Cardiovascular nurses and organizational well-being: a systematic review

AIMS

This systematic review assesses the organizational well-being of nurses working in cardiovascular settings and identifies environmental variables influencing it.

METHODS AND RESULTS

The Joanna Briggs Institute's methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines have been followed. The search was conducted, from the database inception up to and including 1 December 2022, on Medline (via PubMed), Cumulative Index of Nursing and Allied Health, Cochrane Library, and Scopus. Critical appraisal and data extraction were conducted using standardized tools. Six articles of high quality were included. These mostly concerned cross-sectional studies, conducted in heterogeneous contexts, which highlight the peculiarity of the cardiovascular nursing setting. Three thematic areas were identified: stressors of cardiovascular settings; outcomes of stressors on nurses; and coping strategies used by cardiovascular nurses to deal with such stress factors. Identified stress factors included a lack of autonomy, conflicts between professional and family roles, high workloads, and stressful relationships with patients and caregivers. These organizational variables could generate nurses' burnout, depression, irritability, and/or sleep disorders. In trying to cope with such stressors, cardiovascular nurses used different strategies for compensating, avoiding, escaping, or ignoring the problem, or, in other cases, became somewhat aggressive.

CONCLUSION

Considering the limited data, cardiovascular nursing coping strategies should be further investigated, so that effective pathways for preventing or limiting stress factors can be identified and applied by the organizations. Monitoring and intervening on stress factors in this care setting could improve cardiovascular nurses' organizational well-being and accordingly patients' outcomes.

REGISTRATION

PROSPERO: CRD42022355669.

Measuring Nurses' Organizational Well-Being: A Systematic Review of Available Instruments

This systematic review aimed to identify and compare instruments measuring nurses' organizational well-being, summarise the dimensions measured by these instruments, the statistical analysis performed for validity evidence and identify an instrument that comprehensively investigates nurses' organizational well-being. The JBI Manual for Evidence Synthesis and the PRISMA checklist were used as guidelines. The search was conducted on Medline, CINAHL, Cochrane Library and Scopus. Critical appraisal and data extraction were drawn on the COSMIN checklist. Dimensions were conceptually synthesized by the measurement concepts' similarity. Twenty-two articles were retrieved and they included 21 instruments that measured nurses' organizational well-being. The instruments vary by dimension number (range 2-19), items (range 12-118) and concept elicitation. A plurality of methodologies has been used in instrument development and assessments of evidence for validity. Only four instruments reported a concurrent criterion validity or a measurement comparison with an already tested-for-validity instrument. Similar dimensions were leadership and support, relationships and communication, work-family balance, work demands, violence, control and autonomy, satisfaction and motivation, work environment and resources, careers, and organizational policy. This review underlines the core areas of the instruments that measure nursing organizational well-being. It allows administrators and researchers to choose the appropriate instruments for monitoring this multidimensional concept.

Work-related stress, job satisfaction, and quality of work life among cardiovascular nurses in Italy: Structural equation modeling

AIM

To investigate the simultaneous effects of work-related stress and job satisfaction on cardiovascular nurses' quality of work life.

BACKGROUND

Prior research has investigated nurses' work-related stress, job satisfaction, and quality of work life as separate aspects and not in specific nursing settings, such as cardiovascular wards. Cardiovascular care settings can be particularly stressful for nurses, who are often faced with distress, depression and patients and caregivers' physical and psychological exhaustion.

METHODS

A multicenter cross-sectional study was conducted among 1126 cardiovascular nurses from 10 hospitals in Italy. Work-related stress, job satisfaction, and quality of work life were measured using valid and reliable questionnaires. Structural equation modeling was performed.

RESULTS

Nurses working in critical cardiac care units experienced more stress than their colleagues working in other cardiac units. Nurses working in cardiac outpatient clinics reported lower quality of work life than those working in other cardiac settings. There was a negative relationship between work-related stress and nurses' quality of work life, which was partially mediated by job satisfaction, indicating that stress generated by the work environment negatively affect nurses' quality of work life by reducing their job satisfaction.

CONCLUSION

Cardiovascular nurses' quality of work life is negatively affected by work-related stress. The work-related stress is mediated through job satisfaction. Nurse managers should maximize nurses' job satisfaction by providing comfort at work, supporting professional development opportunities, sharing organizational objectives, and actively listening and addressing nurses' concerns. When cardiovascular nurses' quality of work life is elevated, patients' care quality and outcomes are improved.

Remote motivational interviewing to improve patient self-care and caregiver contribution to self-care in heart failure (REMOTIVATE-HF): Rationale, design, and methodology for a multicentre randomized controlled trial

In patients with heart failure (HF), self-care, and caregiver contribution to self-care (i.e., the daily management of the disease by patients and caregivers) are essential for improving patient outcomes. However, patients and caregivers are often inadequate in their self-care and contribution to self-care, respectively, and struggle to perform related tasks. Face-to-face motivational interviewing (MI) effectively improves self-care and caregiver contribution to self-care, but the evidence on remote MI is scarce and inconclusive. The aims of this randomized controlled trial will be to evaluate whether remote MI performed via video call in patients with HF: (1) is effective at improving self-care maintenance in patients (primary outcome); (2) is effective for the following secondary outcomes: (a) for patients: self-care management, self-care monitoring, and self-efficacy; HF symptoms; generic and disease-specific quality of life; anxiety and depression; use of healthcare services; and mortality; and (b) for caregivers: contribution to self-care, self-efficacy, and preparedness. We will conduct a two-arm randomized controlled trial. We will enroll and randomize 432 dyads (patients and their informal caregivers) in Arm 1, in which patients and caregivers will receive MI or, in Arm 2, standard care. MI will be delivered seven times over 12 months. Outcomes will be assessed at baseline and 3 (primary outcome), 6, 9, and 12 months from enrollment. This trial will demonstrate whether an inexpensive and easily deliverable intervention can improve important HF outcomes. With the restrictions on in-person healthcare professional interventions imposed by the COVID-19 pandemic, it is essential to evaluate whether MI is also effective remotely.

Specialized Nurse-led Care of Chronic Wounds During Hospitalization and After Discharge: A Randomized Controlled Trial

OBJECTIVE

To evaluate the effectiveness of specialized nurse-led care of patients with chronic wounds, provided both during hospitalization and postdischarge, on wound healing and readmission rates.

METHODS

An unblinded randomized controlled trial was conducted. Participants were patients with chronic wounds, randomly assigned to either the experimental group (cared for by wound care nurses both during hospitalization and postdischarge) or to the control group (cared for according to standard practice). Wound healing was identified as the primary outcome.

RESULTS

Overall, 1,570 patients were randomized, 1,298 of whom were included in the per-protocol analysis (707 in the experimental group and 591 in the control group). Nurse-led wound care quadrupled the probability of healing and reduced the number of treatment weeks and hospital readmissions.

CONCLUSIONS

Chronic wound care that was entrusted to specialized nurses improved outcomes in terms of wound healing, repair and regeneration, length of treatment, and rate of readmission, compared with standard practice. Future studies should evaluate the impact of care provided by specialized wound care nurses on patients' quality of life and healthcare costs. Nurse managers should promote the implementation of chronic wound clinical-care pathways entrusted to specialized nurses to improve patients' clinical outcomes and reduce hospital readmissions.

Towards a New Conceptual Model for Nurses' Organizational Well-being: An Integrative Review

AIM

To summarize conceptual models of nurses' organizational well-being and identify common variables among them.

BACKGROUND

To understand how the characteristics of an organizational context affect workers' well-being, numerous conceptual models have been developed. Such models have been conceptualized in various working contexts other than healthcare, and not always considering the particularities of the profession of nursing. Evaluation This integrative review was conducted using the resources of PubMed, CINAHL, Scopus and the Cochrane Library, up until March 2022, and by applying a modified version of Cooper's five-stage methodology, in accordance with the PRISMA guideline. Key issues Six reference models focused on different organizational variables and used to evaluate nurses' organizational well-being were identified: the Effort-Reward Imbalance (ERI) model, the Job Demands-Resources (JD-R) model, the Utriainen et al. model, the Demands-Resources and Individual-Effects (DRIVE) model, the Well-Being, Health-Promoting Lifestyle and Work Environment Satisfaction (WHS) model, and the Nursing Worklife Model (NWM).

CONCLUSION

There is no consensus in the nursing literature on an all-encompassing conceptual model of nurses' organizational well-being, or on working environment characteristics to be studied or monitored for defining nurses' well-being.

IMPLICATIONS FOR NURSING MANAGEMENT

Coming to a consensus on the definition of a nurses' organizational well-being model and its variables would facilitate nursing management in monitoring and intervening on nurses' work-life quality, and in improving nursing performance and caring outcomes.

Variables Predicting Academic Success of Nursing Students: a Longitudinal Study in a Nursing Bachelor's Degree Program

BACKGROUND

Academic failure can negatively impact on the student, the university and the nursing workforce in the short term. The aim of this study is to analyze the characteristics and predictors of academic success in two cohorts of students of a Nursing Bachelor's Degree program.

METHODS

This longitudinal study enrolled students who attended the Nursing Bachelor's Degree program. The Tor Vergata University includes 21 Nursing Bachelor's Degree programs at several Sanitary Institutions of the Rome area, with a mean annual recruitment of 800 students. We considered two cohorts of students beginning the program in the 2011-2012 and 2012-2013 academic years, respectively. The follow-up of these two cohorts ended in the 2017-2018 academic year. We considered socio-demographic and academic variables in the nursing field (pre-admission test grade, training exam grade in the first, second and third year and professional license exam grade). The outcome variable is academic success defined as gradua-tion on time; academic failure is defined as changing degree, delay in completion of the course, attrition and dismissal (failure to complete the studies). Data were collected at baseline (T0), at the end of the first year (T1), at the end of the second year (T2) and at the end of the third year (T3) of the course. A logistic regression was performed to identify predictors of academic success.

RESULTS

2,041 students were enrolled, with an average age of 22.0 years (± 4.6, 18-50); 67.4% were female. Regarding academic success, 30.6% of students graduated on time and so achieved academic success, while 69.4% failed to complete the course within the established time: 5.4% (110/2,041) changed the course, the attrition rate was 7.3%, 0.3% (6/2,041) overdue from the course for expiring of the terms, 18.0% (368/2,041) is attending the course and 38.4% (784/2,041) graduated after more than three years. Pre-admission test grade (OR: 10.0, 95% CI: 10.020-10.054) and training exam grade at the second and third years (OR: 10.0 95% CI: 10.027-10.139; OR: 10.2 95% CI: 10.171-10.294) predicted academic success.

DISCUSSION AND CONCLUSIONS

Some nursing students changed course during the last year of the program, while the training exam grade of the second and third years had predicted academic success; this is a brand new information derived from this study. In addition, we confirmed the association of age, gender, secondary school type and grade and preadmission test with academic success. For these reasons, clinical training should be improved and the quality of internship wards, as learning environments, should be monitored. Italian universities should undertake establishing the ideal cut-off in pre-admission tests to determine which students have a high probability of academic success.

The Wounded Healer: A Phenomenological Study on Hospital Nurses Who Contracted COVID-19

Since the pandemic began nurses were at the forefront of the crisis, assisting countless COVID-19 patients, facing unpreparedness, social and family isolation, and lack of protective equipment. Of all health professionals, nurses were those most frequently infected. Research on healthcare professionals' experience of the pandemic and how it may have influenced their life and work is sparse. No study has focused on the experiences of nurses who contracted COVID-19 and afterwards returned to caring for patients with COVID-19. The purpose of this study was therefore to explore the lived personal and professional experiences of such nurses, and to describe the impact it had on their ways of approaching patients, caring for them, and practicing their profession. A phenomenological study was conducted with 54 nurses, through 20 individual interviews and 4 focus groups. The main finding is that the nurses who contracted COVID-19 became “wounded healers”: they survived and recovered, but remained “wounded” by the experience, and returned to caring for patients as “healers,” with increased compassion and attention to basic needs. Through this life-changing experience they strengthened their ability to build therapeutic relationships with patients and re-discovered fundamental values of nursing. These are some of the ways in which nurses can express most profoundly the ethics of work done well.

Effect of a wound healing protocol on patients with stage III and IV pressure ulcers: a preliminary observational study

Objective:

To evaluate the influence of a wound healing protocol for stage III and IV pressure ulcers (PUs), and to determine the predictive power of specific sociodemographic and clinical characteristics on wound healing and infection.

Method:

This longitudinal study included participants with stage III and IV PUs who were recruited from 10 acute care settings of an Italian university hospital, and who were managed with a protocol inspired by the TIMECare model. Data were collected between October 2018 and March 2019. The National Pressure Ulcer Advisory Panel Staging System was used to stage the PUs. Wound healing was assessed with the Pressure Ulcer Scale for Healing (PUSH). Nutritional status was assessed with the Mini Nutritional Assessment Index. Data collection took place at admission and every seven days thereafter—a total of six times before discharge. The outcome and predictors of wound healing were assessed with Student's paired t-tests and multiple linear regressions, respectively.

Results:

Patients (n=126) were almost equally split between male and female, with a mean age of 78.17 years and who were all retired. Stage III and IV PUs were most prevalent at the sacrum (65.5% and 73.2%, respectively). PUSH wound healing scores improved significantly after six weeks in both stage III and IV PUs (p<0.001). Nutritional status was predictive of wound healing (R2=0.12).

Conclusion:

Our results showed that a good nutritional status and a protocol inspired by the TIMECare model were associated with wound healing improvements in stage III and IV PUs. We recommend this protocol in older patients with stage III and IV PUs.

Self-efficacy, burnout and academic success in nursing students: A counterfactual mediation analysis

AIM

To test the mediating role of burnout in the relationship between self-efficacy and academic success in nursing students.

DESIGN

This was a cross-sectional secondary analysis of longitudinal research aimed at exploring the academic success of nursing students.

METHODS

We enrolled a convenience sample of nursing students attending 21 Italian baccalaureate nursing degree programmes. Data were collected from 2014 to the 2018-2019 academic year. We analysed the wave of data collected during the third year of the programme. The measurements were the Academic Nurse Self-Efficacy scale (ANSEs) and the Scale of Work Burnout (SWEBO). A mediation analysis with a counterfactual approach was performed.

RESULTS

The participants (n = 556) had a median age of 20 years (IQR 19-22) and the majority was female [70.5% (392/556)]. Academic success was reached by 51.97% (289/556) of the students. The findings reveal a significant direct effect of self-efficacy on academic success and also a significant indirect effect of this relationship via burnout.

CONCLUSION

The mechanism by which self-efficacy influences academic performance in nursing students is more complex than a simple direct relationship. Universities should consider screening students for variables affecting academic success to decrease academic costs and increase ranking systems classification.

IMPACT

Nurses' professors should be engaged in strategies to promote self-efficacy. The area of intervention should be structured both during classes and internships, in tandem with the mentor and the clinical nurse.

Nurses' Quality of Life Scale: validation and psychometric properties

The Nursing Quality of Life Scale (NQOLS) is a 28-item self-report measure evaluating the four dimensions of nurses' quality of life, namely, the physical, emotional, working, and social dimensions. The purpose of this study is to assess the psychometric properties, including validity and reliability, of the NQOLS. The study enrolled 1,105 nurses who provided direct assistance to patients. The NQOLS factorial structure was tested using a cross-validation approach via Exploratory Structural Equational Modeling, which confirmed the instrument's four-dimension structure. Reliability was assessed using omega coefficients, proving excellent for all factors. Cluster analysis identified five distinct groups, each composed of participants sharing a substantial similarity with respect to their profile in the NQOLS. These five identifiable clusters presented significant differences not only in the NQOLS but also in the risk of work-related stress, emotional labour and burnout. The results show that NQOLS is a simple, reliable, lean tool for measuring nurses' overall QoL, whose various parts can additionally be used to answer specific research questions.

Measuring academic satisfaction in nursing students: a systematic review of the instruments

Student academic satisfaction is one of the most important factors affecting the success and quality of a higher education institute and is an indicator about teaching and learning. This study aims to summarize and critically evaluate the instruments assessing academic satisfaction in nursing education. A systematic review was undertaken, PRISMA were used for the screening of studies. MEDLINE, Cochrane, Scopus and CINAHL were searched using MeSH terms; seven eligible articles were identified referring to five assessment tools. COSMIN was used for evaluation of the methodological of the instruments. The systematic review identified five satisfaction measurement tools used in nursing education. The analysis of the instruments rarely considered a confirmative validity structure, measurement error or criterion validity. The best available instrument was the Nursing Students Satisfaction Scale (NSSS) for validation methodology; however, it needs further validation studies that consider CFA, reliability, criteria validity, hypothesis testing and measurement error.

Development and psychometric evaluation of the motivation for nursing student scale (MNSS): a cross sectional validation study

OBJECTIVES

To develop a self-report scale to measure academic motivation among nursing students and to test its psychometric properties.

METHODS

a cross-sectional validation study with a convenience sample of nursing students (n=1,635) was performed. The Motivation Nursing Students Scale was developed; content, face, construct validity, hypothesis testing and reliability were evaluated.

RESULTS

The validity structure revealed a four-factor solution and the model reached a satisfactory fit (χ²=622.835 df=160, p<0.01, CFI=0.90, TLT=0.83, RMSEA=0.060 (90% [CI] 0.055-0.064, p=0.001, SRMR=0.067). The hypothesis testing was confirmed with a positive correlation of the academic self-efficacy with Introjected, Intrinsic motivation and a negative correlation with Amotivation.

CONCLUSIONS

We verified a link between academic self-efficacy and motivation. Both motivation and self-efficacy may increase academic achievement and the possibility for HEIs to degrees a number of students in line with demands.

Psychometric Evaluation of the Oldenburg Burnout Inventory for Nursing Students

BACKGROUND

Higher education students, especially nursing students, have drawn more attention as a group that is vulnerable to the risk of developing burnout syndrome.

PURPOSE

To test the psychometric properties of the Oldenburg Burnout Inventory in Nursing (OLBI-N).

METHODS

The OLBI-N validity and reliability was tested in a sample of 476 nursing students. The validity was assessed with explorative and confirmative factor analyses. For hypothesis testing, we evaluated the correlation between burnout and academic self-efficacy.

RESULTS

Two factors (exhaustion and disengagement) were identified, and the confirmative factor analysis of the OLBI-N yielded a good fit. The OLBI-N was significantly correlated with academic self-efficacy (r = .29, -.37, p < .01).

CONCLUSIONS

The OLBI-N is a valid, reliable questionnaire for measuring burnout among nursing students.

A mixed methods study of an organization's approach to the COVID-19 health care crisis

Background

Healthcare emergency can increase work-related stress and reduce nurses’ job satisfaction and quality of life. Managerial decisions and proactive interventions implemented to react to the emergency ensure the best patient outcomes.

Purpose

The purpose of this study was to verify whether a proactive organizational approach can limit nurses’ work-related stress and help preserve their job satisfaction and quality of life during a health emergency.

Methods

A longitudinal mixed methods study was conducted. Data were collected before and after the transformation into a SARS-CoV-2 Hospital and the implementation of organizational interventions. Focus groups were conducted to investigate quantitative data.

Findings

After the implementation of interventions and as the pandemic progressed, work-related stress decreased and job satisfaction and quality of life increased.

Discussion

Through proactive organization, even during an emergency, nurses are prepared for working, and work-related stress due to changes is reduced. Nurses are motivated and satisfied with their organization and management, and quality of life increases.

Academic failure and its predictors in Baccalaureate nursing students: A longitudinal study

AIMS AND OBJECTIVES

To describe the sociodemographic and academic characteristics of nursing students who report academic failure and to identify the determinants of academic failure (no degree on time) in a population of nursing students.

BACKGROUND

Although prior studies have shown that academic failure is influenced by multiple factors, the studies mentioned have mostly focused on specific single variables associated with academic failure, and they have reported inconsistent results.

DESIGN

A prospective follow-up study design was used in an Italian Baccalaureate Nursing Degree program. A total sample of 2,040 at baseline and a random subsample of 753 students were considered for academic failure determinants. The study followed the recommendations of STROBE (Strengthening the Reporting of Observational studies in Epidemiology).

METHODS

We included in the model academic background, self-efficacy, sociodemographic variables and self-efficacy in psychomotor skills and motivation. We used the Academic Nurse Self-Efficacy Scale (ANSEs), the Nursing Self-Efficacy in Psychomotor Skill Scale (NSE-PS) and the Motivation Nursing Students' Scale (MNSS) which have been validated on nursing students. For the assessment of predictors of academic failure, a two-stage hierarchical logistic regression analysis was performed.

RESULTS

Students who had academic failure were 69.4% of the sample. Predictors of academic failure were the secondary school certification grade, the university pre-admission test score; the academic self-efficacy, self-efficacy in psychomotor skills and clinical training examination grades were additional predictors.

CONCLUSIONS

The secondary school certification grade, the University pre-admission test score, low academic self-efficacy, low self-efficacy in psychomotor skills and low clinical training examination grades were predictors of academic failure in nursing students.

RELEVANCE TO CLINICAL PRACTICE

Our findings suggest that the universities could consider a cut-off in the pre-admission test score as a critical value for identifying students who are likely to fail. In addition, nursing faculty staff should consider strategies for developing self-efficacy and motivation.

Nursing students' academic self-efficacy: A longitudinal analysis of academic self-efficacy changes and predictive variables over time

AIM

To analyse any changes seen in the academic self-efficacy of nursing students during the three years of their academic education as well as the associated predictive factors.

DESIGN

A longitudinal study design was applied.

METHODS

The sample included 220 students who attended a large university in central Italy. The students' academic self-efficacy was measured using the Academic Nurses' Self-Efficacy Scale. Data were collected annually from 2014/2015 to 2017/2018 at the beginning of the first year (T0), at the end of the first year (T1), at the end of the second year (T2) and at the end of the third year (T3). A repeated measure univariate analysis of variance (ANOVA) was conducted to detect any possible changes in the students' academic self-efficacy scores over the four measurement points. To identify the factors that are predictive of academic self-efficacy, a linear regression model was used.

RESULTS

Overall, the students' academic self-efficacy did not change significantly over the three-year period of their education. Both sex (female) and age (24-50 years) during T0-T2 significantly predicted changes in the students' academic self-efficacy over time. Moreover female students started with lower academic self-efficacy scores than male students, although their academic self-efficacy increased over time, while the male students' academic self-efficacy actually decreased over time. In addition, students with a scientific background reported higher academic self-efficacy than other students.

CONCLUSIONS

Although the students' academic self-efficacy did not change over time, from a theoretical perspective, academic self-efficacy can be developed using a number of strategies such as a well-organised tutorial during the clinical learning phase and feedback or encouragement.

IMPACT

Academic staff should monitor nursing students' academic self-efficacy over time, particularly in the case of male and younger students, students with a partner and students with a humanities background during the first 2 years of the course.

An integrated system for Peripherally Inserted Central Catheter tip confirmation in oncology and haematology patients

INTRODUCTION

Although there are many methods to confirm vascular device tip, chest x-ray represents the recommended procedure to verify the correct positioning of a central device, but it exposes patients to x-rays, delays treatment, and permits device length to be checked post-procedure.

AIM

To evaluate the efficacy of Peripherally Inserted Central Catheter positioning through an Integrated System (ultrasound-guided and electrocardiogram confirmation).

METHODS

A case-control study was conducted on a randomized sample of 165 patients, requiring Peripherally Inserted Central Catheter placement for chemotherapy treatment. The case group was composed of patients with vascular device placed through the Integrated System and the control group devices' length was anthropometrically estimated. Chest radiography was performed on both groups to verify tip location.

RESULTS

No cases of primary malposition related to the Integrated System were registered. The vascular devices positioned with the Integrated System were all correctly placed and in 91.8% (n=101) the intra-procedural tip location was comparable to the one identified in the x-ray.

CONCLUSION

The Integrated System represented a simple and efficient method to correctly place vascular device, allowing intra-procedural tip confirmation and avoiding primary malposition. It would eliminate the need for performing chest radiography, reduce costs and time for healthcare professionals and patients.

Outcomes of wound care nurses' practice in patients with pressure ulcers: An integrative review

BACKGROUND

Wound care nurses are recognised as a key element for improving health outcomes. However, there is still fragmented knowledge of the outcomes associated with their practice in individuals with pressure ulcers.

AIMS AND OBJECTIVES

To identify, summarise and map all available evidence related to the outcomes of wound care nurses' practice in individuals with pressure ulcers.

DESIGN

Integrative literature review.

REVIEW METHOD

To report the review, we followed the modified version of Cooper's five-step methodology, and the PRISMA guidelines.

METHODS

The search was carried out on CINAHL, PubMed, the Cochrane Library and Scopus, with a time frame ranging from each database inception to December 21, 2019. We included observational or experimental studies of adult individuals affected by (or at risk of) developing pressure ulcers who were also cared for by wound care nurses.

RESULTS

Of the 439 peer-reviewed publications, 13 studies met the inclusion criteria. The most frequent outcomes were pressure ulcer incidence, healing rate and time taken for complete healing. Less frequent outcomes were changes in pressure ulcers' stage, number of completely healed wounds, treatment costs and physical discomfort. No patient-reported outcomes were assessed.

CONCLUSION

This review indicates that clinical-related outcomes were by far the most reported. Future studies should broaden the spectrum of outcomes to include more subjective parameters (e.g. pain, quality of life, stress, etc.), in order to gain a better understanding of the global impact of wound care practice on patients with pressure ulcers.

RELEVANCE TO CLINICAL PRACTICE

There is promising evidence of a positive impact of wound care nurses' practice on health and economic outcomes. Nonetheless, more robust and rigorous research is needed to provide stronger evidence in the field and support investment in these practitioners.

The influence of work context and organizational well-being on psychophysical health of healthcare providers

Background:

A high level of organizational well-being improves employee performance and influences the physical and mental health of healthcare providers and students.

Objective:

This study investigates the relationship between the work context, organizational well-being, and the psychophysical health of healthcare providers.

Methods:

A multicentre cross-sectional descriptive study was conducted on a sample of healthcare providers (physicians and nurses) and healthcare students (medical students and nursing students). A self-report questionnaire was administered between September and November 2016.

Results:

Of the 300 questionnaires administered, 201 (67%) were correctly completed. Overall, both the physical and mental health of the healthcare providers and students are explained by the variables of the organizational context: organizational well-being and socio-demographic/work characteristics. In particular, the results show a dependence on gender and age. Furthermore, decision latitude had a positive effect on physical health (b=.134) while job demands had a negative effect (b=-.160) explaining 21% of the PCS of the healthcare providers and students (R2=.209). Mental health improved via the satisfaction (b=.345), and positivity (b=.222) of healthcare professionals and students of these disciplines.

Discussion:

The results are significant because they directly impact the quality of care provided as well as patient safety.

[Integrated Procurement Model: A new approach to Tissue and Organ Procurement]

INTRODUCTION

Literature has shown that the process of procurement of organs and tissues is fundamental in determining the number of donations. Starting from these assumptions, an integrated procurement model of organs and tissues has been designed and tested, where nurse specialists in organ donation coordinate the team and the entire process.

AIM

To evaluate the effectiveness of the Integrated Procurement Models in terms of identifying potential donors and the number of donations.

METHODS

A retrospective observational study was conducted before and after the introduction of the new procurement model in a large University Hospital in Rome. The data of potential donors identified, the number of donations made and the efficiency indicators of the donation process were compared.

RESULTS

692 potential donors were identified. The introduction of the integrated model increased the number of actual donors (from 31 to 51), brain death assessments (from 69 to 99), and the efficiency indicators of the donation process (from 0.25 to 0.29). From the comparison between the activities before and after the introduction of the integrated procurement model, statistically significant differences emerged regarding the number of donors and the amount of corneal tissue extracted.

CONCLUSIONS

The adoption of the standardized Integrated Procurement Model would increase the number of potential donors and actual donations, thanks also to the key role assumed by the nurse specializing in organ donation as team and process coordinator.

The relationship between nurse managers' leadership style and patients' perception of the quality of the care provided by nurses: Cross sectional survey

BACKGROUND

In healthcare systems, human resources play a strategic role that has a significant impact on the whole caring process. When the wellbeing of professionals is low their performance decreases, counterproductive work behaviours may became more likely, and as a result the quality of care is compromised. Studies have shown that leadership style is particularly relevant in relation to the quality of work environments in healthcare organizations.

OBJECTIVE

The main purpose of this study is to test a model that investigates the relationships between nurse managers' leadership style and patients' perception of the quality of the care provided by the nurses, through the mediation of the quality of the working environment (in terms of burnout, interpersonal strain and counterproductive work behaviour).

DESIGN

A multi-centre cross-sectional study was conducted.

SETTING

The study was conducted in five hospitals located two in the north, two in the centre and one in the south of Italy.

PARTICIPANTS

Participants were 479 registered nurses (working as staff nurses, while head nurses and nurse managers were excluded) and 829 patients aged 18 years or older, able to read and write Italian and hospitalized for at least 3 days. Severely ill or mentally disabled patients who were not able to fill in the questionnaire were excluded.

METHODS

The data were collected through two different questionnaires, one for the nurses and one for the patients. A multilevel analysis was conducted to examine the hypothesized model.

RESULTS

Results confirmed the hypothesis that, when nurses were satisfied with leadership, they felt less burned-out and strained in interpersonal relationships, they engaged less in misbehaviour, and, in turn, patients were more satisfied with the quality of the care provided by the nurses.

CONCLUSIONS

The results of this study showed that the characteristics of the organizational context, the leadership, and the behaviours of nurses, influenced patients' perceptions of nurses' care. Therefore, managers of healthcare services should take these results into account seriously in order to improve the quality of care provided to patients.

[Measuring Nurses' Quality of Life: adjustment of Satisfaction Profile (SAT-P)]

INTRODUCTION

Individuals' quality of life (QoL) is strictly linked with working environment experiences. The peculiarities of nursing profession yield it to be stressful, requiring high emotional engagement.

AIM

The main aim of this study was to validate a reliable tool to measure nurses' QoL.

METHODS

A panel of experts selected a tool from literature to measure QoL. They also modified it to achieve more specific version for nurses. The developed tool (NQoLs) was tested on 940 nurses.

RESULTS

NQoLs was a valid and reliable tool to describe different nuances of QoL. Therefore, four dimensions emerge from psychometrics analysis, which were physical, emotional, social and working QoL. Moreover, the overall nurses' QoL was good but with some significant differences related to the clinical settings of belonging. The working dimension had the major impact on the overall nurses' QoL.

CONCLUSION

NQoLs allows to measure QoL amongst nurses, and that is strategic for both research and management, due to NQoLs can help to face with a number of issues coming from an area with many gaps in knowledge. It should also be helpful to assess QoL in relation with organizational wellbeing amongst nurses.

[Pain assessment in Down Syndrome patients: a narrative review of the literature]

OBJECTIVE

The paper provides a description of available measurement tools which are able to adequately assess acute chronic pain in Down Syndrome (DS) patients, regardless of their age and cognitive impairment.

METHODS

Papers referring to DS patients were sought using different databases, such as PubMed, CINAHL, Scopus, Web of Science (ISI) and Cochrane, with no limit of time and published up to October 2017. All validated tools applicable to DS patients were included in the search, which consisted of papers published both in English and Italian. Irrelevant studies not pertaining to this specific query, grey literature publications, Commentaries, Letters and Editorials were excluded.

RESULTS

Six pain assessment tools were obtained, based on the observations of caregivers and healthcare's practitioners and on the interpretation of behavioral cues of patients unable to self-report. The identified tools were: the Non-communicating Children's Pain Checklist-Revised (NCCPC-R), the Pediatric Pain Profile (PPP), the Revised Face, Legs, Activity, Cry and Consolability Scale (r- FLACC), the Individualized Numeric Rating Scale (INRS) and the COMFORT-Behavior Scale (COMFORT-B), all applicable to patients affected by chromosomic diseases. The COMFORT- Behavior Scale (COMFORT-B) could be used only in DS infants (0-3 years) undergoing mechanic ventilation. Four of the six tools have also been validated in Italian.

CONCLUSIONS

To date national and international research studies have not been able to adequately respond to the needs of DS patients who are not be able to clearly express the level of pain they may be experiencing. Only one assessment tool turned out to be suitable for measuring pain intensity in the pediatric population undergoing mechanic ventilation. (COMORT-B), although this latter could not be used for assessing pain intensity in other DS populations. This means that there is the urgent need to carry out further validation studies so that a wider range of pain assessment tools may be used for people with Down's syndrome.

Managing care errors in the wards

Purpose

The importance of an error management culture (EMC) that integrates error prevention with error management after errors occur has been highlighted in the existing literature. However, few empirical studies currently support the relationship between EMC and errors, while the factors that affect EMC remain underexplored. Drawing on the conceptualisation of organisational cultures, the purpose of this paper is to verify the contribution of authentic leadership in steering EMC, thereby leading to reduced errors.

Design/methodology/approach

The authors conducted a cross-sectional survey study. The sample included 280 nurses.

Findings

Results of a full structural equation model supported the hypothesised model, showing that authentic leadership is positively associated with EMC, which in turn is negatively associated with the frequency of errors.

Practical implications

These results provide initial evidence for the role of authentic leadership in enhancing EMC and consequently, fostering error reduction in the workplace. The tested model suggests that the adoption of an authentic style can promote policies and practices to proactively manage errors, paving the way to error reduction in the workplace.

Originality/value

This study was one of the first to investigate the relationship between authentic leadership, error culture and errors. Further, it contributes to the existing literature by demonstrating both the importance of cultural orientation in protecting the organisation from error occurrence and the key role of authentic leaders in creating an environment for EMC development, thus permitting the organisation to learn from errors and reduce their negative consequences.

Vessel health and preservation: An integrative review

AIMS AND OBJECTIVES

To describe and synthesise current knowledge on the maintenance and preservation of vessels in patients who need the placement of a vascular access device.

INTRODUCTION

To administer drugs, blood or intravenous fluids, nurses or doctors insert a peripheral vascular access device on the arm using the traditional approach. This approach implies that devices are blindly inserted until flow is satisfactory and all possible sites have been exhausted. A proactive approach would ensure at the outset that the best device is used for each patient, eliminating repeated attempts at cannulation.

DESIGN

An integrative review was conducted using data recorded until July 2017. Searches were conducted in PubMed, Cochrane Library, CINAHL and Scopus.

REVIEW METHOD

A modified version of Cooper's five-stage method and the PRISMA guidelines were used to perform the integrative review.

RESULTS

Nine papers were included in this review. The patients were active participants in a proactive approach to vessel health and preservation. The involvement of each healthcare professional in vessel health and preservation improves outcomes and expands the use of a proactive approach to vascular device management. Because nurses are directly involved in the use of such devices and support patients during the decision-making process, they should take the lead in the use of the proactive approach.

CONCLUSION

Despite the many documented advantages of the proactive approach to preserving vessels in many settings and healthcare systems, it has not been widely tested. Future research is needed to guarantee high-quality vessel health and preservation care, thus contributing to the development and dissemination of the proactive approach.

RELEVANCE TO CLINICAL PRACTICE

The proactive approach preserves vessels for future needs, improves the delivery of the treatment plan and reduces length of stay, costs, risk of infection, complications and pain perceived by patients. This approach also ensures better use of nurses' time and vascular access device material.

[Influenza prevention in health-care workers: enhancement of the influenza vaccination campaign at Policlinico Tor Vergata in Rome (Italy) during the 2017/2018 epidemic season]

Given the very low influenza vaccination coverage averaging 4% among health-care workers at Policlinico Tor Vergata during the previous epidemic seasons, it was decided to implement a series of interventions to promote influenza vaccination compliance in the current (2017/2018) season. The total number of vaccinated health-care workers at the end of the current season was 364, resulting in a vaccination coverage of approximately 12%. The increase took place in all professional groups, with a coverage of 25% among permanent MDs, 9% among Medical Residents, 3% among nurses and 8% among technicians. The influenza vaccination coverage of 12%, although very low compared to the minimum target of 75%, is broadly in line with the values reported by other hospitals in Italy.

[Construction and validation of a tool for the evaluation of environmental risks and limitations to the manual handling of loads: cross-sectional study]

INTRODUCTION

The manual handling of loads has a strong impact on many types of work. All health professionals, due to their job, are subjected to a high risk of disease from the manual handling of loads.

TARGET

The purpose of our work has been therefore the construction and the validation of a specific tool for the evaluation of both environmental risks and individual limitations of the manual handling of loads / patients.

MATERIALS AND METHODS

The questionnaire we created is composed of two main sections: the first section includes the registry card of the operator personal data while the second section, consisting of eleven items it is further organized into two sections/parts. The first part consists of four items about environmental risk factors, while the second part consists of seven items about generic limitations and the assessment of pain from manual handling of loads.

RESULTS

The operators'health nurses, including those ones with a coordination responsibility, that are available in the structure are 704 while the response rate to the questionnaire was of 93.18%. The test-retest showed optimal values of the intra-class correlation coefficient (0.843) so demonstrating the absence of measurement errors in the two administrations. The values related to the internal consistency of the two sections of the questionnaire were greater than 0.80that also demonstrated the internal stability of the questionnaire.

CONCLUSIONS

The tool we described therefore is to be intended as a means of assessment for environmental risks, restrictions on movement of loads and pain associated with the task.

Modified Moral Distress Scale (MDS-11): Validation Study Among Italian Nurses

BACKGROUND

Moral distress (MD) has significant implications on individual and organizational health. However there is a lack of an instrument to assess it among Italian nurses.

AIM

The main aim of this study was to validate a brief instrument to assess MD, developed from the Corley's Moral Distress Scale (MDS).

METHOD

The modified MDS scale was subjected to content and cultural validity. The scale was administered to 347 nurses. Psychometric analysis were performed to assess construct validity.

RESULTS

The scale consists of 11 items, investigating MD in nursing practice in different clinical settings. The dimensionality of the scale was investigated through exploratory factor analysis (EFA), which showed a two-dimensional structure labeled futility and potential damage. The futility refers to feelings of powerlessness and ineffectiveness in some clinical situations; the potential damage dimension captures feelings of powerlessness when nurses are forced to tolerate or perform perceived abusive clinical proceedings. Nurses who experienced higher MD, were more lilely to experience burnout.

CONCLUSIONS

The modified MDS showed good psychometric properties, and it is valid and reliable for assessing moral distress among Italian nurses. Hence, the modified MDS allows to monitor the distress experienced by nurses and it is an important contribution to the scientific community and all those dealing with well-being of health workers.

Development and validation of Emotional Labour in Nursing Scale in Italy

BACKGROUND

Emotional demands may be a significant risk factor for wellbeing in healthcare professionals. Nurses have been considered the most exposed to emotional burden known as emotional labour. Scholars define it as the process by which nurses sometimes hide/fake the real emotion or struggle to display the appropriate emotion to meet the emotional work requirements. Emotional labour can result in physical, psychological and behavioural disorders. A specific tool to measure it among nurses is still missing.

OBJECTIVES

This study aims to develop and validate an emotional labour scale for nurses.

METHODS

The design process consisted of three different phases. In the first one, 24 items have been selected from different tools. The second consisted of the assessment of the face and content validity. In the third phase, the Emotional labour scale has been psychometrically evaluated through a cross validation approach, including both exploratory factor analysis performed on a sample of 205 Italian nurses, with the final selection of an 11- items tool, and confirmatory factor analysis.

RESULTS

Emotional labour is acted through surface acting, compliance and restraint. The Emotional Labour Nursing scale showed good psychometric properties and was found to be valid and reliable for assessing emotional labour among nurses. The association between emotional labour and burnout was investigated.

CONCLUSIONS

The Emotional Labour scale may foster a fuller understanding of the consequences of emotional labour. Since emotional demands and emotional labour are not included in the most common psychosocial risk assessment tools currently available, our results point out to their role in work stress prevention.

[The burden of informal caregivers of multiple sclerosis patients: a pilot study]

AIM

The main objective of the study was to measure caregiver burden among informal caregivers assisting people with multiple sclerosis (MS).

BACKGROUND

Thirty percent of people with multiple sclerosis require some form of home assistance and 80% of such care is provided by informal caregivers. The quality of life of informal caregivers of patients with multiple sclerosis decreases with increasing physical and depressive symptoms of their loved ones. This can have effects on stress levels, physical and mental health, quality of life, and mortality of informal caregivers.

DESIGN

A descriptive correlational study was performed in a sample of informal caregivers of MS patients.

METHODS

The study enrolled 41 informal caregivers of MS patients at a regional reference center in Rome, Italy. Data collection took place in the period between May and September 2016. A paper questionnaire was used, comprising a socio-demographic section and a "Caregiver Burden Inventory" section.

RESULTS

The subjective burden perceived by informal caregivers of patients with MS is moderate. Socio-demographic characteristics were not found to influence burden of caregivers.

CONCLUSIONS

It is important for nursing professionals to consider and evaluate the burden of informal caregivers of MS patients as they are valuable allies in the management of these patients.

Mental and physical well-being in oncology-hematology-unit personnel

Health care workers (HCWs) in university hematology units (UHUs) face high job demand that can have adverse health effects. This cross-sectional study investigated the relationship between some job stressors and health-related quality of life among HCWs of 3 UHUs in Rome. Work-related stress was measured with the Demand-Control Questionnaire; health-related functioning with the mental component score (MCS) and physical component score (PCS) of the Short Form 12 Survey; positivity with the Positivity Scale. Data of 201 respondents were analyzed. Job demand was inversely associated with MCS (p = .05) and PCS (p = .049); job control was directly associated with PCS (p < .001) and MCS (p = .024). A high positivity scale score and high decision latitude score predicted high MCS and PCS. High job demand score predicted low MCS and PCS scores. Reduced job stressors and enhanced positive attitudes can improve HCWs' health-related quality of life.

Violating organizational and social norms in the workplace: a correlational study in the nursing context

OBJECTIVES

The aim of this study was to examine, in a sample of nurses, the relationships between the organizational context variables (i.e., workload, interpersonal conflicts, organizational constraints), the burnout, the moral disengagement, and the counterproductive work behaviors (CWB), within their clinical work settings.

METHODS

A descriptive, correlational study was conducted in a sample of 347 nurses working in different clinical settings in a big university hospital in Central Italy. A self-report questionnaire was used for data collection, using several scales to assess different variables related to the organisational context, the burnout, the interpersonal strain, the moral disengagement, and the CWB.

RESULTS

The clinical context was found to influence nurses' organizational wellbeing, which in turn was found to foster CWB. Nurses working in outpatients settings and in day hospitals were those who reported the lowest CWB, in comparison with nurses working in the Emergency Department and in the General Medicine Units.

CONCLUSIONS

Findings of this study are important for nursing professional chiefs and for any professional involved in the promotion of workers' wellbeing. Our study findings highlight how the clinical work setting and the organizational context variables can lead to CWB. Researchers and managers should keep these aspects in high consideration due to their influence on the quality of the care delivered.

Towards an integrated model of nursing competence: an overview of the literature reviews and concept analysis

INTRODUCTION

Competence is considered a fundamental element when measuring a nurse's or student's ability to provide nursing care, but there is no consensus on what competence really is. This paper aims to review the existing meanings and models of nursing competence.

METHOD

The overview of literature reviews and concept analysis was performed through a search on Pubmed, Cinahl and PsychINFO from January 2005 to September 2014. It included key words, such as: Competence Model; Professional Competence; Nursing Competence; Competency Model; Professional Competency; Nursing Competency.

RESULT

A total of 14 papers were found, coming from educational or clinical nursing field. It was possible to identify some common themes: description of competence determinants; confu- sion around the competence concept; lack in competence evaluation; lack when competence have to be operationalized.

CONCLUSION

The overview results, enriched by the literature coming out from the organiza- tional studies, build the conceptual basis of an integrated model of nursing competence. More empirical research is needed to test the theoretical assumptions.

[The ethical leadership of the nursing ward managers as a key determinant of nurses' organisational behaviours in the healthcare settings]

AIM

The main aim of this study is to examine the influence of the coordinator's ethical leadership on nurses' emotions (i.e., positive and negative) and work behaviours.

METHOD

A questionnaire was administered in paper format, including well-validated scales reported in literature, to a sample of 347 nurses working in a university hospital. A structural equation model has been tested after examining Pearson's correlations among study variables.

RESULTS

The coordinator's ethical leadership is strongly related to the implementation of nurses' organisational citizenship behaviour and counterproductive work behaviour, which are influenced by their emotions. Positive emotions fully mediate the relationship between ethical leadership and organisational citizenship behaviour, while negative emotions partially mediate the relationship between ethical leadership and counterproductive work behaviour.

CONCLUSIONS

Ethical leadership acts on nurses' organisational behaviour, as described in the modelling process. The nurses' organisational behaviour is crucial to the outcome of the health care service. Therefore, the ethical leadership indirectly affects the quality of the care and the cure offered to the patients.

[Wound Care Management: impact on outcomes of nursing care]

AIM

To evaluate wound care management in Rome's Hospital.

METHOD

Observational study, divided into phases, through the analysis of 301 nursing records of patients either admitted to the hospital with ulcer pressure at the admission or grown later. Among the nursing records, 151 have been analyzed directly in the wards and 150 are referred to the triennium 2010-2012 and have been traced in a computerized version.

RESULTS

The nursing records concerning the ulcer pressure is completed in 4% average. The Push Tool and Braden scale are respectively present in 6% and 86% of the nursing records analyzed. The treatment are correct in the 80% of the cases. The clinic outcome is stable in 68% of the cases and in the 13% is registered an enhancement.

CONCLUSIONS

The study underlined an increase of the nursing documentation, although not completed caused by the absence of the Push Tool scale. It has been registered an enhancement of the clinic outcome in the five years and a better pertinence in the treatment of the ulcers pressure. However is evident the necessity of increasing education courses on the ulcers pressure.

Nurse moral disengagement

Background:

Ethics is a founding component of the nursing profession; however, nurses sometimes find it difficult to constantly adhere to the required ethical standards. There is limited knowledge about the factors that cause a committed nurse to violate standards; moral disengagement, originally developed by Bandura, is an essential variable to consider.

Research objectives:

This study aimed at developing and validating a nursing moral disengagement scale and investigated how moral disengagement is associated with counterproductive and citizenship behaviour at work.

Research design:

The research comprised a qualitative study and a quantitative study, combining a cross-validation approach and a structural equation model.

Participants and research context:

A total of 60 Italian nurses (63% female) involved in clinical work and enrolled as students in a postgraduate master’s programme took part in the qualitative study. In 2012, the researchers recruited 434 nurses (76% female) from different Italian hospitals using a convenience sampling method to take part in the quantitative study.

Ethical considerations:

All the organisations involved and the university gave ethical approval; all respondents participated on a voluntary basis and did not receive any form of compensation.

Findings:

The nursing moral disengagement scale comprised a total of 22 items. Results attested the mono-dimensionality of the scale and its good psychometric properties. In addition, results highlighted a significant association between moral disengagement and both counterproductive and citizenship behaviours.

Discussion:

Results showed that nurses sometimes resort to moral disengagement in their daily practice, bypassing moral and ethical codes that would normally prevent them from enacting behaviours that violate their norms and protocols.

Conclusion:

The nursing moral disengagement scale can complement personnel monitoring and assessment procedures already in place and provide additional information to nursing management for designing interventions aimed at increasing compliance with ethical codes by improving the quality of the nurses’ work environment.

Development and validation of the Nursing Profession Self-Efficacy Scale

AIM

This study describes the development and validation of the Nursing Profession Self-Efficacy Scale.

BACKGROUND

Self-efficacy can be useful in predicting performance, job satisfaction or well-being. In the nursing field, there is a shortage of studies on self-efficacy with regard to nurses' global confidence in coping ability across a range of everyday, challenging work situations.

METHODS

To define the theoretical framework of nursing professional self-efficacy, two focus groups and a literature review were performed. An empirical study was then conducted to test validity and reliability. Face and content validity, construct validity, concurrent validity, internal consistency and test-retest reliability were examined. The content validity index was evaluated by 12 experts who suggested deleting 11 redundant items. The final developed tool was tested for construct analysis using a cross-validation approach, randomly splitting the overall sample of 917 nurses in two sub-groups.

FINDINGS

The construct validity indicated two dimensions. The face and content validity were adequate. Test-retest reliability displayed a good stability, and internal consistency (Cronbach's α) was acceptable. Moreover, concurrent validity using the Generalized Self-Efficacy Scale was in line with the theoretical framework.

CONCLUSION

The scale showed evidence of validity and reliability. The major limitation is the strong influence of the Italian context in the tool development.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

The Nursing Profession Self-Efficacy Scale could be a fruitful tool that facilitates the application of theories (i.e. social-cognitive theory) in the nursing field and even development of interventions. Furthermore, a measurement of self-efficacy could be used to predict nursing clinical performance.

[Nurses and Organizational Citizenship Behavior: contribution to the Italian validation of the Podsakoff et al. scale]

BACKGROUND

Workers engaging in Organizational Citizenship Behaviour (OCB) can benefit colleagues, organization and stakeholders. Such behavior is vital to the efficacy of health care organizations as they can have a positive effect on the quality of care and users' satisfaction. Therefore, it is important to assess such behaviour with a valid and reliable instrument.

OBJECTIVES

The purpose of this study was to test, from a confirmatory perspective, the dimensionality of the Italian version of the Podsakoff et al. OCB scale in a large sample of nurses, and at the same time to evaluate the differences in nurses' OCB considering socio-demographic and job characteristics.

METHODS

The study included 886 nurses from different health organizations in Italy. The psychometric characteristics of the Italian OCB scale were tested through confirmatory factor analysis (CFA). The differences in nurses' OCB, according to several socio-demographic and job characteristics, were evaluated through a series of correlations and analysis of variance.

RESULTS

The CFA of the Italian OCB scale confirmed the hypothesized factor structure, consisting of three dimensions: altruism, civic virtue and conscientiousness. Nurses' gender and professional training were positively correlated with OCB, while the amount of extra work was negatively correlated. In regard to clinical work settings, palliative care nurses engaged in OCB more than nurses working in other areas.

CONCLUSIONS

The Italian OCB scale is a valid and reliable instrument. Its use can support all individuals involved in the promotion of workers' organizational well-being in implementing processes aimed at fostering nurses' OCB.

[Structural empowerment and job satisfaction among nurses coordinators: a pilot study]

INTRODUCTION

In literature, the structural empowerment and the job satisfaction have been studied in many different work settings but more need to be done in the setting of Head Nurses.

OBJECTIVE

The goal of the study is to evaluate the structural empowerment level of head nurses and if it impacts on the job satisfaction.

METHODS

A cross sectional design study was used. We enrolled 125 head nurses from three different hospitals of Rome. To collect the data we used a questionnaire that included both a part of the collection of sociopersonal data and the two scales (job satisfaction and structural empowerment). We used the SPSS19.0 statistical Software for data analysis to detect significant results.

RESULTS

Head Nurse declared to be not enough satisfied at work (mean=3.43) and their structural empowerment level resulted moderate (mean=3.16). The structural empowerment of head nurses impacts their job satisfaction especially concerning opportunities for social and professional interactions, praises, awards, audit and responsibilities.

CONCLUSIONS

Results underline structural empowerment relevance in head nurses job satisfaction. Healthcare organizations need to address job satisfaction to improve quality of care and more specifically that of head nurses since they directly impact on nurses job satisfaction.

[Counterproductive behaviors and moral disengagement of nurses as potential consequences of stress-related work: validity and reliability of measurement scales]

BACKGROUND

Several studies, but no one in the nursing, have shown that work stress can facilitate the adoption of specific behaviors that the literature identifies as Counterproductive Work Behaviors (CWB). Individuals, however, not giving up to their moral principles, may transgress social, organizational, moral and ethical norms, through the adoption of moral disengagement (MD).

OBJECTIVES

The purpose of this study is to validate two specific scales of deviant behaviors and MD in nursing: the Nursing Counterproductive Work Behaviours Scale (Nursing CWBS) and Nursing Moral Disengagement Scale (Nursing MDS).

METHOD

460 nurses participated in the study. After the adaptation of the Counterproductive Work Behavior Checklist by Spector and Fox to Nursing context (Nursing CWBS) and the ex novo development of the Nursing MDS, the psychometric properties of the two scales were tested. Also, the two scales were correlated.

RESULTS

Through a cross-validation approach and based on the results of exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), we have shown that the scales have good psychometric properties. Furthermore, the results, attest that the nurse with high levels of MD implements more CWB in the workplace.

CONCLUSIONS

The Nursing CWBS and Nursing MDS represent a valid starting point for the study of such phenomena in this specific context where stress among nursing staff is sometimes of considerable extent, especially in specific contexts of clinical care.

Nurse coordinator leadership and work environment conflicts: consequences for physical and work-related health of nursing staff

BACKGROUND

Research has amply demonstrated that positive leadership counters the onset of burnout and conflicting situations between colleagues that in turn create favourable conditions for a healthy organization and consequently for good quality of care.

OBJECTIVES

To investigate if more positive leadership is associated with lower levels of conflict in the work environment that in turn are associated with lower levels of burnout, psychosomatic disorders and negative indicators of work environment (feeling not being adequately appreciated, lack of clarity about tasks and roles, gossip, resentment towards the organization), and with higher levels of work satisfaction.

METHOD

Five scales of QISO (Nursing Organizational Health Questionnaire) and the Maslach Inventory (Burnout scale), were administered to a total of 192 nurses working in medical and surgical departments of two different Italian hospitals. The study design was cross-sectional. To test the hypothesis a structural equation model (SEM) was used.

RESULTS

The results of this study demonstrate the crucial role played by positive leadership of nursing coordinators that, directly and indirectly, promotes a healthy work environment with lower conflicts, burnout, and psychosomatic disorders among nurses and limits the presence of negative indicators in workplace.

CONCLUSION

This study demonstrates the key role of the nursing coordinator in creating a healthy work environment that contributes to physical and work-related health of the nursing staff.

[Decreasing preoperative anxiety by music: experimental study in a vascular surgery unit]

INTRODUCTION

Preoperative anxiety is common in patients undergoing surgical interventions. Several international studies have shown the positive effect of music before minor surgery and invasive procedures, but the effect of music before major surgery was not explored.

AIM

The aim of this study was to assess the effectiveness of music on anxiety in patients undergoing vascular surgery (aortic aneurism and thromboendarterectomy). Methods. Surgical patients were randomized to listening to music before surgery (music group) or to routine care. Anxiety was measured with the STAI-Y, administered three hours before surgery (Time 1) and before the induction of anesthesia (Time 2). After Time 1, only patients assigned to the music group listened to music.

RESULTS

The groups were comparable for the main characteristics. In the Music group (N 50) anxiety decreased after listening to music v the controls (N 50) (STAI-Y mean scores 52.2 and 31.1 respectively; p < 0.001). The differences between the two groups in the two measurements explained the 73% of the variance.

DISCUSSION

Listening to music is effective in decreasing anxiety in patients undergoing vascular surgery.

Organizational health and quality of life: survey among ambulance nurses in prehospital emergency care

BACKGROUND

The workplace plays a central role in causing stress and different kinds of syndromes and diseases. More generally, organizational procedures and practices could have an impact on nurses' quality of life. Although several studies have investigated this link, none of them considered nurses working in prehospital emergency care.

OBJECTIVES

To investigate the role of organizational health factors that affect the quality of life and psychosomatic complaints of ambulance nurses.

METHOD

Our sample included 411 ambulance nurses. Workers were administered two questionnaires to assess organizational health and quality of life. Descriptive and correlational analyses were used to test our assumptions.

CONCLUSION

Several organizational health dimensions provided an explanation for the complaints reported by nurses working in prehospital emergency care in terms of quality of life and psychosomatic disorders. The results allowed identification of possible interventions focusing on specific duties and organizational aspects that would improve the quality of nurses' health.

Positive and negative impact of caregiving to older adults: a structural equation model

Caregivers represent an important source of care for older adults. Many studies focused on the negative aspects of elder caregiving but few studies have analyzed also the positive effects. In addition, no studies have considered contemporarily the positive and the negative impact of caregiving to elderly people on the same people using a structural equation modeling. The purpose of this study was to examine the contribution of elder care recipient factors, caregiver factors and caregiving factors in determining the positive and negative impact of informal caregiving to older adults using a structural equation model. A cross-sectional design was used to study eighty caregivers of older people. Several instruments were used to measure elder care recipient factors (functionality, cognition, behavior); caregiver factors (socio-demographics, depression, stress, quality of life, and perceived health); caregiving factors (time from caregiving, time of care, social restriction, place of living, expenses, and living with the elder care recipient); and the positive and the negative impact of caregiving. Caregivers were 59.7 years old while elderly people were 84.0. Several factors were significantly correlated with the positive and negative impact of caregiving. However, when these factors were entered in a structural equation model, only female gender and social restriction predicted the negative impact, while caregiver's quality of life and caregiving expenses predicted both the positive and the negative impact. The results of this study suggest a new framework of caregiving to older adults where the outcomes depend more on caregiver and caregiving factors than on older person characteristics. More research is needed with a larger sample to test further the model outlined in this study.

[Operating theatre and medical ward nurses: two different ways of perceiving one's organizational health]

BACKGROUND

It is widely recognized that the working environment is crucial in the genesis of stress and other disorders that may affect nurses' health. The specific job context and the tasks performed by nurses in different clinical settings can be positive or negative predictors of organizational health.

OBJECTIVES

The aim of this study was to describe and compare organizational health among nurses working in operating theaters and medical wards.

METHODS

For the study 670 nurses from six university hospitals in Italy were asked to participate and a total of 542 nurses constituted the final sample. The Nursing Organizational Health Questionnaire was used to collect the data and was administered from January to March 2010. A descriptive/comparative design was used.

CONCLUSIONS

The results showed that nurses assigned to medical wards perceived their working environment as healthy and were significantly more satisfied and had less psychosomatic complaints than their colleagues working in operating theaters.