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Introduction: Chronic pain is a distressing condition that should be treated in specialized pain clinics. Pain clinics offer a holistic, evidence-based approach, including pharmacological, complementary, and invasive treatments. This study aimed to provide preliminary information regarding chronic pain treatments and identify reasons for accessing an important hub-spoke pain clinic network. Methods: A retrospective multicenter cross-sectional study was carried out. A total of 1606 patients’ records were included. Patients were selected from the 26 pain clinics of a single region in Italy. Univariate and multivariate logistic regression models were used. Results: Multivariate models showed that the use of opioids were considered effective for severe or moderate pain [odds ratio (OR) 0.41; 95% 0.33–0.51], while the use of invasive treatments (OR 2.45; 95% 1.95–3.06) and the use of complementary therapy (OR 1.87; 95% 1.38–2.51) were associated with severe or moderate pain. Overall, age, sex, nonsteroidal anti-inflammatory drugs (NSAID) use, a combination of NSAIDs, complementary therapies, and a combination of opioids and invasive treatments did not seem to be significantly associated with the nature of pain. Multivariate models confirmed that clinical parameters such as the nature of pain, multi-diagnosis, more than one site of pain, treatments, and general practitioner, but not the severity of pain and use of invasive treatments, had an impact on the choice of a pain clinic. Conclusion: Opioids are useful in managing moderate or severe chronic pain. Multimodal approaches are used for the management of chronic pain. Moreover, it is not clear how patients are addressed to access different pain clinics (spoke versus hub) networks. More widespread adoption is needed for an interdisciplinary approach to managing chronic pain and adopting guideline recommendations, and rigorous research is required to provide more substantial evidence and support clinical practice.

Ensuring patients have adequate physiological reserves to meet the demands of major surgery may necessitate nutritional prehabilitation and perioperative medical nutrition therapy (MNT). Parenteral nutrition (PN) via central or peripheral routes is indicated when requirements cannot be met orally or enterally. While patients undergoing major gastrointestinal (GI) surgery are at high nutritional and catabolic risk, guidance on PN is limited in Enhanced Recovery After Surgery (ERAS) protocols. This survey-based study characterized MNT practices among GI surgeons, and the challenges and opportunities for MNT within the context of ERAS.This on-line survey comprised questions and attitudinal statements centred on MNT, particularly PN, for major GI surgery patients, and encompassed the spectrum of the surgical pathway (prehabilitation to postoperative care). GI surgeons in Europe were invited to complete the survey. Respondents described their current clinical practices, while their perceptions, unmet needs, and opportunities to improve nutritional management were explored via Likert-scale responses to statements.GI surgeons (N = 130) from different centres in France, Germany, Italy, Poland, and Spain completed the survey. Enhanced recovery protocols (75%) and multidisciplinary nutritional care teams (72%) were established in the centres of most respondents; surgeons, dieticians/nutritionists, and nurses were most frequently involved in MNT. Nutritional risk screening was common in the centres surveyed prior to surgery (range: 62% in Italy to 96% in Poland) and undertaken less frequently postoperatively (range: 19% in Poland to 54% in Germany) with varied screening methods. Enteral nutrition insufficiency was the most common reason for prescribing PN (83%) and 56% of surgeons prescribed PN when enteral nutrition (EN) was not feasible. Overall, 71% of respondents agreed that peripherally administered PN (PPN), which does not require a central access route, lessens invasive procedures and benefits selected patients who are in a catabolic state, malnourished, or at nutritional/metabolic risk when oral intake/EN is insufficient. However, only 35% of surgeons used PPN in this scenario and only 47% utilized PPN when a central venous catheter is not available. Most surgeons (69%) agreed that PPN is in line with the ERAS concept of using minimally invasive approaches. The respondents raised a need for increasing awareness of PPN indications (81%), inclusion of PPN recommendations in clinical guidelines (79%), implementation of nutritional support teams (79%), and increased PPN-trained personnel (78%) to improve PPN delivery.PPN is perceived by surgeons (with ≥10 patients per month who receive PN) as a favourable strategy to support timely nutritional support in selected patients undergoing major GI surgery. However, from this clinical practice survey it seems PPN is underutilized in nutritional care practices. Findings from this survey of GI surgeons in Europe emphasize the need to improve early identification of patients who are malnourished or at nutritional/metabolic risk and integrate PPN into ERAS GI surgical pathways, within the framework of minimally invasive approaches.

To explore and describe perceived factors that favour or hinder the challenges faced by mothers with congenital heart disease during pregnancy and motherhood.A secondary qualitative analysis, according to the interpretative phenomenological analysis approach.A previous study by Flocco et al., 2020 led us to identify that this population share risks, fear, worries and challenges related to pregnancy. To better understand two a priori themes, barriers and facilitators, we adopted The Standards for Reporting Qualitative Research guidelines, and the processes of credibility, transferability and dependability guaranteed the rigour.The perceived barriers that were identified from the twelve semi-structured interviews were mainly identified in clinical and psychological risks, uncertainty about the future. The main facilitators were identified in positive mental attitude, self-motivation, trust in support by clinicians and nurses.The study results confirmed two main a priori themes, revealing that CHD women perceive considerable obstacles and figure out facilitators to face the difficulties encountered in their path to become mothers.

Background: The Trust Me Scale is a widely used instrument to measure trust in healthcare providers. However, no Italian version of the scale exists yet, limiting its use in Italian-speaking populations. The aim of this study is to translate and validate the Trust Me Scale for use in Italian-speaking populations in nurses and nurse managers. Methods: The translation process involved methodological steps of collaborative and iterative translation with cultural adaptation. The validation process included a cross-sectional study enrolling a convenience sample of 683 nurses and 188 nurse managers who completed the Italian version of the Trust Me Scale and measures of intention to leave, satisfaction, and organizational commitment. Results: Item 5 was removed for poor factor loading, and items 11 and 13 were removed following an a priori strategy focused on deleting items with correlations between residual variables different than expected based on theoretical expectations derived from previous research. The final model fit well to sample statistics with a three-factor structure (harmony, reliability, and concern) and 13 items. A multiple-indicator multiple-cause model showed a measurement invariance between nurses and nurse coordinators. Construct validity was also supported by the evidence that the measured domains of trust align with the theoretical expectations and are related to the intention to leave, job satisfaction, and organizational commitment. Each dimension showed adequate scale reliability. Conclusions: The Italian version of the Trust Me Scale is a valid and reliable instrument to measure trust in nurses and nurse managers in Italian-speaking contexts. It can be used for research in nursing and leadership and evaluation of interventions aimed at improving trust in healthcare contexts.

Background: Nursing education consists of theory and practice, and student nurses’ perception of the learning environment, both educational and clinical, is one of the elements that determines the success or failure of their university study path. This study aimed to identify the currently available tools for measuring the clinical and educational learning environments of student nurses and to evaluate their measurement properties in order to provide solid evidence for researchers, educators, and clinical tutors to use in the selection of tools. Methods: We conducted a systematic review to evaluate the psychometric properties of self-reported learning environment tools in accordance with the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) Guidelines of 2018. The research was conducted on the following databases: PubMed, CINAHL, APA PsycInfo, and ERIC. Results: In the literature, 14 instruments were found that evaluate both the traditional and simulated clinical learning environments and the educational learning environments of student nurses. These tools can be ideally divided into first-generation tools developed from different learning theories and second-generation tools developed by mixing, reviewing, and integrating different already-validated tools. Conclusion: Not all the relevant psychometric properties of the instruments were evaluated, and the methodological approaches used were often doubtful or inadequate, thus threatening the instruments’ external validity. Further research is needed to complete the validation processes undertaken for both new and already developed instruments, using higher-quality methods and evaluating all psychometric properties

In this article the affiliation details for Authors Laura Iacorossi and Irene Terrenato were incorrectly given as ‘‘Department of Nursing & Health Professions, IRRCS Regina Elena, National Cancer Institute, Rome, Italy’’ and ‘‘Biostatistics and Bioinformatic Unit, IRRCS.

Introduction: Primary Nursing (PN) is a patient-focused nursing model that improves the quality of care. It has been defined over the years as a model to develop nurses’ personal knowledge, but the relationship between different nursing care models and nurses’ competence or experience still requires study. Objectives: The study aimed to describe nurses’ perceptions of their competence in the primary nursing care model and to identify sociodemographic and organisational predictors of nurses’ competence. Methods: A cross-sectional design was used to recruit nurses from wards using the PN care model and wards in which a team nursing care model was applied. A convenience sample of 142 nurses completed a self-administered questionnaire composed of a sociodemographic survey and the Nurse Competence Scale (NCS). Nurses’ age, gender, education degree, years as a registered nurse, months as a registered nurse under the specific nursing model, and type of employment contract were tested as potential independent predictors of nurses’ competence. Results: The PN nurses reported a better perception of their competence in all seven NCS categories. Independent predictors of a high level of competence in managing situations were an open-ended employment contract, greater work experience, working in a PN care model, and male gender. Predictors of a high level of competence in ensuring quality were greater work experience and working in a PN care model. Finally, an open-ended employment contract and working in a PN care model were both associated with a higher level of helping role, teaching–coaching, diagnostic functions, therapeutic interventions, and work role. The variables explained from 10% to 26% of the variance in all categories. Conclusion: PN model was found to be significantly positively correlated with nursing competence development. Advanced skills are involved in practising a personalized nursing care plan.

Background: The role of nurse-led motivational interviewing (MI) in improving self-care among patients with heart failure (HF) is promising, even if it still requires further empirical evidence to determine its efficacy. For this reason, this study tested its efficacy in enhancing self-care maintenance (primary endpoint), self-care management, and self-care confidence after three months from enrollment in adults with HF compared to usual care, and assessed changes in self-care over follow-up times (3, 6, 9, and 12 months). Methods: A single-center, randomized, controlled, parallel-group, superiority study with two experimental arms and a control group was performed. Allocation was in a 1:1:1 ratio between intervention groups and control. Results: MI was effective in improving self-care maintenance after three months when it was performed only for patients (arm 1) and for the patients–caregivers dyad (arm 2) (respectively, Cohen’s d = 0.92, p-value < 0.001; Cohen’s d = 0.68, p-value < 0.001). These effects were stable over the one-year follow-up. No effects were observed concerning self-care management, while MI moderately influenced self-care confidence. Conclusions: This study supported the adoption of nurse-led MI in the clinical management of adults with HF.

Introduction In electronic health records (EHRs), standardized nursing terminologies (SNTs), such as nursing diagnoses (NDs), are needed to demonstrate the impact of nursing care on patient outcomes. Unfortunately, the use of NDs is not common in clinical practice, especially in surgical settings, and is rarely included in EHRs. Objective(s) The aim of the study was to describe the prevalence and trend of NDs in a hospital surgical setting by also analyzing the relationship between NDs and hospital outcomes. Methods A retrospective study was conducted. All adult inpatients consecutively admitted to one of the 15 surgical inpatient units of an Italian university hospital across 1 year were included. Data, including the Professional Assessment Instrument and the Hospital Discharge Register, were collected retrospectively from the hospital's EHRs. Results The sample included 5,027 surgical inpatients. There was a mean of 6.3 ± 4.3 NDs per patient. The average distribution of NDs showed a stable trend throughout the year. The most representative NANDA-I ND domain was safety/protection. The total number of NDs on admission was significantly higher for patient whose length of stay was longer. A statistically significant correlation was observed between the number of NDs on admission and the number of intra-hospital patient transfers. Additionally, the mean number of NDs on admission was higher for patients who were later transferred to an intensive care unit compared to those who were not transferred. Conclusion NDs represent the key to understanding the contribution of nurses in the surgical setting. NDs collected upon admission can represent a prognostic factor related to the hospital's key outcomes.

Migration has always been a part of human history [...]

Purpose The effect of systemic hemostatic agents initiated during pre-hospital care of severely injured patients with ongoing bleeding or traumatic brain injury (TBI) remains controversial. A systematic review and meta-analysis was therefore conducted to assess the effectiveness and safety of systemic hemostatic agents as an adjunctive therapy in people with major trauma and hemorrhage or TBI in the context of developing the Italian National Institute of Health guidelines on major trauma integrated management. Methods PubMed, Embase, and Cochrane Library databases were searched up to October 2021 for studies that investigated pre-hospital initiated treatment with systemic hemostatic agents. The certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation approach, and the quality of each study was determined with the Cochrane risk-of-bias tool. The primary outcome was overall mortality, and secondary outcomes included cause-specific mortality, health-related quality of life, any adverse effects and blood product use, hemorrhage expansion, and patient-reported outcomes. Results Five trials of tranexamic acid (TXA) met the inclusion criteria for this meta-analysis. With a high certainty of evidence, when compared to placebo TXA reduced mortality at 24 h (relative risk = 0.83, 95% confidence interval = 0.73–0.94) and at 1 month among trauma patients (0.91, 0.85–0.97). These results depend on the subgroup of patients with significant hemorrhage because in the subgroup of TBI there are no difference between TXA and placebo. TXA also reduced bleeding death and multiple organ failure whereas no difference in health-related quality of life. Conclusion Balancing benefits and harms, TXA initiated in the pre-hospital setting can be used for patients experiencing major trauma with significant hemorrhage since it reduces the risk of mortality at 24 h and one month with no difference in terms of adverse effects when compared to placebo. Considering the subgroup of severe TBI, no difference in mortality rate was found at 24 h and one month. These results highlight the need to conduct future studies to investigate the role of other systemic hemostatic agents in the pre-hospital settings.

ObjectiveThe evaluation of post-traumatic stress disorder (PTSD), depression, anxiety and insomnia in patients with Marfan syndrome (MFS) during the third wave of the COVID-19 pandemic in a region of northern Italy (Lombardy) and the investigation of which mental health, sociodemographic and clinical factors were associated with PTSD.DesignDescriptive observational design with cross-sectional data collection procedure.SettingA single Italian MFS-specific specialised and reference centre in Lombardy (Italy) between February and April 2021.Participants112 adults with MFS. The majority of participants were female (n=64; 57.1%), with a high school diploma (n=52; 46.4%) and active workers (n=66; 58.9%). The mean age was 41.89 years (SD=14.00), and the mean time from diagnosis was 15.18 years (SD=11.91).Primary and secondary outcomesDescriptive statistics described PTSD, which was the primary outcome, as well as depression, anxiety and insomnia, which were the secondary outcomes. Four linear regression models described the predictors of PTSD total score and its three domains: avoidance, intrusion and hyperarousal.ResultsOne out of 10 patients with MFS had mild psychological symptoms regarding depression, anxiety and insomnia, and scores of PTSD that indicated clinical worries about the mental health status. The presence of PTSD was mainly predicted by anxiety (β=0.647; pConclusionDepression, anxiety and insomnia should be monitored in patients with MFS in order to minimise PTSD insurgence. Specific psychosocial interventions should be developed and tested for this population and adopted in clinical practice, given the relevance of mental health outcomes during the pandemic.

The aim was to explore nurses’ experiences of caring for and accompanying patients dying without the presence of family during the COVID-19 pandemic.A qualitative descriptive design was used.A purposive sample of registered nurses, caring for dying patients in Italian health-care settings during the COVID-19 pandemic, were selected. To capture a broad range of experiences, a maximum variety of participants about workplace, age, gender and work experience were included. A total of 31 nurses agreed to participate in the study; 28 participants were female; participants were aged 41 on average (range 25-63 years) and worked in hospitals and nursing homes in the Northern and Central Italian regions. Six focus groups were conducted from August to December 2020 through Microsoft Teams, reaching data saturation. The transcripts were analysed through inductive content analysis. The COREQ checklist was followed for study reporting.Four main categories emerged describing nurses’ experiences: hugely increased deaths in time of COVID-19; ensuring physical, emotional, interpersonal and spiritual care for dying patients and supporting their families despite difficulties; ensuring care procedures of patients’ bodies after death and psychological consequences of caring for dying people during the pandemic.Registered nurses provided physical, spiritual and emotional care to dying patients during the pandemic, despite limited resources and knowledge, standing in for relatives who were not allowed to visit them; the experiences of caring for dying patients in the absence of the family caused emotional distress in nurses.Health-care systems should develop guidelines aiming to meet the psychological needs of dying people in case of restrictions on patients’ family visits. Health-care administrators should offer services to support the grieving process of relatives who cannot accompany dying patients and to reduce emotional distress in nurses caring for dying patients.

Background: Standard precautions (SPs) are first-line strategies with a dual goal: to protect health care workers from occupational contamination while providing care to infected patients and to prevent/reduce health care-associated infections (HAIs). This study aimed at (1) identifying the instruments currently available for measuring healthcare professionals’ compliance with standard precautions; (2) evaluating their measurement properties; and (3) providing sound evidence for instrument selection for use by researchers, teachers, staff trainers, and clinical tutors. Methods: We carried out a systematic review to examine the psychometric properties of standard precautions self-assessment instruments in conformity with the COSMIN guidelines. The search was conducted on the databases PubMed, CINAHL, and APA PsycInfo. Results: Thirteen instruments were identified. These were classified into four categories of tools assessing: compliance with universal precautions, adherence to standard precautions, compliance with hand hygiene, and adherence to transmission-based guidelines and precautions. The psychometric properties of instruments and methodological approaches of the included studies were often not satisfactory. Only four instruments were classified as high-quality measurements. Conclusions: The available instruments that measure healthcare professionals’ compliance with standard precautions are of low-moderate quality. It is necessary that future research completes the validation processes undertaken for long-established and newly developed instruments, using higher-quality methods and estimating all psychometric properties.

Background Nursing students' perception of a safe clinical working environment may impact the development of professional skills and progression in the profession. Purpose The aims of this study were to describe to what extent nursing students perceive the working environments as safe during their most recent clinical rotation and to explore factors associated with their perception of a safe workplace environment. Methods A nationwide Italian cross-sectional study involving 9607 students in 27 universities across 95 three-year nursing programs was performed in 2015-2016, and secondary analyses were run in 2019. Results The workplace environment was perceived by students as only a little (n = 2598 [27.0%]), to some extent (n = 4048 [42.1%]), and always (n = 2555 [26.0%]) safe; 406 (4.2%) students reported to have never felt that the workplace as safe. At the multivariate level, factors promoting students' perception of a safe clinical environment were a setting offering higher (a) learning opportunities, (b) safety and nursing care quality, (c) quality of tutorial strategies, and (d) self-directed learning opportunities. Conclusions Nursing faculty should assess the quality of clinical settings before deciding on environments for students' learning experience.

Living with people diagnosed with a mental disorder is known to increase the risk of developing high levels of so-called "caregiver burden" in informal caregivers. In-depth analysis of this phenomenon and specific assessment tools for caregivers of patients diagnosed with Eating Disorders (EDs) are lacking. In this study, we aimed to evaluate the psychometric properties of the Caregiver Burden Inventory in EDs and employ this adapted tool in this category of caregivers.A cross-sectional study was conducted in the Eating Disorders outpatient unit of an Italian University hospital. Face and content validity were investigated by calculating standard Content Validity Indices (CVI-I and CVI-S) after administering the Inventory to 6 expert nurses with at least 5 years of experience in mental health services assisting people diagnosed with Eating Disorders. Internal consistency was evaluated with Cronbach's α coefficient for the overall scale and subscales. An exploratory factor analysis (EFA) was performed to explore latent constructs. The adapted CBI was then administered to 62 informal caregivers of ED patients.The EFA yielded a 5-factor structure. The CVI-S was 97.2%; the Cronbach α coefficient was 0,90 ( 0.74 in each subscale). The median burden level in the experimental population was 40.0 [range = 21 to 54], in a theoretical range from 0 (no burden) to 96 (highest level of burden).The Caregiver Burden Inventory appears to be a valid and reliable instrument to assess caregiver burden in individuals diagnosed with Eating Disorders. Further research is needed to evaluate this tool's efficiency in improving individually tailored interventions on families.Eating disorders (EDs) are characterized by the development of abnormal eating habits, dysregulation of body weight and/or body image distortion. The pervasiveness of EDs may significantly affect the life of patients’ caregivers in terms of emotional load, termed Caregiver Burden (CB). This may impact the quality of life of the entire family and promote conflicts which may in turn exacerbate ED behaviours. Among several international assessment tools to measure CB, the Caregiver Burden Inventory (CBI) is perhaps the most widely employed. However, this tool has never been specifically tested in caregivers of ED patients. Here we show that CBI can adequately quantify burden in this category of caregivers. Systematic use of this instrument can support healthcare workers who aim to address the carer's discomfort and promote a focused monitoring of subjects with increased risk, in order to adequately plan targeted intervention programs.

Older adults, especially in isolation and with cognitive decline/dementia, can become more anxious and stressed during the quarantine. All these symptoms negatively affect the psycho-physical health of their caregivers. This study aimed to synthesize the current evidence on the impact of the COVID-19 pandemic on caregivers' mental health.A rapid systematic review was conducted using the following databases: Pubmed/Medline, CINAHL, Scopus, and PsycInfo (PROSPERO registration number: CRD42020215485). The 'PRISMA' flow chart guided the selection of articles. The search was entirely performed up to September 15th, 2021.The narrative synthesis has brought out two main themes that represent the current debate in literature: "Family caregivers COVID-19 related stress", and "(Mal)adaptive strategies to the "new" normality".This study provides an evidence synthesis of the negative mental health impact experienced by caregivers of older adults during the COVID-19 pandemic.

Le ulcere/lesioni da pressione hanno una genesi multifattoriale e possono essere causa di svariate complicanze. Un aspetto troppo spesso dimenticato è il loro costo per il Sistema Sanitario Nazionale (SSN). I casi di due pazienti ricoverate presso il reparto di Geriatria e Lungodegenza dell’Azienda Ospedaliera Universitaria “Paolo Giaccone” di Palermo sono in proposito emblematici

Spirituality is a common theme in the field of healthcare research. This study aimed to examine nurses’ perceptions of spirituality in the context of the religious diversity of patients in pluri-religious settings. We performed a scoping review following the methodology on studies conducted between 2010 and 2020. We searched the following databases: CINAHL Plus, PubMed, and PsycINFO. For the identification of grey literature, the OpenGrey database was used. In total, 789 articles were reviewed. Of these, 16 met predetermined inclusion criteria. Two main overarching themes emerged from our inductive analysis: (a) the intertwining of spirituality and spiritual care in diverse religious landscapes and (b) obstacles impeding the inclusion of spiritual care in pluri-religious settings. According to our results, nurses consider that spirituality is interconnected with spiritual care for individuals from different religious backgrounds. Interpretations of spirituality in nursing practice vary widely, with spirituality and religiosity often shaped and influenced by culture and the experience of the professionals. Nurses attribute various meanings to spiritual care, most of which center on respecting personal, interpersonal, and relational aspects of religious and cultural beliefs and practices. Lack of education and specific skills, insufficient time, role ambiguity, and different religious beliefs were identified as hurdles to spiritual care. A poor work environment, a lack of patient privacy, including personal space, and a lack of compassion were also reported as deterrents to spiritual healing. More knowledge and training on different religions and spirituality are required to meet patients’ spiritual needs to better overcome these hurdles.

Despite universities in the UK, USA and Australia having developed tools and strategies to enhance academic engagement, there is a paucity of information from universities and research hospitals where conceptual and theoretical research still appears more heterogeneous. In Italy, there is a growing recognition that more needs to be done to define strategies to improve research engagement. Italian research hospitals are represented by the Scientific Institute for Research, Hospitalization and Healthcare (named IRCCS from the Italian acronym of these organisations), representing the best of Italian research and the National Health Service System. This article provided a pilot description of research engagement in a representative Italian IRCCS hospital for the first time. A pilot study was developed, and a brief questionnaire was validated to explore research engagement. The identified clusters of researchers’ engagement were provided to describe an initial theory-grounded framework. Based on the perspective of research administrators and the Ministry of Health during round tables, the developed questionnaire identified two clusters of researchers’ engagement and measured “Project-oriented” and “Organisation-oriented” engagement. Among the responders, IRCCS senior researchers tended to have higher project-oriented engagement, while young researchers had slightly higher organisation-oriented engagement. The contribution of this article is a hypothesised two-level theory-grounded framework to study and improve research engagement activities and strategies in a research hospital, with the potential for an overlap with other European research institutions.

To translate and validate the Italian version of the Spirituality and Spiritual Care Rating Scale (SSCRS-ita).A single-center cross-sectional study was performed from October 15 to November 15, 2019 in a public hospital in Milan, Italy. The scale was drafted using the back-translation method. Prior to administration, the Italian version of the scale was assessed for content validity and retest stability by calculating the content validity index. Internal consistency was investigated by calculating Cronbach's alpha coefficient, test-retest stability by Spearman's rho coefficient.A total n = 337 nurses participated in the survey by correctly completing the scale. The Kaiser-Meyer-Olkin test (0.81) and Bartlett's test of sphericity (p 0.001) confirmed the adequacy of the sample to conduct exploratory factor analysis (EFA). The factorial model of EFA without rotation and then with nonorthogonal Promax rotation confirmed the presence of the four constructs identified by the original author.SSCRS-ita showed promising psychometric properties in terms of validity and reliability. The results of this study, together with the lack of in-depth studies in the Italian health and educational panorama, suggest the need to develop an educational pathway which, starting from the curricula of basic training and continuing with the updating of nursing staff, is dedicated to the detection of the spiritual needs of the patient.The SSCRS-ita is the first validated Italian tool concerning the consideration of the needs of spirituality and spiritual care in healthcare contexts; the possibility to use this tool is the first step towards a better integration of the mentioned dimensions of care in a nursing care qualitative perspective in Italy.Tradurre e validare la versione italiana della Spirituality and Spiritual Care Rating Scale (SSCRS-ita).È stato effettuato uno studio trasversale monocentrico dal 15 ottobre al 15 novembre 2019 in un ospedale pubblico di Milano, in Italia. La scala è stata redatta utilizzando il metodo della back-translation. Prima della somministrazione, sono state valutate la validità di contenuto e la stabilità di retest della versione italiana della scala calcolando il Content Validity Index. La consistenza interna è stata studiata calcolando il coefficiente alfa di Cronbach, la stabilità test-retest con il coefficiente rho di Spearman.Un totale di n. = 337 infermieri ha partecipato all'indagine completando correttamente lo strumento. Il test Kaiser-Meyer-Olkin (0,81) e il test di sfericità di Bartlett (p 0,001) hanno confermato l'adeguatezza del campione per condurre l'analisi fattoriale esplorativa (EFA). Il modello fattoriale di EFA senza rotazione e poi con rotazione Promax non ortogonale ha confermato la presenza dei 4 costrutti identificati dall'autore originale.La SSCRS-ita ha mostrato proprietà psicometriche promettenti in termini di validità e affidabilità. I risultati di questo studio, insieme alla mancanza di studi approfonditi nel panorama sanitario ed educativo italiano, suggeriscono la necessità di sviluppare un percorso educativo che, partendo dai curricula della formazione di base e proseguendo con l'aggiornamento del personale infermieristico, sia dedicato alla rilevazione dei bisogni spirituali del paziente.La SSCRS-ita è il primo strumento italiano validato riguardante la considerazione dei bisogni di spiritualità e assistenza spirituale nei contesti di assistenza sanitaria; la possibilità di utilizzare questo strumento è il primo passo verso una migliore integrazione delle dimensioni di assistenza menzionate in una prospettiva qualitativa dell'assistenza infermieristica qualitativa.

Introduction Health literacy (HL) can be defined as the individual's ability to understand and process health information. A low level of HL can be viewed as a stronger predictor of a person's health status than age, education level, and race. Although HL is an important determinant of health, it is often underestimated. This systematic review investigates the evidence on HL assessment in hospital settings. Methods PubMed Medline, CINAHL, Scopus, Web of Science and Educational Resources Information Centre databases were searched, with the date last searched being 16 March 2020. The PRISMA guidelines were applied, and the protocol of the study was registered with PROSPERO (CRD42021236029). The quality of the included studies was appraised using the STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies. Results Five studies reported HL assessments in hospital patients’ clinical records. Four main strategies were used to implement HL routine assessment in hospitals: multidisciplinary teams, stakeholders, training, and monitoring. Different performance measures were used to monitor the feasibility of incorporating HL assessment into electronic health records (EHRs). Conclusion This review examined how inpatients’ HL is recorded in hospital settings. HL is poorly measured in a hospital setting. These results guide hospital leadership in involving nurses in HL assessment implementation in hospitals and support nurses in creating a specific performance measure dashboard to monitor effective HL assessments in hospitals.

Objective The present systematic review aimed to identify, critically assess and summarize which risk factors might determine the onset of ostomy complications, describing a pooled incidence and stratified incidences by each identified risk factor. Methods A systematic literature review with a meta-analysis of observational studies was performed by following the PRISMA statement and flow chart. The quality assessment of the included articles was performed through the Newcastle-Ottawa Scale (NOS). Results Sixteen articles published between 1990 and 2018 focused on the risk factors related to intestinal stomal complications, and the performed analysis led to identifying influenceable and non-influenceable risk factors. The median of the NOS evaluation was 6 (IQR = 5.75-6). Among 10,520 included patients, the pooled incidence of stomal complications was 35%, ranging from 9% to 63%, regardless of the nature of the complications. Analysis of the sub-groups highlighted obesity and ostomy surgery performed via laparoscopy or emergency conditions have significant incidences, respectively, of 66% and 68%. Conclusions The pooled incidence of stomal complications requires greater attention for its relevant epidemiology. From the clinical point of view, patients with obesity and chronic conditions require more attention to prevent complications, possibly employing accurate educational interventions to enhance proper stoma management.

Background Heart failure (HF) is characterized by an increasing prevalence, representing a public health problem and a significant cause of morbidity and mortality. Self-care is a cornerstone approach for optimizing therapy for patients with HF. Patients play a crucial role in managing their condition, given that several adverse health outcomes might be avoided with adequate self-care. In this regard, the literature describes motivational interviewing (MI) as highly favorable for treating chronic diseases, with promising results supporting its efficacy in enhancing self-care. Moreover, caregivers’ availability constitutes a fundamental supporting factor among the strategies to improve self-care behaviors in people with HF. Objective The primary study aim is to test the efficacy of a structured program, including scheduled MI interventions, in improving self-care maintenance in the 3-month follow-up from the enrollment. Secondary aims comprehend the assessment of the effectiveness of the above intervention on secondary outcomes (eg, self-care monitoring, quality of life, sleep disturbance) and the corroboration of the superiority of caregivers’ participation to the intervention over the program administrated only to individual patients in enhancing self-care behaviors and other outcomes at 3, 6, 9, and 12 months from the enrollment. Methods This study protocol designed a prospective, parallel-arm, open-label, 3-arm, controlled trial. The MI intervention will be administered by nurses trained in HF self-care and MI; the education program will be provided to nurses by an expert psychologist. Analyses will be performed within the framework of intention-to-treat analysis. Comparisons between groups will be based on an alpha of 5% and 2-tailed null hypotheses. In the case of missingness, analyzing the extent of the missingness and identifying underlying mechanisms and patterns will guide imputation methods. Results The data collection was started in May 2017. We completed the data collection with the last follow-up in May 2021. We plan to perform data analysis by December 2022. We plan to publish the study results within March 2023. Conclusions MI enhances potential self-care practices in patients with HF and their caregivers. Although MI is effectively largely employed either alone or combined with other treatments and is administered in different settings and ways, face-to-face interventions seem to be more effective. Dyads with higher shared HF knowledge are more efficient in promoting self-care adherence behaviors. Moreover, patients and caregivers may perceive proximity with health care professionals, resulting in a better ability to follow the received health professionals’ directions. The scheduled in-person meetings with patients and caregivers will be exploited to administer MI, respecting all the safety regulations for infection containment. The conduction of this study may support changes in clinical practice to include MI to improve self-care for patients with HF. Trial Registration ClinicalTrials.gov NCT05595655; https://clinicaltrials.gov/ct2/show/NCT05595655 International Registered Report Identifier (IRRID) DERR1-10.2196/44629

Although vaccine hesitancy has been reported in many patient groups and countries, there is a lack of data on vaccine hesitancy in patients with Marfan syndrome (MFS). MFS is a rare genetic disorder that can lead to cardiovascular, ocular, and musculoskeletal issues. Because MFS patients may face an increased risk of COVID-19 complications, vaccination is crucial for this population. This brief report aims to describe vaccine hesitancy rates in MFS patients and compare the characteristics of patients who are hesitant and those who are not to gain a better understanding of this specific population. This study analyzes previously published cross-sectional data that examined mental health, sociodemographic, and clinical factors associated with PTSD, depression, anxiety, and insomnia in MFS patients during the third wave of the COVID-19 pandemic in Lombardy, Italy. Of the 112 MFS patients who participated, 26 (23.9%) reported vaccine hesitancy. Vaccine hesitancy may be associated mainly with younger age and not be related to other patient characteristics. Therefore, this report found no differences in individual-level variables, such as sex, education, comorbidities, and mental health symptoms, between those who were hesitant and those who were not. The study findings are insightful and suggest that interventions to address vaccine hesitancy in this population may need to focus on attitudes and beliefs related to vaccination rather than targeting specific sociodemographic or clinical factors.

This study protocol aims to describe the rationale and developmental strategy of the first study in the Italian context which aimed to define a Midwifery Interventions Classification, an evidence-based, standardized taxonomy and classification of midwifery interventions. Midwifery interventions require a specific definition, developed through a consensus-building process by stakeholders to develop the Italian taxonomy of the Midwifery Interventions Classification with the potential for international transferability, implementation, and scaling up. A multi-round Delphi study was designed between June and September 2022, and data collection is planned between February 2023 and February 2024. The developmental phase of the study is based on a literature review to select meaningful midwifery interventions from the international literature, aiming to identify an evidence-based list of midwifery interventions. This phase led to including 16 articles derived from a systematic search performed on PubMed, CINAHL, and Scopus; 164 midwifery interventions were selected from the data extraction performed on the 16 included articles. Healthcare professionals, researchers, and service users will be eligible panelists for the Delphi surveys. The protocol designed a dynamic number of consultation rounds based on the ratings and interim analysis. A nine-point Likert scoring system is designed to evaluate midwifery interventions. Attrition and attrition bias will be evaluated. The results from the study designed in this protocol will inform the development of the Italian taxonomy of the Midwifery Interventions Classification. A shared classification of midwifery interventions will support audit and quality improvement, education, and comparable data collections for research, sustaining public recognition of midwifery interventions to promote optimal maternal and newborn health.

Background. Major trauma describes serious injuries requiring lifesaving interventions or resulting in long-term disability; it represents about 8% of all deaths worldwide. Specific guidelines can help reduce deaths and disabilities, provided they adhere to high quality and trustworthiness standards. This article aims at introducing the development process of the Istituto Superiore di Sanità, ISS (Italian National Institute of Health) guideline for major trauma integrated management. Methods. We applied the ISS methodological standards including the GRADE-ADOLOPMENT approach for adoption, adaptation, and de novo development of trustworthy guidelines. Results. The scope was formulated by the multidisciplinary panel with stakeholders’ involvement; two guidelines were identified as appropriate sources for adolopment. Forty questions from the two source guidelines were prioritised and five new ones formulated. New systematic reviews or updates were conducted for each clinical question, Evidence to Decision frameworks developed or re-assessed and the recommendations formulated after public consultations and external review. The policy on conflicts of interest was applied throughout the process. Conclusions. Through a broad expertise representation, the early and wide stakeholders’ participation, a continual process for disclosure and management of conflict of interests and the transparency of the process, ISS standards are proving to be an efficient model for developing trustworthy clinical guidance.

BACKGROUND AND AIM OF THE WORK: Place of death and disenrollment from specialized palliative care services (SPCSs) are two aspects that determine service utilization. These aspects should be determined by patient needs and preferences, but they are often associated to patient sociodemographic or contextual characteristics. The aim of this study was to describe which factors are associated with utilizing SPCSs in terms of place of death and disenrollment. METHODS: Retrospective cohort study. Patients (>18 years) who died or were disenrolled during SPCSs utilization. Two hierarchical regression models were performed, and variables were categorized in predisposing, enabling, and need factors according to the Andersen behavioral model of health services use. RESULTS: We included 35,869 patients (52,5% male, mean age 74,6 ± 12,3 SD), where 17,225 patients died in hospice and 16,953 at home, while 1,691 patients were disenrolled. Dying at home was associated with older age, oncological diagnosis, painful symptoms and longer survival time. Instead, service disenrollment was associated with less education, longer wait time and longer length of stay. CONCLUSIONS: SPCS utilization was not influenced only by patient need, but also by other factors, such as social and contextual factors. These factors need to be considered by health care providers and efforts are needed for 1) identifying barriers and implementing effective interventions to support patients and caregivers in their preferred place of care and death and 2) for avoiding SPCS disenrollment with an increased probability of aggressive treatments and worse quality of life for patients.

Background During the COVID-19 outbreak, patients with left ventricular assist device (LVAD) faced several changes in their daily life. However, the effects of these changes on the patients’ lived experiences are not still investigated. Aims The current study explored the lived experience of people with left ventricular assist device (LVAD) during the COVID-19 pandemic. During the COVID-19 outbreak, people with LVADs faced several changes in their daily life. However, the effects of these changes on the patients’ lived experiences are not still investigated. Methods and results Qualitative data analysis was conducted employing the interpretative phenomenological analysis approach. We followed the Standards for Reporting Qualitative Research guidelines. Eight male participants with LVAD aged from 65 to 82 were interviewed. Overall, two main themes (‘Worsening of psychological distress’ and ‘Moving forward’) and eight sub-themes emerged from the qualitative analysis. Conclusions People with LVADs experienced feelings of worry and solitude related to the risk of being infected or not receiving adequate treatment due to changes in the healthcare system during the pandemic; however, they managed to move forward with their lives using different strategies for dealing with the difficult situation.

Background The primary nursing care model is considered a personalized model of care delivery based on care continuity and on the relationship between the nurse and patient. Primary nursing checklists are not often mentioned in the literature; however, they represent a valid instrument to develop, implement, and evaluate primary nursing. The aim of this study was to create a structured checklist to explore hospital compliance in primary nursing. Methods The Delphi method was used to develop and validate a checklist. The preliminary version was created and sent to three experts for their opinions. Their comments were ultimately used in the first version, which included four components with 19 items regarding primary nursing characteristics. A two-round Delphi process was used to generate consensus items. The Delphi panel consisted of six experts working in primary nursing contexts and/or teaching or studying primary nursing. Data were collected using a structured questionnaire from July 2020 to January 2021. These experts were asked to rate each element for relevance using a 4-point Likert-type scale. Furthermore, the consensus among the panel of experts was set at ≥78%, with selected items being voted “quite relevant” and “highly relevant”. Content validity index (I-CVI) and modified kappa statistic were also calculated. Following expert evaluation, the first version of the checklist was modified, and the new version, constituting 17 items, was sent to the same experts. Results The first version of the checklist demonstrated a main relevance score of 3.34 (SD = 0.83; range = 1.3–4; mean I-CVI = 0.84; range: 0.83–1), but three items did not receive an adequate I-CVI score, that is, lower than 0.78. After the second round, the I-CVIs improved. The main score of relevance was 3.61 (SD: 0.35; range = 2.83–4; mean = I-CVI: 0.93). The S-CVI/UA was 0.58, and the S-CVI/Ave was 0.93. Conclusion Measuring primary nursing compliance should be implemented to provide continuous feedback to nurses. Moreover, utilizing valid checklists could permit comparing different results from others’ research. Future research should be conducted to compare the results from the checklist with nursing outcomes.

Background One of the most effective smoking cessation strategies involves care and advice from nurses due to their role in the front line of treatment. Lack of education on smoking cessation counselling may be detrimental, and adequate smoking cessation training during healthcare studies is needed. Objectives The study aimed to examine nurses’ attitudes, belief, and knowledge of smoking cessation counselling; knowledge of the health risks associated with smoking was also assessed. Design A cross-sectional survey on 77 nurses from the nursing staff of Cardiology, Cardiac Intensive Care and Surgical Oncology Units of two tertiary hospitals. Methods Cronbach’s alpha was calculated to assess the questionnaire’s internal consistency, and three composite indicators were computed to assess the three dimensions of the questionnaire (knowledge, attitude, belief). Furthermore, a stepwise linear regression model was used to predict the attitude to be engaged in smoking cessation counselling, related to demographic and behavioural variables, as well as knowledge and belief indicators. The analysis was stratified by Unit. Results Nurses from three Units had a significantly different attitude score (2.55 ± 0.93 for Cardiology, 2.49 ± 0.72 for Cardiac Intensive Care and 2.09 ± 0.59 for Surgical Oncology Unit) (P-value = 0.0493). Analogously, knowledge of smoking cessation counselling was reported to be higher for Cardiac Intensive Care Unit nurses (3.19 ± 0.70) compared to Surgical Oncology nurses (2.73 ± 0.74) (P-value = 0.021). At the multivariable analysis, attitude towards smoking cessation counselling was significantly related to the nurse’s belief about counselling, for Cardiology staff (coeff = 0.74, 95% CI [0.32–1.16], P-value = 0.002) and for Surgical Oncology staff (coeff = 0.37, 95% CI [0.01–0.72], P-value = 0.042). Conclusions Incorporation of smoking cessation interventions in nurses’ and nursing managers’ education could improve the nursing staff’s attitude, belief, and knowledge regarding smoking cessation counselling, which would lead to the inclusion of tobacco prevention and cessation as an integral part of patient care.

Self-care is a key concept for ostomy patients as much as for chronically ill patients. Many studies describe how reaching a good self-care level permits patient to perceive a higher quality of life, to adjust faster to the new condition, to grow empowerment feelings and to reduce readmissions and negative outcomes. There are many studies that state the negative impact of living with an ostomy on patients' quality of life. Quality of life is proven to be strictly related to self-care ability. Health professionals cannot fail to consider this aspect of ostomized patients' life to identify existing lacking areas of self-care abilities and to be able to project-specific educative interventions so to improve the impact that living with an ostomy has on patients. Specific self-care assessment tools could ensure self-care measurement, specific educational intervention planning and evaluation of caregivers' role.