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To explore nurses' perspectives on and experiences of safety-related organisational challenges during the coronavirus disease 2019 (COVID-19) outbreak by Iranian nurses.In different clinical contexts, nurses face numerous organisational challenges threatening their safety because of the COVID-19 pandemic.Exploring nurses' perceptions towards safety-oriented organisational challenges might inform nurse managers, healthcare managers, educators and policymakers on the priorities that should be considered to increase organisations' readiness and safety.This qualitative descriptive study is reported according to the Consolidated Criteria for Reporting Qualitative Research guidelines. Through purposeful sampling, 19 participants were involved. The research data were collected from March to August 2021 by conducting semi-structured interviews that were analysed through the content analysis approach.Three organisation-related safety challenges experienced were related to (1) human resource, (2) educational and (3) workforce protection issues.Nurses experienced several safety issues related to the complexity faced by the health care organisations during the pandemic, exacerbated by previous frailties of the nursing system.The three challenges that emerged might be considered a priority in building pandemic plans, transforming the experiences of nurses as a source of learning for all, capitalising on their suggestions and rendering healthcare facilities ready to deal safely with future crises.Adopting appropriate measures to decrease human resource issues and that related to education, and promoting workforce health protection, are both recommended to improve nurses' work environment and satisfy their safety needs.

Rare diseases represent a numerous (more than 30 million patients throughout Europe), diverse (more than 6000 disease ascertained), and complex group of genetic, metabolic, neurologic, congenital and other type of disorders presenting both in pediatric and adult age. Research, education and care are the mainstay of the national rare disease plans of the member states, including Italy. Early diagnosis and multidisciplinary care, particularly in severe or progressive disorder, are mandatory to treat disorders (when a specific treatment is available) and/or avoid life-threatening complications. According to the catchphrase "you can only diagnose what you know", it is intuitive how important is education and the "culture of suspect" in rare disease. In the last decade, a pre- and post-graduate academic planning on rare disease have been set up in Italy, with the aim to be comprehensive and up-to-date with the literature, traversal to both general physicians and all the specialties, longitudinal during all the study courses.

Unfinished nursing care (UNC), as the care required by patients that delayed or not delivered, has been investigated mainly from the perspective of nurses, while little is still known from the side of patients. Some studies have involved patients to measure which elements of care are mostly unfinished (e.g., mouth care), whereas a few studies have investigated the reasons for UNC as perceived by them. Their involvement in understanding the reasons for UNC is crucial to advance the knowledge and co-develop possible strategies to prevent or minimize UNC.This is a descriptive qualitative study performed according to COnsolidated criteria for REporting Qualitative research guidelines in 2022. A purposeful sample of Italian hospitalized patients in two medical and two surgical units was involved. A face-to-face semistructured interview was used to merge reasons for UNC. Qualitative content analysis was conducted to merge subthemes and themes as factors leading to UNC according to the experience of patients.A total of 23 patients (12 surgical and 11 medical) were involved (12/23 male) with an age average of 66.2 years, educated mainly at secondary school, and with previous hospitalizations (20/23), and dependent on nursing care in daily activities (14/23). Reasons for UNC have been identified at four levels: (1) 'New health-care system priorities' and 'Pre-existing frailty of health-care facilities' were reasons identified at the health-care system level; (2) 'Lack of resources attributed to wards', 'Ineffective ward organization' and 'Leadership' were identified at the unit level; (3) 'Nurses' attitudes and behaviour' were reported at the nurses' level and (4) 'Increased nursing care expectations' were pinpointed at the patient level.Patients can be involved in identifying UNC, but also in recognizing the underlying reasons. Engaging them in such investigations might broaden our understanding of the phenomenon and the possibility of identifying strategies to minimize and prevent UNC.Patients from four hospital units (two medical and two surgical) were involved in face-to-face interviews to merge the reasons perceived by them as triggering UNC. All factors (as themes and subthemes) have derived from their words, thus enhancing the evidence available from the side of the patients.

New nurses are needed in healthcare. To meet the role expectations of a registered nurse, nursing students must feel empowered at graduation. However, there are only a few studies focusing on nursing students’ empowerment. This study aims to describe and analyze graduating nursing students’ level of empowerment in six European countries and potential related factors. A comparative and cross-sectional study was performed in the Czech Republic, Finland, Italy, Portugal, Slovakia, and Spain with graduating nursing students (n = 1746) using the Essential Elements of Nurse Empowerment scale. Potentially related factors included age, gender, a previous degree in health care, work experience in health care, graduation to first-choice profession, intention to leave the nursing profession, level of study achievements, satisfaction with the current nursing programme, clinical practicums, theoretical education, and generic competence measured with the Nurse Competence Scale. The data were analysed statistically. Graduating nursing students’ self-assessed level of empowerment was moderate, with statistical differences between countries. Those with high empowerment had no intention to leave the nursing profession, had a higher level of study achievements, and a higher self-assessed generic competence level. The results suggest that empowerment needs to be enhanced during nursing education. Further research is needed to understand the development of empowerment during the early years of a nursing career.

Although quarantine has been largely used in the recent period of novel coronavirus disease (COVID-19), there has to date been no summary of the available literature regarding its implications among health care workers (HCWs). A scoping review was performed, following The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review and the Joanna Briggs Institute Critical Appraisal Checklist. The CINAHL, PubMed, and SCOPUS databases were queried up to 31 January 2021. Nine studies ranging from low to high methodological quality, were included. These were conducted in diverse countries, predominantly regarding the Severe Acute Respiratory Syndrome and using cross-sectional designs. Quarantine was found to have multifaceted negative consequences that affected HCWs psychologically, professionally, personally, socially and economically. These findings could be useful as a framework for researchers while designing future study protocols, and for policy-makers or managers while establishing multidimensional effective strategies increasing HCWs’ resilience and wellness.

Delirium is a frequent and serious acute neuropsychiatric syndrome leading to worse prognosis including mortality. Patients with ischaemic and/or haemorrhagic stroke are vulnerable to delirium. However, predisposing and precipitating factors have not been fully discovered to date, leaving this area of practice under-represented in available guidelines.To describe the prevalence, associated factors and main in-hospital outcomes of post-stroke delirium.A multi-centre observational study was conducted from 2019 to 2020 and reported according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Data were collected in stroke units located in two large hospitals in the North-East region of Italy. Consecutive adult patients with ischaemic and/or haemorrhagic stroke with a Glasgow Coma Scale5, who were willing to participate, were included. Data at admission, during the in-hospital stay and at discharge were collected by trained nurses, not involved in the care of patients, with (a) validated tools, (b) direct observation, and (c) access of patients' records.A total of 78 patients were enrolled (mean 73.1 years; 59% male), and 70.5% of them had suffered an ischaemic stroke. The mean National Institutes of Health Stroke Scale (NIHSS) at admission was 8.2 ± 7.0. A total of 34.6% of patients developed post-stroke delirium; the onset was mainly on the first day of admission (70.4%) and the condition lasted for an average of 3.7 days (SD 2.6). In the multivariate logistic regression, 64.1% of the delirium variance was explained by the NIHSS scores (RR 1.259, 95%CI 1.035-1.533; p = 0.022). Patients with post-stroke delirium reported higher functional dependence at discharge and the need for more delaying of hospital care to be admitted in rehabilitation units.At admission, higher scores in the NIHSS evaluation might suggest which patients are at an increased risk of delirium. Avoiding interventions that could potentially increase this risk, together with continuous surveillance, become imperative for nurses who are constantly and closely present by their patients' side, in order to prevent this serious complication.

Currently, the coronavirus disease 2019 (COVID-19) severely influences physiotherapy education which is based mostly on face-to-face teaching. Thus, educators have been compelled to adapt their pedagogical approaches moving to digital education. In this commentary, we debate on digital education highlighting its effectiveness, the users' perspectives, and its weakness in the context of physiotherapy teaching aimed at informing post-COVID-19 future directions in this educational field. Existing evidence on digital education produced before COVID-19 supports its implementation into entry-level physiotherapy education. However, some challenges (e.g. social inequality and evaluation of students) threaten its applicability in post-COVID-19 era, calling educators to take appropriate actions. ispartof: MEDICAL SCIENCE EDUCATOR vol:31 issue:6 pages:2071-2083 ispartof: location:United States status: published

The primary aim was to describe differences, if any, between learned and practiced competences among a convenience sample of Italian and Slovenian nursing staff; the secondary aim was to validate an instrument capable of measuring internationally such competences.The distance between competences learned and those practiced as a source of under- or over-education has not been investigated to date at the international level.A explorative observational investigation was performed in 2019 by involving 426 Italian and Slovenian members of the nursing staff working in medical and surgical departments. The study was conducted according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.Members of the nursing staff (health care assistants, general nurses, specialist nurses and advanced nurses) were invited to complete the Nursing Competence Instrument based on the European Federation of Nursing Association's four categories of the nursing care continuum, from health care assistants to advanced practice nurses.The construct validity of the Nursing Competence Instrument indicated the presence of four identifiable dimensions (internal consistency ranging from 0.82 to 0.93). On average, the scores of the competences practiced were interestingly slightly higher than those learned among general care nurses. In contrast, health care assistants, specialist nurses and advanced practice nurses, reported to have learned importantly slightly lower as that practiced.At the overall levels, nurses tend to apply what they had been thought; additionally, all profiles seem to rate at low ranges both the competences practiced and those learned, suggesting the need to maximise nursing competences, both in the classroom and in the daily practice. Mapping the degree of competences acquired in education, as applied in the clinical practice, might assist clinical nurses, nurse educators and health care managers to identify areas at need of improvement. Moreover, mapping differences (if any) across countries might have research, managerial and educational implications.

The complexity of the nursing research in the primary health care: methodological challenges and suggestions.Research in primary care nursing has grown in the last decades addressing the national and international call aimed at increasing the primary health care services.A of the main possible challenges that researchers might encounter in primary care research is proposed, as well as suggestions aimed at implementing strong research methodologies.The study designs feasible in this setting such as that observational, randomized cluster and/or pragmatic trials, stepped wedge designs, and mixed-method studies are discussed; as well as strategies to involve the population, e.g., with participatory research; how to describe the interventions and the possible outcomes sensitive to the family/community nurses care to consider.National and international guidelines promote the implementation of the family/community nurses. Many Italian regions are implementing the model tailored to the context: these initiatives should be accompanied studies capable to document their outcomes.

Aim To support the development of appropriate policies and actions in the field of missed nursing care (MNC). Background There has been an ever-growing international debate on MNC, interventions that nurses have identified as necessary for their patients, but which for various reasons they are unable to provide or are forced to delay. Despite MNC's relevance, its translation into policies and actions has not been documented to date. Method A consensus development method was employed involving (a) a nominal group composed of experts in the field, policymakers and the President of the Regional Nursing Professional Boards, and (b) 218 nurses appointed primarily at the managerial levels. Results A total of eight consensus statements were approved and organized in a series of sub-statements designed to (1) render the concept of MNC culturally acceptable in the Italian context, with the agreement that compromised nursing care (CNC) is the best term to be used in this field, as a synonym for MNC; (2) measure CNC as a strategy to increase patient safety; (3) select an appropriate CNC measurement tool; (4) optimize CNC measurement; (5) conduct effective CNC data analysis; (6) design and implement interventions to prevent and/or minimize CNC; (7) assess and disseminate findings on interventions' effectiveness; and (8) provide final remarks on the way to move forward. Conclusions We developed a process to introduce the phenomenon of MNC in the Italian culture and agreed firstly on the term compromised nursing care, which better reflects MNC's meaning according to the context and facilitates an open discussion on the phenomenon both within and outside the profession. The following consensus statements emerged represent a systematic approach, starting from the measurement and finishing with the re-measurement of the occurrence of MNC after having implemented concrete actions. Implications for nursing management The approved consensus statements can guide decision-makers to develop concrete policies and actions that promote the improvement of quality of care and patients' safety by minimizing and/or preventing MNC's occurrence.

BACKGROUND To date, few studies have explored cases of implantable cardioverter defibrillator (ICD) shock delivery with the intent of understanding patients' educational and supportive needs. AIMS AND OBJECTIVES To explore patient experiences as lived before, during and after one or more shocks. DESIGN A descriptive qualitative study carried out between 2016 and 2017. METHODS Semi-structured face-to-face audio-recorded interviews were performed and analysed using a content analysis methodology. RESULTS A total of 50 patients (average age = 68.3 years; largely male = 49; 98%) were interviewed. Four themes emerged: (a) "Feeling surprised vs. alerted by the changes inside me"; (b) "Living an intense, mono-dimensional vs. living a multidimensional storm experience", (c) "Facing the event vs. being supported"; and (d) "Living a drama vs. being used to it". CONCLUSIONS Findings suggest that ICD use can trigger negative physical and emotional effects in patients. Moreover, nurses should recognize patients' educational needs according to the stage of adaptation that each patient is experiencing with the aim of tailoring appropriate supportive interventions. RELEVANCE TO CLINICAL PRACTICE Therefore, it is necessary to consider the psychological needs of patients by integrating these into clinical care at different levels (emergency department, hospital ward, home). Specific structured support aimed at helping patients overcome intense negative experiences is suggested, especially in the first stage of the adaptation process. Nurses should also ensure that appropriate education programmes with adequate follow-up interventions are offered to improve the experience of living with an ICD. In addition, patient-reported outcomes should be routinely collected from patients with an ICD.

Background Medical emergency teams (METs), which have been established in several countries, contribute to a reported decrease in deteriorated patients' in-hospital mortality. To date, no data have been published on critical incidents that occurred in METs affecting patients' safety. Objectives The aim of the study was to identify and describe critical incidents that occurred during METs' activities in a large academic Italian hospital. Methods The data, which were stored in the official incident reporting system of the hospital and included all critical incidents that occurred and were reported in anonymous and voluntary forms over a 5-year period, were retrospectively analyzed. Results Overall, 17 critical incidents emerged, during both the team alert stage (n = 10) and its performance (n = 7), with approximately 3 events per year and an incident rate of 1.7 for every 1000 MET interventions. Discussion Medical emergency teams' critical incidents are rare and mainly due to the lack of compliance with protocols and of training and supplies, which require appropriate educational and organizational strategies.

Aims and objectives To map and summarise published studies on the career opportunities and roles of doctoral-educated (PhD and DNP) nurses in the clinical setting; to collate actions as proposed in the literature to promote career opportunities and roles for PhD and DNP nurses in the clinical setting. Background To improve healthcare outcomes and strengthen leadership in nursing practice, there is the need to place nurses with a doctorate in clinical settings. However, available evidence has never been summarised to map the state of the science in this field. Design A scoping review, in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for scoping reviews statement (PRISMA-ScR). Methods An electronic database of literature was searched by accessing CINAHL Complete and Medline (on EBSCO Host) and SCOPUS to identify studies published between January 2009-December 2019. A thematic analysis was performed by identifying emerging patterns in the research questions. Results Ten studies were found with three types of clinical engagement: (a) a practice influencer/developer; (b) a clinical leader; and (c) a clinical teacher for students. Working in clinical areas, doctoral-educated nurses might influence several outcomes at the patient, research, staff and organisational levels. Conclusions Clinical roles for doctoral-educated nurses are still uncommon. However, in the last ten years, a debate has started to identify the possible careers in clinical settings, the needs and the challenges encountered while developing clinical academic roles, as well as the outcomes and actions that should be undertaken. Relevance to clinical practice Academic nursing bodies, working with professional bodies and healthcare institutions at different levels, are called on to develop career frameworks, allowing the opportunity for doctoral-educated nurses to be involved in clinical practice and to influence its quality and performance; this might in turn lead to an increase in the quality of research.

Objective To explore the experience of patients with systemic lupus erythematosus (SLE). Methods A systematic review of qualitative studies published in English in the past 10 years and identified through the PubMed, CINAHL, Scopus and Web of Science databases was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The methodological quality of each included study was assessed using the Critical Appraisal Screening Programme tool. Study findings were then subjected to a meta-summary and meta-synthesis. Results Twenty-six studies with a good overall methodological quality have been included, documenting the experience of 565 adult patients (95% women). A total of 17 codes emerged, summarising the life experience of SLE patients; the most and least frequent codes in the meta-summary were 'Feeling not as I usually do' (69.2%) and 'Having wishes' (7.7%), respectively. The codes were then categorised into five main themes, summarising the experience of living with SLE: (1) 'Experiencing waves of emotions due to the unpredictable nature of the disease'; (2) 'Trying to live an ordinary life'; (3) 'Listening to and obeying the body's limitations'; (4) 'Reviewing my life projects'; and (5) 'Dealing with future uncertainties'. Conclusions Several qualitative studies have been published to date using good methodological approaches. According to the findings, SLE negatively impacts patient experiences by affecting multiple dimensions of their daily lives, with fatigue and pain as the most frequent symptoms.

The number of community-dwelling people with dementia (PwD) is rising, and the role of their relatives is crucial in addressing and mitigating the implications of dementia on health care systems and on society. We developed a new conceptual framework to promote the collaboration of the community in supporting relatives who are caring for a PwD as well as a range of stakeholders in embracing dementia. A qualitatively driven, multi-method study divided into three phases was performed from 2019 to 2021. A qualitative descriptive study, a mixed-method systematic review and three consensus workshops were conducted, and their results were triangulated. The final version of the Community Collaboration Concept Framework is composed of three main domains based upon seven components: (1) embracing dementia; (2) creating empowerment and a sense of community; (3) collaborating through cocreation and design thinking. The new framework is based on the literature, the synthesis of empirical data and the consensus of a panel of international experts, supporting the global goal of improving community inclusiveness and collaboration. Further studies are needed to confirm its validity, how it should be implemented in practice in various settings and to propose improvements when designing projects based upon it.

Aim To reflect upon the concrete implications of the COVID-19 outbreak regarding ongoing health service and nursing management research (NMR) and to identify possible research priorities for the current and post-pandemic era. Background Health service research and the nursing management research debate have received little attention to date, despite their relevance in responding to the increased demand of care during the COVID-19 outbreak. Methods A critical analysis on experiences was performed while leading international-funded studies at different degrees of complexity and targets, involving nurse managers, nurses, care processes and health care services in the last year. Results Ongoing research projects have been profoundly affected by the COVID-19 outbreak in their aims, methods, management processes, feasibility and outcomes. Conclusions The COVID-19 outbreak is an unprecedented stress test for the health care sector and for the nursing services. Its onset and persistence have rendered more easily to see what prevails in terms of effectiveness and what fails in our health care services. Implications for nursing management Nurse managers have lived and are still living through this crisis, given their omnipresence in the health care systems. Therefore, setting NMR priorities and working together to imagine and design the post-COVID-19 era is essential.

We aimed to assess the attitude towards influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinations among coronavirus disease 2019 (COVID-19) recovered patients. We performed a cross-sectional study consisting of a standardized telephone interview carried out between September and November 2020 targeting a cohort of adult in- and out-patients that had recovered from COVID-19 after the first wave (March–May 2020) at Udine Hospital (Italy). Overall, 599 people participated (320 female, median age 53 years) and most had experienced an acute COVID-19 with mild illness (409, 68.3%). The majority were hesitant or undecided towards influenza (327, 54.6%) and SARS-CoV-2 (353, 59.2%) vaccines. Older age, public work exposure, and previous 2019 flu shots were the main factors associated with a positive attitude toward both vaccinations (p &lt, 0.05). Being hospitalized during the acute COVID-19 phase was associated with the willingness to get a flu shot (94/272, 34.5%) but not SARS-CoV-2 vaccine (70/244, 28.7%). Vaccine hesitancy is diffuse and multifactorial also among COVID-19 recovered.

Objectives To assess the prevalence of and factors associated with post-coronavirus disease 2019 (COVID-19) syndrome 6 months after the onset. Methods A bidirectional prospective study. Interviews investigated symptoms potentially associated with COVID-19 6 months after the disease onset of all consecutive adult inpatients and outpatients with COVID-19 attending Udine Hospital (Italy) from March to May 2020. IgG antibodies against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) were also evaluated 6 months after the onset of symptoms, at the time of the interview. Results A total of 599 individuals were included (320 female, 53.4%; mean age 53 years, SD 15.8) and interviewed 187 days (22 SD) after onset. The prevalence of post-COVID-19 syndrome was 40.2% (241/599). The presence of IgG antibodies was significantly associated with the occurrence of post-COVID-19 syndrome (OR 2.56, 95% CI 1.48–4.38, p 0.001) and median SARS-CoV-2 IgG titres were significantly higher in patients with post-COVID-19 syndrome than in patients without symptoms (42.1, IQR 17.1–78.4 vs. 29.1, IQR 12.1–54.2 kAU/L, p 0.004). Female gender (OR 1.55, 95% CI 1.05–2.27), a proportional increase in the number of symptoms at the onset of COVID-19 (OR 1.81, 95% CI 1.59–2.05) and ICU admission OR 3.10, 95% CI 1.18–8.11) were all independent risk factors for post-COVID-19 syndrome. The same predictors also emerged in a subgroup of 231 patients with the serological follow-up available at the time of the interview alongside the proportional increase in anti-SARS-CoV-2 IgG (OR 1.01, 95% CI 1.00–1.02, p 0.04). Discussion Prospective follow-up could be offered to specific subgroups of COVID-10 patients, to identify typical symptoms and persistently high anti-SARS-CoV-2 IgG titres as a means of early detection of post-COVID-19 long-term sequelae.

Luca Quartuccio,1,2,* Ginevra De Marchi,1,* Danila Azzolina,3 Elisabetta Maresio,4 Donatella Colatutto,1,2 Marco Binutti,1,2 Marinella Monte,5 Silvia Gallipoli,6 Federica Zobec,6 Corrado Lanera,3 Giulia Lorenzoni,3 Alvisa Palese,2,7 Marco Silano,8 Salvatore De Vita,1,2 Dario Gregori3 1Rheumatology Clinic, Department of Specialist Medicine, ASUFC, Udine, Italy; 2Department of Medicine (DAME), University of Udine, Udine, Italy; 3Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiology, Thoracic and Vascular Sciences, University of Padova, Padova, Italy; 4Prochild Onlus, Unit of Psychotherapy and Psychology, Trieste, Italy; 5Associazione Malati Reumatici (A.Ma.Re.), Udine, Italy; 6Zeta Research s.r.l., Trieste, Italy; 7School of Nursing, Department of Medicine, University of Udine, Udine, Italy; 8Unit of Human Nutrition and Health, Department of Food Safety Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Rome, 00161, Italy*These authors contributed equally to this workCorrespondence: Luca QuartuccioDepartment of Medicine (DAME), University of Udine, Udine, ItalyTel +39 0432559352Fax +39 0432559472Email luca.quartuccio@uniud.itObjective: To compare the psychological impact of the lockdown measures contrasting the COVID-19 outbreak between systemic lupus erythematosus (SLE) and general population.Patients and Methods: From July 15th to August 15th 2020, a retrospective survey referring to the period March 9th to May 18th 2020 was administered to SLE patients and the results of the survey, called LEPRE (Lupus Erythematosus PREsto) study, were compared with those from the PRESTO (imPact of quaRantine mEasures againST cOvid19) project, the same survey provided to the general population. Consecutive patients > 18 years old affected by SLE and regularly followed in a single rheumatologic centre were involved. Primary outcome was to compare the scores of the Impact of Events Scale-Revised (IES-R), the General Health Questionnaire 12 (GHQ-12) and the Center for Epidemiological Depression Scale (CES-D) between patients and general population.Results: A total of 64 patients completed the survey. After a propensity score matching, they were compared to 128 people from PRESTO project. The median age among patients was 43 years (I–III interquartile range 35– 54.5), 88% were female and 100% Caucasian. IES-R [(score> 23: 57% (34) vs 49% (58)], GHQ-12 [(score> 13: 85% (52) vs 88% (106)], and CES-D [(score> 15: 45% (28) vs 40% (46)] scores were not statistically different between patients and controls (p> 0.05).Conclusion: Restrictive measures for COVID-19 pandemic had no greater impact on patients with SLE than in the general population. Strategy for coping to the SLE might be useful during lockdown measures and may be helpful for other chronic conditions.Keywords: systemic lupus erythematosus, COVID-19, psychological distress

This chapter is aimed at summarizing an overview regarding: (a) the study designs used to date in the field of missed nursing care; (b) the validated instruments available to measure the occurrence of the phenomenon and its reasons in the clinical practice, by also providing some psychometric characteristics of them as evaluated to date; and (c) the reporting guidelines developed inside of the RANCARE network aiming at supporting the comparison of studies in the field and at addressing essential areas of research in missed care including its conceptualization, measurement, data analysis, and presentation of study findings. According to the state of science available, advancements in the study designs, more specific instruments capable to capture the missed care, as well as increased methodological quality and replicability of the studies performed by using a common guideline are all recommended.

The aim of this study was to assess the long-term dynamics and factors associated with the serological response against the severe acute respiratory syndrome coronavirus 2 after primary infection. A prospective longitudinal study was conducted with monthly serological follow-up during the first 4 months, and then at 6, 8, and 10 months after the disease onset of all recovered adult in- and outpatients with coronavirus disease 2019 (COVID-19) attending Udine Hospital (Italy) during the first wave (from March to May 2020). A total of 546 individuals were included (289 female, mean age 53.1 years), mostly with mild COVID-19 (370, 68.3%). Patients were followed for a median of 302 days (interquartile range, 186 to 311). The overall seroconversion rate within 2 months was 32% for IgM and 90% for IgG. Seroreversion was observed in 90% of patients for IgM at 4 months and in 47% for IgG at 10 months. Older age, number of symptoms at acute onset, and severity of acute COVID-19 were all independent predictors of long-term immunity both for IgM (β, linear regression coefficient, 1.10, P = 0.001; β 5.15 P = 0.014; β 43.84 P = 0.021, respectively) and for IgG (β 1.43 P

AIM: To investigate the experience of Italian nurses during the first wave of the COVID-19 outbreak by analysing professional social media posts. BACKGROUND: The COVID-19 outbreak has overwhelmed health care institutions; as a consequence, nurses' lives and psycho-physical health have been affected. INTRODUCTION: The COVID-19 pandemic forced nurses to work in physically and psychologically stressful conditions impacting on their life. METHODS: A qualitative descriptive study. All narratives (texts and videos) posted by nurses from the 23rd of February 2020 to the 3rd of May (from the start of the outbreak to the end of the first lockdown) were analysed and published on the five most popular Italian professional social media platforms. The Consolidated Criteria for Reporting Qualitative research guidelines were followed. RESULTS: Five themes emerged from the 380 narratives explored: 'Sharing what is happening within myself'; 'Experiencing unprecedented working conditions'; 'Experiencing a deep change'; 'Failing to rehabilitate the image of nurses in society'; and 'Do not abandon us'. Even though nurses appreciated the recognition of their communities, they still felt devalued and not recognized as professionals. DISCUSSION: Several psychological, physical, social and professional implications emerged from nurses working during the COVID-19 pandemic. Despite being highly praised, nurses perceived they had failed in rehabilitating the image of nurses in society. CONCLUSION: The experience of working during the COVID-19 pandemic represented a traumatic event for nurses but it offered them personal and professional growth opportunities. IMPLICATIONS FOR NURSING PRACTICE, NURSING POLICY AND HEALTH POLICY: Supporting nurses' mental health is highly recommended, together with a cultural investment on nurses' role recognition, and a zero-tolerance policy towards violence and aggression towards nurses.

This qualitative descriptive study explored needs, issues, and expectations on dementia care at home as expressed by relatives of people living with dementia (PwD), health and social care professionals (HSCPs), and members of civil society organisations (CSOs) from four European countries. A focus group methodology integrated with individual semi-structured interviews was adopted to collect data by employing a purposeful sampling method. A total of 13 focus groups and 12 individual interviews were conducted in 2019, involving 65 relatives of PwD, 32 HSCPs, and 23 members of CSOs. Deductive content analysis and findings triangulation were performed to analyse data, and a subgroup of participants confirmed the findings. Relatives need to be (a) informed and trained to cope with changes in PwD, (b) recognised for their caregiving role, and (c) assisted by specialised HSCPs. Professionals who work in partnership with PwD and their relatives call for a reorganisation of available services. CSOs compensate for the lack of proper support, promoting networks, and cooperation with local communities. Several commonalities emerged across countries, highlighting the chance to inform and develop common policies to improve the quality of life of PwD and their relatives across Europe. Policies improving person- and family-centred care and spreading dementia-friendly community concepts and practices are suggested. Strong collaborations between formal and informal services and communities are also needed as well as information on educational strategies to improve the use of resources, promote PwD care, and support PwD relatives' needs.

Aims To examine the nursing care factors investigated regarding their influence on outcomes of critically ill patients. Background A large number of studies have considered patients' outcomes as sensitive to nursing practice in intensive care unit environments. However, no summary of nursing factors influencing these outcomes has been provided. Design Rapid review, following the seven-stage process outlined by Tricco and colleagues. Data sources Articles published up to March 2020 were identified in MEDLINE (via PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus databases. Review methods Eligibility of studies was first assessed at the title and abstracts level. Study inclusion was then established by two researchers by analysing the full texts. Results A total of 93 studies were included, with a total of 21 nursing care factors documented. At the structural level, nursing factors have been investigated at the organizational and at the personnel level. At the process level, nurse-led programmes, independent nursing interventions and nurse behaviours have been investigated to date. Conclusion The set of nursing factors that emerged can be used in future research to improve poorly developed areas and to accumulate further evidence through additional studies, both at managerial and practice levels.

Background During COVID-19 pandemic, physiotherapy lecturers faced the challenge of rapidly shifting from face-to-face to online education. This retrospective case-control study aims to compare students’ satisfaction and performances shown in an online course to a control group of students who underwent the same course delivered face-to-face in the previous five years. Methods Between March and April 2020, a class (n = 46) of entry-level physiotherapy students (University of Verona - Italy), trained by an experienced physiotherapist, had 24-hours online lessons. Students exposed to the same course in the previous five academic years (n = 112), delivered with face-to-face conventional lessons, served as a historical control. The course was organized in 3 sequential phases: (1) PowerPoint presentations were uploaded to the University online platform, (2) asynchronous video recorded lectures were provided on the same platform, and (3) between online lectures, the lecturer and students could communicate through an email chat to promote understanding, dispel any doubts and collect requests for supplementary material (e.g., scientific articles, videos, webinars, podcasts). Outcomes were: (1) satisfaction as routinely measured by University with a national instrument and populated in a database; (2) performance as measured with an oral examination. Results We compared satisfaction with the course, expressed on a 5-point Likert scale, resulting in no differences between online and face-to-face teaching (Kruskal-Wallis 2 = 0.24, df = 1, p = 0.62). We weighted up students’ results by comparing their mean performances with the mean performances of the same course delivered face-to-face in the previous five years, founding a statistical significance in favour of online teaching (Wilcoxon rank sum test W = 1665, p < 0.001). Conclusions Online teaching in entry-level Physiotherapy seems to be a feasible option to face COVID-19 pandemic, as satisfies students as well as face-to-face courses and leading to a similar performance. Entry-level Bachelors in Physiotherapy may consider moving to eLearning to facilitate access to higher education. Universities will have to train lecturers to help them develop appropriate pedagogical skills, and supply suitable support in terms of economic, organizational, and technological issues, aimed at guaranteeing a high level of education to their students. Trial registration Retrospectively registered.

Objective To summarize the experience of individuals placed in quarantine during an outbreak. Design A meta‐summary and a meta‐synthesis based upon a systematic review of qualitative studies. Sample The Cumulative Index of Nursing and Allied Health Literature, MEDLINE, and Scopus databases were all searched up to April 2020. Measurements The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines were followed; then, the methodological quality of the studies included was assessed with the Critical Appraisal Screening Programme tool for qualitative studies. Results Five studies have been included documenting the experience of 125 adult individuals. A total of 16 codes emerged: in the meta‐summary, the most and least frequent codes were “Thinking about quarantine” (80%) and “Emotional roller coaster,” “Being alert for any symptom,” “Trusting or not?,” “Knowing who brought the infection,” and “Living in a surreal world” (20%). The codes which emerged were categorized into three main themes which summarized the whole experience of being placed in quarantine: (a) “Being swamped with a thousand emotions”; (b) “Being restrained”; and (c) “Needing to be considered.” Conclusions The experience of quarantine for people is a long journey which can feel chaotic due to uncertainty about the consequences on health, work, and the future. The findings of this study can help nurses in caring for quarantined individuals by enabling them to understand people's need for educational and emotional support. Ensuring the supply of consistent information is also important to increase people's compliance.

The aim is to describe which persuasive tool from the triad of Aristotle (Ethos, Pathos and Logos) is most commonly used in editorials to convey visions and ideas in the nursing journals of the last 5 years (2014-2019). A descriptive qualitative study, based on content analysis, was performed in 2020 and summarized according to the COnsolidated criteria for REporting Qualitative research principles. Two hundred and eighty-five editorials were included in the study, all of which were published in the top-five nursing journals, specifically, the International Journal of Nursing Studies (5-years Journal Impact Factor [5-Y JIF] = 5.022), the Journal of Nursing Scholarship (=3.374), the Journal of Advanced Nursing (=3.010), the Worldviews on Evidence-Based Nursing (2.990) and the Nursing Outlook (=2.867). Logos was the most widely used tool in 148 editorials (51.9%). Ethos was used in a quarter of them (n = 72, 25.3%) and the Pathos tool was used to a similar extent (n = 65, 22.8%). Logic is the most used tool for persuasion in nursing editorials; however, nurses who would capture the attention of the nursing community by writing an editorial should also consider the profiles of the potential readers, who might be attracted in different ways by logical-objective, ethical-moral, or emotional discourses.

Background With the recent challenges due to the Coronavirus 2019 outbreak, distance learning has been largely introduced in healthcare sciences curricula, and universities have been called upon to share learning opportunities with each other to ensure continuity of education and delivery of new graduates to the health system. However, decisions about its introduction should be supported by up-to-date evidence capable of providing an overview of available knowledge. Objectives To map the (a) state of research on massive open online courses in undergraduate and postgraduate health sciences education, (b) evaluation methods and tools used to measure learning outcomes, and (c) factors increasing their effectiveness as documented to date. Design A rapid review following the preferred reporting items for systematic reviews and meta-analysis guidelines. Methods PubMed, the Cumulative Index to Nursing and Allied Health Literature, Cochrane, Scopus, PsycInfo and Medline (via Ovid) were searched. Primary studies reporting one or more massive open online course (1) devoted to undergraduate and/or postgraduate students in nursing and healthcare sciences (2), written in English (3) with abstract available (4) and published up to February 18th, 2020 were all included. After having assessed the need for a review and the topic itself (a), the literature search was performed (b), studies were screened and selected (c), data was extracted (d), and the findings were summarised (e). Results Thirty-six studies emerged with mainly an explorative/descriptive or case study design. The courses have been developed mainly by universities alone or in collaboration with institutions mainly in US, Sweden and the UK. Their delivery has been performed at multi-national levels, mainly in English, and with a number of participants ranging from 45 to >23,000. The duration spanned from two weeks to six months on clinical topics (e.g., emergency medicine) to methods (e.g., statistics). The target audience has been mainly mixed, including students, healthcare professionals, and lay citizens. Evaluation methods and tools have been described in 28 studies, and multiple-choice questions were most frequently adopted. Factors affecting the effectiveness of massive open online courses have been identified analysing the courses themselves and the participants. Conclusion Massive open online courses have recently started to be studied in healthcare sciences: these can be useful to educate students, mainly as elective courses, and to educate a massive audience, thus embodying the third mission of the university. The complexity of factors increasing effectiveness suggests the need for a multidisciplinary approach both in their design and implementation.

Decision Making process and missed nursing care: findings from a scoping review.Several aspects of the Missed Care (MNC) model have been studied (conceptual aspects, causes, process, measurement instruments, outcomes) however, the decision-making processes influencing the MNC have not yet been settled into an accessible guide.To describe (a) the terms most used in the literature to define the decision-making processes influencing the MNC, (b) the conceptual models, as well as (c) the available tools.A scoping review was carried out in March-August 2020 by consulting the following databases: Cochrane Library, Pubmed, Scopus, CINAHL Complete, PsycINFO. Of the 385 retrieved studies, 92 abstracts were evaluated and 36 studies included.Four terms are used to address the process of nursing intervention delivered on time, postponed or missed: (a) Priority setting; (b) Prioritisation of clinical care; (c) Implicit rationing; and (d) Time scarcity. While the lack of time expresses the common denominator, a substantial difference emerges between priority setting and rationing: the first establishes a preferential sequence of activities with the result of delaying those less significant; the second leads to unfinished nursing care. Decision models to date have not considered the processes influencing MNC; therefore, the available measurement instruments are also of little use.The decision-making processes underlying MNC have not yet been well understood, and described using different terms. Reliable instruments to measure them are still lacking.

Even if health care professionals should take into account the active involvement of families in Intensive Care Units (ICUs), little research that investigates family member’s contributions to care and includes its outcomes on both the family itself and the patient care, is available. The aim of this research project is to assess the effects of a family engagement program on family members’ satisfaction and on patients’ well-being and quality of life. A quasiexperimental study with two non-randomized groups (94 per each group) will be performed in two general ICUs of an Academic Italian Hospital. The intervention will be carried out in a single ICU and it consists of family members’ involvement in the care of their loved ones by means of bed physical exercises and simple care tasks. Participants will be evaluated through manifold outcomes: family satisfaction, assessed with the FS-ICU tool within 48 hours after ICU discharge; patients’ sense of well-being, measured with a visual analogue scale within 30 minutes after the time period of a visit; and the quality of life, investigated with the SF- 12 questionnaire within the first 48 hours after admission to ICU, at three and six months after ICU discharge by telephone. From July 2020, 188 subjects are going to be enrolled throughout the year. The latest data will be collected in December 2021 to allow the completion of the follow-ups of all participants. First, this study constitutes a significant step in a research agenda aimed at deepening the nursing sensitive outcomes in ICUs and the quality of hospital care. Secondly, the results of this study might have the potential to provide a better understanding of how families may modify patients’ outcomes and whether family members would benefit from an involvement program.

Missed Nursing Care is widely recognized as affecting patient safety and healthcare outcomes. Theoretical frameworks, antecedents and consequences have been extensively studied while interventions aimed at preventing the Missed Nursing Care remain little investigated to date. Nurse Managers and Nurse Directors play a main role in promoting interventions at the unit, hospital and at the policy levels. However, few evidences are available to date, thus limiting an evidence-based approach. The aim of this study was to emerge interventions used on a daily basis by Nurse Managers and Directors to prevent and/or minimize Missed Nursing Care.A qualitative descriptive study design based upon a positive deviance approach was adopted. Twelve Nurse Managers and Nurse Directors were purposefully selected, working at Hospital, Healthcare Trust or Nursing Home levels, in Italy. Participants were interviewed in two focus group sessions. A thematic analysis of the audio-recorded interviews was performed by two researchers.The following interventions have been reported as effective in preventing and/or minimizing the Missed Nursing Care: (a) Expanding the nursing care capacity; (b) Ensuring the standard of care and an early detection of failures; (c) Monitoring the processes of care; (d) Promoting a shared decision-making; (e) Redesigning the layout of the hospital systems; (f) Promoting a culture towards the Missed Nursing Care prevention, and (g) Realigning the nurse management to the care of patients.Several interventions based mainly on process dimension and with preventive intents are daily enacted by Nurse Managers and Directors to prevent and/or minimize Missed Nursing Care. Measuring the effect of these interventions through rigorous studies could help in expanding the evidence available to contrast a phenomenon that threatens patient safety.

To collate and synthesize published research on interventions developed and tested to prevent or reduce the rates of rationed or missed nursing care in healthcare institutions.Rationed and missed nursing care has been widely studied, including its predictors and associations with patient and nurse outcomes.Scoping review.We searched for eligible studies, published between 1980-2019, in six electronic databases.Researchers independently screened the abstracts of the retrieved studies using the inclusion and exclusion criteria. The decision of whether or not to include any given study was consensus-based.The search yielded 1,815 records, of which 13 were included. Three studies reported structural interventions, namely increased nurse staffing and improved nursing teamwork, both resulted in significant reductions in the rates of rationed or missed nursing care. The remaining 10 studies reported on process interventions: four concerned reminders (via technology or designated persons) and seven described interventions to change or optimize the relevant care processes. All 10 process interventions contributed to significant reductions in the rates of missed nursing care.The results of the scoping review indicate that specific interventions can positively influence the performance of a selected nursing care activity, for example fall prevention. There is no evidence of a global reduction of rationed and missed nursing care through these interventions.Clinicians, managers and researchers can use the results for adapting and implementing interventions to reduce rationed and missed nursing care.目的: 整理归纳已发布的关于已制定并予以测试的干预措施的研究,避免或减少护理机构中护理服务受限或缺失的比例。 背景: 服务受限和缺失的护理已进行过广泛研究,包括其预测因子和对患者和护士影响的相关性。 设计: 范围评估。 数据来源: 我们在六个电子数据库中查询了1980年至2019年期间所有符合条件的研究。 评估方法: 研究员利用纳入和排除标准独立筛选了所检索的研究摘要,并基于共识决定是否包含某项给定研究。 结果: 本研究共筛选了1815条研究记录,共纳入13条。其中三项研究报告了结构性干预,即,增加护士人员配置,加强护理团队,这两项措施均大大减少了护理服务受限或缺失的比例。其余10项研究涉及过程干预:其中4项与提醒机制有关(通过技术手段或指定人员),7项研究说明了采取干预措施可以改变甚至优化相关护理过程。全部10项过程干预研究均得出结论,可以极大降低护理缺失的比例。 结论: 范围评估的结果说明,特定干预可以对选定护理活动的绩效产生积极影响,例如,预防跌倒。但尚无证据表明这些干预措施可以全面降低护理服务受限和缺失比例。 影响: 临床医生、管理人员和研究员可以利用这些结果修改并实施干预,从而减少护理服务受限和缺失的情况。.

How hospitals, Intensive Care Units and nursing care of critically ill patients have changed during the COVID-19 outbreak? Results from an exploratory research in some European countries.During the Covid-19 outbreak, the health care institutions and the Intensive Care Units (ICUs) have been reorganized with significant consequences at both organizational and clinical levels.To investigate (1) the organizational changes of hospitals and ICUs in dealing with the Covid-19 outbreak; (2) the characteristics of the nursing care; (3) the most important challenges perceived by nurses in caring for Covid-19 patients.Cross-sectional online survey, available from May 11th and July 10th, 2020. Participants were nurses caring for Covid-19 patients in European ICUs.A total of 62 nurses responded to the survey; average age 37.5 years, 31 (60.8%) were female, mostly from Italy, France and United Kingdom. All hospitals underwent many changes, such as the opening of new dedicated wards and the restriction of family visits. The number of ICU beds doubled during the pandemic (p0.01), as well as the number of nurses per shift from 10.2 (SD 7.3) before to 17.9 (SD 13.6) during the pandemic (p0.01). However, changes in the nurse-to-patient ratio were not significant: from 1:1.5 to 1:2 (p=0.05). Among nursing care activities, clinical risk management (n=14, 22.6%), psychological support for patients (n=22, 35.5%) and family's involvement (n=31, 50%) resulted as more challenging; 64.5% of nurses suffered from protective equipment shortages, and 66.1% experienced psychological burden.These findings can help to reflect on how to better prepare both nurses and health care institutions for other events that may threaten clinical practice and require major and innovative efforts.

to measure the prevalence of hand-held mobile phone use among drivers in Udine, Italy. Such behaviour is prohibited by law.direct roadside observation of car drivers.groups of nursing students on the roadside observed car drivers either waiting at red traffic lights or driving in selected major urban streets of the city of Udine and of two smaller neighboring towns, in one-hour time slots in different days in November and December 2018, for a total of 24 hours of observation.prevalence of use of handheld mobile phone either for calling or for activities implying visuo-manual interaction (texting or social media browsing), both among drivers waiting at red traffic lights and among those driving along the streets.overall, 8,240 observations of vehicles were carried out. The prevalence of mobile phone use was 9.9% among drivers waiting at red traffic lights and 6.5% among those moving along the streets in Udine; the prevalence was higher in the smaller neighboring towns. Among 6,116 drivers, the type of use has also been recorded: prevalence of texting was 7.2% at traffic lights and 5.0% in moving vehicles; prevalence of phone calls was 3.3% and 3.6%, respectively. Texting represented 68.4% of mobile phone use among drivers waiting at traffic lights and 57.8% among moving drivers. Behaviors of female and male drivers were similar.the use of mobile phones among drivers is very common in Udine, particularly for activities involving both the hands and the eyes. Since the increased risk of road accidents caused by this type of distraction from driving activities is well known, interventions discouraging the use of mobile phones among drivers are needed.

Introduction Future nurses should possess the knowledge and competences necessary to ensure patient safety. However, little evidence is available on the way in which students learn patient safety-related principles over time. This study explored the progress of a cohort of Italian undergraduate nursing students as they acquired patient safety knowledge and competences from time of enrolment to graduation. Methods A longitudinal study carried out between 2015 and 2018 enrolled a cohort of 90 nursing students from two Italian Bachelor of Nursing Science Degree Courses at the Udine University, Italy. The students were followed-up on an annual basis and data collection was performed three times: at the end of the 1st, 2nd and 3rd years. The validated Italian version of the Professional Education in Patient Safety Survey tool was used to collect data. Results At the end of the 1st year, students reported an average 4.19 out of 5 patient safety knowledge acquired in classrooms (CI 95%, 4.11–4.28), which was stable at the end of the 2nd (4.16; CI 95%, 4.06–4.26) and 3rd years (4.26; CI 95%, 4.16–4.32) and no statistical differences emerged over the years. With regard to the competences acquired in clinical settings, at the end of the 1st year the students reported an average 4.28 out of 5 (CI 95%, 4.20–4.37), which decreased significantly at the end of the 2nd year (4.15; CI 95%, 4.07–4.23; p=0.02) and increased at the end of the 3rd year (4.37; CI 95%, 4.27–4.47; p Conclusions Nursing students’ competences in patient safety issues increases over time, while their knowledge remains stable. Students are more vulnerable at the end of the 1st year, when they seem to be overconfident about patient-safety issues.

Aims and objectives To describe contextual factors (CFs) used by nurses to increase placebo and to prevent nocebo effects. Background Placebo effects have been studied in the nursing discipline, but nocebo effects still remain unexplored. Recently, a set of CFs functioning as triggers of placebo/nocebo effects has been described; however, its use in daily care has never been documented to date. Design A national cross-sectional survey, according to the Checklist for Reporting Results of Internet E-Surveys guidelines and STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE), was performed in 2016. Methods A wide sample of Italian nurses belonging to four national associations was involved. A questionnaire based on CFs literature was developed and administered through the SurveyMonkey Software® exploring: (a) CFs definition, (b) beliefs, (c) case-by-case frequency of use, (d) circumstances of application, (e) clinical conditions where participants perceived their potential beneficial effects, (f) ethical implications and (g) communication issues with the patient. Results Out of 1,411 eligible nurses, 455 answered (32.2%) and 425 questionnaires (30.1%) were valid for the analysis. A total of 211 nurses (49.6%) defined the CFs as an intervention with a possible aspecific effect; participants believed in the CFs (2.91; 95%CI 2.88-2.94), using them >2 times/month, mainly in addition to a nursing intervention to optimise clinical outcomes (n = 79; 18.6%). Psychological and physiological therapeutic effects have been perceived mainly in chronic pain (n = 259; 60.9%) and insomnia (n = 243; 57.2%). According to participants, CFs have been reported as ethically acceptable when exerting beneficial psychological effects (n = 148; 34.8%); however, 103 (24.2%) of nurses did not communicate to the patient when CFs were used. Conclusions Nurses are aware of CFs as elements to increase the placebo and prevent the nocebo effects in concomitance with evidence-based nursing interventions. Relevance to clinical practice The CFs valued by nurses and experienced as effective are mainly based upon the internal quality of the nurse and the quality of the relationship between the nurse and the patient. These qualities require a large personal investment; therefore, nurses should be supported in developing these qualities since their nursing graduation.

Notes of method to imagine an education tailored to the future. Health and social inequalities represent a problem not only from an ethical point of view but also from the point of view of public and social health. Unfortunately, this issue remains confined to conferences and debates and is not yet the subject of a serious reflection on how to constructively and permanently incorporate it in the education of health professionals, to provide the skill to read and interpret data, and to make research. This contribution, in addition to providing some reflections, launches an initiative that aims at incorporating these contents in the basic education, to make the message of Florence Nightingale real: wounds, suffering, dying and the absurdity of disability can be taken care of, be part of the care, only if you learn to recognize the causes, which are not only in the medical domain.

In recent years, due to several health care system reforms in different countries, an increased involuntary turnover rate of Chief Nurse Executives has been reported around the World. However, no data on their perceived experience of their dismissal have been documented up to now in the European context. Describing the experience of involuntarily dismissed Chief Nurse Executives was the main aim of this interpretative phenomenological study. Data were collected through face-to-face audiotaped interviews performed by involving a purposeful sample of 13 Chief Nurse Executives; data analysis was performed by using the QSR NVIVO 11 software. The Chief Nurse Executives’ experience of Being fired is characterized by three main themes: (1) “Health Care Institutions are places influenced by political turbulences”; (2) “My competence and presence in the arena is despised by a range of strategies”; and (3) “Transiting from darkness to light”. According to their experience, the reason for dismissal was due to changes in the political climate and the introduction of a new chief executive officer; moreover, Being fired caused a deep pain similar to that experienced during bereavement. In some socio-political contexts, the political climate can influence the role of a Chief Nurse Executive: political membership, whether implicit or explicit, is considered of great value. In other contexts, the Chief Nurse Executives’ value is based on professional competences and achieved outcomes. At times of changes in the political climate, the peculiarities of the specific socio-political context should be evaluated as to whether one should anticipate his/her resignation or not.

Aim To identify and summarize the challenges of conducting qualitative research exploring end‐of‐life communication between healthcare providers and bereaved family carers in nursing homes. Design A descriptive qualitative study based on in‐the‐field‐notes and research diaries collected during a primary study involving 32 bereaved family carers and 14 nurses across 13 Italian nursing homes in 2018–2019. Methods Two trained female nurses conducted semi‐structured, in‐depth, open‐ended interviews and recorded “in action” (i.e. reflections reported as in‐the‐field‐notes) and “on action” (i.e. retrospective reflections within the team reported immediately in the research diaries) narratives, with the aim of identifying challenges encountered during the research process. A content analysis process was performed to analyse the narratives collected. Results We identified three major categories of challenges: (a) obtaining approval from the ethical committee; (b) approaching nursing homes and family carers; and (c) dealing with participant‐related impairments (i.e. memory, emotional, physical).

Patient-centered care is valued by health care professionals working in palliative care settings. However, studies have revealed the difficulty of adopting patient-centered care in daily practice and of sharing its meaning within the interdisciplinary team. The aim of this study was to report the process of transforming end-of-life care by implementing a patient-centered model of care in an Italian hospice. An action research process was conducted between June 2012 and June 2014. The following phases were performed: (a) "looking" phase: the diagnosis was established by collecting data through semistructured interviews in the field study and through the administration of the Frommelt Attitude Toward the Care of the Dying Scale Form B-Italian Version; (b) "thinking" phase: staff members, guided by a research team, redesigned practice by identifying priorities in improvements and actions through multiprofessional focus groups; (c) "acting" phase: actions identified in the previous phase were implemented; and (d) "relooking" phase: the same data collection processes used in the looking phase were applied to evaluate the outcomes achieved. Three areas of improvement have been established: (1) symptoms were intensively audited through patient self-reports by using validated tools; (2) patients' family needs were also regularly collected, documented in clinical records, and addressed; (3) patients' family members were involved in the plan of care through support and education. Inpatient hospice health carers in this study were aware of the concept of patient-centered care. However, its actual implementation was lacking. An action research approach helped them to implement expected changes.

Introduzione: l'eparina a basso peso molecolare (LMWH) è utilizzata come terapia d'elezione per la profilassi delle trombosi venose profonde (TVP) e delle embolie polmonari sia in ambito ospedaliero sia domiciliare. Una delle complicanze più frequenti della somministrazione di LMWH è la comparsa di ecchimosi, evento che produce discomfort e preoccupazione nel paziente. Nonostante le iniezioni di LMWH siano molto frequenti, non è ancora chiaramente documentata la tecnica più efficace per prevenire le ecchimosi.

Purpose: Although the use of soft cervical collars in the emergency department (ED), for whiplash-associated disorders (WAD), is controversial, it is still widely adopted. The purpose of our study was to investigate the impact of the early use of soft cervical collars on the return to the ED, within three months of a road traffic collision. Methods: We conducted a retrospective observational study on WAD patients from two EDs in Verona (Italy). Patients in the earlier acute phase of WAD (within 48 h from the trauma) were included, those with serious conditions (WAD IV) were excluded. As an end point, we considered patients who returned to the ED complaining of WAD symptoms within three months as positive outcome for WAD persistence. Results: 2162 patients were included, of those, 85.4% (n = 1847/2162) received a soft cervical collar prescription. Further, 8.4% (n = 156/1847) of those with a soft cervical collar prescription, and 2.5% (n = 8/315) of those without a soft cervical collar (p &lt, 0.001) returned to the ED within three months. The use of the soft cervical collar was an independent risk factor for ED return within three months, with an OR, adjusted for possible clinical confounders, equal to 3.418 (95% CI 1.653–7.069, p &lt, 0.001). After the propensity score matching, 25.5% of the patients (n = 25/98) using the soft cervical collar returned to the ED at three months, compared to the 6.1% (n = 6/98) that did not adopt the soft cervical collar. The use of a soft cervical collar was associated with ED return with an OR = 4.314 (95% CI 2.066–11.668, p = 0.001). Conclusions: Our study shows that the positioning of the soft collar in a cohort of patients with acute WAD, following a rear-end car collision, is an independent potential risk factor to the return to the ED. Clinically, the use of the collar is a non-recommended practice and seems to be related to an increased risk of delayed recovery. There is a need to inform healthcare providers involved in the ED of the aim to limit the use of the soft cervical collar. A closer collaboration between clinicians (e.g., physicians, physical therapists, nurses) is suggested in the ED. Future primary studies should determine differences between having used or not having used the collar, and compare early physical therapy in the ED compared with the utilization of the collar.

To explore students' perceived quality of the intensive care unit learning environment during their rotations; to compare these perceptions with that reported by students attending other settings and to assess correlations between the perceptions regarding the quality of the environment and the competences learned.A secondary analysis of data collected by a national cross-sectional study carried out in Italy. A total of 9607 nursing students participated; they ranked the intensive care units' quality, as assessed by the Clinical Learning Quality Evaluation Index; the perceived competences learned were also ranked with a Likert scale; from 0 = None to 3 = Very much.A total of 323 (3.5%) participants attended their rotation in an intensive care unit. They perceived the quality of the environment to be significantly higher (n = 2.11 out of 3) than those rotating in non-intensive care unit wards (n = 1.91; p 0.001). The competences learned by intensive care unit students were significantly higher than that reported by students attending non-intensive care unit wards (n = 2.31 out of 3 vs 2.06 out of 3; p 0.001).Intensive care units are highly appreciated by students, both in terms of their quality learning environment and their capacity to promote learning compared to other settings. Therefore, intensive care units should be considered as a place for clinical rotation to promote positive attitudes regarding critical care patients.

Measuring the effectiveness of nursing interventions in intensive care units has been established as a priority. However, little is reported about the paediatric population. The aims of this study were (a) to map the state of the art of the science in the field of nursing-sensitive outcomes (NSOs) in paediatric intensive care units (PICUs) and (b) to identify all reported NSOs documented to date in PICUs by also describing their metrics. A scoping review was conducted by following the framework proposed by Arksey and O’Malley. Fifty-eight articles were included. Publications were mainly authored in the United States and Canada (n = 28, 48.3%), and the majority (n = 30, 51.7%) had an observational design. A total of 46 NSOs were documented. The most reported were related to the clinical (n = 83), followed by safety (n = 41) and functional (n = 18) domains. Regarding their metrics, the majority of NSOs were measured in their occurrence using quantitative single measures, and a few validated tools were used to a lesser extent. No NSOs were reported in the perceptual domain. Nursing care of critically ill children encompasses three levels: improvement in clinical performance, as measured by clinical outcomes; assurance of patient care safety, as measured by safety outcomes; and promotion of fundamental care needs, as measured by functional outcomes. Perceptual outcomes deserve to be explored.

Background In the industrialized world, approximately 1–1.5% of the population has received treatments for skin lesions. In the 1990s, a polymeric barrier film called the No Sting Barrier Film (NSBF) was developed as an alternative to petrolatum-based ointments and zinc oxide formulas. To date, few studies have explored the effectiveness of NSBF in protecting skin integrity. Aims To map the methods, fields and outcomes used to produce evidence on NSBF effectiveness. Methods A scoping review was performed in 2015. A search strategy for identifying relevant studies was designed and performed. Systematic reviews, meta-analyses, randomized controlled trials, controlled clinical trials, and comparative studies for all types of interventions were included; research conducted in any clinical context was eligible for inclusion. Studies were selected by two reviewers; data extraction and analysis also was performed by two reviewers and disagreements were discussed. Results Six studies were included. NSBF's potential as a skin protector was investigated with respect to (a) chronic wounds (pressure ulcers or vascular leg ulcers); (b) urinary or fecal incontinence; and (c) post-mastectomy irradiation. The principal clinical outcomes investigated were, respectively: (a) wound healing, wound exudates and erythema control; (b) incidence of incontinence-associated dermatitis and skin reactions; and (c) intensity of pruritus and skin reactions. Pain and comfort were measured in all clinical applications. The main process outcomes investigated were: (a) ease of application, (b) application and removal time, and (c) costs. Zinc oxide and petroleum formulations were the most common comparison interventions in research on chronic ulcers and incontinence; sorbolene cream and topical corticosteroids were the most frequent comparisons in the context of post-mastectomy irradiation. Linking Evidence to Action NBSF may be used for peri-wound skin protection in patients with chronic wounds, with urinary or fecal incontinence and for women undergoing post-mastectomy irradiation. However, more robust experimental studies are needed in all clinical fields where NBSF is applied.

Background: Old age–based discrimination is observed as the most tolerated prejudice in society and has also been witnessed in healthcare institutions. Aims: The aim of this study is to explore age-based discrimination in healthcare institutions as perceived by seniors and students of Medicine and Nursing. Research design: A multi-method study design, by involving a triangulation design. Participants and research context: A purposeful sample of individuals aged 65+ (n = 80) and medical and nursing students (n = 100) in the eastern region of Poland. Ethical considerations: Ethical approval of the research protocol was received from the Ethics Committee at the Medical University of Lublin. Findings: ‘Old age’ was perceived by groups of participants based on three themes: (a) positive, (b) negative and (c) neutral connotations. The negative connotations predominated. The beginning of old age was defined by the metric of age and described by showing the complexity of the ageing process involving subjective, objective and societal aspects. Experience of age discrimination in healthcare institutions was reported by 24 (30%) seniors and witnessed by 47 (47%) students surveyed and for both groups occurred mainly at the hospital level and by physicians. Only 48 students (48%) declared a willingness to work with the older people in the future, and barriers were reported at the personal and professional levels, and also in some visions of older people. Conclusion: The conceptualization of old age as reported by seniors and students mainly carried negative connotations, reflecting the profoundly based stereotypes within society regarding the older people. Seniors have reported being exposed to ageism and have witnessed ageism episodes in HCIs; also, students have faced ageism episodes during their clinical education. There is a need for ethical education within medical and nursing courses to shape positive attitudes towards the older people. A positive vision of ageing should be promoted not only among young people but also among adults and older people to avoid self-stereotyping of older people and seeing old age from negative perspective.

OBJECTIVES The study aims to evaluate the prevalence of nursing home (NH) resident crying and associated factors at the individual and NH levels. DESIGN A regional retrospective study design has been used. PARTICIPANTS AND SETTING A total of 8875 residents, living in 105 NHs, were included. MEASUREMENTS The occurrence of an episode of crying on at least a daily basis in the last month was the dependent variable; independent variables were set at individual and at the NH levels as reported in the Val.Graf regional database. RESULTS A total of 1,443 (16.3%) residents reported daily episodes of crying over the last month. Several individual variables were significantly associated with crying; female gender (odds ratio [OR] 2.535, 95% confidence interval [CI] 2.069-3.107); sad, pained or worried facial expressions (OR 1.885, 95% CI 1.785-2.021); negative thoughts (OR 1.650, 95% CI 1.508-1.804); unrealistic fears (OR 1.410, 95% CI 1.295-1.534); anger with self or others (OR 1.141, 95% CI 1.043-1.248); repetitive anxious complaints/concerns (OR 1.136, 95% CI 1.045-1.235); clinical instability (OR 1.186, 95% CI 1.018-1.381); pain (OR 1.183, 95% CI 1.058-1.323); night restlessness (OR 1.180, 95% CI 1.100-1.267); communication problems (OR 1.169, 95% CI 1.051-1.300); and cognitive impairment (OR 1.086, 95% CI 1.019-1.156); all increased the likelihood of crying. Conversely, sociability (OR 0.866, 95% CI 0.805-0.932) and being involved in social based activities (OR 0.882, 95% CI 0.811-0.960) were protective against crying. However, the previously mentioned variables have explained only 35.9% of variance in daily crying. CONCLUSIONS Around one out of six residents living in NH cries on a daily basis, and the reasons are also at the individual level. Residents seem to cry for attachment and clinical needs and to express stress and unhappiness; more research is needed, aiming at discovering other factors associated with resident's daily crying. Copyright © 2017 John Wiley & Sons, Ltd.

AIMS Assessing pain in children with autism spectrum disorders (ASDs) can be extremely challenging, since many cannot self-report pain. This study aims to test the validity of the Non-Communicating Children's Pain Checklist - Revised (NCCPC-R) in identifying pain in children and adolescents affected by ASDs. MATERIALS AND METHODS A two-phase validation study based on (a) the translation and cultural adaptation of the NCCPC-R to Italian and to ASD-specific needs and context; and (b) the validation of a modified, 32-item version of the NCCPC-R. In all, 141 carers of children aged 6-16 years with ASDs were asked to recall an in-pain episode and a not-in-pain episode of their child and to rate on a 3-point scale (0 = not at all, 3 = very often) each behaviour included in the tool. Internal consistency (Cronbach's α), explorative and confirmative factorial structure, as well as concurrent and discriminant validity, were all assessed. RESULTS Confirmatory factor analysis established the revised version of the NCCPC-R for children with ASDs (named = NCCPC-RASD ), formed from 10 of the original 30 items categorised into three factors ('Changing in mood', 'Increasing in tension' and 'Alerting reaction') to have an acceptable level of reliability. The tool was internally consistent (α = 0.741 during in-pain episodes, α = 0.790 during not-in-pain episodes) and was able to discriminate between in-pain episodes (13.36 out of 40; CI 95% 12.34-14.39) and not-in-pain episodes (7.84 out of 40; CI 95% 6.86-8.82, p