity, and there is a need for frequent and updated syntheses on the topic. Objective We aimed to evaluate whether using wearable devices increased physical activity and reduced sedentary behaviour in adults. Methods We conducted an umbrella review searching PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, MedRxiv, Rxiv and bioRxiv databases up to February 5th, 2023. We included all SRs that evaluated the efficacy of interventions when wearable devices were used to measure physical activity in adults aged over 18 years. The primary outcomes were physical activity and sedentary behaviour measured as the number of steps per day, minutes of moderate to vigorous physical activity (MVPA) per week, and minutes of sedentary behaviour (SB) per day. We assessed the methodological quality of each SR using the Assessment of Multiple Systematic Reviews, version 2 (AMSTAR 2) and the certainty of evidence of each outcome measure using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). We interpreted the results using a decision-making framework examining the clinical relevance and the concordances or discordances of the SR effect size. Results Fifty-one SRs were included, of which 38 included meta-analyses (302 unique primary studies). Of the included SRs, 72.5% were rated as ‘critically low methodological quality’. Overall, with a slight overlap of primary studies (corrected cover area: 3.87% for steps per day, 3.12% for MVPA, 4.06% for SB) and low-to-moderate certainty of the evidence, the use of WDs may increase PA by a median of 1,312.23 (IQR 627–1854) steps per day and 57.8 (IQR 37.7 to 107.3) minutes per week of MVPA. Uncertainty is present for PA in pathologies and older adults subgroups and for SB in mixed and older adults subgroups (large confidence intervals). Conclusions Our findings suggest that the use of WDs may increase physical activity in middle-aged adults. Further studies are needed to investigate the effects of using WDs on specific subgroups (such as pathologies and older adults) in different follow-up lengths, and the role of other intervention components. Key Points There is a moderate certainty of evidence in our umbrella review, which included 51 systematic reviews (of which 38 included meta-analyses with 302 unique primary studies); Available evidence suggests that using wearable devices may effectively increase physical activity across different population in number of steps per day and in minutes spent from moderate to vigorous physical activity per week; Results on efficacy of wearable devices on minutes of sedentary behaviour per day are inconsistent.

Physical restraints are still a common problem across healthcare settings: they are triggered by patient-related factors, nurses, and context-related factors. However, the role of some devices (e.g., bed rails), and those applied according to relatives’/patients’ requests have been little investigated to date. A mixed-method study in 2018, according to the Good Reporting of a Mixed Methods Study criteria was performed. In the quantitative phase, patients with one or more physical restraint(s) as detected through observation of a single index day in 37 Italian facilities (27 long-term, 10 hospital units, =4562 patients) were identified. Then, for each patient with one or more restraint(s), the nurse responsible was interviewed to gather purposes and reasons for physical restraints use. A thematic analysis of the narratives was conducted to (a) clarify the decision-making framework that had been used and (b) to assess the differences, if any, between hospital and long-term settings. The categories ‘Restrictive’ and ‘Supportive’ devices aimed at ‘Preventing risks’ and at ‘Promoting support’, respectively, have emerged. Reasons triggering ‘restrictive devices’ involved patients’ risks, the health professionals’ and/or the relatives’ concerns. In contrast, the ‘supportive’ ones were triggered by patients’ problems/needs. ‘Restrictive’ and ‘Supportive’ devices were applied based on the decision of the team or through a process of shared decision-making involving relatives and patients. According to the framework that emerged, long-term care patients are at increased risk of being treated with ‘restrictive devices’ (Odds Ratio 1.87, Confidence Interval 95% 1.44; 2.43; p < 0.001) as compared to those hospitalized. This study contributes to the improvement in knowledge of the definition, classification and measurement of physical devices across settings.

Background Self-care plays an important role in the treatment of patients with heart failure (HF) and adequately performed self-care at home can contribute to fewer hospitalizations, lower mortality risk and require less emergency care. The aim of this systematic review and meta-analysis was to synthesise evidence on the effectiveness of nursing interventions on HF-related self-care at home. Methods Medline, Scopus, Cumulative Index to Nursing and Allied Health Literature, Cochrane database, Web of Science, PsycInfo, and trial registers were searched up to 31st December 2022. We aimed to include experimental and observational studies with a control group investigating nursing interventions including transitional care, home care programs, phone calls, digital interventions, or a combination thereof on self-care of patients with HF. Outcomes were self-care maintenance, self-care management, and self-care behaviours, measured with various instruments. The screening and data extraction were performed independently by two reviewers, and disagreements were solved by a third reviewer. Cochrane risk of bias tool for randomised trials and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach were used. Results Twenty-seven studies were included (2176 participants), of which 24 were randomised controlled trials. Three categories of interventions emerged, called “transitional care”, “home care”, and “remote interventions”. Transitional care aimed at caring for patients at their homes after discharge through phone calls, digital interventions, and home visits may result in little to no difference in self-care maintenance (MD 7.26, 95% CI 5.20, 9.33) and self-care management (MD 5.02, 95% CI 1.34, 8.69) while contrasting results emerged in self-care behaviours since two out of six studies reported no improvements in self-care. Home care combined with phone calls or digital interventions likely increase self-management and self-care behaviours (MD -7.91, 95% CI -9.29, -6.54). Remote care could improve self-care behaviours when delivered as phone call programs, but they are ineffective on all outcomes when delivered as digital interventions alone. Conclusion Transitional care and home care combined with phone calls and digital interventions, and phone calls caring for patients at their home could slightly improve self-care in patients with HF. However, more research is needed to study the effects across different domains of self-care and of interventions delivered through digital interventions alone.

Aims To examine the variation of the operative definition and occurrence of unused peripheral intravenous catheters in pre‐hospital and hospital settings, and to describe possible predictors of this phenomenon. Design A scoping review, according to Arksey and O'Malley (2005), was revised by Levac et al. (2010). Methods We searched Medline, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature database, and Scopus up to 30 May 2024. Studies were included when they evaluated the unused peripheral intravenous catheters in the paediatric and adult populations in the pre‐hospital setting, emergency area, and inpatient wards. The title‐ and full‐text screening were performed independently by two reviewers and the data extraction was conducted. Results Twenty‐five studies were included. The majority were conducted in Australia and in the emergency setting. There are three main criteria adopted to define the unused short peripheral intravenous catheter, which are ‘Insertion/usage goals’, ‘Time criteria’ and ‘Patients' clinical conditions’. The prevalence varied from 8.4% to 56% across the settings. The factors affecting the risk of unused peripheral intravenous catheters are related to patients' characteristics, characteristics of peripheral intravenous catheters, and characteristics of professionals in the team. In conclusion, there is a high variability of the definition to indicate the unused peripheral intravenous catheters, of which occurrence emerged as spread on a large range. There is a need to standardise the phenomenon's definition and method of measurement, considering the predicting factors. No Patient or Public Contribution.

Objective To examine the experience of Italian nurses posted on social media and discover changes, if any, over the waves. Methods A mixed methods study reported according to the Good Reporting of a Mixed Methods Study criteria. All narratives (texts, letters and interviews) posted by Italian nurses from February 2020 to May 2020 (first wave) and from October 2020 to May 2021 (second/third wave) on the five most famous Italian professional social media platforms. The data were analysed qualitatively (first wave) and then quantitatively (second/third wave). Results A total of 380 narratives (202,626 words, 2510 quotes) were posted in the first wave, and 161 (68,388 words, 835 quotes) in the second/third wave. In the first wave, the following five themes emerged: (a) ‘sharing what is happening within myself’ (891; 35.5%); (b) ‘experiencing unprecedented working conditions’ (749; 29.8%); (c) ‘failing to rehabilitate the image of nurses in society’ (376; 15%); (d) ‘experiencing a deep change’ (253; 10.1%) and (e) ‘do not abandon us’ (241; 9.6%). The same themes and subthemes also emerged in the second/third wave with some significant differences, indicating changes in the lived experience of nurses. Moreover, in the second/third wave, a new theme emerged: ‘experiencing the mixed emotions towards jabs’. Conclusions By analysing their posts, Italian nurses continue to face challenges during the COVID-19 pandemic, with changes in their lived experiences across the waves. Governments, nursing associations and health care organizations should consider these changes to design policies to prevent the further loss of nurses.