Jordi Adamuz

Purpose: To critically analyze the concept of empowerment in women with endometriosis, developing a clear theoretical and operational understanding as a core component of healthcare, and strengthening its theoretical and practical framework within personalized advanced nursing care. Patients and Methods: A concept analysis was conducted using Wilson’s technique, incorporating an integrative review of 66 studies identified through MEDLINE, CINAHL, and the Merriam-Webster Dictionary. This approach was used to clarify the defining characteristics and attributes of empowerment in women with endometriosis considering contextual factors related to the condition and women’s lived experiences. Results: Empowerment in women with endometriosis emerged as both a dynamic process and an outcome shaped by contextual, emotional and, self-regulatory factors related to the disease. Six interrelated core elements form a conceptual model: Effective Communication, Access and Support Resources, Information for decision-making, Advocacy, Health-Self Management and Additional Resources and Support. These elements interact to promote active participation in care. These findings also support the need for the development of context-specific tools to assess empowerment in women with endometriosis. Conclusion: This concept analysis highlights empowerment as a multidimensional and context-specific unmet need in endometriosis healthcare, supporting the development of targeted, theory-informed nursing interventions.

Background: Adverse events (AEs) are linked to nurse staffing levels and care complexity factors; however, evidence in patients hospitalized for cardiac conditions is limited. The acute to intensive care (ATIC) patient classification system measures patient acuity according to required nurse hours per patient day (NHPPD), thereby enabling calculation of nurse staffing coverage. A prior study defined safe nurse staffing coverage as achieving ≥90% of the required NHPPD with the available nurse staffing. The aim of this study was to examine the associations between safe nurse staffing coverage and care complexity factors and AEs in patients hospitalized for cardiac conditions in three high-complexity hospitals in Catalonia between January and December 2022. Methods: This was a cross-sectional multicenter study that included patients admitted for cardiological reasons at three high-complexity hospitals of the Catalan Institute of Health in Catalonia between January and December 2022. Data regarding care complexity individual factors and patient acuity, according to the ATIC patient classification system, were obtained from electronic health records. The main outcomes were nursing-sensitive AEs that included falls, pressure ulcers, phlebitis, cardiorespiratory arrest, acute pulmonary edema (APE), and aspiration pneumonia. Safe nurse staffing coverage was defined as achieving ≥90% of the required NHPPD. Other clinical and sociodemographic variables were also collected. A descriptive and comparative analysis was performed. Results: Among the 6,873 patients included in the study, 11.4% experienced one of the AEs studied, the most common being APE, present in 5% of cases. The mean nurse staffing coverage was 64.3%. Patients admitted to step-down units and those admitted for surgical reasons received the highest nurse staffing coverage, at 97.7% and 65.7%, respectively. The risk factors independently associated with AEs were old age, consciousness disorders, chronic disease, hemodynamic instability, and transmissible infection. Safe nurse staffing coverage was a protective factor against AEs. Conclusions: Older age, consciousness disorders, chronic disease, hemodynamic instability, and transmissible infection were independently associated with nursing-sensitive AEs, while safe nurse staffing coverage was a protective factor. These findings should inform staffing decisions and shape future healthcare-management policies aimed at improving health outcomes among adults hospitalized in cardiology wards.

Background: Enhanced Recovery After Surgery (ERAS) programmes are structured perioperative care pathways in which clinical outcomes are closely linked to the degree of implementation fidelity. However, the interaction between ERAS adherence, care complexity, and postoperative outcomes in real-world settings remains insufficiently explored. Objective: To evaluate the association between ERAS adherence and postoperative length of stay in oncological colorectal surgery and to analyse whether Care Complexity Individual Factors (CCIFs) influence this relationship. Methods: A retrospective observational cohort study was conducted in two university hospitals in Barcelona, including 90 adult patients undergoing elective colorectal cancer surgery (2022). ERAS adherence was assessed globally and by phase (pre-, intra-, and postoperative) using structured indicators. CCIFs were classified into five domains. Associations between adherence, care complexity, and outcomes were analysed using bivariate methods. Results: Overall adherence was 64%. Higher adherence was associated with shorter hospital length of stay (median 4 vs. 5 days; p = 0.033) and greater compliance with expected length of stay (37.8% vs. 17.0%; p = 0.047). Adherence varied across perioperative phases, with higher compliance in the preoperative phase and lower compliance postoperatively. Care complexity was high (mean CCIF 2.62) and was not significantly associated with adherence or compliance with expected length of stay. Conclusions: Higher ERAS adherence is associated with shorter hospital stay in oncological colorectal surgery within a real-world context. These findings support the importance of implementation fidelity across the perioperative pathway. Further research incorporating multivariable analyses and patient-centred outcomes is needed to better understand the interaction between care complexity and recovery trajectories.

Nipple-Areola Complex complex tattooing is a key intervention following breast cancer. Its use in patients undergoing advanced systemic therapies remains limited due to perceived risks and lack of standardised protocols, often leading to delays and negatively affecting emotional well-being. This study aimed to evaluate the safety and efficacy of areola–nipple complex tattooing in patients receiving advanced systemic anticancer therapies, and to assess patient satisfaction and its impact on quality of life.Methods: A prospective observational case series included breast cancer patients receiving advanced systemic therapies who underwent areolar reconstruction with tattooing. All patients underwent prior clinical and laboratory assessment. Pre-treatment adaptation was based on assessment of neutropenia according to the Common Terminology Criteria for Adverse Events, and systemic therapy was adjusted when haematological abnormalities were detected. Clinical, procedural, safety, and patient-reported outcomes were collected from medical records and a questionnaire.Results: Seven patients were included. All were receiving targeted therapies, including T-DM1, neratinib, abemaciclib or ribociclib. Temporary treatment interruption was required in three cases. No infections or adverse events were observed at 30 days. Patient-reported outcomes showed high levels of satisfaction, with 71.4% reporting high satisfaction with their current quality of life.Conclusions: Nipple-Areola Complex tattooing appears safe and feasible in selected patients undergoing advanced systemic therapies when performed with appropriate clinical assessment and monitoring. It may enhance quality of life and self-image. These findings highlight the role of oncology nursing in ensuring safe implementation and supporting patient-centred care, and underscore the need for standardised clinical protocols.

Background: Many elderly people required hospitalization during the pandemic period, but broader care complexity factors have not been studied in this population. This study aimed to identify the care complexity factors according to age in older people hospitalized with COVID-19.Methods: A multicenter cross-sectional study was conducted from 1 March 2020 to 31 March 2022 at eight public hospitals in Spain. All older patients hospitalized with COVID-19 were classified in the following groups: young-old (65–74 years), middle-old (75–84 years), and oldest-old (≥85 years). The main variable was care complexity individual factors (CCIFs), which included 27 CCIFs classified in four domains: comorbidity/complications, psycho-emotional, mental-cognitive, and sociocultural. Multinomial logistic regressions were performed to identify the association of each CCIFs with age group.Results: A total of 5,658 admissions were included. Of these, 46.3% were young-old (65–74 years), 34.8% middle-old (75–84 years) and 18.8% oldest-old (≥85 years). The analysis shows that middle-old (75–84 years) patients were associated with chronic disease, position impairment, urinary or fecal incontinence, anatomical and functional disorders, vascular fragility, involuntary movements, fear or anxiety and mental status impairments. Extreme weight, communication disorders, aggressive behavior, agitation and perception reality disorders were additional factors associated with the oldest-old (≥85 years) inpatients with COVID-19. The median number of CCIFs was higher in the oldest-old than in the other age groups (four in young-old [65–74 years]; six in middle-old [75–84 years]; seven in oldest-old [≥85 years] [OR:2.9; 95%CI:2.8–3.1; p < 0.001]).Conclusion: The oldest groups of patients (≥75 years) admitted with COVID-19 had more CCIFs than the young-old group. CCIFs should be included in patient assessment in order to identify care needs in older hospitalized patients.

Background Few studies have investigated the prevalence of chronic wounds and the clinical and sociodemographic characteristics of hospitalised patients affected by them. Understanding these characteristics within the inpatient setting can support improved follow-up, inform care strategies, enhance quality and safety and reduce associated healthcare costs. This study aimed to determine the prevalence and the sociodemographic profile of adult inpatients with chronic wounds admitted to the eight hospitals of the Catalan Institute of Health between 2016 and 2020. Methods A descriptive, observational, cross-sectional and retrospective multicentre study was conducted using routinely collected clinical data from 1 January 2016 to 31 December 2020. The study encompassed hospital wards, step-down units and home hospitalisation services across eight public hospitals managed by the Catalan Institute of Health, the main public healthcare provider in Catalonia, Spain. The study included all patients aged 18 years or older who were hospitalised with chronic wounds during the study period. The main variables were nursing diagnoses of chronic wound types: pressure injuries (PIs), arterial ulcers (AUs), venous ulcers (VUs), mixed ulcers and diabetic foot ulcers (DFUs), as recorded in nursing electronic health records. Secondary variables included age, sex, reason for admission, unit of admission, hospital type, source of admission and discharge destination. A descriptive and comparative analysis was performed. Results Among 796 698 hospitalised patients, 16 935 (2.1%) presented with at least one chronic wound. The most common types of chronic wounds were PIs and AUs. A slight decline in the prevalence of chronic wounds was observed over the study period. Cardiovascular and respiratory conditions were the leading causes of admission among these patients. AUs and DFUs were more prevalent in men, whereas VUs were more frequently observed in women. Patients with PIs had longer hospital stays, higher rates of intensive care unit admissions and increased in-hospital mortality. In contrast, patients with vascular ulcers more often required continued care after discharge (pConclusions Chronic wounds continue to represent a significant healthcare challenge. It is essential to consider the clinical characteristics and health outcomes of hospitalised patients with chronic wounds in order to improve care quality and safety. Further research is warranted to explore the relationship between patient care complexity and the type of chronic wounds present.

Few studies have captured the impact of inadequate nurse staffing levels and broader health patient conditions in admitted patients during the COVID-19 pandemic. We aimed to determine the association between nurse staffing coverage, care complexity individual factors (CCIFs) and adverse events (AEs) in patients admitted with COVID-19. A multicentre cross-sectional study was conducted from March 1, 2020 to March 31, 2022 at eight public health hospitals in Spain. All patients with COVID-19 who were admitted to these hospitals were included. The main variables included AEs, nurse staffing coverage (as measured using the ATIC patient classification system) and CCIFs to evaluate broader patient health conditions. Adjusted logistic models were performed to identify associations with AEs, stratified by patients admitted to wards and hospitalized patients who required admission to intensive care units (ICUs). A total of 11,968 hospitalized patients, 2,824 (23.6%) experienced AEs. Multivariate analysis showed that higher levels of nurse staffing coverage protected against AEs. Among patients admitted to acute wards, the independent risk factors for AEs included old age, haemodynamic instability, chronic disease, uncontrolled pain, urinary or faecal incontinence and mental status impairments. In addition to these factors, extreme weight, position impairment and communication disorders were factors associated with AEs in patients who required ICU admission. Nurse staffing coverage was a protective factor for AEs. Several CCIFs related to comorbidity/complications, developmental, and mental-cognitive domains were strongly associated with AEs. Therefore, ensuring safe nurse staffing levels could be improve patient outcomes.

Aim: To analyse the degree of compliance of the care times of hospital emergency departments (EDs) in Spain with the recommended standards and their evolution during the SARS‐CoV‐2 pandemic. Design and Methods: An observational, correlational, cross‐sectional and retrospective study was carried out. All adult patients attended in the EDs of 8 Spanish public hospitals from 2018 to 2021 were consecutively included. The main variables were time spent in the ED, time to triage, waiting time until the start of care, triage level, classified according to the Spanish Triage System and year of care. Other sociodemographic variables were collected, in addition to discharge destination. For each triage level, a negative binomial regression model was performed, adjusted for year, hospital and waiting times. The analysis was performed with R 4.2.2 software. Results: A total of 2,282,555 patients were included; ED lengths of stay varied according to triage levels: Level 1, 21.6 h; Level 2, 26.3 h; Level 3, 22.2 h; Level 4, 8.1 h and Level 5, 10.3 h. Statistically significant differences were detected only in 2021, in all hospitals and from priority Level 2–5. An increase in dwell times was observed in all hospitals, with longer dwell times in high complexity hospitals. Longer waiting times at triage Levels 3, 4 and 5 presented a higher risk of mortality. The percentage of patients leaving the ED was high (3.6%). Conclusions: The degree of compliance with ED care times according to recommended standards was low. The dropout rate, waiting times for initial triage and ED attendance were higher than desired. The SARS‐CoV‐2 pandemic changed the pattern of ED visits, decreasing the frequentation of patients, but did not decrease the length of stay in the ED. This pattern normalised the following year.

Objective: To evaluate the association between nurse staffing coverage and patient outcomes in a context of structural understaffing. Design: This is a population‐based, cross‐sectional, multicenter study, including patient and staffing data from eight public hospitals from Catalonia, Spain. Participants: A total of 183,085 adult in‐patients admitted to hospital wards and step‐down units during 2016 and 2017. Outcomes: In‐hospital mortality, 30‐day hospital readmission, and three cluster nurse‐sensitive adverse events: healthcare‐acquired infections, failure to maintain, and avoidable critical complications. The study factor is safe nursing staffing equivalent to nurse staffing coverage > 90%. Results: Average patient acuity was equivalent to 4.5 required nursing hours per patient day. The mean available nursing hours per patient day was 2.6. The average nurse staffing coverage reached 65.5%. Overall, 1.9% of patients died during hospitalization, 5% were readmitted within 30 days, and 15.9% experienced one or more adverse events. Statistically significant differences were identified for all patient outcomes when comparing patients safely covered (nurse staffing coverage > 90%) and under‐covered (nurse staffing coverage < 90%). Increasing nurse staffing coverage to a safe level (> 90%) is associated with a reduction of the risk of death (RR: 0.41, 95% CI: 0.37–0.45), a decrease in the risk of hospital readmission (RR: 0.93, 95% CI: 0.89–0.97), and a reduction of nurse‐sensitive adverse events (RR: 0.67, 95% CI: 0.66–0.69). Conclusion: Safe nurse staffing coverage acts as a protective factor for detrimental patient outcomes, significantly reducing the risk of in‐hospital mortality, 30‐day hospital readmission, healthcare‐associated infections, failure to maintain, and avoidable critical complications. Further policy efforts are needed to guarantee a safe registered nurse staffing coverage.