Abstract
BACKGROUND: Wellness, a comprehensive approach to patient care, aims to promote freedom, respect and listening to the patient needs in order to prevent abuse. No previous study have assessed the impact of an intervention promoting wellness in older patients within hospital settings. Furthermore, the predictors of key wellness indicators remain unexplored. This gap hinders efforts to target both organizational and individual-level determinants of quality care for older patients. This cross-sectional quasi-experimental multicenter study aimed to assess the effects of introducing a wellness charter intervention on nursing care practices and health outcomes among older patients in Tunisia. METHODS: A before/after study was conducted with a sample of 500 Tunisian nurses. Initially, a self-assessment was carried out using a validated French questionnaire covering eight wellness-related domains (25 items total). This was followed by a communication and awareness campaign explaining the charter, after which the self-assessment was repeated. The domains assessed included: respect for privacy, dignity, and confidentiality (5 items), pain management (2 items), patient/resident comfort (2 items), end-of-life care (3 items), communication (2 items), promotion of patient autonomy (4 items), preservation of personal dignity (3 items), and changes in service organization practices (4 items). To determine factors independently linked to wellness outcomes—specifically, items 21 (discussion of wellness during annual evaluations) and 22 (presence of wellness-related materials in the department)—both univariate and multivariate analyses were performed. RESULTS: After the intervention, all eight domains showed statistically significant improvements: changes range from 8% to 46%. Factors significantly associated with the discussion of wellness during annual reviews included: maintaining confidentiality [odds-ratio (OR) = 2.28], avoiding professional discussions at the patient’s bedside [OR = 1.88], supporting end-of-life care and comfort [OR = 2.76], scheduling staff breaks in rotation [OR = 2.33], and monitoring patient call response times [OR = 2.43]. Factors significantly associated with the presence of wellness-related documents in the department included: consistent attention to pain management [OR = 6.73], collecting advance directives [OR = 2.28], encouraging patient mobility [OR = 0.14], rotating staff breaks [OR = 1.61], monitoring call response times [OR = 2.96], and offering flexible visiting hours [OR = 1.51]. CONCLUSION: Emphasizing staff training on patients’ rights and fostering an ethical nurse-patient relationship are crucial to improving wellness in care settings. CLINICAL TRIAL NUMBER: Not applicable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12912-025-04185-4.