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The aim of the work is to describe the protocol adopted by the Home Care Service in pediatric onco-hematological patients of a large cancer institute in Italy during COVID-19 pandemic and to present preliminary data. Based on our experience, we have developed strategies to ensure continuity of care, non-abandonment, and protection of patients and operators in a period of emergency like this. In this context, the "COVID at home" protocol plays a central role. It aims to be able to safely manage COVID-19 positive onco-hematological patients, allowing nursing and medical care in the home setting, identifying patients at risk for COVID-19 infection, and rationalizing improper accesses to the hospital.

Background The paediatric intensive care unit (PICU) diary is a shared tool, kept at the patient bedside, written by relatives and health care providers. There is little evidence about its feasibility and how it supports the families of children admitted to the PICU. Currently, there is no evidence about how the PICU diary is used and what we can learn from it. Aim To explore the contents of narrative PICU diaries in an Italian PICU. Study design Qualitative study of PICU diaries conducted with a narrative research approach. Methods Children sedated and mechanically ventilated for >48 hours were enrolled in a six-bed Italian PICU of a tertiary care paediatric hospital. During the child's PICU admission, caregivers, relatives, friends, and health care providers were invited to report events, thoughts, and messages, and attach drawings/pictures for the child in the PICU diary. A thematic analysis of the PICU diary contents was performed. Results Thirteen PICU diaries were completed between August and December 2020, mainly by parents (n = 95; 45%) and health care providers (n = 52; 25%). Three main themes emerged: "Social and spiritual support," "Caregiver's emotions, feelings and distress," and "PICU life." Diaries offer insight into caregivers' emotions, social support, clinical activities, and interactions with health care providers, and on progression towards recovery. Conclusion PICU diaries are valuable in facilitating family-centred care by providing a space for the written account of the child's admission by parents, other visitors, and health care providers. Relevance to clinical practice PICU diaries support the relationship and the communication between the family and the team; they provide an informal account of the emotions and needs of parents that has the potential to improve mutual understanding and family-centred care. Social support and spiritual support are key elements reported by parents for coping with their child's PICU admission.

Children with medical complexity (CMC) are a high priority population with chronic illnesses dependent on the use of health services, on technological systems to support their vital functions and characterized by multiple health needs. One of the main challenges linked to chronic conditions is finding solutions to monitor CMC at home, avoiding re-hospitalization and the onset of complications. Telemedicine enables to remotely follow up patients and families. An integrative review was performed to assess whether telemedicine improves health outcomes for CMC. Medline/PubMed, CINAHL, Cochrane Library, Web of Science, and Scopus were searched to identify studies describing the effect of using telemedicine systems on health outcomes for CMC. The PRISMA guidelines were used to select the papers. The methodological quality of the studies was evaluated through the Johanna Briggs Institute critical appraisal tools and the Cochrane Collaboration ROB 2.0. A total of 17 papers met the quality criteria and were included. Specialized telemedicine systems (tele-visits), telehealth, and tele-monitoring have been reported to reduce unplanned hospitalizations and visits, decrease total costs for healthcare services and families, and increase satisfaction for family members. No effect was found on the quality of life in children and their families. Conclusion: Available evidence supporting the use of telemedicine in CMC is favorable but limited. High-quality methodological studies including other unexplored health outcomes such as mental health, hospital readmissions, mortality, caregiver competences, and self-efficacy are needed to confirm the effectiveness of telemedicine systems in improving health outcomes for CMC. What is Known:• CMC are an extremely fragile patient population with frequent access to healthcare services compared with other chronic conditions.• There is conflicting evidence of the effectiveness of telemedicine clinical outcomes, healthcare utilization, and costs in pediatrics.What is New:• There is some evidence that for CMC, telemedicine reduces unplanned hospitalizations, healthcare service costs, and financial burden for families, while increasing caregivers’ satisfaction with care.• Further research is needed to confirm the effectiveness of telemedicine systems in improving health for CMC. Supplementary information The online version contains supplementary material available at 10.1007/s00431-021-04164-2.

This study aimed to evaluate the intensity and characteristics of pain, which was assessed at home by children with cancer or their parents using an app for mobile devices, for a 1-month poststudy enrollment. The participants of this observational prospective study were outpatients at the hematology/oncology department of an academic hospital in Italy, aged between 0 and 21 years, and receiving hospital-at-home care. Patients or their parents were asked to assess pain levels for one month at home using the Faces, Legs, Arms, Cry, and Consolability (FLACC) scale for patients aged

Background Infants, young children, and their mothers are vulnerable in humanitarian emergencies. The health benefits of optimal breastfeeding practices in emergency settings have been demonstrated by many researchers. Infant and Young Children Feeding in Emergency guidelines illustrate a series of interventions to protect, promote, and support breastfeeding, but unfortunately, these recommendations are still scarcely applied. Research Aims (1) To review the literature describing the effectiveness of breastfeeding protection, promotion, and support interventions in humanitarian emergency contexts; (2) to describe the influence of interventions on breastfeeding initiation, exclusivity, and duration; and (3) to evaluate relevant mother and infant/child outcomes available in the literature. Methods PubMed, CINAHL, Cochrane Library, Psychology Database, JSTOR, Web of Science, EMBASE, and Ovid were searched for articles that examined breastfeeding protection, promotion, or support interventions and the resulting outcomes without any time limits ( N = 10). Articles that did not include the interventions and related outcomes were excluded ( n = 1,391). Results Improved breastfeeding outcomes were reported in four (40%) papers, and three (30%) highlighted a behavioral change in infant and young child feeding practices following the implementation of the interventions. Increased knowledge about appropriate infant and young child feeding practices among mothers and humanitarian/health staff was reported in eight (80%) papers. However, outcomes were sometimes only generically reported, and some of the included papers had a low strength of evidence. Conclusion In the literature, there is a great dearth of studies evaluating the influence of interventions aimed at improving breastfeeding in emergency settings. More evidence is urgently needed to encourage and implement optimal breastfeeding practices.

Background The aim of this study is to describe the adherence to the Bedside Pediatric Early Warning System (BedsidePEWS) escalation protocol in children admitted to hospital wards in a large tertiary care children’s hospital in Italy. Methods This is a retrospective observational chart review. Data on the frequency and accuracy of BedsidePEWS score calculations, escalation of patient observations, monitoring and medical reviews were recorded. Two research nurses performed weekly visits to the hospital wards to collect data on BedsidePEWS scores, medical reviews, type of monitoring and vital signs recorded. Data were described through means or medians according to the distribution. Inferences were calculated either with Chi-square, Student’s t test or Wilcoxon-Mann–Whitney test, as appropriate (P Results A total of 522 Vital Signs (VS) and score calculations [BedsidePEWS documentation events, (DE)] on 177 patient clinical records were observed from 13 hospital inpatient wards. Frequency of BedsidePEWS DE occurred P = 0.006). The BedsidePEWS score was correctly calculated and documented in 84 % of the BedsidePEWS DE. Patients in a 0–2 BedsidePEWS score range were all reviewed at least once a day by a physician. Only 50 % of the patients in the 5–6 score range were reviewed within 4 h and 42 % of the patients with a score ≥ 7 within 2 h. Conclusions Escalation of patient observations, monitoring and medical reviews matching the BedsidePEWS is still suboptimal. Children with CHC are at higher risk of lower compliance. Impact of adherence to predefined response algorithms on patient outcomes should be further explored.

Background The role played by nurses in caring for children in pediatricians’ officies in the community is crucial to ensure integrated care. In Italy, pediatricians are responsible for the health of children aged 0–14 years living in the community. This study aimed to describe Italian primary care pediatricians’ opinions about the usefulness of several nursing activities that pediatric nurses could perform in pediatricians’ offices. Methods An online survey with pediatricians working in primary care in Italy was conducted between April–December 2018. A 40-item questionnaire was used to assess four types of nursing activities: clinical care, healthcare education, disease prevention, and organizational activities. The answers ranged from 1 (not useful at all) to 6 (very useful). Moreover, three open-ended questions completed the questionnaire. Results Overall, 707 pediatricians completed the online survey. Participants were mainly female (63%), with a mean age of 57.74 (SD = 6.42). The presence of a pediatric nurse within the pediatrician’s office was considered very useful, especially for healthcare education (Mean 4.90; SD 1.12) and disease prevention (Mean 4.82; SD 1.11). Multivariate analysis confirmed that pediatricians ‘with less working experience’, ‘having their office in a small town’, and ‘collaborating with a secretary and other workers in the office’ rated the nurse’s activities significantly more useful. Conclusions A pediatric nurse in the pediatrician’s office can significantly contribute to many activities for children and their families in the community. These activities include clinical care, healthcare education, disease prevention, and the organizational processes of the office. Synergic professional activity between pediatricians and pediatric nurses could ensure higher health care standards in the primary care setting.

A prospective comparative study was conducted in 487 pediatric patients (69% male, mean age = 6.4 ± 4.0) to evaluate (a) the incidence, intensity, and characteristics of pain in pediatric patients at home during the first 24 hours and 5 days after surgery and (b) the factors associated with higher pain intensity, including the impact of an application (App) compared to the paper-and-pencil approach. Postoperative pain was assessed by patients or their parents at home using the ‘Bambino Gesù’ Children’s Hospital (Ospedale Pediatrico Bambino Gesù, OPBG) tool for participants aged 4–17 years or the Faces, Legs, Arms, Cry, and Consolability scale for participants less than four years old. Participants were assigned to two groups: those who used the paper-and-pencil version of the pain scale and those who used the App. Overall, 209 of the 472 (44%) participants reported pain during the first 24 hours, and 92 of the 420 (22%) reported pain between one and five days after surgery. Higher pain intensity scores were associated with being in the App group, directly assessing own pain, and using the OPBG tool. The App was effective in facilitating pain assessment. Health professionals could empower pediatric patients and their parents in assessing pain at home through a dedicated App.

About 20-30% of children access the Pediatric Accident and Emergency Department (AE) for non-urgent health care that should normally follow other health care paths. This study aimed to investigate why parents take their children to the AE for non-urgent visits rather than using primary care services.A one-year cross-sectional study was conducted in a large pediatric AE in Italy. A paper-and-pencil 40-item questionnaire was administered to parents of children aged between 3 months to 6 years who accessed the AE for non-urgent visits between July 2018 and June 2019.Parents of 238 children completed the questionnaire (mean age = 2.6 years; male 58%). The most common symptoms were fever (n = 105; 44.1%) and skin rash (n = 63; 26.5%); symptoms usually started more than 24 h earlier (n = 163; 69.4%). Reasons for accessing the AE for non-urgent visits included the availability of rapid medical tests (n = 71; 29.8%), deterioration of the clinical conditions after the pediatrician's visit (n = 67; 28.2%), and the perceived need for urgent care (n = 65; 27.3%). Besides, 26.6% (n = 63) of parents reported not being able to contact their pediatrician before accessing AE.Parents may need further education to distinguish between urgent and non-urgent pediatric health conditions.

Despite the fact that cancer patients seem to be at a higher risk of being infected with SARS-CoV-2, limited data are available in the pediatric oncology setting. A systematic rapid review was conducted to analyze scientific literature regarding the management, interventions, and strategies adopted to prevent the spread of COVID-19 in the pediatric cancer population. Our search on PubMed, Scopus, Cochrane, and EMBASE databases yielded 505 articles. After removing duplicates, 21 articles were included. Articles focused on infection prevention (n = 19; 90.5%), management (n = 18; 85.7%), overall management of specific treatments for cancer (n = 13; 61.9%), and education (n = 7; 33.3%). The interventions adopted to prevent the spread of COVID-19 were similar across organizations and in line with general recommendations. Most of them reported interventions that could be used as valid strategies for similar emergencies. The strategies included limiting the risk of contagion by restricting access to the wards and implementing hygiene measures, the identification of separate pathways for the management of patients suspected or confirmed to be infected with COVID-19, the postponement of people accessing the hospital for non-urgent or unnecessary tests or medical examinations, and the preventive screening of patients before chemotherapy treatment or transplantation of hematopoietic stem cells. It is necessary to identify key indicators in order to better evaluate the effectiveness of the interventions implemented over time. A summary of the recommendations is provided.

Background In Neonatal Intensive Care Units (NICUs), parent satisfaction and their experiences are fundamental to assess clinical practice and improve the quality of care delivered to infants and parents. Recently, a specific instrument, the EMpowerment of PArents in THe Intensive Care-Neonatology (EMPATHIC-N), has been developed in the Netherlands. This instrument investigated different domains of care in NICUs from a family-centered care perspective. In Italy, no rigorous instruments are available to evaluate parent satisfaction and experiences in NICU with family-centered care. The aim of this study was to translate and validate the EMPATHIC-N instrument into Italian language measuring parent satisfaction. Methods A psychometric study was conducted in nine Italian NICUs. The hospitals were allocated across Italy: four in the North, four in Central region, one in the South. Parents whose infants were discharged from the Units were enrolled. Parents whose infants died were excluded. Results Back-forward translation was conducted. Twelve parents reviewed the instrument to assess the cultural adaptation; none of the items fell below the cut-off of 80% agreement. A total of 186 parents of infants who were discharged from nine NICUs were invited to participate and 162 parents responded and returned the questionnaire (87%). The mean scores of the individual items varied between 4.3 and 5.9. Confirmatory factor analysis was performed and all factor loadings were statistically significant with the exception of item ‘Our cultural background was taken into account’. The items related to overall satisfaction showed a higher trend with mean values of 5.8 and 5.9. The Cronbach’s alpha’s (at domain level 0.73-0.92) and corrected item-total scale correlations revealed high reliability estimates. Conclusions The Italian EMPATHIC-N showed to be a valid and reliable instrument measuring parent satisfaction in NICUs from a family-centered care perspective. Indeed, it had good psychometric properties, validity, and reliability. Furthermore, this instrument is fundamental for further research and internationally benchmarking. Electronic supplementary material The online version of this article (10.1186/s13052-017-0439-8) contains supplementary material, which is available to authorized users.

[This corrects the article DOI: 10.7748/ncyp.2018.e1081.].

BACKGROUND Assessment of pain in paediatric intensive care units (PICUs) is crucial to minimise the risks of inadequate sedation. AIM To translate and validate the Italian version of the COMFORT behaviour scale (CBS) in a PICU in terms of its psychometric, construct, feasibility and reproducibility properties. METHOD Before and after tracheal suctioning, 71 observations were performed on 35 sedated and mechanically ventilated patients in three PICUs. Pain and distress were assessed using the CBS and the Nurse Interpretation of Sedation Score (NISS). RESULTS Interrater agreement and interrater reliability were high before the procedure and moderate after (pre: 100%, Cohen's kappa = 1; post: 79%, Cohen's kappa = 0.558). The scale's internal consistency was calculated before and after the procedure (Cronbach's alpha = 0.81 and 0.91). Agreement between the CBS and the NISS was low before and after the procedure (20% and 28%). The agreement between the tools was low because the NISS, a tool based on expert opinion, is not as precise as the CBS and could be affected by cultural biases. CONCLUSION The Italian version of the CBS proved to be valid and reproducible for the objective measurement of pain and distress in a wide age range of patients admitted to PICUs.

Hospital mortality in children who undergo stem cell transplant (SCT) is high. Early warning scores aim at identifying deteriorating patients and at preventing adverse outcomes. The bedside pediatric early warning system (BedsidePEWS) is a pediatric early warning score based on 7 clinical indicators, ranging from 0 (all indicators within normal ranges for age) to 26. The aim of this case-control study was to assess the performance of BedsidePEWS in identifying clinical deterioration events among children admitted to an SCT unit. Cases were defined as clinical deterioration events; controls were all the other patients hospitalized on the same ward at the time of case occurrence. BedsidePEWS was retrospectively measured at 4-hour intervals in cases and controls 24 hours before an event (T4-T24). We studied 19 cases and 80 controls. The score significantly increased in cases from a median of 4 at T24 to a median of 14 at T4. The proportion of correctly classified cases and controls was >90% since T8. The area under the curve receiver operating characteristic was 0.9. BedsidePEWS is an accurate screening tool to predict clinical deterioration in SCT patients.

The quality of hospital foodservice is one of the most relevant items of health care quality perceived by patients and by their families. Patient satisfaction is considered a way of measuring the quality of services provided. The purpose of this study was to retrieve and review the literature describing patient satisfaction with hospital foodservices. The systematic review was conducted on three electronic archives, PubMed, Excerpta Medica Database, and the Cumulative Index to Nursing and Allied Health Literature (1988 through 2012), to search for any articles reporting patient satisfaction with hospital foodservices. A total of 319 studies were identified. After removing duplicates, 149 abstracts were reviewed, particular attention being given to the presence of a description of the tool used. Thirty-one articles were selected and the full texts were reviewed. Half the studies (n=15) were performed in North America. Patient satisfaction scores were generally high, with some variation among hospitals and different modes of food delivery that was investigated through intervention studies. Qualitative studies were also reported (ethnographic-anthropologic methods with interviews and focus groups). Quantitative tools were represented by questionnaires, some of which relied on previous literature and only a few were validated with factorial analysis and/or Cronbach's α for internal consistency. Most analyses were conducted assuming a parametric distribution of results, an issue not primarily tested. More studies on the quality of hospital foodservice have been carried out in North America than in Europe. Also, a variety of tools, most of which have not been validated, have been used by the different investigating facilities.

Objectives To explore family-centred care practices in Italian neonatal intensive care units and describe areas for improvement. Methods A cross-sectional, multicentre, survey was conducted using the Italian language version of “Advancing family-centred new-born intensive care: a self-assessment inventory”. The instrument is divided into 10 sections rating the status of family-centred care (1 = not at all, 5 = very well) and ranking the perceived priority for change/improvement (1 = low, 3 = high). A representative group of staff and parent for each unit were invited to complete the survey. Data was collected between January and June 2015. Correlations among unit characteristics and sections within the survey were explored. Settings All Italian neonatal intensive care units (n = 105) were invited. Results Forty-six (43.8%) units returned the survey. The “Leadership” section scored highest in status of family-centred care (mean = 3.45; SD 0.78) and scored highest in priority for change (mean = 2.44; SD 0.49). Section “Families as Advisors and Leaders” scored lowest both in status (mean = 1.66; SD 0.67) and in priority for change (mean = 2.09; SD 0.59). The number of discharged infants was positively correlated with many sections in priority for change (r 0.402–0.421; p Conclusion This study showed a variability in the organisation of family-centred care practices in Italian neonatal intensive care units and the need to involve parents as partners in the care team. Although family-centred care is considered important by Italian neonatology healthcare professionals, much remains to be done to improve family-centred care practices in neonatal intensive care units in Italy.

This systematic review synthesised and described instruments measuring parent satisfaction with the increasing standard practice of family-centred care (FCC) in neonatal intensive care units. We evaluated 11 studies published from January 2006 to March 2016: two studies validated a parent satisfaction questionnaire, and nine developed or modified previous questionnaires to use as outcome measures in their local settings. Most instruments were not tested on reliability and validity. CONCLUSION Only two validated instruments included all six of the FCC principles and could assess parent satisfaction with FCC in neonatal intensive care units and be considered as outcome indicators for further research.

The Bambino Gesu Children's Hospital, Rome (Italy), is a Research Institute whose main objectives are to ensure the health care for children and to pursue research projects in the biomedical field as well as in health services management and organisation. In December 2007, the hospital inaugurated a new service, namely the Unit for Nursing and Allied Health Personnel Professional Development, Continuing Education and Nursing Research with the objective of improving nursing research. The aim of this paper is to describe the framework of nursing research of children and the steps to improve nursing research in the hospital. Nursing research in paediatric nursing is oriented towards ‘family-centred care': this means that the research questions must arise from the relative nursing care, and that the results of nursing research must return to paediatric nursing practice. The first step of the research programme has been the creation of a research group within the hospital. The research group is, for all of us, an important opportunity offered by the hospital, an occasion for learning and for expanding scientific and methodological expertise. The research group is multidisciplinary and allows comparison and sharing between peers of elements concerning paediatric nursing research; it is a research laboratory, stimulating research and reaching all the nursing staff throughout the hospital. Members of the research group have taken part in a study on nursing participation in research during recent years, as well as on research priorities for the future.

The first core of the Hospital started with few beds in a small street (via delle Zoccolette) and the religious Institute “Figlie della Carita di San Vincenzo de Paoli” was entrusted with the management of this new hospital, hosting children aged from four to twelve. In 1887 the Hospital moved to the building of the S. Onofrio ancient Convent, on the Gianicolo hill. This was bound to become the final premises of the Bambino Gesu Hospital. The hospital nursing service has been evolving in accordance with the hospital's objectives and can guarantee quality, safety, and resource management in nursing care provided by health care professionals according to their role and function. It is structured in Departments. Our nursing service belongs to Healthcare Department and our main responsibilities are technical coordination and programming, management and organizational consulting. The nursing service is structured into three levels: a strategic planning central level, an intermediate level providing nursing planning, coordination and management and a peripheral level. Our hospital is a Research Institute with the main objective of pursuing research projects in the biomedical field together with health services management and organization.

Background The quality of family-centered care (FCC) in Neonatal Intensive Care Unit (NICU) is often assessed through Parental satisfaction (PS). Empathic-N, a validated questionnaire to evaluate PS in NICU, was recently developed in the Netherlands [1].To our knowledge similar instruments have not yet been used in Italy. The aim of this project is to translate the 57-item Empathic-N questionnaire and to develop and adapted Italian version for postNICU (Empathic-SN) taking the Italian cultural adaptation into account, and to test their psychometric validity.

Objective To assess the effectiveness of an improvement programme to reduce the number of interruptions during the medication administration process in a paediatric hospital. Design and methods A prestudy–post study design was used to monitor nursing interruptions during medication cycles in a paediatric hospital. Interruptions were reported on an observation sheet (MADOS-P) adapted to the paediatric context. Setting A 600-bed tertiary paediatric research hospital in Italy. Intervention The interventions included a yellow sash worn by nurses during medication cycles, a yellow-taped floor area indicating the ‘No interruption area’, visual notices in the medication areas, education sessions for healthcare providers and families, patient and parent information material. Results 225 medication cycles were observed before the intervention (T0) and 261 after the intervention (T1). The median of interruptions occurring in each cycle decreased significantly from baseline to postintervention (8.0 vs 2.0, p=0.002), as the rate ratios (interruptions/patient post–pre ratio: 0.34; interruptions/medication post–pre ratio: 0.37; interruptions/hour of medication cycle post–pre ratio: 0.53, p

UNLABELLED Theme: Leadership, management, nursing education. INTRODUCTION Family-centered care (FCC) in NICUs is related to staff culture and the organization of the unit. AIM To describe the organizational characteristics and services for families in Italian NICUs. METHODS This survey involved 105 NICUs in Italy. The Italian version of the 'FCC in the NICUs: A Self-Assessment Inventory' developed by the Institute for FCC was sent to the nurse managers in January 2015. RESULTS Forty-seven NICUs answered (49%). The means of the NICU characteristics are number of beds: 20; newborns discharged/year: 331, of which very low birth weight infant: 68; unit's rooms: 3.7). The total mean score of the 10 areas explored by questionnaire was 2.6 (on 5 points Likert scale) for the 'status' and of 2.3 (on 3 points scale) for priority for change. CONCLUSION The results show an organizational lack, but also the consciousness of the need of change. Sharing new organizational strategies could be an important issue for the future.

Pain is a common experience among children and infants in clinical settings worldwide. Nurses often depend upon parents to aid in assessment of pain. Yet, the unique parent's processes of appraising pain are not fully known. The purpose of this study was to explore the social process of parent appraisal of child and infant pain and to examine cultural influences upon this appraisal. A qualitative design with grounded theory method was used to guide data collection and analysis in the larger international study. Settings were two acute care clinical sites, one in Rome, Italy and one at a large Midwestern tertiary hospital in the USA. This paper reports on findings from the Italian sample of 12 parents of children hospitalized in three units (the cardiac surgical intensive care, the neonatal intensive care unit and the oncology-emathology unit). Data were drawn from semi-structured interviews and bedside observations of parent-child interactions. A constant comparative data analysis approach resulted in coding of text and observation data, thematic naming, comparison of differences and commonalities between participants, and re-assembling of the themes. The core process of parent appraisal of pain was identified as “struggling to understand the hurdle of pain while protecting the child” Parents described a process of comparing, observing, grading, and rationalizing in their struggle to understand child pain. Unique cultural values and beliefs influenced the parent's depth of involvement in the appraisal process. Parent sense of success in protecting the child was interwoven with the relationship with the provider.