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To assess the level of chronic obstructive pulmonary disease (COPD)-related knowledge within patient and informal caregiver dyads, and to identify factors influencing the knowledge level considering the interdependence within the dyads.Patients with COPD and their informal caregivers present poor disease knowledge and different characteristics are associated with their level of knowledge. Disease knowledge and related characteristics have been assessed separately in patients and informal caregivers, without considering possible influence within the dyads.Cross-sectional study.A convenience sample of dyads was recruited in outpatient and inpatient settings in Central and South Italy. The Bristol COPD Knowledge Questionnaire was used to measure disease knowledge. Sociodemographic, clinical and caregiving characteristics, self-efficacy and depression were measured in patients and caregivers. Multilevel modelling was used to analyse COPD knowledge at the level of the dyad to control for interdependency between patients and informal caregivers. The STROBE guidelines for cross-sectional studies were followed for study reporting.We recruited 133 dyads. The total level of correct knowledge shared by dyads was 32.89%. Dyads presented higher levels of correct knowledge about disease symptoms, smoking cessation and vaccination, and lower about COPD treatment. Younger patients with greater self-efficacy, who attended pulmonary rehabilitation and were cared for by a spouse/partner with low levels of depression, and informal caregivers who were patients' spouse/partner were more likely to have higher levels of disease-related knowledge.Our study advances dyadic research in COPD. Future studies should investigate the effects of shared knowledge and incongruent knowledge (where one member knows more than the other) on patient self-care and caregiver contribution to patient self-care.Our study shows what knowledge nurses should provide in educational programmes directed at patients and caregivers, and which dyads have greater knowledge deficits, to whom offer targeted educational interventions.

Aim To explore the experiences of being discharged from hospital of older patients with chronic diseases at time of discharge. Design Multi-centre descriptive qualitative study. Methods Semi-structured interviews were conducted with older patients with chronic diseases discharged from two Italian university hospitals, between March 2017 and October 2019. The interviews were audio-recorded, transcribed verbatim and analysed using inductive content analysis. Several strategies were used to ensure the credibility, dependability, confirmability, authenticity and transferability of the findings. The study was reported in accordance with Standards for Reporting Qualitative Research and Consolidated criteria for reporting qualitative research. Results Sixty-five patients participated in the study. Six main categories emerged: feelings, need for information, time of fragility, need for support, need for trusting relationships, and home as a caring place. Conclusion Older patients with chronic diseases are patients who require quality discharge planning with a patient-centred care vision. Healthcare professionals should intervene more extensively and deeply in the discharge process, balancing the patients' perception of their needs against organizational priorities and the wish to return home with that of not being abandoned. Impact Discharge from hospital remains an area of concern as older people have varying degrees of met and unmet needs during and following hospital discharge. Discharge is characterized by conflicting feelings of patients, who need information and support of healthcare professionals through trusting and continuous relationships. Understanding the experience of discharge is essential to support older patients with chronic diseases, considering that discharge from hospital is not an end point of care but a stage of the process involving care transition. The reframing of discharge as another transition point is crucial for healthcare professionals, who will be responsible for making their patients fit for discharge by preparing them to manage their chronic condition at home.

The purpose of the this study was to test the factorial structure, internal consistency reliability and concurrent validity of the Caregiver Contribution to Self-Care Chronic Illness Inventory.Existing measures of caregiver contribution to self-care are disease-specific or behaviour-specific; no generic measures exist.A cross-sectional study.Between April 2017 - December 2018, we enrolled a convenience sample of 358 patients with chronic illnesses and their caregivers. Patients completed the Self-Care of Chronic Illness Inventory while caregivers completed the Caregiver Contribution to Self-Care of Chronic Illness Inventory, a modification of the Self-Care of Chronic Illness Inventory, which includes three scales as follows: the Caregiver Contribution to Self-Care Maintenance, the Caregiver Contribution to Self-Care Monitoring and the Caregiver Contribution to Self-Care Management. Of each scale, we tested the factorial structure with confirmatory factor analysis and reliability with the factor score determinacy coefficient, the global reliability index for multidimensional scale and Cronbach's alpha. Also, we used Pearson's correlations for concurrent validity purposes.Confirmatory factor analysis supported the two-factor structure of the Caregiver Contribution to Self-Care Maintenance and Management scales and the one-factor structure of the Caregiver Contribution to Self-Care Monitoring scale. A simultaneous confirmatory factor analysis on the combined set of items supported the more general model (Comparative Fit Index = 0.933). Reliability estimates ranged between 0.701 and 0.961 across the three scales. Concurrent validity of Caregiver Contribution to Self-Care of Chronic Illness Inventory with the Self-Care of Chronic Illness Inventory was not sufficiently supported since weak correlations were found.The Caregiver Contribution to Self-Care of Chronic Illness Inventory is valid and reliable and can be used in clinical practice and research.The Caregiver Contribution to Self-Care of Chronic Illness Inventory is an useful instrument to evaluate the extent to which caregivers contribute to patient self-care in chronic illnesses.目的: 本研究旨在检验慢性疾病护理人员自我照顾贡献量表的因子结构、内部一致信度及并发效度。 背景: 现有护理人员对自我照顾的贡献衡量标准均是以疾病或行为为基础;无通用衡量标准。 设计: 横断面研究。 方法: 2017年4月至2018年12月间,我们对358名慢性病患者及其护理人员进行随机抽样调查。患者已填写慢性疾病自我照顾量表,且护理人员已填写其对慢性病自我照顾贡献量表,此量表是在慢性疾病自我照顾量表的基础上修订,包括三个量表:护理人员对自我照顾的贡献,护理人员对自我照顾监控的贡献以及护理人员对自我照顾管理的贡献。各量表中,我们通过验证性因子分析对因子结构进行检验,并用因子得分确定系数、多维量表整体信度指标和克隆巴赫系数,以进行信度检验。同时,我们利用皮尔逊相关系数进行并发效度分析。 结果: 验证性因子分析可在护理人员自我照顾共享维持与管理量表中所列双因素结构和护理人员自我照顾监测量表中所列单因素结构中适用。一般模型可在组合项目的同时验证性因素分析中适用(比较拟合指数=0.933)。经预计,上述三个量表的信度介于0.701到0.961之间。慢性疾病护理人员自我照顾量表与慢性疾病患者自我照顾量表的并发效度呈弱相关,因此,慢性疾病患者自我照顾量表未充分使用。 结论: 慢性疾病护理人员自我照顾贡献量表有效、可靠,可在临床实践和研究中使用。 影响: 慢性疾病护理人员自我照顾贡献量表是评估护理人员对慢性疾病患者自我照顾的贡献程度的有效工具。.

This review aimed to summarize existing nursing literature to provide an overview of the extent, range, and nature of nurses' involvement in artificial nutrition and hydration (ANH) at the end of life and to map the key concepts underpinning nurses' involvement in ANH. A scoping review was designed following the methodological framework guidelines of Arksey and O'Malley and the recommendations for advancing the methodology by Levac et al. An inductive qualitative content analysis was conducted according to the guidelines by Elo and Kyngäs. Thirty-nine articles were identified. Content analysis revealed 1 main category: "nurses' role in the decision-making process," with the 2 subcategories of "mediator" and "activator." The category and subcategories are influenced by the following generic categories: "being," "feeling," and "knowing," each of them constituted by 2 subcategories in their turn. Nurses perform the roles of activator and mediator. Their ability to establish good relationships and their attitudes enable the creation of teamwork and closeness to patients and family: relationships and attitudes are the subcategories of the "being" category. The category "feeling" represents the ways nurses experience the decision-making process, which can raise ethical and moral dilemmas and cause emotional responses. For these reasons, nurses have to create the right balance between personal-self and professional-self. The category "knowing" includes nurses' clinical and ethical knowledge about ANH. It emerges that deep clinical and ethical knowledge of ANH is necessary to provide consistent, adequate care at end of life.

Aim and objective To test the psychometric properties of the nursing students' version of the 24-item Caring Behaviours Inventory. Background Caring is at the heart of nursing and should also be a core value in nursing education. Caring can be manifested through measurable behaviours. The Caring Behaviors Inventory is a valid and reliable measure of nurses' caring behaviours in clinical settings. It has already been used among nursing students, but it needs more psychometric testing. Design Cross-sectional validation study. Method The questionnaire was filled in by 300 undergraduate nursing students at two Italian universities in May 2016. Exploratory factor analysis was conducted using Mplus maximum likelihood with GEOMIN oblique rotation. A multifaceted approach was used to evaluate the model fit. The STROBE checklist for cross-sectional studies was followed. Results Four dimensions were identified: "being with," "doing with competence," "responding to individual needs" and "providing effective care." Adequate fit indices and high reliability of the factors were found. Correlations between factors were positive and significant. Conclusion This study makes it possible to use the same tool to compare the caring practices perceived by students, nurses and patients. Further studies with bigger samples could be stratified to investigate the associations between caring levels and student characteristics. The Caring Behaviors Inventory can be used to call attention to caring in nursing education, helping to make this concept less elusive. Relevance to clinical practice The effective self-assessment of nursing students' caring behaviours offers opportunities for reflection on their caring practice. This could improve the caring level of their behaviours in clinical practice and help them to become caring nurses in the future.

Aims and objectives To summarise the evidence about patient-related risk factors for difficult intravenous access in adults, and at identifying nurses' beliefs and their consistency with evidence. Background Peripheral intravenous cannulation is a common procedure for nurses, but rates of failure at first attempt of peripheral intravenous cannulation range 10%-40%. Nurses' beliefs about difficult intravenous access factors might influence their clinical practice more than current evidence. Design The study included a literature review of the evidence on patient-related risk factors for difficult intravenous access, the development of an instrument to investigate nurses' beliefs about this topic and a cross-sectional multicentre survey on clinical nurses. Methods The quality of the studies included was evaluated through the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A synthesis of evidence for each risk factor was produced. A survey instrument was developed including 26 risk factors, which were then rated by nurses as perceived predictors of difficult intravenous access. The STROBE guidelines for study reporting were followed. Results Four hundred and fifty clinical nurses working in four hospitals in Italy were surveyed. Nurses' beliefs were in line with evidence in considering body mass index, drug abuse, lymphadenectomy and chemotherapy as difficult intravenous access factors. Beliefs about difficult intravenous access factors were influenced by nurses' work experience and frequency of peripheral intravenous cannulation. Nurses also identified as risk factors for difficult intravenous access oedema, thrombophlebitis, hypovolaemia, skin lesions and irritant therapies, which have been minimally investigated by research. Conclusions An overall congruence between nurses' beliefs and evidence about risk factors for difficult intravenous access was found. With their expertise, nurses may fill the knowledge gap of clinical evidence and open new paths for clinically meaningful research. Relevance to clinical practice Nurses' beliefs about difficult intravenous access factors can be influenced by their work experience and clinical setting. Integrating nurses' beliefs with scientific evidence can increase the quality of care.

Aims and objectives To describe which nursing activities are observed during the discharge of older patients with chronic diseases and to investigate the consistency between the nursing activities actually observed and those documented. Background The discharge from hospital of older patients with chronic diseases is a critical transition that can lead to dissatisfaction, delays in discharge, re-admission, adverse events and increased mortality. Although nurses' interventions during discharge are important for patient outcomes, little is known about the nursing activities actually performed as compared with those documented. Design An observational study of the nursing activities performed during patients' discharge and a retrospective audit of the nursing records of the same patients and nurses. Methods Structured nonparticipant observations were conducted of the activities performed by nurses at discharge. A retrospective audit of the nursing records relating to patient discharge, including the nursing diary and the assessment of critical issues at hospital discharge, was also conducted. The STROBE guidelines were followed (See Supporting Information Appendix S2). Results During hospital discharge of 102 patients, 1,224 nursing activities were observed. The number of activities was not related to patients' age, gender and educational level, nor to nurses' postgraduate education. Statistically significant correlations emerged between the number of activities observed and the nurses' work experience. Conclusions A predefined discharge plan guiding nurses' activities during discharge would enable them to respond better to the care needs of elderly patients. Relevance to clinical practice Results from the study could help clinical nurses to address care priorities of patients at discharge, by using appropriate plans and checklists and improving recording rates. Novice nurses should be supported when caring for elderly patients with chronic disease at discharge.

Purpose This systematic review identified, synthesized, and integrated concept analyses on self-care and related concepts. Design The guidelines for systematic literature reviews of the Joanna Briggs Institute were followed. Methods The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, PsycINFO, and EMBASE databases were searched for concept analyses published in the past 20 years. Findings A total of 26 concept analyses were identified that had been published on self-care, self-care agency, self-monitoring, self-management, self-management support, symptom management, and self-efficacy. Differences and commonalities in the examined literature were identified, and a model was delineated, explaining the relations among the various concepts from the nursing perspective. Conclusions The healthcare literature has broadly described self-care and related concepts; however, consensus on the definitions remains beyond our reach and should not be expected, due to the different perspectives and paradigms from which the concepts are interpreted. From a nursing perspective, self-care can be considered a broad concept encompassing the other concepts, which describe more specific individual levels of activities and processes. Clinical relevance Nurses are actively involved in disease management and self-management support as well as in promoting self-care in healthy and sick people. Referring to a model on self-care and related concepts could avoid misinterpretations in nursing practice, research, and policy.

Aims and Objectives To explore the lived experiences of patients with haematological malignancies who had been in protective isolation during their hospital stay for autologous haematopoietic stem cell transplantation. Background Although protective isolation aims to benefit patients’ health by preventing infection, it could also imply harmful psycho-social implications for patients, such as loneliness. Design A descriptive phenomenological study was conducted in an Italian university hospital. Methods Nine patients with haematological malignancies who had been in protective isolation for autologous haematopoietic stem cell transplantation were enrolled. They were interviewed during their weekly ambulatory visits, which are usually carried out up to 100 days post-transplant, and asked about their stay in isolation. Giorgi's method of analysis was used to describe the experience of protective isolation from the patient’ perspective. Results Eight themes emerged: isolation is a defence, threats from which patients have to defend themselves, rules for defence, the burden of the defence, external strategies for defence, inner strengths for defence, defending loved ones and outcomes of the defence. The general structure was expressed as a defence from suffering. Conclusions While fighting a hard battle against cancer, informants largely accepted the strict isolation measure and represented it as a shield for an effective defence. Relevance to clinical practice Nurses should provide emotional and social support to help patients feel like active fighters and strengthen their strategies for an effective defence from suffering.

Historically, the practical work of nursing has been based on a relationship and contact with the human body (Collie re, 2001; Draper, 2014; Lawler, 2006; Pupulim & Sawada, 2005; Sakalys, 2006; Wolf, 2014). Nurses interact with the patient's body so frequently that they touch the patient more than other healthcare professionals do (McCann & McKenna, 1993; Melia, 2014; Ribeiro Souza & Ordones do Nascimento Brandao, 2013). The human body is nursing's "site of labor" (Wolkowitz, 2002, p. 497), and nursing benefits from "privileged access" to the body (Lawler, 2006, p. 11) in states, places, and circumstances in which the body has the same need: to be assisted (Melia, 2014; Twigg, Wolkowitz, Cohen, & Nettleton, 2011; Wilde, 2003).In the literature, the human body is interpreted as a physical, concrete, and material entity to heal, treat, and medicate (body) and as a "lived body," which refers to the sensations, emotions, and feelings experienced through the body, in other words, a way of being and living "in," "with," and "through" one's own body (embodiment; Draper, 2014; James & Hockey, 2007; Lawler, 2006; Mariotti de Santana & Bessa Jorge, 2007; Moreno Altamirano, 2010; Sakalys, 2006; Wilde, 1999; Yakhlef, 2010).Scientific reflection has embraced the Cartesian dualism that sees the body-object as a physical entity, the object of disease treatment, and the body-subject as a subjective experience of illness (Carnevale, 1995; Carr, 2000; Lakoff & Johnson, 1999; Sakalys, 2006; Wilde, 2003; Yakhlef, 2010). This perspective has been questioned by modern antireductionist and antipositivist perspectives, such as that of Merleau-Ponty (Benner, 2000; Thomas, 2005). He contended that a person is an indissoluble unity of the "I" who thinks, his or her body, and his or her embodiment; we do not "have" a body, "we are" a body (Merleau-Ponty, 1945). Consequently, the meanings that we give to body and embodiment are linked to social rules and cultural beliefs (Lawler, 2006; Vannini & Waskul, 2012).However, dichotomous thinking has been strongly established in scientific research, creating a hierarchy in which the body has become the subject of detailed clinical studies, whereas embodiment has a marginal role (Holmes, 1994; Madjar, 1997). This is due to the biomedical model's preference for investigation methods applicable to the body and the objectively measurable knowledge that these methods generate, instead of patients' embodiment (Draper, 2014).Despite the increase in scientific literature and the recognition of the importance of body and embodiment in nursing over the last two decades, international theoretical and empirical research of these concepts is still neglected (Draper, 2014). The terms body and embodiment, although conceptually different, are used interchangeably and are little known and developed within the nursing discipline; researchers in the nursing field have taken very sporadic theoretical interest in the concepts (Sakalys, 2006; Thomas, 2005). Furthermore, the recognition of people's embodiment in the body as an explicit focus of the care process is rare in nursing theories (Lawler, 2006; Sakalys, 2006). Consequently, nurses learn how to work on the body through medicine, science, and practice, but they receive little instruction about the meaning of the "lived body" and the privilege of caring for it (Draper, 2014). Although both concepts are understood and defined differently in various disciplines (philosophy, anthropology, sociology, etc.), the specific contribution of nursing science is missing. The nursing field could provide a coherent representation of body and embodiment as the fundamental conditions of a person, reflecting his or her multiple dimensions and levels of understanding (Sakalys, 2006).Although body care and attention to embodiment are the central focus of nursing practice, these concepts have not yet been openly, explicitly, and theoretically accepted in the nursing discipline. …

Demographic and epidemiological transitions are causing major social and health changes worldwide. Increased life expectancy, combined with a growing burden of chronic diseases, will likely lead to a higher number of people with severe chronic conditions and/or disabilities over the next decades (World Health Organization [WHO], 2011). Thus, more people will be care dependent by others for their health or personal needs (WHO, 2002). Several studies measuring patients' care dependence in different settings and countries showed a high prevalence of care dependence (Dijkstra et al., 2012), which places a great burden on healthcare professionals and budgets. High care dependence has also been associated with an increased mortality risk in elderly persons institutionalized (Caljouw, Cools, & Gussekloo, 2014).Care dependence is essential for nursing, which is aimed at helping people who are no longer independent in activities of daily living and at promoting and restoring all levels of independence (Henderson, 1966; Orem, 1995). Nursing care dependence was defined as "A nurse-patient relationship resulting from a person's decrease in self-care and simultaneous increase in dependence on nursing care whenever needs must be satisfied" (Dijkstra, Buist, & Dassen, 1998, p. 144). In nursing literature, care dependence is generally described negatively, and nurses' awareness of patients' experiences of nursing care dependence seems to be scarce (Strandberg & Jansson, 2003).Dependence is an experience that all humans have starting from birth. As we grow, we eventually achieve personal independence by adulthood and then return to a certain level of dependence in older age or when certain health conditions arise (MacIntyre, 1999). Dependence itself is constitutive of human beings as a consequence of the fragility and relationality of human condition (Kittay, 1999; Ricoeur, 1960). However, contemporary Western culture views independence as a key characteristic of the human individual, while dependency is viewed as negative (MacIntyre, 1981). When dependency arises within a context where it is viewed negatively, it might be perceived as a negative experience. In particular, how dependency is perceived can intensify the suffering of patients who become dependent for personal care (Strandberg, Norberg, & Jansson, 2003). "Being a burden to others" was a great concern and a distressing experience for chronically ill patients (Refsgaard & Frederiksen, 2013). In some cases the fear of dependency was greater than that of pain, and could play a key role in requesting euthanasia (Flanagan & Holmes, 1999).Qualitative studies described how care dependence was viewed in different settings and populations, showing it mostly perceived as a distressing experience (Ellefsen, 2002; Lomborg, Bjorn, Dahl, & Kirkevold, 2005). However, they reported fragmented experiences, while an overall description of the experience of being adult patients living with care dependence is lacking. Therefore, as care dependence is key to nursing, but still understudied, this metasynthesis of qualitative evidence aimed at describing adult patients' experience of nursing care dependence. This could contribute to raising nurses' awareness of how their patients live with dependence and how they could improve the care provided to them.MethodsThis metasynthesis incorporated the Johanna Briggs Institute (JBI, 2014) integrative or meta-aggregative approach, which allows combining the results of qualitative studies in a reliable way (Hannes & Lockwood, 2011). It provides standardized methods and tools for data extraction, critical appraisal, and integration. This study aimed to achieve comprehensiveness in order to collect the evidence available and to achieve a broad understanding of the phenomenon under study (Sandelowski & Barroso, 2007). This implied conducting a systematic and comprehensive search strategy, planning the widest possible inclusion criteria, and setting only strictly necessary limits as described below. …

Aims To determine the most accurate fall risk screening tools for predicting falls among patients aged 65 years or older admitted to acute care hospitals. Background Falls represent a serious problem in older inpatients due to the potential physical, social, psychological and economic consequences. Older inpatients present with risk factors associated with age-related physiological and psychological changes as well as multiple morbidities. Thus, fall risk screening tools for older adults should include these specific risk factors. There are no published recommendations addressing what tools are appropriate for older hospitalized adults. Design Systematic review. Data sources MEDLINE, CINAHL and Cochrane electronic databases were searched between January 1981–April 2013. Only prospective validation studies reporting sensitivity and specificity values were included. Review methods Recommendations of the Cochrane Handbook of Diagnostic Test Accuracy Reviews have been followed. Results Three fall risk assessment tools were evaluated in seven articles. Due to the limited number of studies, meta-analysis was carried out only for the STRATIFY and Hendrich Fall Risk Model II. In the combined analysis, the Hendrich Fall Risk Model II demonstrated higher sensitivity than STRATIFY, while the STRATIFY showed higher specificity. In both tools, the Youden index showed low prognostic accuracy. Conclusion The identified tools do not demonstrate predictive values as high as needed for identifying older inpatients at risk for falls. For this reason, no tool can be recommended for fall detection. More research is needed to evaluate fall risk screening tools for older inpatients.

Purpose Describe the development and validation of the Nursing Assessment Form (NAF), within a clinical nursing information system, to support nurses in the identification of nursing diagnoses. Methods Content validity and consensus on NAF contents were established using a panel of experts in nursing diagnosis and Delphi rounds. Findings Expert consensus was achieved to validate an instrument to support nurses in the process of nursing diagnoses identification. Conclusions The use of the NAF can help nurses in diagnostic reasoning, facilitating the identification of the more suitable nursing diagnoses, and provide a basis for the best nursing interventions and outcomes. Implications for Nursing Practice The use of computerized decision support can improve the implementation of standardized terminology and the accuracy of nursing diagnosis. Scopo Descrivere lo sviluppo e il processo di validazione della Scheda di Accertamento Infermieristico (SAI), contenuta all'interno di un sistema informativo infermieristico, ideata al fine di supportare gli infermieri nel processo di identificazione delle diagnosi infermieristiche. Metodi La validita di contenuto e il consenso sui contenuti della SAI sono state stabilite tramite un panel di esperti sulla diagnosi infermieristica e Delphi rounds. Risultati Un consenso di esperti e stato ottenuto al fine di validare uno strumento utile per supportare gli infermieri nel processo di identificazione delle diagnosi infermieristiche. Conclusioni L'uso della SAI puo aiutare gli infermieri nel ragionamento diagnostico, facilitando l'identificazione delle diagnosi infermieristiche piu adatte e fornire una base per i migliori interventi e risultati infermieristici. Implicazioni per la Pratica Infermieristica L'uso di sistemi di supporto decisionale computerizzati puo favorire l'implementazione della terminologia standard e l'accuratezza della diagnosi infermieristica.

Aims and objectives. To estimate the diagnostic value and determine the feasibility of the NEECHAM Confusion Scale on critically ill older patients. Background. Delirium is a common syndrome in hospitalised older patients, especially in surgical intensive care units, and the consequences of under-detection can be very serious for older people. Therefore, assessment of the cognitive status of older patients using a valid instrument is important in intensive care units. Design. A descriptive prospective design was used. Methods. Consecutive non-intubated patients aged 65 and older, admitted to a surgical intensive care unit of an Italian hospital during a seven months period, were assessed for delirium using the NEECHAM scale and the Confusion Assessment Method for intensive care unit, once per shift, for 48 hours after admission. Cohen’s kappa coefficient, ROC curve, sensitivity and specificity were estimated. An open ended questionnaire was used to assess user-friendliness of the scale. Results. A sample of 41 older patients with a mean age of 783 years was studied. The kappa coefficient was 095. The sensitivity was 9919%, specificity 95% at cut-off of 25, and the area under the curve was 099 (CI 099–100). Nurses evaluated positively the scale as they were able to collect data during care process in maximum 10 minutes, but experienced problems in rating the appearance behaviour and physiological control items of the scale. Conclusions. Findings from this study confirm the good diagnostic value and ease of application of the NEECHAM scale with non-ventilated intensive care patients. Relevance to clinical practice. The NEECHAM scale can be used to detect delirium during the routine nursing assessment of non-intubated older patients as it requires minimal demand and stress on the patient as well as on the bedside nurse.

Aim. This paper reports a study testing the validity and reliability of the Italian version of the Kogan Attitude towards Older People scale. Background. Nursing students’ attitudes towards older people can affect their preference for working with them. One of the most common instruments used to assess these attitudes is the Kogan Attitude towards Older People scale. Previous validation studies performed on college students internationally have demonstrated good reliability and validity. The psychometric properties of the Italian version have not yet been tested. Design. A cross-sectional, descriptive study. Method. The study was conducted from March–June 2010 with a convenience sample of nursing students attending two Italian universities. Reliability was evaluated using internal consistency and item-to-total correlation. Content and construct validity were evaluated using a content validity index and principal factor analysis. Results. A total of 1637 nursing students participated in the study. Two factors were extracted from the factor analysis: prejudice describing a negative disposition and appreciation indicating a favourable feeling and opinion towards older people. Conclusion. The Kogan Attitude towards Older People scale applied to Italian nursing students exhibited good internal consistency. The two-dimensional construct of the scale was congruent with some, but not all, results of previous studies due to methodological differences among the studies. Based on the study findings, the scale can be recommended for future research studies in Italy including use as pre/post-test measurement associated with nursing education programmes.

Aims. The aim of this study is to evaluate the consistency between the care given to patients and that documented, by comparing care observations with nursing records and describing which interventions were reported and which were omitted. Background. Assumptions have been made about the relationship between documentation and care actually delivered, but there is insufficient evidence on the relationship between the actual care given and its recording. Design. Observational study of the care given, completed by interviews and retrospective survey of records. Methods. Structured observation during day shifts in the first six days of admission of pre and postsurgical care provided to 21 consecutive patients undergoing major abdominal surgery and audit of their nursing records. Each observation was completed by short interviews to nurses to ensure observations validity. Results. Only 40% of nursing activities observed were included in the nursing records (37% of the assessments and 45% of the interventions). This indicated that nurses carry out more activities than they report. Consistency between performed and recorded care decreased significantly during the days when a higher number of activities were performed. Consistency between recording and observation of assessment activities was 38% for physical needs and 0% for educational needs. Consistency was higher for the assessments of physical signs/symptoms and risk factors for complications compared to the assessment of basic needs and pain. Consistency was 47% for technical interventions and 3% for educational activities. Conclusions. Nursing records were not found to be an adequate tool for quality care evaluation, because they did not include all the caring activities that the nurses had carried out. Relevance to clinical practice. This study supports the need to identify documentation systems that are easy to complete. Moreover, nursing education should pay more attention to the competences in the field of holistic care and patient education.