Filipa Pereira

Given the growing pressures on Switzerland’s healthcare system, developing innovative approaches that put humanism at the heart of care practices seems essential to respond to patients’ complex needs and to support healthcare professionals’ well-being. Although several frameworks address humanistic care or interprofessional collaboration, few have been co-developed with healthcare professionals to guide the implementation of both dimensions at the organisational level. This article explores the development of an interprofessional healthcare model aimed at integrating humanistic values into a public hospital network in a French-speaking region of Switzerland. This community-based participatory action research involved healthcare professionals representing different hospital departments and a patient feedback unit. The study focused on the co-development of an organisational model through three iterative phases: initiation (identification of needs), diagnosis (analysis of current practices) and design (development of strategies and solutions). The model was based on the three overarching themes: Care for Others and Oneself, Constructive Interactions, and Professional Excellence. The resulting model provides an organisational framework for integrating humanistic values into interprofessional practice in a hospital setting. Its implementation and evaluation will be required to assess its effects on patient experience, professional well-being, and organisational practices.

Introduction: Physical assessment is a fundamental component of nursing practice, yet various barriers can limit its use in clinical settings. Objectives: To evaluate the construct validity and reliability of a culturally adapted, French-language version of the Barriers to Nurses’ Use of Physical Assessment Scale . Methods: We conducted a cultural adaptation and validation study, using secondary data analysis. Data were collected using three cross-sectional surveys conducted among nurses working in surgical, geriatrics and rehabilitation units in French-speaking Switzerland ( N = 246). Psychometric evaluations included both exploratory and confirmatory factor analyses to assess construct validity, and Cronbach's alpha was calculated to determine internal consistency. Results: The Kaiser–Meyer–Olkin sampling adequacy value was 0.848, and Bartlett's test of sphericity was significant ( p < .001), confirming the data's suitability for factor analysis. We identified a seven-factor structure (similar to the original scale) that explained 54.6% of the total variance. The 38-item scale's overall internal consistency was excellent (α = .89). However, the Speciality Area (α = .47) and Ward Culture (α = .29) subscales demonstrated lower reliability, indicating a need for further refinement. Conclusion: The French-language version of the Barriers to Nurses’ Use of Physical Assessment Scale is a reliable, valid instrument for measuring nurses’ perceptions of the barriers to them using their physical assessment skills. Further research is recommended to improve the internal consistency of some subscales and to validate these findings across diverse clinical settings. Patient or Public Contribution: This study did not include patient or public involvement in its design, conduct, or reporting.

With aging populations worldwide, informal caregivers (ICs) play an essential role in transitional hospital-to-home care for older people, providing essential first-line support, clinical assistance, emotional care, and crucial coordination of care. However, their involvement in discharge planning remains insufficiently recognized, potentially compromising patient safety and continuity of care. Despite their vital contributions and growing policy initiatives, ICs’ involvement in hospital discharge planning remains insufficiently recognized. This lack of structured integration leads to significant gaps in communication, education, and collaborative care planning—factors that can compromise patient safety, disrupt continuity of care, and increase caregiver burden. ICs often report feeling unheard and excluded from key decisions, which contributes to adverse outcomes for both patients and ICs. Addressing these gaps requires comprehensive systemic changes aimed at formalizing the role of ICs in professional training, hospital discharge protocols, and integrating ICs meaningfully into care decision-making processes. This perspectives article provides an overview of the current state of IC involvement in transitional care, reflects on its relevance among healthcare professionals, policymakers, and researchers, and explores the implications for patient safety and health outcomes. Drawing on evidence-based models such as the Transitional Care Model and Better Outcomes for Older people through Safe Transitions, the article discusses key strategies to enhance IC participation. These include raising awareness among professional caregivers, improving communication and information transfer, formally recognizing and integrating ICs as care partners, and leveraging technology and support systems tailored to their needs. By fostering structured partnerships and collaborative approaches with ICs, healthcare systems can improve the quality and safety of transitional care while alleviating caregiver burden and promoting better long-term health trajectories for older people.

Background: Using evidence-based practice (EBP) is one of the core skills that students should have acquired by the end of their Bachelor of Science in Nursing (BSN). However, little is known about how their beliefs about EBP and their frequency of implementation relate to multi-component educational programmes on this topic. This study aims to investigate the impact of a multi-component educational programme on nursing students’ beliefs about EBP and their frequency of implementation at the School of Health Sciences, HES-SO Valais. Methods: This quantitative, pre–post-design study compared undergraduate nursing students’ beliefs about EBP and their frequency of implementation before and after completing a multi-component educational programme on EBP. The programme included integrative workshops based on the steps of EBP held during their clinical internships throughout their three-year curriculum. The study occurred between September 2017 and June 2020: the start and end of their studies. The programme’s impact was measured using Melnyk et al.’s self-reported EBP Beliefs and Implementation Scales. Descriptive, comparative, correlational and regression statistics were computed to evaluate nurses’ responses and scores. Results: Ninety-five eligible first-year undergraduate nursing students were invited to participate in this EBP study and 81 completed the pre- and post-test questionnaires. Mean EBP scores improved significantly versus baseline on both the Beliefs (49.1 vs. 53.3; p < 0.001) and Implementation (1.7 vs. 9.0; p < 0.001) scales. Cronbach alphas for the EBP Beliefs scale were 0.799 pre-test (95% CI: 0.729, 0.858) and 0.869 post-test (95% CI: 0.823, 0.907). Cronbach’s alphas for the EBP Implementation scale were 0.804 pre-test (95% CI: 0.736, 0.861) and 0.939 post-test (95% CI: 0.918, 0.957). There were significant correlations between EBP Beliefs and Implementation scores (p < 0.001). Linear regression analysis showed that the programme’s theory-based component contributed significantly more than clinical internships to raising EBP Beliefs and Implementation scores. Conclusions: The multi-component educational programme on EBP improved undergraduate nursing students’ EBP Beliefs and Implementation scores. Future research should investigate means of optimally integrating EBP into undergraduate nursing curricula and explore nursing students’ intentions to implement EBP in clinical practice.

Background: Frailty is a widespread geriatric syndrome among older adults, including hospitalized older inpatients. Some countries use electronic frailty measurement tools to identify frailty at the primary care level, but this method has rarely been investigated during hospitalization in acute care hospitals. An electronic frailty measurement instrument based on population-based hospital electronic health records could effectively detect frailty, frailty-related problems, and complications as well be a clinical alert. Identifying frailty among older adults using existing patient health data would greatly aid the management and support of frailty identification and could provide a valuable public health instrument without additional costs. Objective: We aim to explore a data-driven frailty measurement instrument for older adult inpatients using data routinely collected at hospital admission and discharge. Methods: A retrospective electronic patient register study included inpatients aged ≥65 years admitted to and discharged from a public hospital between 2015 and 2017. A dataset of 53,690 hospitalizations was used to customize this data-driven frailty measurement instrument inspired by the Edmonton Frailty Scale developed by Rolfson et al. A 2-step hierarchical cluster procedure was applied to compute e-Frail-CH (Switzerland) scores at hospital admission and discharge. Prevalence, central tendency, comparative, and validation statistics were computed. Results: Mean patient age at admission was 78.4 (SD 7.9) years, with more women admitted (28,018/53,690, 52.18%) than men (25,672/53,690, 47.81%). Our 2-step hierarchical clustering approach computed 46,743 inputs of hospital admissions and 47,361 for discharges. Clustering solutions scored from 0.5 to 0.8 on a scale from 0 to 1. Patients considered frail comprised 42.02% (n=19,643) of admissions and 48.23% (n=22,845) of discharges. Within e-Frail-CH’s 0-12 range, a score ≥6 indicated frailty. We found a statistically significant mean e-Frail-CH score change between hospital admission (5.3, SD 2.6) and discharge (5.75, SD 2.7; P<.001). Sensitivity and specificity cut point values were 0.82 and 0.88, respectively. The area under the receiver operating characteristic curve was 0.85. Comparing the e-Frail-CH instrument to the existing Functional Independence Measure (FIM) instrument, FIM scores indicating severe dependence equated to e-Frail-CH scores of ≥9, with a sensitivity and specificity of 0.97 and 0.88, respectively. The area under the receiver operating characteristic curve was 0.92. There was a strong negative association between e-Frail-CH scores at hospital discharge and FIM scores (rs=–0.844; P<.001). Conclusions: An electronic frailty measurement instrument was constructed and validated using patient data routinely collected during hospitalization, especially at admission and discharge. The mean e-Frail-CH score was higher at discharge than at admission. The routine calculation of e-Frail-CH scores during hospitalization could provide very useful clinical alerts on the health trajectories of older adults and help select interventions for preventing or mitigating frailty.

Background: As early as 1995, the Institute of Medicine suggested that nurses were inadequately prepared for and educated about climate change and its health consequences. The aim of this systematic review is to identify the most reliable, robust, and valid instruments for measuring nurses’ knowledge and awareness of climate change and climate-associated diseases. Methods: Included studies were appraised using the Mixed-Methods Appraisal Tool and the Appraisal tool for Cross-Sectional Studies. The psychometrics and clinimetrics of the instruments were evaluated using the COSMIN Risk of Bias checklist and the COSMIN methodology for assessing content validity. Results: Medline, PubMed, Embase, CINAHL Ebesco, Cochrane Library Wiley, Web of Science Core Collection, Trip Database, JBI OVID SP, GreenFILE EBSCO, Google Scholar, ProQuest Dissertations and Theses Global, and DART-EU were consulted. The 14 studies retained identified eight different instruments evaluating attitudes, perceptions, environmental awareness, environmental sensitivity, environmental attitudes, behaviours, motivation, concern, optimism, and experience. This review is reported according to the PRISMA guidelines. Conclusions: The New Ecological Paradigm Scale (NEPS) and the Climate, Health, and Nursing Tool (CHANT) are the most reliable, robust, and valid instruments for measuring nurses’ knowledge and awareness of climate change and climate-associated diseases.

More than half of older persons admitted to an emergency department after a fall have a hip fracture and require surgery for a total hip replacement. This procedure has a high risk of postoperative complications and consequences for older persons, their informal caregivers, and the healthcare system. This study aimed to explore the perceptions of older persons, their informal caregivers and health professionals about intra-personal, inter-personal and extra-personal stressors arising from hip surgery following the fall of an older person hospitalised in orthopaedics, as well as the coping strategies used and the results obtained. A qualitative multiple case study. The sample consisted of eight cases. Each case consisted of one older person, their informal caregiver and the professionals involved in their care: a nurse, an orthopaedic surgeon and a physiotherapist. A total of 32 participants were recruited. Data were collected between August 2018 and February 2019 in a public hospital in French-speaking Switzerland. Intra- and inter-case analyses were performed. Five topics emerged: two concerning stressors for older persons (the physical and psychological consequences of the fall and hospitalisation; the loss of relational and environmental markers and habits); two relating to the coping strategies used to face the stressors (being resilient and involved in their own care; partially meeting the older person’s needs); and one regarding the results of the strategies used (reassurance through consideration of some of their needs). Older persons hospitalised for hip surgery after a fall are confronted with various intra-, inter- and extra-personal stressors and have to explore, together with their informal caregivers, strategies to cope with the consequences of these stressors. Healthcare professionals should possess efficient intervention strategies to help identify and support older persons who experience various types of stressors during hospitalisation for hip surgery following a fall.

BACKGROUND Frailty is a widespread geriatric syndrome among older adults, including hospitalized older inpatients. Some countries use electronic frailty measurement tools to identify frailty at the primary care level, but this method has rarely been investigated during hospitalization in acute care hospitals. An electronic frailty measurement instrument based on population-based hospital electronic health records could effectively detect frailty, frailty-related problems, and complications as well be a clinical alert. Identifying frailty among older adults using existing patient health data would greatly aid the management and support of frailty identification and could provide a valuable public health instrument without additional costs. OBJECTIVE We aim to explore a data-driven frailty measurement instrument for older adult inpatients using data routinely collected at hospital admission and discharge. METHODS A retrospective electronic patient register study included inpatients aged ≥65 years admitted to and discharged from a public hospital between 2015 and 2017. A dataset of 53,690 hospitalizations was used to customize this data-driven frailty measurement instrument inspired by the Edmonton Frailty Scale developed by Rolfson et al. A 2-step hierarchical cluster procedure was applied to compute e-Frail-CH (Switzerland) scores at hospital admission and discharge. Prevalence, central tendency, comparative, and validation statistics were computed. RESULTS Mean patient age at admission was 78.4 (SD 7.9) years, with more women admitted (28,018/53,690, 52.18%) than men (25,672/53,690, 47.81%). Our 2-step hierarchical clustering approach computed 46,743 inputs of hospital admissions and 47,361 for discharges. Clustering solutions scored from 0.5 to 0.8 on a scale from 0 to 1. Patients considered frail comprised 42.02% (n=19,643) of admissions and 48.23% (n=22,845) of discharges. Within e-Frail-CH’s 0-12 range, a score ≥6 indicated frailty. We found a statistically significant mean e-Frail-CH score change between hospital admission (5.3, SD 2.6) and discharge (5.75, SD 2.7; P<.001). Sensitivity and specificity cut point values were 0.82 and 0.88, respectively. The area under the receiver operating characteristic curve was 0.85. Comparing the e-Frail-CH instrument to the existing Functional Independence Measure (FIM) instrument, FIM scores indicating severe dependence equated to e-Frail-CH scores of ≥9, with a sensitivity and specificity of 0.97 and 0.88, respectively. The area under the receiver operating characteristic curve was 0.92. There was a strong negative association between e-Frail-CH scores at hospital discharge and FIM scores (rs=–0.844; P<.001). CONCLUSIONS An electronic frailty measurement instrument was constructed and validated using patient data routinely collected during hospitalization, especially at admission and discharge. The mean e-Frail-CH score was higher at discharge than at admission. The routine calculation of e-Frail-CH scores during hospitalization could provide very useful clinical alerts on the health trajectories of older adults and help select interventions for preventing or mitigating frailty.

Objective This study aimed to investigate medication management among polymedicated, home-dwelling older adults after discharge from a hospital centre in French-speaking Switzerland and then develop a model to optimise medication management and prevent adverse health outcomes associated with medication-related problems (MRPs). Design Explanatory, sequential, mixed methods study based on detailed quantitative and qualitative findings reported previously. Setting Hospital and community healthcare in the French-speaking part of Switzerland. Participants The quantitative strand retrospectively examined 3 years of hospital electronic patient records (n=53 690 hospitalisations of inpatients aged 65 years or older) to identify the different profiles of those at risk of 30-day hospital readmission and unplanned nursing home admission. The qualitative strand explored the perspectives of older adults (n=28), their informal caregivers (n=17) and healthcare professionals (n=13) on medication management after hospital discharge. Results Quantitative results from older adults’ profiles, affected by similar patient-related, medication-related and environment-related factors, were enhanced and supported by qualitative findings. The combined findings enabled us to design an interprofessional, collaborative medication management model to prevent MRPs among home-dwelling older adults after hospital discharge. The model comprised four interactive fields of action: listening to polymedicated home-dwelling older adults and their informal caregivers; involving older adults and their informal caregivers in shared, medication-related decision-making; empowering older adults and their informal caregivers for safe medication self-management; optimising collaborative medication management practices. Conclusion By linking the retrospective and prospective findings from our explanatory sequential study involving multiple stakeholders’ perspectives, we created a deeper comprehension of the complexities and challenges of safe medication management among polymedicated, home-dwelling older adults after their discharge from hospital. We subsequently designed an innovative, collaborative, patient-centred model for optimising medication management and preventing MRPs in this population.

Background: Effective medication management is one of the essential preconditions for enabling polymedicated home-dwelling older adults with multiple chronic conditions to remain at home and preserve their quality of life and autonomy. Lack of effective medication management predisposes older adults to medication-related problems (MRPs) and adverse health outcomes, which can lead to the degradation of a patient’s acute clinical condition, physical and cognitive decline, exacerbation of chronic medical conditions, and avoidable health care costs. Nonetheless, it has been shown that MRPs can be prevented or reduced by using well-coordinated, patient-centered, interprofessional primary care interventions. Objective: This study aimed to explore the feasibility and acceptability of an evidence-based, multicomponent, interprofessional intervention program supported by informal caregivers to decrease MRPs among polymedicated home-dwelling older adults with multiple chronic conditions. Methods: This quasi-experimental, pre-post, multisite pilot, and feasibility study will use an open-label design, with participants knowing the study’s objectives and relevant information, and it will take place in primary health care settings in Portugal and Switzerland. The research population will comprise 30 polymedicated, home-dwelling adults, aged ≥65 years at risk of MRPs and receiving community-based health care, along with their informal caregivers and health care professionals. Results: Before a projected full-scale study, this pilot and feasibility study will focus on recruiting and ensuring the active collaboration of its participants and on the feasibility of expanding this evidence-based, multicomponent, interprofessional intervention program throughout both study regions. This study will also be essential to projected follow-up research programs on informal caregivers’ multiple roles, enhancing their coordination tasks and their own needs. Results are expected at the end of 2024. Conclusions: Designing, establishing, and exploring the feasibility and acceptability of an intervention program to reduce the risks of MRPs among home-dwelling older adults is an underinvestigated issue. Doing so in collaboration with all the different actors involved in that population’s medication management and recording the first effects of the intervention will make this pilot and feasibility study’s findings very valuable as home care becomes an ever more common solution. Trial Registration: Swiss National Clinical Trials Portal 000004654; https://tinyurl.com/mr3yz8t4