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Ms Claire Farrugia
Department of Nursing, Faculty of Health Sciences

Introduction: Catheter-associated urinary tract infections (CAUTIs) comprise 9% of European healthcare-associated infections, with approximately 70% considered preventable. Part of the EU-JAMRAI-2 project, this study aims to reduce unnecessary catheter use at Mater Dei Hospital, Malta, through a targeted behaviour change intervention.

Methods: Guided by the COM-B framework, two surveys were designed to identify barriers to evidence-based catheter insertion (doctors) and removal (nurses). Following a pilot (n=34), the nurse's survey achieved a 69% response rate in December 2025; the doctors' survey follows in February 2026. Findings will inform a tailored strategy, which will be evaluated by catheter prevalence at 3 and 12 months post-intervention.

Results: Pilot data revealed a gap between perceived competence and operational reality.

• Under Capability – while 89% of doctors and 68% of nurses felt confident in assessments, a structured process was followed by 89% of doctors but only 44% of nurses. Furthermore, 50% of doctors and 31% of nurses reported a lack of adequate training.
• Regarding Opportunity – significant systemic barriers emerged: 75% of doctors and 56% of nurses cited insufficient institutional guidelines. Resource deficits, specifically a lack of bladder scanners and high workloads, were primary deterrents for nurses.
• Under Motivation – 89% of doctors and 75% of nurses indicated that receiving practice feedback would significantly improve the adoption of routine assessments, despite high levels of reported ‘automatic’ decision-making (94% doctors; 62.5% nurses).

Conclusion: Findings suggest that clinical confidence is frequently undermined by systemic barriers and resource deficits. This underscores the need for context-specific interventions that address environmental enablers to improve patient outcomes.

Mr Geoffrey Axiak
Department of Public Health, Faculty of Medicine and Surgery

Aim of the research: To develop a digital self-assessment tool to assess nursing competence in Malta.

Objectives of the research:

1. To develop a digital self-evaluation tool to assess nursing competency for use in Malta.
2. To validate the tool.
3. To help nurses identify areas where their standard of patient care might need improvement.
4. To create a national appraisal system for assessing nursing care competence.

Methodology: Phase 1 involved a sample of around 240 participants (chosen by intermediaries) who completed an open-ended questionnaire identifying the most important issues related to nursing competence within their areas of nursing in Malta. Following this, a number of focus groups and expert meetings were organised to consolidate or amend the competencies identified through literature and the questionnaires. The tool was then drafted, a final focus group confirmed its face and content validity, and a statistical analysis was carried out.

Phase 2 will include a pilot study consisting of 10% of the total population (100). Participants will be nurses working in various healthcare settings. These will test the tool for reliability and face, content and construct validity. Digitalisation will simplify tool dissemination, data collection, and analysis. Anonymity and confidentiality will be maintained throughout the study, with ethical and institutional approvals already obtained.

Impact of study: The study aims to identify gaps in the competencies of nurses and form the basis for future monitoring of nursing competencies across various Maltese healthcare settings.

Ms Bernice Azzopardi Meli
Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine and Surgery

Background: The use of digital technologies in healthcare requires a workforce able to use them effectively within complex care systems. However, the digital competences and capabilities required to engage and enable healthcare professionals remain insufficiently specified. This review aims to identify core competencies and capabilities as a foundational step towards a digital health competency framework.

Method: A systematic review following PRISMA guidance was conducted. Literature published in English between 2014 and 2024 was searched across nine databases and grey literature. Two reviewers independently screened all records, resolving discrepancies through discussion within a team of five. Methodological quality was assessed using JBI and MMAT tools. Thematic analysis identified patterns across digital health competences reported in studies and frameworks.

Results: The initial search identified 9,362 records, from which 154 peer-reviewed studies and digital health competency frameworks were included. Findings indicate that competences identified fall within three core domains: (a) Leadership Competences focused on governance and strategic thinking, (b) Procedural Competences addressing technical application and safety, and (c) Enabling Competences, emphasising patient engagement, and the mindset required for the effective use of digital tools.

Discussion: Most of the existing literature presents lists of digital competences rather than frameworks that connect digital practice with workforce development. This review shifts the focus from professional obligation to a proactive digital mindset. This synthesis goes beyond existing frameworks by explicitly incorporating behavioural and systems-based perspectives into digital competences for the healthcare workforce.

Conclusion: Identification of core digital competences across the healthcare workforce provides a basis for aligning professional development and organisational strategies.

Ms Gertrude Spiteri
Department of Business and Enterprise Management, Faculty of Economics, Management and Accountancy

This research investigated how stress influenced quality decisions across two contrasting hospital contexts: the Emergency Department (ER) and Planned Ward (PW). In high-stakes healthcare environments, decision-making is often examined in isolation from the complex pressures that shape it. Addressing this gap, the research conceptualises decision-making as a dynamic, context-sensitive process shaped by cognitive, emotional and environmental demands.

Study 1 employed semi-structured interviews with 12 physicians (six from each context) to explore their lived experiences and to co-define the components of high-quality decision-making. Study 2 applied this checklist in a five-day naturalistic mixed-methods investigation, combining self-reports, objective physiological data, and daily reflective diaries across 180 decision points. Findings revealed that stress exerts an adaptive rather than uniformly negative effect. ER physicians tended toward risk-averse, consultative strategies under stress, while PW physicians adopted more autonomous, risk-seeking behaviours.

Notably, while risk-taking was regarded as a dimension of quality decisions in ER contexts in Study 1, ER physicians in the naturalistic fieldwork of Study 2 exhibited greater risk aversion when stress was high. The opposite trend emerged in PW contexts.

By reframing stress as a context-dependent influence on quality decisions rather than a uniform source of disruption, this research challenges deficit-based views and definitions of stress and decision-making. It advances theoretical understanding by reframing decision-making in high-stress healthcare environments as an intelligible and adaptive process – one best supported by focusing on the context in which decisions are made and how quality is defined within it.

Mr Duncan Munro
Department of Radiography, Faculty of Health Sciences

Introduction: Artificial Intelligence (AI) is reshaping radiography, yet little consensus exists on AI-related educational priorities in radiographer curricula. This study collated relevant Learning Outcomes (LOs) from existing literature, categorising them using the European Qualifications Framework (EQF) model of Knowledge, Skills, and Competences (KSCs).

Methods: A systematic literature search was followed by a thematic analysis. Data were coded deductively against the EQF model and inductively to identify broader educational requirements, such as pedagogical strategies.

Results: The analysis identified five primary themes: Knowledge, Skills, Competencies, Pedagogical Approaches, and Design Principles, subdivided into 21 subthemes. Proposed LOs ranged from foundational practice to highly specialised roles involving AI coding and development.

Conclusion & Implications: Given the diversity of identified LOs, it is disingenuous to present AI education in radiography as a single unified framework. Instead, educational approaches should be tailored to the various roles radiographers may undertake in relation to AI. This will ensure that radiographers at various levels of practice are equipped with the most relevant AI-KSCs. While AI literacy should be embedded within standard curricula, more complex KSCs are required for advanced practice. Future research is essential to determine which specific LOs should be prioritised for different levels of professional roles and specialisation.