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Introduction Objectives Methods Results Conclusions The aging of the population requires an appropriate knowledge of the type of care that needs to be provided to inform healthcare policies. In Italy, neither home care nursing, nor the patient experiences have ever been described.To describe the characteristics of nurses and care recipients involved in home care.A descriptive cross‐sectional study conducted in 18 Italian Regions. Between April and October 2023, data from nurses and patients involved in home care were collected through two surveys. Psychosocial conditions in workplaces, missed care, and care experiences were assessed using validated tools. Descriptive statistics and Pearson's correlations were performed.A total of 46 local healthcare units were included in this study, with a total of 2549 nurses and 4709 care recipients. Nurses (mean age 46.60; 79.48% female; 44.68% regional nursing diploma as the highest qualification) reported good working conditions (42.37; SD = 12.25; range = 0–100) and a high mean number of missed care activities (5.11; SD = 3.19; range 0–9). Most nurses (83.41%) reported high levels of job satisfaction, while 20.28% intended to leave their job. Patients (mean age 75.18; 57.57% female; 36.95% primary school), on the other hand, rated positively the care they had received (8.23; range = 0–10).Despite the perception of critical issues at work and some missed care, satisfaction in nurses and patients was high. These data constitute a preliminary snapshot of the studied phenomena, which will be investigated through more in‐depth analyses. [ABSTRACT FROM AUTHOR]

Osteoporosis mostly affects females over 50 years old, worldwide. The main osteoporosis complication is fragility fractures that reduce quality of life and cause morbidity and mortality. Most patients who have fragility fractures are treated for the fracture. However, patients' adherence to follow-up treatment plans is poor. Therefore, tailored educational interventions are needed to improve medication adherence and healthy lifestyles. In this context, the role of bone care nurses is important, as they can act at different levels of osteoporosis prevention and fracture liaison services, which are se-condary fracture prevention programmes implemented by health care systems to treat osteoporotic patients. In Italy, a research project called Guardian Angel® was developed to provide tailored education to osteoporotic women in order to improve their disease management and reduce related complications. [ABSTRACT FROM AUTHOR]

The purpose of this study is to assess the incidence of female urinary incontinence (UI), risk factors, severity, and functional limitation using a cross-sectional survey in an Italian region. The method employed in this study was a questionnaire-based interview on non-institutionalized women. Outcomes were the UI prevalence, severity, associated factors, and functional limitation (ICIQ score). From October 2008 to February 2009, 1,346 women were interviewed and 15.3% were affected by UI. Univariate analysis found different risk factors, but multivariate analysis revealed only pelvic floor surgery, diabetes, vaginal deliveries, age, and educational level as significant. The involuntary loss of stools was more common in incontinent patients compared with healthy participants. The ICIQ values were significantly different between healthy and incontinent participants and a positive correlation existed with the estimated daily urine loss ( r = 0.885, p < 0.001). Symptoms of UI affected a substantial proportion of the population investigated. Pelvic floor surgery, diabetes, and vaginal deliveries are the most significant risk factors implicated. [ABSTRACT FROM AUTHOR]

Purpose: To investigate occupational exposures to biological material potentially infected by blood-borne viruses in nursing student population during the course years. Design and Methods: An observational retrospective study was designed. Data were collected in May 2007. Two-thousand-two-hundred-fifteen nursing students from the 3 years of degree course were enrolled in the four Italian universities. A structured questionnaire was constructed and was given out unannounced to nursing students in four universities on a randomly chosen day. The likelihood of association between nursing student exposure and certain assumed risk factors was measured. Findings: The exposure risk is associated with each study year of nursing students. Specifically, the probability of accidental exposure is reduced significantly with the increase of clinical skills during the training period. The risk for exposure in the 1st year students appears significantly higher than in those of the next years (odds ratio [ OR] 1.465; 95% confidence interval [ CI] 1.105–1.943). Data highlighted a gradual increase of bio-safety knowledge in nursing students from the 1st to the 3rd years of study. However, a statistically significant association exists only between awareness of a correct use of gloves and exposure risk ( OR 0.435; 95% CI 0.227–0.834). Mucocutaneous exposures are more frequent than percutaneous exposures (62.2%), and the hollow-bore needle is the device most often involved. In 42.5% of cases, accidental exposures occurred when nursing students are working alone in a medical ward or surgery area. Conclusions: During their clinical training, nursing students can encounter a real risk for percutaneous and mucocutaneous exposures to blood potentially infected with blood-borne viruses. However, this risk is reduced with an increase in clinical skills. Clinical Relevance: Results show that some new strategies are necessary for exposure risk reduction such as development of simulation laboratories for nursing practice and the adequate presence of tutors in clinical training education. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative patients with ostomies experience significant changes in their lives as a result of the device implantation. Self-care is important to improve their health outcomes. Telehealth provides an opportunity to expand access to self-care education. Aim: This is a multicenter, non-inferiority randomized, open-label, controlled trial to evaluate the non-inferiority of a telehealth intervention to the standard in-person approach in improving self-care behaviors. Methods and analysis: Three hundred and eighty-four patients aged ≥ 18 years, with a recently placed ostomy, no stomal/peristomal complications, and documented cognitive integrity will be randomly assigned (1:1) to receive either a telehealth intervention (four remote educational sessions) or a standard educational approach (four in-person sessions) delivered in outpatient settings. Every session (remote and in-person) will occur on Days 25, 32, 40, and 60 after discharge. Follow-ups will occur 1, 3, and 6 months after the last intervention session. Primary outcome is self-care maintenance measured using the Ostomy Self-care Index (OSCI). Secondary outcomes include self-care monitoring, self-care management, self-efficacy (OSCI), quality of life (Stoma specific quality of Life), depression (Patient Health Questionnaire-9), adjustment (Ostomy Adjustment Inventory-23), stomal and peristomal complication rates, healthcare services utilization, mobility, and number of working days lost. Analyses will be performed per intention-to-treat and per protocol. Ethics and dissemination: This study has been approved by the Institutional Review Board of the main center (registration number: 119/22). Following completion of the trial, dissemination meetings will be held to share the results of the study with the participants and the health-care team. Adoption of telehealth technologies for ostomy patients can improve service organization by ensuring better integration and continuity of care. If the remote intervention produces comparable effects to the in-person intervention, it would be wise to make telehealth education an alternative treatment for addressing the educational needs of uncomplicated postoperative ostomy patients. Trial registration: ClinicalTrials.gov (identifier number: NCT05796544). [ABSTRACT FROM AUTHOR]

Aims Mutuality, a positive quality of the relationship between patients and their informal caregivers characterized by love and affection, shared pleasurable activities, shared values, and reciprocity, influences several patient–caregiver outcomes in chronic-condition cases, but it remains unknown whether it influences the heart failure (HF) patient–caregiver dyad quality of life (QOL). The aim of this study was to evaluate the influence of mutuality and its four dimensions (love and affection, shared pleasurable activities, shared values, and reciprocity) on QOL in HF patient–caregiver dyads Methods and results Cross-sectional study: Using the actor–partner interdependence model, we examined how an individual's mutuality influenced his/her own QOL (actor effect) and his/her partner's QOL (partner effect). Mutuality and physical and mental QOL were measured with the Mutuality Scale and Short Form 12, respectively. A total of 494 HF patient–caregiver dyads were enrolled in the study. Mutuality showed strong evidence of caregiver partner effects on the HF patients' physical QOL (total score B = 2.503, P = 0.001; shared pleasurable activities B = 2.265, P < 0.001; shared values B = 1.174, P = 0.420 and reciprocity B = 1.888, P = 0.001). For the mental QOL, mutuality and its four subscales had actor effects only on the patients' mental health (total mutuality B = 2.646, P = 0.003; love and affection B = 1.599, P = 0.360; shared pleasurable activities B = 2.599, P = 0.001; shared values B = 1.564, P = 0.001 and reciprocity B = 1.739, P = 0.020). In caregivers, mutuality had an actor effects on mental QOL (total score B = 1.548, P = 0.041 and reciprocity B = 1.526, P = 0.009). Conclusion Our results confirm the important role of mutuality in determining the physical and mental QOL in HF patient–caregiver dyads. Interventions aimed at improving the relationships within HF patient–caregiver dyads may have an impact on HF patients' and caregivers' QOL. [ABSTRACT FROM AUTHOR]

Background Aim Study Design Results Conclusion Relevance to Clinical Practice Post‐intensive care syndrome (PICS) is characterized by all three adverse survivorship dimensions: physical function, cognitive function and mental health status.This review aimed to describe the quality of life (QoL) of Intensive Care Unit (ICU) survivors with PICS after discharge and of their relatives with Family Post‐intensive care syndrome (PICS‐F) and to report anxiety, depression and Post‐Traumatic Stress Disorders (PTSD) in studies investigating PICS.A systematic review was carried out. We searched PubMed, Scopus, Web of Science and the Cumulative Index to Nursing and Allied Health Literature. This review was registered in the PROSPERO database (CRD42022382123).We included 19 studies of PICS and PICS‐F in this systematic review. Fourteen observational studies report the effects of PICS on depression, 12 studies on anxiety and nine on post‐traumatic stress disorder and 10 on QoL. Mobility, personal care, usual activities and pain/discomfort in QoL were the domains most affected by PICS. A significant association was demonstrated between a high level of ICU survivors' anxiety and high levels of ICU relatives' burden. Strain‐related symptoms and sleep disorders were problems encountered by ICU relatives with PICS‐F.PICS and PICS‐F were widespread experiences among ICU survivors and their ICU relatives, respectively. The results of this review showed the adverse effects of PICS and PICS‐F on QoL.PICS and PICS‐F strongly impact the rehabilitation process and are measured in terms of health costs, financial stress and potentially preventable readmission. [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusion Implications for the Profession and/or Patient Care Impact Patient or Public Contribution To describe how workplace violence (WPV) is experienced by nurses in hospitals and community services and identify protective and risk factors.An online cross‐sectional national study was conducted from January to April 2021 in Italy. Hospitals and community services were involved in the study. The survey combined the adapted and validated Italian version of the Violence in Emergency Nursing and Triage (VENT) questionnaire, which explores the episodes of WPV experienced during the previous 12 months, the Practice Environment Scale of the Nursing Work Index (PES‐NWI) and some additional questions about staffing levels extracted from a previous RN4CAST study. Nurses working in all clinical settings and community services were invited to participate in the survey. Descriptive and inferential statistics were used for data analysis. We adhered to the STROBE reporting guidelines.A total of 6079 nurses completed the survey, 32.4% (n = 1969) had experienced WPV in the previous 12 months, and 46% (n = 920) reported WPV only in the previous week. The most significant protective factors were nurses' age, patients' use of illegal substances, attitude of individual nurses and considering effective the organization's procedures for preventing and managing episodes of violence. The most significant risk factors included workload, recognizing violence as an inevitable part of the job, patients' cultural aspects and patients' agitated behaviour. The frequency of WPV was significantly higher in certain areas, such as the emergency department and in mental health wards.Workplace violence (WPV) against nurses is a very frequent and concerning issue, especially in hospitals and community services. Based on our findings, integrated and multimodal programmes for prevention and management of WPV are recommended. More attention and resources need to be allocated to reduce WPV by improving the quality of nurses' workplace environment and implementing violence‐free policies for hospitals. Workplace verbal and physical violence is a widespread phenomenon, both in hospital and community settings, and even during COVID‐19 pandemic. This problem is exacerbated by the lack of effective reporting systems, fear of retaliation and the tendency to consider violence as an inevitable part of the job. The characteristics of professionals, patients, work environment and organizational factors are involved in the spread of workplace violence, determining its multifactorial nature. Integrated and multimodal programmes to prevent and manage of workplace violence are probably the only way to effectively counteract workplace violence against nurses. Healthcare policymakers, managers of hospital and community services need to proactively prevent and effectively manage and monitor episodes of violence. Nurses need to feel protected and safeguarded against any form of verbal or physical violence, to provide high‐quality care in a totally safe environment. No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim Design Data Sources Review Methods Data Synthesis Conclusions Impact Patient or Public Contribution To examine studies involving the impact of telerehabilitation (TLR), tele‐training and tele‐support on the dyad stroke survivor and caregiver in relation to psychological, physical, social and health dimensions.A systematic review was conducted.The following electronic databases were consulted until September 2023: PsycInfo, CINAHL, Eric, Ovid, PubMed, Scopus, Cochrane Central and Web of Science.It was conducted and reported following the checklists for Reviews of PRISMA 2020 Checklist. Critical evaluation of the quality of the studies included in the review was performed with the Joanna Briggs Institute Checklists.A total of 2290 records were identified after removing duplicates, 501 articles were selected by title and abstract and only 21 met the inclusion criteria. It included 4 quasi‐experimental studies, 7 RCTs, 1 cohort study and 9 qualitative studies. The total number of participants between caregivers and stroke survivors was 1697, including 858 stroke survivors and 839 caregivers recruited from 2002 to 2022. For a total of 884 participants who carried out TLR activities in the experimental groups,11 impact domains were identified: cognitive/functional, psychological, caregiver burden, social, general health and self‐efficacy, family function, quality of life, healthcare utilization, preparedness, quality of care and relationship with technology.The results support the application of telehealth in the discharge phase of hospitals and rehabilitation centres for stroke survivors and caregivers. TLR could be considered a substitute for traditional rehabilitation only if it is supported by a tele‐learning programme for the caregiver and ongoing technical, computer and health support to satisfy the dyad's needs.Designing a comprehensive telemedicine programme upon the return home of the dyad involved in the stroke improves the quality of life, functional, psychological, social, family status, self‐efficacy, use of health systems and the dyad's preparation for managing the stroke.No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Patients with heart failure may experience poor quality of life due to a variety of physical and psychological symptoms. Quality of life can improve if patients adhere to consistent self-care behaviors. Patient outcomes (i.e., quality of life) are thought to improve as a result of caregiver contribution to self-care. However, uncertainty exists on whether these outcomes improve as a direct result of caregiver contribution to self-care or whether this improvement occurs indirectly through the improvement of patient heart failure self-care behaviors. Aims: To investigate the influence of caregiver contribution to self-care on quality of life of heart failure people and explore whether patient self-care behaviors mediate such a relationship. Methods: This is a secondary analysis of the MOTIVATE-HF randomized controlled trial (Clinicaltrials.gov registration number: NCT02894502). Data were collected at baseline and 3 months. An autoregressive longitudinal path analysis model was conducted to test our hypotheses. Results: We enrolled a sample of 510 caregivers [mean age = 54 (±15.44), 24% males)] and 510 patients [mean age = 72.4 (±12.28), 58% males)]. Patient self-care had a significant and direct effect on quality of life at three months (β = 0.20, p <.01). Caregiver contribution to self-care showed a significant direct effect on patient self-care (β = 0.32, p <.01), and an indirect effect on patient quality of life through the mediation of patient self-care (β = 0.07, p <.001). Conclusion: Patient quality of life is influenced by self-care both directly and indirectly, through the mediation of caregiver contribution to self-care. These findings improve our understanding on how caregiver contribution to self-care improves patient outcomes. [ABSTRACT FROM AUTHOR]

(1) Background: Older patients who attend emergency departments are frailer than younger patients and are at a high risk of adverse outcomes; (2) Methods: To conduct this systematic review, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. We systematically searched literature from PubMed, Embase, OVID Medline®, Scopus, CINAHL via EBSCOHost, and the Cochrane Library up to May 2023, while for grey literature we used Google Scholar. No time restrictions were applied, and only articles published in English were included. Two independent reviewers assessed the eligibility of the studies and extracted relevant data from the articles that met our predefined inclusion criteria. The Critical Appraisal Skills Program (CASP) was used to assess the quality of the studies; (3) Results: Evidence indicates that prolonged boarding of frail individuals in crowded emergency departments (Eds) is associated with adverse outcomes, exacerbation of pre-existing conditions, and increased mortality risk; (4) Conclusions: Our results suggest that frail individuals are at risk of longer ED stays and higher mortality rates. However, the association between the mortality of frail patients and the amount of time a patient spends in exposure to the ED environment has not been fully explored. Further studies are needed to confirm this hypothesis. [ABSTRACT FROM AUTHOR]

Aims The aims of this study were to: (i) test if there are clusters of stroke survivors who experience distinct trajectories of quality of life (QOL) from hospital rehabilitation discharge to 12-month follow-up; (ii) test if any sociodemographic or clinical variables predict this class membership; and (iii) examine the associations between the clusters of stroke survivors' and their caregivers' trajectories of anxiety, depression, and burden over time. Methods and results A total of 415 stroke survivors and their caregivers were recruited in Italy for this 1-year, longitudinal, multicentre prospective study, filling out a survey at five time points. We found two distinct trajectories of change in stroke survivors' psychological QOL (i.e. Memory, Communication, Emotion, and Participation). The first trajectory (86% of the survivors) included those who started with greater levels of QOL and improved slightly to markedly in all psychological domains, while the second trajectory (14% of the survivors) comprised those who started with lower overall levels of psychological QOL and experienced a worsening or no changes at all in these dimensions up to 12-month follow-up. Very few clinical and sociodemographic variables at baseline predicted class membership. Finally, caregivers of those patients who experienced no change or a worsening in psychological QOL reported greater distress and burden over time. Conclusion Our results highlight the need for more tailored interventions to improve patients' psychological QOL and consequently their caregivers' well-being. This requires a shift from a stroke survivor–centred approach to a stroke survivor– and caregiver-centred one. [ABSTRACT FROM AUTHOR]

Aim Design Methods Findings Conclusion Implications for the Profession and/or Patient Care What Problem Did the Study Address? What Were the Main Findings? Where and on Whom Will the Research Have An Impact? Patient or Public Contribution Reporting Method To catch a representative view of a multicultural population's needs.Qualitative study.Semi‐structured interviews were conducted from July 2022 to January 2023 with the project's stakeholders, migrants, and residents. Data analysis was performed using a multimethod textual analysis technique.Territorial barriers, lack of social network, and specific professionals' training emerged as healthcare delivery obstacles. For migrants, language improvement emerged as a health priority. A deep relationship with migrants emerged as a deficiency for residents.A welcoming project equipped with solid leadership and the right resources can be fundamental in mediating health promotion and integration. In this process, the involvement of the resident population is essential.Analysing the migrants' needs and the strengths and limitations of a reception system could help identify the challenges for professionals in delivering culturally competent care. In this context, the nurse's role becomes relevant, being responsible for taking charge and caring for the population and the link between professionals and the population.The study addressed the problem of improving the overall health of migrants, refugees, and asylum seekers, mainly focusing on reception and integration into a new society process.Worse health was identified with adaptation, integration, and family problems. Territorial barriers emerged, hindering good health.These research findings can be valuable for health professionals who want to improve the reception process and enhance a care model integrated with residents.No patient or public contribution.To describe the research report, we referred to the COREQ checklist (Tong et al., 2007). [ABSTRACT FROM AUTHOR]

Abstract Purpose Materials and methods Results Conclusions \nIMPLICATIONS FOR REHABILITATION To describe which needs and difficulties are experienced by stroke patients and caregivers regarding their return to work and to synthesise the lived experiences of stroke patients and caregivers.A systematic review and metasynthesis was conducted on PubMed, CINAHL, Scopus, Web of Sciences and PsycInfo, in according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research. Studies eligible for the review had to fulfil the following inclusion criteria: qualitative studies, stroke patients and their caregivers in a working age (approximately from 18 to 65 years old), discharged from the hospital.Thirty-eight studies involving stroke patients and caregivers were included in this review. For the stroke patients’ group, three main themes were identified: (a) Towards the future; (b) Professional support in return to work; and (c) return to work and employment perspective, while for caregivers two main themes were: (a) daily life challenges and role overload; and (b) employment challenges.Integrating public employment, social and health services, support for job placement, return to work, and social participation of stroke patients should be more supported in individual rehabilitation programs to help stroke survivors and caregivers in their return-to-work process. A program for returning to work after stroke should be developed as part of neurorehabilitation. Stroke survivors and caregivers need psychological and social support during rehabilitation. Integrating public employment, social and health services, support for job placement, return to work, and social participation would help stroke survivors and caregivers in the return-to-work process. A program for returning to work after stroke should be developed as part of neurorehabilitation.Stroke survivors and caregivers need psychological and social support during rehabilitation.Integrating public employment, social and health services, support for job placement, return to work, and social participation would help stroke survivors and caregivers in the return-to-work process. [ABSTRACT FROM AUTHOR]

Background: An increasing number of patients worldwide are living with an ostomy. Among them, self-care management skills and stoma self-care abilities are associated with better quality of life. Aims: To identify the sociodemographic and clinical characteristics of Italian ostomy patients and investigate their knowledge of stoma management. Methods: A questionnaire was used to gather the sociodemographic and clinical data of 433 adult patients. Participants responded to a nine-item survey assessing their knowledge of stoma management. Findings: Respondents reported having received extensive or adequate information in 64.4% of cases, and the remaining 35.6% reported receiving little or no information at any time. The health professional who imparted at least adequate information was a stoma nurse specialist in 32.1% of cases, usually during admission (24.0%) or before and during admission (19.6%). Conclusion: This study demonstrated that most patients received adequate information regarding the ostomy. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the association between patient and caregiver depression and patient self‐care and caregiver contribution to self‐care in the context of ostomy care. Background: Self‐care is essential for ostomy patients and their caregivers. The ostomy self‐care process can be considered a dyadic phenomenon in which the patient and the caregiver interact together and work as a team. The presence of depressive symptoms may limit the patient's ability to perform self‐care and caregivers' abilities to engage in caregiving tasks. Research into the dyadic influence of depression on self‐care behaviours from the perspective of ostomates and their caregivers is still in its infancy. Design: Secondary analysis of a multicentre, cross‐sectional study. The STROBE checklist was used to report the present study. Methods: Patient–caregiver dyads were recruited from eight ostomy outpatient clinics from February 2017 to May 2018. Depression was assessed with the nine‐item Patient Health Questionnaire in both patients and caregivers. Patient self‐care was evaluated with the Ostomy Self‐Care Index, and caregiver contribution to self‐care was assessed with the Caregiver Contribution to Ostomy Self‐Care Index. Both instruments measure the dimensions of maintenance, monitoring and management. The actor–partner interdependence model was performed for the dyadic analysis. Results: In total, 252 patient–caregiver dyads (patients: 69.8% male, mean age 70.05; caregivers: 80.6% female, mean age 58.7) were enrolled. Patient depression was positively associated with caregiver contribution to self‐care maintenance. Caregiver depression was negatively associated with self‐care management. Relevance to Clinical Practice: These findings add a better understanding of the reciprocal influence of dyadic depression on patient and caregiver contributions to self‐care in ostomy contexts was found. Patient and caregiver depression influence patient self‐care and caregiver contribution to self‐care. Therefore, clinicians should assess and treat depression in both members of the dyad to improve self‐care. [ABSTRACT FROM AUTHOR]

Mutuality in patient–caregiver dyad may improve heart failure (HF) patient self-care and caregiver contribution to self-care, but literature is scarce. We evaluated the influence of mutuality and its dimensions on patient–caregiver dyad self-care. A sample of 366 HF patient–caregiver dyads was enrolled. The Actor–Partner Interdependence Model was used to identify the influence of individual patient and caregiver mutuality on their own self-care (actor effect) and on partner self-care (partner effect). The total mutuality score had an actor effect on patient self-care maintenance (i.e., behaviors aimed at maintaining HF stability) and on patient and caregiver self-care confidence. Total score of patient mutuality also had a partner effect on caregiver self-care management (i.e., responses to symptoms of HF exacerbation). Specific mutuality dimensions had different actor and partner effects on patient and caregiver self-care. Interventions to improve mutuality in HF patient–caregiver dyads may influence patient self-care and caregiver contribution to self-care. [ABSTRACT FROM AUTHOR]

In recent years, the increase in textual data production has meant that researchers require faster text analysis techniques and software to reliably produce knowledge for the scientific–nursing community. Automatic text data analysis opens the frontiers to a new research area combining the depth of analysis typical of qualitative research and the stability of measurements required for quantitative studies. Thanks to the statistical–computational approach, it proposes to study more or less extensive written texts produced in natural language to reveal lexical and linguistic worlds and extract useful and meaningful information for researchers. This article aims to provide an overview of this methodology, which has been rarely used in the nursing community to date. [ABSTRACT FROM AUTHOR]

Aims Provide an overview of remote motivational interviewing (MI) interventions for chronically ill patients, and understand their degree of effectiveness on different health outcomes. Methods and results A systematic review with meta-analysis was conducted using the following databases: PubMed, CINAHL, PsychInfo, and Web of Science. Eligibility criteria included studies that administered remote MI alone or in combination with other remote approaches. A narrative synthesis and two meta-analyses were performed. Fifteen studies met the inclusion criteria. MI administration almost exclusively occurred by telephone and individual sessions. Eight studies reported treatment fidelity aspects, and four declared adopting a theoretical framework. Most targeted outcomes were therapeutic adherence, physical activity, depression, quality of life, and mortality. Risk of bias varied markedly, with the largest source resulting from selection process and intervention performance. The two meta-analyses indicated a significant effect of MI on depression [standardized mean difference = –0.20, 95% confidence interval (CI): –0.34, –0.05, Z = 2.73, P = 0.006, I 2 = 0%], and no effect of MI on glycosylated haemoglobin (mean difference = –0.02, 95% CI: –0.48, 0.45, P = 0.94, I 2 = 84%). Conclusion Remote MI can be a promising approach for improving depression in chronic disease patients. However, studies are inconclusive due to risks of bias, heterogeneity, and lack of reporting of interventionist's training, treatment fidelity, and theoretical frameworks' use. More studies with solid designs are needed to inform clinical decision-making and research. Registration PROSPERO: CRD42021241516. [ABSTRACT FROM AUTHOR]

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

Aims To examine the moderating role of caregiver preparedness on the association between stroke survivors' depression and stroke-specific quality of life dimensions. Methods and results We used a multilevel modelling approach to analyse trajectories of change in the eight Stroke Impact Scale 3.0 subscales [i.e. strength, communication, mobility, activities of daily living (ADL)/instrumental activities of daily living (IADL), memory, emotion, hand function, participation] using Hierarchical Linear Modeling. Caregiver preparedness significantly moderated the association between survivor depressive symptoms and survivor communication (B = −0.95, P < 0.01), mobility (B = −0.60, P < 0.05), and ADL/IADL (B = −0.73, P < 0.01) at baseline; linear change for strength (B = 0.83, P < 0.05) and communication (B = 0.66, P < 0.05); and quadratic change for strength (B = −0.19, P < 0.01). Although caregiver preparedness did not significantly moderate the association between survivor depressive symptoms and strength at baseline, there was a significant moderating effect for change over time. Higher levels of caregiver preparedness were significantly associated with higher survivor scores of emotion, hand function, and participation at baseline. Conclusions Including immediate caregivers in the care process, through a psycho-educational training, would mean having better-prepared caregivers and consequently more-healthy stroke survivors. Given that preparedness includes coping with stress, responding and managing emergencies, assessing help and information may require tailored interventions aimed at improving the caregivers' skills and knowledge about stroke survivors' management. [ABSTRACT FROM AUTHOR]

Qualitative research is fundamental to understanding the nature and complexity of human phenomena. While cultural and psychometric validations exist for quantitative tools, the same cannot be said of qualitative ones. There are other many challenges when conducting a multinational qualitative study, which includes different cultural and linguistic 'biases'. This paper presents some key issues that researchers may encounter when designing and developing multinational and multicultural qualitative studies, and also provides some strategies to overcome difficulties and ensure rigour. [ABSTRACT FROM AUTHOR]

Aims Caregiver characteristics and behaviours are associated with patients' and caregivers' outcomes. However, there is scarce evidence on interventions aimed at improving caregiver contribution (CC) to patient self-care, caregiver self-efficacy, and caregiver preparedness in heart failure (HF). This study aims to evaluate the effect of Motivational Interviewing (MI) on CC to patient self-care, caregiver self-efficacy, and caregiver preparedness in HF. Methods and results This is a secondary outcome analysis of MOTIVATE-HF randomized controlled trial. Caregivers of patients with HF were randomized into three arms: Arm 1 (MI for patients), Arm 2 (MI for patients and caregivers), and Arm 3 (standard care). The intervention consisted of one MI session plus three telephone contacts. Data were collected at baseline and after 3, 6, 9, and 12 months. A total of 510 patient and caregiver (median age 54 years, 76% females) dyads were enrolled, 235 caregivers and 238 patients completed the study until 12 months. Caregiver contribution to self-care maintenance and management and caregiver preparedness significantly improved over time, but without significant differences among the three arms. At 9 months, caregiver self-efficacy improved more in Arm 2 than Arm 3 [difference: 8.36, 95% confidence interval (CI) (3.13; 13.59), P = 0.001]. This improvement remained significant also at linear mixed model [ β ^ = 1.39, 95% CI (0.02; 2.75), P = 0.046]. Conclusion Motivational Interviewing did not improve CC to patient self-care and caregiver preparedness. However, it increased caregiver self-efficacy, which is known to be a powerful mediator of CC to self-care. Registration Clinicaltrials.gov: NCT02894502. [ABSTRACT FROM AUTHOR]

Purpose of review: Continuous progress in cancer care has led to its increased use in oral anticancer agents that are easily managed by patients at home with fewer costs and hospitalizations. However, correct self-care behaviors are needed for the safe use of these medications. This review aimed to synthesize studies on self-care behaviors in patients treated with oral anticancer agents. Methods: This systematic review used a convergent qualitative synthesis design for mixed studies. Studies on adult patients with cancer using any kind of oral anticancer agent and describing self-care maintenance, self-care monitoring, and/or self-care management behaviors were searched on PubMed, EMBASE, and CINAHL. After data extraction, the findings were retained for qualitative synthesis. Findings: Of 3419 records, 19 studies were included in this review. From the qualitative synthesis, all the retrieved behaviors were synthesized in the three self-care dimensions. Five themes and 18 subthemes were identified. Self-care maintenance included "adherence to the medications" and "prevention." Self-care monitoring consisted of "health surveillance and recognition of illness changes." Self-care management included "seeking help" and "autonomous management of side effects." Overall, most of the behaviors described focused only on adherence. Conclusion: The findings of this systematic review could guide future studies on self-care and drive future interventions aimed at improving self-care in this vulnerable population. Nurses and other healthcare professionals should provide self-care support to patients taking oral anticancer agents. In particular, they should promote behaviors aimed at improving well-being, preserving health, or managing side effects. [ABSTRACT FROM AUTHOR]

Aim: To test the mediating role of burnout in the relationship between self‐efficacy and academic success in nursing students. Design: This was a cross‐sectional secondary analysis of longitudinal research aimed at exploring the academic success of nursing students. Methods: We enrolled a convenience sample of nursing students attending 21 Italian baccalaureate nursing degree programmes. Data were collected from 2014 to the 2018–2019 academic year. We analysed the wave of data collected during the third year of the programme. The measurements were the Academic Nurse Self‐Efficacy scale (ANSEs) and the Scale of Work Burnout (SWEBO). A mediation analysis with a counterfactual approach was performed. Results: The participants (n = 556) had a median age of 20 years (IQR 19–22) and the majority was female [70.5% (392/556)]. Academic success was reached by 51.97% (289/556) of the students. The findings reveal a significant direct effect of self‐efficacy on academic success and also a significant indirect effect of this relationship via burnout. Conclusion: The mechanism by which self‐efficacy influences academic performance in nursing students is more complex than a simple direct relationship. Universities should consider screening students for variables affecting academic success to decrease academic costs and increase ranking systems classification. Impact Nurses' professors should be engaged in strategies to promote self‐efficacy. The area of intervention should be structured both during classes and internships, in tandem with the mentor and the clinical nurse. [ABSTRACT FROM AUTHOR]

Objectives To identify, critically appraise and synthesize qualitative evidence of self-care experiences in health promotion for home-dwelling elders. Design A meta-synthesis was conducted following the Joanna Briggs Institute guidelines and using Qualitative Assessment and Review Instrument Software. Data sources The literature search was conducted on PubMed, CINHAL, Embase, PsycInfo, Eric and ILISI databases from inception up until March 2015. Other articles were searched on Scopus and Web of Knowledge. The reference list of all the identified articles was also searched for additional studies. Studies published in English, Italian, French, Portuguese, and Spanish were considered for inclusion in the review. Review methods Data from the selected qualitative articles were extracted independently by two reviewers using the data extraction tool of the Joanna Briggs Institute-Qualitative Assessment and Review Instrument. The meta-synthesis involved the following three steps: the production of a set of statements representing the aggregated data obtained by assembling the findings of qualitative studies; the categorization of findings on the basis of similarity in meaning; and the aggregation of these categories to produce a comprehensive set of synthesized findings. No studies were excluded due to methodological quality. Results Of the 4001 records identified, 11 articles met the inclusion criteria. Most articles were conducted in Scandinavian countries and used a phenomenological design. Most elders in the sample were middle-class, cognitively intact, independent, and in good health. The meta-synthesis revealed that older people living at home make decisions about their self-care activities on the basis of their attitudes toward their life and future. These self-care activities are directed toward holistic wellness, prevention and treatment of aging effects, obtaining a sense of satisfaction, and self-realization. Furthermore, self-care activities are settled in a social and relational network that allows old people to take care of themselves and of others or to be cared for by others. Conclusions This meta-synthesis presents the perspectives of home-dwelling old people on health-promoting self-care experiences. Such information can help healthcare professionals to maintain long-term autonomy of elders in self-care and to promote healthy aging. Further qualitative research describing self-care experiences of home-dwelling elders from different cultures, education levels, and social backgrounds is needed. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the factors influencing self-care in a consecutive sample of postmenopausal osteoporotic Italian women.Study Design: This was a multicentric, longitudinal study (Guardian Angel) conducted across several osteoporosis centres throughout Italy.Main Outcome Measures: Sociodemographic and clinical data (age, education, employment status, body mass index (BMI), fracture history) were collected at baseline, while self-care behaviours were assessed at baseline, and at one, three and six months from enrolment with the Self-Care of Osteoporosis Scale (SCOS). The SCOS has a total score ranging from 15 to 75 for women who take osteoporosis drugs, while for those who do not take any osteoporosis drug the score is between 13 and 65. Higher scores indicate better self-care. A three-level general linear mixed model with a random intercept for participants and regions was implemented to investigate the possible associations of the sociodemographic and clinical factors with longitudinal SCOS scores.Results: The sample (n= 1525) had a mean age of 72.1 years (standard deviation [SD] = ±10.07), with a high proportion retired (64.2%) and with a low education level (45.8%). Approximately half of the women declared taking multiple medications (70.14%) and osteoporosis pharmacotherapy (69.7%). Average longitudinal SCOS scores ranged between 53.17 and 56.68, indicating a satisfactory level of self-care. There were significant and positive relationships between SCOS scores and time (p < 0.001) and number of medications taken (p < 0.001). Negative relationships were found between SCOS and BMI scores (p= 0.013), smoking status (p < 0.001) and presence of recent fractures (p < 0.001).Conclusions: Several modifiable characteristics were associated with self-care behaviours in our sample of women with postmenopausal osteoporosis. Psychoeducational interventions are promising in this population to counteract unhealthy behaviours and, ultimately, to promote self-care. [ABSTRACT FROM AUTHOR]

Home care workers (HCWs) are a highly heterogeneous population in Italy in terms of their professional qualifications. HCWs play an important role in helping patients affected by chronic diseases and their families. Although many investigators have studied the lived experiences of family caregivers, few have been conducted "to give a voice" to HCWs and even fewer have examined the experiences of HCWs during the present COVID‐19 pandemic. We investigated the lived experiences of HCWs during the first wave of the pandemic in Italy. Cohen's phenomenological research approach was used to conduct this study. In our study, we enrolled and interviewed 19 HCWs who were female, and most were married, with an average age of 52 years. The participants were enrolled from September 2020 to November 2020, after the first COVID‐19 wave in Italy. Four main themes emerged from the analysis of the data: (1) "I found myself alone"; (2) from invisibility to visibility; (3) a fear of getting sick and infecting others; and (4) "Health or work? That is the question." Understanding HCWs' lived experiences, especially those related to the COVID‐19 pandemic, is a first step in giving a voice to this important but vulnerable population in the healthcare workforce. [ABSTRACT FROM AUTHOR]

We analyzed the lived experiences of frontline nurses and physicians who were affected by COVID‐19 through a phenomenological approach, using Cohen's methodology with interview data. The participants were enrolled in the study in May 2020 during the COVID‐19 pandemic in Italy. The inclusion criteria were (i) being a nurse or physician employed full time caring for COVID‐19 patients before falling ill; (ii) contracting SARS‐CoV‐2 between February 2020 to May 2020; (iii) having recovered before enrollment; and (iv) providing informed consent to participate. Sixteen participants (60% nurses) with an average age of 45 years were included. The following main themes were extrapolated from our data analysis: "fear of diagnosis," "loneliness (as isolation)," "touch of nurses," and "feeling guilty of abandonment." Several aspects emerging from our study highlight the strong emotional impact of COVID on nurses and physicians infected during their activities, such as feelings of fear and loneliness on the one hand, and of impotence and guilt for not being able to help on the other. [ABSTRACT FROM AUTHOR]

Background: Moral distress, defined as moral suffering or a psychological imbalance, can affect nursing students. However, many new instruments or adaptations of other scales that are typically used to measure moral distress have not been used for nursing students. Aim: This study aimed to translate, culturally adapt and evaluate the psychometric properties of an Italian version of the Moral Distress Scale for Nursing Students (It-ESMEE) for use with delayed nursing students (students who could not graduate on time or failed the exams necessary to progress to the next level). Research design: The study used a cross-sectional research design. Participants and research context: Incidental sampling resulted in a sample of 282 delayed nursing students (mean age = 26.73 ± 4.43 years, 73% female) enrolled between May and August 2020 in a University of central Italy. Ethical considerations: The research protocol was approved by the internal review board of the university, and all participants provided their written informed consent. Results: The study confirmed a multidimensional second-order factorial structure for the It-ESMEE with five dimensions: improper institutional conditions to teach user care, authoritarian teaching practices, disrespect for the ethical dimension of vocational training, lack of competence of the teacher and commitment of ethical dimension of user care. The internal consistency was high (0.753–0.990 across the factors), and the standard error of measurement and smallest detectable change were adequate. Discussion: The It-ESMEE is able to assess moral distress in delayed nursing students with good validity and reliability. It can be used in research and to determine moral distress levels, helping teachers to monitor the condition in nursing students. Conclusion: This instrument can help in comprehending moral distress, enabling students to develop coping and intervention strategies to maintain their well-being, and to ensure the quality of nurse education. [ABSTRACT FROM AUTHOR]

Background: Given that emergency procedures must be performed immediately and without the possibility of sufficiently informing and preparing a patient, the lived experiences of patients who undergo emergency procedures and those who undergo elective procedures may well differ. Elucidating the lived experiences of patients who underwent percutaneous coronary intervention (PCI) with stent implantation in an emergency situation is crucial because such knowledge might prove helpful in tailoring post‐procedure interventions intended to improve the lives of PCI patients. Aim: To describe the experiences of patients 1 month after they underwent emergency PCI with coronary stent implantation. Methods: Cohen's phenomenology was applied in this study. This method combines the characteristics of descriptive (Husserlian) phenomenology with those of interpretative (Gadmerian) phenomenology, and it is by nature an inductive approach. The participants were enrolled 1 month after undergoing PCI with coronary stent implantation. They were interviewed using open‐ended questions to provide them full freedom of expression. They were asked to describe their experiences of the PCI and stent implementation they have gone through. This study followed the recommendations of the Standard for Reporting Qualitative Research. Results: Our sample consisted of 15 participants. Data analysis revealed three main themes: (1) catheter lab and pain, (2) anxiety and feeling uncertain about the future, and (3) lifestyle changes. The anxiety theme encompassed two subthemes: (a) anxiety related to the procedure and (b) anxiety related to the continuation of life. Conclusion: Our study is one of the first works to explicitly investigate the lived experiences of patients who underwent emergency PCI. Understanding the experiences of these patients is key in understanding their realistic needs and concerns. Relevance to clinical practice: Knowledge of the lived experiences of patients who underwent emergency PCI with coronary stent implantation is fundamental in identifying aspects that warrant tailored interventions. [ABSTRACT FROM AUTHOR]

Although several studies have analyzed the effects of spirituality on stroke survivors’ physical functioning and their caregiver’s outcomes, no systematic review or meta-synthesis was found to identify the lived experiences of stroke survivors and caregivers regarding spirituality. For these reasons, this study aimed to analyze quantitively and qualitatively research relating to stroke survivors’ and caregivers’ experiences. The included studies were RCT studies, quasi-experimental studies, qualitative, descriptive, ethnographic, and phenomenological studies, and cross-sectional studies (n = 37), with a total of 6850 stroke survivors and 1953 caregivers enrolled. Spirituality appears to play an important role in improving the quality of life and decreasing anxiety and depression of both stroke survivors and their caregivers. [ABSTRACT FROM AUTHOR]

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

Aims and objectives: To describe caregiver contribution (CC) to ostomy self‐care and identify its associated variables among caregivers of ostomy patients. Background: Self‐care is essential for ostomy patients, but it can be difficult to perform. In these cases, caregivers play a key role in promoting self‐care behaviours. So far, the CC to ostomy self‐care has not been investigated thoroughly. Design: This is a cross‐sectional and multicentre study conducted at seven outpatient clinics of two Italian regions. Methods: We recruited 252 caregivers between February 2017–May 2018. The Caregiver Contribution to Ostomy Self‐Care Index (CC‐OSCI) was used to measure CC to ostomy self‐care. Three multivariable linear regression models were fitted to identify variables associated with CC dimensions (maintenance, monitoring and management). The STROBE checklist was used to report the present study. Results: The sample (mean age = 58.73, SD = 13.98) was mostly female (80.60%), unemployed (58.70%) and resided with the patient (81.00%). Caregivers being employed and those declaring more hours of contribution per week were associated with a significantly lower contribution to self‐care maintenance. Caregivers with lower levels of education and those residing with the patient were less likely to contribute to CC to self‐care monitoring. Spousal caregivers and those with higher preparedness contributed significantly lower to CC to self‐care management. Conclusions: We found a variety of sociodemographic factors associated with CC to ostomy self‐care. Relevance to clinical practice: Sociodemographic variables associated with CC to ostomy self‐care can help clinicians develop more tailored educational interventions for caregivers who find their contribution challenging. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to explore the experience of Italian nurses engaged in caring for patients with COVID‐19. Background: COVID‐19 found the health care world unprepared to face an emergency of such magnitude. Italy was one of the most affected European countries, with more than 250,000 cases. Understanding the impact of events of this magnitude on nurses provides a framework of knowledge on which educational training could be based to face similar situations in the future to prevent further breakdown. Methods: The hermeneutic approach by Cohen was used. Semi‐structured interviews were conducted using a voice‐over Internet protocol. Interviews were transcribed, read in depth and analysed. Results: Twenty nurses were interviewed. Four themes were extracted: uncertainty and fear, alteration of perceptions of time and space, change in the meaning of 'to care' and changes in roles and relationships. Conclusions: Psychological support in association with emergency training prevents stress and helps tackle compassion fatigue. Implications for nursing management: Policies to improve nursing science should be developed to ensure better quality of care, a higher number of professionals and, consequently, an increase in the safety of patients. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe the sociodemographic and academic characteristics of nursing students who report academic failure and to identify the determinants of academic failure (no degree on time) in a population of nursing students. Background: Although prior studies have shown that academic failure is influenced by multiple factors, the studies mentioned have mostly focused on specific single variables associated with academic failure, and they have reported inconsistent results. Design: A prospective follow‐up study design was used in an Italian Baccalaureate Nursing Degree program. A total sample of 2,040 at baseline and a random subsample of 753 students were considered for academic failure determinants. The study followed the recommendations of STROBE (Strengthening the Reporting of Observational studies in Epidemiology). Methods: We included in the model academic background, self‐efficacy, sociodemographic variables and self‐efficacy in psychomotor skills and motivation. We used the Academic Nurse Self‐Efficacy Scale (ANSEs), the Nursing Self‐Efficacy in Psychomotor Skill Scale (NSE‐PS) and the Motivation Nursing Students' Scale (MNSS) which have been validated on nursing students. For the assessment of predictors of academic failure, a two‐stage hierarchical logistic regression analysis was performed. Results: Students who had academic failure were 69.4% of the sample. Predictors of academic failure were the secondary school certification grade, the university pre‐admission test score; the academic self‐efficacy, self‐efficacy in psychomotor skills and clinical training examination grades were additional predictors. Conclusions: The secondary school certification grade, the University pre‐admission test score, low academic self‐efficacy, low self‐efficacy in psychomotor skills and low clinical training examination grades were predictors of academic failure in nursing students. Relevance to clinical practice: Our findings suggest that the universities could consider a cut‐off in the pre‐admission test score as a critical value for identifying students who are likely to fail. In addition, nursing faculty staff should consider strategies for developing self‐efficacy and motivation. [ABSTRACT FROM AUTHOR]

Purpose: Anxiety, depression, poor sleep quality and lower quality of life (QOL) are associated with worse outcomes in heart failure (HF) patients. Motivational interview (MI) has been effective in different patient populations to promote self-care. However, its effect on anxiety, depression, sleep quality and QOL in HF patients is unknown. The aim of this study was to evaluate the effect of MI on anxiety, depression, sleep quality and QOL over 12 months from the intervention. Methods: This was a planned, secondary outcome analysis of the MOTIVATE-HF study, a three-arm randomized controlled trial (1:1:1) evaluating the effect of MI in improving self-care in HF patients. In Arm 1, the patient received MI, while in Arm 2, the patient and the caregiver received MI. Arm 3, the control group, received standard treatment. Endpoints were evaluated with the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI), the 12-Item Short-Form Health Survey (SF-12) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) every three months for one year. Results: We enrolled and randomized 510 HF patient and caregiver dyads (155 dyads in Arm 1, 177 dyads in Arm 2, and 178 dyads in Arm 3). A total of 238 HF patients and 235 caregivers completed the 12-month trial. No significant changes were seen in anxiety, depression and sleep quality over time among the three study arms, but disease-specific QOL improved in the intervention groups, especially in Arm 2. Conclusion: Clinicians may want to include both patients and caregivers when providing MI interventions. Further research is needed to investigate the required intensity of MI to be effective on sleep quality, anxiety and depression (ClinicalTrials.gov Identifier: NCT02894502). [ABSTRACT FROM AUTHOR]

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

Aim and objectives: To assess the prevalence of anxiety, sleep disorders and self‐efficacy and their predicting factors among nurses facing COVID‐19. Background: The spread of COVID‐19 throughout the world determined a series of modifications of several National Health Service organisations, with a potential series of psychological consequences among nurses, who were particularly afflicted by this situation of changes and precariousness. Design: A cross‐sectional study was carried out from February–April 2020. Methods: A total of 1,005 nurses employed in different Italian hospital wards, during the COVID‐19 pandemic, were recruited. Analyses were based on descriptive statistics and multivariate logistic regression. The STROBE checklist for cross‐sectional studies was used in this study. Results: The prevalence of sleep disturbances, moderate anxiety and low self‐efficacy was 71.4%, 33.23% and 50.65%, respectively. We found a positive correlation between anxiety and sleep quality (0.408; p <.0001) and negative correlations between self‐efficacy and anxiety (−0.217; p <.0001) and sleep quality and self‐efficacy (−0.134; p <.0001). The factor independently associated with all variables was gender. Females were more prone to sleep disturbances, anxiety and low levels of self‐efficacy than males (p <.05). Conclusions: The prevalence of anxiety, sleep disorders and low self‐efficacy among Italian nurses during the COVID‐19 pandemic was high. Healthcare managers should recognise and consider these results to reduce the risk of the onset of major mental problems that could result in post‐traumatic stress disorder. Relevance to clinical practice: Nurses facing major incidents as COVID‐19 pandemic are among healthcare personnel exposed to a high risk to develop psychological disturbance that should be assessed and recognised, in order to find helpful coping strategies to inform support services and avoid to hesitate in post‐traumatic stress disorders. [ABSTRACT FROM AUTHOR]

Aim: To analyse any changes seen in the academic self‐efficacy of nursing students during the three years of their academic education as well as the associated predictive factors. Design: A longitudinal study design was applied. Methods: The sample included 220 students who attended a large university in central Italy. The students' academic self‐efficacy was measured using the Academic Nurses' Self‐Efficacy Scale. Data were collected annually from 2014/2015 to 2017/2018 at the beginning of the first year (T0), at the end of the first year (T1), at the end of the second year (T2) and at the end of the third year (T3). A repeated measure univariate analysis of variance (ANOVA) was conducted to detect any possible changes in the students' academic self‐efficacy scores over the four measurement points. To identify the factors that are predictive of academic self‐efficacy, a linear regression model was used. Results: Overall, the students' academic self‐efficacy did not change significantly over the three‐year period of their education. Both sex (female) and age (24–50 years) during T0–T2 significantly predicted changes in the students' academic self‐efficacy over time. Moreover female students started with lower academic self‐efficacy scores than male students, although their academic self‐efficacy increased over time, while the male students' academic self‐efficacy actually decreased over time. In addition, students with a scientific background reported higher academic self‐efficacy than other students. Conclusions: Although the students' academic self‐efficacy did not change over time, from a theoretical perspective, academic self‐efficacy can be developed using a number of strategies such as a well‐organised tutorial during the clinical learning phase and feedback or encouragement. Impact: Academic staff should monitor nursing students' academic self‐efficacy over time, particularly in the case of male and younger students, students with a partner and students with a humanities background during the first 2 years of the course. [ABSTRACT FROM AUTHOR]

Aim: To investigate the longitudinal growth trajectories of disease‐specific quality of life (QoL) dimensions and their associations over 1 year. Design: A longitudinal design. Data were collected between February 2015‐May 2017. Methods: Four hundred and fifteen stroke survivors (mean age 70.6 years; 81% ischaemic stroke) were recruited after discharge from rehabilitation hospitals and were followed up every 3 months for 1 year. Changes in Stroke Impact Scale (SIS) dimension scores were evaluated using hierarchical linear models (HLMs) and linear, logarithmic, quadratic, and cubic time slope. Results: We observed a significant linear and quadratic increase in most SIS dimensions from the baseline to 12‐month follow‐up, especially in physical dimensions. The communication dimension was stable over time, while the memory dimension increased only linearly. Higher physical dimension scores were significantly associated with lower age, hypercholesterolaemia, and better physical functioning at baseline, while higher communication was associated with lower age, better physical functioning, and a diagnosis of peripheral vascular disease. Better memory was associated with lower age, married status, better physical functioning, and left‐hemisphere stroke. Better participation was associated with lower age and better physical functioning. No significant associations were observed for emotion. Conclusions: This study provides important information about the trajectories of stroke survivors' specific QoL and their associated variables. Impact: Stroke has a great impact on stroke survivors' QoL. Disease‐specific QoL significantly increases from the baseline to 12‐month follow‐up, especially in physical dimensions. Lower age, hypercholesterolaemia, better physical functioning, and diagnosis of peripheral vascular disease seem to be associated with better QoL. Through the analyses of associated variables, we identified stroke survivors who are more at risk and who need more tailored interventions to improve their physical, psychological, emotional, and social dimensions. [ABSTRACT FROM AUTHOR]

Background Chronic illness management is increasingly carried out at home by individuals and their informal caregivers (dyads). Although synergistic in concept, the nuances of dyadic congruence in caring for patients with heart failure are largely unexamined. Aims The purpose of this study was to examine the role of dyadic-type congruence on patient self-care (maintenance, symptom perception, and management) while controlling for actor and partner effects. Methods This secondary data analysis of 277 dyads consisted of a series of multilevel models to examine the impact of dyadic congruence on a patient's self-care maintenance, symptom perception, and self-care management. Patient-level and caregiver-level data were input into each model simultaneously to account differential appraisals of factors related to the dyad. Results Bivariate analyses yielded dyad congruence which was associated with better patient self-care maintenance, symptom perception and management. However, after multilevel models were constructed, dyad congruence was found to be a significant predictor of patient's symptom perception scores, but not self-care maintenance or management scores. Caregiver's satisfaction with the dyad was differentially and significantly associated with self-care - it was inversely associated with patient self-care maintenance and positively associated with patient self-care management. Conclusion This is the first study, to our knowledge, reporting that congruence in heart failure dyads is associated with better patient symptom perception and this advances our prior hypothesis that dyad typologies could be used to predict patient self-care performance. Since symptom perception is the key to preventing heart failure exacerbation, screening heart failure patient and caregiver dyads for congruence is important in clinical settings. [ABSTRACT FROM AUTHOR]

Background Sleep disturbance is one of the most common symptoms among heart failure patients. Sleep disturbance reduces quality of life and leads to higher rates of mortality. It may affect the ability of patients to perform adequate self-care. Although some research has evaluated the association between sleep quality and heart failure self-care, a synthesis of the most recent available evidence is lacking. Aims This systematic review aimed to assess the association between sleep quality and self-care in adults with heart failure. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology was used. Medline, CINAHL, PsycINFO and SCOPUS were searched. Observational, case-control and cohort studies were considered. The quality of the studies was evaluated with the Joanna Briggs Institute's Critical Appraisal Tools. Results Six articles were included. Association between sleep quality and self-care was reported by three studies. One of these did not find an association between sleep disturbance and heart failure self-care, while the other two studies did. An association between sleep quality and medication adherence was reported by three studies. All three of these studies found associations between these two variables. Studies have measured similar but different constructs. Two studies assessed sleep quality, while four other studies measured excessive daytime sleepiness. Half of the studies examined self-care, while the other half measured medication adherence. Conclusions Although the evidence should be strengthened, sleep quality seems to affect self-care in heart failure patients. The mechanism underlying the effect of sleep quality on heart failure self-care remains unclear. Future longitudinal interaction analyses could be useful to clarify this mechanism. [ABSTRACT FROM AUTHOR]

Background: Wound care nurses are recognised as a key element for improving health outcomes. However, there is still fragmented knowledge of the outcomes associated with their practice in individuals with pressure ulcers. Aims and objectives: To identify, summarise and map all available evidence related to the outcomes of wound care nurses' practice in individuals with pressure ulcers. Design: Integrative literature review. Review method: To report the review, we followed the modified version of Cooper's five‐step methodology, and the PRISMA guidelines. Methods: The search was carried out on CINAHL, PubMed, the Cochrane Library and Scopus, with a time frame ranging from each database inception to December 21, 2019. We included observational or experimental studies of adult individuals affected by (or at risk of) developing pressure ulcers who were also cared for by wound care nurses. Results: Of the 439 peer‐reviewed publications, 13 studies met the inclusion criteria. The most frequent outcomes were pressure ulcer incidence, healing rate and time taken for complete healing. Less frequent outcomes were changes in pressure ulcers' stage, number of completely healed wounds, treatment costs and physical discomfort. No patient‐reported outcomes were assessed. Conclusion: This review indicates that clinical‐related outcomes were by far the most reported. Future studies should broaden the spectrum of outcomes to include more subjective parameters (e.g. pain, quality of life, stress, etc.), in order to gain a better understanding of the global impact of wound care practice on patients with pressure ulcers. Relevance to clinical practice: There is promising evidence of a positive impact of wound care nurses' practice on health and economic outcomes. Nonetheless, more robust and rigorous research is needed to provide stronger evidence in the field and support investment in these practitioners. [ABSTRACT FROM AUTHOR]

Aims: To describe the image of the female Licensed Nurse in Italy as promoted by the Fascist party from 1939–1943 and to understand how gender stereotypes influenced the construction of this image. Design: Mixed methods design. Method: The study started in 2016 and ended in 2019. In the qualitative phase, the primary source was analysis, following Chabod's historical method (2012), while the quantitative phase involved statistical analysis of textual data. Data sources: All data came from the only nursing category magazine of the time: 'L'Infermiera Italiana' (The Italian Nurse), published from 1939–1943. Results: From 112 articles analysed, the gradual elevation of the nurse emerged, including the partial replacement of 'old' nurses with Graduate Nurses. The analysis shows the maturation in structure, differentiation and specification, together with the birth of a new professional image. The accepted image of the nurse was now a woman of high moral character with religious ideals, but less known for her technical skills, an exception being the Visiting Health Assistant who functioned at a high level in the society. Conclusions: The study shows an articulated, congruent and cohesive set of dimensions through which to review history and to understand the dynamics underlying the structuring of the nurse's professional image. Impact: A better understanding of the dynamics behind the development of the professional image will guide present and future actions on gender stereotypes and their negative effects on the safety and quality of nursing care. International synergies and alliances are required. [ABSTRACT FROM AUTHOR]

Background: Because of the importance of a dyadic approach, it is necessary to conduct a systematic review to identify which dyadic intervention could be implemented for stroke survivor–caregiver dyads after discharge from the rehabilitation hospital to improve outcomes. Aims: The aims were to systematically review the evidence to identify which dyadic interventions have been implemented in stroke survivor–caregiver dyads to improve stroke survivor–caregiver dyads' outcomes and to analyse, through a meta-analysis, which intervention was found to be the most effective. Methods: A systematic review and meta-analysis were conducted using the following electronic databases: PubMed, CINAHL and PsycInfo. Randomized controlled trials (RCTs) and quasi-RCT studies published within the last 10 years were included. Quantitative data were extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI. Pooled effects were analysed between the experimental and control groups for each outcome. Results: Sixteen studies involving 2997 stroke survivors (male gender=58%) and 2187 caregivers (male gender=25%) were included in this review. In 16 studies, which were subdivided into three quasi-RCTs and 13 RCTs, the application of dyadic interventions for stroke survivors and caregivers was systematically reviewed, but only a few of these identified a significant improvement in the stroke survivors' and caregivers' outcomes of its intervention group. Dyadic interventions showed a significant effect on stroke survivors' physical functioning (p =0.05), memory (p <0.01) and quality of life (p =0.01) and on caregivers' depression (p =0.05). Conclusions: This study provides moderate support for the use of a dyadic intervention to improve stroke survivors' physical functioning, memory and quality of life and caregiver depression. [ABSTRACT FROM AUTHOR]

Purpose: To explore and understand the lived experiences of women with endometriosis. Method: Qualitative study using Cohen phenomenology. Results: The data analysis identified four main themes and two sub-themes. The main themes are: delay in diagnosis, which includes the sub-theme of the misunderstanding of one's state; worsening of one's life, which includes the sub-theme of a painful life; disastrous intimate life with one's partner; and uncertainty about being able to have one's own children. Conclusions: The themes that emerged represent the starting point for further research and for the implementation of specific educational and support strategies that improve self-care, commitment and quality of life for women with endometriosis. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe the care provided to patients admitted into a community Nursing‐Led inpatient unit and to identify factors predicting a length of stay exceeding an established threshold. Background: Few studies have been conducted to describe the care provided in a Nursing‐Led unit. No studies have investigated factors affecting length of stay in these services. Design: Retrospective cohort study. Methods: Consecutive patients admitted to a community Nursing‐Led unit between 2009–2015 were enrolled. Sociodemographic, medical and nursing care (diagnoses and activities) variables were collected from electronic health records. Descriptive analysis and a backward stepwise logistic regression model were applied. The study followed the STROBE guidelines. Results: The study enrolled 904 patients (mean age: 77.7 years). The most frequent nursing diagnoses were bathing self‐care deficit and impaired physical mobility. The nursing activities most provided were enteral medication administration and vital signs measurement. Approximately 37% of the patients had a length of stay longer than the established threshold. Nine covariates, including being discharged to home, having an impaired memory nursing diagnosis or being treated for advanced wound care, were found to be independent predictors of prolonged length of stay. Variables related to medical conditions did not affect the length‐of‐stay threshold. Conclusions: The length of stay in the community Nursing‐Led unit was mainly predicted by conditions related to sociodemographic factors, nursing complexity and functional status. This result confirms that the medical and nursing needs of a community Nursing‐Led unit population substantively differ from those of hospitalised acute patients. Relevance to clinical practice: The nursing complexity and related nursing care to be provided may be adopted as a criterion to establish the appropriate length of stay in the community Nursing‐Led unit for each individual patient. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine nursing students' health habits. More specifically, the objectives were to determine whether there were any changes in their health habits during their course of study, and to understand whether the students' perceptions about good health conditions cohered with their health‐related behaviour. Background: The transition from high school to university has an undesirable effect on students' health habits, and nursing students' unhealthy behaviours may prevent them from helping patients improve their poor health habits. Design: A longitudinal design was used. The study followed the recommendations of STROBE (Strengthening the Reporting of Observational studies in Epidemiology). Methods: All students were recruited from a nursing science degree course in an Italian university. The sample consisted of 351 nursing students. Data were collected at the baseline during their entrance into the university (T0) and at the end of their third year of coursework (T3). We developed the Nursing Student Health Habits Scale, which was administered by a trained researcher. The McNemar test and the Wilcoxon signed‐rank test to evaluate the differences in health habits between T0 and T3, and a logistics model to assess the factors influencing students' good health perceptions were used. Results: From T0 to T3, there were decreases in the number of students who requested physician consultations (p =.01) and increases in those who exercised daily (p =.003). There was also a change in the nutrition model (p =.018). In the multivariate model, physician consultations for medical problems and performing physical exercise were factors influencing good health perceptions. Conclusions: Future research is needed to illuminate other aspects of students' health habits. Relevance to clinical practice: Universities are advised to address these problems by reflecting on undergraduate and postgraduate curriculum content concerning health management and disease prevention. [ABSTRACT FROM AUTHOR]