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To discuss the possible contribution of nurses to the Silver Economy.Older people constitute a growing sector of the population of developed countries and there is increasing interest in the concept of the Silver Economy which is the contribution older people can and do make to the general economies of their communities and countries.We obtained a range of relevant documents from international organisations and related academic literature.There is a range of interrelated health promotion aspects of ageing related to physical health, mental health and cognitive health. Promoting activities related to these could have both direct and indirect impact on the economy in addition to improving the health and well-being of older people.Nurses have a responsibility to understand the health promotion related aspects of ageing and the contribution they can make to improving the health and well-being of older people. Nurses could, specifically, promote activities amongst older people that will have an impact on health and on the economy.Nurses need to integrate more health promotion related aspects of ageing into their practice and to be able to evaluate the health-related improvements they make and also to evaluate and indicate the contribution this makes to the health of older people and to the economy.

Background The indication for implantable cardioverter-defibrillators (ICDs) to prevent sudden death is now consolidated. However, there is no unanimous agreement on how patients experience certain aspects of their lives after an ICD implant. Various clinical studies have evaluated the impact of ICDs on patient mortality, survival, and their beneficial effects. Given the growing number of qualitative studies, a synthesis of qualitative evidence became desirable. Aims To explore and synthesize the results of qualitative studies addressing the experiences of patients with an ICD. Methods We employed a systematic review and meta-synthesis. PubMed, CINAHL, and PsycINFO were systematically searched to identify qualitative studies published between January 2005 and October 2020, which investigate the experience of patients living with an ICD. Selected studies were assessed for quality by two reviewers independently. Results A total of 24 papers were selected. Six themes emerged: fear and insecurity, the need for information, new impacts on life, living with ICD shocks, gender differences, and the role of the family. These results could help clinicians and researchers to develop new strategies and interventions to improve the quality of life in these patients. Conclusion This meta-synthesis underlines the difficulties experienced by patients with ICD implants. Despite the advanced therapeutic management programmes for this type of intervention, it is necessary to adopt and implement the current post-discharge care plans, where the family’s involvement is essential to help patients adapt to their new lifestyle.

IntroductionThe development of this study protocol occurred in conjunction with the new Regulation defining models and standards for the development of community care in the National Health Service (Ministerial Decree n. 77-2022) with the redefinition of care in the community. Considered the increase in the elderly population, in the complexity of care and the workload for home care, it is important and urgent to describe the work environment and the Italian community care reality. The main objective of this study is to evaluate the characteristics of nursing care and the quality of home care in the community in Italy.MethodsThis is a cross-sectional descriptive observational study using the survey method. The study protocol uses quantitative data from three sources: 1) primary data on organizational characteristics, professional satisfaction, intention to leave home care services, and burnout; 2) secondary data on the experience of patients and their informal carers; 3) data on improper access to the emergency department, readmission to hospital, comorbidities, services offered, and user level of autonomy, and main and secondary diagnoses. Data will be analyzed using descriptive and inferential statistics.ConclusionsThe systematic analysis of the different national community care contexts will enable to increase the knowledge and awareness of the need for community health care. The availability of specific data will promote and support the role of the family and community nurse in district health care contexts, to increase the quality of care perceived by patients and their families.

To investigate the factor structure of an Italian translation of the Practice Environment Scale of the Nursing Work Index (PES-NWI).Italy suffers from high turnover rates, yet validated tools in Italian to study and manage the problem are lacking. The PES-NWI measures aspects of nurses' working environment. This study reports on the translation and investigation of the structure of the translated PES-NWI scale.A survey was conducted with 3667 nurses from 182 hospitals across 13 Italian regions using the PES-NWI. The structure of this scale was investigated using principal components analysis and other properties, including internal consistency (Cronbach's alpha). Construct validity was investigated using logistic regression.The Italian translation of the PES-NWI showed a five-factor structure, and Cronbach's alpha of the factors ranged between 0.80 and 0.92. Logistic regression showed that the PES-NWI was positively related to job satisfaction (odds ratio = 10.3; CI 8.62-12.35) and negatively related to intention to leave (odds ratio = 0.14; CI 0.12-0.16).The original five-factor structure of the PES-NWI was evident in the present study, albeit with some different factor loadings.The Italian version of the PES-NWI can be used by nurse managers to tackle the workforce issues related to nurses' work environments in a major European country.

During their clinical practice, nursing students learn to manage patient safety through their experiences, emotions, and interpersonal relationships.To explore contextual and mechanistic factors that facilitate a sense of emotional safety for learning in nursing students, particularly regarding patient safety events experienced during their placements.A descriptive qualitative study using narratives and thematic analysis.A university in Northern Italy.Undergraduate nursing students recruited through purposive sampling.Twenty cases relevant to the present study were selected from the "Sharing LearnIng from Practice for Patient Safety" (SLIPPS) project database containing 100 narratives collected using the patient safety learning Event Recording Tool. The data were analysed using thematic analysis according to BraunClarke's methodology. The themes that emerged from the thematic analysis were rearranged in Context-Mechanism-Outcomes.Students identified clinical practice experiences as important occasions for their personal and professional development. Emotional safety and tutoring were the elements that effectively "govern" the students' learning and development process.Emotional safety is key for nursing students because it enables them to constructively overcome any relational and emotional tensions that may develop during their clinical placements.

To report an analysis of the concept of fundamental care in the literature.An evolutionary concept analysis.PubMed and CINAHL Complete databases were consulted using the key terms: fundamental care, fundamentals of care, essential care, basic nursing care and basic care revised. Articles published from 2008 to 2022, in English and Italian, in scholarly/peer-reviewed nursing journals were included.Rodgers's Evolutionary Method of concept analysis was used. Our thematic analysis yielded common themes related to the concept, antecedents, attributes and consequences of fundamental care.A total of 50 articles were analysed. Thirty-eight attributes were identified, such as integration of care, patient and family centred care and trusting relationship; eight antecedents including nursing care, nursing practice and care context; and 17 consequences including the safety, quality and consistency of care.This review of literature reveals that there is no consistent definition of the concept of 'fundamental care'. Findings from this exploration of the literature emphasized the importance of communication, the contextual environment, leadership influence and nurse-patient relationship in providing effective and high-quality fundamental care. Our definition of this concept may help nurse leaders in practice, research, education, management and policy to promote and enhance the application of fundamental care.What problem did the study address? While numerous studies examine fundamental nursing care, various terms are used with no consensus on definitions emerging. Given the relevance of this topic, reaching a clear and agreed definition of fundamental care is essential. What were the main findings? Fundamental care encompasses the importance of communication, the contextual environment, leadership influence and nurse-patient relationship in providing effective and high-quality care. Where and on whom will the research have an impact? This definition of fundamental care will assist nurse leaders and researchers to promote and enhance the examination and application of fundamental care in clinical practice to ensure better care outcomes across all healthcare settings.

IntroductionConsidering the increasing complexity of care and workload for home care nurses due to the ageing of the population, it is crucial to describe the work environment and the community care setting. The aim of this study protocol is to map the characteristics and identify gaps of home care in the community to design future interventions aimed at ensuring quality and safety.Methods and analysisThis is a national cross-sectional descriptive observational study using the survey method. Nurses from all participating community care centres will be recruited through convenience sampling by the coordinators of each centre, who will act as facilitators for this study. All community care recipients and their informal carers during the study period will be invited to complete a survey.To map the characteristics and identify gaps of home care in the community, three sources of data will be collected: (1) organisational characteristics, professional satisfaction, intention to leave and burn-out; (2) experience of care recipients and their informal carers and (3) improper access to the emergency department, readmission to hospital, comorbidities, services offered and users’ level of autonomy, and main and secondary diagnoses.Considering the total Italian nursing population of approximately 450 000 registered nurses, a sample size of 1% of this population, equal to approximately 4600 nurses, was hypothesised.This study started in July 2022 and is planned to end in December 2023.Data will be analysed using descriptive and inferential statistics.Ethics and disseminationThis study protocol was approved by the Liguria Regional Ethics Committee in November 2022. Informed consent will be obtained from participants and confidentiality will be ensured. Data collected for this study will be kept anonymised in a protected database.The results of the study will be disseminated mainly through conferences, publications and meetings with government representatives.

The aim of this study was to explore and understand the interprofessional collaboration preparation processes implemented by clinical tutors and students, in various professions, involved in interprofessional education experiences.A constructivist grounded theory approach. The study was carried out between 2015-#2017.Semi-structured interviews were conducted with a total of ten undergraduate students and the seven clinical tutors who supervised them from three undergraduate courses in a university of applied sciences and arts in Switzerland. Students were sampled during their clinical placement. Data were analysed and coded using constant comparative analysis with the support of Nvivo 10 software.A substantive theory "Practicing contextual models of interprofessional care" was generated. It explains how the whole process takes place, the tutor-student interactions, and how together they gradually build models of interprofessional care, linked to their clinical context and to the patients/families who are part of it.The process describes a journey to comprehensively explain the roles played by the two main actors (student and tutor) who build a relationship of interaction.This theory provides an understanding of the complex process set up by students and how they are prepared for collaboration with other professionals. Its importance is mainly expressed in the educational field because it reveals a different vision from the one present so far and enables a thorough reflection from the pedagogical point of view. Teachers will be able to observe and approach the students' training curricula from a different point of view by evaluating any changes to favour it and rethink the organizational and training models of current programs.目的: 本研究旨在探讨和了解临床导师与学生在跨专业教育经历中采取的基于不同专业的跨专业合作的准备过程。 设计: 采取建构主义基础理论方法。该研究在2015年至2017年期间进行。 方法: 对瑞士一所应用科学与艺术大学的10名本科生和7名临床导师进行了半结构化的访谈。对于临床实习期的学生进行抽样调查。使用Nvivo 10软件,采取持续比较分析法对数据进行分析和编码。 结果: 由此得出了“跨专业护理情境模式实践”的实体理论。解释了“跨专业护理情境模式实践”整个过程如何进行、导师与学生如何互动、以及他们如何共同逐步建立跨专业护理的模型,并与临床背景联系起来,与参与其中的患者和家庭联系起来。 结论: 研究过程全面描述了两个主要角色(学生和导师)建立互动关系的过程。 影响: 这一理论让我们了解学生建立互动关系的复杂过程,以及如何训练学生与其他专业人员合作。此理论的重要性主要体现在教育领域,因为其揭示了一种与目前不同的视角,并能从引领人们站在教育学角度进行彻底的反思。教师将能够从全新角度观察和设置学生的培训课程,进行评估和改进,并重新思考当前教育程序的组织和培训模式。.

Aim To explore influences on nurses' missed care decision-making processes in acute hospital paediatric care. Background Many contemporary studies describe the phenomenon of missed care. It is clear that environment and organizational culture influence the nursing activities; however, what influences their decision-making processes has not been investigated. Method A descriptive qualitative inquiry was performed using semi-structured interviews with paediatric nurses (n = 20) from one Italian paediatric hospital. Findings Thematic analysis revealed four themes: nurses' value system; hospital logistics, structures and resources; prioritization processes; and the informal caregiver's role. Conclusion This paper offers insights into the various factors involved in nurses' decision-making process when contemplating missed care that will be of use to managers when planning care or addressing missed care in the paediatric clinical setting. Implications for nursing management Knowledge and awareness of missed care in children's nursing needs greater exploration, especially in relation to what influences nurses' decision-making choices around missed care. Overall, a greater understanding of this will help managers to manage situations effectively and ethically so that missed care does not impact on outcomes for children in health care.

Introduction: The COVID-19 pandemic is heavily hitting healthcare systems around the world, and nurses are battling in the front line. Previous studies have reported nurses��� responses to catastrophic situations, but also interviews released by Italian nurses to the main mass media channels could bear important messages for policy makers and stakeholders.This study describes Italian front-line nurses��� experiences during the COVID-19 pandemic through television interviews. Methods: This is a descriptive qualitative study. Data were collected through purposive sampling from Italian front-line nurses��� interviews during the COVID-19 pandemic. Publicly available interviews between 7th and 29th March 2020 were collected from the websites of national and regional television stations. Thematic content analysis was used to describe, summarize, and classify data into macro themes. The study is compliant with Standards for Reporting Qualitative Research. Results: A total of 21 television interviews were collected from front-line clinical nurses, nursing managers, nursing trade union representatives and representatives of the Nursing Regulator. Thematic analysis yielded four macro-themes: psycho-social effects of the COVID-19 pandemic on health professionals; altered patient relationships; personal safety; recognition and promotion of the profession. Conclusions: The COVID-19 pandemic has exacerbated some problems already present, such as the shortage of nurses, but has also turned the spotlight on the nursing profession. Highly involved and affected by the pandemic, nurses have become better known by the public and often also protagonists of public discussions. It is important that nurses��� value as allies of the public emerges stronger from this dramatic situation., Journal of Preventive Medicine and Hygiene, Vol. 62 No. 4 (2021): 2021624

Background: Underpinning all nursing education is the development of safe practitioners who provide quality care. Learning in practice settings is important, but student experiences vary. Purpose: This study aimed to systematically develop a robust multilingual, multiprofessional data collection tool, which prompts students to describe and reflect on patient safety experiences. Approach: Core to a 3-year, 5-country, European project was development of the SLIPPS (Sharing Learning from Practice for Patient Safety) Learning Event Recording Tool (SLERT). Tool construction drew on literature, theory, multinational and multidisciplinary experience, and involved pretesting and translation. Piloting included assessing usability and an initial exploration of impact via student interviews. Outcomes: The final SLERT (provided for readers) is freely available in 5 languages and has face validity for nursing across 5 countries. Student reports (n = 368) were collected using the tool. Conclusions: The tool functions well in assisting student learning and for collecting data. Interviews indicated the tool promoted individual learning and has potential for wider clinical teams. The project “Sharing Learning from Practice to Improve Patient Safety” was cofunded by the Erasmus+ Programme of the European Union (Grant Agreement 2016-1-UK01-KA203-024-258).

To identify predictors and consequences of violence or aggression events against nurses and nursing students in different work contexts.Workplace violence against nurses and nursing students is a very common and widespread phenomenon. Actions to manage or prevent violent events could be implemented knowing the risk factors and consequences. However, there is a lack of systematic reviews that summarize knowledge on the predictors and consequences of workplace violence.A scoping review was conducted using electronic databases including APA PsycInfo, CINAHL, Cochrane, Ovid Medline, PubMed and Scopus.After full text analysis, 87 papers were included in the current scoping review. Risk factors of horizontal violence were grouped into 'personal' and 'Environmental and organizational', and for violence perpetrated by patients into 'personal', 'Environmental and organizational' and 'Characteristics of the perpetrators'.The results of this scoping review uncover problems that often remain unaddressed, especially where these episodes are very frequent. Workplace violence prevention and management programmes are essential to counter it.The predictors and the consequents identified constitute the body of knowledge necessary for nurse managers to develop and implement policy and system actions to effectively manage or prevent violent events.

Emergency departments are the services with the highest risk of violence for nurses. Reports of violence in health care have increased exponentially in the last decade. Front line hospital services are more at risk, and worldwide there are attempts to quantify, manage and prevent episodes of violence, but no consistent solutions have yet been identified.To stimulate reflection on causal factors of violence against nurses in emergency departments and discuss potential solutions and strategies for aspects that largely remain unresolved.A position paper underpinned by experiences and evidence reported in the literature.A search of Scopus and CINAHL using the term 'violence' provided information concerning the prevalence of the term 'violence' in contemporary literature and enabled to capture a general overview of contributing factors of violence and current approaches to its management and prevention.However, while risk factors have been identified, there is a tendency to over accentuate the extent of their contribution. The main risk factors present conditions related to or accompanied by mental illness and the impact of overcrowding and long waiting times.More is needed in terms of implementation of more far-reaching, holistic, practical and effective management solutions to promote nurses' safety and adequately support vulnerable patients.

Background: Patient safety is a global concern. Learning to provide safe, high-quality care is core to nursing education. Problem: Students are exposed to diverse clinical practices, and experiences may vary between placements and across countries. Student experience is seldom used as an educational resource. Approach: An international, European Union-funded project, Sharing Learning from Practice for Patient Safety (SLIPPs), aimed to develop an innovative online educational package to assist patient safety learning. Based on student reported data and educational theory, multiple elements were iteratively developed by a multicountry, multidisciplinary group. Outcomes: The educational package is freely available on the SLIPPs Web site. Materials include a student reporting and reflection tool, virtual seminars, student reports data set, pedagogical game, high-fidelity simulation scenarios, scenario development and use guidelines, debriefing session model, and videos of simulations already performed. Conclusions: E-learning enables removal of physical barriers, allowing educators, professionals, and students from all over the world to collaborate, interact, and learn from each other. The project “Sharing Learning from Practice to Improve Patient Safety” was cofunded by the Erasmus + Programme of the European Union (grant agreement 2016-1-UK01-KA203-024-258).

AimsThe management of cardiovascular patients requires increasingly competent nursing professionals. In Italy, there are no specific postgraduate courses focused on specialist cardiac skills development for nurses. To develop such courses, content incorporating appropriate competencies is required and this study was designed to meet this. To delineate a set of core competencies to develop national educational interventions to ensure cardiac nurses in Italy achieve international standards.Methods and resultsA three-round e-Delphi study including a panel of 32 expert cardiac nurses from the UK, Canada, Australia, New Zealand, and Italy was conducted; 26 respondents completed all three rounds. The first round sought a list of five competencies from each participant which they were asked to prioritize in Round 2. In Round 3, they were asked to prioritize again with the knowledge of the priorities identified in Round 2. The final list of competencies was those achieving 70% agreement among participants. We identified 14 core competencies spanning a range of areas of competence including technical, interpersonal, health promotion, use of evidence, and management. Only minor differences were evident between the Italian and the international panel regarding the priority given to some core competences, such a leadership and taking patient history.ConclusionThis is the first study in Italy to delineate cardiac nurses’ core competencies. As such, it provides a foundation for the development of postgraduate educational programmes for cardiac nurses including competencies that are congruent with international standards.

Aim The aim of this study is to explore how a nutritional intervention that improves the biochemical and functional profile of dysphagic older people impacts on nursing workload and costs for nursing homes. Background Dysphagic institutionalized older people particularly at risk of malnutrition require more intensive support from nursing staff and higher costs for nursing homes. Method This is an open pre-post longitudinal multicentre quasi-experimental study without a control group. Results There is a significant reduction in the number of enemas (from 3.51 to 1.11 enemas), with an average nursing workload reduction from 52 to 16 min per patient every month. Each nurse also spent 20 h less per patient every month spoon-feeding. This resulted in nursing staff cost savings. Conclusions The nutritional intervention led to a significantly better quality of life for the patients manifested through increased independence and social engagement. This reduced workload for nursing staff and costs for nursing home administrators. Implications for nursing management Sensitive, targeted nutritional interventions have the potential to improve nursing home residents' quality of life and enable a more efficient use of resources. This study revealed reduced workload and cost savings due to less time spent administering enemas and spoon-feeding, in addition to reduced malnutritional consequences.

© 2019 John Wiley & Sons Ltd Aims and objectives: To review and synthesise research studies on surgical and medical inpatients’ perceptions on unmet nursing care needs. Background: Missed nursing care is a growing phenomenon that has been shown to adversely affect care outcomes—mainly in adult medical and surgical care settings. However, to date the aggregated and synthesised evidence of missed care comes from research that measures perceptions on missed care in surgical and medical settings from nurses, but not from the patients. Design: Scoping review. Methods: In September 2018, three databases were searched: MEDLINE/PubMed, CINAHL and SCOPUS and papers were selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were as follows: primary studies; published in peer-reviewed journals; in English or Italian; and regarding routine care provided to adult inpatients. Quality appraisal and a thematic analysis were conducted. Results: Of the 1541 abstracts initially identified, 44 papers were included. Five themes emerged: “communication,” “self-management, autonomy and education,” “personal sphere,” “essential physical care” and “emotional and psychological care.” The majority of the unmet needs were related to the “personal sphere” and “emotional and psychological care.” These unmet needs were not identified in previous literature on nurses’ perspectives of missed care. Also, physical care deficits like oral hygiene were identified. Conclusion: It is important to take into account patients’ perspectives. The themes focusing on patients’ personal sphere, and emotional and psychological care, underline how patients need nurses to pay more attention to their cultural background, consider the person as a whole and for nursing care to be holistic and respectful of patients’ dignity. Relevance to Clinical Practice: This study intends to raise awareness amongst nurses and policymakers about the importance of addressing missed nursing care and unmet patients’ needs in adult medical or surgical inpatient settings to ensure high-quality care and patient satisfaction.

Background Patient safety is key for healthcare across the world and education is critical in improving practice. We drew on existing links to develop the Shared LearnIng from Practice to improve Patient Safety (SLIPPS) group. The group incorporates expertise in education, research, healthcare, healthcare organisation and computing from Norway, Spain, Italy, the UK and Finland. In 2016 we received co-funding from the Erasmus + programme of the European Union for a 3-year project. Aim SLIPPS aims to develop a tool to gather learning events related to patient safety from students in each country, and to use these both for further research to understand practice, and to develop educational activities (virtual seminars, simulation scenarios and a game premise). Study outline The SLIPPS project is well underway. It is underpinned by three main theoretical bodies of work: the notion of diverse knowledge contexts existing in academia, practice and at an organisational level; the theory of reflective practice; and experiential learning theory. The project is based on recognition of the unique position of students as they navigate between contexts, experience and reflect on important learning events related to patient safety. To date, we have undertaken the development of the SLIPPS Learning Event Recording Tool (SLERT) and have begun to gather event descriptions and reflections. Conclusions Key to the ongoing success of SLIPPS are relationships and reciprocal openness to view things from diverse perspectives and cultures.

Despite the growing importance of nursing fundamentals of care, nurses often overlook these aspects of care. In this study, we explored why this happens precisely where nursing education is initially provided. In fact, little is known about how undergraduate nursing students perceive the teaching of fundamentals of care and how they value them.This pilot cross-sectional study used a questionnaire adapted and validated in Italian to assess the perceptions of first, second, and third-year undergraduate nursing students (n=150) in an Italian university about the teaching of fundamentals of care during theoretical lessons and clinical practice.In the first section of the tool, on general fundamentals of care (nutrition, hygiene, mobility, rest and sleep, the expression of sexuality, safety, etc), students reported high levels of agreement for all items: range between 61.2% (95% CI: 57.1-65.3) and 100%.In the section on nutrition, divided into nutrition, oral intake of fluids, and malnutrition high percentages of agreement from 53.1% (95% CI: 46.0-60.2) to 91.8% (95% CI: 87.9-95.7%) were obtained, but for questions regarding 'learning how to document food and fluid intake', first-year students reported low levels of agreement.With regard to the 'Communication Section', the item about 'learning how to inform minor patients' presented low percentages of agreement throughout the three-year programOf the first-year students, between 71.4% (95% CI: 64.9-77.9) and 77.6% (95% CI: 71.6-83.6) declared they had not received instructions about this.Understanding how nursing students perceive the importance of learning of fundamentals of care during their curriculum and how their multidimensional nature is highlighted by teachers and clinical supervisors, will enable educators to address the gaps in the way they taught and prioritized within the curriculum.

La violenza o aggressione verso gli infermieri sul luogo di lavoro è un evento estremamente comune, soprattutto nelle aree critiche ed emergenziali ospedaliere. Negli ultimi anni il problema sembra essersi palesato anche in altre realtà, intra- ed extra-ospedaliere, rendendo il fenomeno sempre più all'ordine del giorno. Molti sono gli studi che identificano le importanti conseguenze fisiche, psico-sociali ed economiche per i soggetti e le istituzioni che subiscono questo fenomeno, ma lo studio e la prevenzione della violenza si colloca ai primi posti delle agende delle organizzazioni e agenzie per la sicurezza dei lavoratori e delle associazioni internazionali dei professionisti della salute.

Aim To explore nursing management issues within COVID-19 narratives of Italian front-line nurses. Background The COVID-19 pandemic has dramatically affected health systems and professionals worldwide. Italian nurses have key messages for nursing leaders following their acute experiences in the pandemic. Method A descriptive qualitative study with thematic analysis. Results Twenty-three testimonies from clinical nurses were analysed. Six macrothemes were identified as follows: organisational and logistic change; leadership models adopted to manage the emergency; changes in nursing approaches; personal protective equipment issues; physical and psychological impact on nurses; and team value/spirit. Conclusions Our testimonies highlighted the huge impact of COVID-19 on the Italian nursing workforce, especially in terms of the high risks associated with caring for COVID-19 patients, exacerbated by the shortage of appropriate personal protective equipment. Nurses had to care for their colleagues and live separately from their families to avoid infecting them, revealing nurses' resilience and the important role of effective and sensitive management. Implications for nursing management Nurse managers must be prepared for the impact of pandemics on staff and need to ensure availability and replacement of quality personal protective equipment, rehearse strategies for communicating with patients while wearing personal protective equipment and establish protocols for communicating with relatives.

In the Italian and European literature there are still few studies describing the impact of the COVID-19 pandemic on the organization of nursing care in hospitals, on the actions taken by nursing leaders to contain it, and on the outcomes of these interventions.To describe nursing leaders' experiences with reorganizing healthcare pathways, through management data and personal accounts.A retrospective quali-quantitative observational study was conducted at the Mauriziano Hospital in Turin, with 484 beds and over 1,700 workers. Quantitative data were analyzed through descriptive statistical indices and integrated with qualitative data collected through semi-structured telephone interviews. The analysis of the quantitative and qualitative data provided an objective and experiential representation of the implemented interventions.We described the impact of interventions introduced by the nursing leadership during the pandemic on hospital services. In particular, the reorganization of the emergency department and of the prevention and psychological support services for the hospital's health workers. In addition, specific initiatives to support the discharge of COVID-19 positive patients, and to support and manage contacts with family members both during the hospitalization of their loved ones and following death are described.This study contributes to the discussion on some crucial issues: the increasingly clear relationship between adequate staffing and safety of patients and professionals, the importance of a good working environment and a solid leadership, the importance of continuing education for professionals and adequate skill mixes; all highlighted by the pandemic.Nella letteratura italiana ed europea sono ancora pochi gli studi che descrivono l'impatto della pandemia COVID-19 sull'organizzazione dell'assistenza infermieristica negli ospedali, sulle azioni attuate dai leader infermieristici per contenerla e sui risultati di tali interventi.Descrivere le esperienze di riorganizzazione dei percorsi assistenziali da parte dei leader infermieristici, attraverso i dati di gestione e le testimonianze.Studio osservazionale retrospettivo quali-quantitativo, svolto presso l’Ospedale Mauriziano di Torino, 484 posti letto e oltre 1700 operatori. I dati quantitativi sono stati analizzati con indici di statistica descrittiva e sono stati integrati con i dati qualitativi raccolti mediante interviste telefoniche semi strutturate. L’analisi dei dati quanti-qualitativi ha fornito una rappresentazione oggettiva ed esperienziale degli interventi implementati.I dati raccolti descrivono la ricaduta sui servizi degli interventi introdotti dalla leadership infermieristica durante la pandemia; in particolare la riorganizzazione del pronto soccorso e dei servizi di prevenzione e supporto psicologico per sostenere i dipendenti dell’Azienda. Inoltre, sono state descritte alcune iniziative particolari a sostegno delle dimissioni dei pazienti COVID-19 positivi e del sostegno e contatto con i familiari durante la degenza dei propri cari e in seguito al decesso.I risultati di questo studio sono un contributo alla discussione su alcuni temi cruciali: il rapporto sempre pi˘ chiaro tra staffing adeguato e sicurezza dei pazienti e dei professionisti, l’importanza delle caratteristiche dell’ambiente di lavoro e di una leadership consolidata, l’importanza della formazione dei professionisti e di skill mix adeguati. Resi più evidenti dal contesto di emergenza pandemica.

World Health Organization (WHO) reports emphasize the need to implement new healthcare models centred on Primary Health Care and in this context both WHO and EU recommendations identify the Family and Community Nurse (FCN) as a key actor. However, despite WHO recommendations, there is a lack of standardized Professional Profile for FCN at EU level in the main EU reference tools and classifications. In the effort to address this gap, the ENhANCE (EuropeaN curriculum for fAmily aNd Community nursE) project aims to elaborate a European Professional Profile for FCNs, along with a European Curriculum to become FCN. In this contribution, the Curriculum development process is described. This encompassed four main steps: (1) studying the current educational provision for FCN in Europe, (2) profiling FCN, (3) developing the actual European Curriculum, and (4) instantiating the EU Curriculum into national curricula and validating such localizations through piloting. The preliminary evaluation results of the Professional Profile, the European Curriculum, as well as the national curricula are presented. In the Discussion section, the main criticalities, challenges, as well as strong points are highlighted.

Introduction The relationship between burnout and patient safety is widely demonstrated in the literature. Recent studies have shown that in pediatrics the burnout rates are even higher, thus increasing young patients' exposure to risks. Pediatric cardiology is often characterized by acute onset in the pre-natal period and requires long periods of hospitalization. Strategies to reduce burnout and its impact on patient safety is a priority. Purpose To test the relationship between nursing work environment and emotional exhaustion in nurses in pediatric cardiology. Methods Data were drawn from the database of a larger study, RN4CAST@IT-Ped, a cross-sectional study in which 13 Italian hospitals were involved. Convenience sampling was adopted, and inclusion criteria were nurses providing direct routine care in wards. For this study, only data relating to nurses working in Pediatric Cardiology were extracted. The data were collected through a web survey from September 2017 to January 2018. The questionnaire investigated several aspects relating to care and nursing staff including workload, skill mix, work environment measured with PES-NWI, and emotional exhaustion with the Maslach Burnout Inventory. Descriptive statistical analyses were conducted to describe the sample and variables taken into consideration; a binomial logistic regression model was built to test the relationships between the dependent variable “high Emotional Exhaustion” and the independent variables “PES-NWI composite score”, adjusted for “workload” and “skill mix”. Results The responses from eighty-five pediatric nurses from 7 units (mixed cardiology-cardiac surgery, cardiology, arrhythmology, cardiac surgery and a cardiology intensive care unit), in 5 hospitals, were analyzed. These findings show that with the same skill mix and workload, the improvement of the workplace environment conditions decreased by 81% (OR 0.192; 95% CI 0.062–0.591) the risk that nurses working in pediatric cardiology would develop a high level of Emotional Exhaustion. Conclusions Demonstrating the association between emotional exhaustion and work environment in pediatric cardiology is only a first step towards improvement. Workplace environment includes relational, logistic, and organizational aspects that require further investigation to ensure that nursing in pediatric cardiology is even safer and of better quality in all its key aspects: urgency, intensity, chronicity and complexity. Funding Acknowledgement Type of funding source: None

Aim To describe nurses' reported missed nursing care activities among hospitalized adult patients medical and surgical wards and explore gaps in service provision. Background In 2015, Italy replicated the RN4CAST study, which heralded the exposition of missed care as an international phenomenon. In Italy, nurse-patient workload is high, with high levels of burnout and dissatisfaction reported, all factors associated with missed care. Methods A cross-sectional study (n = 3,590) was conducted using the 13-item online Task Left Undone Tool aimed at collecting data on missed nursing care. Results The frequency of omission of activities ranged between 7% and 50%. There were significant differences between morning, afternoon and night shifts and the various clinical settings. Oral care was the most frequently missed care activity. Conclusions This study takes step forward in identifying and reducing missed care on medical and surgical wards, both in Italy and also internationally, which needs to take into account the specific organisational characteristics of each setting. Implications for nursing management Although more essential activities are missed less frequently, much is known about the relational deficits such as information giving, education, communication and discharge advice, which managers ought to spearhead through local initiatives to improve these practices.

PURPOSE Unmet needs for advanced-disease cancer patients are fatigue, pain, and emotional support. Little information is available about the feasibility of interventions focused on patient-reported outcome measurement developed according to the Medical Research Council (MRC) Framework in advanced-disease cancer patients. We aimed to pilot a nurse-led complex intervention focused on QoL assessment in advanced-disease cancer patients. METHODS The INFO-QoL study was based on an exploratory, nonequivalent comparison group, pre-test-post-test design. Study sites received either the INFO-QoL intervention or usual care. Adult advanced-disease cancer patients admitted to hospice inpatient units that gave their informed consent were included in the study. Subjects were 187 patients and their families and 19 healthcare professionals. We evaluated feasibility, acceptability, and patients' outcomes using the Integrated Palliative Care Outcome Scale. RESULTS Nineteen healthcare professionals were included. The mean competence score increased significantly over time (p

BACKGROUND: The terms critical incident technique and reflection are widely used but often not fully explained, resulting in ambiguity. PURPOSE: The aims of this review were to map and describe existing approaches to recording or using critical incidents and reflection in nursing and health professions literature over the last decade; identify challenges, facilitating factors, strengths, and weaknesses; and discuss relevance for nursing education. METHODS: A systematic narrative review was undertaken. MEDLINE and the Cumulative Index to Nursing and Allied Health Literature were searched using MeSH terms, returning 223 articles (2006-2017). After exclusions, 41 were reviewed. RESULTS: Articles were categorized into 3 areas: descriptions of the development of an original tool or model, critical incidents or reflection on events used as a learning tool, and personal reflections on critical incidents. CONCLUSIONS: Benefits have been identified in all areas. More attention is needed to the pedagogy of reflection and the role of educators in reflection.

AIMS AND OBJECTIVES To understand the experiences and support needs of informal caregivers of patients with chronic obstructive pulmonary diseases chronic obstructive pulmonary disease who return home following an acute exacerbation. BACKGROUND The presence of an informal caregiver is important to provide practical and emotional support after an episode of acute exacerbation of chronic obstructive pulmonary disease. However, caregiving in such circumstances can be challenging and stressful. DESIGN Phenomenology. METHODS This is a phenomenological study based on semi-structured interviews with sixteen primary caregivers of chronic obstructive pulmonary disease patients. Interview data were analysed using Colaizzi's descriptive analysis framework, to identify significant themes and sub-themes. Data were collected between April-December 2017 in a Teaching Hospital in Italy. The study was designed and reported following the COREQ guidelines and checklist. RESULTS Analysis elicited five themes embracing various aspects of the caregivers' lived experiences: (a) a home disrupted, (b) living with constant vigilance and anxiety, (c) feeling the need to escape (d) self-justifications for caregiving role/duty, and (e) feeling abandoned by professionals. CONCLUSIONS Our results show that carers experience a range of difficulties when caring for their relative at home with chronic obstructive pulmonary disease. Some of these are linked to the physical disruption of their home but many are linked to feelings of inability to cope and the psycho-social impact of the caring role. The study also shows how participants felt unsupported by professionals. Focused support for carers is required to enable them to meet these challenges. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals should be trained to provide technical and psychological support to caregivers especially during the phases of disease that may involve episodes of exacerbation. Home care and continuity of care can work if there is excellent communication and collaboration between healthcare professionals and caregivers. Developing appropriate support for family caregivers is essential to address the problems they can face.

Background: Developing nursing research skills, awareness and research utilisation are important for improving healthcare outcomes and are key to ensuring the full understanding and knowledge base necessary for optimal delivery of care. Nevertheless, little is known about research awareness in children's nurses. Aims and objectives: To address this issue, an integrative literature review was conducted for studies published between January 2007 and January 2017 to obtain up-to-date evidence about the extent of research awareness and utilisation among children's nurses. Methods: Using PubMed, Cochrane Library, ILISI and CINAHL databases, 21 studies related to children's nurses' research awareness were included in the final review, which was later developed and structured in keeping with PRISMA checklist and guidelines. Conclusions: The studies isolated show that nurses' knowledge about and utilisation of research vary and that there are many existent barriers to and facilitators of evidence-based practice in the paediatric setting. Some studies report that introducing a cultural and/or change in clinical practice change to improve research utilisation can have positive impacts on healthcare outcomes and the quality of nursing care of children. It is recommended that structured approaches to improving research utilisation be considered and additional research is needed to explore the benefits of these approaches. Relevance to clinical practice: Despite more than three decades of the evidence-based practice movement within nursing, barriers still exist among children's nurses in the use of research in practice. If the use of research to improve the delivery of children's nursing care is to become a reality, then nurses' research awareness needs to improve to underpin care delivery with optimal evidence in a cohesive informed manner. Keywords: awareness; evidence-based nursing; evidence-based practice; nurses; nursing research; paediatric.

International mobility for nursing students is still a relatively new phenomenon. While educators and students are both excited by the opportunity that mobility presents, there are often many challenges inherent within third level organisations and practice organisations. These obstacles not only serve to make international mobility arrangements complex to manage but also mean that these opportunities are only available to very small numbers of students. Furthermore the benefits of undergraduate international exchanges remain largely anecdotal and the elements that facilitate success are not entirely clear. To address these issues, a qualitative study was conducted to identify the elements that characterize a nursing student's successful learning during international clinical placement. Semi-structured interviews were carried out with six students who had completed their international clinical placements experiences in Portugal, Spain, and Italy. Three common themes emerged from the data analysis: relationship with institutions and countries, student's thoughts and feelings and learning outcomes and the role of the nursing student's clinical supervisor. These themes contain seven sub-categories, representing the characterizing elements of the student's experience of mobility in the foreign country. These results are useful to nurse educators internationally to inform clinical learning experiences within exchange programmes.

© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd. Aim: To develop an instrument to investigate knowledge and predictive factors of needlestick and sharps injuries (NSIs) in nursing students during clinical placements. Design: Instrument development and cross-sectional study for psychometric testing. Methods: A self-administered instrument including demographic data, injury epidemiology and predictive factors of NSIs was developed between October 2018–January 2019. Content validity was assessed by a panel of experts. The instrument's factor structure and discriminant validity were explored using principal components analysis. The STROBE guidelines were followed. Results: Evidence of content validity was found (S-CVI 0.75; I-CVI 0.50–1.00). A three-factor structure was shown by exploratory factor analysis. Of the 238 participants, 39% had been injured at least once, of which 67.3% in the second year. Higher perceptions of “personal exposure” (4.06, SD 3.78) were reported by third-year students. Higher scores for “perceived benefits” of preventive behaviours (13.6, SD 1.46) were reported by second-year students.

Introduction Nursing care in cardiology requires advanced skills, continuity of care and global care of the chronic patient. The relationship with the patient requires a psychological and moral commitment which, combined with time-pressure and high workloads, increases the risk of negatively impacting nurses' well-being. Emotional exhaustion in nurses has negative consequences on care, therefore nursing leaders should monitor this outcome and ensure that its incidence is limited. Purpose To test the relationship between the nursing working environment and emotional exhaustion among nurses in cardiology wards. Methods The data are drawn from the database of the larger study, RN4CAST@IT. This was a multi-center and multi-level study. A convenience sample of nurses providing bedside care was included. For the analyses presented here, the data relating to nurses working in Cardiology wards were extracted. The data were collected through a web survey between September and December 2015. The questionnaire investigated several topics about nursing staff including nurse-patient ratios, skill mix, working environment measured with PES-NWI, and emotional exhaustion with the Maslach Burnout Inventory. Descriptive statistical analyses were conducted to describe the sample and variables taken into consideration; a binomial logistic regression model was built to test the relationships between the dependent variable “high Emotional Exhaustion;' and the independent variables “PES-NWI composite score”, “workload” and “skill mix”. Results Responses by 291 cardiology nurses were analysed. Binary logistic regression, adjusted for skill mix and staffing, showed that, better working environment conditions reduced the risk that nurses working in the cardiology develop high Emotional Exhaustion by 96% (OR 0.038; 95% CI 0.011–0.136). Conclusions Considering the relationship that these analyses have shown between a favourable working environment, capable of involving professionals, of providing adequate resources and leadership, and the risk that professionals may develop a high level of emotional exhaustion, we need to reflect how it impacts on patients. These results are the starting point for analysing the organization of clinical contexts, with their peculiarities, to make them more and more suitable for people, both patients and professionals. Funding Acknowledgement Type of funding source: None

Aim To explore Italian paediatric nurses’ reported burnout and its relationship to their perceptions of safety and adverse events. Design A cross‐sectional study using the RN4CAST@IT‐Ped database with a web‐based survey design. Methods The RN4CAST@IT‐Ped questionnaire was used to collect data in 2017. This comprised three main components: three dimensions (22 items) of the Maslach Burnout Inventory including emotional exhaustion, depersonalization and personal accomplishment. Participants also scored an overall grade of patient safety and estimated the occurrence of adverse clinical events. Results Nurses (N = 2,243) reported high levels of burnout. Most rated clinical safety as high. The risk of adverse events ranged from 1.3–12.4%. The degree of burnout appeared to influence the perception of safety and adverse events. Conclusion The association between nurses’ burnout and perceptions of higher rates of adverse events and reduced safety in clinical practice is an important finding. However, it is unclear whether this was influenced by a negative state of mind, and whether reduced safety and increased adverse events negatively influenced nurses’ well‐being, thus leading to burnout. Regardless, the association between nurses’ burnout and these quality concepts needs further exploration to examine the effect, if any, on burnout and safety, and identify supportive mechanisms for nurses. Impact The association between reported burnout and perception of safety and risk of adverse events in Italian paediatric nurses has been reported for the first time. Nurses reporting burnout are at greater risk of intensely negative perceptions of clinical safety and adverse events. This is an important finding as perceptions can influence practice and behaviours. Quality measures in children's clinical environments need to go beyond obvious indicators to examine nurses’ well‐being as this also influences quality and safety.

Background In some clinical settings, nurses have difficulty describing the outcomes of their caring activities. Understanding the reasons for this could help nurse leaders to improve the effectiveness and visibility of nursing practice and safeguard nurses' working conditions. Objective The aims of this study were to understand how nurses working in 2 different adult cancer centers make healthcare decisions and assess the respective outcomes on their patients. Methods Through a constructivist grounded theory approach, we involved 15 clinical cancer nurses with different experiences and educational backgrounds and 6 nurse managers, working in 2 comprehensive cancer centers, 1 in Italy and 1 in Switzerland. Data were collected in 2 phases using 20 semistructured interviews and 9 field observations. Results Six macrocategories emerged: interacting with situational factors, deciding relevant interventions, using multiple decision-making approaches, evaluating interventions and reporting them, pursuing healthcare outcomes, and clarifying professional identity and roles. Nurses' decision-making processes varied and were influenced by various factors, which mutually influenced one another. This process was interpreted using an explicative theory called "dynamic decision-making adaptation." Conclusions The present study showed how the aims, contents, and degree of autonomy in the nurses' decision-making process are strongly influenced by the dialectic interaction between professional and contextual factors, such as competency and professional identity. Implications for practice Cancer nurses could influence their clinical practice by developing nursing competencies that effectively resolve patients' problems. This is a key factor that nurses govern autonomously and therefore a responsibility that involves the entire nursing educational, organizational, and scientific leadership.