Perceived usefulness of the nurse-patient therapeutic relationship in the rehabilitation journey of people with urinary incontinence: A mixed-method study

INTRODUCTION

Despite various studies on the impact of incontinence on patients' lives, the existing literature has not investigated the contribution of nursing care during rehabilitation in terms of quality of life. Fewer data, therefore, exist on the characteristics and perceived impact of the therapeutic relationship as part of the rehabilitation program.

AIMS

To investigate the characteristics of the nurse-patient therapeutic relationship and its impact throughout the rehabilitation program; to describe the levels of patient burden on everyday activities.

MATERIALS AND METHODS

A monocentric, retrospective, multimethod descriptive study was conducted in the nurse-led continence clinic of a major teaching hospital in Northern Italy. A phenomenological approach with semistructured interviews was adopted after 6 weeks of rehabilitation, following the method of phenomenological enquiry by Giorgi. The short form 12 questionnaire was administered upon admission of patients to the clinic, after 6 weeks, and during the last consultation to investigate the impact of urinary incontinence (UI) on daily activities and physical and psychological quality of life.

RESULTS

Ninety-one adult patients of both genders presenting for nonneurogenic nonpostpartum UI were consecutively enrolled. Physical scores (PCS-12) and MCS-12 scores significantly increased over time. Psychological scores showed great variability upon admission, which was reduced halfway through the rehabilitation program. The thematic analysis highlighted four categories based on data saturation: the impact of UI on daily activities, strategies to face the problem, feelings, and the role of nurses.

CONCLUSIONS

This mixed-method investigation suggests the importance of therapeutic nursing relationships, clinical expertise, and rehabilitative skills. Quality of life is arguably related to the positive results of the rehabilitation program but also to the environment, patients perceive in terms of support, honesty, and trust.

Abdominal massage and laxative use for constipation: a pilot study

BACKGROUND

Constipation is a very frequent condition. Pharmacological treatment leads to the onset of complications in the long term.

AIM

To study the effects of abdominal massage and bowel training combined with polyethene glycol compared with laxative alone. Researchers studied the frequency of evacuations, use of laxatives, appetite, and food intake of older persons. In addition, feasibility in the daily routine of nursing care was studied.

METHODS

A pilot, randomised controlled trial was conducted. Older people living in a facility for self-sufficient residents were enrolled and randomised to the intervention or control group. The massage was administered for 4 weeks. The stool type according to the Bristol Stool Form Scale and secondary outcomes were collected at baseline, before any massage session and at the end of the intervention.

FINDINGS

32 participants were enrolled. Significant improvements were found in the number of evacuations, need for enemas, Bristol scores, appetite and food intake.

CONCLUSION

Significant improvements were found in all major outcomes.

A qualitative phenomenological study of nurses' experiences in caring for infants and children with life-limiting and life-threatening conditions

PURPOSE

To understand the experience of nurses caring for infants and children with life limiting and life-threatening conditions.

DESIGN AND METHODS

A qualitative phenomenological study was conducted, collecting data through deep interviews. Sample included twenty-seven nurses working in paediatric and neonatal intensive care units.

RESULTS

Four themes emerged: suffering, being there, protect yourself and support. The experience of caring for children with limiting and life-threatening conditions affects nurses positively, with personal and professional gratification, but also negatively, as it leads to the development of compartmentalization, avoidance, and high levels of stress.

CONCLUSIONS

The organization should make resources available to help nurses build resilience, improve emotional intelligence, and process experiences and emotions, thereby bringing benefits and improvements in infant and childcare.

PRACTICE IMPLICATIONS

Comparison between colleagues is one of the most effective tools for supporting each other. Dedicated times and spaces to be able to carry out the debriefings managed by the nurses themselves, guided and mediated by an expert figure, such as a psychologist or a trainer, would be recommended.

The Effects of Early Mobilization on Acquired Weakness in Intensive Care Units: A Literature Review

BACKGROUND

Intensive care unit (ICU)-acquired weakness (ICUAW) is defined as a clinical syndrome of neuromuscular weakness, and a consequence of critical illness, unrelated to any other etiology. It is associated with difficult weaning from the ventilator, prolonged ICU stay, increased mortality, and other important long-term outcomes. Early mobilization is defined as any active exercise in which patients use their muscle strength actively or passively within the first 2 to 5 days of critical illness. Early mobilization can be safely initiated from the first day of admission to the ICU during mechanical ventilation.

OBJECTIVES

The purpose of this review is to describe the effects of early mobilization on complications from ICUAW.

METHOD

This was a literature review. Inclusion criteria were as follows: observational studies and randomized controlled trials conducted with adult patients (aged ≥18 years) admitted to the ICU were included. Studies selected were published in the last 11 years (2010-2021).

RESULTS

Ten articles were included. Early mobilization reduces muscle atrophy, ventilation, length of hospital stay, and ventilator-associated pneumonia and improves patients' responses to inflammation and hyperglycemia.

DISCUSSION

Early mobilization appears to have a significant impact on the prevention of ICUAW and appears to be safe and feasible. The results of this review could be useful for improving the provision of efficient and effective tailored care for ICU patients.

Alarm Fatigue in Nursing Students Undertaking Clinical Training in Intensive Care Units: A Multicenter Study

BACKGROUND

The frequency of alarms from monitors and other electro-medical devices is of great utility but can increase the professional's workload and expose nurses in the intensive care unit to Alarm Fatigue. A recent study suggested that students in training can also experience the problem during their first clinical experiences in intensive care. Unfortunately, no data are available about the Italian panorama. To explore Alarm Fatigue among Bachelor of Science in Nursing students at the end of their internship experience in intensive care settings.

METHODS

Multicenter cross-sectional design. A convenience sample of nurses from 3 Italian university hospitals was recruited. The students completed the revised version of the "Alarm Fatigue questionnaire-ita" at the end of the clinical internship in intensive care settings.

RESULTS

130 nursing students were enrolled (response rate 59.36%). The overall level of Alarm Fatigue was Me= 24.5 IQR [17.5, 30.5]. In addition, 9.23% of the sample reported errors or near misses related to Alarm Fatigue during the internship experience. The alarm fatigue level was higher in students who committed "errors/almost errors" (p=0.038) and in "student workers" (p=0.005).

DISCUSSION

The extent of alarm fatigue experienced by nursing students requires developing a preventive strategy.

Approach to fever in children among final-year nursing students: a multicenter survey

BACKGROUND

Unfounded concerns regarding fever are increasingly observed among nurses worldwide. However, no study has so far explored the preferred approach towards pediatric fever among nursing students. Therefore, we aimed to investigate the attitude towards pediatric fever among final-year nursing students.

METHODS

Between February and June 2022, final-year nursing students of 5 Italian university hospitals were asked to answer an online survey on their approach to fever in children. Both quantitative and qualitative methods were utilized. Multiple regression models were employed to explore the existence of moderators on fever conceptions.

RESULTS

The survey was filled in by 121 nursing students (response rate 50%). Although most students (98%) do not consider discomfort to treat fever in children, only a minority would administer a second dose of the same antipyretic in nonresponsive cases (5.8%) or would alternate antipyretic drugs (13%). Most students would use physical methods to decrease fever (84%) and do not think that fever has mainly beneficial effects in children (72%). The own know-how adequacy on fever was inversely associated (OR 0.33, 95% CI 0.13-0.81) with the beliefs that high fever might lead to brain damage. No further predictive variable was significantly associated with the concern that fever might be associated with brain damage, the advice of physical methods use, and the assumption that fever has mostly positive effects.

DISCUSSION

This study shows for the first time that misconceptions and inappropriate attitudes towards fever in children are common among final-year nursing students. Nursing students could potentially be ideal candidates for improving fever management within clinical practice and amongst caregivers.

Transcutaneous electrical nerve stimulation for pelvic pain: A scoping review of treatment protocols, practical indications, and caveats

BACKGROUND

Neuromodulation (NM) is a family of therapies based on electrical stimulation to target specific nerves that control LUTS (Lower Urinary Tract Symptoms) and pain. The aim is to modulate what is happening within the nervous system to achieve therapeutic effects. A particular type of neuromodulation, called TENS (Transcutaneous Electrical Nerve Stimulation), has proven effective for treating pelvic pain. The available evidence provides indications regarding the many aspects of TENS that influence therapeutic effects, but a comprehensive review has yet to be conducted.

METHODS

Scoping review on Pubmed, CINAHL, Embase, Scopus, and Web of Science, including clinical trials, reviews, case studies or series, and other descriptive studies, according to the Joanna Briggs and PRISMA methodology.

RESULTS

The 31 papers retrieved allowed the formulation of precise indications about the DOs and DON'Ts of electrode placement, waveform, pulse duration, pulse frequency, amplitude, session duration, and frequency of sessions. This paper also discusses the biochemical and neuro urological mechanisms of TENS.

CONCLUSION

TENS effectiveness is influenced by many factors, some self-evident, others subtle, which this paper elucidates. Pelvic pain requires a multimodal approach, of which TENS is just a part. TENS should therefore be viewed as one of the components of the rehabilitation program in the frame of thorough and continuous patient assessment.

Nurses' role in the management of persons with chronic urogenital pelvic pain syndromes: A scoping review

BACKGROUND

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.

METHODS

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).

RESULTS

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.

CONCLUSION

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.

A nurse-led educational intervention for relieving idiopathic constipation: a retrospective study

BACKGROUND

Constipation is a common condition. Although numerous articles emphasise the importance of conservative interventions, none have set out a complete educational programme.

AIMS

To describe the results of an evidence-based, nurse-led educational intervention for functional constipation in adults.

METHODS

A retrospective study of patient records with an analysis of Wexner constipation scores and Bristol stool charts was carried out before and after a nurse-led educational programme on nutrition and bowel habits.

FINDINGS

Twenty-nine patients were enrolled (19 women and 10 men), with a median age of 61 (53-71) years, a mean BMI of 24.4±3.88 kg/m² and comparable baseline Wexner and Bristol scores. A statistically significant improvement in Wexner scores (P<0.001) and a clinically relevant but not statistically significant (P=0.682) improvement in Bristol scores were observed.

CONCLUSION

The results suggest this investigation should be repeated on a larger scale. An educational intervention could be included in all consultations on any issue that could affect bowel activity.

Violence and unsafety in Italian hospitals: Experience and perceptions of nursing students

BACKGROUND: Assessment of workplace violence towards healthcare workers represents a challenge for healthcare organizations worldwide. Workers’ experience and perceived risk of violence may have a serious impact on job satisfaction and retention of workers. To date, no studies have been conducted on nursing students. OBJECTIVES: To assess the prevalence of physical and non-physical violence among nursing students during their clinical experiences and to analyze the perceived risk of violence. METHODS: Multicentre, cross-sectional survey. We enrolled a convenience sample of nursing students of the bachelor’s degree in Nursing of the University of Milan (Italy). The students completed a structured questionnaire prepared in accordance with the available literature on violence in healthcare settings. RESULTS: Out of 1185 questionnaires sent, 603 were collected (50.89%). 35.1% had experience of verbal violence during the clinical internship training period, while 8.1% were victims of physical violence. 202 students (33.5%) reported unsafety, which was related to experience of physical or psychological violence, witnessed episodes of violence, gender, hospital structure and efficacy of the safety policies. CONCLUSIONS: Our findings highlight that nursing students are exposed to the risk of violence which influences their perception of risk.

Validation of the Italian version of the spirituality and spiritual care rating scale (SSCRS‐ita)

PURPOSE

To translate and validate the Italian version of the Spirituality and Spiritual Care Rating Scale (SSCRS-ita).

METHODS

A single-center cross-sectional study was performed from October 15 to November 15, 2019 in a public hospital in Milan, Italy. The scale was drafted using the back-translation method. Prior to administration, the Italian version of the scale was assessed for content validity and retest stability by calculating the content validity index. Internal consistency was investigated by calculating Cronbach's alpha coefficient, test-retest stability by Spearman's rho coefficient.

FINDINGS

A total n = 337 nurses participated in the survey by correctly completing the scale. The Kaiser-Meyer-Olkin test (0.81) and Bartlett's test of sphericity (p < 0.001) confirmed the adequacy of the sample to conduct exploratory factor analysis (EFA). The factorial model of EFA without rotation and then with nonorthogonal Promax rotation confirmed the presence of the four constructs identified by the original author.

CONCLUSIONS

SSCRS-ita showed promising psychometric properties in terms of validity and reliability. The results of this study, together with the lack of in-depth studies in the Italian health and educational panorama, suggest the need to develop an educational pathway which, starting from the curricula of basic training and continuing with the updating of nursing staff, is dedicated to the detection of the spiritual needs of the patient.

IMPLICATIONS FOR NURSING PRACTICE

The SSCRS-ita is the first validated Italian tool concerning the consideration of the needs of spirituality and spiritual care in healthcare contexts; the possibility to use this tool is the first step towards a better integration of the mentioned dimensions of care in a nursing care qualitative perspective in Italy.

A new tool for assessing the risk of fall in children with severe disability: development of the ALICE scale

INTRODUCTION

It is known in the literature that the main cause of physical impairment in children with severe disabilities is falling, which can worsen their already compromised condition. There are no specific scales for this population in the literature, neither in Italian nor in other languages. We created and validated a scale for assessing the risk of falling in children with severe disabilities.

STUDY DESIGN

Observational prospective study.

METHODS

We enrolled children (inpatients or day-hospital) admitted to the "Santa Maria Bambina Centre" of the "Fondazione Onlus Sacra Famiglia" in Cesano Boscone, Milan; the Content Validity Index of the Scale was calculated to assess the content validity of a new scale (ALICE). Cronbach's alpha coefficient (α) was used to examine internal consistency, Spearman's rho coefficient to test inter-rater reliability. Sensitivity, specificity, positive and negative predictive values were calculated.

RESULTS

Out of 48 patients enrolled, 14 fell (29.2%). The ALICE scale, with cut-off set at 16, showed a sensitivity of 100%, a specificity of 88.2%, a positive predictive value of 77.8% and a negative predictive value of 100%. The Content Validity Index of the Scale (=0.93), inter-rater reliability (rho=0.91, p<0.001) and Cronbach's alpha (=0.72) were satisfactory.

CONCLUSIONS

The ALICE scale seems reliable and valid in the disabled population and can be applied by nurses. Further studies with larger samples and a multicentre design are needed.

Assessing non-technical skills in undergraduate nursing students: a validation study

OBJECTIVES

Non-technical skills (NTS) are fundamental to the nursing profession to ensure safe, quality care. Purpose: The aim of this study was to develop a new instrument to assess NTS among nursing students: the Non-Technical Skills Student Evaluation (NTS-SE) tool.

METHODS

A cross-sectional study was conducted to test the psychometric properties of the tool. A number of 1,087 nursing students were enrolled from five Bachelor Schools of Nursing.

RESULTS

Exploratory and confirmatory factor analysis suggested the suitability of a two-factor model. The final version of the NTS-SE consisted of 23 items distributed in two domains: cognitive skills and interpersonal skills. For each domain, Cronbach's alpha coefficients were above 0.94. There were significant differences in scores between second- and third-year students (p<0.001) and among the different nursing schools (p<0.001).

CONCLUSIONS

The NTS-SE can be useful when assessing the effect of educational strategies and/or clinical traineeship experiences on the acquisition of NTS.

Alarm fatigue in nurses working in intensive care units: A multicenter study

BACKGROUND: Technological progress improves health care efficiency, quality, safety, and cost, supporting clinical activity in various scenarios, such as Intensive Care Unit (ICU). A timely response to alarms from monitors and other ICU electromedical devices is therefore crucial. The number of false alarms tend to desensitize care providers increasing the risk of experiencing alarm fatigue and, at times, lead to severe consequences for patients. OBJECTIVES: To assess the psychometric properties of the Italian version of the Alarm Fatigue Questionnaire and to explore the phenomenon of alarm fatigue among nurses working in intensive care settings. METHODS: The CVI-I was calculated to evaluate the validity of the content of the tool. Construct validity was investigated through exploratory factor analysis. Cronbach’s alpha coefficient (α) was used to examine the internal consistency of the scale and Spearman’s rho coefficient to test for stability. We designed a multicentre cross-sectional survey. A convenience sample of nurses from 4 Major Italian hospitals was recruited. The nurses completed the Italian version of the Alarm Fatigue Questionnaire. RESULTS: The content validity index CVI-S of the scale (CVI-S) was 91.11%; Cronbach’s alpha coefficient was 0.71. The Italian version of the tool explained 67.18%of the overall variance. 396 nurses were enrolled (79.84%). The overall level of alarm fatigue was Me = 29 [22;30]. 42.17%of the sample reported prior experience with alarm fatigue incidents. CONCLUSIONS: The extension of alarm fatigue requires the adoption of a preventive intervention plan. The Italian version of the Alarm Fatigue Questionnaire shows promising psychometric properties.

[The need for preventive nursing care from a gender perspective at Bollate prison. An example: breast cancer.]

Breast cancer is prevalent in females, accounting for 25% of the world's cancers. Prevention is strategic, and the nurse is an active part in educational and preventive programs, highlighting how the need for preventive nature is combined with gender medicine. The objective was to investigate the knowledge of breast cancer prevention among inmates of Bollate prison (Milan). 51% (52) adhered; women had an average age of 44 years (SD: 9.8), and 39% (20) were inmates from 1 to 3 years. 93% (48) knew about breast cancer prevention, 43% (26) had undergone specific preventive checkups outside of the prison, and 62% (31) had performed self-palpation. All women felt it was important to implement prevention in the prison environment. A high percentage of female inmates with an educational qualification was observed to be aware of breast cancer prevention and to have undergone screening programs in their lifetime. Emerges the strong willingness of women prisoners to be involved and the educational role of the nurse in the prison setting also from a gender perspective.

Adaptation and validation of the Caregiver Burden Inventory in eating disorders

BACKGROUND

Living with people diagnosed with a mental disorder is known to increase the risk of developing high levels of so-called "caregiver burden" in informal caregivers. In-depth analysis of this phenomenon and specific assessment tools for caregivers of patients diagnosed with Eating Disorders (EDs) are lacking. In this study, we aimed to evaluate the psychometric properties of the Caregiver Burden Inventory in EDs and employ this adapted tool in this category of caregivers.

METHODS

A cross-sectional study was conducted in the Eating Disorders outpatient unit of an Italian University hospital. Face and content validity were investigated by calculating standard Content Validity Indices (CVI-I and CVI-S) after administering the Inventory to 6 expert nurses with at least 5 years of experience in mental health services assisting people diagnosed with Eating Disorders. Internal consistency was evaluated with Cronbach's α coefficient for the overall scale and subscales. An exploratory factor analysis (EFA) was performed to explore latent constructs. The adapted CBI was then administered to 62 informal caregivers of ED patients.

RESULTS

The EFA yielded a 5-factor structure. The CVI-S was 97.2%; the Cronbach α coefficient was 0,90 (> 0.74 in each subscale). The median burden level in the experimental population was 40.0 [range = 21 to 54], in a theoretical range from 0 (no burden) to 96 (highest level of burden).

CONCLUSION

The Caregiver Burden Inventory appears to be a valid and reliable instrument to assess caregiver burden in individuals diagnosed with Eating Disorders. Further research is needed to evaluate this tool's efficiency in improving individually tailored interventions on families.

[Severe marginality in the Como area. Homelessness phenomenon and nursing care.]

Homelessness is a growing problem. These people face huge inequalities and frequent hospitalizations, often lacking social support. The condition is one of extreme poverty and affects public health care costs. The risk of mortality and morbidity is high. Together with the synergy between health care institutions and targeted policies, Third Sector Associations are fundamental. The nurse is crucial in responding to the needs of the most fragile individuals by ensuring an integrated approach to care. The Como Services for Serious Marginalization are concerned with taking charge of and satisfying the needs of homeless people through the services provided also in the current pandemic. The main exigencies that emerge are hospitality, active listening and the need for primary services. Both Italian and immigrant populations are represented. The realities involved rely on the figure of the nurse both directly and indirectly. The health inequity faced by the homeless requires special attention. The homelessness needs require an integrated service model with reorganization needed due to the ongoing pandemic. The Nurse can become central to the territorial management of frailty and social vulnerabilities.

Nursing students' attitudes towards suicide and suicidal patients: A multicentre cross-sectional survey

BACKGROUND

Education of nursing students can be a valuable resource in contributing to suicide prevention in mental health service users. The evaluation of students' attitudes towards a complex clinical issue is an important aspect of education that can expand traditional paths to acquisition of competence. Thus far, very few studies investigated attitudes towards suicidal risk among nursing students, and no data are available on Italian settings.

OBJECTIVES

The aim of this study was to explore nursing students' attitudes towards suicidal risk across the Nursing schools in three Italian universities.

DESIGN

Multicentre cross-sectional survey incorporating a before-after design.

SETTING AND PARTICIPANTS

A non-randomized sample of nursing students of the bachelor's degree in Nursing in three University hospitals was recruited.

METHODS

Nursing students completed "Suicide Behaviour Attitude questionnaire-Italian version" (SBAQ-ita scale); second-year nursing students of the University of Milan completed the scale before (T0) and 2 months after (T1) a specific lecture on suicide and suicidal risk.

RESULTS

Three hundred and fourteen students were enrolled (response rate 76.77%). The overall score of sample attitudes had a Median (Me) of 3.5[2.5;4] for the domain "Feeling towards the patient", 3[2;4] for the domains "Professional ability", 5[3;7] for the domain "Right to suicide", 5[4;6] for the domain "Knowledge". Improved median score regarding the domain "Professional ability" (0.015), and decreased median score on the "Knowledge" (0.021) domain were observed at T1.

CONCLUSIONS

The study highlights the impact of an educational intervention on nursing students' attitudes, supporting its implementation to improve academic education programmes.

Multi-Dimensional Dyspnea-Related Scales Validated in Individuals With Cardio-Respiratory and Cancer Diseases. A Systematic Review of Psychometric Properties

CONTEXT

In order to examine the multi-dimensional nature of dyspnea and its impact on the activities of daily living (ADLs) in patients with cardio-respiratory and cancer diseases, validated measures are needed.

OBJECTIVES

Our aim was to identify all the multi-dimensional clinical scales assessing dyspnea and its impact on ADLs in patients with cardio-respiratory and cancer diseases, and to critically appraise their psychometric properties.

METHODS

Five databases were systematically searched up to July 2020. Eligible criteria were: the examination of at least one psychometric property, and the recruitment of adults with a cardio-respiratory or cancer disease in non-emergency settings. The characteristics and psychometric properties of the studies included were presented through a narrative synthesis. The methodological quality of the studies and evidence synthesis were rated using the "COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)" criteria.

RESULTS

Forty-three studies, for which eight assessment scales had been identified, were included in the review. At the time of the review, three multi-dimensional assessment scales were available for assessing dyspnea symptoms, and five multi-dimensional scales were available to examine the impact of dyspnea on ADLs. Although the use of these scales has rapidly grown, evidence of psychometric properties has been reported as limited in most of the scales.

CONCLUSION

Despite the potential of the identified scales, further studies are needed to strength evidence on the validity and reliability of the multi-dimensional dyspnea scales. Furthermore, more studies appraising the content validity and responsiveness of the scales are specifically recommended.

Adaptation and validation of the Ethical Conflict Nursing Questionnaire-Critical Care Version to Italian language

Background and aim of the work Ethical conflict in Intensive Care Unit (ICU) can lead to poor quality health care and attention. Knowing the level of exposure to ethical conflict in health professionals allows to design strategies for improve the ethical environments and making decisions process. To study ethical conflict in health professionals it is necessary to have valid and reliable instruments that can be applied to different health and cultural contexts. No tool existed in Italian context still now. Therefore, the aim of this study was to adapt and validate the Ethical Conflict Nursing Questionnaire-Critical Care Version to the Italian sociocultural context. Methods This is a two-phase psychometric study, including one translation-back-translation phase, and an analysis phase for determining the content and construct validity, by means respectively Content Validity Index, Principal Component Analysis (PCA) and Confirmatory Factor Analysis(CFA), and reliability of the instrument, by means Cronbach's α calculation. Results The sample included 286 nurses from critical care units of four hospitals in (deleted for review) (Italy). Translation-back-translation phase was successful. A Content Validity Index of 95.39 was obtained. The overall Cronbach's α value was 0.866. When an item was eliminated, this value oscillated between 0.871 and 0.881. As the original tool, Principal Component Analysis (PCA) and Confirmatory Factor Analysis (CFA) confirmed a single factor capable of explaining more than 30% of the variance. Conclusions The ECNQ-CCV Italian version is a valid and reliable instrument for measuring the exposure of ICU nursing professionals to ethical conflict.

Validation of the Italian version of the ROSIER scale for stroke patients at triage

BACKGROUND

The ROSIER scale allows rapid evaluation of patients with suspected stroke; this paper presents the validation of an Italian version of the ROSIER scale.

METHODS

Observational study in the emergency department of a major teaching hospital. Patients aged 18 or more, admitted to the emergency department, during a period of two years were enrolled. Construct validity was investigated through exploratory factor analysis (EFA), content validity through the content validity index (CVI-I). Internal consistency, interrater reliability and test-retest stability were assessed. Sensitivity, specificity, positive and negative predictive values were calculated.

RESULTS

539 subjects were enrolled. The Italian ROSIER scale (ROSIER-ita) showed a sensitivity of 97.6%, a specificity of 90.1%, a positive predictive value of 97.5% and a negative predictive value of 82.7%. EFA pointed out 1 factor; the ROSIER-ita explained 59.79% of total variance. Content validity was satisfying (CVI-I = 0.97). No significant differences (p = 0.90) were found in the scores of the first 50 recorded at the time of admission and after 10 min. Interrater reliability was excellent (rho = 0.96, p = 0.0066). Cronbach's alpha was 0.74, indicating acceptable correlation between the items.

CONCLUSION

The Italian version of the ROSIER scale showed satisfactory results, comparable to the original English version, and can be applied by emergency nurses.

Teaching Strategies and Tools for Ensuring Safe and Quality Care: A Scoping Review

AIM

The aim of this scoping review was to map teaching strategies incorporating Quality and Safety Education for Nurses (QSEN) competencies and assessment tools based on the QSEN framework.

METHOD

The search was conducted through MEDLINE, Embase, Scopus, and Web of Science databases and carried out through the framework developed by Arksey and O'Malley and revised by Levac et al.

RESULTS

Thirty-one studies were included. Among QSEN competences, patient-centered care, safety, and teamwork and collaboration were most frequently incorporated into teaching strategies. Most assessment tools aimed at capturing the achievement of QSEN competencies after a classroom learning experience.

CONCLUSION

The scoping review made it possible to identify various teaching strategies and assessment tools developed on the QSEN framework. Further studies are needed to test teaching strategies to facilitate students' acquisition of QSEN competencies in clinical environments.

Unfinished Nursing Care Survey for Students (UNCS4S): A multicentric validation study

BACKGROUND

Unfinished Nursing Care (UNC) indicates required interventions that are delayed or omitted. Nursing students are also exposed to UNC during their clinical rotations. However, no tools have been validated to date to collect UNC as perceived by them.

OBJECTIVES

To validate a tool measuring UNC as perceived by nursing students.

DESIGN

A validation study in 2018 by following the COnsensus-based Standards for the selection of health Measurement INstruments guideline.

SETTING

Three nursing programmes in Northern Italy.

PARTICIPANTS

All 1190 students who were attending their clinical rotation in hospital or community settings, were eligible. To assess the criterion validity, 30 clinical nurse supervisors in a random sample of units were involved.

METHODS

Content and face validity of the Unfinished Nursing Care Survey tool (UNCS) were assessed; then the tool, divided into part A (unfinished interventions) and B (reasons) was administered via Google and paper-pencil. Acceptability, construct validity (Mokken Scale Analysis, Exploratory and Confirmatory Factor Analyses), hypothesis testing, and criterion validity were assessed.

RESULTS

737 students (61.9%) and 30 (100%) clinical nurse supervisors participated. On the Mokken Scale, with regard to part A, nursing interventions were ordered in higher and lower priority, reflecting different degrees of difficulty in terms of leaving the interventions unfinished. In the Confirmatory Factor Analyses, reasons for UNC were categorised into 'Communication', 'Priority setting', 'Nurses' aides' supervision', 'Material resources', 'Human resources', and 'Workload unpredictability'. Students in the second year perceived higher UNC occurrence; only some individual and nursing programme variables were significantly correlated with the UNC. No statistical differences emerged between the UNC perceptions of students and that of their clinical supervisors.

CONCLUSION

The Unfinished Nursing Care Survey for Students is composed of part A (22 items) and part B (18 items) seems to be valid in terms of acceptability, construct validity, hypothesis testing, and criterion validity.

[Euthanasia and Assisted Suicide: nursing perceptions survey]

INTRODUCTION

Despite the possibility of providing palliative care, the global requests of patients to be included in assisted suicide and euthanasia pathways have significantly increased in the last 15 years. According to the law, the discussion on these procedures is still open in many countries, including Italy. Therefore, it is important to investigate the opinion of health care workers.

METHODS

A questionnaire was designed and administered to nurses working in two hospitals in Milan, with the aim of investigating their opinion and working propensity in the context of assisted suicide. The instrument has undergone a preliminary validation process to in order to asses its psychometric properties.

RESULTS

The opinions of the sample (n=430) were mostly in favor of assisted suicide and euthanasia; however, as regards "propensity", only a small majority was in favor or very much in favor of working in contexts where the procedures described above were practiced, with increase in undecided and in those against.

DISCUSSION

According to the Italian law in force, anyone participating in assisted suicide or euthanasia procedures would be prosecuted by law; this implies that healthcare professionals do not have direct knowledge of assisted dying procedures and could be an explanation for the large numbers of undecided respondents in the last questions of the questionnaire. In spite of the limitations of the survey carried out, consisting mainly in the limited sample and in the monocentric design, the opinion of the staff seems to be largely in favor of the patient's freedom of choice; it is likely that similar percentages are justified by a deep-rooted direct experience in a general situation where the assistance that can be provided to the patient is not sufficient.

[Nursing Students' Attitudes Toward Suicide and Suicidal Patients: italian validation of the Suicide Behavior Attitude Questionnaire (SBAQ)]

BACKGROUND

Suicidal acts are a public health problem worldwide and require nurses to have appropriate skills to deal with it. It is important to study the level of knowledge, as well as the perception of nursing students towards suicidal ideation; a tool created for this purpose, the Suicide Behavior Attitude Questionnaire (SBAQ) has proven its validity and reliability in English.

AIM

To assess the psychometric properties of the Italian version of the SBAQ (SBAQ-ita).

METHODS

Multicentric study. The SBAQ-ita was administered to students of two Nursing schools in two universities in Italy. The CVI-I was calculated to evaluate the validity of the content of the SBAQ-ita. Construct validity was investigated through exploratory factor analysis. Cronbach's alpha coefficient (α) was used to examine the internal consistency of each scale factor. Spearman's rho coefficient was used to test stability.

RESULTS

The SBAQ-ita was administered to 205 students from October to November 2019. The analysis showed a four-factor structure with Cronbach's α always ≥0.70. The CVI-I was 0.97. 25 students filled in the scale again after 7 days (test-retest rho=0.92).

CONCLUSION

The SBAQ-ita is a valid and reliable tool for the study of the students' attitude in the Bachelor of Science in Nursing towards caring for the person with suicidal ideation. postoperative settings.

[Empowerment of informal caregivers in mental health in childhood: validation of the Italian - Family Empowerment Scale (I-FES)]

AIM

The Family Empowerment Scale (FES) is a tool, constituted by three subscales (family, services and community), which allows to have a picture of the state of empowerment of informal caregivers (IC) of minors with neurodevelopment disorder. The aim of this study is to present the transcultural validation of the Italian version, the Italian-Family Empowerment Scale (I-FES).

METHODS

Through the experts and focus groups, the definitive translation of the I-FES was identified, compiled by 115 IC, with a preliminary data questionnaire and Rogers' Empowerment Scale.

RESULTS

The I-FES has good face and construct validity (Bartlett test p<0.01), shows superior loads to the cutoff of Stevens (0.48), cluster analysis identifies the subdivision of the three subscale), and is reliable (Cronbach's α=0.96). The results obtained from the compilation of the IC show how much more empowerment is expressed at a family level and partly services level, this isn't associated with community life.

DISCUSSION AND CONCLUSIONS

The I-FES is valid and reliable and in comparison to existing scales, it allows to measure personal and interpersonal empowerment, but also that community level, combining everything in a single questionnaire. The mental health care systems in the developmental age can support empowerment, through the I-FES and associated parent training, allowing the informal IC a greater critical awareness, control, acceptance of the itself, participation; with increase of the health literacy.

Nutritional care of older people: Investigating nurses' attitudes in medical and surgical units

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 towards nutritional care of older people in surgical and medical wards. Design: Multicentre cross-sectional survey, conducted in January 2015.Methods: All nurses in surgical and medical wards in 10 hospitals in northern Italy were surveyed using the Staff Attitudes to Nutritional Nursing Care Geriatric Scale (SANN-G scale).Results: 799 out of 1,293 questionnaires were returned (61.8%). 23.2% (185) had a negative attitude, 56.6%(452) had a neutral attitude, and 20.2%(162), positive. Multivariate analysis showed no significant differences between medical and surgical wards (OR = 1.298; CI95% = .883-1.886, p = .18).Conclusions: It is necessary to raise nurses' awareness of poor nutritional care in both settings. More research is needed within the barriers to nutritional care.Impact statement: Strategies such as education and more clearly defined nutritional responsibilities are needed to improve nurses' attitudes.

Respiratory Distress Observation Scale Italian Version: Cultural-Linguistic Validation and Psychometric Properties

Dyspnea can be assessed using self-rating scales but, as death approaches, self-reporting becomes difficult. The validated Respiratory Distress Observation Scale measures dyspnea distress. The aim of this study was to develop the Italian version of the Respiratory Distress Observation Scale and to examine its psychometric properties. This was a cross-sectional study, analyzing cultural and linguistic validation, content validity, and psychometric properties. Eighty-nine palliative care subjects were enrolled to validate the Italian version of the Respiratory Distress Observation Scale. Patients had an average age of 74.5 (SD, 11.6) years, and 52% (n = 46) were female. Fourteen experts in palliative care evaluated the Italian Respiratory Distress Observation Scale in terms of the content validity ratio and the content validity index (CVI). The Italian Respiratory Distress Observation Scale was reported with an internal consistency (Cronbach α value) of .72 and an overall substantial interrater reliability (Cohen κ method). The Italian Respiratory Distress Observation Scale achieved a scale-level CVI of 93%, an items-level CVI of greater than 86%, and a minimum content validity ratio value of 0.71. A weak positive correlation was found between the Respiratory Distress Observation Scale and the Dyspnea Visual Analog Scale scores (0.374; P < .001). The Italian Respiratory Distress Observation Scale showed good reliability and validity for patients in palliative care. The Respiratory Distress Observation Scale measured respiratory distress in patients nearest to death.

Italian Version of Cancer Dyspnea Scale: Cultural-Linguistic and Clinical Validation in Patients With Advanced Cancer Disease in Palliative Care Settings

CONTEXT

The Cancer Dyspnea Scale (CDS) is a self-reported multidimensional tool used for the assessment of dyspnea, a subjective experience of breathing discomfort, in patients with cancer. The scale describes dyspnea using three distinct factors: physical, psychological, and discomfort at rest.

OBJECTIVES

To crossculturally validate the Italian version of CDS (CDS-IT) and examine its content validity, feasibility, internal consistency, and construct validity in patients with advanced cancer.

METHODS

A cross-sectional study was conducted. CDS-IT was forward-backward translated, and its content was validated among a group of experts. Cronbach's α coefficients were used to assess the internal consistency. Construct validity was examined in terms of structural validity through confirmatory factor analysis, and convergent validity was examined with Visual Analogue Scale Dyspnea through the Pearson's correlation coefficient (r). Cancer Quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care) and Italian Palliative Outcome Scale were also tested.

RESULTS

The CDS-IT was crossculturally validated and showed satisfactory content validity. A total of 101 patients (mean age = 76 [SD = 12]; 53% females) were recruited in palliative care settings. CDS-IT reported a good internal consistency in the total score and its factors (α = 0.74-0.83). The factor analysis corresponded acceptably but not completely with the original study. CDS-IT strongly correlated with Visual Analogue Scale Dyspnea (r = 0.68) and moderately with Italian Palliative Outcome Scale and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (r = 0.33-0.36, respectively).

CONCLUSION

The study findings supported the crosscultural validity of the CDS-IT. Its feasibility, internal consistency, and construct validity are satisfactory for clinical practice. The CDS-IT is available to health care professionals as a useful tool to assess dyspnea in patients with cancer.

Assessment of nutritional risk in persons with mental health disorders admitted to the acute psychiatric inpatient unit: an Italian study

BACKGROUND

Mental disorders can impact on several aspects of the person and therefore also on nutritional models; the literature shows that psychiatric persons are at risk of malnutrition, but the available studies are limited, particularly in Italy.

AIMS

To investigate the prevalence of malnutrition by defect and metabolic syndrome in inpatients in an acute Psychiatric unit. To evaluate the characteristics and food habits of the sample.

METHODS

Assessment of the risk of malnutrition (Mini Nutritional Assessment Scale) and Metabolic Syndrome (APTIII criteria) by administering a new scale to all persons aged 18+ at admission in two inpatient units of a major teaching hospital in Milan, Italy.

FINDINGS

One Hundred one people were enrolled; 29.70% were malnourished or at risk of malnutrition by defect; Major Depressive Disorder, serum levels of albumin below range and low levels of appetite were significantly associated with malnutrition. 11.88% was suffering from Metabolic Syndrome, which was significantly associated with Psychotic Disorder, high levels of appetite and junk food consumption.

CONCLUSIONS

The results highlighted the relevance of malnutrition in the psychiatric population and suggest the need for a systematic evaluation, in every clinical context as well as the key role of nurses.

[Head and neck neoplasms and palliative care, symptoms and quality of life: literature review.]

Head-neck neoplasms are the fifth most common cancer. Head-neck patients are particularly exposed to quality of life impairment due to the central anatomical-functional role of this region in primary functions such as breathing, swallowing and phonation. Many patients are already at an advanced stage of the disease at the time of diagnosis and their prognosis remains unfavourable despite new treatment options. They face daily with multiple and simultaneous symptoms. In 20% of cases the average survival is only 5 months, making it appropriate to take charge early for the important need of palliative care. The aim of this review is to deepen the knowledge concerning the neoplasms of the head-neck district, with particular reference to the symptoms and quality of life of people in advanced stage and in palliative care. The literature review was performed through CINAHL, Cochrane Library, Embase, PsycINFO, PubMed, Scopus and Web of Science. The research identified 9 studies that met the inclusion criteria. The results of the studies showed the prevalent symptoms of dyspnea, fatigue, nutrition and oral problems, pain, insomnia, anxiety and depression. Oral nutrition could be compromised, producing weight loss and malnutrition. In such a condition, the enteral route could be necessary. The impact of the symptoms was greater for those who could not maintain adequate nutrition and was a predictor of reduced food intake, weight loss and survival. Malnutrition influenced the performance status and quality of life which seemed to remain unchanged as the end of life approached. Mucositis, dysphagia and xerostomia had a strong association. Dysphagia was related to dysphonia. A worsening of emotional distress was shown in relation to the female gender and the tumor site. Head-neck cancer had a strong impact on the quality of life. Patients considere dyspnea, dysphonia, mobility problems, anger and weakness as the most important issues. Earlier interventions could allow a partial and temporary improvement of quality of life compatible with the patient's conditions. Nursing care involves multidimensional assessment and an early individualized, symptom-driven and needs-oriented approach.

Family ENgagement in Intensive Care Environments (FENICE): A quasi-experimental study protocol

Even if health care professionals should take into account the active involvement of families in Intensive Care Units (ICUs), little research that investigates family member’s contributions to care and includes its outcomes on both the family itself and the patient care, is available. The aim of this research project is to assess the effects of a family engagement program on family members’ satisfaction and on patients’ well-being and quality of life. A quasiexperimental study with two non-randomized groups (94 per each group) will be performed in two general ICUs of an Academic Italian Hospital. The intervention will be carried out in a single ICU and it consists of family members’ involvement in the care of their loved ones by means of bed physical exercises and simple care tasks. Participants will be evaluated through manifold outcomes: family satisfaction, assessed with the FS-ICU tool within 48 hours after ICU discharge; patients’ sense of well-being, measured with a visual analogue scale within 30 minutes after the time period of a visit; and the quality of life, investigated with the SF- 12 questionnaire within the first 48 hours after admission to ICU, at three and six months after ICU discharge by telephone. From July 2020, 188 subjects are going to be enrolled throughout the year. The latest data will be collected in December 2021 to allow the completion of the follow-ups of all participants. First, this study constitutes a significant step in a research agenda aimed at deepening the nursing sensitive outcomes in ICUs and the quality of hospital care. Secondly, the results of this study might have the potential to provide a better understanding of how families may modify patients’ outcomes and whether family members would benefit from an involvement program.

Efficacy of Triple Chronotherapy in unipolar and bipolar depression: A systematic review of the available evidence

BACKGROUND

Given the strong relationship between circadian rhythm disruption and mood regulation, combined chronotherapeutic approaches have been proposed for mood disorders. However, a comprehensive review of the available evidence on the efficacy of such interventions for depression is lacking.

AIM

To systematically review available literature on Triple Chronotherapy (Sleep Deprivation - Sleep Phase Advance - Bright Light Therapy) for depressive symptoms in Major Depression and Bipolar Depression.

METHODS

We followed the PRISMA statement for systematic reviews to conduct a web-based search on PubMed, Scopus and Embase using a list of selected keywords relevant to depression and chronotherapy.

RESULTS

After title and abstract screening of the 321 records retrieved, 25 potentially eligible studies were assessed at full-text screening. Nineteen studies were excluded for failure to match inclusion criteria. Six records of Triple Chronotherapy in addition to conventional treatment, published between 2009 and 2019, were included in the revision. All studies reported significant improvements on HAM-D scores at the end of treatment, with 50% to 84% response rates. Efficacy of treatment was confirmed on follow-up by three studies, with 58% to 61% response rates. Remission rates varied from 33,3% to 77%. Reported side effects were negligible across studies.

LIMITATIONS

Available trials are very few and only one included a control group treated with a daily exercise program.

CONCLUSIONS

The limited literature suggests that Triple chronotherapy might be a safe and effective addition to conventional antidepressant interventions, although well-designed, randomized controlled trials are needed.

Tobacco and e-cigarette smoking habits among Italian healthcare students

BACKGROUND

Healthcare professionals might play a significant role in tobacco control. The aims of this study were to investigate tobacco cigarette and electronic cigarette (e-cigarette) consumption among university students enrolled in courses of the healthcare area, and to understand whether training in healthcare could induce to smoking cessation.

STUDY DESIGN

Cross-sectional survey using a self-administered, structured questionnaire.

METHODS

Tobacco smoking habits of 560 students of four different medical area courses at the University of Milan, enrolled both in the first and in the last course year during the 2017-2018 academic year, were collected.

RESULTS

The prevalence of smokers was 34.8%, almost the same for males and females, and higher in Italian students compared to foreigners. Smoking prevalence was higher among employed (46.9%) than unemployed (35.1%) students, without differences between healthcare and non-healthcare workers. The influence of family, and particularly friends, is confirmed to be relevant. About 25% of respondents tried e-cigarettes, mainly smokers (44.6%) and former smokers (38.6%) with the goal of quitting smoking. More than 44% were dual users of both tobacco cigarettes and e-cigarettes. Comparing smoking habits between first-year and final-year students, only students of healthcare assistance course showed a significant drop in smoking during the university studies.

CONCLUSIONS

The implementation of specific educational curricula on smoking dangers and on smoking cessation techniques might have the double effect of supporting students in quitting smoking and of properly preparing them for their future task of helping people to quit smoking.

Nursing students' experience of the mental health setting as a clinical learning environment: Findings from a national study

PURPOSE

To explore nursing students' perceptions of their clinical learning experiences in the mental health (MH) setting.

DESIGN AND METHODS

Secondary analysis of data collected within an Italian national cross-sectional study involving students (N = 9607) who were attending 95 3-year baccalaureate nursing programs.

FINDINGS

Students in MH settings scored the quality of the learning environment overall significantly higher (P = .008) compared to those who rotated in other clinical settings, specifically with respect to (a) the tutorial strategies' quality; (b) the learning opportunities; and (c) the learning environment's quality.

PRACTICE IMPLICATIONS

MH settings emerged as a worthy clinical environment where less pressing rhythms allow preceptors to provide students more learning opportunities that, in turn, affect the perceived degree of competence achieved and the desire to work in these contexts after graduation.

Systematic review of shift work and nurses' health

BACKGROUND

Nursing is characterized by a working articulation in shifts to ensure continuity of care throughout the 24 h. However, shift work and the resulting desynchronization of circadian rhythms may have adverse effects on nurses' health.

AIMS

To describe the effects of shift work and desynchronization of circadian rhythms on nurse's health.

METHODS

Databases: PubMed, Cinahl, Scopus, Embase and Ilisi. Search terms (free terms, MeSH): 'nurses', 'shiftwork', 'nightwork', 'sleep disorder, circadian rhythm', 'work schedule tolerance', 'breast neoplasm', 'metabolic syndrome X', 'metabolic cardiovascular syndrome', 'Cardiovascular disease', 'stress', 'diabetes'. We included all randomized controlled trials, observational studies, reviews and papers studying nurses' shift work. Quality assessment of the retrieved papers was verified according to Dixon-Woods checklist.

RESULTS

Twenty-four articles were analyzed. Literature review has shown that shift work involves an alteration in psychophysical homeostasis, with a decrease in performance. It is an obstacle for social and family relationships, as well as a risk factor for stress, sleep disorders, metabolic disorders, diabetes, cardiovascular disorders and breast cancer.

CONCLUSIONS

An organized ergonomic turnaround can be less detrimental to the health of nurses and more beneficial for the healthcare providers. Therefore, we suggest organizing studies to assess whether improving nurses' health would lead to a reduction in miscarriages, absenteeism and work-related stress.

[Triple Chronotherapy approach for reducing depressive symptoms and suicidal intent in hospitalized patients: Study protocol of a Randomized Controlled Trial]

BACKGROUND

Depressive disorders are a relevant burden for public health due to their prevalence and high levels of associated disability and mortality. Recent studies suggest that the combination of multiple chronotherapuetic interventions may reveal effective in the rapid improvement of depressive symptoms.

OBJECTIVES

This paper describes the protocol of a study that aims to test the efficacy of a triple chronotherapy intervention (combined total sleep deprivation, light therapy and sleep phase advance) in the improvement of depressive symptoms in individuals diagnosed with unipolar or bipolar depression.

METHODS

A randomized controlled trial will be conducted in patients hospitalized with a unipolar or bipolar depression at the Servizio Psichiatrico di Diagnosi e Cura inpatient unit of the San Paolo - ASST Santi Paolo e Carlo Hospital in Milan, Italy. Individuals will be randomly assigned to the intervention (triple chronotherapy add-on to standard pharmacological treatment) or to the "control" group (standard pharmacological treatment).

RESULTS

Enrolment began in December 2018 and will end in October 2020, or at any earlier point in which the expected sample size will be reached. The study protocol has already been approved by the local ethics committee and is registered as EudraCT 2019-000892-18. Outcome analyses aim to verify whether triple chronotherapy produces a rapid and stable improvement in depressive symptoms in individuals hospitalized for an acute unipolar or bipolar depressive episode.