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Aim This study aimed to develop and validate a nursing self-efficacy scale for OAC management (SE-OAM). Background Oral anticoagulant therapy (OAC) requires specific nursing competencies. Given that self-efficacy acts as a proxy assessment of nursing competence, its measurement is pivotal for addressing educational programs to enhance nursing competence in managing OAC. Thus far, the measurement of self-efficacy in OAC is undermined by the unavailability of valid and reliable tools. Methods A multi-method and multi-phase design was adopted: Phase one was a methodological study encompassing developmental tasks for generating items. Phase two comprised the validation process for determining the content validity, construct and concurrent validity, and internal consistency through two cross-sectional data collections. Results In total, 190 nurses were enrolled for determining the psychometric structure of the SE-OAM through an exploratory approach, and 345 nurses were subsequently enrolled to corroborate its most plausible factor structure derived from the exploratory analysis. The SE-OAM showed evidence of face and content validity, adequate construct, concurrent validity, good internal consistency, and stability. The final version of the scale encompassed 21 items kept by five domains: clinical management, care management, education, clinical monitoring, and care monitoring. Conclusions The SE-OAM showed evidence of initial validity and reliability, fulfilling a current gap in the availability of tools for measuring nursing self-efficacy in managing OAC. SE-OAM could be strategic for performing research to improve the quality of OAC management by enhancing nursing self-efficacy.

Purpose: The purpose of this study was to develop the modified research utilization questionnaire (M-RUQ) and to establish its content and face validity, construct validity, and reliability. Methods: This study has a multiphase (three phases), methodological, and cross-sectional design. First, research utilization questionnaire (RUQ) was translated into Italian, which is the target language to develop the M-RUQ. Second, the RUQ psychometric proprieties were assessed using exploratory factorial analysis to identify ambiguous or problematic items (e.g., cross-loadings) (cross-sectional sampling A). The RUQ modification (i.e., item deleting, wording modification, and scoring procedure) represented the development of the M-RUQ among Italian nurses. The third phase was aimed to confirm the construct validity of the M-RUQ and to test its stability and internal consistency (cross-sectional sampling B). Results: This study's findings show that M-RUQ has a three-dimensional structure and a total of 22 items. The M-RUQ shows evidence of validity and reliability. Precisely, the factorial structure coming from an exploratory factorial analysis on the first sample (n = 504) was confirmed by a final model of confirmatory factorial analysis (CFA) on a second sample (n = 362). The final CFA model showed adequate goodness of fit, where all the factor loadings showed values higher than .40. Cronbach's α was satisfactory for each domain and for the overall scale. Furthermore, the M-RUQ showed good stability described by the test–retest. Conclusion: The M-RUQ should be used to assess research utilization among nurses for educational or research purposes to address the practice. Further research about its validity and reliability is suggested. Keywords: evidence-based nursing, nursing, psychometrics

Summary Background & aims Data about the prevalence of sarcopenia among hospitalized patients is lacking and it is unclear whether the diagnostic criteria commonly used in community-dwellers is applicable in acutely ill subjects. The aims of this report are: (i) to assess the prevalence of sarcopenia among hospitalized patients; (ii) to assess whether the European Working Group on Sarcopenia in Older People (EWGSOP) criteria are applicable in an acute care setting; and (iii) to assess the mortality rate at 3 months. Methods 103 patients admitted to the Acute Geriatric Clinic were enrolled. Inclusion criteria were: age ≥65 years and malnutrition or risk of malnutrition, according to the Mini Nutritional Assessment Short Form. Sarcopenia was diagnosed using the EWGSOP criteria by means of bioimpedance analysis, handgrip strength and gait speed, within 72 h of admission. Information on deaths was obtained by telephone interview at 3 months following discharge. Results Sarcopenia was diagnosed in 22 patients (21.4%). Twenty-three patients (22.3%) were not able to perform the gait speed and/or the handgrip strength because bedridden or requiring intensive treatments. In this group, a definite diagnosis of sarcopenia was not possible, lacking at least one EWGSOP criteria. Eleven (10.7%) patients died within the 3 months post-discharge period. Kaplan–Meier survival curves showed that sarcopenic patients died significantly more frequently than others (log-rank p ≤ 0.001). Conclusions In a population of hospitalized elderly malnourished or at risk of malnutrition, sarcopenia is highly prevalent and associated with an increased risk to die in the short-term. Furthermore, the EWGSOP criteria cannot be satisfactorily applied in a relevant proportion of patients.

Aim To summarize, critically review, and interpret the evidence related to the systematic reviews on health literacy (HL) amongst type 2 diabetes mellitus (T2DM). Methods The methodology for this study consisted of a systematic review of systematic reviews, using the PRISMA statement and flowchart to select studies, and searching on PubMed, CINAHL, Scopus, and Cochrane. The search covered the period between January 2006 and June 2016. Results From the 115 identified record by the queries, only six systematic reviews were included, following a quality evaluation using AMSTAR. The included systematic reviews content was analyzed by the independent work of two authors, using a narrative synthesis approach. The findings of this study (i.e., main themes) are areas of consensus and gaps in knowledge. Areas of consensus are HL definition, HL measurement tools, and the relationship between T2DM patient knowledge (or literacy) and his/her HL. The gaps in knowledge were the assessment of the relations between HL and health outcomes and self-efficacy, the gender differences, the effectiveness of interventions to improve HL, the cost-effectiveness study of interventions to improve HL, and the understanding of the influence of organizational environment on HL. Conclusion This review provides a current state of knowledge to address clinical practice and research proposals. HL could be useful to personalize patients' follow-up and it should be routinely assessed in its three dimensions (i.e. functional, interactive and critical) to enhance patients' ability to cope with clinical recommendations. Future research should be mainly aimed to test the effectiveness of evidence-based interventions to improve HL amongst T2DM patients.

Different studies described the important role of wellbeing, self-care and self-efficacy (i.e. health determinants) to achieve best health outcomes in Type 2 Diabetes Mellitus (T2DM) patients. However, literature has paid little attention to highlight the possible gender differences related to the T2DM perception of those health determinants. For these reason, the aim of this study was to describe T2DM patients' gender differences related to their wellbeing, self-care and self-efficacy. This study was performed by a secondary analysis of data from a cross-sectional research, conducted in an outpatient setting in Northern Italy. Data was collected from March 2014 and July 2016 in a cohort of 115 T2DM outpatients, aged from 60 to 91 years (mean = 69.78 ± 7.11). Our results showed that men perceived more general wellbeing than women, and more diabetes specific self-efficacy. No differences seemed to be related to self-care. Indeed, the stratification by gender of the bivariate analysis allowed to identify many peculiarities related to wellbeing domains and self-efficacy. This study had a pioneering nuance in Italian assessment of T2DM health determinants, and it could have a number of future implications. Further empirical researches should provide more information to deeply understand the T2DM patients' peculiarities, which could help nurses to improve a personalized care delivery.