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To compare the occurrence and the reasons for unfinished care among coronavirus disease (COVID-19) and non-COVID-19 patients as perceived by nurses.The recent pandemic has imposed tremendous changes in hospitals in all countries.Investigating the occurrence of and the reasons for unfinished care as perceived by nurses working in COVID-19 and non-COVID-19 units might help to gain insights and to address future pandemics.A comparative cross-sectional study based on the STROBE guideline has been conducted during November 2020-January 2021. The Unfinished Nursing Care Survey, comprising part A (elements) and part B (reasons), was administered online to all 479 nurses working in medical and surgical units converted progressively into COVID-19 and non-COVID-19 units. A total of 90 and 200 nurses participated, respectively.No differences in the unfinished care occurrence have emerged at the overall level between nurses caring for COVID (2.10 out of 5; 95% confidence interval [CI], 1.94-2.27) and non-COVID-19 patients (2.16; 95% CI, 2.06-2.26). Reasons for unfinished care reported significant higher averages among nurses caring for COVID (2.21; 95% CI, 2.10-2.31) as compared with those caring for non-COVID-19 patients (2.07; 95% CI, 2.01-2.14; p = 0.030).The overall occurrence of unfinished care was slightly higher compared with pre-pandemic data in all patients.Reasons triggering unfinished care were slightly different and were due to priority setting and human resources issues, which were perceived at higher significance among nurses working in COVID-19 compared with non-COVID-19 units.A clear map of action has emerged that might be valid in the post-COVID-19 era as well as in the case of future pandemics.

To identify the profile of time restrictions and their justifications as reported on a set of published reviews.There is a body of methodological knowledge addressing how to design and perform reviews in their different designs. However, how the time restrictions should be set and the justifications that should be provided have received limited attention to date.A Focused Mapping Review and Synthesis following three steps (Focus, Mapping and Synthesis) was performed on 2021. The ENTREQ checklist was followed to report methods and findings.All Journal of Clinical Nursing reviews published in online or printed version on 2020 (n = 85). Time limits imposed in the literature search, and justifications provided were mapped and synthetised with quantitative and a qualitative analysis.Time restrictions in reviews are not always reported and, when available, reflect three different profiles: (a) including all studies, to provide a comprehensive review; (b) selecting a period, to provide reviews for a contemporary practice; and (b) including only recent studies for reviews reflecting current practice. Reasons justifying time restrictions are not always reported; when documented, justifications regard changes in the practice, in the research or in the theory occurred over time, recent or ongoing.In exploring the date restrictions applied in reviews published over the course of a year, it emerged that the time of access to the sources and the justifications are not always indicated. The attributes of the emerging concepts of "comprehensive reviews," "contemporary practice reviews" and "current practice reviews" might be further developed to support researchers in selecting an appropriate time frame.Reviews require improvements regarding the time restrictions and their justifications. Methodological efforts to standardise the approach ensuring transparency in review protocols and in the following review publication are recommended.

This study aimed (a) to identify the communication issues and problems faced by individuals with hearing impairment (HI)/deafness during the COVID-19 pandemic and (b) to describe strategies to overcome the issues/problems and/or prevent their negative impact.Individuals with mild or severe HI face everyday communication problems, which have been worsened during the COVID-19 pandemic. However, no studies have summarised the available evidence to better understand the communication challenges faced by them and strategies allowing better interactions. The long duration of the outbreak-more than 2 years, with policies that have just been lifted in some countries-and the possible return of restrictions in the next Winter suggest the need to summarise evidence in the field.A rapid review is reported here in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Medline, CINAHL and Scopus databases were searched, including (a) primary or secondary studies published from January 2020 to 12 January 2022, (b) involving individuals with HI/deafness, (c) during the COVID-19 pandemic and (d) written in English. Data were extracted and summarised by using a content analysis approach.No Patient or Public Contribution.Fourteen studies were included as follows: three non-systematic reviews, seven cross-sectional, three quasi- experimental and one qualitative study, performed mainly in the US and the UK. Face mask covering use; physical and social distancing; and information, education, rehabilitation, and healthcare accessibility have emerged as the main challenges triggering consequences such as social isolation, loneliness, poor knowledge regarding the prevention and mental health issues. Strategies mitigating these challenges are as follows: (a) adopting transparent face masks, (b) using basic skills while interacting (e.g. maintaining eye contact), (c) improving the availability of sign language interpreters, (d) allowing the presence of family members and (e) teaching basics of sign language to healthcare professionals.Individuals with HI/deafness live with several challenges, suggesting that their vulnerability has increased tremendously during the COVID-19 pandemic. The effectiveness of strategies to overcome these difficulties should be scrutinised by conducting more research. Moreover, there should be increased awareness among all citizens by equipping them with simple strategies to communicate effectively with individuals with HI, an approach that may increase inclusiveness and prevent further negative consequences and burden.

BACKGROUND To date, few studies have explored cases of implantable cardioverter defibrillator (ICD) shock delivery with the intent of understanding patients' educational and supportive needs. AIMS AND OBJECTIVES To explore patient experiences as lived before, during and after one or more shocks. DESIGN A descriptive qualitative study carried out between 2016 and 2017. METHODS Semi-structured face-to-face audio-recorded interviews were performed and analysed using a content analysis methodology. RESULTS A total of 50 patients (average age = 68.3 years; largely male = 49; 98%) were interviewed. Four themes emerged: (a) "Feeling surprised vs. alerted by the changes inside me"; (b) "Living an intense, mono-dimensional vs. living a multidimensional storm experience", (c) "Facing the event vs. being supported"; and (d) "Living a drama vs. being used to it". CONCLUSIONS Findings suggest that ICD use can trigger negative physical and emotional effects in patients. Moreover, nurses should recognize patients' educational needs according to the stage of adaptation that each patient is experiencing with the aim of tailoring appropriate supportive interventions. RELEVANCE TO CLINICAL PRACTICE Therefore, it is necessary to consider the psychological needs of patients by integrating these into clinical care at different levels (emergency department, hospital ward, home). Specific structured support aimed at helping patients overcome intense negative experiences is suggested, especially in the first stage of the adaptation process. Nurses should also ensure that appropriate education programmes with adequate follow-up interventions are offered to improve the experience of living with an ICD. In addition, patient-reported outcomes should be routinely collected from patients with an ICD.

Aims and objectives To describe contextual factors (CFs) used by nurses to increase placebo and to prevent nocebo effects. Background Placebo effects have been studied in the nursing discipline, but nocebo effects still remain unexplored. Recently, a set of CFs functioning as triggers of placebo/nocebo effects has been described; however, its use in daily care has never been documented to date. Design A national cross-sectional survey, according to the Checklist for Reporting Results of Internet E-Surveys guidelines and STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE), was performed in 2016. Methods A wide sample of Italian nurses belonging to four national associations was involved. A questionnaire based on CFs literature was developed and administered through the SurveyMonkey Software® exploring: (a) CFs definition, (b) beliefs, (c) case-by-case frequency of use, (d) circumstances of application, (e) clinical conditions where participants perceived their potential beneficial effects, (f) ethical implications and (g) communication issues with the patient. Results Out of 1,411 eligible nurses, 455 answered (32.2%) and 425 questionnaires (30.1%) were valid for the analysis. A total of 211 nurses (49.6%) defined the CFs as an intervention with a possible aspecific effect; participants believed in the CFs (2.91; 95%CI 2.88-2.94), using them >2 times/month, mainly in addition to a nursing intervention to optimise clinical outcomes (n = 79; 18.6%). Psychological and physiological therapeutic effects have been perceived mainly in chronic pain (n = 259; 60.9%) and insomnia (n = 243; 57.2%). According to participants, CFs have been reported as ethically acceptable when exerting beneficial psychological effects (n = 148; 34.8%); however, 103 (24.2%) of nurses did not communicate to the patient when CFs were used. Conclusions Nurses are aware of CFs as elements to increase the placebo and prevent the nocebo effects in concomitance with evidence-based nursing interventions. Relevance to clinical practice The CFs valued by nurses and experienced as effective are mainly based upon the internal quality of the nurse and the quality of the relationship between the nurse and the patient. These qualities require a large personal investment; therefore, nurses should be supported in developing these qualities since their nursing graduation.

To collate and synthesize published research on interventions developed and tested to prevent or reduce the rates of rationed or missed nursing care in healthcare institutions.Rationed and missed nursing care has been widely studied, including its predictors and associations with patient and nurse outcomes.Scoping review.We searched for eligible studies, published between 1980-2019, in six electronic databases.Researchers independently screened the abstracts of the retrieved studies using the inclusion and exclusion criteria. The decision of whether or not to include any given study was consensus-based.The search yielded 1,815 records, of which 13 were included. Three studies reported structural interventions, namely increased nurse staffing and improved nursing teamwork, both resulted in significant reductions in the rates of rationed or missed nursing care. The remaining 10 studies reported on process interventions: four concerned reminders (via technology or designated persons) and seven described interventions to change or optimize the relevant care processes. All 10 process interventions contributed to significant reductions in the rates of missed nursing care.The results of the scoping review indicate that specific interventions can positively influence the performance of a selected nursing care activity, for example fall prevention. There is no evidence of a global reduction of rationed and missed nursing care through these interventions.Clinicians, managers and researchers can use the results for adapting and implementing interventions to reduce rationed and missed nursing care.目的: 整理归纳已发布的关于已制定并予以测试的干预措施的研究,避免或减少护理机构中护理服务受限或缺失的比例。 背景: 服务受限和缺失的护理已进行过广泛研究,包括其预测因子和对患者和护士影响的相关性。 设计: 范围评估。 数据来源: 我们在六个电子数据库中查询了1980年至2019年期间所有符合条件的研究。 评估方法: 研究员利用纳入和排除标准独立筛选了所检索的研究摘要,并基于共识决定是否包含某项给定研究。 结果: 本研究共筛选了1815条研究记录,共纳入13条。其中三项研究报告了结构性干预,即,增加护士人员配置,加强护理团队,这两项措施均大大减少了护理服务受限或缺失的比例。其余10项研究涉及过程干预:其中4项与提醒机制有关(通过技术手段或指定人员),7项研究说明了采取干预措施可以改变甚至优化相关护理过程。全部10项过程干预研究均得出结论,可以极大降低护理缺失的比例。 结论: 范围评估的结果说明,特定干预可以对选定护理活动的绩效产生积极影响,例如,预防跌倒。但尚无证据表明这些干预措施可以全面降低护理服务受限和缺失比例。 影响: 临床医生、管理人员和研究员可以利用这些结果修改并实施干预,从而减少护理服务受限和缺失的情况。.

Background In the industrialized world, approximately 1–1.5% of the population has received treatments for skin lesions. In the 1990s, a polymeric barrier film called the No Sting Barrier Film (NSBF) was developed as an alternative to petrolatum-based ointments and zinc oxide formulas. To date, few studies have explored the effectiveness of NSBF in protecting skin integrity. Aims To map the methods, fields and outcomes used to produce evidence on NSBF effectiveness. Methods A scoping review was performed in 2015. A search strategy for identifying relevant studies was designed and performed. Systematic reviews, meta-analyses, randomized controlled trials, controlled clinical trials, and comparative studies for all types of interventions were included; research conducted in any clinical context was eligible for inclusion. Studies were selected by two reviewers; data extraction and analysis also was performed by two reviewers and disagreements were discussed. Results Six studies were included. NSBF's potential as a skin protector was investigated with respect to (a) chronic wounds (pressure ulcers or vascular leg ulcers); (b) urinary or fecal incontinence; and (c) post-mastectomy irradiation. The principal clinical outcomes investigated were, respectively: (a) wound healing, wound exudates and erythema control; (b) incidence of incontinence-associated dermatitis and skin reactions; and (c) intensity of pruritus and skin reactions. Pain and comfort were measured in all clinical applications. The main process outcomes investigated were: (a) ease of application, (b) application and removal time, and (c) costs. Zinc oxide and petroleum formulations were the most common comparison interventions in research on chronic ulcers and incontinence; sorbolene cream and topical corticosteroids were the most frequent comparisons in the context of post-mastectomy irradiation. Linking Evidence to Action NBSF may be used for peri-wound skin protection in patients with chronic wounds, with urinary or fecal incontinence and for women undergoing post-mastectomy irradiation. However, more robust experimental studies are needed in all clinical fields where NBSF is applied.

Aims and objectives To validate a tool measuring self-directed learning (SDL) abilities and to determine these abilities among older individuals attending the University of the Third Age. Background Health literacy (HL) and SDL abilities have been documented as being closely linked to each other and as prerequisites in enhancing self-management competences required by older people to protect their health and to manage health issues. Furthermore, individuals with SDL abilities have been documented to have a full understanding of their health treatment prescriptions, to be able to demonstrate increased compliance and to further develop self-care competences. Design A validation and a cross-sectional study design. Methods A consecutive sample of 313 older people (68.7% female) who attended lessons in two Italian Universities of the Third Age and who were willing to participate in the study were enrolled. The Self-Rating Scale of Self-Directed Learning (SRSSDL) validated previously in the healthcare context, was used. Results At the exploratory and confirmatory factor analysis, the SRSSDL in Older people (SRSSDLO) has demonstrated good psychometric properties: the tool is composed by four factors ("Awareness," "Attitudes," "Availability" and "Motivation") and 13 items. According to the findings, the average SDL score was 54.27 ± 6.69 out of 65, and women achieved significantly higher scores compared with men (54.81 ± 6.69 vs. 53.08 ± 6.54, p = .033), while participants with a university degree (55.95 ± 6.56) or secondary education (54.75 ± 6.13) had higher scores than those with lower secondary education (50.37 ± 7.34, p = .002). Conclusions Participants were responsible for their learning processes and were capable of identifying learning needs and goals. They were also internally motivated to develop learning methods and to organise learning activities. However, they were less able to keep up to date with the learning resources available. Implications for practice The SRSSDLO can help nurses identify healthy older people that lack SDL abilities and design tailored educational interventions to prevent health conditions and/or promote self-care management in chronic conditions.

Rationale There is growing interest in validating tools aimed at supporting the clinical decision-making process and research. However, an increased bureaucratization of clinical practice and redundancies in the measures collected have been reported by clinicians. Redundancies in clinical assessments affect negatively both patients and nurses. Methods To validate a meta-tool measuring the risks/problems currently estimated by multiple tools used in daily practice. A secondary analysis of a database was performed, using a cross-validation and a longitudinal study designs. In total, 1464 patients admitted to 12 medical units in 2012 were assessed at admission with the Brass, Barthel, Conley and Braden tools. Pertinent outcomes such as the occurrence of post-discharge need for resources and functional decline at discharge, as well as falls and pressure sores, were measured. Explorative factor analysis of each tool, inter-tool correlations and a conceptual evaluation of the redundant/similar items across tools were performed. Therefore, the validation of the meta-tool was performed through explorative factor analysis, confirmatory factor analysis and the structural equation model to establish the ability of the meta-tool to predict the outcomes estimated by the original tools. Results High correlations between the tools have emerged (from r 0.428 to 0.867) with a common variance from 18.3% to 75.1%. Through a conceptual evaluation and explorative factor analysis, the items were reduced from 42 to 20, and the three factors that emerged were confirmed by confirmatory factor analysis. According to the structural equation model results, two out of three emerged factors predicted the outcomes. Conclusions From the initial 42 items, the meta-tool is composed of 20 items capable of predicting the outcomes as with the original tools.

Aim To compare students' and families' nursing education expenditures across Europe. Background Nursing education costs are affected by investments in public education. The remaining costs fall on the shoulders of students and their families. While remaining somewhat understudied, public and student expenditure for nursing education is becoming critical in the current crisis context. Comparative studies on education costs are inevitably affected by a currency bias. Therefore, a standard measure named the Purchasing Power Standard, which has received no attention in nursing research, has been introduced. Design A mixed-method study incorporating qualitative and quantitative study designs was undertaken in 2011–2012. Methods Five nursing faculties located in the Czech Republic, Greece, Italy, Slovakia and Slovenia were included in the study. A questionnaire evaluating students' expenditures was developed in five languages and validated. Six hundred and twenty-five full-time students were recruited. Results A Slovakian student wishing to pursue a nursing career is required to commit an amount of money per year that corresponds to 15% of the average annual income of a Slovakian citizen. Lower percentages were required by students in Greece (10%), Italy (11%) and Slovenia (12%), while Czech students bore the lowest costs (5%). Conclusion None of the countries involved was supporting nursing students through either direct or indirect financial incentives. Students in some countries were also required to buy and maintain uniforms. There is a need to develop supportive policies, especially in those countries where nursing programmes are expensive and may not be accessible to all talented and motivated students due to limited public support in education and the current economic context.

Background: In accordance with the process of nursing globalization, issues related to the increasing national and international mobility of student and qualified nurses are currently being debated. Identifying international differences and comparing similarities for mutual understanding, development and better harmonization of clinical training of undergraduate nursing students is recommended. Aims: The aim of the study was to describe and compare the nature of the nursing clinical practice education models adopted in different countries. Methods: A qualitative approach involving an expert panel of nurses was adopted. The Nominal Group Technique was employed to develop the initial research instrument for data collection. Eleven members of the UDINE-C network, representing institutions engaged in the process of professional nursing education and research (universities, high schools and clinical institutes), participated. Three data collection rounds were implemented. An analysis of the findings was performed, assuring rigour. Results: Differences and homogeneity are reported and discussed regarding: (a) the clinical learning requirements across countries; (b) the prerequisites and clinical learning process patterns; and (c) the progress and final evaluation of the competencies achieved. Conclusions: A wider discussion is needed regarding nursing student exchange and internalization of clinical education in placements across European and non-European countries. A clear strategy for nursing education accreditation and harmonization of patterns of organization of clinical training at placements, as well as strategies of student assessment during this training, are recommended. There is also a need to develop international ethical guidelines for undergraduate nursing students gaining international experience.

Aims and objectives To explore nurses’ narratives of unexpected patient deaths during nightshifts. Background Despite the importance of patient care and safety during the night, little attention has been paid to this issue in scientific literature. Very few studies have investigated the outcome of night-time nursing care in patients, and there is a distinct paucity of knowledge regarding the experiences of nurses who discover a patient who has died unexpectedly during a night shift. Design A qualitative study design using semi-structured interviews, interpreted by a narrative inquiry methodology, was adopted. Methods A purposeful sample of 15 nurses working in Italian medical wards who had found a patient who had died unexpectedly during a night shift, and who had given their informed consent were interviewed in the period from 2009–2011. An inductive content analysis of the narrated experiences was performed. Findings A patient's unexpected death during a night shift is something that nurses fear, and when it occurs, the experience is remembered as a nightmare. From the narratives of the participant nurses, five categories described what happened at night when a patient who had died unexpectedly was discovered: (1) the night started by nurses selecting patients needing intensive surveillance; (2) patients were reprioritised for intensive surveillance; (3) nurses were deceived by apparently normal findings; (4) nurses realised the failure of their protective role; and (5) as a consequence, more intrusive surveillance measures were adopted after the event. Conclusions From the narratives, a number of failures in cumulative and individual surveillance occurred during the night when a patient died unexpectedly. The deaths were recognised late, causing intense pain in nurses; this experience affected the following night shifts, when the nurses’ surveillance was more intensive, insistent and intrusive towards patients, even if this was unnecessary. Relevance to clinical practice The continuing belief that the night shift is a time when fewer nurses are needed means that the number of registered nurses is reduced and reliance is placed on nursing aides instead, placing patients at risk by compromising the effectiveness of surveillance and the consequent clinical decisions made by nurses and physicians.

The main aims of this study were to evaluate the intensity of stress, anxiety and depression as well as the effectiveness of coping strategies adopted pre-operatively in brain neoplasm patients. A descriptive-explorative study design was undertaken. During 2008, patients admitted to a large Italian hospital neurosurgical unit with their first (n = 21) or recurrent (n = 15) brain neoplasm, on the day before their surgical procedure, were consecutively recruited into the study. The Perceived Stress Scale, the Hospital Anxiety and Depression Scale and the Jalowiec Coping Scale were administered via face-to-face interview. Patients with their first occurrence of neoplasm perceived the same stress intensity as those with recurrent neoplasm (mean ± standard deviation: 14.9 ± 6.7 versus 17.2 ± 8.8, p = 0.36). They also reported the same likelihood of anxiety at a borderline level (odds ratio (OR) 4.88, 95%CI 0.42 to 40.97, p = 0.06) and at a clinically relevant level (OR 0.32, 95%CI 0.01 to 5.37, p = 0.35) as well as the same likelihood of depression at a borderline level (OR 1.25, 95%CI 0.20 to 8.40, p = 0.78). Only one case of clinically relevant depression emerged among patients at their first diagnosis. Patients at their first occurrence, as well as those at recurrence, reported that they adopted optimistic coping strategies (mean 2.20, 95%CI 2.01 to 2.38 versus mean 1.96, 95%CI 1.71 to 2.20) and sought support (mean 1.81, 95%CI 1.58 to 2.05 versus mean 1.89, 95%CI 1.63 to 2.15). According to the findings of this exploratory study, on the pre-operative day, brain neoplasm patients at their first diagnosis and at recurrence wish to confront the situation: they adopt optimistic coping strategies, they seek support and they wish to take a constructive problem-solving approach. Knowledge of the intensity of stress, anxiety and depression as well as the coping strategies adopted by the patients is important for clinicians in their efforts to tailor care to patients' individual needs.

Aim The objectives of this study were to describe (a) the reasons why students about to start university did not choose a nursing degree, (b) the source of information/data on which they based this decision, and (c) the accuracy of this information with regard to the nursing profession in Italy. Background Although data are available for students who embark on a degree and the reason(s) why they choose nursing, few data are available for students at the point of matriculation who have not chosen a nursing degree. Methods A cross-sectional study design, including six Italian degree programmes randomly selected among the 12 available, was performed. A structured questionnaire was administered to 580 students willing to participate of the 1095 eligible (53%) in their first university lecture in autumn 2011. Results Some 507 (87.4%) questionnaires were analysed. The main reason for not having chosen a nursing degree is the lack of interest in nursing (235; 47.2%), followed by not wanting contact with ill or dying people (87; 17.5%), the fear of contact with biological material (71; 14.2%) and the lack of recognition of nursing work (44; 8.8%). Among the participants, personal experience (186; 37.1%) and relatives (124; 24.8%) are the main sources of information on the nursing profession. Moreover, only 340 participants (67.1%) recognized the degree as a necessary qualification for nursing in Italy; the majority know nothing about nursing career opportunities (452; 89.2%) or the initial salary of a nurse (250; 49.3%). Conversely, 447 (88.2%) participants indicated correctly the responsibilities imposed on nurses by the law. Discussion A considerable proportion of non-nursing students are not interested in the nursing profession and the information in their possession regarding nursing profession is incorrect. Conclusions Multiple strategies helping potential candidates to make the best career decision on the basis of valid information should be strengthened and offered during the secondary school, through nursing students, families, teachers and networks, and not just the media. In addition, efforts to improve the working conditions of nurses must be undertaken.

PURPOSE. The purpose of this study was to describe the implementation strategies of measurement instruments and their validity as adopted in Italian hospital nursing practice. METHOD. A descriptive, regionally based study was adopted in 2008. Eight public hospitals were included. After collecting the available instruments used by nurses and/or patients in the measurement of patients' problems or perceptions of those problems (actual and/or potential), the researchers conducted two structured interviews per ward: the first with the chief nurse, the second with a clinical nurse. The interviews focused on each measurement instrument collected, on the implementation strategies adopted for the instruments, and on the perceived usefulness and appropriateness of each instrument. FINDINGS. Overall, 70 wards were included; 18 (25.7%) of the wards did not use any instrument. In the remaining 52 wards, 156 instruments were collected (from 1 to 10 per ward) evaluating 55 different actual or potential patient problems. Of the instruments adopted, 70.9% were not formally validated. Hospital administration primarily determined which instruments were to be used (67, 42.9%), and introduction to staff was mainly supported by continuing education courses (92, 59%). The level of appropriateness and usefulness of the instruments, as perceived by the clinical nurses and chief nurses, was high (>8 on a scale of 0–10, where 0 = not at all appropriate/useful and 10 = very appropriate/useful). CONCLUSION. Despite the increasing demands for reliable nursing data as a basis for measuring nursing effects on nursing outcomes and safety, a number of wards used no measurement instruments at all; within wards that used measurement tools, many instruments had not been validated. IMPLICATIONS. The introduction of nonvalidated instruments in Italian hospitals needs to be restricted because of the short- and long-term negative effects these nonvalidated instruments may have. A national consensus on approved and validated instruments for nursing assessment should be made available in the wards as a priority.

papastavrou e., efstathiou g., tsangari h., suhonen r., leino-kilpi h., patiraki e., karlou c., balogh z., palese a., tomietto m., jarosova d. & merkouris a. (2011) A cross-cultural study of the concept of caring through behaviours: patients’ and nurses’ perspectives in six different EU countries. Journal of Advanced Nursing 68(5), 1026–1037. Abstract Aim. This paper is a report of an international study of patients’ and nurses’ perceptions of nurse caring behaviours. Background. Current economic constraints on healthcare systems, demand to increase the quality of care and the incorporation of the consumers’ perspective into care, have created a need to develop a clear understanding of nursing behaviours which convey caring. Patients in different areas of the world report different expectations of nurses’ caring actions when compared to nurses’ views. Method. A descriptive comparative survey design was used to analyse a sample of surgical patients (n = 1659) and their nurses (n = 1195) in 88 wards of 34 hospitals in Cyprus, the Czech Republic, Finland, Greece, Hungary and Italy. Data were collected in autumn 2009 using the Caring Behaviours Inventory-24. Nurses’ and patients’ responses were compared using both inferential and descriptive statistics. Results. Independent samples t-tests showed important differences between nurses’ and patients’ views. Although both groups perceived knowledge and skill as being the most important sub-scale, the nurses’ responses were higher compared to patients (P

Aim. To synthesise the evidence available in the literature on the effectiveness of the ultrasound bladder scanner in reducing the risk of urinary tract infection. Background. Acute urinary retention is the inability to empty the bladder notwithstanding it being full and is frequent in the postoperative period. Using the ultrasound bladder scanner for the measurement of urinary residue, nurses are able to evaluate the presence of urinary retention, monitor the volume and the excessive relaxation of the bladder and avoid unnecessary catheterisations. The association between urinary catheterisation and urinary tract infection is well documented in the literature. Design. A meta-analysis was conducted. Method. An extensive review was carried out by two researchers using multiple databases, including all articles published from 1 January 1986–8 February 2008. No restrictions were adopted with regard to language. Studies on (1) documenting hospitalised patients with a need to evaluate bladder urinary volume, (2) comparing the use of the ultrasound bladder scanner vs. the clinical judgment of the nurses in the evaluation of acute urinary retention followed by a decision regarding whether or not to apply a bladder catheter and (3) those documenting the impact on urinary tract infection associated with catheterisation were included. Results. A total of 61 articles were retrieved, of which 58 were excluded because they did not meet the inclusion criteria. The overall effectiveness of the bladder ultrasound scanner in the reduction of urinary tract infection associated with catheterisation was OR 0·27 (IC95% 0·16–0·47; p-value 0·00000294, variance 0·08, weight 12·50). Discussion. The ultrasound bladder scanner helps to define and monitor bladder urinary volume and therefore, to catheterise patients only when necessary. Although there were numerous factors affecting the clinical heterogeneity of the included studies, the reduction in risk of urinary tract infection associated with catheterisation was consistent. Conclusion. The use of the ultrasound bladder scanner for evaluating and monitoring the residue volume in immediate postoperative patients, aged 18 or above, reduces unnecessary catheterisations and therefore the risk of urinary tract infection associated with catheterisation. Relevance to clinical practice. The systematic use of the ultrasound bladder scanner in the peri-operative period could increase the appropriateness of catheterisation and reduce patient discomfort, costs and days of hospitalisation associated with urinary tract infection associated with catheterisation.

palese a., granzotto d., broll m.g. & carlesso n. (2010) From health organization-centred standardization work process to a personhood-centred care process in an Italian nursing home: effectiveness on bowel elimination model. International Journal of Older People Nursing 5, 179–187 Aims. An Italian nursing home’s standardized work process redesign towards a personhood-centred nursing care is the focus of this study. The aim was to develop and implement a multi-method, personhood-centred, bowel elimination programme, to reduce the number of patients suffering from constipation and lessen the use of the invasive practises routinely adopted in nursing home (laxatives, enemas, rectal exploration). Background. Although the importance of the application of personhood-centred care concepts in gerontology nursing has been widely recognized, the actual tendency of the Italian National Health System, which has few nursing resources for to the care of the older persons, is standardization. Standardization is enacted mainly by a functional pattern and carries the risk of using the same nursing answer to patient’s different needs, priorities, preferences and histories. Constipation in older people living in nursing homes is one of the effects of extreme standardization. Methods. A case-crossover study design was adopted from 2006 to 2007. Twenty persons were enrolled in the programme. The multi-method programme included three phases: assessment (first phase), development/implementation (second) and evaluation (third phase). Results. In the first phase, nine (45%) persons were constipated; in the third phase, only two (10%) were constipated (χ2 6.14, P = 0.013). The relative risk of being a constipated person in the first phase compared with the third phase was 4.5 (confidence interval 95%: 1.11–18.27). During the first phase 562 invasive procedures were observed (± 25.5, range: 2–85) for bowel elimination whereas during the third phase 120 were observed (± 12, range: 0–58). Conclusion. After the personhood-centred multi-method programme, seven persons have modified their bowel elimination pattern, and they were no longer constipated. The programme has also reduced the use of invasive procedures. The reduction of invasive practises might have affected positively the persons’ quality of life, their comfort and also the workload of the nurses, reducing the time they needed for constipation management and using it for prevention strategies.

PALESE A., CRISTEA E., MESAGLIO M. & STEMPOVSCAIA E. (2010) Italian–Moldovan international nurse migration: rendering visible the loss of human capital. International Nursing Review57, 64–69 Aim: To describe the process of the migration of Moldovan nurses to Italy. Background: Formerly a part of the Soviet Union, the Republic of Moldova gained independence in 1991. Currently, there are 25 848 nurses (60.6 per 10 000 inhabitants) working mainly in the public health system. Each year, around 2000 nurses leave the country in search of better working conditions and a better quality of life. Methods: A longitudinal study design was adopted (2006–2007). In the first phase, we contacted all known nurses living in Moldova and their available colleagues following a snowball sampling strategy. Inclusion criteria were nurses who had decided to migrate to Italy and had already prepared the migration documents and/or were awaiting their departure. In the second phase, we interviewed the same sample of nurses on arrival in Italy. Findings: After one year, only 25 nurses out of the 110 initially interviewed (22.7%) had arrived in Italy; none were working as nurses. The cost of the migration process incurred by each nurse was around 3278 euros, and the waiting time from the decision to leave until arrival was around 24 months. Conclusions: All Moldovan nurses involved in this study, once they arrived in Italy, ceased to exist from an official perspective. Policy and recommendations need to be developed to ensure the integration of Moldovan-educated nurses into the health-care system and to monitor the amount of human capital (in terms of care drain, brain drain and youth drain) that this process risks wasting.

The study analysed two key questions: (i) the prevalence of informal caregiving in medical and surgical wards of a high specialization hospital; (ii) the reasonable cost for the structure that would have to pay to replace informal caregiving? The study was conducted in June 2006 as a prevalence survey, using a questionnaire administered to informal caregivers and nurses working in medical and surgical wards of a high specialization hospital by ad hoc trained personnel. Questionnaire consisted in three sections: the first focused on patient's characteristics, the second on caregivers and the third on nurses' perception on caregiving phenomenon. One hundred and twenty-four eligible caregivers were identified. During the study patients admitted to hospital medical and surgery wards were 520. Among these 16.5% (86/520) was assisted by one or more caregivers. Caregivers' response rate was 69.4% (86/124), corresponding to 66 patients. This study yielded an average of 455.9 minutes per day (SD = 370.2; range = 120-1440) or 52.9 hours per week. Caregiver's presence was recognized in 88.9% (56/63) of patients. Despite the societal perspective, the costs and effects of informal caregiving to the informal caregiver are often ignored in economic evaluation. The costs of informal care are an important extent related to time inputs by relatives and friends of the care recipients. Our approach has been to monetize the informal activity care contribution of family members and/or caregivers.

Purpose: The objective of this study was to describe for how long a homogeneous group of 17 Romanian nurses who first arrived at the ‘Teaching Hospital’ in Italy in 2003, stayed in the same hospital/ward of the host country, why and when they decided to move from one hospital to another, and their levels of competence in core skills, after either 6 months or 3 years. Methods: A longitudinal study design was adopted. The first phase was carried out in 2004, the second in 2006. We used an anonymous questionnaire. Results: Only ten of the 17 nurses, who had started working in Italy 3 years before, remained in the same Hospital where they first started working. In spite of being given the opportunity to stay, some decided to move to hospitals where it is possible to earn more money or where they could save more by living in less expensive towns. The first nurse left the hospital in the first year, five in the second and one in the third year. Levels of perceived professional independence after 3 years are very good: the permanent group had improved their skills in all areas even though they felt a lack of confidence during the first 6 months. Conclusions: This study, within the limits of the sample and the methods, shows that foreign nurses are highly mobile in the host country and this revolves around the opportunity to earn more. With increasing recruitment of nurses from within the European continent, it is necessary to continue studying the factors that sustain foreign nurses, to find out how they can be helped, how to value their imported professional skills, how to reduce the initial lack of faith in their own abilities and to discover which strategies would encourage them to stay in the hospital where they arrived.

Aims and objectives. Aims of this study were to describe (a) the Romanian nurses’ reasons for emigration and the difficulties experienced in the first six months of integration, (b) their perception of the level of professional independence and competence gained in the first six months of working and (c) the strategies that either facilitated or impeded their development of professional independence at a teaching hospital. Background. The international recruitment of nursing staff is a strategy adopted by the Italian State to confront nursing shortages. Although the critical aspects and the opportunities available have been reported for many years, little has been written about the professional autonomy perceived by these nurses six months after their placement in the host country. Design. A descriptive study involving Romanian nurses working at the Udine University Training Hospital (Italy) was used. Methods. The participants were interviewed using anonymous questionnaires, which contained eight open and 20 closed questions. With their consent, the interview was done in the ward and took on average 45 minutes (from 30–60 minutes). Given a choice of language to use by the bilingual researcher, half the participants chose Romanian. Results. The small, homogenous group of Romanian nurses used as the sample and employed at the University Training Hospital, felt satisfied (in the areas of culture/placement/integration) and recorded similar facilitating factors and obstacles as those documented by other authors. By the sixth month following placement they felt they had a sufficient level of autonomy, but this was not the case in many skills, which are an essential part of Italian nursing. Conclusions. The expectations of the hospitals involved in international recruitment are higher than the Romanian nurses can guarantee, especially in the first six months. Integration obviously needs substantial investment, less ‘red-tape’ and a longer period of time for adjustment. Relevance to clinical pratice. It is necessary to help and support the placement of these nurses into the Italian workforce with programmes where their practical work is supervised by permanent trained staff, allowing them to develop autonomy and ensuring an optimal standard of nursing care for the patients. It would be necessary to continue these programmes for more than six months.