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© 2019 John Wiley & Sons Ltd Aims and objectives: To review and synthesise research studies on surgical and medical inpatients’ perceptions on unmet nursing care needs. Background: Missed nursing care is a growing phenomenon that has been shown to adversely affect care outcomes—mainly in adult medical and surgical care settings. However, to date the aggregated and synthesised evidence of missed care comes from research that measures perceptions on missed care in surgical and medical settings from nurses, but not from the patients. Design: Scoping review. Methods: In September 2018, three databases were searched: MEDLINE/PubMed, CINAHL and SCOPUS and papers were selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were as follows: primary studies; published in peer-reviewed journals; in English or Italian; and regarding routine care provided to adult inpatients. Quality appraisal and a thematic analysis were conducted. Results: Of the 1541 abstracts initially identified, 44 papers were included. Five themes emerged: “communication,” “self-management, autonomy and education,” “personal sphere,” “essential physical care” and “emotional and psychological care.” The majority of the unmet needs were related to the “personal sphere” and “emotional and psychological care.” These unmet needs were not identified in previous literature on nurses’ perspectives of missed care. Also, physical care deficits like oral hygiene were identified. Conclusion: It is important to take into account patients’ perspectives. The themes focusing on patients’ personal sphere, and emotional and psychological care, underline how patients need nurses to pay more attention to their cultural background, consider the person as a whole and for nursing care to be holistic and respectful of patients’ dignity. Relevance to Clinical Practice: This study intends to raise awareness amongst nurses and policymakers about the importance of addressing missed nursing care and unmet patients’ needs in adult medical or surgical inpatient settings to ensure high-quality care and patient satisfaction.

Aims and objectives To explore the experience of patients affected by chronic obstructive pulmonary disease following hospitalisation due to an acute exacerbation event. Background Chronic obstructive pulmonary disease is a progressively debilitating disease, often with very burdensome symptoms such as acute and chronic breathlessness and fatigue. Acute exacerbation often creates a life-threatening event. Exacerbation can also have substantial psychological effects including anxiety and depression although this aspect is less well researched-especially amongst people with chronic obstructive pulmonary disease recovering from an acute event and facing a return home. Design A descriptive phenomenological study. Methods In-depth interviews were conducted with 12 chronic obstructive pulmonary disease patients recently recovering from an acute exacerbation of their chronic obstructive pulmonary disease. Data were analysed using Colaizzi's phenomenological framework. Results Four themes were identified from the data: a sense of loss and frustration, hopelessness, uncertainty about the future and fear of becoming a burden. Participants expressed quite negative views including a loss of hope, uncertainty about their future care and the burden they may become on their families. They appeared stressed and anxious as a result of the acute event they had experienced. Conclusions This study shows that an acute episode of illness can generate a sense of hopelessness and uncertainty about their future care in people with chronic obstructive pulmonary disease. This occurs as they recover physically and think about the future, often in quite negative terms. Relevance to clinical practice For healthcare professionals, it is important to take into account the potential feelings of loss, hopelessness and uncertainty that people can experience following an acute exacerbation of their chronic obstructive pulmonary disease and ensure that psychological care is available as physical recovery takes place. Such care to include good discharge planning, giving patients time to express concerns and referral to counselling services if appropriate.

AIMS: This paper critically reviews the use of mixed method research in nursing with a particular focus on the extent to which current practice informs nurse researchers. It also aims to highlight gaps in current knowledge, understanding and reporting of this type of research. BACKGROUND: Mixed method research is becoming increasingly popular among nurses and healthcare professionals. Emergent findings from this type of research are very useful for nurses in practice. The combination of both quantitative and qualitative methods provides a scientific base for practice but also richness from the qualitative enquiry. However at the same time mixed method research is underdeveloped. METHODS: This study identified mixed methods research papers and critically evaluated their usefulness for research practice. To support the analysis we performed a two-stage search using CINAHL to find papers with titles that included the key term 'mixed method'. RELEVANCE TO CLINICAL PRACTICE: This paper highlights current gaps in knowledge, understanding and reporting of mixed method research. While these methods are useful to gain insight into clinical problems nurses lack guidance with this type of research. This study revealed that the guidance provided by current mixed method research is inconsistent and incomplete and this compounds the lack of available direction. There is an urgent need to develop robust guidelines for using mixed method research so that findings may be critically implemented in practice. CONCLUSION: An analysis of studies that used mixed method research revealed some inconsistencies in application and reporting. Attempts to use two distinct research methods in these studies often meant that one or both aspects had limitations. Overall methods were applied in a less rigorous way. This has implications for providing somewhat limited direction for novice researchers. There is also potential for application of evidence in healthcare practice that limited validity. This article is protected by copyright. All rights reserved.

Aims and objectives To assess the effects of a texture-modified food program for dysphagia on the nutritional, biochemical and functional profile in a cohort of institutionalised older people in Italy. Background Dysphagic institutionalised older people, often also affected by dementia, are frequently exposed to malnutrition. Malnutrition in older people has negative effects on mortality, days of hospitalisation, infection, wound healing and risk of pressure injuries. Therefore, it is very important to prevent malnutrition in this frail population. Design A pre–post study without a control group. Methods The study included 479 dysphagic institutionalised older people from 20 nursing homes. Anthropometrical, biochemical, nutritional and functional parameters were collected retrospectively, 6 months before the study intervention, at time zero and, prospectively for 6 months after implementing the NUTRICARE food programme, for a total of nine evaluations. The NUTRICARE programme includes meals without nutritional supplementation, and personalised levels of density, viscosity, texture and particle size. Results The total mean body mass index of our sample passed from 17.88–19.00; body weight averagely improved by 7.19%, as well as their nutritional and biochemical profiles. There was a progressive improvement of total protein and serum albumin values. Nutritional parameters (serum transferrin and lymphocytes) displayed similar changes. Plasma lymphocytes reached normal levels in 98.23% of the sample. Plasma creatinine levels remained steady throughout the study and within the normal range. No side effects were reported. Conclusion The NUTRICARE food programme with a adequate proteins, calories, balanced nutritional and bromatological properties, and appropriate texture and palatability significantly improved the nutritional, biochemical and functional profile in a cohort of institutionalised dysphagic older people. Relevance to clinical practice The introduction of a balanced nutritional programme, using high-quality natural ingredients, appropriate texture and palatability can significantly improve health and quality of life in dysphagic older people.

Aims and objectives To describe the knowledge, attitudes and beliefs of nurses and midwives who have attended to women who suffered violence. This study further analyses the possible changes of attitude that have occurred over the past five years. Background Gender violence or violence against women is the largest problem with regard to public health and violated human rights all over the world. In Italy, it is estimated that 31·5% of women suffer physical or sexual violence during their life. Healthcare operators play a crucial role in recognising the signs of the violence suffered when taking care of victims. Design A cross-sectional study was conducted. Methods A questionnaire was administered; this was used in a previous survey of a convenience sample of 51 nurses and midwives who work in an emergency room or in an obstetrics emergency room and gynaecological ward. Results Of the respondents, 51 (80·4%) have taken care of women who suffered violence, and 25 (49%) believe they can detect violence. The relational/communicative approach presents the most difficulty, and all the operators believe they need more knowledge. The number of operators who suggest women be observed in an emergency room and file a complaint or who primarily consider listening to women has decreased. A tendency to ‘blame’ women, although decreasing, persists; it is higher among male nurses and, in general, among male operators. Conclusion Knowledge of this issue has not been completely recognised among operators despite training and the emergence of the phenomenon in the mass media. Difficulties in receiving and in relational procedures continue to exist, in addition to ‘blaming’ the woman. Relevance to clinical practice Awareness paths and cultural changes regarding the phenomenon of violence need to be developed, as does a specific training programme on the approach to and assessment of the abused woman.

Aims. To understand what level of awareness health professionals working in a hospital of Northern Italy had of the patient safety culture by using the Italian version of the Hospital Survey on Patient Safety Culture questionnaire and also validate its use in this setting. Background. The Hospital Survey on Patient Safety Culture questionnaire was developed by the Agency for Health Research and Quality in 2008 and validated by several studies. Therefore, we decided to test the Italian version of this tool to see if it could be used effectively to measure and appraise patient safety culture also in Italy. Design. Survey. Methods. To check the validity of the questionnaire, we applied the continued comparison and the global data treatment methods. Results. Of the 1008 questionnaires we administered, 724 (71%) were returned. The majority of the questions were answered (mean 98, SD 3·4%). From a Chi-square test on the consistency of the answers, we found that six of the 12 perspectives we explored had a high level of significance, whereas in the other six, the differences in the answers were just casual. Conclusions. The Italian version of the Hospital Survey on Patient Safety Culture questionnaire allowed us to assess health professionals’ awareness of patient safety culture and thus validate the effectiveness of this tool. Relevance to clinical practice. The findings of our survey could be useful to design an objective tool that would allow the five health professional groups involved in the study (directors/coordinators, physicians, nurses/midwives, physiotherapists and technicians) gain a better knowledge of the patient safety culture and thus improve the quality of clinical practice.

In Italy, there is controversy in nursing about impact factors.The recent introduction of nursing education in universities(June 2000), specifically in the Faculties of Medicine, requiresthat scientific output is measured based on the impact factorand h-index, to rate academics’ performance.The current necessity in Italy to reduce the number ofacademic staff has excessively raised academics’ performancerating targets. In fact, the Italian Ministry of Education,University and Research has recently declared that Italianacademics have to achieve an h-index of at least 25, if theywant to obtain governmental funding and enrol newresearchers.In nursing, this situation runs the risk of giving rise to twocritical and related phenomena:• First, in Italy, nursing research, as well as the first PhDprogrammes of nursing, started only in 2006; very fewItalian indexed scientific nursing journals are available topublish. Novice nursing researchers are obliged to findspace in an already overcrowded international sector.Furthermore, owing to the nature of nursing, the impactfactors of nursing journals tend to be lower than medicaljournals. Above all, the combination of all these factorscould generate an unhealthy frenzy to publish at all costs,known as ‘impact fever’ (Bloch & Walter 2001, Anseelet al. 2004, Ironside 2007, Nolan et al. 2008).• Second, the consequence of this ‘impact fever’ could leadto ‘impact factor addiction that can generate an impactfactor cessation’ (Jackson et al. 2009). The result of thiscould be that nursing professionals, pressured by the needto compete with overwhelmingly high-rating models (im-pact factors and h-indices) for nursing, could concentrateon publishing, at the expense of the true development ofnursing.Thompson and Watson (2010) report that, in the UK,which boasts a long tradition of nursing publications, onlyeight of the top-ranking nursing scholars have an h-index>10 (meaning that 10 papers of their papers have beencited at least 10 times). It is, therefore, clear that thedecision to set an exceedingly high h-index for Italiannursing academics has no rational foundation; moreover,owing to the intrinsic nature of nursing, the h-index cannotbe the sole measurement to rate nurses’ academic excel-lence. As suggested by Hack et al. (2010), nurse academicswho are in difficulty should on the contrary be supported,so that they may have sufficient time and resources todedicate to their research activities and be in the conditionto achieve an acceptable h-index in line with internationalstandards.

We are very grateful to Sasso (2011) for her commentary on our original piece on h-indexes (Thompson & Watson 2010) and to see that this is an issue that is having an impact outside the UK – albeit that the impact on Italian nursing may be negative. Clearly, we are advocates for the use of the h-index to measure individual academic performance. It is not perfect – no citation based measures are – but it is less easy to manipulate than total citations and provides a number that assesses contribution to a field, through readership and citation of a person’s work, over a relatively long period. Our purpose in writing about this in the first place and subsequently (Hunt et al. 2011) has been to try to develop some norms for our subject and also to begin to make international comparisons. As both our papers show, h-indexes of greater than 10 are very rare among nursing academics – even long-established nursing professors – with only a handful exceeding 20. In the above light, the Italian Ministry of Education, University and Research declaration – reported by Sasso (2011) – that government research funding will only be awarded to those with h-indexes 25 or above is likely to be very damaging to nursing. In the same vein, it is a ludicrous declaration, as nursing will not be alone in having few people with an h-index of 25 or above. As originally conceived by Hirsch (2005), an academic in physics would be doing well to have an h-index unit for each year of academic activity. Using this criterion, only academics with at least 25 years experience would be eligible for Italian research funding, albeit that there are some more highly citing subjects such as medicine. This will skew the allocation of funding to those in the middle years of their career; cutting off people at the start and providing no incentive to those nearer the end of their careers in low-citing subjects who will never achieve an h-index of 25. As Sasso (2011) points out, and in accordance with Jackson et al. (2009) and Nolan et al. (2008), such an institutionalisation of the use of h-indices will lead to some unhealthy activity associated with increasing citations in such a way that they deliberately increase h-index. Foremost, this will be fruitless but all absorbing activity because of the very intractability of the h-index: to increase your h-index by one unit at any level requires that all the papers below the one contributing to the increase have been cited at least as may times as the one ‘on the cusp’. In other words, if you have an h-index of 10 based on the top 10 of your cited papers having been cited 10 times each and no more, then you are required to have a further 11 citations equally spread across all those papers – with citations to any lower cited papers making no contribution – before your h-index will shift. Imagine the effort required to, for example, double your h-index. Therefore, h-indexes certainly have a place and there is a case, for example, for using them in promotions within universities along with a range of other performance indicators. There is no case for giving them priority of place in the allocation of research funding.