Aim To verify the association between the nurse staffing and the quality of nursing care, mediated by the care process, based on a hypothetical model, in Portuguese public hospitals. Background Nurse staffing influences health outcomes. Understaffing is associated with an increased risk for adverse events (AEs) and a reduction in the quality of care. Method A cross‐sectional study was conducted using a sample of 55 Portuguese nurse managers. A path model was developed to analyze potential causal mediation effects on care quality. Results Nurse staffing (number and competencies) and teamwork indirectly influence the quality of care. This process is mediated by the response capacity, the use of new techniques and work methods and patient's surveillance capacity. The AEs occurrence also has a mediating role, being negatively associated with the quality of care. Conclusions Optimizing nursing care safety and quality requires an adequate nurse staffing level, both in terms of number and competencies, as well as teamwork. Process components seem to play a mediating role in these relations. Implications for Nursing Management These results deserve the attention of nursing management for investment in the nursing staff and in the care process, to improve quality and create value in health care.

A maioria das mulheres cerca de 85%, ao longo do trabalho de parto, sofrem algum tipo de lesão perineal, que pode ser espontânea, ou através da episiotomia. A posição que a parturiente adota no período expulsivo, origina resultados diferentes quanto ao tipo de lesão perineal, pelo que é necessário entender os fatores envolvidos no processo do parto. O objetivo é mapear a evidência científica sobre a posição da parturiente no período expulsivo e o resultado a nível perineal. Revisão Scoping (RS), em quatro bases de dados: MEDLINE, CINAHL, BOn e PubMed. A questão de pesquisa foi “Qual o resultado a nível perineal face à posição adotada pela parturiente no período expulsivo?” formulada com recurso à mnemónica PCC - População (parturientes), Conceito (posição da parturiente no período expulsivo e os resultados produzidos a nível perineal) e Contexto (período expulsivo). Identificaram-se 107 artigos, excluíram-se os duplicados, após leitura do título e resumo selecionaram-se 13 artigos para leitura integral e incluíram-se 13 artigos na RS. Com a utilização de posições verticalizadas no período expulsivo, há uma maior taxa de integridade perineal, contudo há mais lacerações perineais de grau I e II, em comparação com as posições horizontais. Nas posições de litotomia e semi-sentada há maior taxa de episiotomia e menor de lacerações perineais de grau I e II. Existem outros fatores que podem influenciar a ocorrência de lacerações, tais como o uso de técnicas para proteção perineal, as condições do períneo e a paridade. O resultado perineal é influenciado pela posição adotada pela parturiente, os profissionais de saúde devem estar munidos de técnicas e conhecimentos para facilitarem diferentes posições, de acordo, com as necessidades, decisões e conforto da parturiente.

(1) Background: The transition to twin parenthood is a demanding challenge with a higher risk of maternal and fetal complications during pregnancy and a postpartum period that involves caring for more than one newborn at the same time with similar and simultaneous needs. (2) Aim: To find out about parents’ needs when experiencing the transition to twin parenthood and to describe the intervention of their specialized nursing support network. (3) Methodology: A descriptive exploratory study, based on a proper non-probabilistic sample of 15 nurses and 55 couples who are parents of twins, using two online questionnaires publicized on social networks. (4) Results: The couple’s needs were identified through knowledge of their experiences and difficulties during pregnancy and after the twin birth. Couples’ and nurses’ perceptions differed on the identified needs. The specialized nursing support network focuses its intervention on providing informative guidance on twin pregnancy and postpartum period, health education, group sharing experiences, home visits, planning, and including a family support network in the management of twin care and the creation of a daily routine. (5) Conclusions: There is a need to implement a program focused on the needs of parents of twins, promoting realistic expectations for the birth and parenting of twins, preparing parents, improving their well-being, and creating a specialized nursing support network available to this population.