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Background: In Italy, Diagnosis-Related Groups (DRGs) have been adopted for hospital services reimbursement. In some Italian regions, nurse staffing allocation is purely volume-based, with different minutes/patient/day categories determined by the type of hospital ward. The Information System of Nursing Performance (SIPI) is a valid and reliable tool assessing nursing care complexity as an indicator of the actual nursing care demand. Evidence is lacking about the ability of current resource allocation methods to account for the nursing care demand. Objective: To evaluate the association between (1) DRG rates and nursing care complexity and (2) hospital ward categories of nurse staffing and nursing care complexity. Methods: All patients discharged from the medical department of an Italian hospital over a data collection period were eligible. To assess the association between nursing care complexity (SIPI) and DRGs, the distribution of the DRG rate (median and first–third quartile) was compared for cases with high or low complexity. To evaluate the association between nursing care complexity (SIPI) and nurse staffing, the frequency of high complexity within nurse staffing categories (120/180/240 min/patient/day) was compared. Because the sample was very large, methods of statistical inference were not applied, and only descriptive measures were reported. Results: 6872 hospitalizations were included. The median DRG rate for high and low complexity admissions were very similar (EUR 3536 and EUR 3285, respectively). The proportion of admissions with high complexity decreased for wards with higher staffing allocation rates. Conclusion: DRG reimbursement and the nurse staffing allocation systems were ineffective in accounting for nursing care complexity. The SIPI could help identify areas requiring more financial and staffing resources for nursing care. [ABSTRACT FROM AUTHOR]

Delirium is highly prevalent among hospitalized older adults and is associated with unfavorable outcomes. However, delirium often remains undiagnosed in the hospital context. Having a valid, simple, and fast screening tool could help in limiting the additional workload for healthcare professionals, without leaving delirium undetected. The aim of this study was to estimate the sensitivity and specificity of the Recognizing Acute Delirium As part of your Routine (RADAR) scale in an Italian hospital. An observational cross-sectional study was conducted. A total of 150 patients aged ≥70 years were enrolled. Receiver operating characteristic (ROC) curves using the Confusion Assessment Method (CAM) criterion-defined delirium as the gold standard were plotted to evaluate the performance of the RADAR scale. The cut-off suggested by previous research was used to estimate the sensitivity, specificity, and positive and negative predictive values of the RADAR scale. The involved patients were mostly females (60%; n = 90), with a median age of 84 years (I–III quartiles: 80–88). According to the CAM and the RADAR scale, 37 (25%) and 58 (39%) patients were classified as experiencing delirium, respectively. The area under the ROC curve of the RADAR scale was 0.916. Furthermore, the RADAR scale showed robust sensitivity (95%), specificity (80%), and positive (60%) and negative predictive values (98%). The RADAR scale is thus suggested to be a valid tool for screening assessment of delirium in hospitalized older adults. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To evaluate the impact of the professional transition of new graduate nurses during the COVID‐19 pandemic. Background: The transition from the role of student to the professional role can be challenging for new graduate nurses for the acquisition of higher autonomy and responsibility. The COVID‐19 pandemic impacted the quality of the professional transition. Design: This was a cross‐sectional observational study following the Strengthening and Reporting of Observational Studies in Epidemiology checklist. Methods: One hundred and two nurses who graduated in three consecutive sessions (November 2019—pre‐pandemic, March 2020—pandemic outbreak, and November 2020—2nd wave) in a north Italian university located in the most affected Italian region by the COVID‐19 pandemic, completed an online survey assessing well‐being, risk of burnout, resilience, perceived stigma, strengths and limitations and quality of the professional transition. The study was performed between March and May 2021. Results: 81.4% of participants described the professional transition as worse than expected, and new graduate nurses who worked in COVID‐19 settings reported a more difficult transition to professional life. No differences emerged in burnout, mental well‐being and perceived stigma between new graduate nurses who worked in COVID‐19 settings and those who did not. Similarly, no differences emerged amongst the three graduated cohort sessions. The most commonly mentioned challenges faced during the transition were organisational aspects, suddenly acquired autonomy and lack of suitable coaching. Conclusion: New graduate nurses reported a challenging academic‐professional transition, in particular, those who worked in COVID‐19 settings. The mid‐ and long‐term impact of experiencing an academic‐professional transition in COVID‐19 settings should be assessed and monitored. Relevance to clinical practice: The professional transition of new graduate students should be adequately planned and monitored, new graduates should be assisted to develop realistic expectations about the transition, and an adequate coaching period should be guaranteed all the more during health emergencies. [ABSTRACT FROM AUTHOR]

Type 2 Diabetes Mellitus can cause serious complications; it has a severe impact on the quality of life and high costs. One of the key strategies to manage diabetes is self-care, a complex multifactorial process influenced by personal, cultural, and systemic factors, that comprises self-care maintenance, self-care monitoring, and self-care management. Few patients perform adequate self-care. To deepen our understanding of patients' experiences of self-care maintenance, self-care monitoring, and self-care management, we conducted the first qualitative study on this topic. This study used Interpretive Phenomenological Analysis, informed by the Middle-range Theory of Self-care of Chronic Illness, to explore the experience and meaning of self-care maintenance, self-care monitoring, and self-care management in adults with T2DM (n = 10). Three themes were identified: self-care is renouncement, self-care is routine, and self-care is control. A cross-cutting moral pattern connects the three themes. Our findings corroborate the Middle-range Theory of Self-care of Chronic Illness in the field of diabetes self-care and could inform practitioners in understanding the experience of self-care as a complex phenomenon and in developing tailored interventions. [ABSTRACT FROM AUTHOR]

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

Our aim is to culturally adapt the first section of the Patient Continuity of Care Questionnaire (PCCQ) for use among older Italian patients with chronic diseases and to test its psychometric properties. The PCCQ was translated, adapted to the Italian context, and completed by 236 older inpatients with chronic diseases at the point of discharge through a cross-sectional multi-centre validation study. Face and content validity were assessed. Exploratory factor analysis (EFA) with Mplus MLr estimator was conducted. Internal consistency was analysed through Cronbach's alpha and factor score determinacy coefficients. The overall content validity index of the 15-item Italian version of the questionnaire was 0.9. The EFA revealed a four-factor model yielding adequate fit indices. The factor score determinacy coefficients ranged from 0.87 to 0.94. The Cronbach's alpha coefficients ranged from 0.71 to 0.86 showing good reliability. The study provides health professionals with an instrument with adequate psychometric properties to assess patients' perception of the information received before hospital discharge. [ABSTRACT FROM AUTHOR]

Background: Personal values influence nursing students' development of professional values, which affect professional outcomes, and how nursing students react to different situations. Personal values can be shaped by different factors, including culture, gender, and age. Aims: To explore personal values held by nursing students, and to verify if and how gender and year of study affect nursing students' personal values. Research design: A multicenter, cross-sectional study was used. Participants and research context: The whole population of nursing undergraduate students available at the time was recruited from eight centers of two Universities, composing a sample of 947 students. Demographic data were collected and it was administered the Portrait Values Questionnaire. Ethical considerations: Ethical approval was obtained from the Institutional Review Boards of the University of the participating centers. Findings: The study sample was mainly composed of young (92.6%, n = 877), female (77.3%, n = 732), Italian (95.8%, n = 907), and unmarried (98.6%, n = 934) nursing students. The most important value for nursing students, consistently through the years of nursing school, was Self-transcendence, which has the motivational emphasis on helping others and selflessness. Then, we found that male students had higher levels of Power (p < 0.001) and Achievement (p = 0.031), while female students outscored male students in Benevolence (p = 0.005) and Security (p = 0.006). Year of study showed no statistically significant difference. Discussion: Nursing students express high levels in hetero-directed values. Male nursing students, although they choose a stereotypically feminine profession, outscored females in stereotypical masculine values such as dominance and success. This is the first study that describes the personal value profile of undergraduate nursing students, according to the Theory of Basic Human Values, and it is a starting point for future research. Conclusion: Nursing educators might want to consider the findings from this study while guiding students in developing awareness for their personal values. [ABSTRACT FROM AUTHOR]

In type 2 diabetes mellitus (T2DM) patients, human values have been identified as having a possible impact on self-care. Despite this, basic human values have never been described in the T2DM population and the association between basic human values and self-care has not been assessed. The aims of this study were to describe basic human values and self-care, and investigate the associations between basic human values and self-care in adults with T2DM. The study was cross-sectional multicentre with T2DM patients (n = 390). Sociodemographic and clinical data were collected from charts, and two questionnaires were administered. The Portrait Values Questionnaire (PVQ) measured basic human values and allowed us to group patients into four groups based on the value profile: (A) Openness to Change and Self-Transcendence, (B) Conservation and Self-Transcendence, (C) Conservation and Self-Enhancement, and (D) Openness to Change and Self-Enhancement. The Self-care of Diabetes Inventory measured self-care maintenance, self-care monitoring, self-care management, and self-care confidence, according to the Middle-Range Theory of Self-Care of Chronic Illness. Multiple regression models were used to assess associations between the basic human values and self-care. Group D (Openness to Change and Self-Enhancement) performed significantly lower self-care maintenance (p =.024) and self-care monitoring (p =.031) when compared with Group A, and lower self-care monitoring (p =.008) and self-care management (p =.018) when compared with Group B. Group D showed significantly lower self-care monitoring (p =.027) when compared with Group C. People with T2DM who value more self-enhancement and openness to change might be more prone to perform worse self-care compared with those who value conservation and self-transcendence. Clinicians should consider this when designing interventions aimed at improving self-care behaviors in patients with T2DM. [ABSTRACT FROM AUTHOR]

Background: The Informative System of Nursing Performance was developed to measure complexity of nursing care based on the actual interventions performed by nurses at the point of care. The association of this score with in-hospital mortality was not investigated before. Having this information is relevant to define evidence-based criteria that hospital administrators can use to allocate nursing workforce according to the real and current patients' need for nursing care. The aim of this study is to assess the association between complexity of nursing care and in-hospital mortality.Methods: Register-based cohort study on all patients admitted to acute medical wards of a middle-large hospital in the North of Italy between January 1, 2014, to December 31, 2015 and followed up to discharge. Out of all the eligible 7247 records identified in the Hospital Discharge Register, 6872 records from 5129 patients have been included. A multivariable frailty Cox model was adopted to estimate the association between the Informative System of Nursing Performance score, both as continuous variable and dichotomized as low (score < 50) or high (score ≥ 50), and in-hospital mortality adjusting for several factors recorded at admission (age, gender, type of admission unit, type of access and Charlson Comorbidity Index).Results: The median age of the 5129 included patients was 76 [first-third quartiles 64-84] and 2657(52%) patients were males. Over the 6872 admissions, there were 395 in-hospital deaths among 2922 patients at high complexity of nursing care (13.5%) and 74/3950 (1.9%) among those at low complexity leading to a difference of 11.6% (95% CI: 10.3-13.0%). Adjusting by relevant confounders, the hazard rate of mortality in the first 10 days from admission resulted 6 times significantly higher in patients at high complexity of nursing care with respect to patients at low complexity (hazard ratio, HR 6.58, 95%CI: 4.50;9.62, p < 0.001). The HR was lower after 10 days from admission but still significantly higher than 1. By considering the continuous score, the association was confirmed.Conclusion: Complexity of nursing care is strongly associated to in-hospital mortality of acute patients admitted to medical departments. It predicts in-hospital mortality better than widely used indicators, such as comorbidity. [ABSTRACT FROM AUTHOR]

Copyright of L'Infermiere is the property of IPASVI - Italian Nursing Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To verify the role of dispositional mindfulness, difficulties in emotion regulation and empathy in explaining burnout levels of emergency room (ER) nurses. Background: Many studies have examined the variables that can affect burnout amongst ER nurses, but little is known about factors that can protect ER nurses against work‐related stress. Method: A multi‐centre cross‐sectional design was used. Burnout level intensity, dispositional mindfulness facets, difficulties in emotion regulation and empathy dimensions were assessed using valid and reliable self‐report questionnaires in a sample of ER nurses (N = 97) from three different hospitals. Results: Higher dispositional mindfulness and cognitive empathy levels and lower difficulties in emotion regulation, were negatively associated with emotional exhaustion levels. Conclusion: ER nurses with more mindful, emotion regulation and empathy skills are more able to manage work‐related distress. Implications for Nursing Management: Experiential interventions to promote mindfulness skills, emotion regulation variability and flexibility in a clinical context and the cognitive side of empathy are recommended for ER nurses to reduce professional distress, and to enhance personal and work satisfaction. Future research should assess the effectiveness of new multi‐factorial interventions which combine the development of mindfulness, emotion regulation and empathy skills in ER nurses. [ABSTRACT FROM AUTHOR]

Copyright of L'Infermiere is the property of IPASVI - Italian Nursing Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of L'Infermiere is the property of IPASVI - Italian Nursing Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Two surveys were carried out to establish the status of enzyme replacement therapy (ERT) for lysosomal storage diseases in Italy. The first was a national survey covering the regional reference centres (RRCs) for these diseases; replies disclosed that 57.7% of patients are on ERT, administered almost exclusively in hospital settings (local hospital 60.7%, RRC 34.8%, home 2.6%); Italian health service procedures do not support ERT at home. The second survey was a regional survey in Lombardy, involving 48 patients (six of whom were on ERT at home). According to 40% of the patients, hospital-based ERT is disruptive, causing loss of days at school/work, stress and family issues. The patients on home therapy did not have these problems. However, 93% of patients receiving ERT in hospital perceived the advantages of greater safety, closer monitoring and more support from health professionals and experts. A total of 55% were willing to receive ERT at home, but 33% were against it. This may be the result of a lack of experience with ERT at home in Italy, or because of different opinions between family members and physicians. As international experience shows that ERT at home saves healthcare resources and improves quality of life, the issue should be raised with Italian healthcare policy makers, who should ensure nursing support for home-based ERT. [ABSTRACT FROM AUTHOR]

Undergraduate nursing students show high-stress levels. In students, stress has been linked to adverse physical and psychological health outcomes and academic and clinical demands. To date, there are few studies dealing with psychological predictors of stress amongst nursing students. This study aimed to assess psychological distress in a sample of Italian nursing students and to explore its relationship with sociodemographic and psychological factors, specifically dispositional mindfulness, emotional regulation difficulties, and empathy. A multicenter cross-sectional survey design was employed. Participants were recruited from five teaching hospitals associated with a public university in northern Italy. A sample of 622 undergraduate nursing students was recruited. Participants were recruited on campus and completed a paper-and-pencil survey. More than 70% of nursing students reported meaningful levels of psychological distress. Students with higher dispositional mindfulness scores had lower psychological distress, whereas emotional regulation difficulties and empathic personal distress were positively associated with perceived stress. No gender differences were found in stress levels, but senior students showed lower psychological distress than more junior students. Interventions aimed at increasing mindfulness facets and improving emotional regulation strategies may help to reduce perceived psychological stress in nursing students. • High levels of psychological distress are prevalent in nursing students. • There are no gender differences in nursing students' stress levels. • Senior nursing students show lower psychological distress than more junior students. • Dispositional mindfulness is a protective factor for stress in nursing students. • Improving emotional regulation strategies is recommended in nurse education. [ABSTRACT FROM AUTHOR]

Background Self-care is vital for patients with heart failure to maintain health and quality of life, and it is even more vital for those who are also affected by diabetes mellitus, since they are at higher risk of worse outcomes. The literature is unclear on the influence of diabetes on heart failure self-care as well as on the influence of socio-demographic and clinical factors on self-care. Objectives (1) To compare self-care maintenance, self-care management and self-care confidence of patients with heart failure and diabetes versus those heart failure patients without diabetes; (2) to estimate if the presence of diabetes influences self-care maintenance, self-care management and self-care confidence of heart failure patients; (3) to identify socio-demographic and clinical determinants of self-care maintenance, self-care management and self-care confidence in patients with heart failure and diabetes. Design Secondary analysis of data from a multicentre cross-sectional study. Setting Outpatient clinics from 29 Italian provinces. Participants 1192 adults with confirmed diagnosis of heart failure. Methods Socio-demographic and clinical data were abstracted from patients’ medical records. Self-care maintenance, self-care management and self-care confidence were measured with the Self-Care of Heart Failure Index Version 6.2; each scale has a standardized score from 0 to 100, where a score <70 indicates inadequate self-care. Multiple linear regression analyses were performed. Results Of 1192 heart failure patients, 379 (31.8%) had diabetes. In these 379, heart failure self-care behaviours were suboptimal (means range from 53.2 to 55.6). No statistically significant differences were found in any of the three self-care measures in heart failure patients with and without diabetes. The presence of diabetes did not influence self-care maintenance ( p = 0.12), self-care management ( p = 0.21) or self-care confidence ( p = 0.51). Age (p = 0.04), number of medications (p = 0.01), presence of a caregiver (p = 0.04), family income (p = 0.009) and self-care confidence (p < 0.001) were determinants of self-care maintenance. Gender (p = 0.01), number of medications (p = 0.004) and self-care confidence (p < 0.001) were significant determinants of self-care management. Number of medications (p = 0.002) and cognitive function (p < 0.001) were determinants of self-care confidence. Conclusions Self-care was poor in heart failure patients with diabetes mellitus. This population needs more intensive interventions to improve self-care. Determinants of self-care in heart failure patients with diabetes mellitus should be systematically assessed by clinicians to identify patients at risk of inadequate self-care. [ABSTRACT FROM AUTHOR]

Abstract: Background: The traditional model for nursing staff management widely used in Italian hospitals assumes that diagnosis determines the amount of nursing required, but this has been widely criticized. In order to quantify and monitor the fluctuation of the complexity in nursing care, a questionnaire, called SIPI (Sistema Informativo della Performance Infermieristica), that is based on the care needs expressed by the patients, has been proposed in the Monza Hospital. Design: A group of trained nurses were asked to indicate their own perception of the level of nursing day-care complexity provided to each patient and then to complete the SIPI. Settings: The Monza Hospital coordinated this multi-centre study that involved 25 Hospitals of North Italy. Participants: Each hospital contributed with a minimum of three units, at least one for each area of intensity of clinical care, as defined by health regulators. All adult in-patients being in the units from at least 24h were included in the survey. Psychiatric wards, neonatology, intensive and semi-intensive care wards were non considered. Methods: A group of nurses trained with the use of SIPI completed the questionnaires based on the nursing file of performed activities. Before filling the questionnaire, the nurses were asked to indicate their perception of the level of complexity of the day-care provided to each patient. In order to calculate the SIPI scores that discriminate different nurse complexity levels, a ROC analysis and the multinomial logistic regression model were used, considering the perceived complexity as the standard of reference. Results: The nursing day-care complexity was measured in 115 wards, for a total of 17,803 completed questionnaires. Nursing complexity was roughly the same in areas of different intensity of clinical care, both according to perception and as measured by SIPI. A cut-off of 49.2 was identified as optimal to distinguish two classes of complexity with a good performance (80% of specificity, 85% of sensitivity). Conclusions: The SIPI was shown to be a simple and useful tool that may be adopted in the future for an optimal allocation of nursing resources. The results of this study confirmed that elevated intensity of care from the clinical perspective does not necessarily correspond to high nursing complexity. [Copyright &y& Elsevier]

Background: Collaboration in healthcare is essential but differences in personal values can be a potential source of disagreements between physicians and nurses., Objectives: The purpose of this study was to verify if and to what extent there were divergences in the personal values profile between medical and nursing students at the beginning of their education and training. A second aim was to explore gender differences in personal values., Design: This is an observational cross-sectional study., Settings: This study was conducted at one University in northern Italy., Participants: We compared the personal values of 393 first-year medical students with those of 403 first-year nursing students., Methods: The Portrait Values Questionnaire-40 was administered and analyses of variance were performed to assess degree group and gender differences in terms of personal values., Results: Medical students scored significantly higher than nursing ones on values related to dominance over others and personal success. Female students significantly outscored males on personal values that reflect other-oriented and social focus, whereas male students obtained higher scores than females on personal values related to personal and selfish orientation., Conclusions: Schwartz's Theory of Basic Human Values may be a valuable theoretical framework for interprofessional education to promote a common reflection on personal values held by medical and nursing students since the early years of study., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background and Aims: Nonalcoholic fatty liver disease (NAFLD) may be crucial in subjects with familial hypercholesterolemia (FH). We aimed to evaluate the effect of the inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9-i) on steatosis biomarkers such as triglyceride-glucose index (TyG) and hepatic steatosis index (HSI) and analyse the role of TG/HDL in this population before and after adding-on PCSK9-i., Methods and Results: In this observational study, we evaluated 26 genetically confirmed FH patients with NAFLD and an LDL-C off-target despite high-intensity statins plus ezetimibe. All patients added PCSK9-i treatment and obtained biochemical analysis and TyG and HSI evaluation at baseline and after six months of PCSK9-i. No difference of steatosis biomarkers was found after adding-on PCSK9-i therapy. In a secondary analysis, we divided the study population in two groups according to TG/HDL median value: high TG/HDL group (H-TG/HDL) and low TG/HDL group (L-TG/HDL). TyG and HSI were significantly lower in the L-TG/HDL than H-TG/HDL group (for TyG 9.05 ± 0.34 vs 9.51 ± 0.32; for HSI 38.43 ± 1.35 vs 41.35 ± 1.83, p value for both < 0.05). After six months of PCSK9-i therapy, TyG and HSI were significantly reduced in the L-TG/HDL group after PCSK9-i therapy (-7.5% and -8.4% respectively, p value for both < 0.05) and these biomarkers were lower compared to H-TG/HDL group (for TyG 8.37 ± 0.14 vs 9.19 ± 0.12; for HSI 35.19 ± 1.32 vs 39.48 ± 1.33, p value for both < 0.05)., Conclusion: In conclusion, PCSK9-i therapy significantly ameliorate steatosis biomarkers in FH patients with low TG/HDL; our results appear to be consistent with a beneficial role of PCSK9-i on steatosis biomarkers in FH subjects with NAFLD., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Aim: To develop the Self-Care in COVID-19 (SCOVID) scale and to test its psychometric characteristics in the general population., Methods: We tested SCOVID scale content validity with 19 experts. For factorial and construct validity, reliability, and measurement error, we administered the 20-item SCOVID scale to a sample of 461 Italians in May/June 2020 (mean age: 48.8, SD ± 15.8)., Results: SCOVID scale item content validity ranged between 0.85-1.00, and the total scale content validity was 0.94. Confirmatory factor analysis supported SCOVID scale factorial validity (comparative fit index = 0.91; root mean square error of approximation = 0.05). Construct validity was supported by significant correlations with other instrument scores measuring self-efficacy, positivity, quality of life, anxiety, and depression. Reliability estimates were good with factor score determinacy, composite reliability, global reliability index, Cronbach's alpha, and test-retest reliability ranging between 0.71-0.91. The standard error of measurement was adequate., Conclusions: The SCOVID scale is a new instrument measuring self-care in the COVID-19 pandemic with adequate validity and reliability. The SCOVID scale can be used in practice and research for assessing self-care in the COVID-19 pandemic to preventing COVID-19 infection and maintaining wellbeing in the general population.

Aims: To describe self-care maintenance, monitoring, and management behaviors in adults with type 1 diabetes (T1DM), and to identify clinical and socio-demographic determinants of inadequate self-care., Methods: A cross-sectional study was conducted in two diabetes outpatient clinics in Italy. Clinical and socio-demographic characteristics were collected from the medical records of 181 consecutively enrolled T1DM patients. The Self-Care of Diabetes Inventory was used to measure self-care maintenance, self-care monitoring, self-care management and self-care confidence. A standardized 0-100 score was used for each self-care dimension. A score < 70 was considered inadequate self-care. Three multiple logistic regression models were run to find determinants of inadequate self-care maintenance, monitoring, and management., Results: The majority of patients had adequate self-care maintenance (74%; n = 134), self-care monitoring (68.5%; n = 124) and self-care confidence (87.3%; n = 158), while self-care management was adequate for only a minority (34.8%; n = 63). The odds of inadequate self-care maintenance increased by 4.5 times when self-care confidence was inadequate (OR adjusted 4.589; 95% CI 1.611-13.071; p = 0.004). The odds of inadequate self-care monitoring increased four times when patients had inadequate self-care confidence (OR adjusted 4.116; 95% CI 1.457-11.628; p = 0.008). Inadequate self-care confidence increased the odds of performing inadequate self-care management more than five times (OR adjusted 5.313; 95% CI 1.143-24.686; p = 0.033)., Conclusions: Self-care management is commonly inadequate in adults with T1DM. Self-care confidence is the most important determinant of self-care behaviors in this population. Educational interventions are recommended to improve self-care confidence in adults with T1DM.

Background: Delirium has a high incidence pathology associated with negative outcomes. Although highly preventable, half the cases are not recognized. One major cause of delirium misdiagnosis is the absence of a versatile instrument to measure it., Aims: Our objective was to translate the nursing delirium screening scale (Nu-DESC) and evaluate its performance in Italian settings., Methods: This was a methodological study conducted in two sequential phases. The first was the Italian translation of Nu-DESC through a translation and back-translation process. The second aimed to test the inter-rater reliability, the sensibility and specificity of the instrument on a convenience sample of 101 hospitalized elderly people admitted to relevant wards of the San Gerardo Hospital in Monza. To evaluate the inter-rater reliability, two examiners tested Nu-DESC on 20 patients concurrently without comparison. To measure the sensibility and specificity of Nu-DESC, the confusion assessment method was used as a gold standard measure., Results: The inter-rater reliability (Cohen Kappa) was 0.87-an excellent agreement between examiners. The study of the ROC curve showed an AUC value of 0.9461 suggesting high test accuracy. Using 3 as a cut-off value, Nu-DESC showed 100 % sensibility and 76 % specificity., Discussion and Conclusion: Further research is needed to test Nu-DESC on a larger sample. However, based on our results, Nu-DESC can be used in research and clinical practice in Italian settings because of its very good and similar performances to previous validation studies. The value of 3 appears to be the optimal cut-off in the Italian context.

Introduction: Self-care represents a key factor for diabetes patients to maintain quality of life and to prevent serious disease complications. Self-care standardized assessment tools are needed to evaluate and to promote self-care in diabetes patients. The Summary of Diabetes Self-Care Activities Scale (SDSCA) has been widely used in clinical and research settings and has been translated in many languages. Validity and reliability of this self-report scale were reported by several studies. However, SDSCA has not yet been translated, culturally adapted and tested in the Italian context. The aim of this methodological research was to translate and to provide a first validation study of the Italian SDSCA - 11 item Version., Methods: A process of translation, back-translation and semantic concordance evaluation has been performed in order to translate the SDSCA into Italian language in collaboration with the original authors. A cross-sectional survey has been planned to test internal consistency and test -retest reliability on a convenience sample of 80 type 2 diabetes patients. As secondary objective, SDSCA criterion validity has been explored referring to a range of clinical outcomes as glicated emoglobin and presence of complications., Results: A description of respondents' self-care abilities is provided for the whole sample and for sub-groups by gender, age, instruction and income levels. Cronbach's Alfa and Intraclass Correlation Coefficient showed acceptable values considering the multidimensionality of SDSCA. High values were obtained in 3 out of 5 sub-classes of items. As in previous studies, specific diet and physical exercise sub-classes showed limited internal consistency. Cohen's Kappa Concordance Correlation Coefficient and t-test demonstrated high test-retest reliability of SDSCA. Overall SDSCA score did not show significant correlations with selected clinical outcomes; however 3 SDSCA single items significantly correlated with glicated emoglobin, complications and the clinical judgment of the diabetes case manager nurse., Conclusion: Further researches involving larger samples are needed to integrate data about Italian SDSCA performances, especially concerning construct and criterion validity. However, based on these preliminary results, SDSCA could find relevant applications in clinical settings to systematically evaluate, to compare over time and to improve specific self-care abilities of diabetes patients.

Introduction: In recent years, in Italy, population lengthening of life leads to an higher number of individuals with chronic diseases (Osservatorio, 2010). The hospital which deals with the acute phase of diseases needs to be integrated with primary care. This connection is particularly important for the treatment, care and rehabilitation of patient, as well as a general need for more health and social care integrated tools., Objective: At the San Gerardo Hospital in Monza, in the context of the patient's post-acute rehabilitation, we analyze the phase between discharge from hospital and the expected date of hospitalization in facilities providing rehabilitation. The aim of this observational descriptive study is to determine the distribution of days of waiting. Furthermore, several different approach are analysed (i.e. Integrated Home Care) in order to reduce unnecessary days hospitalization and a more intelligent and cost effective use of resources The research question are the follow, to quantify waiting time between discharge and hospitalization in the rehabilitation facility and to ascertain if patients are sent to the correct facility., Result: 1083 individuals were taken into account, of those 55% (N=652) were discharged from the hospital later. This leads to a 4505 days of inappropriate hospitalization., Conclusion: Although the use of home care could be beneficial to the hospital, this can be used only for tiny part of the patients and it is not cost effective. A possible solution can be set up a number of low cost bed entirely managed by nurses due to the low level of intensity care.

The purpose of this historical research project is to examine the contribution of 19th-century religious congregations in the development of the nursing profession, based on the historical example of the Sisters of Charity of Sts. Bartolomea Capitanio and Vincenza Gerosa (or the Sisters of the Holy Child Mary). To this end, sixty three volumes were analysed, all taken from the historical archive of the Generalate of the Sisters of the Holy Child Mary in Milan, in via S. Sofia n.13, with the exception of just one, taken from the Braidense National Library, also in Milan. This research project has highlighted the sociological contribution provided by the Sisters of the Holy Child Mary to the professional nature of nursing, and to the development of the distinctive features of the nursing profession (Greenwood, 1980). All documentary sources were analysed in line with the Chabod historical research method (2006), and for their critical interpretation, a scheme of analysis was created. Two lines of investigation emerged from the data collected: the role of Sister Emilia Vinante as an expert with regard to the nursing profession, and the professional strategies promoted by FIRO (Federation of Italian Religious Nurses). Based on the conclusions of the research project, it may be stated that religious congregations contributed greatly to the nursing profession, leaving a decisive mark on the cultural and professional development of nurses.

Aim: On 6 April 2009, at 3:32 GMT, central Italy was struck by a 6.3-magnitude earthquake with its epicentre near L'Aquila, the capital city of the Abruzzo region. Earthquakes may precipitate psychiatric symptoms. The aim of this study was to investigate cognitive functioning and positive and negative symptoms before and after the 2009 L'Aquila earthquake in patients with first-episode psychosis (FEP) and chronic schizophrenia (CS)., Methods: A total of 54 FEP patients (34 males and 20 females) and 63 CS patients (39 males and 24 females) were investigated. Psychometric scores were submitted to a 2 × 2 mixed analysis of variance, with group (FEP and CS) as the between-subjects variable and time (pre- and post-earthquake) as the within-subjects variable., Results: Positive symptoms increased significantly from the pre- to the post-earthquake assessment in FEP patients but not in those with CS. There were no significant differences between the pre- and post-earthquake period in terms of negative symptoms in both groups. Compared with the pre-earthquake assessment, FEP patients scored significantly worse at the post-earthquake evaluation in terms of Wisconsin Card Sorting Test categories achieved, immediate verbal memory and delayed verbal memory. However, there were no significant differences in cognitive scores between the pre- and post-earthquake periods in patients with CS., Conclusions: Our findings suggest that a disastrous earthquake has a negative impact on cognitive functioning and positive symptoms in FEP patients, but not in those with CS., (© 2011 Blackwell Publishing Asia Pty Ltd.)