The problem the researchers set out to solve is familiar to anyone who has worked in chronic disease care. Sustained self-care is central to long-term blood pressure control, yet in busy primary care settings it often remains suboptimal. Patients may struggle with daily blood pressure monitoring, lifestyle modification, medication adherence, securing adequate family support, and keeping up routine follow-up appointments. Existing self-management materials typically offer either education or monitoring support, but few are designed to connect a patient’s daily home-based self-care records with structured, nurse-led review during routine primary care visits. That disconnect, the authors argue, is where blood pressure control quietly fails.

The research team, led by Ni Putu Ayu Ratna Dewi of the Faculty of Nursing at Airlangga University in Surabaya and the Institute of Technology and Health Bali in Denpasar, together with colleagues Nursalam Nursalam, Sriyono Sriyono, Israfil Israfil, and Komang Ardidhana Nugraha Putra, approached the challenge systematically. Their study was a sequential intervention-development and expert-validation project with both qualitative and quantitative components, conducted with support from primary healthcare centers in Gianyar Regency, Bali. The work received ethical approval from the Ethics Committee of the Institute of Technology and Health Bali and was carried out in accordance with the Declaration of Helsinki.

Phase I of the study examined the contextual relevance of four predefined self-care domains. The researchers conducted focus group discussions with three distinct stakeholder groups: patients living with hypertension, family caregivers who support them at home, and healthcare providers who treat them. This triangulation of perspectives is technically significant because it grounds the intervention in lived experience rather than clinical assumption. Input from these discussions, along with stakeholder feedback and preliminary expert review, was then integrated into the design of two separate but linked modules, one for patients and one for nurses.

The architecture of the resulting bundle reflects a deliberate division of labor. The patient module is structured as a self-care guide, a daily record, a checklist, and a communication tool. In practice, this means a hypertensive patient can log daily readings, track lifestyle behaviors, tick off self-care tasks, and carry a structured summary of that information into their clinic visit. The nurse module, by contrast, provides guidance for education, record review, monitoring, individualized feedback, documentation, and follow-up. Together, the two modules form a feedback loop: the home record becomes the raw material for the nurse’s structured review, and the nurse’s feedback shapes the patient’s next round of self-care.

Phase II put the draft modules in front of seven experts, who assessed them across five dimensions: content, presentation, language, graphic design, and suitability as health-promotion media. The quantitative backbone of this evaluation was the content validity index, a standard psychometric tool in instrument development. At the item level, the researchers calculated the item-level Content Validity Index, or I-CVI, while at the scale level they used the average of item scores, known as S-CVI/Ave. For the four non-content domains, the same proportional calculations were used to summarize domain-specific expert agreement. Qualitative comments from the experts guided subsequent refinement of the modules.

The numbers tell a story of strong expert confidence. Content-domain S-CVI/Ave values came in at 0.89 for the patient module and 0.91 for the nurse module, both comfortably within the range conventionally interpreted as acceptable content validity. Domain-average agreement for presentation, language, graphic design, and media suitability ranged from 0.93 to 1.00, while overall multidomain agreement reached 0.94 for the patient module and 0.95 for the nurse module. The team had prespecified a threshold of 0.86, and three items fell below it. Those items were revised, and the experts subsequently confirmed that the requested changes had been addressed. Notably, the researchers did not obtain repeat ratings or post-revision content validity estimates, a transparency point they acknowledge in their reporting.

The theoretical framing of the bundle is as important as its statistics. The intervention is built on person-centered nursing, an approach that treats patients as active partners in their own care rather than passive recipients of instructions. By embedding a daily record and checklist into the patient module, the design gives patients a tangible role in generating the data that drives their care. By equipping nurses with a structured review and feedback protocol, it ensures that the information patients generate is actually used. This bidirectional design is what distinguishes the bundle from the many one-way educational leaflets that have historically dominated hypertension self-management efforts.

The authors are careful about the limits of what they have shown, and that caution matters for how the findings should be read. The non-content ratings, they note, reflect expert judgment rather than target-user usability. In other words, seven professionals believed the modules were well designed, clearly written, visually appropriate, and suitable as health-promotion media, but patients and nurses in real clinics have not yet been tested with the bundle. Expert validation is a necessary early gate in intervention science, but it is only a gate. The study establishes that the toolkit is credible and coherent; it does not yet establish that it works in the field.

That is precisely where the research agenda now points. The authors call for further studies to examine feasibility, implementation fidelity, patient usability, nurse adherence, and preliminary effects on self-care behavior and blood pressure control. Each of these questions addresses a distinct failure mode: feasibility asks whether the bundle can be delivered at all in resource-constrained primary care; fidelity asks whether it is delivered as designed; usability and adherence ask whether patients and nurses will actually sustain it; and the outcome measures ask whether any of this translates into lower blood pressure. If subsequent trials bear out the promise of this early validation work, the dual-module bundle could offer primary care systems, particularly in Indonesia and comparable settings, a practical, structured way to turn daily self-care records into better hypertension control.

Subject of Research: Development and expert validation of a dual-module person-centered nursing self-care bundle for hypertension management in primary care

Article Title: A dual-module person-centered nursing self-care bundle for hypertension management: development and expert validation

Article References: Dewi, N. P. A. R., Nursalam, N., Sriyono, S., Israfil, I., & Putra, K. A. N. (2026). A dual-module person-centered nursing self-care bundle for hypertension management: development and expert validation. BMC Nursing. https://doi.org/10.1186/s12912-026-05377-2

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05377-2

Keywords: hypertension, self-care, person-centered nursing, primary health care, content validity, nursing intervention, patient education, blood pressure control, expert validation, care bundles, Indonesia, chronic disease management

The recommendation comes from the Pediatric and Neonatal Vascular Access Special Interest Group of the ESPR, working alongside NEVAT, a European network dedicated to vascular access care. The author group, led by Matheus van Rens and Robin van der Lee of Radboudumc Amalia Children’s Hospital in Nijmegen, the Netherlands, includes neonatologists, nurses and vascular access experts from institutions across the Netherlands, Belgium, Italy, Austria, the United Kingdom, France, Portugal, Spain, Bulgaria and beyond, with international contributors such as Yogen Singh of the University of California Davis Children’s Hospital. Their stated goal is deceptively simple: ensure that the right vascular access device is chosen from the very start of therapy, rather than discovered through a process of trial and error at the patient’s bedside.

The clinical problem the VAMP addresses is well documented in the authors’ own prior work. In the ABBA project, short for Assess Better before Access, a retrospective cohort study of neonatal intravascular device outcomes published in Frontiers in Pediatrics in 2022, the group catalogued how frequently neonatal vascular access devices fail before therapy is complete. Peripheral intravenous catheters in newborns are notoriously short-lived, and repeated replacement attempts mean repeated needle sticks, repeated pain and repeated exposure to complications. Research cited by the group, including a 2023 study in the Journal of Vascular Access examining how catheter type and material affect therapy failure in neonates, underscores that even the physical properties of the device matter in this population, whose veins may be smaller than a millimeter in diameter.

The stakes extend beyond immediate mechanical failure. Neonatal sepsis, which can be triggered by catheter-associated bloodstream infections, has been linked in a 2024 systematic review and meta-analysis in BMC Pediatrics to adverse neurocognitive outcomes later in life. Pain experienced in the first days and weeks of life is likewise not a transient concern; a 2020 review in Frontiers in Pediatrics by Williams and Lascelles summarized clinical and experimental evidence that early neonatal pain can have lasting implications for painful conditions later in life. In other words, every unnecessary needle stick and every preventable catheter infection is not merely an acute event but a potential contributor to long-term developmental burden. This is why the VAMP authors frame vascular access decision-making as a neuroprotective issue, a theme they developed further in a 2025 patient-centered framework based on the 7-Rights concept published in Pediatric Research.

Technically, the VAMP functions as a structured, patient-centered decision pathway, presented by the authors as a flow diagram that guides clinicians through the assessment of an individual newborn’s veins, the expected duration and type of therapy, and the characteristics of available devices before any needle is inserted. The approach draws on a growing body of standardized pre-procedural assessment protocols. Among these is the Rapid Superficial Vein Assessment, or RaSuVa, described by D’Andrea and colleagues in 2024 as a systematic pre-procedural evaluation of superficial veins to optimize venous catheterization in neonates. Similar systematic ultrasound protocols exist for deeper vessels: the Rapid Central Vein Assessment, or RaCeVa, published by Spencer and Pittiruti in 2019, and the Rapid Femoral Vein Assessment, or RaFeVa, described by Brescia and colleagues in 2021, both of which standardize ultrasound evaluation before central catheterization. The VAMP embeds this assessment-first philosophy into routine neonatal practice.

The framework also builds on and harmonizes existing consensus documents rather than replacing them. The authors position VAMP alongside the neonatal DAV-expert algorithm, a GAVeCeLT/GAVePed consensus published in the European Journal of Pediatrics in 2023 for choosing the most appropriate venous access in newborns, and the ERPIUP consensus on the proper indication and use of peripheral venous access devices, a WoCoVA project published in the Journal of Vascular Access. Other reference points include the UK Vessel Health and Preservation framework updated in 2020, the miniMAGIC appropriateness guide for intravenous catheters in pediatrics published in Pediatrics in 2020, the Infusion Therapy Standards of Practice ninth edition from 2024, and the NANN neonatal peripherally inserted central catheter guideline for practice in its fourth edition. By synthesizing these sources into a single European recommendation, the ESPR group aims to reduce the fragmentation that currently produces wide variation in practice between units and countries.

Insertion technique and device maintenance form a second pillar of the plan. The recommendation references novel insertion bundles developed by Italian collaborators, including the SIUVeC protocol for safe insertion of umbilical venous catheters and the SIECC protocol for epicutaneo-cava catheters, both designed to minimize placement and management complications, as well as the SIC seven-step strategy for centrally inserted central catheters. Once a device is in place, the plan emphasizes evidence-based securement and site care, drawing on trials of cyanoacrylate glue as part of bundles to decrease neonatal PICC-related complications and to secure umbilical venous catheters, and on experience with dialkylcarbamoylchloride dressings at catheter exit sites in pediatric and neonatal populations. Care bundles of this kind have already been shown in a 2018 systematic review and meta-analysis in Archives of Disease in Childhood to reduce central line-associated bloodstream infections in neonatal units, and the SHEA NICU white paper series from 2023 offers practical approaches to the same goal.

Two technological themes run through the recommendation with particular force. The first is point-of-care ultrasound, which the authors describe as central to modern neonatal vascular access, from pre-procedural vein mapping to real-time guidance during insertion. A 2024 review in the European Journal of Pediatrics by Pittiruti, Annetta and D’Andrea summarized the role of ultrasound for vascular access in neonates and children, and a 2023 systematic review and meta-analysis in Diagnostics examined the role of ultrasound specifically in epicutaneo-caval catheter insertion. A related narrative review from 2025 weighs intracavitary electrocardiography against real-time ultrasound for tip navigation and tip location of central venous access devices in the neonate, a question also addressed in a 2025 Italian expert consensus on tip location methods. The second theme is standardization itself: the VAMP’s authors contend that a uniform, reproducible method, applied by every clinician on every shift, is what converts scattered best practices into reliable outcomes.

Notably, the recommendation also extends beyond the technical to the human. The framework incorporates family-centered principles, citing recent work on family integrated care in Acta Paediatrica, a 2024 study in Advances in Neonatal Care on family management skills reported by parents of preterm infants, and a 2025 nonrandomized clinical trial in JAMA Network Open on outcomes following close collaboration with parents interventions in neonatal intensive care units. Pain assessment and management in preterm infants, summarized in a 2022 practice update in Children, are likewise woven into the plan, reflecting the view that vascular access decisions should minimize discomfort as well as complications. The involvement of the European Foundation for the Care of Newborn Infants and the Global Foundation for the Care of Newborn Infants, acknowledged by the authors for contributions and critical readings of earlier drafts, signals that parent perspectives were part of the drafting process itself.

The authors state that proper use of the VAMP ensures choosing the right vascular access device from the start of therapy, that the method offers a structured and patient-centered approach, that its implementation ensures more uniform practice regarding vascular access in neonates, and that it has the potential to greatly decrease the number of vascular access-related complications in this population. As the first in what the group describes as a ten-recommendation project, VAMP represents the opening move of a coordinated European effort to professionalize neonatal vascular access in the way that adult vascular access care has been professionalized over the past two decades. If the framework achieves its stated aims, the routine insertion of a cannula in a premature newborn could shift from an improvised procedure, repeated until something works, into a planned, ultrasound-informed, family-aware intervention with fewer sticks, fewer infections and fewer of the long-term consequences that follow them. For the smallest patients in intensive care, that shift could matter for a lifetime.

Subject of Research: A structured European recommendation for vascular access device selection and management in neonatal intensive care

Article Title: Vascular access management plan (VAMP): neonatal European vascular access team—ESPR Recommendation 1

Article References: van Rens, M., Hugill, K., Piersigilli, F., Schwaberger, B., Mader, S., Geiger, I., Singh, Y., Ouwehand, T., van den Hoogen, A., Van Eenoo, S., van der Lee, R., on behalf of the Pediatric and Neonatal Vascular Access Special Interest Group (SIG) of the ESPR and NEVAT, van Rens, M., Van Der Lee, R., van den Hoogen, A., Rodriguez-Perez, C., Barone, G., van Eenoo, S., Hugill, K., … Tuna, M. L. (2026). Vascular access management plan (VAMP): neonatal European vascular access team—ESPR Recommendation 1. Pediatric Research. https://doi.org/10.1038/s41390-026-05467-6

Image Credits: AI Generated

DOI: 10.1038/s41390-026-05467-6

Keywords: neonatology, vascular access, VAMP, ESPR, central venous catheters, PICC, ultrasound, neonatal sepsis, care bundles, point-of-care ultrasound, umbilical venous catheter, family integrated care