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Pelvic pain has cognitive, behavioral, sexual, and emotional consequences. Nurses involved in pelvic floor rehabilitation clinics have contacts with patients reporting chronic pain and should know the most appropriate service for patient referral, to submit the problem to professionals capable of correctly assessing and managing the condition. Furthermore, in some countries nurses can use conservative methods to treat the painful symptoms inside a multidisciplinary team such as breathing retraining, biofeedback, and noninvasive neuromodulation. This paper aims to provide an overview of the literature regarding the role of rehabilitation nurses in dealing with patients suffering from chronic urogenital pelvic pain or urogenital painful syndromes, inside a multidisciplinary team.Scoping review on Pubmed, CINAHL, Embase, Scopus, Web of Science including trials, reviews, case studies or series, and other descriptive studies regarding the role of nurses inside the multidisciplinary team in the management of males and females presenting chronic pelvic pain (CPP) or chronic pelvic pain syndrome (CPPS).The 36 papers included in this review allowed answering research questions in four areas of nursing: collecting basic information, referring the person to appropriate services, evidence-based nursing interventions for CPP and CPPS, and proper documentation. Clinical history and assessment of breathing pattern, Muscular assessment and research of trigger points are the main points of data collection. Techniques for muscular relaxation and breathing retraining are important aspects of treatment, as well as biofeedback and noninvasive neuromodulation where the law allows nurses to practice such techniques. The McGill pain questionnaire and the pain inventory of the International Pain Society allow systematic data collection and handover.Rehabilitation nurses work inside multidisciplinary teams when dealing with persons suffering from pelvic pain; further research is needed as our comprehension of the underlying pathophysiological mechanisms of CPP and CPPS evolve.

Objective Peripherally inserted central catheters (PICC) guarantee a stable and safe vascular access to administer irritants or vesicants therapies. However, they may occasionally be affected by relevant thrombotic complications especially in patients with hypercoagulability such as oncological patients. Among the identification of independent risk factors, the role of body mass index (BMI) ≥25 kg/m2 is now emerging in literature with conflicting results. The aim of this systematic review is to analyze the available scientific literature in order to determine whether BMI could represent a risk factor in the development of thromboembolic event among cancer patients with PICCs. Data sources and review methods A scientific literature review was performed in Pubmed, Embase and Cinahl from Jan 1, 2010 to September 10, 2020 in which we identified 100 records. Of these, 88 were excluded and 14 were reviewed in full text. Among the reviewed records, 6 articles satisfied the inclusion criteria for analysis. These criteria included the English language, oncological patients with PICCs, the evaluation of catheter-related thrombosis as well as the stratification of patients according to BMI. Studies off topic and lacking data on PICC related complications among overweight and underweight patients were excluded. The includedstudies, judged with Newcastle-Ottawa Scale, was fair-lower quality. The primary endpoint was the relative risk (RR) of PICC-related thrombosis of overweight/obese vs normal weight/underweight (i.e., BMI ≥25 vs Results A total of 2431 patients were included in the analysis. Overall, 15.1% of patients developed PICC-related thrombosis within a median time of 23.2 days (range 11.0-42.5) after PICC implantation. Concerning BMI, 52.6% of the entire population was overweight/obese. We assessed the proportion of patients with PICC-related thrombotic events in the two groups, with 28% (95% CI, 12%-45%) of events registered in the overweight/obese patients cohort, and 13% (95% CI, 6%-19%) in the normal weight/underweight cohort. The pooled relative risk (RR) was 2.06 (95% CI, 1.21-3.49, p Conclusion This review showed a two-fold risk of thrombosis in overweight/obese compared to normal weight/underweight oncological patients with PICCs. Underweight condition could also play a role in thrombosis development, especially in nasopharyngeal and digestive system cancer. Future prospective studies are needed to achieve reliable results and produce useful conclusion.

In this updated Self-Care of Coronary Heart Disease Inventory (SC-CHDI) v3.0, items were added to better reflect the theory of self-care of chronic illness and revised based on recent research. The expanded SC-CHDI now reflects the theoretical concepts of self-care maintenance, monitoring, and management.The aim of this study was to evaluate the psychometric properties of the SC-CHDI v3.0.In a sample of adults with coronary heart disease, we tested the SC-CHDI v3.0 validity with confirmatory factor analysis. Reliability was calculated using Cronbach α, factor score determinacy coefficient, and global reliability index for multidimensional scales, with values0.70 considered adequate.The sample (n = 205) was predominantly male (79%) with a mean age of 65.3 ± 11.1 years. The self-care maintenance scale encompassed 2 distinct behaviors, namely, "illness related behaviors" and "health promoting behaviors," which reflect consulting and autonomous dimensions, respectively. The goodness-of-fit indices were adequate: χ2(25, N = 205) =31.86, P = .16, comparative fit index = 0.97, Tucker-Lewis Index = 0.95, root mean square error of approximation = 0.04 (90% confidence interval, 0.00-0.07), P = .705, and standardized root mean square residual = 0.045. Analysis of the new self-care monitoring scale yielded a single factor; goodness-of-fit indices were excellent: χ2(12, N = 205) =11.56, P = .48, comparative fit index = 1.00, Tucker-Lewis Index = 1.00, root mean square error of approximation0.001 (90% confidence interval, 0.000-0.07), P = .86, and standardized root mean square residual = 0.02. The self-care management scale had 2 dimensions of autonomous and consulting behavior with strong goodness-of-fit indices: χ2(7, N = 205) =6.57, P = .47, comparative fit index = 1.00, Tucker-Lewis Index = 1.00, root mean square error of approximation ≤ 0.001 (90% confidence interval, 0.00-0.08), P = .76, and standardized root mean square residual = 0.02. Reliability estimates were ≥0.80 for all scales.Our testing suggests that the SC-CHDI v3.0 is a sound measure of the essential elements of self-care for adults with coronary heart disease.

Background: Malnutrition in older people in hospitals leads to negative patient outcomes. Nurses often underestimate the problem, showing negative attitudes.Aims: To compare nurses' attitudes towar...

Among the distraction techniques used for the non-pharmacological management of acute pediatric pain, one of the most performed is clown therapy. Despite the presence in the literature of some systematic reviews that evaluate its effectiveness, none of them examines its outcomes on procedural pain which has therefore been investigated in this study. The literature search for randomized controlled trials (RCTs) was performed on the Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and Scopus over a time frame ranging from each database setup date to 31 July 2021. The primary outcome was the procedural pain of children. We used the Cochrane Risk of Bias tool to assess the risk of bias of the included studies. Six RCTs were selected for this review, which included a total of 517 pediatric subjects. Children undergoing clown therapy during the venipuncture or peripheral vein cannulation procedure reported less pain than those exposed to the standard of care (SMD = -0.55; 95% CI: -1.23, 0.13) but the result was not found to be statistically significant. School-aged children and adolescent reported significantly less pain (SMD = -0.51; 95% CI: -0.92, -0.09). Compared to the standard of care, children's anxiety was significantly lower with clown therapy (SMD = -0.97; 95% CI: -1.38, -0.56).Clown therapy seems effective in reducing procedural pain in children, particularly for older age groups, but due to poor methodological quality and the high risk of bias of the studies included, the results obtained should be considered with caution.• Clown therapy is one of the most used techniques in the non-pharmacological management of acute pediatric pain. • Laughter physiologically stimulates the production of beta-endorphins, substances with an effect similar to opiates.• Clown therapy seems effective in reducing procedural pain and anxiety in children. • The intervention in school-age children or adolescents produces a statistically significant decrease in the symptom.

The aim was to explore nurses’ experiences of caring for and accompanying patients dying without the presence of family during the COVID-19 pandemic.A qualitative descriptive design was used.A purposive sample of registered nurses, caring for dying patients in Italian health-care settings during the COVID-19 pandemic, were selected. To capture a broad range of experiences, a maximum variety of participants about workplace, age, gender and work experience were included. A total of 31 nurses agreed to participate in the study; 28 participants were female; participants were aged 41 on average (range 25-63 years) and worked in hospitals and nursing homes in the Northern and Central Italian regions. Six focus groups were conducted from August to December 2020 through Microsoft Teams, reaching data saturation. The transcripts were analysed through inductive content analysis. The COREQ checklist was followed for study reporting.Four main categories emerged describing nurses’ experiences: hugely increased deaths in time of COVID-19; ensuring physical, emotional, interpersonal and spiritual care for dying patients and supporting their families despite difficulties; ensuring care procedures of patients’ bodies after death and psychological consequences of caring for dying people during the pandemic.Registered nurses provided physical, spiritual and emotional care to dying patients during the pandemic, despite limited resources and knowledge, standing in for relatives who were not allowed to visit them; the experiences of caring for dying patients in the absence of the family caused emotional distress in nurses.Health-care systems should develop guidelines aiming to meet the psychological needs of dying people in case of restrictions on patients’ family visits. Health-care administrators should offer services to support the grieving process of relatives who cannot accompany dying patients and to reduce emotional distress in nurses caring for dying patients.

Skin tears are a significant problem for patients and healthcare professionals. They can cause pain, impact quality of life, and become chronic and infected. The risk of skin tears is associated with dependence in daily life activities and with nursing interventions.To examine which nursing interventions increase the risk of skin tears.Systematic review.The MEDLINE, CINAHL, Scopus, and Cochrane Library databases were searched in March 2022.Publications included were from 2012 to 2022.Seventeen articles were included in the final analysis reporting nursing interventions associated with the risk of skin tears. Hygiene with cold water and soap, not applying leave-on products to moisten/protect dehydrated skin, and wearing short sleeves were found to be associated with skin tears. Transferring patients into and out of bed in a rough manner and wearing jewelry or long nails can increase the risk of skin tears. Removal of adhesive dressings or bandages can also cause skin tears.Nursing staff need to know which interventions put their patients at risk of skin tears and which interventions are recommended to prevent skin tears. Nursing care can affect the health of the patient's skin.

Literature reports that the use of Standardized Nursing Terminology contributes to a better implementation of nursing care and patients' safety and to do research. ICNP is an international and combinatorial standard terminology proposal by ICN, adaptable to different settings, among which paediatric and neonatal.A literature review on different databases (Medline/Pubmed, CINAHL, Embase, Web of Science and Scopus) was conducted to investigate the use of ICNP in professional practice in paediatric and neonatal settings.44 papers were included in the review; 33 of which focused on the paediatric setting while 11 on the neonatal setting. It is evident ICNP is usable in both settings, permitting to describe nursing care to different age groups, in-hospital, out-of-hospital and in specific clinical situations.ICNP is up to the task of describing nursing care, implementing nursing care plans, analysing types of nursing care for management aims, studying concepts or specific pediatric or neonatal situations. ICNP is adaptable to different nursing frameworks and models. Few studies analyses ICNP implementation or effectiveness in clinical settings. Additional research is needed to verify ICNP effectiveness in paediatric and neonatal settings and to implement contextual catalogues.La letteratura indica che un utilizzo di terminologie infermieristiche standardizzate porti a un miglioramento della qualit dell’assistenza e della sicurezza dei pazienti, oltre che a un implemento della possibilit di svolgere ricerca. ICNP una terminologia infermieristica standardizzata proposta da ICN di tipo combinatorio, adattabile a diversi contesti professionali, tra cui quello pediatrico e neonatale.E’ stata svolta una revisione della letteratura allo scopo di indagare l’utilizzo del linguaggio ICNP nella pratica professionale in area pediatrica e neonatale attraverso le banche dati Medline/Pubmed, CINAHL, Embase, Web of Science e Scopus.Sono state incluse nella revisione 44 pubblicazioni, 33 riguardanti l’ambito pediatrico e 11 riguardanti quello neonatale. E’ emerso che ICNP utilizzabile in entrambi gli ambiti, permette di descrivere l’assistenza erogata in diverse fasce d’et , in contesti ospedalieri o extraospedalieri e in casi di situazioni cliniche specifiche.ICNP risulta in grado di descrivere l’assistenza, implementare piani di assistenza infermieristica, approfondire il tipo di assistenza erogata a fini manageriali, studiare alcuni concetti o situazioni specifiche di area pediatrica e neonatale. ICNP adattabile a diversi modelli concettuali dell’assistenza infermieristica. Pochi studi interessano l’effettiva implementazione del linguaggio in un contesto clinico o l’analisi di efficacia del suo utilizzo in questo ambito. Servono ulteriori ricerche per verificare l’efficacia di utilizzo di ICNP in contesti clinici neonatali e pediatrici e per sviluppare Cataloghi di contesto.

People with amyotrophic lateral sclerosis become dependent on caregivers for daily activities and to perform self-care activities at home. The family caregiver has an important role in the care. The patient decides and controls care but depends on the caregiver to implement self-care behaviours. The quality of caregiver-patient relationships could influence clinical outcomes, as it occurs in other illnesses, so the aim of this study was to investigate the relationship between the Amyotrophic Lateral Sclerosis patients and their family caregiver and how it impacts care, and patient and caregiver outcomes. We interviewed 22 patients/caregivers in a Neuromuscular Clinical Center in the South of Europe, between July and October 2018. A Grounded Theory approach was used, comprising line by line 'initial coding', memos writing, 'focused coding', advanced memos and categories definition. From the interviews three main categories emerged: 'reciprocity', 'loving to care' and 'changing to care' and four secondary categories: 'having support', 'sharing suffering', 'protecting each other' and 'thinking positive'. A stable and calm relationship between patient and caregiver, characterised by reciprocity, mutual help and affection affected patient self-care provided at home and the caregiver burden. The concept of mutuality seems to describe this relationship, despite the patient's dependence on the caregiver. The relationship with health professionals and educational interventions could influence the quality of the relationship. Further studies are needed to describe the quality of the relationship in this dyad, to investigate the presence of mutuality and how it affects patient and caregiver outcomes.

Older adults living in nursing homes (NHs) are at greater risk of injury resulting from a fall due to multiple factors, such as functional/cognitive impairment, postural instability, polytherapy, and psychotropic drugs. We aimed to assess characteristics of fallers, and investigate risk factors associated with falls among older NHs residents, through one-year longitudinal study. Demographic and clinical characteristics, number/typology of drugs, and fall occurrence were collected for each resident. We recruited 409 residents (82% women; 83 ± 9.4 years) in geriatric units (331, 81%) and in specialized dementia units (SDUs, 78%). 111 residents fell (27%), and 54 (48.6%) of them had an injury related to a fall. We detected an average of 1.3 falls (±0.48, range 1–10) per resident. Higher autonomy in activities of daily living, living in SDUs, and previous falls were significantly associated with falls. Thus, these findings should be considered as an alert to subsequent falls.

This review aimed to summarize existing nursing literature to provide an overview of the extent, range, and nature of nurses' involvement in artificial nutrition and hydration (ANH) at the end of life and to map the key concepts underpinning nurses' involvement in ANH. A scoping review was designed following the methodological framework guidelines of Arksey and O'Malley and the recommendations for advancing the methodology by Levac et al. An inductive qualitative content analysis was conducted according to the guidelines by Elo and Kyngäs. Thirty-nine articles were identified. Content analysis revealed 1 main category: "nurses' role in the decision-making process," with the 2 subcategories of "mediator" and "activator." The category and subcategories are influenced by the following generic categories: "being," "feeling," and "knowing," each of them constituted by 2 subcategories in their turn. Nurses perform the roles of activator and mediator. Their ability to establish good relationships and their attitudes enable the creation of teamwork and closeness to patients and family: relationships and attitudes are the subcategories of the "being" category. The category "feeling" represents the ways nurses experience the decision-making process, which can raise ethical and moral dilemmas and cause emotional responses. For these reasons, nurses have to create the right balance between personal-self and professional-self. The category "knowing" includes nurses' clinical and ethical knowledge about ANH. It emerges that deep clinical and ethical knowledge of ANH is necessary to provide consistent, adequate care at end of life.

To describe and develop a conceptual framework for the process of mutuality between nurse and patient.This was a qualitative study with a grounded theory (GT) design following the constructivist approach of Charmaz (SAGE handbook of research, 2014).A sample of 33 patients with one or more chronic diseases and 35 nurses were interviewed between July and October 2020. Comparative and simultaneous data analyses were conducted. Theoretical sampling and saturation of categories were used to define the sample size.A conceptual framework for mutuality between nurse (mean age 42 SD ±7 years, 89% female) and patient (mean age 63 SD ±8 years, 42% female) was developed, including the mutuality process, potential influencing factors for both nurses and patients, and outcomes. The mutuality process was characterised by three dimensions: developing and going beyond, being a reference, and deciding and sharing care. Influencing factors for nurses were personal characteristics and professional organisation, while for patients these were age and past experiences. Nurse outcomes were satisfaction and quality of life; patient outcomes were improved self-care and reduction of hospitalisation and emergency admissions.This study described a new conceptual framework for mutuality between nurse and patient, which could improve our understanding of the relationship between nurses and patients, thus enhancing both nurse and patient outcomes.

It is estimated that 20-40 % of medication errors (MEs) made by nursing students are not reported, thus creating a gap in learning from mistakes. There is scarce literature on the reasons for the underreporting of MEs made by nursing students.The aim was to analyse the opinions of nursing students about MEs, types and causes and factors that facilitate or discourage ME reporting during clinical training.Qualitative descriptive design.Nursing School affiliated with Milan University, Italy.A purposeful sample of third-year or near-graduation nursing students.Data were collected between October and November 2019 through focus groups until data saturation. A semi-structured interview was used for conducting the focus groups and categories were identified by content analysis. Triangulation of researchers and member checking were performed to ensure result trustworthiness.The study sample was 37 students assigned to four focus groups. Four ME categories were identified: type; cause(s); barriers; and facilitators of reporting. The most common errors were wrong drug, incorrect drug dosage and dilution, which were attributed to individual and/or organizational factors. The main barrier to ME reporting was fear of receiving a negative evaluation by the head nurse. Nonetheless, constructive reflexive evaluation was perceived as a facilitator of ME reporting.Our findings show that MEs made by nursing students during their placement oftentimes go unreported to avert negative evaluation. Barriers to ME reporting may be reduced by enhancing risk awareness and error analysis with the support of clinical nurses and nursing mentors.

The use of central venous catheters with peripheral insertion (PICC) has increased rapidly in recent years, particularly in cancer patients. The benefits provided may occasionally be affected by relevant complications, such as infections and thrombotic events, especially in neuro-oncological patients. To date, the risk of PICC-related complications in this subset of patients is unknown, as is tolerability. As a primary objective, this study aimed to collect complications related to PICCs in primary neuro-oncological patients. As a secondary objective, the study aimed to evaluate PICC tolerability. Neuro-oncological patients with PICCs that were placed as part of normal clinical practice at IRCCS Neurologico C. Besta were consecutively enrolled in the study. PICC-related complications were recorded immediately (during the procedure), early (within 1 week after PICC insertion), and late (1–3-5 months after PICC placement). At the same time points, all patients were also evaluated for tolerability through interviews with semi-structured, open-ended questions. Sixty patients were enrolled (41 males and 19 females, with a median age of 56.2 years). Excluding loss to follow-up, 33/49 patients developed at least one complication related to the PICC. Immediate complications mainly included hematoma (8), accidental arterial puncture (4), and primary malpositioning (3). Regarding early and late complications, 3 device-related infections, 8 thrombotic events, and 20 mechanical complications were registered. Semi-structured interviews revealed an overall positive experience with the device. The most negative impact was on hygiene habits, with 34 patients becoming caregiver-dependent. Over time, almost all patients became used to the device and perceived greater security during chemotherapy. A strongly negative issue was the difficulty of relying on competently trained healthcare personnel in outpatient setting. The results showed a nonnegligible increased thromboembolic risk in neuro-oncological patients with PICCs, almost double that in historical oncological populations. It is essential to extend the study to a greater number of patients to achieve reliable results and to identify patients at high risk. The device seems to be positively accepted by the majority of patients, without affecting activities of daily living.

OBJECTIVE The aim of this study was to develop and psychometrically test the properties of the Self-care in Motor Neuron Disease (SCMND) Index. METHODS This instrument development and validation study was conducted in 3 phases. The first is to identify self-care behaviors in people with motor neuron disease (MND), and the second is to evaluate the content validity of the SCMND Index. Then, between March 2017 and March 2018, the tool was administered to 107 people with MND for psychometric tests. RESULTS The SCMND Index was developed based on the middle-range theory of self-care of chronic illness, including 15 self-care behaviors related to respiration, nutrition, mobility, medication, medical visits, and complication management. Content validity was excellent. Data analysis suggests that the instrument has a good internal consistency in all 3 domains and excellent reproducibility. Increased self-care behaviors' median values were associated with mechanical ventilation, cough assistance, and dysphagia. Domains differed significantly based on access (maintenance), hospital admissions (monitoring and management), and respiratory infection (management). CONCLUSIONS Self-care is a patient-centered outcome, and it is a key point of healthcare. Results suggest that the SCMND Index is useful for both clinicians and researchers to evaluate self-care in MND.

Background Dependence is a common life experience and innate condition for human beings due to their bodily and relational essence, but in contemporary society, it has become a stressful condition. Care dependence is central to nursing, and patients with advanced cancer are often dependent on care. Understanding nurses' perceptions of care dependence can contribute to awareness of the impact it has on nurses. Objective The aim of this study was to explore palliative care nurses' experiences and perceptions regarding patient dependence. Methods Sixteen nurses taking care of dependent patients in a palliative care center in Rome were interviewed. Giorgi's descriptive phenomenological method was used. Results Nurses caring for dependent patients transcend the boundaries of dependence. Care dependence is an experience of powerlessness and regression. A patient's life in dependence is precarious, as they have to overcome the daily limits of life. Taking care of dependent patients requires nurses to manage the unmanageable and to know and to embrace change from within in order to build positive relations of personal closeness and reciprocal self-giving. Conclusions Nurses should be aware that self-transcendence and the consequent positive relations could make the difference in the experience of care dependence and promote personal growth for both patient and nurse. Positive and transcending relationships can transform care dependence into the opportunity to find meaning and purpose in life. Implications for practice The study highlights what nurses feel in caring for dependent patients. Understanding nurses' perceptions is important to delineate a proper caring for dependent patients.

The spread of Coronavirus Disease 2019 (COVID-19) has reached a pandemic dimension within a few weeks. Italy has been one of the first countries, together with Cina, dealing with the outbreak of COVID-19 and adopting severe measures to limit viral transmission. The spread of COVID-19 may have several implications in organ transplant activity and medical and nursing personnel should be know these implications. The initial experience gained during the COVID-19 outbreak shows that around 10% of infected patients in Italy need intensive care management to overcome the acute respiratory distress syndrome. Due to the exponential rise of infected patients we are now facing an actual risk of saturation of potential tissue donors which can adversely affect the overall donation activity and reduce the number of transplants. Italian preliminary data show an overall decrease of 40% in March 2020. This paper aim at showing how the pandemic affects procurement of corneal tissues through a comparative analysis 2019-2020 related to the quarter February-April.La diffusione della malattia da Coronavirus (COVID-19) ha raggiunto una dimensione pandemica in poche settimane. L’Italia è stata uno dei primi Paesi, con la Cina, ad affrontare l’epidemia e ad adottare misure severe per limitarne la trasmissione. La diffusione del virus, denominato , può avere diverse implicazioni nell’attività di procurement e trapianto di tessuti oculari, di cui i professionisti sanitari dovrebbero essere a conoscenza. L’esperienza iniziale acquisita durante la pandemia mostra che circa il 10% dei pazienti infetti in Italia ha bisogno di una terapia intensiva per superare la sindrome da distress respiratorio acuto. A causa dell’aumento esponenziale dei pazienti contagiati, stiamo affrontando un rischio reale di saturazione dei potenziali donatori di tessuti che può condizionare sfavorevolmente l’attività complessiva di donazione e ridurre il numero dei trapianti. I dati preliminari italiani mostrano, nel mese di marzo 2020, una diminuzione complessiva del 40% delle donazioni. L’obiettivo del presente articolo è mostrare in che modo la pandemia abbia influenzato l’attività di procurement dei tessuti corneali, attraverso un’analisi comparativa riferita ai trimestri febbraio-aprile 2019 e 2020.

BACKGROUND: Mutuality, a positive relationship between caregiver and care receiver that affects patient's health and caregiver's burden, stress, and well-being, has never been investigated in motor neuron disease. METHOD: We conducted a mixed-method study with convergent parallel design. Quantitative data were collected with the Mutuality Scale, and qualitative data were collected using deep interviews. The sample was composed of 30 people with motor neuron diseases and 24 family caregivers. RESULTS: Deductive, qualitative content analysis of the interviews confirmed the presence of mutuality and its 4 dimensions. The average score of patients' Mutuality Scale was 3.07 (SD, 0.79; range, 1.3-4), and that of the caregivers was 3.16 (SD, 0.53; range, 2.2-3.9). The dimensions "love" and "shared values" had the highest scores, whereas the dimension "shared pleasurable activities" had the lowest score. Patients' and caregivers' answers correlated. CONCLUSION: Mutuality concept and its 4 dimensions had content validity in motor neuron disease people. Nurses should consider the level of mutuality and adopt strategies to increase and preserve it.

Background Nutrition is a basic patients' need and an important component of nursing. End-of-life cancer patients can experience difficulties in eating and drinking, sometimes requiring artificial nutrition and hydration (ANH). Nurses' knowledge and attitudes greatly influence nursing care. Nurses may lack knowledge of ANH. To date, no study has explored the knowledge and attitudes of oncology and palliative care nurses toward end-of-life ANH. Objective To describe oncology and palliative care nurses' knowledge of and attitudes toward ANH. Methods A multicenter cross-sectional study was conducted in 7 regions of Italy using the Italian version of the Questionnaire on Knowledge and Attitudes in Providing ANH for Terminal Cancer Patients. Attitudes were divided into benefits and burdens of providing ANH. Data were analyzed by descriptive statistics. Results High percentages of oncology and palliative care nurses showed reasonable knowledge about ANH. More disagreement was evidenced about benefits and burdens of ANH, and lower importance was given to them. Conclusions Some misconceptions and a low level of awareness exist among some nurses about ANH. More nursing studies should be conducted and extended to different care settings. Moreover, guidelines should be reinforced with a nursing perspective to better define nurses' role in the decision-making process on ANH. Implications for practice This exploration of nurses' knowledge of and attitudes toward ANH in end-of-life cancer patients can contribute to an understanding of how nurses can be involved in better meeting cancer patients' nutritional needs at the end of life.

The paper investigates the critical care staff's support towards organ donation by analysing how their attitude, knowledge, confidence, engagement, and training can act as predictors of donation consent rates. Our study focused on hospitals in the Apulia Region, Italy.The study employs a quantitative methodology based on a survey of healthcare professionals. The rate of consent to organ and tissue donation at the hospital level, given as a ratio of the permissions received to the proposals performed, was extracted from GEDON software related to the year 2019 report. For each Apulian participating hospital, we calculated a median score for each of the five predictors (namely, attitude, knowledge, confidence, engagement, and training) and investigated the association with hospital consent rates.The results highlight that the engagement of the intensive care units' healthcare personnel stands as the only influential predictor of the consent rate.In Italy's Apulia Region, efforts are needed to increase consent rates for organ donation. Strategies should concentrate on continuous support, as well as specific training of hospital staff involved in the donation process.

Half of the deaths recorded in non-surgical patients attributable to venous thromboembolism (VTE) affect those with stroke. The uncertain benefit of anticoagulant therapy has increased interest in non-pharmacological intervention to prevent VTE.To evaluate the efficacy and safety of non-pharmacological interventions to prevent VTE in stroke patients.Overview of systematic reviews with retrieval of documents in compliance with the PICOS Framework and through a research strategy implemented on 4 April 2019 in six biomedical databases and in the PROSPERO registry. The tools used to assess the methodological quality and the risk of bias were the AMSTAR checklist and the ROBIS tool, respectively. The results have been synthesized with narrative modality.Seven systematic reviews of different methodological quality and risk of bias met the inclusion criteria. The non-pharmacological interventions of prophylaxis used are graduated compression stockings (GCS) and intermittent pneumatic compression devices (IPCD). The first has no effect on VTE and has important side effects, the second is promising in reducing mortality from all causes and decreases the incidence of deep vein thrombosis.The use of IPCD, despite the efficacy observed, should be reserved, after a risk assessment of VTE and a subgroup analysis, for patients who can derive the maximum benefit from the intervention.In stroke patients the use of GCS to prevent VTE is not recommended because it is not superior to standard care and can cause damage. IPCD as a intervention of prophylaxis appears to be effective but further confirmation is needed from future studies.La meta' dei decessi registrati nei pazienti non chirurgici attribuibili a tromboembolismo venoso (TEV) colpisce quelli con stroke.L'beneficio della terapia anticoagulante ha accresciuto interesse verso gli interventi non farmacologici per prevenire il TEV.Valutare efficacia e la sicurezza degli interventi non farmacologici per prevenire il TEV nei pazienti con stroke.Overview di revisioni sistematiche con reperimento dei documenti nel rispetto del PICOS Framework e tramite strategia di ricerca implementata il 4 aprile 2019 su sei database biomedici e sul registro PROSPERO. Gli strumenti utilizzati per la valutazione della qualita' metodologica e del rischio di bias sono stati rispettivamente la checklist AMSTAR e lo strumento ROBIS. I risultati sono stati sintetizzati con modalita' narrativa.Sette revisioni sistematiche di differente qualita' metodologica e rischio di bias hanno rispettato i criteri di inclusione. Gli interventi non farmacologici di profilassi utilizzati sono stati calze a compressione graduata (CCG) e dispositivi di compressione pneumatica intermittente (DCPI). Il primo non ha effetto sul TEV e comporta importanti effetti collaterali, il secondo è promettente nel ridurre la mortalita' per tutte le cause e diminuisce l'incidenza di trombosi venosa profonda.L'utilizzo di DCPI, nonostante l'efficacia osservata, andrebbe riservato, dopo una valutazione del rischio di TEV e una analisi per sottogruppi, ai pazienti che possono trarre il massimo beneficio dall'intervento.Nei pazienti con stroke l'utilizzo di CCG per prevenire il TEV sconsigliato perche' non superiore alle cure standard e puo' arrecare danno. I DCPI come intervento di profilassi sembrano efficaci ma sono necessarie ulteriori conferme da studi futuri.

BACKGROUND Spinal muscular atrophy (SMA) is one of the most common genetic causes of death in children. Recently, European Commission (EU) has approved a new gene therapy based on onasemnogene abeparvovec (Zolgensma) for the treatment of patients with SMA. It is essential that children suffering from SMA also apply self-care methods to maintain their health, monitor their weight and food intake, and use appropriate remedies. Indeed, self-care is a crucial element in the health care system because it is able to improve survival and prevent hospitalizations. The purpose of this review is to systematically explore the characteristics of self- care in children with spinal muscular atrophy and the relationship with their parents and the collaboration of healthcare professionals. METHODS An integrative review of the literature has been conducted. The electronic databases CINAHL, Embase, PubMed, and SCOPUS were searched. RESULTS Thirteen articles met the inclusion criteria and were reviewed using Whittemore and Knalf's integrative review methodology. The analysis of the 13 articles selected for the review show that previous literature has focused on six prevalent themes: problem solving and care behavior, decision making, optimizing living with an illness, high quality, childfocused homecare, healthcare professionals, and monitoring behaviors. CONCLUSIONS This paper highlights how self-management behaviors depend on four basic aspects: the person (individual, cognitive, and social perceptions), the patient's family (level of knowledge of the pathology, involvement in the management and quality of relationship with the patient), the community (relationships with external social contexts, such as school and other organizations), and the healthcare system (availability of resources and the degree of evolution of healthcare).

The European Quality Questionnaire (euroQ2) is the culturally-adapted version to the European context of the Family Satisfaction in Intensive Care Unit (FS-ICU) and Quality of Dying and Death (QODD) tools in a single instrument divided into three parts (the last is optional). These tools were created for an adult setting. The aim of this study was the Italian validation and analysis of the euroQ2 tool. The Italian version of euroQ2 questionnaire was administered to the relatives, over 18 years of age, of adult intensive care unit patients, with the Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale—Revised (IES-r). For the re-test phase the questionnaire was administered a second time. One hundred questionnaires were filled in. The agreement between test and retest was between 17–19 out of 20 participants with an upward trend in the re-test phase. A measure of coherence and cohesion between the euroQ2 variables was given by Cronbach’s alpha: in the first part of the questionnaire alpha was 0.82, in the second part it was 0.89. The linear Pearson’s correlation coefficients between all questions showed a weak positive correlation. The results obtained agreed with the original study. This study showed a good stability of the answers, an indication of an unambiguous understanding of the Italian translation.

Second edition of problem-solving incorporated into blended learning was implemented in a Masters Nursing Degree. The new redesign took into account the critical issues recorded in the previous edition and made the necessary changes. The changes should facilitate students’ online activities and allow them to become more involved in learning how to solve health problems in communities. It was considered interesting to investigate if the students perceived the problem-solving’ usefulness in a blended learning environment. The descriptive study is based on a questionnarie completed by 24 students at the end of problem-solving. The students’ perceptions of different elements were investigated both including their attitude in using the Moodle forum and worshop and the Mindomo software upload on Moodle, in learning through the sharing questions and ideas in an blended environment. The empirical results show the students’ agreement on the usability and applicability of blended problem-solving, with the exception of Mindomo. The answers given by students lead to reflection on the need for a better their blended learning adaptability. In fact, students’ responses are neutral, both in terms of their greater involvement in the construction of their learning, and in terms of the extension of problem-solving incorporated into blended learning to other courses

Health determinants in irregular migrants with chronic diseases: analysis of the accesses to the clinic of a non-governmental organization.Of the 112 thousand irregular migrants in Lombardy, 49 thousand reside in the area of Milan. Data on their health conditions and needs are scarce and fragmented, especially about their socio-demographic and clinical determinants.To describe the main socio-demographic and clinical characteristics of irregular migrants with chronic diseases who access the clinic of a non-governmental organization that provides primary care and their association with the number of accesses.Retrospective observational study of a dataset containing information on irregular migrants with chronic diseases (N = 411) carried out at the Naga Onlus clinic in 2017.The males come essentially from Africa and are often affected by back pain or low back pain (BP-LBP); females, mostly from East Europe or Central-South America, are frequently hypertensive. Up to 24 years of age, anxiety or depression prevails; at 25-44 years BP-LBP, at 45-64 years diabetes and in advanced age, hypertension. The knowledge of a EU language and the diagnosis of BP-LBP are respectively positively and negatively associated to the number of accesses.Following the progressive aging with the increasing prevalence of chronic conditions, marginalization and stigma, the "healthy migrant" effect once characterizing irregular migrants is being replaced by the "exhausted migrant" effect and the assimilation of a state of health similar to that of native counterparts.

The spread of the donation culture is a crucial element in promo- ting solidarity and altruistic ideas necessary for meeting the needs of tissue transplants present on the territory. The research intends to assess the knowledge, the values, the attitude and the willingness to donate their corneas of adults, residents in the Province of Barletta - Andria - Trani (BT).The sample was composed of 815 adults aged between 18 and 70 years and it was selected with simple random sampling among population residents in the Province of Barletta - Andria - Trani. All participants were interviewed by means of a questionnaire formulated and sent via Google modules. Their knowledge, values and attitudes were evaluated to deter- mine their willingness to donate their corneas.The participation rate was 64.4% (525/815). 68.4% (359/525) of participants would agree to donate their corneas. 89% (467/525) of participants know the theme of dona- tion. Asking specific questions to the participants on the donation path, the correct answers are on average 80%. This percentage increases to 86.2% considering only those who are willing to donate. Greater knowledge and an increase in altruistic values can be associated with an increase in willingness to donate.A good percentage of participants, about at 68,4% (359/525), is willing to donate their corneas. The awareness in this regard turns out to be very high, but the specific knowledge of the entire process should be further increased anyway.INTRODUZIONE . Le procedure di emodinamica ed elettrofisiologia (coronarografie radiali/femorali, impianto di pacemaker/defibrillatore) possono provocare dolore di diverso tipo ed intensità durante l’esecuzione e nelle ore seguenti. OBIETTIVI. Valutare l’insorgenza di dolore e ansia in pazienti sottoposti a procedure di emodinamica ed elettrofisiologia. Descrivere la somministrazione, la frequenza, la tempistica e il dosaggio di farmaci analgesici e ansiolitici pre, intra, post procedura e l’esito ottenuto. METODI. E’ stato condotto uno studio descrittivo multicentrico; rilevati dati su ansia, dolore con una scala VAS (0-10) prima, durante, post procedura e sulla soddisfazione del paziente per le informazioni ricevute e il controllo del dolore. RISULTATI. Sono stati raccolti dati su 230 pazienti, la procedura più eseguita è stata la coronarografia radiale (68.7% dei casi), la più dolorosa (mediana 4, IQR 3-6) e ansiogena (mediana 5, IQR 2-6) l’impianto di pacemaker/defibrillatore. Durante la procedura 13 pazienti hanno ricevuto un’analgesia per un dolore da lieve ad elevato; nelle 24 ore successive 34 (5 sottoposti a coronarografia radiale e 29 ad impianto pacemaker/defibrillatore) hanno riferito un dolore elevato e tutti tranne 5 hanno richiesto un’analgesia. La soddisfazione per il controllo del dolore è stata insufficiente per i pazienti sottoposti ad impianto pacemaker/defibrillatore e 55 pazienti avrebbero desiderato più spiegazioni sul dolore. CONCLUSIONI. L’attenzione al controllo del dolore e la soddisfazione del paziente sono migliorabili. Eventuali stati d’ansia andrebbero indagati maggiormente e si dovrebbero fornire più informazioni sulla procedura.

Organ transplantation is considered a life-saving treatment for patients with end-stage pathologies. The knowledge and the attitude of nurses can positively influence the willingness of family members and patients to give consent to organ and conse- quently organ donation rates. To understand the critical capacity of nursing students to self- evaluate themselves on information on brain death, donation and transplantation, investi- gating scientific knowledge, predisposition and attitude related to these topics through a survey.This work is a cross-sectional descriptive study carried out among conveniently selected undergraduate nursing students (n = 578) of three Universities respectively in northern, center and southern of Italy using a questionnaire formulated on the basis of the FAQs prepared by the National Transplant Center (CNT).Most of students show an adequate level of knowledge and attitudes favorable to organ and tissue donation even if very few students have signed the donor card. Students' knowledge and perceptions are still lacking in specific areas such as legislations (only 6%).The findings suggest the need for revising the nursing curricula to improve the future nurses' skills, increase the modality to sign the donor card and favor the rate of organ donation.Il trapianto d’organi è considerato un trattamento salvavita per pazienti con patologie end-stage. Le conoscenze degli infermieri e le loro opinioni possono influenzare la volontà di familiari e pazienti a dare l’assenso alla donazione di organi e tessuti. Lo scopo del presente lavoro è comprendere la capacità critica degli studenti di auto-valutarsi in merito alle informazioni sui temi di morte cerebrale, donazione e trapianto, indagando attra- verso una survey le conoscenze scientifiche, la predisposizione e l’atteggiamento relativi a questi argomenti.Lo studio è di tipo multicentrico e trasversale, realizzato attraverso la collaborazione di tre Università rispettivamente del Nord, Centro e Sud dell’Italia. È stato effettuato un campionamento di convenienza con un disegno descrittivo e quantitativo. Il campione si compone di 578 studenti, con l’esclusione 20 studenti che non hanno dato il loro consenso alla compilazione del questionario.La maggior parte degli studenti presenta un livello adeguato di conoscenza e atteg- giamenti favorevoli alla donazione di organi e tessuti, pochissimi hanno firmato la carta del donatore. Inoltre, le conoscenze e le percezioni degli studenti sono ancora carenti in aree speci- fiche, come la comprensione della morte cerebrale (92%) e la conoscenza relativa alle leggi specifiche (solo il 6%).Il principale suggerimento tratto dello studio è quello di rivedere i curricula degli studenti in infermieristica, per migliorare le competenze dei futuri infermieri.

Background Patients in palliative care are the population cohort that most frequently develop pressure injuries, severely impacting their quality of life. Data from prospective studies on the prevalence and incidence of pressure injuries in hospices are lacking. Aim To describe the point prevalence and cumulative incidence of pressure injuries in patients admitted to residential hospices, and to analyze their predictive factors over time. Design Multicentre prospective longitudinal observational study. Setting/participants Adult patients (n = 992) enrolled in 13 Italian residential hospices, with a minimum sample of 280 for each macro-region (North, center, South/Islands). Methods Assessments including the Karnofsky Performance Status, Braden, Edmonton Symptom Assessment System Revised scales and pressure injury staging according to National Pressure Ulcer Advisory Panel were conducted at least every four days, from admission to patients’ death/discharge. Results The 7,967 observations recorded provided prevalence and incidence rates of 34.1% and 26.5%, respectively. The logistic regression model showed non-cancer disease (OR = 2.39, 95%CI = 1.65–3.47), age >80 (OR = 2.01, 95%CI = 1.49–2.71), Braden score ‘at risk’ (OR = 1.92, 95%CI = 1.17–3.14), urinary catheter (OR = 1.96, 95%CI = 1.40–2.75), drowsiness (OR = 1.41, 95%CI = 1.02–1.95) and artificial nutrition (OR = 1.47, 95%CI = 1.01–2.14) as the variables associated with pressure injury at admission. The generalized estimating equations models, built on the timeframes for observation groups, revealed male gender (OR = 1.68, 95%CI = 1.01–2.79) and Braden score ‘at risk’ (OR = 4.45, 95%CI = 1.74–11.34) as predictive factors of a new pressure injury developed up to three weeks before a patient's death, while in the last ten days of life these predictors were replaced by diagnosis of cancer (OR = 1.80, 95%CI = 1.11–2.91), worsening pain (OR = 1.65, 95%CI = 1.10–2.49), drowsiness (OR = 1.79, 95%CI = 1.25–2.57) and dyspnea (OR = 1.48, 95%CI = 1.01–2.18). Conclusions The high incidence and prevalence of pressure injuries confirm the importance of palliative care nurses continuously focusing on prevention and management strategies. In the last three weeks of a patient's life, the predictive power of the Braden scale for a new pressure injury is not confirmed, throwing doubt on the effectiveness of aimed interventions at modifying risk factors. Along the different disease trajectories, pressure injuries developed during the instability/worsening phases of illness, occurring before hospice admission for non-cancer patients and in the end-of-life phase for cancer patients. Despite continuous provision of appropriate interventions, most of the new pressure injuries were detected during the last ten days of a patient's’ life and assessed as 'unavoidable'. These results are crucial to guiding palliative care nursing plans during the different phases of illness, and to predicting care needs, possible management strategies (‘wound management’ vs. ‘wound palliation’), and resource utilization.

Background Intensive care unit diaries are often used to support patients during their psychological recovery. The intensive care unit stay can be upsetting, disturbing and traumatic for both patients and their families especially when the patient does not survive. Aim To investigate the connection between intensive care unit diaries and the grieving process experienced by family members of adult patients deceased in the intensive care unit. Methods Systematic literature review according to PRISMA guidelines: PubMed, CINAHL and Cochrane Library were consulted. The Caldwell’s framework was used for the quality appraisal. Results Only six studies examine this topic. The potential benefits of intensive care unit diaries in family members’ bereavement process may be an aid to realise how extremely ill their loved one was, may provide comfort and may help relatives to cope with their loss. Conclusion The use of intensive care unit diaries to help family members’ bereavement process may be a useful tool but further research is necessary to better understand their role and benefits.

INTRODUZIONE E SCOPO: L'incremento di peso si osserva frequentemente nei pazienti sotto- posti a Trapianto di Fegato. Questa condizione e spesso associata allo sviluppo di altre compli- canze che potrebbero influenzare la sopravvivenza a lungo termine. Tuttavia, i fattori di rischio non sono stati ancora chiarificati. Lo scopo dello studio e di rilevare la prevalenza di sovrappeso e obesitaI€, e la variazione del BMI nei tre anni successivi al trapianto, e di identificare i fattori di rischio associati. METODO: Sono stati retrospettivamente reclutati i soggetti sottoposti a Trapianto di Fegato, presso la Fondazione IRCCS " CaI€ Granda – Ospedale Maggiore Policlinico" di Milano dal 1° Gennaio 2005 al 30 Giugno 2014.Sono stati reperiti parametri clinici, biochimici e farmaco- logici, alla dimissione e ad 1,2,3 anni dal trapianto di fegato. RISULTATI: Sono stati inclusi 145 soggetti, 95(66%) uomini, 53 anni (44-59), 48(33%) affetti da Cirrosi HBV+HDV correlata, 30(21%) da Cirrosi Etiltossica. Alla dimissione il BMI dei soggetti era 21.9 Kg/m2 e la prevalenza di sovrappeso era del 14%; gli stessi parametri dopo 1,2 e 3 anni di follow-up erano, rispettivamente, 25.6 Kg/m2 e 40%, 25.5 Kg/m2 e 41%, 25.4 Kg/m2 e 37%. L'incremento medio di peso corporeo, durane il primo anni, e stato di 9.8 Kg(p

Objective To validate the International Skin Tear Advisory Panel (ISTAP) Classification System in Italian. Methods In collaboration with the ISTAP, the classification system was translated into Italian using a forward-back translation process. To validate the translated system, a convenience sample of 212 health professionals classified 30 photographs of skin tears originally used by ISTAP. The wound images were labeled type 1, 2, or 3 as described by the classification system. The resulting scores were compared with the ISTAP classification, and the reliability of agreement was calculated with Fleiss κ. Results Complete data were obtained from 209 healthcare professionals. When the image classifications were compared with the original ISTAP indications, 72.5% of all classifications were correct. Data indicated a moderate level of agreement (Fleiss κ = 0.466, range = 0.41-0.60). Data analysis showed similar agreement levels between nurses (n = 197, Fleiss κ = 0.466) and nonnurses (n = 12, Fleiss κ = 0.46). Conclusions The study validates the Italian version of the ISTAP skin tear classification system. Further studies are necessary to confirm the system's usability in Italian research and clinical settings.

Currently more than 40% of surgical procedures are performed on subjects over65 years. this event has brought to the fore the concept of frailty. The aim of this work is to summarize the knowledge available in the literature in order to better understand what are the essential aspects of frailty, which impact it has on surgical outcomes of the elderly and what action we need to apply to prevent it.A narrative literature review was conducted using the principal bibliographic biome- dical and nursing databases.Literature analysis revealed that frailty is a medical syndrome with multiple causes characterized by reduced physiological functions and decreased stress resistance, resulting in several adverse outcome following surgery. In the selected studies, frailty has emerged as a reliable indi- cator of increased morbidity and mortality, long-term hospital stay, post-discharge institutionali- zation, and increased healthcare costs. For frailty prevention and treatment, the most important clinical intervention is physical exercise.Identifying a patient like frail in the preoperative period allows the health profes- sional to adequately transmit information about individual perioperative risks. It should provide an opportunity to discuss the expectations and wishes of the patient for whom an adverse posto- perative outcome is expected. In addition, for high risk subjects, a clinical pathway with a well- structured discharge program can be anticipated in order to avoid hospital prolongations, thus reducing hospitalization costs.SCOPO: più del 40% delle procedure chirurgiche sono condotte su soggetti ultrasessantacinquenni; ciò ha portato alla ribalta il concetto di fragilità. Scopo di questo lavoro è compendiare le cono- scenze disponibili in letteratura per meglio comprendere quali siano gli aspetti essenziali della fragi- lità, quale sia l’impatto che essa ha sugli outcomes chirurgici dell’anziano e quali interventi appli- care per prevenirla.È stata condotta una revisione narrativa della letteratura utilizzando le principali banche dati bibliografiche di stampo biomedico ed infermieristico.Dall’analisi della letteratura è emerso che la fragilità è una sindrome medica con molte- plici cause caratterizzata da ridotte funzionalità fisiologiche e diminuita resistenza allo stress, che causa diversi outcome avversi a seguito degli interventi chirurgici. Negli studi considerati la fragi- lità, comunque essa venga considerata, è emersa come un indicatore attendibile di aumentata morbilità e mortalità, di degenza ospedaliera protratta nel tempo, di istituzionalizzazione post- dimissione e di aumento dei costi sanitari. Per la correzione della fragilità, l’intervento di maggior significato clinico è costituito dall’esercizio fisico.L’identificazione di un paziente fragile nel preoperatorio consente agli operatori sanitari di trasmettere adeguatamente le informazioni riguardanti i rischi perioperatori individuali: dovrebbe fornire l’occasione di discutere riguardo alle aspettative ed ai desideri del paziente per il quale si prevede un esito postoperatorio sfavorevole. Inoltre, per i soggetti ad alto rischio, è possi- bile prevedere anticipatamente un percorso clinico con un programma di dimissioni ben struttu- rato, per evitare prolungamenti della degenza, diminuendo così le spese per i ricoveri ospedalieri.