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Background: Caring in nursing is a fundamental aspect, yet teaching and fostering caring behaviours in nursing students remain challenging. Clinical instructors play a crucial role in this process. Objectives: The aims of this study were a) to describe nursing students' caring behaviours and perceptions of instructor caring, b) to assess sex-related and year of course differences in students' caring behaviours and perceptions of nursing caring, and c) to investigate the association between nursing students' caring and their perception of instructors' caring. Design: A multi-centre, cross-sectional observational study was conducted. Setting: The study involved undergraduate nursing students from four teaching hospitals of a university in Northern Italy. Participants: A total of 316 nursing undergraduate students participated in the study (83.9 % female, 16.1 % male, 23.1 % 1st year, 48.1 % 2nd year, 28.8 % 3rd year). Methods: Participants completed online self-reported surveys assessing caring behaviours, empathy, burnout, and perceptions of instructor caring. Caring behaviours, expressive and instrumental caring, were measured using the Caring Behaviour Inventory (CBI), and perceptions of instructor caring were assessed using the Nursing Students' Perceptions of Instructor Caring (NSPIC) questionnaire. Results: Students' caring behaviours were positively associated with their perceptions of instructor caring, particularly in relation to a supportive learning climate and instructor flexibility. Female students displayed higher scores in expressive caring, while students in their second and third years demonstrated increased instrumental caring behaviours. Responding to Individual Needs was significantly lower in third-years students, compared to first- and second-year ones. Conclusions: This study emphasizes the crucial role of clinical instructors in shaping nursing students' caring attributes. However, the influence of sex on caring behaviours remains unclear, nece

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

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BACKGROUND The International Classification for Nursing PracticeTM (ICNP) is a standardized nursing terminology. After the 2020 agreement with Snomed-I, ICNPTM ownership is still retained from International Council of Nurses, while Snomed-I is responsible for its distribution. So many benefits came from this agreement, but for no SNOMED-I members countries, a deep reflection was necessary, not only for new projects, but also for all the nurses who were using ICNPTM in their clinical settings. The aim of this study is to present an educational program organized to facilitate ICNPTM implementation. METHODS A protocol was created to manage new request of ICNPTM use. A new program, both theoretical and practical, was organized to meet the educational needs to use the terminology after the agreement. A satisfaction questionnaire was administered after each course. RESULTS Preliminary results will be presented . The protocol and the educational program became official from January 2022, due to pandemic period. Two editions of the program were performed for seventeen nurses coming from different clinical settings and responsible for the implementation in their contexts. Most of partecipants judged the educational program very relevant and effective for their practice, and excellent in its teaching and organizational quality. CONCLUSION The educational program described is helping nurses to use ICNPTM in their contexts and in clinical documentation. The management protocol allowed to be in contact with them during the implementation. Future editions of the program will be able to help ICNPTM disseminationthroughtout Italian territory, also using leadership strategies and digital tools.

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

Due to coronavirus disease 2019 (COVID-19), diabetes services have been disrupted, causing difficulties for people with type 2 diabetes mellitus (T2DM), and understanding their experience could help improve diabetes care. Therefore, we used a qualitative interpretive description to explore the experience of self-care of adults with T2DM during the COVID-19 pandemic. Data were collected using semi-structured interviews and analyzed theoretically. The sample (N = 30) was composed of 7 females and 23 males, with a mean age of 69.9 years (60–77) and 19.4 mean years (3–40) of people living with T2DM. Our findings show reduced physical activity and increased smoking and alcohol consumption affected that self-care. Increased food consumption and stress eating, with greater stress and anxiety, caused worsening of glycemic values. Participants were able to contact healthcare professionals via eHealth or telephone. Others, even those with complications, were not able to receive care or advice. These results suggest that easier contact with health providers, continuous engagement, eHealth solutions, and formal peer support could help self-care in T2DM. Advanced nursing roles and services could solve many issues reported in this study during and after the pandemic.

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

Purpose: To describe the role and activities of epilepsy specialist nurses (ESNs) operating as a team in the setting of a hospital specialising in the diagnosis and management of seizure disorders. Methods: We conducted a descriptive mixed-methods embedded single case study. We recruited 9 ESNs, 14 of their professional colleagues and 9 ‘key informants’ to analyse their perceptions of the role and activities of ESNs. We collected data through interviews, questionnaires, observations, and documentation. The study was conducted at the Filadelfia Epilepsy Hospital, Denmark. Results: The team of ESNs offers holistic care to patients and their caregivers regarding the clinical, social, and emotional aspects of epilepsy. The ESNs are integrated in a multidisciplinary team and promote collaboration among the team members. ESNs also contribute to organisational aspects and perform research activities. Conclusion: A structured group of ESNs can operate effectively and extensively in a specialised hospital setting. Our findings contribute to clarifying the description of the ESN's role, and provide an example of how ESNs can be incorporated into a hospital's organisational structure.

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

Having a retro-auricular left ventricular assist device (LVAD) requires patients to learn specific self-care behaviors, with a considerable burden; the present study aimed at exploring and describing the experience of self-care in this population. An Interpretive Description was conducted, informing the analysis with the Middle-Range Theory of Self-care of Chronic Illness. A purposeful sample of ten people with a retro-auricular LVAD participated in in-depth, semi-structured interviews. Four themes were identified: Innovations and Limitations in Daily Life, Problems Detection, Response to Problems, and Learning Process. All of these were deeply influenced by a cross-cutting theme: Support System. People with a retro-auricular LVAD have self-care needs different from those of people with heart failure or with the abdominal version of the device, and there is a great need for targeted intervention that could be developed in consideration of our findings.

INTRODUZIONE: L’ambiente di apprendimento clinico è il contesto di sovrapposizione tra il sistema educativo e l'ambiente lavorativo in cui gli studenti applicano le conoscenze apprese durante gli insegnamenti teorici, apprendono abilità pratiche, relazionali e di caring. È fondamentale per la formazione infermieristica ed esistono numerosi strumenti finalizzati a valutarlo: la qualità degli studi che ne indagano le performance è eterogenea. La scala CLEI-19 è uno strumento conciso e facile da usare ma le sue performance non sono state testate nel contesto italiano. OBIETTIVI: Lo studio ha l’obiettivo di valutare le proprietà psicometriche dello strumento in termini di struttura fattoriale e affidabilità. METODI: È stato condotto uno studio osservazionale trasversale multicentrico in Italia, presso l’Università degli Studi di Milano-Bicocca. Sono stati impiegati due strumenti: un questionario di raccolta dati di contesto e la scala CLEI-19 italiana. Le variabili di contesto sono state analizzate tramite statistica descrittiva. La struttura fattoriale della scala è stata indagata attraverso i modelli esplorativi di equazione strutturale (ESEM). L’affidabilità della scala è stata valutata mediante i coefficienti Alpha e Omega. RISULTATI: Il campione è costituito da 1095 unità statistiche. Dall’analisi fattoriale emerge la presenza di due fattori latenti correlati che sono stati denominati “Assistente di Tirocinio” ed “Ambiente di Tirocinio”. Gli indici di fit confermano la solidità del modello a due fattori. La coerenza interna è risultata adeguata o più che adeguata sia per i singoli fattori che per lo strumento complessivo. CONCLUSIONI: La scala CLEI-19 è uno strumento affidabile, che indaga in modo esaustivo le due componenti cardine dell’ambiente di apprendimento clinico: l’Assistente di Tirocinio e l’Ambiente di Tirocinio nel complesso. L’impiego semplifica il processo di valutazione dell’ambiente di tirocinio, offre la possibilità di migliorar, INTRODUCTION: The clinical learning environment is the context of overlap between the educational system and the working environment. Here students apply the knowledge learned during theoretical teachings, acquire practical, relational and caring skills. It is fundamental for nursing training and there are several rating scales aimed at evaluating it: the presence and quality of the studies that investigate their performances are heterogeneous, so it is difficult to identify the best tool. The CLEI-19 scale is the most concise instrument and its performance has not been tested in the Italian context. OBJECTIVES: The study aims to evaluate the psychometric properties of the instrument in terms of factor structure and reliability. METHODS: A multicenter cross-sectional observational study was conducted in Italy, at the University of Milan-Bicocca. Two tools were used: a context data collection questionnaire and the Italian CLEI-19 scale. The data were analyzed through descriptive statistics, the scale's factorial structure was tested by Exploratory Structural Equation Modeling ESEM. The reliability of the scale was evaluated by Alpha and Omega coefficients. RESULTS: The sample consists of 1095 statistical units. The factor analysis shows the presence of two latent factors that have been called Internship Assistant and Internship Environment. They correlate significantly and the fit indices confirm the solidity of the two-factor model. Internal coherence was adequate or more than adequate for single factors and overall tool. CONCLUSIONS: The CLEI-19 scale is a reliable tool, which comprehensively investigates the two key components of the clinical learning environment: the Internship Assistant and the Environment. The employment simplifies the process of evaluating the internship environment, offers the possibility of improving its quality, facilitates the comparison between realities and enhances the perception of students.

Aim: To explore the associations between coping strategies (social support, avoidance strategies, positive attitude, problem orientation, and transcendent orientation) and professional quality of life (compassion satisfaction, burnout, and secondary traumatic stress) of nurses and physicians during COVID-19. Background: Little is known about the association between the way health care workers cope with stress and their professional quality of life during the unusual circumstances that the COVID-19 pandemic imposed. Methods: A single-centre cross-sectional observational study was conducted with health care professionals (n = 143). The Professional Quality of Life scale Version 5 and the Italian Version of the Coping Orientations to the Problems Experienced measured the professional quality of life and coping strategies, respectively. Results: Avoidance, problem orientation and social support coping worsened professional quality of life, whereas a positive attitude improved it. Conclusions: This study on the relationship between coping strategies and the professional quality of life during health emergencies like the COVID-19 pandemic can inform interventions aiming to foster functional coping strategies in health care personnel to sustain their professional quality of life. Implications for Nursing Management: Identifying people at greater risk of burnout and secondary traumatic stress can guide tailored interventions to improve health care workers' wellbeing. Increased professional quality of life might turn in improved quality of care and reduced absenteeism and intention to leave.

Background: University students are known to have higher sleep disorders prevalence than the general population. Among them, nursing students are even more susceptible to sleep disorders. This study evaluates sleep disorders’ risk factors among nursing students and their potential association with symptoms and assesses whether night shifts affect sleep quality by increasing the prevalence of sleep disorders. Methods: A total of 202 nursing students were included; a self-administered questionnaire was used to collect data on sociodemographic and academic characteristics (i.e., gender, age, height, weight, and year of nursing program) and risk factors for sleep disorders (e.g., smoking, lack of physical activity, and coffee intake late in the evening). The survey included the General Health Questionnaire to assess perceived stress, the Sleep and Daytime Habits Questionnaire, and the Epworth Sleepiness Scale to assess sleep disorders symptoms. Results: A high level of perceived stress is associated with sleep disorders symptoms and with poor sleep quality. Daytime symptoms are also associated with smoking. Students who drink coffee late in the evening report fewer nighttime symptoms. Night shifts and their increasing number are not associated with sleep disorders symptoms. The perception of an unsatisfying academic performance is associated with daytime symptoms and poor sleep quality. Conclusions: Although night shifts seem to not affect sleep quality among nursing students, sleep disorders represent a critical issue in this population since sleep disorders symptoms may result in errors, accidents, or low academic performance.

Background The Self-care of Diabetes Inventory (SCODI) is a theory-based tool that measures self-care, a key strategy in the appropriate treatment of diabetes. However, despite the clinical differences between people with Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM), the psychometric properties of the SCODI were only tested in mixed samples. Purpose This study aims to test the psychometric performances of the SCODI in two separate groups of adults with T1DM and T2DM. Methods This is a secondary analysis from two previous multicentre cross-sectional observational studies involving patients with T1DM (n = 181) and T2DM (n = 540). We tested dimensionality with confirmatory factor analysis and reliability with a multidimensional model-based coefficient for every scale of the SCODI: self-care maintenance, self-care monitoring, self-care management, and self-care self-efficacy. Results We found that the SCODI showed the same dimensionality, with minimal variation in factor loadings for each factor and each scale among T1DM and T2DM groups. High reliability for each scale in both groups was also found (self-care maintenance: T1DM = 0.86, T2DM = 0.83; self-care monitoring: T1DM = 0.84, T2DM = 1.00; self-care management: T1DM = 0.87, T2DM = 0.86; self-care self-efficacy: T1DM = 0.88; T2DM = 0.86). Conclusion The SCODI can be used for measuring self-care in people with T1DM, T2DM, or mixed groups using identical scoring procedures. Considering the well-known differences between Type 1 and Type 2 diabetes diseases and patients' characteristics, our results support the generalizability of the self-care theory on which the instrument is based.

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

L’Evidence-Based Nursing Ë un processo che richiede agli infermieri di avere le conoscenze, le competenze e la fiducia necessarie per riflettere criticamente sulla loro pratica, articolare domande strutturate e poi cercare in modo affidabile la letteratura per rispondere alle domande poste. Ci sono molti tipi di evidence che vengono utilizzate per informare le decisioni nell'as- sistenza sanitaria e i risultati di studi di ricerca qualitativa sanitaria sono utili per fornire nuove intuizioni sulle esperienze, i valori, le convinzioni, i bisogni o le percezioni degli individui. Prima che l'evidence qualitativa possa essere utilizzata in una decisione, deve essere valutata criticamente per determinare se i risultati sono affidabili e se hanno rilevanza per la questione o la decisione identificata. In questo articolo forniamo una guida pratica su come selezionare una checklist o uno strumento per guidare la valutazione critica degli studi qualitativi e, poi, forniamo un esempio che dimostra come applicare il processo di valutazione critica a uno scenario clinico., Evidence-based nursing is a process that requires nurses to have the knowledge, skills, and confidence to critically reflect on their practice, articulate structured questions, and then reliably search for research evidence to address the questions posed. Many types of research evidence are used to inform decisions in health care and findings from qualita- tive health research studies are useful to provide new insights about individuals' experi- ences, values, beliefs, needs, or perceptions. Before qualitative evidence can be utilized in a decision, it must be critically appraised to determine if the findings are trustworthy and if they have relevance to the identified issue or decision. In this article, we provide practical guidance on how to select a checklist or tool to guide the critical appraisal of qualitative studies and then provide an example demonstrating how to apply the critical appraisal process to a clinical scenario.

Background: The COVID-19 pandemic has spread widely among healthcare workers. Recently, new effective vaccines against COVID-19 have begun to be administered to healthcare workers in several countries, including Italy. Purpose: Our aim was to evaluate the intentions to be vaccinated against COVID-19 in a population of nursing students, identifying factors associated with the intentions. Method: We conducted an anonymous online survey among 728 nursing students. The questionnaire collected data on demographic and academic characteristics, health status, vaccine attitudes, and specific reasons regarding the intention to get or not get the COVID-19 vaccination. Results: A total of 422 nursing students completed the survey. Almost 81% of participants wanted to take the vaccine against coronavirus. The intention to adhere to the vaccination program was associated with male gender, a previous flu vaccine uptake, and high school education. The main reason in favor of taking the vaccine was to protect family and friends. The main reason for opposition was the fear of adverse events. Conclusion: It is fundamental to consider vaccine hesitancy in healthcare students and face it properly, since these are the healthcare workers of the future who will have to provide recommendations to patients and promote adherence to vaccination programs.

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

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

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.

Introduction. Self-care is a key for people with diabetes mellitus (DM) to avoid severe complications and to maintain quality of life. Person-centered and accurate nursing care plans can help nurses to deliver effective self-care promotion interventions. Few studies focused on nursing diagnoses that are specific for diabetes self-care education, and none of them used the International Classification for Nursing Practice (ICNP). International Catalogues of ICNP nursing diagnoses are missing in this field. Aims. To identify the ICNP nursing diagnoses that are useful to promote self-care in people with DM; to describe the prevalence of ICNP nursing diagnoses in self-care of people with DM. Methods. A subset of 55 ICNP nursing diagnoses was developed based on the Middle Range Theory of Selfcare of Chronic Illness, and most recent diabetes clinical guidelines. Then, the subset was tested through a multicenter cross-sectional design involving a consecutive sample of 170 adults with confirmed diagnosis of Type 1 or Type 2 DM. Data were collected by medical records, physical examinations and semi-structured interviews. Results. 1343 nursing diagnoses were identified, with an average of 8 nursing diagnoses per patient. The 100% of the nursing diagnoses were described using the pre-developed subset. Overall, the five prevalent nursing diagnoses were: Body weight problem (56.4%), Non adherence to immunization regime (53.5%), Conflicting attitude toward dietary regime (41.7%), Impaired weight monitoring (39.4%), and Lack of knowledge about blood glucose diagnostic test result (32.3%). Nursing diagnoses by self-care maintenance, monitoring and management were also described. Conclusion. A huge amount of nursing diagnoses was identified suggesting the need of intensive education. Clinicians and administrators can use this subset to improve the accuracy of the documentation of diabetes care. In Public Health, the subset can be used to assess the cost-effectiveness of diabetes heal

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

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

Aim: The purpose of the this study was to test the factorial structure, internal consistency reliability and concurrent validity of the Caregiver Contribution to Self-Care Chronic Illness Inventory. Background: Existing measures of caregiver contribution to self-care are disease-specific or behavior-specific; no generic measures exist. Design: A cross-sectional study. Method: Between April 2017 - December 2018, we enrolled a convenience sample of 358 patients with chronic illnesses and their caregivers. Patients completed the Self-Care of Chronic Illness Inventory while caregivers completed the Caregiver Contribution to Self-Care of Chronic Illness Inventory, a modification of the Self-Care of Chronic Illness Inventory, which includes three scales: the Caregiver Contribution to Self-Care Maintenance, the Caregiver Contribution to Self-Care Monitoring and the Caregiver Contribution to Self-Care Management. Of each scale, we tested the factorial structure with confirmatory factor analysis and reliability with the factor score determinacy coefficient, the global reliability index for multidimensional scale and Cronbach's alpha. Also, we used Pearson's correlations for concurrent validity purposes. Results: Confirmatory factor analysis supported the two-factor structure of the Caregiver Contribution to Self-Care Maintenance and Management scales and the one-factor structure of the Caregiver Contribution to Self-Care Monitoring scale. A simultaneous confirmatory factor analysis on the combined set of items supported the more general model (Comparative Fit Index=0.933). Reliability estimates ranged between 0.701-0.961 across the three scales. Concurrent validity of Caregiver Contribution to Self-Care of Chronic Illness Inventory with the Self-Care of Chronic Illness Inventory was not sufficiently supported since weak correlations were found. Conclusion: The Caregiver Contribution to Self-Care of Chronic Illness Inventory is valid and reliable and can be used in clinical p

Introduction: Meeting the literature standards during the triage process of trauma victims, allows to make optimal use of the resources available in Trauma Centers and defines their level of quality and efficiency. Otherwise, it may occur over or under-triage. Up to now, in the reality under study and in the national literature, there wasn't any available data about efficiency and effectiveness in the triage of traumatic patients, therefore the primary objective of this study is to evaluate the over and under-triage rate in activating Trauma Team (TT) in the ASST of Monza San Gerardo Hospital. Method: The study design is retrospective monocentric observational. Results: During the analysis, the TT-activation in ASST of Monza-San Gerardo Hospital produced an over-triage of 62,9% and an under-triage of 1,7% for the same year. Discussion: The use of TT-activation algorithm is the first step of the entire care process ofthe trauma victim. This tool should guarantee the right balance between high sensitivity and high specificity (minimum over-triage rate with the possibility of higher under-triage). However, there is no sharing of these algorithms as they are inhomogeneous in the different realities; for example, the definition of major trauma, of TT and of its composition is still uneven. Conclusion: This study measured the over and under-triage rate related to the TT activation in the ASST of Monza. It is therefore advisable to monitor those rates periodically, as possible indicators of quality of assistance and to pursue the mission of increasing efficiency as well as effectiveness.

Purpose: To evaluate how self-care maintenance, self-care monitoring, and self-care management affect glycated haemoglobin in type 2 diabetes mellitus patients and to set cut-off points of the Self-Care of Diabetes Inventory scales using glycated haemoglobin as outcome of interest. Methods: A secondary analysis of a previous multicentre observational cross-sectional study was conducted. Overall, 540 adults with type 2 diabetes mellitus confirmed diagnosis were involved. Socio-demographic and clinical data were collected. Self-care maintenance, self-care monitoring, and self-care management were measured by the Self-Care of Diabetes Inventory. Linear regression models were performed to assess the relationship between self-care maintenance, self-care monitoring, and self-care management and glycated haemoglobin. Receiver operating characteristics curves were carried out to identify the best cut-off score for each self-care scale considering glycated haemoglobin >7% as outcome of interest. Results: Self-care monitoring and self-care management were associated to glycated haemoglobin in both patients without (self-care monitoring p = 0.0008; self-care management p = 0.0178) and with insulin therapy (self-care monitoring p = 0.0007; self-care management p = 0.0224). Self-care maintenance was associated to glycated haemoglobin in patients without insulin therapy (p = 0.0118). Cut-off scores providing the best performance were 70 points for self-care maintenance and self-care monitoring, and 60 points for self-care management. Conclusions: Self-care maintenance, self-care monitoring, and self-care management differently affect glycated haemoglobin in patients with type 2 diabetes mellitus. Clinicians could implement tailored interventions to improve glycaemic control considering the lacking area of self-care.

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

BACKGROUND: Increasingly, there is a trend toward the use of left ventricular assist devices (LVADs) for treating advanced heart failure, as both bridge-to-transplant therapy and destination therapy. Living with an LVAD profoundly influences patients' lives. Only a few study authors investigated the experience of people with abdominal LVADs, and nothing is known about the unique experience of those with retro-auricular LVADs. OBJECTIVE: The aim of this study was to explore and describe experiences and lifestyle adjustments in adults with retro-auricular LVADs implanted as destination therapy. METHODS: Interpretive description methodology was used to explore the experiences of a purposeful sample of 10 individuals with retro-auricular LVADs implanted as destination therapy. Data were collected using in-depth semistructured interviews. Data collection and analysis were simultaneous. Triangulation, journaling, and the "thoughtful clinician test" were used to increase trustworthiness of the findings. RESULTS: Three primary themes describing the experience of people with retro-auricular LVADs were developed: "a new life," "self-care," and "resilience"; in addition, a crosscutting theme was identified: "support system." This article focuses on the theme "a new life," described as a continuum of events. Individuals with advanced heart failure struggle with symptom burden and consider the implantation of the device as the final option to delay death; then, they wait for the surgery that represents a turning point, after which they begin to recover through a process of adjustment until they reach a new normality. CONCLUSIONS: Living with a retro-auricular LVAD impacts every aspect of people's lives. Knowing their experiences can help clinicians to develop targeted interventions and offer tailored support.