Mutuality between nurses and patients with chronic illnesses: A cross-sectional descriptive study

BACKGROUND AND AIM

Mutuality is a process in which the patient participates and is involved in decision-making and care interventions. The aim of this study was to measure mutuality in the relationship between nurses and chronic illness patients.

METHODS

This study had a cross-sectional design; the sample included 249 patients and 249 nurses. Mutuality was measured with the Nurse-Patient Mutuality in Chronic Illness scale.

RESULTS

Patients had higher scores in almost all items (p < 0.001). Patients demonstrate high reciprocity towards nurses and the ability to express and share their emotions. Patients consider nurses their point of reference and share with them their health goals. Nurses show more difficulty in being mutual with the patient, especially in the aspects related to the sharing of emotions, objectives, and planning. The egalitarian relationship score was low in both patients and nurses.

CONCLUSION

These findings are important to consider at clinical, educational, organisational, and policy levels. Nurse education and organisation must push towards respect for the wishes of patients, the possibility of expressing their choices, and their involvement in the care plan.

PRACTICE IMPLICATIONS

In clinical practice, it is necessary to put the patients more at the centre, involving them in the identification of objectives and in making decisions.

Contributing to self-care of a person with chronic obstructive pulmonary disease: A qualitative study of the experiences of family caregivers

AIM

To explore family caregivers' experiences of contributing to self-care of patients with chronic obstructive pulmonary disease (COPD).

DESIGN

A qualitative description study.

METHODS

Individual semi-structured interviews were conducted face-to face, by telephone or video calls in a purposive sample of 17 family caregivers of patients with COPD recruited in Italy, and analysed through content analysis. The consolidated criteria for reporting qualitative studies (COREQ) checklist was used for study reporting.

RESULTS

Ten subcategories were derived from 106 codes grouped into three main categories: family caregiver contributions to maintaining disease stable and ensuring a normal life for patients; family caregiver contributions to disease monitoring; and family caregiver contributions to coping with disease exacerbations. Family caregivers provided practical and emotional support, and their contribution was essential to improve treatment adherence, to enable the patient to continue living a normal life, and to have access to the healthcare services. Family caregivers were constantly vigilant and monitored patients daily to detect worsening conditions, and they managed exacerbations especially when patients were unable to do it due to their critical conditions.

CONCLUSION

This study broadens knowledge of family caregivers' contributions to patients' self-care in COPD, describing the different ways family members provide daily care to patients and the many responsibilities they take on.

IMPACT

Family caregivers perform a variety of behaviours when supporting patients with COPD in self-care, especially when patients are more dependent and the disease more severe. Nurses should acknowledge the various contributions provided by family caregivers and develop educational interventions aiming to support them in patient care and improve patient outcomes.

PATIENT OR PUBLIC CONTRIBUTION

Researchers shared the draft study report with participants for validation and feedback. This helped to strengthen the study design and results.

The role of nurse-patient mutuality on self-care behaviours in patients with chronic illness

AIM

To examine the role of nurse-patient mutuality on three self-care behaviours in chronic illness patients.

DESIGN

A cross-sectional multi-centre study was conducted.

METHODS

Mutuality was measured with the Nurse-Patient Mutuality in Chronic Illness scale which has the dimensions of developing and going beyond, being a point of reference and deciding and sharing care, and self-care was measured with the Self-care of Chronic Illness Inventory (SC-CII). Multivariable linear regression analyses were used to assess the contribution of three dimensions of mutuality on self-care maintenance, monitoring and management behaviours controlling for patient gender, age, education, number of medications, and presence of a family caregiver.

RESULTS

The sample included 465 inpatients and outpatients with at least one chronic illness. The three dimensions of mutuality had different roles in their influence on the three dimensions of self-care. Developing and going beyond was significantly associated with self-care maintenance and self-care monitoring behaviours. Point of reference was significantly associated with self-care maintenance behaviour. Deciding and sharing care was significantly associated with self-care monitoring and self-care management behaviours.

CONCLUSION

The mutuality between nurse and patient may be a novel area of research to support and improve patient self-care behaviours with implications for clinical practice and education.

IMPLICATION FOR PROFESSION AND PATIENT CARE

Mutuality between nurse and patient increases patient engagement, symptom recognition, decision-making process and patient-centred approach favouring the development of self-care behaviours.

IMPACT

Mutuality between nurse and patient is a new concept and its association with the patient outcomes could bring relevance to the nursing profession. Self-care behaviours are important in the management of chronic diseases, but are difficult to perform. Mutuality between nurse and patient influences the three different behaviours of self-care in chronic illness, for this reason it is important to increase the level of mutuality in this dyad.

REPORTING METHOD

STROBE checklist for cross-sectional studies was followed in this study.

PATIENT OR PUBLIC CONTRIBUTION

Patients were involved in the sample of the study.

Serosusceptibility and hesitancy for booster HBV vaccination among health care workers in Italy: A cross-sectional study

BACKGROUND

Health care workers (HCWs) are at increased risk of exposure to hepatitis B virus (HBV). The most effective prevention measure is vaccination, with a serum hepatitis B surface antibody (HBsAb) titre > 10 mIU/ml considered protective. To date, the sociodemographic and occupational characteristics related to HBV serosusceptibility and factors associated with booster hesitancy remain unclear. Therefore, this study aimed to identify factors associated with maintaining a protective HBsAb titre in a large sample of HCWs and to evaluate factors potentially associated with hesitancy towards vaccine boosters.

METHODS

A cross-sectional study was conducted among HCWs who underwent a health surveillance visit between 2017 and 2022. If the serum HBsAb titre was < 10 MIU/ml, a vaccine booster dose was offered. Based on their willingness to be vaccinated, employees were classified into three groups: acceptance, hesitation, and refusal. Uni- and multivariable analyses were performed to assess the association of demographic and occupational characteristics with serosusceptibility and attitudes towards vaccination.

RESULTS

A total of 1632 (27%) employees were shown to be nonimmune. A lower median age and being a physician were significantly associated with a protective HBsAb titre. A total of 706 nonimmune employees (43.3%) accepted the vaccination, 865 (53%) hesitated, and 61 (3.7%) refused. The median age of those who refused vaccination was significantly higher than that of those who hesitated and those who were vaccinated. Acceptance of vaccination was significantly higher among nurses, while nurse aides hesitated more; among nonmedical graduate staff both hesitation and refusal were higher than expected. In the multivariable analysis, higher age, female sex, and employment as an allied health care professional were shown to be significantly associated with hesitation/refusal, while being born abroad turned out to be protective.

CONCLUSIONS

Our study showed that approximately a quarter of HCWs were not immune to HBV infection, and of these, more than half were hesitant towards or refused the booster dose. The risk of hesitation/refusal was higher with age in women and among allied health care staff. Based on these findings, further studies are needed to prospectively evaluate HBV seroprevalence, vaccination adherence, factors associated with hesitancy, and the effectiveness of health surveillance strategies in a high-risk population susceptible to infection.

Changes in nurses' work: A comparative study during the waves of COVID-19 pandemic

AIM

The aim of this study is to describe and evaluate how nurses caring for COVID and non-COVID patients assess changes in their work and in nursing activities during the two waves of the COVID-19 pandemic.

METHODS

Two cross-sectional surveys were conducted for Estonian nurses working during the first and second waves of the COVID-19 pandemic, using The impact of COVID-19 emergency on nursing care questionnaire. Based on convenience sampling, the data were collected among the members of professional organizations, unions and associations. Responses from the first (n = 162) and second wave (n = 284) were analysed using descriptive statistics, Fisher's exact test and McNemar's test.

RESULTS

The COVID-19 pandemic changed the working context during both waves for nurses caring for COVID and non-COVID patients. Changes were considered to a greater extent during the second wave, when Estonia was severely affected, and by nurses caring for COVID patients. During the second wave, the number and complexity of patients increased, and nurses caring for COVID patients performed fundamental care, nursing techniques and symptom control significantly more frequently compared to nurses caring for non-COVID patients.

CONCLUSION

Taking care of COVID patients is demanding, requiring nurses to perform more direct patient care. However, the pandemic also increased the frequency of activities not related with direct patient care.

Effectiveness of interventions to increase healthcare workers' adherence to vaccination against vaccine-preventable diseases: a systematic review and meta-analysis, 1993 to 2022

BackgroundVaccination adherence among healthcare workers (HCWs) is fundamental for the prevention of vaccine-preventable diseases (VPDs) in healthcare. This safeguards HCWs' well-being, prevents transmission of infections to vulnerable patients and contributes to public health.AimThis systematic review and meta-analysis aimed to describe interventions meant to increase HCWs' adherence to vaccination and estimate the effectiveness of these interventions.MethodsWe searched literature in eight databases and performed manual searches in relevant journals and the reference lists of retrieved articles. The study population included any HCW with potential occupational exposure to VPDs. We included experimental and quasi-experimental studies presenting interventions aimed at increasing HCWs' adherence to vaccination against VPDs. The post-intervention vaccination adherence rate was set as the main outcome. We included the effect of interventions in the random-effects and subgroup meta-analyses.ResultsThe systematic review considered 48 studies on influenza and Tdap vaccination from database and manual searches, and 43 were meta-analysed. A statistically significant, positive effect was seen in multi-component interventions in randomised controlled trials (relative risk (RR) = 1.37; 95% CI: 1.13-1.66) and in observational studies (RR = 1.43; 95% CI: 1.29-1.58). Vaccination adherence rate was higher in community care facilities (RR = 1.58; 95% CI: 1.49-1.68) than in hospitals (RR = 1.24; 95% CI: 0.76-2.05).ConclusionInterventions aimed at increasing HCWs' adherence to vaccination against VPDs are effective, especially multi-component ones. Future research should determine the most effective framework of interventions for each setting, using appropriate study design for their evaluation, and should compare intervention components to understand their contribution to the effectiveness.

Association between exposure to wind turbines and sleep disorders: A systematic review and meta-analysis

To date, there is scarce evidence on the association between sleep disorders and noise generated by wind turbines. We searched six relevant electronic databases from the inception to May 2023 for relevant articles. The methodological quality of the included articles was evaluated using the US National Institutes of Health tool. Fifteen articles met the inclusion criteria. The overall prevalence of sleep disorders among residents close to wind turbines was 34% (95% Confidence Interval, 0.22-0.47). Univariate meta-regressions for distance and sound power level showed that at higher distance the prevalence of sleep disorders decreases (p = 0.010) and with a higher sound power level the prevalence increases (p = 0.037). Furthermore, this systematic review and meta-analysis highlighted that the overall quality of current research on this topic is poor, and the methods to measure the results are often based on subjective assessments and not validated questionnaires. In conclusion, our preliminary findings suggest that there may be a possible relation between exposure to wind turbines and sleep disorders, although no conclusions can be drawn in terms of causality due to the nature of the retrieved data and the poor quality of current evidence. Future studies should adopt a longitudinal design and focus on objective measurements, supported by validated subjective methods such as questionnaires.

Moving forward the Italian nursing education into the post-pandemic era: findings from a national qualitative research study

BACKGROUND

During the CoronaVIrus-19 (COVID-19) pandemic, nursing education has been dramatically transformed and shaped according to the restrictions imposed by national rules. Restoring educational activities as delivered in the pre-pandemic era without making a critical evaluation of the transformations implemented, may sacrifice the extraordinary learning opportunity that this event has offered. The aim of this study was to identify a set of recommendations that can guide the Italian nursing education to move forward in the post-pandemic era.

METHODS

A qualitative descriptive design was undertaken in 2022-2023 and reported here according to the COnsolidated criteria for REporting Qualitative research guidelines. A network was established of nine Italian universities offering a bachelor's degree in nursing for a total of 6135 students. A purposeful sample of 37 Faculty Members, 28 Clinical Nurse Educators and 65 Students/new graduates were involved. A data collection was conducted with a form including open-ended questions concerning which transformations in nursing education had been implemented during the pandemic, which of these should be maintained and valued, and what recommendations should address the transition of nursing education in the post-pandemic era.

RESULTS

Nine main recommendations embodying 18 specific recommendations have emerged, all transversally influenced by the role of the digital transformation, as a complementary and strengthening strategy for face-to-face teaching. The findings also suggest the need to rethink clinical rotations and their supervision models, to refocus the clinical learning aims, to pay attention towards the student community and its social needs, and to define a pandemic educational plan to be ready for unexpected, but possible, future events.

CONCLUSIONS

A multidimensional set of recommendations emerged, shaping a strategic map of action, where the main message is the need to rethink the whole nursing education, where digitalization is embodied. Preparing and moving nursing education forward by following the emerged recommendations may promote common standards of education and create the basis on for how to deal with future pandemic/catastrophic events by making ready and prepared the educational systems.

Occupational asbestos exposure and urinary bladder cancer: a systematic review and meta-analysis

PURPOSE

There is conflicting evidence on the association between asbestos exposure and bladder cancer. We performed a systematic review and meta-analysis to provide evidence on occupational asbestos exposure and the risk of mortality and incidence of bladder cancer.

METHODS

We searched three relevant electronic databases (Pubmed, Scopus, and Embase) from inception to October 2021. The methodological quality of included articles was evaluated using the US National Institutes of Health tool. Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) for bladder cancer, as well as respective 95% confidence intervals (CIs), were extracted or calculated for each included cohort. Main and subgroup meta-analyses according to first year of employment, industry, sex, asbestos type, and geographic region were performed.

RESULTS

Fifty-nine publications comprising 60 cohorts were included. Bladder cancer incidence and mortality were not significantly associated with occupational asbestos exposure (pooled SIR: 1.04, 95% CI: 0.95-1.13, P = 0.000; pooled SMR: 1.06, 95% CI: 0.96-1.17, P = 0.031). Bladder cancer incidence was higher among workers employed between 1908 and 1940 (SIR: 1.15, 95% CI: 1.01-1.31). Mortality was elevated in asbestos workers cohorts (SMR: 1.12, 95% CI: 1.06-1.30) and in the subgroup analysis for women (SMR: 1.83, 95% CI: 1.22-2.75). No association was found between asbestos types and bladder cancer incidence or mortality. We observed no difference in the subgroup analysis for countries and no direct publication bias evidence.

CONCLUSION

There is evidence that workers with occupational asbestos exposure have a bladder cancer incidence and mortality similar to the general population.

Leaders' Role in Shaping Followers' Well-Being: Crossover in a Sample of Nurses

The link between well-being at work and leadership has received considerable attention. Leaders have the power to influence followers not only due to formal position, but also their positive behaviors could reinforce the followers' positive working experience. Following the crossover model (Westman, 2001), this study investigates whether leaders' work-related positive psychological states (i.e., work engagement) cross over to those of the followers (i.e., work engagement and job satisfaction) through the mediation of the latter's perception of transformational leadership. We used MPlus 8 to test two multilevel mediations in a sample of 1505 nurses nested in 143 groups led by as many leaders (87.19% of nurses and 56.50% of head nurses of the entire population). Results show that while there is not a crossover of leader work engagement to nurse work engagement, manager work engagement can cross over to nurse job satisfaction, enhancing their well-being through transformational leadership behaviors. This study adds further insights both on crossover theory and on the importance of leaders in expanding and transferring resources to followers at work. Fostering work engagement at a managerial level in the healthcare sector could be the driver to facilitate the well-being of nurses at work, address negative outcomes, and promote positive ones.

[Transitioning Italian nursing education in the post-pandemic period: priorities in the light of lessons learnt]

. Transitioning Italian nursing education in the post-pandemic period: priorities in the light of lessons learnt.

INTRODUCTION

Once back to normalcy, many nursing education activities have been restored without an in-depth analysis of which transformations enacted in the pandemic period should be maintained and valued.

AIM

To identify priorities to effectively transitioning nursing education in the post-pandemic period.

METHOD

Descriptive qualitative design. A network of nine universities involved 37 faculty members, 28 clinical nurse educators and 65 students/new graduates. Data were collected through semi-structured interviews; the main priorities reported in each university were combined to gain a global view.

RESULTS

Nine priorities emerged, including the need to: 1. reflect on distance learning to promote its complementary role to face-to-face teaching; 2. rethinking the rotations of clinical practical training by refocusing their aims, duration, and preferred settings; 3. understanding how to integrate the virtual and the in-presence learning spaces into the educational pathway; 4. continuing with inclusive and sustainable strategies. Considering that nursing education is essential, it is a priority to develop a pandemic education plan capable of guaranteeing its continuity in all circumstances.

CONCLUSIONS

Nine priorities have emerged all considering the importance of digitalization; the lessons learnt, however, indicate the need to enact an intermediate phase capable of guiding towards the complete transition of the education in the post-pandemic era.

Risk of Mortality from Respiratory Malignant and Non-Malignant Diseases among Talc Miners and Millers: A Systematic Review and Meta-Analysis

There is contrasting data on the association between talc exposure and lung and pleural cancer. Given the potential importance of this aspect, we performed a systematic review and meta-analysis to investigate the association between working in the talc extractive industry and mortality from malignant and non-malignant respiratory diseases. We followed PRISMA guidelines to systematically search for pertinent articles in three relevant electronic databases: Pubmed, Scopus, and WebOfScience, from their inception to 30 November 2021. The methodological quality of included articles was evaluated using the US National Institutes of Health tool. Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) for malignant and non-malignant respiratory diseases as well as respective 95% confidence intervals (CIs) were extracted or calculated for each included cohort. Six articles comprising 7 cohorts were included in the metanalysis. There was increased mortality for pneumoconiosis, especially in the miner's group (SMR = 7.90, CI 95% 2.77-22.58) and especially in those exposed to higher quartz concentration and for non-malignant respiratory diseases in the overall analysis (SMR = 1.81, CI 95% 1.15-2.82). The risk for lung cancer mortality was slightly increased in the overall analysis (SMR = 1.42, CI 95% 1.07-1.89). The risk for malignant mesothelioma could not be calculated due to an insufficient number of studies assessing this outcome. This systematic review and meta-analysis provides evidence that men working in the talc mining industry have increased mortality for non-malignant respiratory diseases including pneumoconiosis. The small excess in lung cancer mortality may be, in part, explained by the high prevalence of the smokers in some of the analyzed cohorts or by the exposure to other carcinogens like radon decay products and diesel engine exhaust.

Work Placement and Job Satisfaction in Long-Term Childhood Cancer Survivors: The Impact of Late Effects

Late effects of cancer and its treatments during childhood or adolescence can impact work placement and increase the risk of unemployment. The aim of this study is to describe the work placement and the perceived job and economic satisfaction of long-term childhood cancer survivors (CCS). Jobs have been categorized according to the International Standard Classification of Occupations version 08 (ISCO-08), and satisfaction has been evaluated through the Satisfaction Profile (SAT-P). Out of 240 CCS (female = 98) included: 53 were students, 46 were unemployed and 141 were employed. Within unemployed survivors, 89.13% were affected by late effects (n = 41). The presence of at least one severe late effect was significantly associated with the probability of unemployment (OR 3.21; 95% CI 1.13−9.12, p < 0.050), and having any late effect was inversely related to the level of satisfaction of the financial situation of unemployed CCS (b −35.47; 95% CI −59.19, −11.74, p = 0.004). Our results showed that being a survivor with severe comorbidities has a significantly negative impact on occupation and worsens the perception of satisfaction of economic situations. Routinary follow-up care of CCS should include the surveillance of socioeconomic development and provide interventions, helping them to reach jobs suitable for their health.

Immune Response of a Heterologous mRNA-1273 Second-Dose Immunization after a First Dose of ChadOx1 against SARS-CoV-2: A Cross-Sectional Study

Heterologous vaccination regimens could contribute to broadening vaccination coverage. To date, there is little evidence on the effectiveness of a combination of adenoviral COVID-19 vaccines with a second dose of mRNA vaccines. This study aims to evaluate the antibody response to the SARS-CoV-2 spike protein 25 weeks after vaccination with mRNA-1273 after a first dose of ChAdOx1. A cross-sectional study was conducted collecting sociodemographic data, clinical characteristics, and serological data from among the general population. Antibody levels were expressed as binding antibody units (BAU) per mL (cutoff = 33.8 BAU/mL). Linear regression models were used to assess the relationship between the subjects’ characteristics and anti-SARS-CoV-2 antibody levels. A total of 229 participants were followed up after a median time of 173 days. The overall anti-SARS-CoV-2 IgG antibody titer was 729.0 BAU/mL. The multivariable analysis showed that the only factor associated with anti-SARS-CoV-2 IgG levels was the BMI (p = 0.007), with decreases within the healthy range weight and increases in under- or overweight people. Our results support the use of heterologous COVID-19 vaccination regimens, as they can guarantee a sustained immune antibody response. More studies are needed to understand the link between BMI and body composition and the immune response to COVID-19 vaccinations.

Factors Associated With Missed Nursing Care in Nursing Homes: A Multicentre Cross-sectional Study

BACKGROUND

Despite its association with patient safety, few studies on missed nursing care have been conducted in nursing homes. We aimed to describe individual and environmental factors in a sample of registered nurses (RNs) reporting missed nursing care in nursing homes, and to explore the association between these factors and missed nursing care.

METHODS

In the present, multicentre cross-sectional study, 217 RNs from 43 nursing homes in Northern Italy reported all episodes of missed nursing care (ie, any aspect of required care that was omitted or delayed) that occurred in the 20 most dependent residents (according to RNs' judgement; 860 residents in total) over 3 consecutive days. Multilevel multivariable logistic regression models were used to test possible explanatory factors of missed nursing care (individual, work-related, organisational, and work environment factors), which were entered in a step-wise manner.

RESULTS

Younger RNs (P=.026), freelance RNs (P=.046), RNs with a permanent contract (P=.035), and those working in publicly-owned nursing homes reported more episodes of missed nursing care (P<.012). Public ownership (odds ratio [OR]=9.88; 95% CI 2.22-44.03; P=.003), a higher proportion of residents with severe clinical conditions (OR=2.45; 95% CI 1.12-5.37; P=.025), a lower proportion of RNs (OR=2.24; 95% CI 1.10-4.54; P=.026), and perceived lack of time to care for residents (OR=2.33; 95% CI 1.04-5.26; P=.041) were statistically significantly associated with missed nursing care.

CONCLUSION

Factors associated with missed nursing care are similar in hospitals and nursing homes, and include heavy workload and perceived lack of time for care. Because missed nursing care in nursing homes represents tasks performed specifically by RNs, missed nursing care in this setting should be measured in terms of these tasks. An optimal skill mix is crucial to guarantee not only comfort and basic care for nursing home residents, but also good outcomes for residents with severe clinical conditions.

Physical Health and Work Ability among Healthcare Workers. A Cross-Sectional Study

Healthcare workers’ age is increasingly rising, negatively affecting their physical health. In particular, workability is an emerging phenomenon that predominantly affects healthcare workers. This study aims to assess physical health status and workability among ageing healthcare workers. A cross-sectional study using the Work Ability Index (WAI) was performed. Data were collected in a university hospital in northern Italy. Data were collected voluntary through a questionnaire. Healthcare workers participating in the survey were contacted personally by two resident physicians. Thus, the total number of study participants was 220 among nursing aides, nurses, and physicians. Data were analyzed by performing ANOVA and regression to assess the differences between the healthcare workers and age groups. A generalized linear model was tested to evaluate the effect of age and task on workability. The majority of healthcare workers had good WAI values. Physicians’ workability was higher than nursing aides. Nursing aides suffered more from cardiovascular disorders, while physicians and nurses had more musculoskeletal disorders. However, the distribution was statistically different (χ² = 24.03, p = 0.00), as most of the physicians’ workability values were good and good, while those of nursing aides and nurses were good and medium. In line with previous studies, the decrease in WAI with ageing is strictly dependent on the type of task assigned. Due to heavy physical tasks, nurses and nurses’ aides showed a greater WAI than physicians. This study highlights the critical issues faced by ageing healthcare professionals. In the near future, it is necessary to find solutions to cope with these changes and devise possible interventions aimed at ameliorating workability.

Exploring the Use and Usefulness of Educational Resources Among Nurses During the First Wave of the COVID-19 Pandemic: A Cross-Sectional Study

Nurses needed to learn rapidly how to care for patients with coronavirus disease 2019 (COVID-19). This cross-sectional study identified the educational resources RNs used to learn how to care for these patients, measured the perceived usefulness of the content of these resources, and explored the most relevant educational content sought during the first wave of the pandemic. A total of 799 RNs completed an online survey. Significant differences were found in the educational resources used between RNs who cared for patients with COVID-19 and RNs who did not, as well as for RNs who changed units following the pandemic. The educational resources most often used were also ranked as most useful. The most relevant educational content sought was related to respiratory care techniques and infection containment. These findings provide insight into the educational resources available during the first wave of the COVID-19 pandemic. They could help in developing educational programs relevant to nurses' needs during future pandemics. [J Contin Educ Nurs. 2022;53(2):63-69.].

Multi-level analysis of individual and work environment factors associated with nurses' perceived emotional exhaustion

BACKGROUND

Several factors at the individual- and work environment-level were suggested to correlate with emotional exhaustion development in nurses.

AIM

To explore nurses' perceived emotional exhaustion and associated factors by employing hierarchical modelling techniques.

METHODS

1539 nurses completed the cross-sectional survey. Generalized Linear Mixed Model was performed to identify predictors of emotional exhaustion.

RESULTS

At the individual level, female gender, high workload and emotional job demands increased the risk of emotional exhaustion; instead, higher education, satisfaction with the role of follower, perceiving nursing profession as meaningful, feeling independent at work, and group closeness were protective factors. At the work environment level, hospital ward type did not affect emotional exhaustion.

CONCLUSIONS

Emotional exhaustion is largely influenced by ward culture and organizational policies, and to a lower extent by socio-demographic variables. Moreover, it emerges as an intrinsic risk of the nursing profession rather than being associated with the clinical area profile.

The impact of COVID-19 on hospital-based workers influenza vaccination uptake: A two-year retrospective cohort study

OBJECTIVES

This study aimed at exploring 2020/2021 and 2019/2020 seasonal influenza vaccine uptake among healthcare and non-healthcare workers, hereafter hospital-based workers (HBWs); examining attitudes and motivations for uptake in the 2020/2021 season; and exploring the amount, types, and sources of information used by HBWs.

METHODS

A retrospective cohort study. Socio-demographics, working profile, working area, and vaccination status data were collected. Motivations for vaccination uptake in the 2020/2021 season were also explored. Descriptive and inferential statistics were used.

RESULTS

Overall, uptake increased from 14.8% in 2019/2020 to 31.7% in 2020/2021. Male workers show greater vaccination uptake than their female counterparts (20.4% vs. 12.6% in 2019/2020, and 36.5% vs. 29.8% in 2020/2021). Uptake increased for healthcare assistants (+8.9%), administrative/managerial staff (+17%), nurses/midwives (+17.1%), non-medical graduate staff (+22.8%), and physicians (+33.2%), while it decreased slightly for resident physicians despite still being one of the most vaccinated categories (-4.6%). Main reasons for vaccination were the desire to protect patients (33.0%) and relatives (51.1%). Lastly, 60.8% of HBWs relied on institutional sources of information; the remainder relied on non-institutional sources including social media and chatting with colleagues.

CONCLUSIONS

Vaccination uptake increased in the 2020/21 season. Tailored educational interventions are required on the impact of influenza in care settings, vaccine efficacy, and vaccination safety. Investments in improving HBWs' reliance on institutional sources, and their ability to find them, are also needed.

Interventions to reduce arterial puncture-related pain: A systematic review and meta-analysis

BACKGROUND

Arterial puncture-related pain remains unaddressed across several clinical settings. Analgesic techniques are not routinely employed before arterial puncture despite the recommendation that local anesthesia be used, except in emergencies. A comprehensive review of interventions aimed at reducing arterial puncture-related pain and their potential effectiveness is lacking, and the benefit of some interventions is uncertain.

OBJECTIVE

To describe interventions aimed at reducing arterial puncture-related pain and provide an estimate of their effectiveness.

DESIGN

Systematic review and meta-analysis (PROSPERO no. CRD42020212299).

DATA SOURCE(S)

PubMed, CINAHL EBSCO, EMBASE, the Cochrane Database of Systematic Reviews, and Scopus were searched from their inception to 7 October 2020. No temporal or language limits were applied.

METHODS

Published, quantitative studies on interventions aimed at reducing arterial puncture-related pain among adults were included. Screening, quality appraisal, and data extraction were undertaken independently by two reviewers. Random effects meta-analyses were performed to assess the association between interventions aimed at reducing arterial puncture-related pain and patients' perceived pain using difference in means (MD) with 95% confidence intervals (CIs). A funnel plot and Egger test were used to assess publication bias.

RESULTS

The titles and abstracts of the 2446 identified articles were screened, and 43 and 31 studies were finally included in the systematic review and meta-analysis, respectively. Interventions to reduce arterial puncture-related pain included: topical anesthetics (n = 16), cryotherapy (n = 9), local anesthetic infiltration (n = 5), narrower needle gage (n = 5), ultrasound-guided procedure (n = 3), topical anesthetics combined with local anesthetic infiltration (n = 1), iontophoresis using anesthetics (n = 1), engineered blood gas syringe (n = 1), jet injector (n = 1), and local massage (n = 1). Topical anesthetics [MD -0.58, 95% CI -1.00, -0.15], cryotherapy [MD -1.13, 95% CI -1.72, -0.53], and local anesthetic infiltration [MD -1.13, 95% CI -1.72, -0.53] reduced arterial puncture-related pain. No benefit was found for narrower needle gage [MD -0.07, 95% CI -0.86, 0.71] or ultrasound-guided procedure [MD -1.74, 95% CI -3.51, 0.03]. No publication bias was detected.

CONCLUSIONS

Local anesthetic infiltration provided the greatest pain reduction and should be considered standard practice. Cryotherapy may be a safe, convenient alternative to local anesthetic infiltration. Topical anesthetics had limited benefit, and their lengthy time of onset makes them unsuitable for critical or emergency situations, though they may represent an option when comorbid conditions make cooling impossible. Caution must be used when interpreting these results, given the high risk of bias in the methods of included studies and the heterogeneity across the studies.

Quality of dying in hospital general wards: a cross-sectional study about the end-of-life care

Background

In the last decade, access to national palliative care programs have improved, however a large proportion of patients continued to die in hospital, particularly within internal medicine wards.

Objectives

To describe treatments, symptoms and clinical management of adult patients at the end of their life and explore whether these differ according to expectation of death.

Methods

Single-centre cross-sectional study performed in the medical and surgical wards of a large tertiary-level university teaching hospital in the north of Italy. Data on nursing interventions and diagnostic procedure in proximity of death were collected after interviewing the nurse and the physician responsible for the patient. Relationship between nursing treatments delivered and patients’ characteristics, quality of dying and nurses’ expectation about death was summarized by means of multiple correspondence analysis (MCA).

Results

Few treatments were found statistically associated with expectation of death in the 187 patients included. In the last 48 h, routine (70.6%) and biomarkers (41.7%) blood tests were performed, at higher extent on patients whose death was not expected. Many symptoms classified as severe were reported when death was highly expected, except for agitation and respiratory fatigue which were reported when death was moderately expected. A high Norton score and absence of anti-bedsore mattress were associated with unexpected death and poor quality of dying, as summarized by MCA. Quality of dying was perceived as good by nurses when death was moderately and highly expected. Physicians rated more frequently than nurses the quality of dying as good or very good, respectively 78.6 and 57.8%, denoting a fair agreement between the two professionals (k = 0.24, P <  0.001). The palliative care consultant was requested for only two patients.

Conclusion

Staff in medical and surgical wards still deal inadequately with the needs of dying people. Presence of hospital-based specialist palliative care could lead to improvements in the patients’ quality of life.

Barriers to and Facilitators of Bedside Nursing Handover: A Systematic Review and Meta-synthesis

BACKGROUND

Bedside nursing handover (BNH) has been recognized as a contributor to patient-centered care. However, concerns about its effectiveness suggest that contextual factors should be considered before and after BNH implementation.

PURPOSE

This review aimed to identify, evaluate, and synthetize the qualitative literature on the barriers to and facilitators of BNH as experienced by nurses and patients.

METHODS

The Joanna Briggs Institute meta-aggregation method was applied. A systematic search was performed to identify qualitative studies published from inception to June 30, 2020. Two independent researchers assessed methodological quality and extracted data.

RESULTS

Twenty-four articles were included, comprising 161 findings, and 5 synthesized findings emerged with a moderate level of confidence.

CONCLUSIONS

BNH ensures patient safety and increases satisfaction and recognition among patients and nurses. This evidence on the barriers to and facilitators of BNH could help health care providers who have implemented or plan to implement this practice.

A qualitative study of family carers views on how end-of-life communication contributes to palliative-oriented care in nursing home

BACKGROUND

Although family-centered communication about end-of-life care has been recognized to promote palliative-oriented care in nursing home (NH), how this communication may work is still unknown. Therefore, we explored the mechanisms by which end-of-life communication may contribute to palliative-oriented care in NH from the perspective of bereaved family carers.

METHODS

A descriptive qualitative design was performed. Interviews were conducted with 32 bereaved family carers whose relative had died between 45 days to 9 months prior from 13 different NHs. A two-steps analysis process firstly with deductive and then with inductive content analysis was adopted.

RESULTS

Four mechanisms by which end-of-life communication contributed to palliative-oriented care were identified: a) promoting family carers understanding about their relative's health conditions, prognosis, and treatments available; b) fostering shared decision-making between healthcare professionals and residents/family carers; c) improving knowledge of residents' preferences; and d) improving knowledge of family carers' preferences.

CONCLUSION

Clear and in-depth communication provides insight into residents' and family carers' preferences for care and treatment at the end-of-life, and increases understanding and shared decision-making.

Job demands and perceived distance in leader-follower relationships: A study on emotional exhaustion among nurses

BACKGROUND

Emotional exhaustion is the most important component of burnout syndrome, which is a threat to nurses' psychological well-being.

OBJECTIVES

The study investigated the impact of job demands - workload, cognitive demands, emotional demands, role conflict - and perceived leader-follower interaction frequency on emotional exhaustion among nurses.

METHODS

This study was conducted at three hospitals in northern Italy through an anonymous self-report questionnaire administered to 560 nurses. Multiple hierarchical regression was performed.

RESULTS

Workload and role conflict were positively related to emotional exhaustion, whereas cognitive demands and perceived leader-follower interaction frequency were negatively related. Emotional demands displayed a non-significant relationship with emotional exhaustion. Further analyses were performed to comment on the unexpected outcome of cognitive demands. A critical role of the perception of "distance" in leader-follower relationships on burnout was found.

CONCLUSIONS

This study provides novel insights into the relationship between job demands and burnout, and much needed empirical evidence on leader-follower relationships among nurses, pointing to the important role played by leader distance in nurses' well-being at work. Findings highlight the importance of training head nurses in managing their working relationship distance from their followers in order to help them soothing emotional exhaustion.

Discussing treatment burden

Treatment burden is defined as “the workload of healthcare and its effect on patient functioning and well-being” [1, 2]. It has also been defined as “the self-care practices that patients with chronic illness must perform to respond to the requirements of their healthcare providers, as well as the impact that these practices have on patient functioning and well-being” [3]. In this issue of Breathe, there are several articles addressing treatment burden from different perspectives. This Viewpoint article focusses on the discussions between the patient and their healthcare professional (HCP). What are the important topics to cover in discussions about treatment burden? What are the barriers to these discussions? What facilitates a productive conversation about treatment burden? The authors of this article include three patients (with asthma, COPD and idiopathic pulmonary fibrosis (IPF), four HCPs representing different specialties (primary care, secondary and tertiary care, nursing and pharmacy) and a representative of the European Lung Foundation (ELF). This article is based on a video discussion between the authors; it was then refined via e-mail by all the authors.

Healthcare professionals should help patients to reach informed decisions about treatments in order to maximise benefits while minimising treatment burdenhttps://bit.ly/2XRtRPK

Prevalence of musculoskeletal disorders among perioperative nurses: a systematic review and META-analysis

BACKGROUND

To evaluate the prevalence of work-related musculoskeletal disorders (WRMSDs) in perioperative nurses and to explore their association with personal characteristics.

METHODS

Medline, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, Cochrane Library and Joanna Briggs Institute Database were systematically searched. A meta-analysis calculating event rates, and relative 95% Confidence Intervals (CI) was performed for each musculoskeletal body region. The contribution of perioperative nurses' sex, age, and BMI was assessed through a meta-regression.

RESULTS

Twenty-two studies, considering 3590 perioperative nurses, were included in the systematic review. The highest prevalence of WRMSDs was found for the lower-back (62%; 95% CI 0.54-0.70), followed by knee (47%; 95% CI 0.36-0.59), shoulder (44%; 95% CI 0.37-0.51), waist (42%; 95% CI 0.31-0.53), neck (39%; 95% CI 0.29-0.51), ankle-feet (35%; 95% CI 0.22-0.51), upper-back (34%; 95% CI 0.25-0.44), hand-wrist (29%; 95% CI 0.20-0.40), and elbow (18%; 95% CI 0.12-0.26). Meta-regression showed that sex, age, and BMI were not significant predictors of low-back disorders (p = 0.69; R² = 0).

CONCLUSIONS

WRMSDs represent a high prevalence issue among perioperative nurses. Perioperative nurses, in general, are steadily exposed to both physical and temporal risk factors. Further studies should be addressed to identify specific interventions aimed at reducing the burden of WRMSDs including ergonomic education and physical rehabilitation. Our data could be used in future studies as a reference to assess the risk of WRMSDs in other health-care professionals' population.

Nursing students' perspectives of dance movement therapy to learn relational skills: A qualitative description study

BACKGROUND

Nursing students are expected to develop communication and relational skills during their undergraduate education, and the literature on art-based methods for teaching these skills is growing. Art-based education seems to be a promising method for teaching relational skills, especially embodied and performing arts. Dance Movement Therapy has been used previously to learn relational skills, but never in undergraduate nursing students.

AIM

To describe how first-year undergraduate nursing students experienced the learning of communication and relational skills through a Dance Movement Therapy workshop.

SETTINGS & PARTICIPANTS

First-year undergraduate nursing students who completed a two-session Dance Movement Therapy workshop.

DESIGN & METHODS

This study utilised a Qualitative Description design. Data were gathered from students' reflective journals (n = 226 journals, 113 students) and analysed with a thematic analysis approach.

RESULTS

Three themes were identified: learning happens through the experience of competences, learning happens through corporeality, and learning takes time. The first theme describes how students experienced theoretical concepts through workshop games. "Learning happens through corporeality" focuses on the role of the body during Dance Movement Therapy games as a medium for learning. "Learning takes time" describes students' evolution during the workshop, both within and between sessions, and the graduality of comprehension and learning.

CONCLUSIONS

The findings of this study suggest that Dance Movement Therapy can be an applicable methodology for nursing students to learn communication and relational skills. Most of the relational skills and non-verbal communication components were explored and strengthened during the workshop. Students were also able to create links between theoretical concepts and nursing practice. Nurse educators may want to consider using Dance Movement Therapy to teach communication and relational skills.

[Nurses' perception of the organisational context of nursing homes: a descriptive study]

. Nurses' perception of the organisational context of nursing homes: a descriptive study.

INTRODUCTION

The increasing number of the elders admitted to nursing homes (NH) requires a particular emphasis on improving the quality of nursing care. The evaluation of the organizational context has recently received growing interest, for its contribution to understanding of care outcomes and staff's needs.

AIM

To describe the characteristics and the nurses'perception of organizational context of NHs in which they work.

METHODS

A cross-sectional study was conducted in 50 NHs in the Piedmont and Aosta Valley regions. The following data were collected: sociodemographic information on nurses, years of work experience, contract type, and work-hour profile; organizational information included ownership, size, occupancy rate; and for the organizational context, the Alberta Context Tool was administered.

RESULTS

Of the 312 nurses, 266 (85%) participated in the study; 79% had a university degree. Perceived organisational context scored low (median values 2.5) in terms of the availability of Interactions (Formal and Informal), Resources, Personnel and time, but good with median values above 3.5/5 on Leadership, Culture, Evaluation, Social Capital and Space, with differences according to years of experience, type and size of facility; for example, nurses working in private facilities perceived their organisational context as better than those working in public facilities.

CONCLUSIONS

NHs are workplaces that are still not frequently chosen by nurses and essentially considered as places of transition or end of the career. In spite of organizational contexts perceived as positive, tangible efforts are needed to improve working conditions and the perception of nurses' role.

Prevalence of Workplace Sexual Violence against Healthcare Workers Providing Home Care: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis sought to explore the prevalence of sexual violence including both sexual harassment and abuse, perpetrated by clients against home healthcare workers (HCWs), including professional and paraprofessional HCWs. To this end, we systematically searched five relevant databases. Two reviewers extracted data from the included studies independently and performed a quality appraisal. Overall and subgroup random-effects pooled prevalence meta-analyses were performed. Due to high heterogeneity, a more robust model using a quality effect estimator was used. Fourteen studies were included, and the prevalence of sexual violence was 0.06 (95% confidence interval (CI): 0.01–0.13). Paraprofessionals had a higher prevalence of sexual violence (0.07, 95% CI: 0.00–0.18 vs. 0.05, 95% CI: 0.00–0.12), and the prevalence of sexual abuse was lower than that of sexual harassment (0.04, 95% CI: 0.00–0.10 vs. 0.10, 95% CI: 0.03–0.18). This systematic review estimated the prevalence of sexual violence across home HCWs from different high-income countries, highlighting the presence of this phenomenon to a lesser but nevertheless considerable extent compared to other healthcare settings. Health management should consider interventions to prevent and reduce the risk of home HCWs from being subjected to sexual violence, as the home-care sector presents particular risks for HCWs because clients’ homes expose them to a relatively uncontrolled work environment.

Impact of wearing a surgical mask on respiratory function in view of a widespread use during COVID-19 outbreak. A case-series study

BACKGROUND

Because of the COVID-19 outbreak, the widespread use of Respiratory Protective Devices (RPD) is recommended to prevent the spread of infection. This recommendation involves not only healthcare workers but other category of workers and the general population as well, in public places, especially where social distancing is difficult to maintain. The use of facemasks should not cause physical impairment to individuals, especially for people suffering from lung and heart diseases.

OBJECTIVES

To evaluate the impact of RPDs on the respiratory function in healthy and asthmatic subjects, in order to identify the fitness for use mainly, but not only for, occupational purposes during COVID-19 outbreak.

METHODS

Ten individuals were included, three of which affected by asthma and three current smokers. A Respiratory Functional Test (RFT) was performed at three times: at the beginning of the work shift 1) without wearing and 2) wearing surgical masks, and 3) after 4 hours of usual working activities wearing the masks. Arterial Blood Gas (ABG) samples were also tested before the first test and the third test.

RESULTS

Observed RFTs and ABG parameters did not suffer significant variations, but for Maximal Voluntary Ventilation (P=0.002). Data on asthmatic subjects and smokers were comparable to healthy subjects.

DISCUSSION

Our results suggest that wearing a surgical mask does not produce significant respiratory impairment in healthy subjects nor in subjects with asthma. Four hours of continuing mask-wearing do not cause a reduction in breathing parameters. Fitness for use in subjects with more severe conditions has to be evaluated individually. Our adapted technique for RFTs could be adopted for the individual RPDs fitness evaluation.

Assessment of air and surfaces contamination in a COVID-19 non-Intensive Care Unit

BACKGROUND

Severe Acute Respiratory Syndrome - Coronavirus - 2 (SARS-CoV-2)  is a virus, primarily transmitted through  droplets, able to persist on different surfaces and in the air for several hours. During the COVID-19 pandemic, Health Care Workers should be considered a high risk profession. Beside social distancing rules and the proper use of Personal Protective Equipment,  sanitization measures and ventilation system disinfection are essential to reduce viral transmission.

OBJECTIVES

This is the first Italian study aiming to assess the magnitude of environmental contamination in a COVID-19 non-Intensive Care Unit.

METHODS

In addition to ordinary cleaning procedures, surface and air samplings have been performed before and after the application of two different sanitization devices. Samples have been analyzed with Real Time-Polymerase Chain Reaction in order to find viral RNA.

RESULTS

All samples obtained from surfaces and air before and after extra-ordinary sanitization procedures turned out negative for viral detection.

DISCUSSION

These findings highlight the efficiency of ordinary cleaning procedures in guaranteeing a safer workplace. The adoption of additional sanitization protocols should be considered in order to further reduce environmental viral contamination.

Do we need tailored training and development plans for European Union respiratory nurses?

Nurses are critical players in healthcare and should be the next profession to standardise levels of education, preparing them for an active partnership with other healthcare professionals prepared to tackle the chronic disease problem in Europe https://bit.ly/3bMR76b.

What self-care behaviours are essential for people with spinal cord injury? A systematic review and meta-synthesis

Purpose: To systematically identify, evaluate, and synthesise the qualitative literature on the self-care behaviours, skills, and strategies performed by individuals with spinal cord injury (SCI).Review methods: The Joanna Briggs Institute (JBI) meta-aggregation method was followed. The search was conducted on five databases and limited to papers published from January 2000 to March 2020. Two independent reviewers screened, extracted the data from, and assessed the methodological quality of selected papers using the JBI qualitative assessment and critical appraisal instrument.Results: Eleven qualitative papers were included. Three synthesised findings with a moderate level of confidence emerged from 90 findings: people with SCI perform self-directed or directed-by-other behaviours focused on their physical condition (i); and on their social life (ii); people with SCI perform self-directed behaviours focused on their emotional well-being (iii). Individuals with SCI are aware of their condition and incorporate self-care behaviours into their routine to maintain health and prevent complications.Conclusion: This meta-synthesis provides evidence on the self-care behaviours performed by people with SCI to prevent, control, and manage the physical, emotional, and social effects of their condition. These findings may help healthcare providers to understand the self-care process in SCI survivors and tailor educational programmes to their experiences.IMPLICATIONS FOR REHABILITATIONSCI survivors are directly responsible for their health and must reach their maximum level of independence by acquiring self-care behaviours and adjusting them over time.Self-care behaviours must be incorporated into SCI survivors' daily routine to maintain their condition, promote their social participation, and prevent complications.Caregiver contributions to self-care should be given more value, as these are fundamental to maintain SCI survivors' well-being and social participation.

COVID-19 infection and diffusion among the healthcare workforce in a large university-hospital in northwest Italy

Backgroud: Since the beginning of the coronavirus disease 2019 (COVID-19) outbreak, healthcare workers (HCWs) have been the workers most likely to contract the disease. Intensive focus is therefore needed on hospital strategies that minimize exposure and diffusion, confer protection and facilitate early detection and isolation of infected personnel.

METHODS

To evaluate the early impact of a structured risk-management for exposed COVID-19 HCWs and describe how their characteristics contributed to infection and diffusion. Socio-demographic and clinical data, aspects of the event-exposure (date, place, length and distance of exposure, use of PPE) and details of the contact person were collected.

RESULTS

The 2411 HCWs reported 2924 COVID-19 contacts. Among 830 HCWs who were at 'high or medium risk', 80 tested positive (9.6%). Physicians (OR=2.03), and non-medical services -resulted in an increased risk (OR=4.23). Patient care did not increase the risk but sharing the work environment did (OR=2.63). There was a significant time reduction between exposure and warning, exposure and test, and warning and test since protocol implementation. HCWs with management postitions were the main source of infection due to the high number of interactions.

DISCUSSION

A proactive system that includes prompt detection of contagious staff and identification of sources of exposure helps to lower the intra-hospital spread of infection. A speedier return to work of staff who would otherwise have had to self-isolate as a precautionary measure improves staff morale and patient care by reducing the stress imposed by excessive workloads arising from staff shortages.

A qualitative study of nurses' perspective about the impact of end-of-life communication on the goal of end-of-life care in nursing home

BACKGROUND

With a growing nursing home population suffering from chronic progressive illnesses and evolving patterns of comorbidities, end-of-life communication takes on a critical role to enable healthcare professionals to gather information about the resident's wishes for care at the end-of-life and organise the care plan accordingly.

AIM

To explore nurses' perspective about the process by which end-of-life communication impacts on the goal of end-of-life care in nursing home residents.

DESIGN

A qualitative descriptive research design based on thematic analysis was performed. Fourteen nurses involved in the care of residents during their last week of life were recruited across 13 Italian nursing homes and accounted for 34 semi-structured interviews. A combined approach of analysis that incorporated a data-driven inductive approach and a theory-driven one was adopted.

RESULTS

Twelve themes described how end-of-life communication may contribute to adjust the care plan in nursing home according to the nurses' perspective. Five antecedents (i.e. life crisis or transitions, patient-centered environment, arising the question of possible dying, quality of relationships and culture of care) influenced the establishment and quality of communication, and five attributes depicted the characteristics and potential mechanisms of end-of-life communication (i.e. healthcare professional-resident and healthcare professional-family carers communication, knowledge of family carers' preferences, knowledge of residents' preferences, family carers and residents understanding, and shared decision-making), while curative-oriented and palliative-oriented care goals emerged as consequences.

CONCLUSION

This study provides insight into the nursing perspective of end-of-life communication between healthcare professionals and bereaved family carers of nursing home residents. Several factors influenced the occurrence and quality of end-of-life communication, which contributed to the transition towards palliative-oriented care by using and improving knowledge about family cares' and resident's preferences for end-of-life care, promoting family carers and residents understanding about prognosis and treatments available, and fostering shared decision-making.

ERS International Congress, Madrid, 2019: highlights from the Allied Respiratory Professionals' Assembly

This article provides an overview of outstanding sessions that were (co)organised by the Allied Respiratory Professionals' Assembly during the European Respiratory Society International Congress 2019 in Madrid, Spain. Session content was mainly targeted at allied respiratory professionals such as respiratory physiologists, respiratory physiotherapists and respiratory nurses, and is summarised in this document. Short take-home messages related to pulmonary function testing highlight the importance of quality control. Furthermore, novel findings regarding the assessment of functional status call attention to bodily factors that can affect functional status. Regarding pulmonary rehabilitation, data were presented about the use of equipment and type of exercise training in COPD and lung cancer. Recent developments in physical activity-related research give insight in enablers of physical activity after hospital admission. The importance of integrated respiratory care was also highlighted, with the occupational therapist, nurse, and nutritional and psychological counsellor playing a pivotal role, which relates directly to research in the field of respiratory nursing that formulates the need for more nursing led-interventions in the future. To conclude, this review provides readers with valuable insight into some of the emerging and future areas affecting clinical practice of allied healthcare professionals.

A highlights review of selected presentations from #ERSCongress 2019 by @ERS_Assembly9http://bit.ly/2VNFgAj

The Relationship Between Psychological and Physical Secondary Conditions and Family Caregiver Burden in Spinal Cord Injury: A Correlational Study

Background: Caregiver burden (CB) is a consequence of providing care to people with spinal cord injury (SCI). However, there is a lack of clarity about the influence of secondary conditions of care recipients on family caregivers. Secondary conditions refer to the physical and psychological complications that can occur after SCI and lead to increased hospitalization and reduced functionality, quality of life, and social participation. Objective: To assess the impact of physical and psychological secondary conditions of people with SCI on the perceived burden of family caregivers. Methods: A multicenter, cross-sectional study of 56 dyads of family caregivers and individuals with SCI in two urban spinal units in Italy and Ireland. Care recipients completed a toolset consisting of demographic information and assessments of functional, physical, and psychological health. Caregivers completed a multidimensional measure of CB. Bivariate data analysis was used. Results: No significant differences between centers were identified. CB was found to be related to physical secondary conditions and functional independence but not to mental health of care recipients. Bladder dysfunction and urinary tract infections influenced all dimensions of CB, whereas pressure injuries influenced only the time-dependent dimension. Level and completeness of injury and duration of caregiving increased CB. Conclusion: Findings indicate the value of a reduction in secondary conditions not just for individuals with SCI but also for their family caregivers. To reduce the individual and family burden of secondary conditions, a two-pronged, multidimensional approach, focusing on self-management for care recipients and psychoeducational support for caregivers, is required.

A contribution to the validation of the Italian version of the work-related quality of life scale

BACKGROUND

Quality of working life has been shown to play a key role in reducing strain inside and outside the workplace, supporting the fulfillment of workers' wellbeing and increasing workforce productivity. Van Laar et al. in 2007 developed the Work-Related Quality of Life (WRQoL) scale that was applied to several different work environments and translated into nine languages.

OBJECTIVES

We aimed to test and validate an Italian version of the WRQoL scale.

METHODS

A cross-sectional design was conducted to collect a sample of healthcare professionals (N=430) in 8 hospitals in the Northwest of Italy. Internal consistency of each scale was tested through Cronbach's alpha. A Confirmatory factor analysis was performed. Independent samples t-tests and ANOVA were performed to determine whether the scores on the subscales differed according to various socio-demographic variables.

RESULTS

A seven factors structure was confirmed (Control at work; General well-being; Home-work interface; Stress at Work; Job and career satisfaction; Working conditions; Employee Engagement; χ2=682.453, p<.001; χ2 and df(251) ratio=2.71; CFI=.90; RMSEA=.06; SRMR=.06). All subdimensions showed Cronbach's alphas ≥ 0.70 but for Stress at Work (alpha 0.65). The subscales differentiated between groups of people according to several socio-demographic characteristics (i.e., profession, age, length of employment).

DISCUSSION

The Italian version of WRQoL is a brief and sufficiently reliable tool that can contribute to a more complex and complete evaluation of the psychological well-being at work due to its multidimensionality. Overall, the use of this tool in occupational health practice, in addition to that of other instruments already available, should prove useful in monitoring workers' well-being before and after interventions.

Cross-cultural adaptation and validation of questionnaire for knowledge, attitudes, and behavioral intentions in Italian nurses with regard to provision of artificial nutrition and hydration to patients terminally ill with cancer

OBJECTIVES

Decision-making on artificial nutrition and hydration for patients terminally ill with cancer can be influenced by nurses' knowledge, attitudes, and behavioral intentions. A comprehensive 57-item questionnaire including six sections on the knowledge, attitudes, and behavioral intentions in providing artificial nutrition and hydration to patients terminally ill with cancer has been developed and used in Taiwan. However, the questionnaire needs further psychometric testing and adaptation for other cultures. This study aimed to cross-culturally adapt the questionnaire within the Italian cultural context and test its psychometric properties.

METHODS

The questionnaire was translated into Italian and cross-culturally adapted per the recommendations by Beaton. A panel of 10 experts assessed content validity. A multicenter cross-sectional study was conducted with 411 nurses to test its psychometric properties. Dimensionality and construct validity were assessed through exploratory and confirmatory factor analyses. Reliability was estimated by composite ω and traditional methods, such as the Kuder Richardson formula-20 and Cronbach's α coefficients.

RESULTS

The overall content validity index was 0.85. A confirmatory factor analysis was conducted for the knowledge section and the four attitudes sections. A preliminary analysis for the behavioral intentions section yielded non acceptable results. The internal consistency of the scales was adequate (range, 0.64-0.93).

CONCLUSIONS

This study constituted a notable advancement in the psychometric testing of the tool, and provides evidence that the Italian version of the questionnaire has acceptable psychometric characteristics for the sections on knowledge and attitudes.

Teaching resilience and vulnerability to nursing students using films: A qualitative study

BACKGROUND

There is a limited tradition of using films in healthcare education, although it is constantly developing. Further, to understand complex concepts, such as vulnerability and resilience, is fundamental to improving nursing education.

OBJECTIVE

This study aims to explore how a combined approach, using films and expert patients, could influence nursing education on the topics of vulnerability and resilience.

METHODS

A qualitative descriptive study was carried out. Reflective writings of eight bache- lor's degree students during the first semester of the second year were analysed through a con- tent analysis methodology.

RESULTS

Two main themes emerged: 1) To face up to vulnerability through resilience expe- riences, with three sub-themes: active behaviours to cope with disability; carrying the heavy load of vulnerability; using resilience as a new beginning; 2) Students' difficulties and perspectives on caring vulnerable people, with two sub-themes: awkwardness of facing vulnerability; and walk together to overcome disability CONCLUSIONS: The use of films, enhanced by the lived experiences of expert patients, would improve the learning in the new generation of nursing students that are actually more involved in the use of innovative learning strategies. The adoption of new ways to teach complex con- cepts to bachelor degree nursing students is pivotal to simplify theories and to establish a posi- tive connection between nursing students and educators. The education system should consider that, only through emotionally strong educational strategies, is possible to foster an endu- ring emotional knowledge in students.

Factors influencing the perception of protective isolation in patients undergoing haematopoietic stem cell transplantation: A multicentre prospective study

OBJECTIVES

To identify which factors can influence the patients' perception of protective isolation following Haematopoietic Stem Cell Transplantation (HSCT).

METHODS

This is a prospective study conducted in 10 Italian centres, members of the Italian Group of stem cell transplant (GITMO). Patients' perception of protective isolation was assessed using the ISOLA scale between 7 and 9 days post-transplant. Statistical linear regression analysis was performed.

RESULTS

The participants were 182 adult patients receiving autologous (48%) or allogeneic (52%) HSCT in protective isolation. Male sex (β = .152), education level (β = -.245), double room (β = .186), satisfaction with visiting hours (β = -.174) and emotional support from nurses (β = -.169) were independently associated with isolation-related suffering. Significant predictors of the relationship with oneself included body temperature (β = -.179), fatigue (β = -.192) and emotional support from nurses (β = -.292). Factors independently associated with the relationship with others were education (β = -.230), chemotherapy cycles (β = -.218), pain (β = .150) and satisfaction with visiting hours (β = -.162).

CONCLUSION

Healthcare providers should pay greater attention in caring for those patients who are at risk for a negative isolation experience. Nurses should provide emotional support.

Upper Limb Work-Related Musculoskeletal Disorders in Operating Room Nurses: A Multicenter Cross-Sectional Study

This study aimed to evaluate the association between personal and job characteristics and the risk of upper limb work-related musculoskeletal disorders (WMSDs) among operating room nurses (ORNs). To this end, we collected data from 148 ORNs working at 8 Italian hospitals and measured any upper limb disabilities experienced in the previous year using the Italian version of the disabilities of the arm, shoulder and hand (DASH) questionnaire. The associations between personal and job characteristics and risk of upper limb WMSDs were estimated by unconditional logistic regression models. The prevalence of upper limb WMSDs was 45.9%. Multivariate analysis showed the "female gender" and "monthly hours spent working as a scrub nurse" to be directly associated with a higher DASH score (adjusted OR for gender = 5.37, 95% CI: 1.65-17.51, p < 0.01; adjusted OR for monthly hours as scrub nurse = 3.09, 95% CI: 1.33-7.19, p < 0.01). Overall, our findings indicate that a full-time job (>120 h/month) as a scrub nurse significantly increases the risk of developing upper limb WMSDs among female ORNs. Thus, to reduce such risk in this particularly sensitive population, we recommend urgent implementation of ergonomic interventions on surgical equipment alongside job rotation and medical surveillance programs.

The Self-Care in Chronic Obstructive Pulmonary Disease Inventory: Development and Psychometric Evaluation

This study developed two instruments, the Self-Care in Chronic Obstructive Pulmonary Disease (COPD) Inventory (SC-COPDI) and the COPD-Self-Care Self-Efficacy Scale (SCES), and tested their psychometric properties on a convenience sample of 498 patients from Northern, Central, and Southern Italy. First, the domains and the items of the SC-SCOPDI were generated based on the middle-range theory of self-care of chronic illness, comprising the dimensions of self-care maintenance, self-care monitoring, and self-care management, and the SCES-COPD was developed accordingly. Second, we assessed the content validity of each scale. Third, we conducted a multicenter cross-sectional study to test their structural validity, convergent and discriminative validity, internal consistency, and test–retest reliability. The theoretical dimensions of the two instruments were confirmed through confirmatory factor analysis. Convergent validity was demonstrated by the correlation among the three self-care scales and the Self-Efficacy Scale, and discriminative validity by higher self-care scale scores in individuals with greater COPD severity and poorer health status. The global reliability index ranged from .78 to .92 for all scales. The intraclass correlation coefficients were higher than .70. Further studies are needed to confirm the psychometric properties of the two instruments in different COPD populations and countries to extend their use in clinical practice.

Sensitivity and specificity of trauma team activation protocol criteria in an Italian trauma center: A retrospective observational study

BACKGROUND

The trauma team (TT) model could reduce mortality, morbidity, and duration of hospital stay, costs, and complications. To avoid over- or undertriage for trauma team activation, robust criteria have to be chosen.

OBJECTIVE

This study aimed to evaluate the sensitivity and specificity of a TT activation protocol for major trauma patients to predict the need for emergency treatment.

METHODS

A retrospective observational study was carried out in the Emergency Department (ED) of a major Italian trauma center. Patients with trauma or burns who accessed the ED in 2015 with a triage red or yellow priority treatment code were included, while pediatric patients were excluded. Sensitivity, specificity and positive predictive values were calculated for each TT activation criteria and the aggregated criteria.

RESULTS

Data from 240 patients were collected: 40.42% of patients had a congruent triage while 50% were overtriaged and 9.58% undertriaged. A correct triage led to a lower hospital stay (p < 0.01), while undertriage was not associated with patients' death (p = 0.16). All criteria had a specificity higher than 95%, a total sensitivity of 80.83% and a total positive predictive value of 43.49%.

CONCLUSION

This study highlighted that the TT activation criteria had high specificity and sensitivity, while the positive predictive value of the criteria was lower. Mechanisms of injury criteria were less specific and sensitive in detecting the TT activation correctly. As nurses play a pivotal role in the triage of traumatized patients and the TT, reduction of under- and overtriage is essential to improve the patients' health outcome.

The effect of the burden of caregiving for people with spinal cord injury (SCI): a cross-sectional study

AIM

To assess the caregiver burden (CB) of caregivers for people with Spinal Cord Injury (SCI) and to examine the psychological impact of the burden of caregiving.

MATERIALS AND METHODS

Cross-sectional study. A set of structured questionnaires was administered to 55 family caregivers of individuals with SCI. The Modified Barthel Index was used to evaluate the independence of care recipients. The Caregiver Burden Inventory was modified and used to assess the CB. The Family Strain Questionnaire - Short Form was administered to measure the psychological impact of CB. The Short Form 36 was used to assess the health status of the participants.

RESULTS

CB affects mainly the domains related to time management, the physical condition of caregivers and their sense of personal failure. An increased level of CB and the dependency level of SCI survivors is significantly correlated (p < 0.01) with an increase in the need of psychological support and a decrease in perceived health and quality of life.

CONCLUSIONS

Caregiving for people with SCI implies the occurrence of CB. The contribution of caregivers should be recognised and supported with tailored relief interventions.

Anxiety, depression and quality of life in chronic obstructive pulmonary disease patients and caregivers: an actor-partner interdependence model analysis

PURPOSE

We aimed to assess the influence of anxiety and depression on the physical and mental quality of life (QoL) in patient with chronic obstructive pulmonary disease (COPD) and caregiver dyads, detect the simultaneous effect of anxiety and depression of each partner on the other's QoL and determine the dyadic patterns.

METHODS

A cross-sectional descriptive design was used. The actor-partner interdependence model estimated by structural equation modeling was used for the dyadic analysis. Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and 12-Item Short-Form Health Survey (SF-12) were used to measure depression, anxiety and QoL, respectively.

RESULTS

Eighty COPD dyads were enrolled in the study. Patients presented higher depression symptoms and poorer physical and mental QoL than their caregivers, whereas comparable levels of anxiety were found in patients and caregivers. The model exploring the effects of depression and anxiety on mental QoL found that patients' depressive symptoms negatively influence their mental QoL, and caregivers' anxiety and depression symptoms negatively impact their mental QoL. The model exploring the effects of anxiety and depression on physical QoL detected one statistically significant actor effect with patients' depressive symptoms negatively influencing their physical QoL, and two partner effects with caregivers' anxiety worsening patients' physical QoL and caregivers' depression improving patients' physical QoL.

CONCLUSIONS

The results suggest that caregivers' psychological distress influences caregivers' mental QoL and patients' physical QoL. Therefore, health-care professionals should assess and treat anxiety and depression in both members of the COPD dyad to improve their QoL.