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Aim: Patients with heart failure experience multiple co-occurring symptoms that lower their quality of life and increase hospitalization and mortality rates. So far, no heart failure symptom cluster study recruited patients from community settings or focused on symptoms predicting most clinical outcomes. Considering physical and psychological symptoms together allows understanding how they burden patients in different combinations. Moreover, studies predicting symptom cluster membership using variables other than symptoms are lacking. We aimed to (a) cluster heart failure patients based on physical and psychological symptoms and (b) predict symptom cluster membership using sociodemographic/clinical variables. Design: Secondary analysis of MOTIVATE-HF trial, which recruited 510 heart failure patients from a hospital, an outpatient and a community setting in Italy. Methods: Cluster analysis was performed based on the two scores of the Hospital Anxiety-Depression scale and two scores of the Heart-Failure Somatic Perception Scale predicting most clinical outcomes. ANOVA and chi-square test were used to compare patients' characteristics among clusters. For the predictive analysis, we split the data into a training set and a test set and trained three classification models on the former to predict patients' symptom cluster membership based on 11 clinical/ sociodemographic variables. Permutation analysis investigated which variables best predicted cluster membership. Results: Four clusters were identified based on the intensity and combination of psychological and physical symptoms: mixed distress (high psychological, low physical symptoms), high distress, low distress and moderate distress. Clinical and sociodemographic differences were found among clusters. NYHA-class (New York Heart Association) and sleep quality were the most important variables in predicting symptom cluster membership. Conclusions: These results can support the development of tailored symptom management intervention and the investigation of symptom clusters' effect on patient outcomes. The promising results of the predictive analysis suggest that such benefits may be obtained even when direct access to symptoms-related data is absent. Implications: These results may be particularly useful to clinicians, patients and researchers because they highlight the importance of addressing clusters of symptoms, instead of individual symptoms, to facilitate symptom detection and management. Knowing which variables best predict symptom cluster membership can allow to obtain such benefits even when direct access to symptoms-data is absent. Impact: Four clusters of heart failure patients characterized by different intensity and combination of psychological and physical symptoms were identified. NYHA class and sleep quality appeared important variables in predicting symptom cluster membership. Reporting Method: The authors have adhered to the EQUATOR guidelines STROBE to report observational cross-sectional studies. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the association between patient and caregiver depression and patient self‐care and caregiver contribution to self‐care in the context of ostomy care. Background: Self‐care is essential for ostomy patients and their caregivers. The ostomy self‐care process can be considered a dyadic phenomenon in which the patient and the caregiver interact together and work as a team. The presence of depressive symptoms may limit the patient's ability to perform self‐care and caregivers' abilities to engage in caregiving tasks. Research into the dyadic influence of depression on self‐care behaviours from the perspective of ostomates and their caregivers is still in its infancy. Design: Secondary analysis of a multicentre, cross‐sectional study. The STROBE checklist was used to report the present study. Methods: Patient–caregiver dyads were recruited from eight ostomy outpatient clinics from February 2017 to May 2018. Depression was assessed with the nine‐item Patient Health Questionnaire in both patients and caregivers. Patient self‐care was evaluated with the Ostomy Self‐Care Index, and caregiver contribution to self‐care was assessed with the Caregiver Contribution to Ostomy Self‐Care Index. Both instruments measure the dimensions of maintenance, monitoring and management. The actor–partner interdependence model was performed for the dyadic analysis. Results: In total, 252 patient–caregiver dyads (patients: 69.8% male, mean age 70.05; caregivers: 80.6% female, mean age 58.7) were enrolled. Patient depression was positively associated with caregiver contribution to self‐care maintenance. Caregiver depression was negatively associated with self‐care management. Relevance to Clinical Practice: These findings add a better understanding of the reciprocal influence of dyadic depression on patient and caregiver contributions to self‐care in ostomy contexts was found. Patient and caregiver depression influence patient self‐care and caregiver contribution to self‐care. Therefore, clinicians should assess and treat depression in both members of the dyad to improve self‐care. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study was to develop and psychometrically test the Nurse–Patient Mutuality in Chronic Illness (NPM‐CI) scale in two versions, one for nurses and one for patients. Method: A multiphase methodological study was conducted. In the first phase, a qualitative investigation was conducted through interviews and an analysis of the content; inductively, the items of two instruments were generated, one for nurses and one for patients. In the second phase, the content and face validity were assessed through the expert consensus method. In the third phase, exploratory factor analysis (EFA), Cronbach's alpha test, intraclass correlation and Pearson correlation coefficients were conducted to estimate construct, criterion validity and instrument reliability. For each phase, the sample included nurses and patients recruited from a large hospital in Northern Italy. Data collection was conducted between June and September 2021. Results: Nurse and patient versions of the NPM‐CI scale were developed. Two rounds of consensus reduced the items from 39 to 20; content validity index ranged between 0.78 and 1, content validity ratio was 0.94. Face validity indicated clarity and comprehensibility of the items. EFA identified three latent factors for both the scales. Internal consistency was satisfactory, with Cronbach's alphas ranging between.80 and.90. Test–retest stability was suggested, with an intraclass correlation coefficient of.96 (nurse scale) and.97 (patient scale). Predictive validity was established, with a Pearson correlation coefficient of.43 (nurse scale) and 0.55 (patient scale) between the mutuality scales and satisfaction in providing and receiving care. Conclusion: The results suggest that the NPM‐CI scales are sufficiently valid and reliable for the clinical practice among chronic illness patients and the nurses caring for them. A more in‐depth exploration of this construct in the context of nursing and patient outcomes is warranted. Patient or Public Contribution: Patients were involved in all study phases. Impact: Mutuality is fundamental in the relationship between nurse and patient, based on trust, equality, reciprocity, and mutual respect. The NPM‐CI scale was developed and psychometric estimated through a multiphase study in both nurse and patient versions. The NPM‐CI scale measures the factors of 'developing and going beyond', 'being the point of reference' and 'deciding and sharing care'. The NPM‐CI scale allows us to measure mutuality in clinical practice and research. Expected outcomes and influencing factors for patients and nurses could be associated. [ABSTRACT FROM AUTHOR]

Aim: To test the mediating role of burnout in the relationship between self‐efficacy and academic success in nursing students. Design: This was a cross‐sectional secondary analysis of longitudinal research aimed at exploring the academic success of nursing students. Methods: We enrolled a convenience sample of nursing students attending 21 Italian baccalaureate nursing degree programmes. Data were collected from 2014 to the 2018–2019 academic year. We analysed the wave of data collected during the third year of the programme. The measurements were the Academic Nurse Self‐Efficacy scale (ANSEs) and the Scale of Work Burnout (SWEBO). A mediation analysis with a counterfactual approach was performed. Results: The participants (n = 556) had a median age of 20 years (IQR 19–22) and the majority was female [70.5% (392/556)]. Academic success was reached by 51.97% (289/556) of the students. The findings reveal a significant direct effect of self‐efficacy on academic success and also a significant indirect effect of this relationship via burnout. Conclusion: The mechanism by which self‐efficacy influences academic performance in nursing students is more complex than a simple direct relationship. Universities should consider screening students for variables affecting academic success to decrease academic costs and increase ranking systems classification. Impact Nurses' professors should be engaged in strategies to promote self‐efficacy. The area of intervention should be structured both during classes and internships, in tandem with the mentor and the clinical nurse. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe caregiver contribution (CC) to ostomy self‐care and identify its associated variables among caregivers of ostomy patients. Background: Self‐care is essential for ostomy patients, but it can be difficult to perform. In these cases, caregivers play a key role in promoting self‐care behaviours. So far, the CC to ostomy self‐care has not been investigated thoroughly. Design: This is a cross‐sectional and multicentre study conducted at seven outpatient clinics of two Italian regions. Methods: We recruited 252 caregivers between February 2017–May 2018. The Caregiver Contribution to Ostomy Self‐Care Index (CC‐OSCI) was used to measure CC to ostomy self‐care. Three multivariable linear regression models were fitted to identify variables associated with CC dimensions (maintenance, monitoring and management). The STROBE checklist was used to report the present study. Results: The sample (mean age = 58.73, SD = 13.98) was mostly female (80.60%), unemployed (58.70%) and resided with the patient (81.00%). Caregivers being employed and those declaring more hours of contribution per week were associated with a significantly lower contribution to self‐care maintenance. Caregivers with lower levels of education and those residing with the patient were less likely to contribute to CC to self‐care monitoring. Spousal caregivers and those with higher preparedness contributed significantly lower to CC to self‐care management. Conclusions: We found a variety of sociodemographic factors associated with CC to ostomy self‐care. Relevance to clinical practice: Sociodemographic variables associated with CC to ostomy self‐care can help clinicians develop more tailored educational interventions for caregivers who find their contribution challenging. [ABSTRACT FROM AUTHOR]

Background: Wound care nurses are recognised as a key element for improving health outcomes. However, there is still fragmented knowledge of the outcomes associated with their practice in individuals with pressure ulcers. Aims and objectives: To identify, summarise and map all available evidence related to the outcomes of wound care nurses' practice in individuals with pressure ulcers. Design: Integrative literature review. Review method: To report the review, we followed the modified version of Cooper's five‐step methodology, and the PRISMA guidelines. Methods: The search was carried out on CINAHL, PubMed, the Cochrane Library and Scopus, with a time frame ranging from each database inception to December 21, 2019. We included observational or experimental studies of adult individuals affected by (or at risk of) developing pressure ulcers who were also cared for by wound care nurses. Results: Of the 439 peer‐reviewed publications, 13 studies met the inclusion criteria. The most frequent outcomes were pressure ulcer incidence, healing rate and time taken for complete healing. Less frequent outcomes were changes in pressure ulcers' stage, number of completely healed wounds, treatment costs and physical discomfort. No patient‐reported outcomes were assessed. Conclusion: This review indicates that clinical‐related outcomes were by far the most reported. Future studies should broaden the spectrum of outcomes to include more subjective parameters (e.g. pain, quality of life, stress, etc.), in order to gain a better understanding of the global impact of wound care practice on patients with pressure ulcers. Relevance to clinical practice: There is promising evidence of a positive impact of wound care nurses' practice on health and economic outcomes. Nonetheless, more robust and rigorous research is needed to provide stronger evidence in the field and support investment in these practitioners. [ABSTRACT FROM AUTHOR]

Aims: To investigate the relationship between depression and self‐care behaviours in older individuals with multimorbidity. Design: Cross‐sectional study. Data were collected between April 2017 – June 2019. Methods: Patients were enrolled from community and outpatient settings and included if they were ≥65 years, affected by heart failure, diabetes mellitus or chronic obstructive pulmonary disease and at least another chronic condition. They were excluded if they had dementia and/or cancer. Patient Health Questionnaire‐9 was used to measure depression and Self‐Care of Chronic Illness Inventory was used to measure self‐care maintenance, monitoring, and management. The relationship between depression and self‐care was evaluated by performing two sets of univariate analyses, followed by multivariate and step‐down analyses. The second set was performed to control for the number of chronic conditions, age, and cognitive function. Results: The sample (N = 366) was mostly female (54.2%), with a mean age of 76.4 years. Most participants (65.6%) had mild to very severe depressive symptoms. Preliminary analysis indicated a significant negative association between depression and self‐care maintenance and monitoring and a significant negative association between depression and multivariate self‐care. Step‐down analysis showed that self‐care maintenance was the only dimension negatively associated with depression, even after controlling for the number of chronic conditions, age, and cognitive function. Conclusion: In multimorbid populations, depression is more likely to be associated with self‐care maintenance than the other self‐care dimensions. Therefore, self‐care maintenance behaviours (e.g., physical activity and medication adherence) should be prioritized in assessment and focused on when developing interventions targeting depressed older adults with multimorbidity. Impact: The results of this study may help guide clinical practice. In patients with depressive symptoms, self‐care maintenance behaviours should be assessed first, as a potential first indicator of poor self‐care. [ABSTRACT FROM AUTHOR]

Objective Design Methods Results Conclusion Impact Reporting Method To describe self‐care in Italian adults with coronary heart disease and to identify sociodemographic and clinical determinants of self‐care.This is a cross‐sectional analysis of data from the Italian multicentre longitudinal study.We used the follow instruments: Self‐Care of coronary heart disease inventory, Self‐care Self Efficacy Scale, Charlson Comorbidity Index and Sociodemographic questionnaire. Descriptive statistics including absolute numbers, percentages, means and standard deviations were used to describe the sociodemographic and clinical characteristics of the sample, and the items. A structural equation model was fitted to understand sociodemographic and clinical variables associated with self‐care, and possible effects mediated by self‐efficacy.We enrolled 427 patients. Self‐care maintenance, monitoring, management and self‐care self‐efficacy means scores were 58.27 (SD = 20.07), 48.53 (SD = 26.97), 65.34 (SD = 22.85) and 77.16 (SD = 20.76), respectively. Except for the self‐care self‐efficacy scale, all the scores lay below the cut off 70 for adequacy. Older age, higher comorbidities, a higher number of stents placed, and the presence of a caregiver predicted poor self‐care.Self‐care in Italian CHD populations is poor. Several associations were found between the dimensions of self‐care and sociodemographic factors. Implications for the profession these findings are important for health care providers to plan interventions to improve self‐care behaviour. The study addressed self‐care behaviours of coronary heart disease patients. Self‐care was poor in this population; several associations were found between the dimensions of self‐care and sociodemographic and clinical determinants. Our results can be used to support health professionals in planning interventions to improve specific self‐care domains. STROBE checklist was followed. [ABSTRACT FROM AUTHOR]