The effectiveness of elevated boardwalks in restoring coastal dunes

Coastal dunes are important habitats that also play an important role in coastal protection. In areas of high tourist activity, they have often been degraded by trampling and intensive use, resulting in a loss of ecological, aesthetic and protective values. As a result, several management actions have been taken to minimise dune degradation and enhance their recovery. One of these measures is the installation of elevated boardwalks and dune crossovers to regulate human access to the beaches. This paper quantifies and analyses the impact of the installation of boardwalks and dune crossovers on dune recovery in a highly touristic area in southern Portugal. This was done using aerial photographs taken before and 5-10 years after the implementation of the measures, and an effectiveness index was applied. The recovery observed was high to very high, ranging from 51% to 98% of the previously degraded dune. The areas with the oldest interventions showed an average recovery of 86% of the degraded area, while the most recently managed areas showed an average recovery of 69%. The high rate of recovery is mainly explained by the new habits developed by the population and tourists to access the beaches. Nevertheless, in some specific cases (i.e. where the use of the boardwalks requires a detour or where they end far from the beach) new degraded areas were observed, indicating the high relevance of the design of the boardwalks to the final recovery result. This work can serve as a basis for assessing the effectiveness of coastal management measures in any other coastal dune area with similar interventions.

Nursing Interventions in the Perioperative Pathway of the Patient with Breast Cancer: A Scoping Review

The decrease in average hospitalisation time and the increase in outpatient surgery in some types of breast cancer represent gains for the reduction of the negative impact of hospitalisation in women with breast cancer but are also a challenge for the organisation of nursing care to prepare women for surgery, reduce anxiety about the interventions, and ensure continuity of care in the postoperative period. The aim of this study is to identify nursing interventions present in the care provided to patients with breast cancer during the perioperative period. A scoping review was the method chosen to answer the research question: What are the specialised nursing interventions in the perioperative pathway of the patient with breast cancer? Inclusion and exclusion criteria were defined for the articles that were identified in the CINAHL and MEDLINE databases; later, additional sources were identified from the list of bibliographic references for each selected study. The final bibliographical sample consisted of seven articles, which allowed the identification of three key moments of nursing interventions in the perioperative period of patients with breast cancer: the preoperative consultation, the reception of the patient in the operating room, and the postoperative consultation. Factors such as psychological, emotional, and spiritual support, communication and patient-centred care, health education and surgical safety, and the definition of a perioperative pathway for these patients contribute significantly to patients' satisfaction and the improvement of their quality of life. The results of this study make it possible to establish recommendations for practise and for research, increasing the range of nurses' actions.

Conceptual and quantitative categorization of wave-induced flooding impacts for pedestrians and assets in urban beaches

Beaches combined with sloping structures are frequently the first element of defense to protect urban areas from the impact of extreme coastal flooding events. However, these structures are rarely designed for null wave overtopping discharges, accepting that waves can pass above the crest and threat exposed elements in hinterland areas, such as pedestrians, urban elements and buildings, and vehicles. To reduce risks, Early Warning Systems (EWSs) can be used to anticipate and minimize the impacts of flooding episodes on those elements. A key aspect of these systems is the definition of non-admissible discharge levels that trigger significant impacts. However, large discrepancies in defining these discharge levels and the associated impacts are found among the existing methods to assess floodings. Due to the lack of standardization, a new conceptual and quantitative four-level (from no-impact to high-impact) categorization of flood warnings (EW-Coast) is proposed. EW-Coast integrates and unifies previous methods and builds on them by incorporating field-based information. Thus, the new categorization successfully predicted the impact level on 70%, 82%, and 85% of the overtopping episodes affecting pedestrians, urban elements and buildings, and vehicles, respectively. This demonstrates its suitability to support EWSs in areas vulnerable to wave-induced flooding.

From Evidence Synthesis to Transfer: Results from a Qualitative Case Study with the Perspectives of Participants

The increase in health research brings challenges to the production, synthesis, and use of research findings in clinical practice. In the case of undergraduate training in nursing, it is necessary to think about the curricular contents and create opportunities to develop skills for learning evidence-based practice. The objective of this study was to analyze nurses’ perspectives regarding the effects of their participation in a project of translation of knowledge into clinical practice during undergraduate nursing education, specifically involving knowledge, attitudes, and competencies related to the use of evidence. This is a qualitative case study grounded in the knowledge-to-action theoretical framework. The participants were 13 nurses who were involved in a project about the translation of knowledge into clinical practice during the last term of their undergraduate course. The data were collected by applying interviews between December 2020 and April 2021. Content analysis was carried out by using the qualitative data analysis software tool webQDA^®. The following categories emerged from the content analysis carried out on the material gathered during the interviews: understanding evidence; learning how to use evidence; transferring evidence; adjusting to the context; and observing the advantages of evidence-based practice. Extracurricular activities were perceived as an opportunity to understand what evidence is and observe in loco the advantages of health care for clients, teams, and services. During the project, the participants developed cross-sectional competencies and envisaged changes to their professional activity as a result of changes in their attitude regarding evidence and its use. We concluded that the opportunity to develop evidence-related activities allows for the development of skills and influences the attitude towards evidence-based practice and knowledge use.

Rehabilitation Nurse’s Perspective on Transitional Care: An Online Focus Group

The increasing incidence of chronic and dependence leads to the need for hospitalization and adaptation in the process of returning home, as well as transition between care levels to ensure continuity of care. The World Health Organization has been warning about this problem since 2016, and consider reorganizing the care model as one of the solutions. The present study aimed to analyse the nurses’ perspective on transitional care for dependent people with rehabilitation care needs after hospital discharge. Methods: A focus group was developed with the participation of Rehabilitation Nurses from the hospital and community context, and content analysis was defined a posteriori. Results: From the content analysis emerged four related categories: promotion of continuity of care, nurse of advanced practice as a care manager, capacitation of the person and caregiver, and promotion of the care coordination. Conclusions: The present study allowed the strategies identification that minimize fragmentation risk of care and promote the person participation in transitional care. Ensuring transitional care is imperative to increase the quality of care, the satisfaction of professionals, clients, and the development of a system of sustainable health.

APRENDER PRÁTICA BASEADA NA EVIDÊNCIA PELO ENVOLVIMENTO EM ATIVIDADES DE INVESTIGAÇÃO – AUTOPERCEPÇÃO DOS ESTUDANTES

Objetivo: compreender como os estudantes percepcionam o seu envolvimento em atividades de investigação e o contributo para o desenvolvimento de uma prática baseada na evidência.Método: estudo qualitativo, transversal, descritivo e exploratório, realizado em Portugal, em agosto de 2019, que recorreu ao grupo focal, com oito participantes, para responder à questão: “Quais as vantagens da participação dos estudantes de enfermagem em atividades de investigação para o desenvolvimento de conhecimentos, atitudes e competências de utilização da evidência?”. A análise de conteúdo foi realizada com o software NVivo.Resultados: da análise qualitativa dos achados, emergiram cinco categorias e subcategorias: autoaprendizagem, integração teórico-prática, trabalho interdisciplinar, tomada de decisão baseada na evidência e literácia científica.Conclusão: a criação de uma experiência eficaz de aprendizagem ajuda na construção do conhecimento e potencialmente contribui para a saúde da comunidade, os resultados de aprendizagem do estágio e o desenvolvimento de competências essenciais para uma Prática Baseada na Evidência.

Effectiveness assessment of risk reduction measures at coastal areas using a decision support system: Findings from Emma storm

Storms impact coastal areas often causing damages and losses at occupied areas. On a scenario of increasing human occupation at coastal zones and under climate change conditions (including sea level rise and increasing frequency of extreme sea levels), the consequences of storms are expected to be amplified if no adaptation or further management actions are implemented. The selection of the best possible coastal management measures, considering both costs and effectiveness, will be mandatory in the future, in order to optimise resources. This work analyses the performance of risk reduction measures (beach nourishment and receptors - house and infrastructures - removal), using a decision support system comprised by a morphodynamic numerical model (XBeach) and a Bayesian network based on the source-pathway-receptor concept. The effectiveness of the risk reduction measures is then assessed by a simple index expressing the consequences to the receptors. The approach was tested at Faro Beach by evaluating its performance for a particular storm, Emma (Feb/March 2018), which fiercely impacted the southern coast of Portugal. The output results from the modelling were compared to field observations of the actual damages caused by the storm. The combined use of both measures or the solely use of the nourishment would avoid almost all observed impacts from this storm. The work is pioneer on demonstrating the use of a decision support system for coastal regions validated against observed impacts for a high-energy storm event. The methodology and the proposed index are adaptable to any sandy coastal region and can be used to test (and improve) management options at a broad number of coastal areas worldwide, minimizing implementation costs and reducing the risk to the occupation and to the people.

Active Life: a project for a safe hospital-community transition after arthroplasty

ABSTRACT Objective: To define the criteria for the continuity of care to elderly people submitted to arthroplasty. Method: This is a qualitative study, inserted in the constructivist paradigm, whose methodological option fell on research-action. The participants were the health professionals of an orthopedic service and of the community care teams in the area of the hospital. Results: The different techniques allowed us to identify the difficulties in the safe transition from the hospital to the community. At this level, two categories of criteria for continuity of care emerged: criteria associated with the risk of ineffective management of the therapeutic regimen, and criteria associated with the knowledge and level of competence of the informal caregiver. Final Considerations: An elderly person undergoing arthroplasty (hip or knee) has functional alterations that affect their capacity for self-care and may lead to dependence, our findings allowed the design of an algorithm to facilitate clinical decision making and promote a safe hospital-community transition.

Project K: Training for hospital-community safe transition

ABSTRACT Objective: To define the safe transition process from hospital to community of patients with chronic mental disorders and their families. Method: This was an action research study included in the constructivist paradigm. The participants in the study were nurses from a psychiatry service and from primary healthcare services. Results: After the identification of causes of continuity fragmentation, the following items emerged from the participants’ speeches: a) two criteria categories for safe transition (those associated with health status, dependence level, and self-care capacity of patients, and those associated with knowledge and competence level of informal caregivers); b) the design of an algorithm to facilitate clinical decision-making. Final considerations: In order to promote adherence to therapeutic treatment in the hospital-community transition, treatment plans must include patients and their families, and improve communication networks and support among care levels.

Coastal barrier stratigraphy for Holocene high-resolution sea-level reconstruction

The uncertainties surrounding present and future sea-level rise have revived the debate around sea-level changes through the deglaciation and mid- to late Holocene, from which arises a need for high-quality reconstructions of regional sea level. Here, we explore the stratigraphy of a sandy barrier to identify the best sea-level indicators and provide a new sea-level reconstruction for the central Portuguese coast over the past 6.5 ka. The selected indicators represent morphological features extracted from coastal barrier stratigraphy, beach berm and dune-beach contact. These features were mapped from high-resolution ground penetrating radar images of the subsurface and transformed into sea-level indicators through comparison with modern analogs and a chronology based on optically stimulated luminescence ages. Our reconstructions document a continuous but slow sea-level rise after 6.5 ka with an accumulated change in elevation of about 2 m. In the context of SW Europe, our results show good agreement with previous studies, including the Tagus isostatic model, with minor discrepancies that demand further improvement of regional models. This work reinforces the potential of barrier indicators to accurately reconstruct high-resolution mid- to late Holocene sea-level changes through simple approaches.