Background/Objectives: Although nursing complexity and health literacy (HL) are critical determinants of patient outcomes, their combined impact on mortality, hospital re-admissions, and emergency department (ED) visits remains poorly understood. This study aims to measure nursing complexity and HL in hospitalized patients, examine their interaction, and analyze their impacts on mortality, hospital re-admissions, and ED visits over a one-year follow-up period. Methods: Adult patients from two hospital centers were enrolled, excluding those with stays under two days or cognitive impairments. Data were collected at baseline to assess nursing complexity (measured according to the number of nursing diagnoses assigned to patients within 24 h from hospital admission) and HL (assessed using the Single-Item Literacy Screener, SILS). Patients were followed during a 12-month follow-up period to track mortality, hospital re-admissions, and ED visits. Latent class analysis classified patients into distinct nursing complexity and HL profiles. Survival analyses and Cox proportional hazard models were used to evaluate the relationships between variables. Results: At baseline, among the 2667 enrolled patients, 55.9% were classified as having high nursing complexity, and 32% had inadequate HL. High nursing complexity was associated with lower HL (r = 0.384; p < 0.001). During follow-up, 387 patients (14.5%) were lost. Of the remaining sample, mortality occurred in 8.3% of the patients, hospital re-admissions in 27.2%, and ED visits in 16.8%. Nursing complexity was significantly associated with higher mortality (HR: 1.84, adjusted HR: 1.81), but not with hospital re-admissions or ED visits. The patients with inadequate HL (32%) had increased risks of mortality (HR: 11.21, adjusted HR: 7.75), hospital re-admissions (HR: 3.61, adjusted HR: 3.58), and ED visits (HR: 20.78, adjusted HR: 14.45). The patients with both high nursing complexity and inadequate HL had the highest mortality risk and the lowest 12-month survival rate (75%; 95% CI: 71.1–79.1%; p < 0.001). Conclusions: This study demonstrates that both high nursing complexity and inadequate HL independently and jointly contribute to adverse patient outcomes. Interventions targeting HL and supporting patients with high nursing complexity could reduce risks, enhance care, and improve patient survival. While these findings underscore the critical role of both factors in patient outcomes, the limitations include this study’s single-country setting and reliance on a single-item HL measure. Future research should validate these findings in broader healthcare contexts and integrate multidimensional HL assessments for a more comprehensive evaluation.

Background: The primary nursing care model is considered a personalized model of care delivery based on care continuity and on the relationship between the nurse and patient. Primary nursing checklists are not often mentioned in the literature; however, they represent a valid instrument to develop, implement, and evaluate primary nursing. The aim of this study was to create a structured checklist to explore hospital compliance in primary nursing. Methods: The Delphi method was used to develop and validate a checklist. The preliminary version was created and sent to three experts for their opinions. Their comments were ultimately used in the first version, which included four components with 19 items regarding primary nursing characteristics. A two-round Delphi process was used to generate consensus items. The Delphi panel consisted of six experts working in primary nursing contexts and/or teaching or studying primary nursing. Data were collected using a structured questionnaire from July 2020 to January 2021. These experts were asked to rate each element for relevance using a 4-point Likert-type scale. Furthermore, the consensus among the panel of experts was set at ≥78%, with selected items being voted “quite relevant” and “highly relevant”. Content validity index (I-CVI) and modified kappa statistic were also calculated. Following expert evaluation, the first version of the checklist was modified, and the new version, constituting 17 items, was sent to the same experts. Results: The first version of the checklist demonstrated a main relevance score of 3.34 (SD = 0.83; range = 1.3–4; mean I-CVI = 0.84; range: 0.83–1), but three items did not receive an adequate I-CVI score, that is, lower than 0.78. After the second round, the I-CVIs improved. The main score of relevance was 3.61 (SD: 0.35; range = 2.83–4; mean = I-CVI: 0.93). The S-CVI/UA was 0.58, and the S-CVI/Ave was 0.93. Conclusion: Measuring primary nursing compliance should be implemented to provide continuous feedback to nurses. Moreover, utilizing valid checklists could permit comparing different results from others’ research. Future research should be conducted to compare the results from the checklist with nursing outcomes.

In recent years, the number of large subtropical and tropical cities with defined climate plans has increased as a result of the initiatives of local governments, multi-bilateral development aid and development banks. Surveys carried out to date on climate planning consider the overall cities, at times by continent, without underscoring those that present planning deficiencies. For instance, we have no idea whether the cities that are most affected by hydro-meteorological and climatic disasters have plans, nor if their climate plans are ready to be implemented. Clarifying these aspects would strengthen the foundation of the current discussion on the United Nations' Sustainable Development Goals 2016-2030. Hence, the objective of this chapter is to ascertain the relevance and quality of climate planning in large subtropical and tropical cities populated by over 1 million inhabitants. Our survey found 344 large cities in the two climate zones concerned, and 82 of these have mitigation, adaptation, resilience or emergency plans, strategies or policies. We verified the relevance of these tools for the climate zones concerned, the type of economy and the frequency of hydro-meteorological and climate-related disasters. The quality of plans was assessed, ensuring that they had taken climate characterisation into account, that every measure was managed by a designated agency or office, and that funds were secured for implementing measures, as well as a monitoring and reporting sytem was defined. The analysis of collected information underscores considerable differences between large cities in terms of per capita greenhouse gas emissions (which were double in the subtropics relative to the tropics) and exposure to hazards (which were greater in the subtropical zone). Emergency and mitigation plans were the most common, while adaptation plans and resilience strategies were more unusual. The relevance of plans is still weak, given that barely 1/4 of the large cities had a plan. Plans were unquestionably more common in the subtropics, especially in OECD countries and in the BRICS, while they were absent in the Least Developed Countries (LDCs), despite the presence of large cities that have been repeatedly affected by hydro-meteorological and climate-related disasters. Planning quality was good for 30% of cities only. In the remaining 70% of cities, climate characterisation was briefly defined; the planning process was fully funded by multi-bilateral development aid; measures were without a clear manager; cost, funds and monitoring of measures were not specified. Thus the indication being that local plans were still scarcely action-oriented. Hence, the fact that two sustainable development goals (# 11 and 13) address human settlements and climate change, respectively, especially through assistance to LCDs, seems justified

Background: Nurses worldwide are acknowledged for their role in health education across various settings. However, doubts often arise regarding their competence in this domain. This study aims to validate the Nurse Health Education Competence Instrument (NHECI) linguistically and culturally in the Italian context. Methods: Following Beaton et al.’s (2000) guidelines, we conducted cross-cultural adaptation to develop the Italian version of the questionnaire. Results: The Italian version demonstrates a good internal consistency and stability, making it suitable for assessing nursing students during clinical internships and practicing nurses. The availability of Italian tools promotes healthcare research, ensuring patient-centric care. Conclusions: The validity and reliability of the Italian version of the instrument for assessing health education competencies, essential for self-assessment among health education nurses, are established.