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. Impact of 12-hour shifts on nurse, patient and organizational outcomes. A critical review., Introduction: The use of 12-hour shifts has been considered beneficial in reducing staffing costs, attracting more nurses, improving work-life balance, and organizing care more efficiently., Objective: The aim of this review is to critically examine the available evidence on the impact of 12-hour shifts on nurse, patient, and organizational outcomes., Methods: A critical review of the literature was undertaken. Quantitative, qualitative and mixed methods studies analyzing the effect of long shifts (>12 working hours) were included. The search was performed on MEDLINE through PubMed and Cinhal., Results: Fifty-four articles were included, covering publications from 1976 to 2024. Evidence suggests that nursing care and patient safety may deteriorate with 12-hour shifts, with mixed findings on continuity of care. 12-hour shifts can lead to increased nurses' fatigue, without a decrease in job performance, and can have negative impacts on physical health, continuing education, burnout, and job satisfaction. While qualitative studies indicate improved work-life balance, this is not supported by empirical evidence. One study suggests a decrease in costs, but the effects on sick leave are inconclusive. Additionally, intention-to-leave among nurses appears to increase., Conclusions: The evidence generally does not support the use of 12-hour shifts. However, due to methodological limitations in the included studies, firm conclusions cannot be drawn. Organizations and nurses should carefully consider the introduction of 12-hour shifts, evaluating nurses' needs and implementing patient-centered care models that support nursing professionalism, along with a continuous monitoring of patient, nurse, and organizational outcomes.

. Investing in healthcare professionals. The motivation for enrollment in bachelor nursing courses: results from a pilot study., Introduction: Understanding the reasons for enrolling in a Bachelor of Science in Nursing (BSc Nursing) is crucial for devising strategies to stimulate enrollment and counteract the current decline in applications. A multi-center longitudinal study was initiated to explore motivations for enrollment and dropout rates. The results of the pilot study focusing on enrollment motives are presented., Objective: To identify the reasons for enrolling in BSc Nursing programs at five Italian universities., Methods: First-year BSc Nursing students enrolled in the academic year 2022-2023 completed an online questionnaire exploring socio-demographic and personal information, priority criteria for their choice, information sources, and the following reasons for enrolling (Likert scale 1-5): altruistic motivations, personal interests, preferences, past experiences, job security, advice, fallback options, and the social image of nursing., Results: 759 questionnaires were analyzed (78% of those involved). 64.7% of the students indicated nursing as their first choice, while one-third enrolled as a fallback option, by chance, or because they were uncertain. Altruism was the primary motivation for enrollment (91.8%), but 74.2% of students enrolled to secure a good job or to pursue a career (52.3%), or due to curriculum counseling sessions (13.7%). Some differences were observed between geographical areas., Conclusions: Students primarily enroll in BSc Nursing programs due to altruism, personal experience, and job prospect. These findings may be valuable for guiding and tailoring information campaigns, and for enhancing the appeal of nursing courses.

. Transitioning Italian nursing education in the post-pandemic period: priorities in the light of lessons learnt., Introduction: Once back to normalcy, many nursing education activities have been restored without an in-depth analysis of which transformations enacted in the pandemic period should be maintained and valued., Aim: To identify priorities to effectively transitioning nursing education in the post-pandemic period., Method: Descriptive qualitative design. A network of nine universities involved 37 faculty members, 28 clinical nurse educators and 65 students/new graduates. Data were collected through semi-structured interviews; the main priorities reported in each university were combined to gain a global view., Results: Nine priorities emerged, including the need to: 1. reflect on distance learning to promote its complementary role to face-to-face teaching; 2. rethinking the rotations of clinical practical training by refocusing their aims, duration, and preferred settings; 3. understanding how to integrate the virtual and the in-presence learning spaces into the educational pathway; 4. continuing with inclusive and sustainable strategies. Considering that nursing education is essential, it is a priority to develop a pandemic education plan capable of guaranteeing its continuity in all circumstances., Conclusions: Nine priorities have emerged all considering the importance of digitalization; the lessons learnt, however, indicate the need to enact an intermediate phase capable of guiding towards the complete transition of the education in the post-pandemic era.

. Community as learning opportunity for nursing students: The LaVàl. project of Val Chiusella., Introduction: The new competencies required for Family and Community Nurses (FFCN) involve the ability to make a community diagnosis., Aim: To describe the steps in designing an innovative internship for university students (nurses, anthropologists, educators, sociologists etc.)., Methods: After involving the municipalities, associations and local community networks, the students were asked to enter the community, keep a diary of what they had done and observed, and the nursing students were asked to produce a report based on the synthesis of the diaries, in which they would highlight the specific features, strengths, weaknessess and potentials for development of the observed community., Results: As of 31 March 2022, 50 nursing students and 6 FFCN Master's students had thier practical training in addition to anthropology, sociology, geology an occupational therapist students. By 30 September 2022, 20 nursing students, 10 Master's and Master's degree students, are expected. 96 hours of interviews were carried out with local residents, meetings were held with 30 Associations and 40 events, meetings and assemblies, 12 meetings for Walking Groups, Adapted Physical Activity and Pilates, 70 hours of direct observation in the five pharmacies and 100 hours of debriefing, supervision and multidisciplinary discussion to rework and systematise the information acquired were conducted., Conclusions: An innovative experience of training in making community diagnosia and projects for solutions for a community is feasible. However, both the organisational and local concertation prerequisites are necessary to make these experiences possible.

. Conclusions and reflections for planning not based on average numbers. Planning for the number of Family and community nurses (FCNs) needed cannot be based on average estimates issued at the national level. In fact, organizing a service requires in-depth knowledge not only of patients, but also of the local area, health, social, and volunteer services. This information is available, however not always easy to use and combine with other useful data stored in databases not connected to each other. While waiting to have enough FCNs, priorities for those available should be set at local level. The choice of priority target groups of population depends on local data but also on a careful assessment of the services already available in the area, in order to identify the populations most at risk or with limited access of services of the national health and social systems.

. Nurses' perception of the organisational context of nursing homes: a descriptive study., Introduction: The increasing number of the elders admitted to nursing homes (NH) requires a particular emphasis on improving the quality of nursing care. The evaluation of the organizational context has recently received growing interest, for its contribution to understanding of care outcomes and staff's needs., Aim: To describe the characteristics and the nurses'perception of organizational context of NHs in which they work., Methods: A cross-sectional study was conducted in 50 NHs in the Piedmont and Aosta Valley regions. The following data were collected: sociodemographic information on nurses, years of work experience, contract type, and work-hour profile; organizational information included ownership, size, occupancy rate; and for the organizational context, the Alberta Context Tool was administered., Results: Of the 312 nurses, 266 (85%) participated in the study; 79% had a university degree. Perceived organisational context scored low (median values 2.5) in terms of the availability of Interactions (Formal and Informal), Resources, Personnel and time, but good with median values above 3.5/5 on Leadership, Culture, Evaluation, Social Capital and Space, with differences according to years of experience, type and size of facility; for example, nurses working in private facilities perceived their organisational context as better than those working in public facilities., Conclusions: NHs are workplaces that are still not frequently chosen by nurses and essentially considered as places of transition or end of the career. In spite of organizational contexts perceived as positive, tangible efforts are needed to improve working conditions and the perception of nurses' role.

. The missed care in Nursing Homes: a pilot study., Introduction: To date missed care have been described mostly in hospitals and data on nursing homes (NH) are missing., Aim: To describe missed care in NH residents identifying their perceived impact and seriousness., Methods: A pilot study was conducted in 10 Piedmont NHs. For each omitted or delayed care on 20 residents observed for 3 consecutive days, the nurses provided information on the type of care, and information on the residents and on the organization were collected., Results: Twenty-three nurses reported 57 missed care for 44/200 residents (22%; median 5 for each NH, range 0-13). Twenty-five missed/omitted care on 20 residents were considered of medium/high severity: 14 (56%) involved drug therapies and 5 (20%) the monitoring of vital signs. The level of severity derived from the distress caused to the resident, the risk of deterioration of residents'conditions and the repeated omissions on the same resident. Of the 32 missed care on 25 residents, judged of limited impact, the more frequent were dressing changes (12, 37.5%), and drugs administration (10, 31.3%). The most frequent reasons for delay/omission were unplanned events (16, 28.1%), shortage of nurses (12, 21.1%), and residents' clinical conditions (9, 15.7%)., Conclusions: Missed care occur also in NHs. If staff shortage play a key role among potentially modifiable factors, a sizeable number of omission is associated to unlikely forseeable or avoidable events.

. The Emergency Department visits of Nursing Home residents: descriptive study in a Nursing Home., Introduction: Many Emergency Departments (ED) transfers of Nursing Home (NH) residents are potentially avoidable or even inappropriate since problems could be prevented or managed in the NH., Aim: To describe characteristics and outcomes of NH residents transferred to ED for respiratory, cardiovascular and neurological problems and symptoms of infection., Methods: A retrospective descriptive study using clinical records data from 2013-2016 of a NH was conducted., Results: In 4 years (2013-2016), 143 ED accesses occurred, 55 (38.6%) for medical problems in 48 residents. The residents were mainly women, with advanced age. Forty-two/55 accesses (76.4%) resulted in an hospital admission and 16 residents (38.1%) died in hospital; of the 13 discharged, 3 died the NH after a few days. The most frequent reason for hospitalization was an infection (22): respiratory (18), urinary (2) or both (2). The week before ED admission 1/3 of residents was asymptomatic, 1/3 had only one typical symptom accompained by drowsiness or agitation (7), gastrointestinal problems (5), or other non-specific symptoms. On ED admission prevalent signs and symptoms were desaturation (13), dyspnea (10) and fever (9). Six/22 residents had started an antibiotic treatment in the NH., Conclusions: Proactive management policies need to be promoted for residents with infections, based on explicit criteria to promptly monitor changes in clinical conditions and on the education educate professionals to suspect an infection even with non-specific symptoms.

. The Clinical Learning Quality Evaluation Index for nursing students., Introduction: The Italian nursing programs, the need to introduce tools evaluating the quality of the clinical learning as perceived by nursing students. Several tools already exist, however, several limitations suggesting the need to develop a new tool., Aim: A national project aimed at developing and validating a new instrument capable of measuring the clinical learning quality as experience by nursing students., Methods: A validation study design was undertaken from 2015 to 2016. All nursing national programs (n=43) were invited to participate by including all nursing students attending regularly their clinical learning. The tool developed based upon a) literature, b) validated tools already established among other healthcare professionals, and c) consensus expressed by experts and nursing students, was administered to the eligible students., Results: 9606 nursing in 27 universities (62.8%) participated. The psychometric properties of the new instrument ranged from good to excellent. According to the findings, the tool consists in 22 items and five factors: a) quality of the tutorial strategies, b) learning opportunities; c) safety and nursing care quality; d) self-direct learning; e) quality of the learning environment., Conclusions: The tool is already used. Its systematic adoption may support comparison among settings and across different programs; moreover, the tool may also support in accrediting new settings as well as in measuring the effects of strategies aimed at improving the quality of the clinical learning.

. A comparison of the most used instruments to assess the quality of clinical learning environments of nursing students., Introduction: A clinical learning environment (CLE) promotes the development of professional competences, of critical and diagnostic reasoning in future nurses, thus the continuous assessment of its quality is pivotal., Aim: To describe and compare the most used instruments to measure the nursing students' perception of the quality of CLEs., Methods: Six validated questionnaires were identified and compared: CLE (Clinical Learning Environment), CLEDI (Clinical Learning Environment Diagnostic Inventory), SECEE (Student Evaluation of Clinical Education Environment), CLEI (Clinical Learning Environment Inventory), CLES (Clinical Learning Environment and Supervision), CLES+T (Clinical Learning Environment and Supervision plus Teacher nurse). The following elements were described: conceptual framework, psychometric properties, dimensions explored, the more relevant constructs able to guarantee a high quality CLE: relations between students and ward staff; level of involvement of nurse coordinators; inclusion of the student in the ward team, ward climate, involvement of clinical teacher and feedback to the students., Results: The only instrument that explores all the relevant constructs is the CLES+T. The involvement of clinical nurse teacher and nurse coordinator are the less explored dimensions. The questionnaires CLEI, CLES and CLES+T, validated in Italian and used in several learning environments share the following weaknesses: do not assess the feedback offered to the students, the students' satisfaction for the tutoring strategies and the role of different professionals in the students' learning., Discussion: The analysis of strengths and weaknesses is the basis to start from to devise and validate a new questionnaire.

. The debate on the development of advanced nursing competences. The dossier aims to describe and disentagle the present Italian and international debate on the development and recognition of advanced nursing competences. Following a general brief description of the legislative national background, the attention is first of all focused on the lack of clarity on the definition of advanced competence, which is further complicated by the issue of their formal, contractual and economic recognition. To explore these issues a list of contributions is presented and some proposals are formulated to favor a better oriented development of the debate: a. A convenience sample of 139 nurses were interviewed asking to describe problems occurred in the last month that could prompt the intervention of an expert nurse and to list the clinical, managerial and educational competences of a specialized nurse in their ward. The results document the quality and the dispersion of the definitions which are perceived and applied in the general settings of care. b. The issue the post basic courses (master, specialization) offered to nurses in 2015-2016 by Italian universities were described and their aims. While the contribution of the courses in increasing the theoretical knowledge is well defined, the aims and the description of the clinical training are badly developed and an acquisition of advanced competences would seem unlikely. c. The definition of advanced competences was explored in the international literature: while evidences are available on the impact of advanced nursing on patients' outcomes, what is advanced nursing is far from being clear, and an impressive list of roles, activities and functions are considered advanced. d. Although at national level there is no formal recognition for nurses with advanced competences (with the exception of the head nurse that holds mostly an organizational rather than clinical role), the opportunities for promoting the role of specialistic/advanced nurses were described. An interview to 20 nursing managers representing 23 Italian hospitals and districts shows the huge variability of what is recognized and considered specialistic/advanced competence. Competences in stoma care, venous catheters, pressure sores, do not necessarily cover the concept of advanced competence. e. Two further contributions explore how the challenge of what is ill-defined (or cannot be defined) can be transformed in a methodological opportunity and how the growth of an health profession may break the delicate balance of the boundaries between professions.

Unlabelled: . Italian validation of the Chemotherapy Induced Taste Alteration Scale. Introdution. Taste alterations (TAs) are an underestimated side effect despite affecting 75% of chemo-radiotherapy patients. TAs may cause discomfort and food aversions up to loss of appetite and anorexia. The available instruments do not discriminate the different types of TAs., Aim: The aim of the study is to validate the Italian version of CiTAS, a 18-items scale that assesses specific TAs, symptoms of discomfort and their impact on patient nutrition., Methods: A convenience sample of 243 patients with chemotherapy-induced taste alterations were enrolled. Data were analyzed for item consistency using Cronbach alpha and construct validity using factor analysis., Results: The factor analysis identified four dimensions that explained a total variance of 67%: decline in basic taste, discomfort, phantogeusia and parageusia, and general taste alterations. The scale showed good validity (Cronbach's alpha = 0.82)., Conclusions: The CiTAS enabled the valid and reliable measurement of specific symptoms of chemotherapy-induced TAs. It can be used both as a clinical tool and in future studies to evaluate the effectiveness of specific TAs treatments.

Unlabelled: . Burnout and risk of burnout in the Italian teams of bone marrow transplant: a multicentre survey., Introduction: The term burnout is used to describe a state of work-related psychological distress in healthcare employees characterized by three related, but independent, components: emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA)., Aim: The aim of this study was to evaluate the prevalence of burnout and stress symptoms in physicians, nurses, and other healthcare professionals in Italian Bone Marrow Transplantation Units., Methods: All personnel of a multidisciplinary group of the Italian Group of Bone Marrow Transplantation were asked to answer two different validated questionnaires: the Maslach Burnout Inventory (MBI) and the General Health Questionnaire (GHQ-12) for the assessment of general wellbeing. Logistic regression was used to investigate possible risk factors for burnout., Results: This study showed a relatively low burnout prevalence (3.7%), however about 43.5% of health workers were at risk for developing a burnout syndrome. No personal or center characteristics seemed related to burnout risk, but there was a strong correlation between higher scores from the general health questionnaire and burnout risk., Conclusions: Results from our survey suggest that burnout is a relevant problem in transplant teams and as such strategies should be implemented to prevent it.

Unlabelled: . Validation of the Italian Clinical Learning Environment Instrument (SVIAT): study protocol., Introduction: Nursing students obtain most of their university credits in internship environments whose quality can affect their clinical learning. Several tools are available to measure the quality of the clinical learning environment (CLE) as perceived by students: these instruments developed in other countries, were validated in Italian but do not discriminate those CLEs capable (or not) to promote significant clinical learning., Aim: To validate an instrument to measure the capability of the CLE to generate clinical learning; the secondary aim is to describe the learning environments as perceived by nursing students according to individual course site and tutorial models adopted., Methods: The study will be developed in three phases: a) instrument development and pilot phase, b) validation of the psychometric properties of the instrument and c) description of the CLEs as perceived by the students including factors/item confirmed in the validation process. Expected outcomes. A large validation, with more than 8,000 participating students is expected; the construct under lying will be confirmed through exploratory and confirmatory factor analysis and will report high internal consistency; the instrument will report also a high test-retest and inter-rater reliability; in addition, the instrument will demonstrate predictive ability by discriminating those units able (or not) to activate effective learning processes.

Introduction: Clinical trials are pivotal for the development of nursing knowledge., Aims: To describe the clinical trials published in nursing journals in the last two years and propose some general reflections on nursing research., Methods: A search with the key-word trial was done on PubMed (2009-2013) on Cancer Nursing, European Journal of Oncology Nursing, International Journal of Nursing Studies, Journal of Advanced Nursing, Journal of Clinical Nursing and Nursing Research., Results: Of 228 trials identified, 104 (45.8%) were published in the last 2 years. Nurses from Asian countries published the larger number of trials. Educational and supportive interventions were the most studied (61/104 trials), followed by clinical interventions (33/104). Samples were limited and most trials are monocentric., Conclusions: A growing number of trials is published, on issues relevant for the nursing profession, however larger samples and multicentric studies would be necessary.

Introduction: The aim of treatment for most dementia patients should be comfort, symptoms control and withholding of futile or invasive treatments., Aim: To describe the decision of Nursing Home (NH) nurses towards some critical situations for advanced dementia patients., Methods: A questionnaire with 7 clinical cases was administered to the nurses of 7 Italian NHs. The cases described a common or exemplar situation in an advanced dementia patient (FAST stage >7a) and limited life expectation. For each case the 4 closed ended questions described a behavior oriented to comfort (one answer) or aggressive treatment (3 answers)., Results: Sixty-three/92 nurses (68.5%) answered the questionnaire. The majority (39, 61.9%) would feed the patient until death; 53 (84.1%) would favor hospital admission or resuscitation attempts while 55 (87.3%) would administer antibiotics for pneumonia even without distressing symptoms. With an expected survival <15 days 34 (54%) would favor a terminal sedation with refractory symptoms and 35 (55.6%) would stop unnecessary treatments (only 4 would prefer subcutaneous route). Thirty-two nurses (50.8%) would assess pain while 28 (44.4%) would contain an agitated patient. Continuing education is associated to cestrain behaviors, specifically for sedation (p 0.01) and revision of drug regimens (p 0.05)., Conclusions: Nurses are not fully competent in providing palliative care. Due to the impact of education, courses should be developed to improve the care of the dying and make nurses aware of the natural course of dementia.

Unlabelled: Assessment of pain associated to common invasive procedures and nurse's opinion., Introduction: Invasive diagnostic and therapeutic procedures (IDTP) may be painful and cause physical and emotional discomfort., Aim: An observational study was conducted in three medical wards of S. Giovanni Battista Hospital, to a) assess pain and discomfort experienced by patients during IDTPs and nurses' opinion; b) describe frequency and outcomes of the administration of analgesics and anxiolitics., Methods: Pain was assessed with a Numeric Rating Scale (NRS) before and after IDTPs and patients were asked to describe the main causes of pain/discomfort experienced. Nurses expressed their opinion on pain and discomfort caused by a list of IDTPs. Means and DS sere calculated for each IDTP., Results: Data on 186 patients and 200 IDTPs were collected. The most performed IDTPs were EGDS (18%), blood gas analysis (14%) and colonoscopy (12.5%). The most painful were Bone Marrow Biopsy (BOM) (NRS 7.05) and colonoscopy (NRS 6.44); those more anxiety provoking the BOM (NRS 7.26) and bronchoscopy (NRS 5.09). No analgesic or insufficient dosages were administered before some IDTPs and 56% patients would have liked it. Nurses rated patients pain and fear/anxiety significantly higher than patients., Conclusions: Acute pain, fear and anxiety are poorly controlled; the lack of protocols for pain control may be responsible for the different levels of discomfort experienced.

Aim: The aim of the study was to assess the variability of implementation of bladder training (BT) before removal of indwelling catheter and the reasons for implementing it or not., Methods: A multicentre survey was conducted administering a questionnaire to 338 nurses of 28 wards (medicine, surgery, urology and orthopedic wards) of 6 large hospitals in the Turin area. Seven clinical cases were proposed and for each nurses were asked to specify if they would use bladder training and the reasons for doing it or not., Results: Two hundred and forty questionnaires (71%) were returned. Overall, only 10% of nurses (24) routinely implement BT; 24.2% (58) only occasionally while 65,8% (158) never. The BT is used mostly in surgical and urological wards. When considering behaviors related to the proposed cases, in 63.3% nurses would not consider BT. The choice of using it is not associated to basic training (p=0.43) neither to professional experience (p=0.62) but to the experience of the patients' conditions. In fact, less frequent is the experience with the patients' clinical case, more frequent the performance of BT., Conclusions: The use of BT is limited, but due to the lack of evidences and indications, behaviours vary across wards. Even in wards were BT is never used, nurses would practice it in situations where they lack of clinical experience.

Aims: Aging of registered nurses workforce is already a worrying issue in many countries and therefore attempts to estimate its alarming dimension are on course. Some worrying signals are already evident in Italy but, to date, no data are available on the size and possible evolution of the problem., Methods: This study aims to describe the trend of the aging of nurses workforce in three hospitals of Turin in the next 25 years and to explore retention strategies., Results: The percentage of nurses > 45 years ranges from 19 to 21% but it is bound to steadily increase, ranging from 59 to 71%., Conclusions: The creation of an healthy work place, tailored to the needs of ageing of the workforce and the implementation of retention strategies and incentives centered on this age-group will be one of the immediate future challenges, to govern an highly predictable emergency.