Search

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

Background: Despite its association with patient safety, few studies on missed nursing care have been conducted in nursing homes. We aimed to describe individual and environmental factors in a sample of registered nurses (RNs) reporting missed nursing care in nursing homes, and to explore the association between these factors and missed nursing care. Methods: In the present, multicentre cross-sectional study, 217 RNs from 43 nursing homes in Northern Italy reported all episodes of missed nursing care (ie, any aspect of required care that was omitted or delayed) that occurred in the 20 most dependent residents (according to RNs’ judgement; 860 residents in total) over 3 consecutive days. Multilevel multivariable logistic regression models were used to test possible explanatory factors of missed nursing care (individual, work-related, organisational, and work environment factors), which were entered in a step-wise manner. Results: Younger RNs (P=.026), freelance RNs (P=.046), RNs with a permanent contract (P=.035), and those working in publicly-owned nursing homes reported more episodes of missed nursing care (P<.012). Public ownership (odds ratio [OR]=9.88; 95% CI 2.22–44.03; P=.003), a higher proportion of residents with severe clinical conditions (OR=2.45; 95% CI 1.12–5.37; P=.025), a lower proportion of RNs (OR=2.24; 95% CI 1.10–4.54; P=.026), and perceived lack of time to care for residents (OR=2.33; 95% CI 1.04–5.26; P=.041) were statistically significantly associated with missed nursing care. Conclusion: Factors associated with missed nursing care are similar in hospitals and nursing homes, and include heavy workload and perceived lack of time for care. Because missed nursing care in nursing homes represents tasks performed specifically by RNs, missed nursing care in this setting should be measured in terms of these tasks. An optimal skill mix is crucial to guarantee not only comfort and basic care for nursing home residents, but also good outcomes for residents with severe clinical conditions. [ABSTRACT FROM AUTHOR]

Background: Most people with dementia transition into nursing homes as their disease progresses. Their family caregivers often continue to be involved in their relative's care and experience high level of strain at the end of life. Aim: To gather and synthesize information on interventions to support family caregivers of people with advanced dementia at the end of life in nursing homes and provide a set of recommendations for practice. Design: Mixed-Methods Systematic Review (PROSPERO no. CRD42020217854) with convergent integrated approach. Data sources: Five electronic databases were searched from inception in November 2020. Published qualitative, quantitative, and mixed-method studies of interventions to support family caregivers of people with advanced dementia at the end of life in nursing home were included. No language or temporal limits were applied. Results: In all, 11 studies met the inclusion criteria. Data synthesis resulted in three integrated findings: (i) healthcare professionals should engage family caregivers in ongoing dialog and provide adequate time and space for sensitive discussions; (ii) end-of-life discussions should be face-to-face and supported by written information whose timing of supply may vary according to family caregivers' preferences and the organizational policies and cultural context; and (iii) family caregivers should be provided structured psychoeducational programs tailored to their specific needs and/or regular family meetings about dementia care at the end of life. Conclusion: The findings provide useful information on which interventions may benefit family caregivers of people with advanced dementia at the end of life and where, when, and how they should be provided. [ABSTRACT FROM AUTHOR]

Background: With a growing nursing home population suffering from chronic progressive illnesses and evolving patterns of comorbidities, end‐of‐life communication takes on a critical role to enable healthcare professionals to gather information about the resident's wishes for care at the end‐of‐life and organise the care plan accordingly. Aim: To explore nurses' perspective about the process by which end‐of‐life communication impacts on the goal of end‐of‐life care in nursing home residents. Design: A qualitative descriptive research design based on thematic analysis was performed. Fourteen nurses involved in the care of residents during their last week of life were recruited across 13 Italian nursing homes and accounted for 34 semi‐structured interviews. A combined approach of analysis that incorporated a data‐driven inductive approach and a theory‐driven one was adopted. Results: Twelve themes described how end‐of‐life communication may contribute to adjust the care plan in nursing home according to the nurses' perspective. Five antecedents (i.e. life crisis or transitions, patient‐centered environment, arising the question of possible dying, quality of relationships and culture of care) influenced the establishment and quality of communication, and five attributes depicted the characteristics and potential mechanisms of end‐of‐life communication (i.e. healthcare professional‐resident and healthcare professional‐family carers communication, knowledge of family carers' preferences, knowledge of residents' preferences, family carers and residents understanding, and shared decision‐making), while curative‐oriented and palliative‐oriented care goals emerged as consequences. Conclusion: This study provides insight into the nursing perspective of end‐of‐life communication between healthcare professionals and bereaved family carers of nursing home residents. Several factors influenced the occurrence and quality of end‐of‐life communication, which contributed to the transition towards palliative‐oriented care by using and improving knowledge about family cares' and resident's preferences for end‐of‐life care, promoting family carers and residents understanding about prognosis and treatments available, and fostering shared decision‐making. [ABSTRACT FROM AUTHOR]

Objectives: Family carers (FCs) of nursing home (NH) residents are best placed to notice deteriorations that signal impending death in their relative, which can open a conversation with healthcare professionals (HCPs) about adjusting the care plan. We explored contributors to bereaved FCs' decision to transition towards palliative-oriented care for their relatives in NHs.Methods: This qualitative descriptive study used a phenomenological design. Thirty-two bereaved FCs across 13 Italian NHs completed semi-structured interviews. Additional data were collected on NH referrals to palliative care services (PCS) in the 6 months before study start and treatments provided in the last week of life. Content analysis with a combined inductive and deductive approach was applied to identify codes and fit them into an a priori framework. When codes did not fit, they were grouped into new categories, which were finally gathered into themes.Results: FCs reported four types of "trigger events" that made them doubt that their relative would recover: (1) physical deterioration (e.g., stopping eating/walking or swallowing problems); (2) social confirmation (e.g., confirming their relative's condition with friends); (3) multiple hospitalizations; and (4) external indicators (e.g., medical examinations by external consultants). A "resident-centered environment" helped FCs recognize trigger events and "raise awareness of the possibility of death"; however, the "need for reassurance" was pivotal to a "gradual transition towards palliative-oriented care". When participants did not recognize the trigger event, their relative continued to receive curative-oriented care. NHs that referred residents to PCS discussed palliative-oriented care more frequently with FCs, had a lower nurse-to-resident and nurse aide-to-resident ratio, and administered more palliative-oriented care.Significance Of Results: Trigger events represent an opportunity to discuss residents' prognosis and are the starting point for a gradual transition towards palliative-oriented care. Adequate staffing, teamwork, and communication between FCs and healthcare professionals contribute to a sensitive, timely shift in care goals. [ABSTRACT FROM AUTHOR]

Poor treatment adherence and lack of self-care behaviors are significant contributors to hospital readmissions of people with heart failure (HF). A transitional program with non-invasive telemonitoring may help sustain patients and their caregivers to timely recognize signs and symptoms of exacerbation. We will conduct a Randomized Clinical Trial (RCT) to evaluate the feasibility and acceptability of a 6-month supportive intervention for patients discharged home after cardiac decompensation. Forty-five people aged 65 years and over will be randomized to either receive a supportive intervention in addition to standard care, which combines nurse-led telephone coaching and a home-based self-monitoring vital signs program, or standard care alone. Four aspects of the feasibility will be assessed using a mixed-methods approach: process outcomes (e.g., recruitment rate), resources required (e.g., adherence to the intervention), management data (e.g., completeness of data collection), and scientific value (e.g. 90- and 180-day all-cause and HF-related readmissions, self-care capacity, quality of life, psychological well-being, mortality, etc.). Participants will be interviewed to explore preferences and satisfaction with the intervention. The study is expected to provide valuable insight into the design of a definitive RCT., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier B.V.)

. The missed care in Nursing Homes: a pilot study., Introduction: To date missed care have been described mostly in hospitals and data on nursing homes (NH) are missing., Aim: To describe missed care in NH residents identifying their perceived impact and seriousness., Methods: A pilot study was conducted in 10 Piedmont NHs. For each omitted or delayed care on 20 residents observed for 3 consecutive days, the nurses provided information on the type of care, and information on the residents and on the organization were collected., Results: Twenty-three nurses reported 57 missed care for 44/200 residents (22%; median 5 for each NH, range 0-13). Twenty-five missed/omitted care on 20 residents were considered of medium/high severity: 14 (56%) involved drug therapies and 5 (20%) the monitoring of vital signs. The level of severity derived from the distress caused to the resident, the risk of deterioration of residents'conditions and the repeated omissions on the same resident. Of the 32 missed care on 25 residents, judged of limited impact, the more frequent were dressing changes (12, 37.5%), and drugs administration (10, 31.3%). The most frequent reasons for delay/omission were unplanned events (16, 28.1%), shortage of nurses (12, 21.1%), and residents' clinical conditions (9, 15.7%)., Conclusions: Missed care occur also in NHs. If staff shortage play a key role among potentially modifiable factors, a sizeable number of omission is associated to unlikely forseeable or avoidable events.

. The recent global economic recession has affected nursing working conditions in terms of salary reductions, increased workload and staff shortages. Poor nursing working conditions are associated with higher levels of burnout. A literature review was conducted to identify contributions of European nurses from 2010 on the consequences of the economic crisis on the health services. Only few contributions were identified and from a limited number of countries (UK, Italy, Spain and Greece).

Introduction: The aim of treatment for most dementia patients should be comfort, symptoms control and withholding of futile or invasive treatments., Aim: To describe the decision of Nursing Home (NH) nurses towards some critical situations for advanced dementia patients., Methods: A questionnaire with 7 clinical cases was administered to the nurses of 7 Italian NHs. The cases described a common or exemplar situation in an advanced dementia patient (FAST stage >7a) and limited life expectation. For each case the 4 closed ended questions described a behavior oriented to comfort (one answer) or aggressive treatment (3 answers)., Results: Sixty-three/92 nurses (68.5%) answered the questionnaire. The majority (39, 61.9%) would feed the patient until death; 53 (84.1%) would favor hospital admission or resuscitation attempts while 55 (87.3%) would administer antibiotics for pneumonia even without distressing symptoms. With an expected survival <15 days 34 (54%) would favor a terminal sedation with refractory symptoms and 35 (55.6%) would stop unnecessary treatments (only 4 would prefer subcutaneous route). Thirty-two nurses (50.8%) would assess pain while 28 (44.4%) would contain an agitated patient. Continuing education is associated to cestrain behaviors, specifically for sedation (p 0.01) and revision of drug regimens (p 0.05)., Conclusions: Nurses are not fully competent in providing palliative care. Due to the impact of education, courses should be developed to improve the care of the dying and make nurses aware of the natural course of dementia.

Assessing safety culture is the first step towards a responsible and wary system to the errors and to the quality of the performance. The aim of the study was to assess nurses' safety culture, in order to identify improvement's priorities. A survey of nursing staff, using a questionnaire was carried out in a Piedmont hospital. Of 1056 health care workers, 707 participated (67%). The staff's perception of patient safety was positive: the results of the domains "Information and communication", "Suggestions and development" and "Safety guarantees" tend to be fair, while "Teamwork" was sufficient. The weakest areas were related to involvement (Items: "We are consulted when choosing equipment and devices to be used", 25.9% agreement, "At the end of the year we discuss together activities carried out and results" 31,8%), and "Work organization (shifts, workload) doesn't cause overload and stress", 25.3% agreement, "When an error occurs we know how to communicate with the patient as we have a guideline to lead us" 35.8% agreement. The study shows that, even if the safety culture is overall positive, there are some critical aspects that lead to distress and uncertainty between nursing staff. Improvement strategies may include: staff training to improve teamwork skills and staff involvement, increasing opportunities for discussion, organizing systematic multi-professional audit, to reflect in a structured way on clinical practice.