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To compare the occurrence and the reasons for unfinished care among coronavirus disease (COVID-19) and non-COVID-19 patients as perceived by nurses.The recent pandemic has imposed tremendous changes in hospitals in all countries.Investigating the occurrence of and the reasons for unfinished care as perceived by nurses working in COVID-19 and non-COVID-19 units might help to gain insights and to address future pandemics.A comparative cross-sectional study based on the STROBE guideline has been conducted during November 2020-January 2021. The Unfinished Nursing Care Survey, comprising part A (elements) and part B (reasons), was administered online to all 479 nurses working in medical and surgical units converted progressively into COVID-19 and non-COVID-19 units. A total of 90 and 200 nurses participated, respectively.No differences in the unfinished care occurrence have emerged at the overall level between nurses caring for COVID (2.10 out of 5; 95% confidence interval [CI], 1.94-2.27) and non-COVID-19 patients (2.16; 95% CI, 2.06-2.26). Reasons for unfinished care reported significant higher averages among nurses caring for COVID (2.21; 95% CI, 2.10-2.31) as compared with those caring for non-COVID-19 patients (2.07; 95% CI, 2.01-2.14; p = 0.030).The overall occurrence of unfinished care was slightly higher compared with pre-pandemic data in all patients.Reasons triggering unfinished care were slightly different and were due to priority setting and human resources issues, which were perceived at higher significance among nurses working in COVID-19 compared with non-COVID-19 units.A clear map of action has emerged that might be valid in the post-COVID-19 era as well as in the case of future pandemics.

This paper analyses whether and how investments in financial technology (FinTech) affect performance, risk, and value of listed Italian banks. This paper tests the effect of return on equity (ROE) and capital asset pricing model (CAPM) Beta coefficient — and, secondly, of the price-to-book value (PBV) ratio, on a sample of 17 Italian listed banks from 2013 to 2019, representing the largest institutions operating in the Italian banking industry. The FinTech variable is declined into two different statuses: digital active banks and digital-focused banks. The study adds useful insights to the positive effects of innovation on banks’ value, in a market, like the Italian one, where investments in FinTech have spread in recent years. Controlling for other financial statements and market variables, the presence of FinTech investments does not affect the CAPM Beta coefficient, while the relationship is positive and significant with ROE for digital active banks only, and with the PBV for digital-focused banks. These results confirm a positive effect on performance for banks investing in FinTech, while greater expectations from investors and a positive effect on bank value creation are significant for digital-focused banks only.

Accumulating evidence indicates that the COVID-19 pandemic carries risks to psychological health and represents a collective traumatic experience with consequences at the social, economic, and health levels. The primary aim of this study was to collect ongoing COVID-19 survivors’ pandemic-related experiences as expressed through the use of metaphors; the secondary aim was to explore socio-demographic variables associated with the metaphor orientation as negative, positive or neutral. An observational follow-up survey was conducted and reported according to the STROBE guidelines. Patients ≥ 18 years, who were treated for COVID-19 during the first wave (March/April 2020) and who were willing to participate in a telephone interview were involved and asked to summarize their COVID-19 experience as lived up to 6 and 12 months in a metaphor. A total of 339 patients participated in the first (6 months) and second (12 months) data collection. Patients were mainly female (51.9%), with an average age of 52.9 years (confidence interval, CI 95% 51.2–54.6). At 6 months, most participants (214; 63.1%) used a negative-oriented metaphor, further increasing at 12 months (266; 78.5%), when they used fewer neutral-/positive-oriented metaphors (p < 0.001). At the 6-month follow-up, only three individual variables (female gender, education, and experiencing symptoms at the COVID-19 onset) were significantly different across the possible metaphor orientation; at 12 months, no individual variables were significantly associated. This study suggests increasingly negative lived experiences over time and the need for personalized healthcare pathways to face the long-term traumatic consequences of COVID-19.

AIM The aim of this study is to describe the prevalence and reasons for non-nursing tasks as perceived by nurses. BACKGROUND Four types of non-nursing tasks have been identified to date: (a) auxiliary; (b) administrative, (c) expected by allied health care professionals; and (d) medical. However, no studies on a large scale have been performed with the aim of identifying the prevalence of all of these non-nursing tasks, and factors promoting or hindering their occurrence, given that they represent a clear waste of nurses' time. METHODS A cross-sectional study in 2017, following The Strengthening the Reporting of Observational studies. All active nurses registered in an Italian provincial Nursing Board (=1331) willing to participate were involved. A questionnaire survey exploring the nature of the nursing tasks performed in daily practice and the underlying reasons was administered via paper/pencil and e-mail. RESULTS A total of 733 nurses participated of which 94.5% performed at least one type of non-nursing task, mainly administrative and auxiliary. Auxiliary tasks are less likely among nurses working in a community (odds ratio [OR] 0.43, 95% CI 0.29-0.63, p

In this work we analyse basketball play-by-play data in order to evaluate the efficiency of different five-man lineups employed by teams. Starting from the adjusted plus-minus framework, we present a model-based strategy for the analysis of the result of partial match outcomes, extending the current literature in two main directions. The first extension replaces the classical response variable (scored points) with a comprehensive score that combines a set of box score statistics. This allows various aspects of the game to be separated. The second extension focuses on entire lineups rather than individual players, using a suitable extended model specification. The model fitting procedure is Bayesian and provides the necessary regularization. An advantage of this approach is the use of posterior distributions to rank players and lineups, providing an effective tool for team managers. For the empirical analysis, we use the 2018/2019 regular season of the Turkish Airlines Euroleague Championship, with play-by-play and box scores for 240 matches, which are made available by the league website. The results of the model fitting can be used for several investigations as, for instance, the comparative analysis of the effects of single players and the estimation of total and synergic effects of lineups monitoring. Moreover, the behaviour of players and lineups during the season, updating the estimation results after each gameday, can represent a rather useful tool.

Aims To highlight (a) trends common to all nurses on priorities attributed to interventions, and (b) whether there are profiles of nurses working in the same context who prioritize interventions in a similar way. Background The underlying prioritization of interventions leading to unfinished nursing care has been minimally investigated. Methods A 2017 pilot Q methodology study. Full-time nurses, with at least 6 months of experience in a surgical unit, were involved. Eleven nurses rated the priority given in daily practice (from -3 as the lowest to +3 as the highest) to 35 Q-sample statements representing nursing care, non-nursing and organisational interventions. Results Overall, the intervention receiving the lowest priority was 'Providing patient hygiene', while the highest was 'Answering phone calls'. In the by-person factor analysis (total variance = 60.79%), three profiles of nurses emerged, (a) 'Patient safety-oriented' (variance = 31.66%); (b) 'Nursing task-oriented' (=16.32%); and (c) 'Team process-oriented' (=12.81%). Conclusions Three profiles of nurses emerged in the same setting with significant differences both in the statistical order of priorities and in their practical implications. Implications for nursing management Understanding levels of prioritization, which are not only affected by the unit but also by sub-groups of nurses who rank priorities in a similar way, can support nurse managers in their role.

Background Nursing students' perception of a safe clinical working environment may impact the development of professional skills and progression in the profession. Purpose The aims of this study were to describe to what extent nursing students perceive the working environments as safe during their most recent clinical rotation and to explore factors associated with their perception of a safe workplace environment. Methods A nationwide Italian cross-sectional study involving 9607 students in 27 universities across 95 three-year nursing programs was performed in 2015-2016, and secondary analyses were run in 2019. Results The workplace environment was perceived by students as only a little (n = 2598 [27.0%]), to some extent (n = 4048 [42.1%]), and always (n = 2555 [26.0%]) safe; 406 (4.2%) students reported to have never felt that the workplace as safe. At the multivariate level, factors promoting students' perception of a safe clinical environment were a setting offering higher (a) learning opportunities, (b) safety and nursing care quality, (c) quality of tutorial strategies, and (d) self-directed learning opportunities. Conclusions Nursing faculty should assess the quality of clinical settings before deciding on environments for students' learning experience.

This paper delves into the implications for the bank behaviour about firm loan pricing conditions of the new direction undertaken by supervisory and regulatory authorities in the aftermath of the deterioration of the loan portfolio quality that hit EU banks. The 2014 AQR exercise embraces the new direction and extensively uses debt service coverage measures to assess a firm’s loan quality. We, therefore, check whether the DSCR has influenced debt pricing conditions by analysing a panel of 655 listed EU firms from 2009 to 2017. Our findings show that Z-score is unable to discriminate between high and low credit risk firms. The DSCR becomes significant only after 2014, highlighting the incremented importance of this ratio in the bank’s loan pricing determination. Our work contributes to the literature investigating third-party interdependencies with the interplay between lender-borrower relationship and loan pricing and further extends the literature on creditworthiness metrics beyond their mere default-prediction ability (Beaver, 1966; Houghton & Woodliff, 1987). Our results highlight the relevance of the DSCR in the bank’s loan pricing determination and inform firm managers about the drivers that influence the cost of debt thereby enhancing their operational and financial planning.

The application of extended producer responsibility (EPR) in Europe has followed different patterns, with varying intensity of competition among producer organisations responsible for meeting take-back and recycling obligations. The literature has suggested possible reasons in favour or against the creation of dedicated compliance organisations, and arguments in support or against having many alternative recycling schemes competing on the market. However, little has been done on the empirical side to test these hypotheses. Our study contributes to filling this gap in the empirical literature by analysing the effect of competition and regulation in the field of waste from electric and electronic equipment (WEEE). We exploit an original database to provide an econometric assessment of the effects of competition and regulation on the cost of dealing with WEEE. The European case is interesting since all member country are subject to the same policy targets imposed by EU directives but enjoy significant degrees of freedom in choosing the policy mix and the industrial structure to which the achievement of policy targets is devoted. Our results are several. First, we provide valuable details on EPR models. Second, we present collection and economic results achieved by compliance organisations. Third, with a statistical analysis based on the panel data structure, we provide significant evidence that a more competitive market structure allows achieving the same collection outcomes at a lower cost. This result is potentially relevant for waste management policies since it encourages the search for a more articulated market architecture for the design of EPR systems.

PurposeThis paper investigates the effect of entrepreneurial orientation (EO) on small- and medium-sized enterprises' (SMEs) access to credit. Starting with the idea that SMEs' strategy-making process, structures and behaviour can favour credit access, the authors also explore the moderating role of bank lending technologies in shaping this relationship.Design/methodology/approachThis study relies on a unique survey of Austrian and Italian SMEs which contains detailed information on access to credit, EO dimensions, relationship lending and firm-level characteristics. The authors perform stepwise logistic regressions to assess whether EO interacts with SME's access to finance, and how relationship lending enhances this relationship.FindingsProactiveness, autonomy and competitive aggressiveness are important constructs for improving access to bank financing. Those dimensions became more important when a relationship bank is involved, suggesting a role for relationship lending in overcoming SMEs' opaqueness. In addition, relationship lending is crucial for innovative SMEs in overcoming credit denial rates.Research limitations/implicationsThe small sample did not allow to analyse the effect of EO on discouraged borrowers. Furthermore, alternative measures of relationship lending (such as geographical proximity or the length of the relationship) and the share of credit granted by the relationship bank would have been interesting to further validate our results.Practical implicationsThis study shows that EO dimensions and the type of lending technology are relevant for the financial success of SMEs. More precisely, the authors show that diversity within the banking system helps innovative, autonomous, proactive and competitive SMEs. These important pieces of soft information are injected into the final lending decision when a relationship bank is involved. The evidence suggests the need for SMEs to interact with local banks to fully exploit their EO posture.Originality/valueTo the authors' knowledge, this paper is the first attempt to analyse whether relationship lending can affect the EO–credit access relation.

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

To protect and promote the originality and authenticity of mountain foodstuffs, the European Union set Regulation No 1151/2012 to create the optional quality term “mountain product”. Our research aimed at exploring the attractiveness of the mountain product label for consumers, considering both attitude towards the label itself and purchase intentions. We propose a model to investigate relationships between four latent constructs — mountain attractiveness, mountain food attractiveness, attitude towards the mountain product label, and purchase intention — which have been tested, thus confirming the statistical relevance of the relationships. All 47 items selected for describing the latent constructs are suitable for this purpose. Ridge and LASSO results also show that 17 items of the first three constructs are relevant in explaining purchase intentions. Some contextual variables, such as age, income, geographical origin of consumers, and knowledge of mountain products and mountains for tourism purposes, can positively influence consumers’ behavior. These findings could support the design of mountain development strategies, in particular marketing actions for both the product and the territory.

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

Missed nursing care and physical restraint have been identified as indicators of patient safety, but no studies to date have explored their relation. To explore the relation between these two phenomena, a secondary analysis of a longitudinal study on 1464 in-hospital patients and 314 registered nurses was performed. The use of physical restraint was assessed at the bedside on a daily basis; missed care was assessed with the MISSCARE survey. Individual, nursing care, and hospital-level variables were measured. A total of 184 (12.6%) patients were restrained for 20.33% of their in-hospital stay. No significant differences emerged in the occurrence of missed care between restrained and unrestrained patients. However, some common antecedents of these two phenomena emerged: in units where there is a lack of personnel, both an increase in missed care and physical restraint duration should be expected. As a consequence, patients are threatened in their right to receive the required care and they are at risk of being restrained. Moreover, a higher skill mix is a preventive factor, which suggests that the increased numbers of registered nurses on the team, may prevent routine forms of physical restraint use by analyzing the physical restraint in place critically and removing them as soon as possible, thus reducing the duration of the restraints.

Aims To develop and validate a comprehensive tool based on those established in the field capable of reflecting the broader concept of Unfinished Nursing Care. Background Different tools have been established in the field of Missed Care, Rationing Care and Tasks Left Undone. However, despite them sharing similar items and all referring to the common concept of Unfinished Nursing Care, no attempts to collapse them in a single tool capable of reflecting current nursing practice, and its increased complexity, have been attempted to date. Methods A development and validation study was performed in 2017. After developing the instrument starting from the MISSCARE Survey and critically reviewing the other tools available in the field, the Unfinished Nursing Care Survey (UNCS) was subjected to validation. A total of 1977 nurses from 13 acute Italian hospitals were recruited. Acceptability, construct validity (Mokken Scaling, Explorative and Confirmative Factor Analysis), internal consistency, hypothesis testing and criterion validity were assessed according to the COnsensus-based Standards for the selection of health Measurement INstruments guideline. Results 1,400 (70.8%) nurses participated. The UNCS is composed of part A (=elements of unfinished care) and part B (=reasons for unfinished care) with 21 and 18 items, respectively. The UNCS has showed high acceptability (>90%). Part A has reported a strong scalability (H = .52), thus suggesting a hierarchical structure among the items. The six factors in part B explained a total variance of 64.3% (internal consistency = .806) as confirmed by the Confirmative Factor Analysis. Conclusions The comprehensive nature of the UNCS can contribute to the establishment of a common reference measure of the phenomenon worldwide although its psychometric properties require future investigation in different cultural contexts, languages and clinical settings. Implications for nursing management Measuring Unfinished Nursing Care provides information on the processes implicated in the development of adverse events before these become visible; moreover, it can increase awareness on nurses' performance and inform appropriate interventions to improve it.

Background Unfinished Nursing Care (UNC) indicates required interventions that are delayed or omitted. Nursing students are also exposed to UNC during their clinical rotations. However, no tools have been validated to date to collect UNC as perceived by them. Objectives To validate a tool measuring UNC as perceived by nursing students. Design A validation study in 2018 by following the COnsensus-based Standards for the selection of health Measurement INstruments guideline. Setting Three nursing programmes in Northern Italy. Participants All 1190 students who were attending their clinical rotation in hospital or community settings, were eligible. To assess the criterion validity, 30 clinical nurse supervisors in a random sample of units were involved. Methods Content and face validity of the Unfinished Nursing Care Survey tool (UNCS) were assessed; then the tool, divided into part A (unfinished interventions) and B (reasons) was administered via Google and paper-pencil. Acceptability, construct validity (Mokken Scale Analysis, Exploratory and Confirmatory Factor Analyses), hypothesis testing, and criterion validity were assessed. Results 737 students (61.9%) and 30 (100%) clinical nurse supervisors participated. On the Mokken Scale, with regard to part A, nursing interventions were ordered in higher and lower priority, reflecting different degrees of difficulty in terms of leaving the interventions unfinished. In the Confirmatory Factor Analyses, reasons for UNC were categorised into ‘Communication’, ‘Priority setting’, ‘Nurses' aides' supervision’, ‘Material resources’, ‘Human resources’, and ‘Workload unpredictability’. Students in the second year perceived higher UNC occurrence; only some individual and nursing programme variables were significantly correlated with the UNC. No statistical differences emerged between the UNC perceptions of students and that of their clinical supervisors. Conclusion The Unfinished Nursing Care Survey for Students is composed of part A (22 items) and part B (18 items) seems to be valid in terms of acceptability, construct validity, hypothesis testing, and criterion validity.

This study looks at the performance of household electrical and electronic waste (WEEE) collection in 20 Italian regions from 2008 to 2015. The impact of several explicative variables on the results of e-waste collection is evaluated. The independent variables are socio-economic and demographic ones (age, gender, household size, education level, migration and income) along with technical-organisational variables (population density, presence of metropoles, macro regions, characteristics of the territory, percentage of household waste collected separately and number of e-waste collection points). The results show that the presence of collection points, the percentage of household waste collected separately and the percentage of females are positively correlated with the kg collected per inhabitant per year. For example, a variation of 1% of input (presence of collection points) corresponds to a 0.25% variation in the output (collection results) while 1% difference in the percentage of females in the population corresponds to a 7.549% difference in the collection rate. Population density, instead, is negatively correlated. It is interesting to note that there is a discrepancy between the Southern regions and the Centre regions (the former have an outcome 0.66 times lower than the latter) while the Northern regions perform similarly to the Centre ones. Moreover, the first year (2008) had a very low performance compared to the following years when the scheme constantly improved, mainly due to the additional collection points available. The Stochastic Frontier Model allows for the identification of the optimal production function among the 20 Italian regions. The best performing region is Tuscany (in the Centre), followed by Sardinia and Sicily (in the South).

Paraffinoma is a destructive complication of paraffin oil injection, usually associated with massive tissue destruction, thus requiring radical surgery and subsequent complex reconstruction. Although breast and penile paraffinomas have been widely described and their management is quite standardized, paraffinomas of the knee are still rare and only few case reports or small case series are available in the current literature. We describe the case of a 77-year-old man with a large paraffinoma of the right knee that occurred after self-injection of paraffin oil, 58 years before. He underwent wide surgical resection of the soft tissues overlying the knee and subsequent two-stage reconstruction by using acellular dermal matrix and, after 20 days, split-thickness skin grafts. Follow-up after 16 months showed no signs of skin ulcerations or inflammation, with an overall improvement in function. Even though conventional flap reconstructions may be still useful, the authors believe that acellular dermal matrices represent a safe, reliable, and less invasive alternative for challenging soft tissue reconstructions even in elderly patients with multiple medical problems.

Swelling is the most common symptom of extremities lymphedema. Clinical evaluation and laboratory analysis were conducted after far infrared radiation (FIR) treatment on the main four components of lymphedema: fluid, fat, protein, and hyaluronan. Far infrared radiation is a kind of hyperthermia therapy with several and additional benefits as well as promoting microcirculation flow and improving collateral lymph circumfluence. Although FIR therapy has been applied for several years on thousands of lymphedema patients, there are still few studies that have reported the biological effects of FIR on lymphatic tissue. In this research, we investigate the effects of far infrared rays on the major components of lymphatic tissue. Then, we explore the effectiveness and safety of FIR as a promising treatment modality of lymphedema. A total of 32 patients affected by lymphedema in stage II and III were treated between January 2015 and January 2016 at our department. After therapy, a significant decrease of limb circumference measurements was noted and improving of quality of life was registered. Laboratory examination showed the treatment can also decrease the deposition of fluid, fat, hyaluronan, and protein, improving the swelling condition. We believe FIR treatment could be considered as both an alternative monotherapy and a useful adjunctive to the conservative or surgical lymphedema procedures. Furthermore, the real and significant biological effects of FIR represent possible future applications in wide range of the medical field.

To explore the influence of the Nursing Home (NH) environment on eating independence while taking into account individual and nursing care factors, was the aim of the study. A secondary analysis was performed based on data collected in a multicentre prospective observational study involving 13 NHs. Residents aged >65 were included (n = 1,027). Dependence in eating was measured using the Edinburgh Feeding Evaluation in Dementia scale (EdFED, range 0–20). In addition to individual and nursing care variables, the NHs environments were assessed with the Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH, range 0–149). The mean EdFED score was 2.48 (95% Confidence Interval [CI]=2.22–2.73) and the TESS-NH score was 122.19 (95% CI=115.89−128.49). A linear regression analysis explained 30.8% of the total variance in eating dependence. Alongside individual and nursing care factors, in poor NH unit environments, residents with severe cognitive impairment showed increased eating dependence; in contrast, in better environments, similar residents showed maximal eating performance.

Aims and objectives To validate a tool measuring self-directed learning (SDL) abilities and to determine these abilities among older individuals attending the University of the Third Age. Background Health literacy (HL) and SDL abilities have been documented as being closely linked to each other and as prerequisites in enhancing self-management competences required by older people to protect their health and to manage health issues. Furthermore, individuals with SDL abilities have been documented to have a full understanding of their health treatment prescriptions, to be able to demonstrate increased compliance and to further develop self-care competences. Design A validation and a cross-sectional study design. Methods A consecutive sample of 313 older people (68.7% female) who attended lessons in two Italian Universities of the Third Age and who were willing to participate in the study were enrolled. The Self-Rating Scale of Self-Directed Learning (SRSSDL) validated previously in the healthcare context, was used. Results At the exploratory and confirmatory factor analysis, the SRSSDL in Older people (SRSSDLO) has demonstrated good psychometric properties: the tool is composed by four factors ("Awareness," "Attitudes," "Availability" and "Motivation") and 13 items. According to the findings, the average SDL score was 54.27 ± 6.69 out of 65, and women achieved significantly higher scores compared with men (54.81 ± 6.69 vs. 53.08 ± 6.54, p = .033), while participants with a university degree (55.95 ± 6.56) or secondary education (54.75 ± 6.13) had higher scores than those with lower secondary education (50.37 ± 7.34, p = .002). Conclusions Participants were responsible for their learning processes and were capable of identifying learning needs and goals. They were also internally motivated to develop learning methods and to organise learning activities. However, they were less able to keep up to date with the learning resources available. Implications for practice The SRSSDLO can help nurses identify healthy older people that lack SDL abilities and design tailored educational interventions to prevent health conditions and/or promote self-care management in chronic conditions.

The aim of this regionally-based, retrospective study was to describe the incidence of self-feeding dependence and predictors among elderly patients admitted from 2008 to 2013 to 105 Italian nursing homes. Data reported in a regional database collected at the time of nursing home admission and every 6 months up to the resident's death were accessed. The self-feeding degree of dependence was the dependent variable; at the individual and nursing home levels, explanatory variables were those collected at nursing home admission and every 6 months. The structural equation model and the ordinal polynomial logit regression analysis were performed. A total of 13 175 records of residents when admitted to the nursing home and their following 69 341 records, were included. At the time of nursing home admission, 6496 residents (49.3%) reported a certain degree of dependence in self-feeding and showed slight worsening in their dependence every 6 months. At the individual level, the increased functional dependence raised the proportional odds ratios of approximately 4.36 times of an increased dependence in self-feeding; the degree of cognitive impairment, the lack of social interactions, the occurrence of pressure sores, comorbidities, as well as the clinical instability and time all raised the risk of self-feeding dependence progression. At the nursing home level, an increased number of beds emerged as a factor also increasing the proportional odds of dependence in self-feeding. Factors affecting self-feeding dependence are multi-faceted at the individual and at the nursing home levels.

Effective performance of clinical handovers should be one of the priorities of nursing education to promote efficient communication skills and ensure patient safety. However, to date, no studies have explored to what extent nursing students are involved in handovers.To explore nursing students' handover involvement during their clinical rotations and associated factors.This was a secondary analysis of a large national cross-sectional study that involved 9607 undergraduate nursing students in 27 universities across 95 three-year Italian baccalaureate nursing programs. The involvement in the clinical handovers was the end point (from 0, never, to 3, always). A path analysis was performed to identify variables directly and indirectly affecting students' handover involvement.Handover involvement was reported as 'only a little', 'to some extent', and 'always' by 1739 (18.1%), 2939 (30.6%), and 4180 (43.5%) students, respectively; only 749 (7.8%) of students reported never being involved. At the path analysis explaining the 19.1% of variance of nursing students' involvement, some variables emerged that directly increased the likelihood of being involved in handovers. These were being female (β = 0.115, p 0.001); having children (β = 0.107, p = 0.011); being a 3rd-year student (β = 0.142, p 0.001) and being a 2nd-year student as compared to a 1st-year student (β = 0.050, p = 0.036); and having a longer clinical rotation (β = 0.015, p 0.001) in units with high 'quality of the learning environment' (β = 0.279, p 0.001). Moreover, students who were supervised by the nurse teacher (β = -0.279, p 0.001), or by a nurse on a daily basis (β = -0.253, p = 0.004), or by the staff (β = -0.190, p 0.001) reported being less involved in handovers as compared to those students supervised by a clinical nurse. Variables with indirect effects also emerged (model of student's supervision adopted at the unit level, and number of previous clinical rotations attended by students). Moreover, handover involvement explained 11.5% of students self-reported degree of competences learned during the clinical experience.Limiting students' opportunity to be involved in handover can prevent the development of communication skills and the professional socialization processes. Strategies at different levels are needed to promote handover among undergraduate nursing students.

Purpose The purpose of this paper is to investigate whether guarantees characterised by different degrees of relationship lending (particularly referring to collateral and guarantees provided by Mutual Loan Guarantee Institutions) are able to convey some entrepreneurial orientation (EO) dimensions from firms to banks. Design/methodology/approach Exploiting data from a survey of Austrian and Italian SMEs, the empirical analysis is based on a sample of 328 small business firms. To test the signalling hypothesis, the authors used logistic regressions to assess the explanatory power of EO dimensions on the presence of several types of guarantees. Findings The analyses suggest that collateral cannot signal any EO dimension, even when controlling for the strength of the bank – firm relationship. Furthermore, SMEs are able to mitigate their financial risk through collateral only in a multiple bank – firm relationship. Lastly, innovativeness, competitive energy and aggressiveness allow SMEs to obtain external guarantees (mutual guarantees, bank guarantees and public guarantees, respectively), helpful in order to promote credit access. Research limitations/implications The mediation role of collateral and external guarantees on EO – credit access relation should be analysed in future research. Since the role of guarantees can change among different bank lending technologies, further studies should carefully consider lender’s characteristics. Lastly, the use of loan data in respect of the firm data can help to better separate the effect of loan and firm attributes on the collateral. Practical implications The study suggests how managers and entrepreneurs should manage the financial risk through collateral in different situations (one–to–one and multiple bank – firm relationship). Furthermore, depending on the level of innovativeness, competitive energy and aggressiveness, a firm should request a specific type of external guarantees in order to increment the credit availability, to maximise the possibility of success and to improve its performance. Originality/value To the authors’ knowledge, this paper is the first attempt to analyse whether EO affects the request for guarantees instead of credit access. This can be helpful especially when the banks involved in the relation apply a transaction lending technology.

This study examines the relationship between strategic choices and the use of strategic management accounting (SMA) techniques in large manufacturing companies and investigates whether external factors such as environmental uncertainty and competitive forces affect the SMA system. The survey results show that SMA usage does not depend on strategy type and only marginally depends on geographic orientation. These findings have been integrated using qualitative data collected in seven large companies through interviews. Although significant progress has been made over the last two decades in describing SMA practices in Europe, the contribution of this study to the accounting (SMA) literature involves both the research content and design. Having identified gaps in previous SMA research, we design a study focused on large manufacturing firms that considers different hypotheses and adopts a mixed method approach.

Rationale There is growing interest in validating tools aimed at supporting the clinical decision-making process and research. However, an increased bureaucratization of clinical practice and redundancies in the measures collected have been reported by clinicians. Redundancies in clinical assessments affect negatively both patients and nurses. Methods To validate a meta-tool measuring the risks/problems currently estimated by multiple tools used in daily practice. A secondary analysis of a database was performed, using a cross-validation and a longitudinal study designs. In total, 1464 patients admitted to 12 medical units in 2012 were assessed at admission with the Brass, Barthel, Conley and Braden tools. Pertinent outcomes such as the occurrence of post-discharge need for resources and functional decline at discharge, as well as falls and pressure sores, were measured. Explorative factor analysis of each tool, inter-tool correlations and a conceptual evaluation of the redundant/similar items across tools were performed. Therefore, the validation of the meta-tool was performed through explorative factor analysis, confirmatory factor analysis and the structural equation model to establish the ability of the meta-tool to predict the outcomes estimated by the original tools. Results High correlations between the tools have emerged (from r 0.428 to 0.867) with a common variance from 18.3% to 75.1%. Through a conceptual evaluation and explorative factor analysis, the items were reduced from 42 to 20, and the three factors that emerged were confirmed by confirmatory factor analysis. According to the structural equation model results, two out of three emerged factors predicted the outcomes. Conclusions From the initial 42 items, the meta-tool is composed of 20 items capable of predicting the outcomes as with the original tools.

This investigation compared the application of color Doppler ultrasound and computed tomographic angiography in preoperative planning of lower extremity perforator flaps.This study was a prospective comparative analysis of 40 patients with lower extremity defects who underwent reconstruction with perforator flaps. The position, caliber, route, and quality of the perforator vessels were detected by computed tomographic angiography and color Doppler ultrasound preoperatively. The results of the preoperative navigation with both imaging techniques were verified during the operation.Color Doppler ultrasound had a higher accuracy in terms of identifying (95 percent versus 90 percent) and locating (95 percent versus 82.5 percent) the perforators in the lower extremity. Color Doppler ultrasound required approximately 25 minutes for examination, whereas computed tomographic angiography required 46 seconds for the scan and approximately 22 minutes for the image analysis. There was no significant difference between the two methods.Preoperative radiologic vessel navigation is capable of offering valuable information such as the perforator's location, diameter, and path; and information regarding the quality of the perforators, which can shorten the operative time and improve the surgical results. The authors recommend color Doppler ultrasound for preoperative planning when harvesting perforator flaps from the lower extremity. In cases where the patient has a metal implant, allergy to the contrast agent, or renal insufficiency, color Doppler ultrasound is the only option. In time, the use of color Doppler ultrasound and computed tomographic angiography in combination will be recommended to improve the accuracy of preoperative perforator navigation.Diagnostic, IV.

Background: Undergraduate nursing students have been documented to experience ethical distress during their clinical training and felt poorly supported in discussing the ethical issues they encountered. Research aims: This study was aimed at exploring nursing students’ perceived opportunity to discuss ethical issues that emerged during their clinical learning experience and associated factors. Research design: An Italian national cross-sectional study design was performed in 2015–2016. Participants were invited to answer a questionnaire composed of four sections regarding: (1) socio-demographic data, (2) previous clinical learning experiences, (3) current clinical learning experience quality and outcomes, and (4) the opportunity to discuss ethical issues with nurses in the last clinical learning experience (from 0 – ‘never’ to 3 – ‘very much’). Participants and research context: Participants were 9607 undergraduate nursing students who were attending 95 different three-year Italian baccalaureate nursing programmes, located at 27 universities in 15 Italian regions. Ethical considerations: This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines after the research protocol was approved by an ethics committee. Findings: Overall, 4707 (49%) perceived to have discussed ethical issues ‘much’ or ‘very much’; among the remaining, 3683 (38.3%) and 1217 (12.7%) students reported the perception of having discussed, respectively, ‘enough’ or ‘never’ ethical issues emerged in the clinical practice. At the multivariate logistic regression analysis explaining 38.1% of the overall variance, the factors promoting ethical discussion were mainly set at the clinical learning environment levels (i.e. increased learning opportunities, self-directed learning, safety and nursing care quality, quality of the tutorial strategies, competences learned and supervision by a clinical nurse). In contrast, being male was associated with a perception of less opportunity to discuss ethical issues. Conclusion: Nursing faculties should assess the clinical environment prerequisites of the settings as a context of student experience before deciding on their accreditation. Moreover, the nursing faculty and nurse managers should also enhance competence with regard to discussing ethical issues with students among clinical nurses by identifying factors that hinder this learning opportunity in daily practice.