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Background and Aim: Mutuality is a process in which the patient participates and is involved in decision‐making and care interventions. The aim of this study was to measure mutuality in the relationship between nurses and chronic illness patients. Methods: This study had a cross‐sectional design; the sample included 249 patients and 249 nurses. Mutuality was measured with the Nurse–Patient Mutuality in Chronic Illness scale. Results: Patients had higher scores in almost all items (p < 0.001). Patients demonstrate high reciprocity towards nurses and the ability to express and share their emotions. Patients consider nurses their point of reference and share with them their health goals. Nurses show more difficulty in being mutual with the patient, especially in the aspects related to the sharing of emotions, objectives, and planning. The egalitarian relationship score was low in both patients and nurses. Conclusion: These findings are important to consider at clinical, educational, organisational, and policy levels. Nurse education and organisation must push towards respect for the wishes of patients, the possibility of expressing their choices, and their involvement in the care plan. Practice Implications: In clinical practice, it is necessary to put the patients more at the centre, involving them in the identification of objectives and in making decisions. [ABSTRACT FROM AUTHOR]

Background: With a growing nursing home population suffering from chronic progressive illnesses and evolving patterns of comorbidities, end‐of‐life communication takes on a critical role to enable healthcare professionals to gather information about the resident's wishes for care at the end‐of‐life and organise the care plan accordingly. Aim: To explore nurses' perspective about the process by which end‐of‐life communication impacts on the goal of end‐of‐life care in nursing home residents. Design: A qualitative descriptive research design based on thematic analysis was performed. Fourteen nurses involved in the care of residents during their last week of life were recruited across 13 Italian nursing homes and accounted for 34 semi‐structured interviews. A combined approach of analysis that incorporated a data‐driven inductive approach and a theory‐driven one was adopted. Results: Twelve themes described how end‐of‐life communication may contribute to adjust the care plan in nursing home according to the nurses' perspective. Five antecedents (i.e. life crisis or transitions, patient‐centered environment, arising the question of possible dying, quality of relationships and culture of care) influenced the establishment and quality of communication, and five attributes depicted the characteristics and potential mechanisms of end‐of‐life communication (i.e. healthcare professional‐resident and healthcare professional‐family carers communication, knowledge of family carers' preferences, knowledge of residents' preferences, family carers and residents understanding, and shared decision‐making), while curative‐oriented and palliative‐oriented care goals emerged as consequences. Conclusion: This study provides insight into the nursing perspective of end‐of‐life communication between healthcare professionals and bereaved family carers of nursing home residents. Several factors influenced the occurrence and quality of end‐of‐life communication, which contributed to the transition towards palliative‐oriented care by using and improving knowledge about family cares' and resident's preferences for end‐of‐life care, promoting family carers and residents understanding about prognosis and treatments available, and fostering shared decision‐making. [ABSTRACT FROM AUTHOR]

Context: The hidden curriculum is a learning dimension made up of culturally acquired, unintended lessons. Although nurse educators are not fully aware of it, through the hidden curriculum students are prepared for adult professional roles, internalising professional values and developing a professional identity. However, academic nursing education has paid relatively scarce attention to it. The objective was to map the nursing education literature about the hidden curriculum and to identify and verify to which of the four areas suggested by Hafferty (institutional policies, resource allocation decisions, institutional slang and evaluation) it refers. Methods: A scoping study was conducted. In July 2018, a search was performed in MEDLINE/PubMed, Scopus, EBSCO/ Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Library databases, without time or language restrictions. Two authors independently performed the selection of studies, which followed the preferred reporting items for systematic reviews and meta‐analysis (PRISMA) flowchart. Data charting was conducted with both an analytical and a narrative approach. Results: The study included 18 articles, 13 of which were published during the last 5 years. A total of 12 were research articles, 10 of which used qualitative methodology. Regarding the area of analysis, all four areas could be identified within nursing education literature. The most widely explored area proved to be institutional policies, mentioned by 15 articles, predominantly to highlight the negative effect of the hidden curriculum. Some relational aspects, attributed to the hidden curriculum within nursing literature, belong to the informal curriculum. Conclusions: The hidden curriculum in nursing education remains a largely overlooked topic. It appears to be a broader concept than that theorised by Hafferty, often also encompassing the informal curriculum. Furthermore, the literature reviewed mostly highlights the negative consequences of the hidden curriculum, such as the difficulty of transmitting professional values and ethics. Conversely, future researchers should concentrate on its positive consequences as a way to limit the loss of professional values. Through a scoping review, Raso et al. help to clarify the concept of the hidden curriculum as it is represented in the nursing literature. [ABSTRACT FROM AUTHOR]

The type of central vascular access device providers chosen for providing parenteral supportive treatments has evolved over the past years, going from routinely used centrally inserted catheters to a more recent trend of peripherally‐inserted central catheters (PICCs) when expected treatment duration is less than 6 months. This multicenter retrospective study aimed to provide a comprehensive assessment of the safety of PICCs in administering parenteral supportive treatments. All adult inpatients and outpatients who had a PICC inserted for the administration of parenteral supportive treatments (i.e., parenteral nutrition, intravenous fluids, blood products, or antibiotics) between September 2007 and December 2014 in four public Italian hospitals were included. The primary outcome was PICC removal because of an adverse event (AE, defined as occlusion, exit‐site infection, or symptomatic thrombosis). Among the 1,250 included patients, 178 PICC‐related removals because of AEs (14.2%; 1.62 AEs per 1,000 PICC days) were reported. Rates of PICC removal because of occlusion, exit‐site infection, and symptomatic thrombosis were 1.08, 0.32, and 0.23 per 1,000 PICC days, respectively. The median dwell‐time between PICC insertion and its removal because of an AE was 67 days (interquartile range 28–180 days). Risk of PICC removal due to AE was higher with open‐system PICCs [hazard ratio = 2.75, 95% confidence interval 1.52–4.96]. In this study, we found preliminary evidence that PICCs can be safely used to administer parenteral supportive treatments lasting up to 6 months. PICCs may be a relevant alternative to centrally inserted catheters for medium‐term parenteral supportive treatments. [ABSTRACT FROM AUTHOR]

Context: Error reporting is considered one of the most important mediating factors for patient safety (PS). However, reporting errors can be challenging for health care students. Objectives: The aims of the study were: (i) to describe nursing students' opportunity to report errors, near misses or PS issues that emerged during their clinical learning experience; and (ii) to explore associated factors of the process of reporting itself. Methods: A national survey was conducted on 9607 (91.7%) undergraduate nursing students. The endpoint was to have reported PS issues in the last clinical learning experience (from 0 'never' to 3 'always'). Explanatory variables were set individual, nursing programme and regional levels. Results: A total of 4004 (41.7%) nursing students reported PS issues from 'never/rarely' to 'sometimes'. In the multi‐level analysis, factors increasing the likelihood of reporting events affecting PS have been mainly at the nursing programme level: specifically, higher learning opportunities (odds ratio [OR] = 3.040; 95% confidence interval [CI], 2.667–3.466), self‐directed learning opportunities (OR = 1.491; 95% CI, 1.364–1.630), safety and nursing care quality (OR = 1.411; 95% CI, 1.250–1.594) and quality of tutorial strategies OR = 1.251; 95% CI, 1.113–1.406). By contrast, being supervised by a nurse teacher (OR = 0.523; 95% CI, 0.359–0.761) prevented the disclosure of PS issues compared with being supervised by a clinical nurse. Students attending their nursing programmes in some Italian regions showed a higher likelihood (OR from 1.346 to 2.938) of reporting PS issues compared with those undertaking their education in other regions. Conclusions: Nursing students continue to be reticent to report PS issues. Given that they represent the largest generation of future health care workers, their education regarding PS should be continuously monitored and improved; moreover, strategies aimed at developing a non‐blaming culture should be designed and implemented both at the clinical learning setting and regional levels. Palese et al. disclose that many nursing students do not discuss safety issues that emerge during their clinical practice, highlighting environmental features that discourage such reporting. [ABSTRACT FROM AUTHOR]

ABSTRACT: Implantable cardioverter defibrillators (ICDs) can reduce unexpected cardiac mortality, but they also have a dramatic impact on a patient's quality of life. We aimed to explore ICD recipients’ experiences in order to foster improvements in the quality of care. Analyses were done using a descriptive phenomenological method, based on qualitative interview data from a purposive sample of 20 ICD recipients. Four main themes emerged: living with fear; relying on technology; knowing about the ICD and how to live with it; and coping with the effects of the ICD on daily life. ICD recipients lived in a constant state of fear due to the presence of the device and the uncertainty related to the potential electrical shocks it could deliver. This fear was compounded by changes that severely affected the quality of their daily life. ICD recipients felt they were always on the brink of death, and that although they received sufficient technical information they did not feel they received meaningful information to help them accept, live with, and cope with the device. Emotional information and support, rather than technical information, must be provided to ICD recipients to give them the ability to cope with the everyday threats they perceive because of the device. Qualitative evidence may help professionals tackle known threats to patients’ quality of life and increase the quality of care. [ABSTRACT FROM AUTHOR]

This methodological study was conducted to test the psychometric properties of the Jefferson Scale of Empathy- Health Professional Student's version ( JSE-HPS), in a convenience sample of 797 Italian nursing students and to describe their empathic engagement. Data were subjected to exploratory and confirmatory factor analysis, test-retest, correlation analysis, t-test, and analysis of variance method. Principal component factor extraction with Oblimin rotation on the first half of the sample was conducted. The analysis suggested a three-factor solution for 14 items: 'compassionate care/emotional engagement,' 'perspective-taking,' and 'standing in the patient's shoes.' Confirmatory factor analysis on the second half of the sample showed good fit indexes for the 14-item solution, indicated by the exploratory factor analysis, and the 20 item solution of the scale, with the exception of one item. Test-retest correlation was 0.50 ( P < 0.001) for the overall scale. Results from group comparisons and correlations are also provided and discussed. The Italian version of the JSE-HPS is a psychometrically sound tool. The translated 20-item solution is also suitable to carry out cross-cultural comparisons. [ABSTRACT FROM AUTHOR]

Title. Validation of the Italian version of the Discomfort Scale – Dementia of Alzheimer Type. Aim. This paper is a report of a study to validate the Discomfort Scale – Dementia of Alzheimer Type in Italian. Background. Dementia is a long and highly debilitating illness with a slow course and a steadily rising prevalence. Improving the quality of life of patients with dementia requires instruments to measure their problems and symptoms, because they are unable to communicate and interact with others. In Italy, there are no validated scales to assess discomfort for this population. The Discomfort Scale – Dementia of Alzheimer Type was developed in the USA and has been further tested there as well as in Germany. Methods. The data were collected by 21 nurses during 2006 in five nursing homes with 71 patients with severe dementia. Face and content validity were evaluated in a focus group. Discriminant validity was assessed with the opposite-group approach and internal consistency and inter-rater reliability were measured. Results. The discriminant validity of the Italian Discomfort Scale – Dementia of Alzheimer Type showed its ability to detect patients with high and low levels of discomfort. Reliability testing gave positive results: the internal consistency level was satisfactory (0·814) and comparisons of overall discomfort scores across nurses show good reliability. Conclusion. These findings support the use of Discomfort Scale – Dementia of Alzheimer Type in a clinical setting for people with severe dementia for both research and practice. Its ease of use and comprehensibility, and the limited time required to observe patients renders the Discomfort Scale – Dementia of Alzheimer Type a practical instrument for assessment and choosing care interventions. [ABSTRACT FROM AUTHOR]

Background: Nursing students report care of the older people as an undesirable career pathway. Positive clinical placement experiences influence students' attitudes and career intentions with respect to nursing home (NH) setting. The clinical environment's quality depends on meaningful learning opportunities, the relationship with the preceptors, and the pedagogical atmosphere as influenced by the staff–student interactions. Aim: The aim of this study was to explore nursing students' perceptions on their clinical learning experience and competence learned in the NH setting as compared to other clinical areas. Methods: A secondary analysis was performed of an Italian national cross‐sectional study involving 9,607 nursing students attending 95 different three‐year bachelor laureate nursing programmes in 27 universities. A questionnaire exploring individual and nursing programme variables was devised. Moreover, students self‐reported the perceived quality of the clinical learning experience using the Clinical Learning Quality Evaluation Index tool and the degree of competence learned using a four‐point Likert‐type scale. Results: Students in the NH setting scored the overall quality of the learning environment significantly higher (p = 0.046) compared to those experiencing other clinical settings, and they scored higher learning occasions (p = 0.002) and self‐directed learning opportunities (p = 0.018). No difference emerged in the perceived mean degree of competences learned at the end of the clinical rotation (p = 0.271). Conclusion: Nursing students perceive the NH setting to be a good quality learning environment with valuable learning opportunities and self‐directed learning opportunities compared to other settings. The nursing home setting provides opportunities to acquire clinical competences comparable to the ones in other clinical settings such as hospital units. Implications for practice: Nursing home settings should be considered by all nursing programmes as a learning environment particularly worthy for students at different levels of their education. [ABSTRACT FROM AUTHOR]