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.

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.

Violence and unsafety in a major Italian hospital: experience and perceptions of health care workers

Workers' experience of violence and perceived unsafety can have a profound impact on job satisfaction, job performance, and workers' decision to leave.

OBJECTIVES

The aim of the study was to assess the prevalence of physical and non-physical violence among hospital workers, explore the complaints and reactions of victims, assess the relationship between violence and psychosocial/work factors and analyze the levels of perceived unsafety.

METHODS

A cross-sectional study was conducted, via a structured self-administered questionnaire given to all the employees of a major hospital in Italy. Cronbach's alpha coefficient was used to assess the internal consistency of the questionnaire. A logistic regression model was used for data analysis.

RESULTS

903 questionnaires out of 1853 (48.7%) were correctly returned; 11.5% had experience of physical violence and 40.2% had been victims of verbal violence in the previous 12 months. The most common consequences were fear, anger, frustration, and anxiety. Verbal violence was influenced by age, role, department, night/holiday shift work and experience in the current ward. Experiences of physical violence were related to gender, role, and department; 469 responders (51.9%) reported feelings of unsafety, which were related to their professional role, department, shift work, experience of physical or psychological violence, having seen episodes of violence and having received specific training.

CONCLUSIONS

Our findings suggest that several factors are associated with workplace violence in health care settings and some of these also influenced the levels of perceived unsafety.

Aerophagia increases the risk of ventilator-associated pneumonia in critically-ill patients

BACKGROUND

Gastric residual volume in ventilated critically ill may complicate gut function. Over the years studies suggested to tolerate progressively higher residuals. The relationship between such volumes and the development of ventilator-associated pneumonia (VAP) is still under debate. No reports deal with the relevant anecdotal finding of air in the stomach. Aim of the present study is to test the role of air in the development of VAPs.

METHODS

Prospective observational trial in consecutive patients with a predicted length of ICU stay >3 days. The first 8 days of stay were studied. Sedation was targeted to have awake/cooperative patients. Early enteral nutrition was attempted. Gastric content was measured every 4 hours by 60 mL-syringe suction. Upper digestive intolerance (UDI) was defined as >2 consecutive findings of liquid >200 mL, aerophagia was defined as >2 consecutive findings of air >150 mL.

RESULTS

Three hundred sixty-four patients enrolled, 43 developed VAP (11.8%). Patients were sedated with enteral (76% total time), intravenous (6%) or both (28%) drugs. Conscious sedation was achieved in 54% of the observations. 326 patients began enteral nutrition during the first 24 hours (1000 kcal median calorie intake). 10% developed UDI, 15% had aerophagia. No association was found between VAP and UDI (P=0.78), while significant association was found between VAP and aerophagia (OR=2.88, P<0.01). A sensitivity analysis, excluding patients admitted with respiratory infection, confirmed the results.

CONCLUSION

High volumes of air in the stomach significantly increased the risk of developing VAP, while gastric residual volumes were not associated with the incidence of pneumonia.

[A national survey on the activities performed by nurses and aids in Italian outpatients' services]

In Italy, the National Health System (SSN) grants healthcare to the citizens; its realization is up to the Government, the Regions and local institutions, with the participation of citizens. The Health Ministry determines the essential levels of care, and dictates the general guidelines for the activities of the SSN. On the whole national territory, a network of Local Healthcare Units (ASL) is present; such institutions, although belonging to the SSN, have local autonomy. Their activity is based upon principles of efficacy and efficiency; each one includes one or more Districts, which usually group a minimum of 60,000 citizens. Until 1999, Italian nurses have based their activity on a law that enumerated their tasks (DPR 225/74); nowadays, they work according to the indications of a professional profile (DM 739/94), a code of deontology, a law (L. 42/99) that has eliminated the old DPR, and university programmes. Apart from nurses, both in public and private healthcare facilities it is possible to find aids called OSS; their education consists of a twelve months programme, for which the regional institutions are responsible. Specific laws define their field of activity. For all these reasons, and also because of a major nursing shortage, in Italy it is not possible to talk about tasks delegations from doctors to nurses; we can, however, think about this process from nurses to aids and employees. Italy has the highest number of doctors in the world, with more than 6 every 1000 citizens in 2005 (approximately 370,000 units); nurses suffer from the opposite problem; nurses were 348,415 in 2005 and 360,874 in 2007, that is to say 5.4 nurses each 1000 citizens. This means a shortage of 60,000 nurses.

GOALS

Our research is aimed at: Studying the activities deployed by nurses in outpatients' facilities, that could be assigned to aids,; Identifying the tasks currently deployed by nurses, that are beyond their competence; Estimating how much time nurses could save, if they were not busy with activities that could be assigned to others.

MATERIALS AND METHODS

Our study sample included only of manager nurses, who were responsible of nursing offices in ASLs which included outpatients. facilities on the whole territory ofl Italy. We choose to make a convenience sampling, choosing a manager nurse for each regional chief town. Our study is an observational, non-experimental quantitative research. To collect our data we used an anonymous questionnaire, based on a reference model, which had already been used in older studies. The model allowed a classification of the tasks performed by nurses in three categories: Nursing activities without chances of delegation; Nursing activities that could be assigned to aids; Activities beyond the competence of nurses. The questionnaire was articulated in 7 categories (general situation, booking, acceptation, preparation of patients' units, nursing care, tasks usually performed in outpatients' services, rearrangement of patients' units). We made a comparison between our data and the reference model. In the studied outpatients' services, nurses take in charge a high percentage of tasks (39%) that should be performed by others. More precisely, there are activities that should be carried out by aids (17%) or employees (22%). For example, in the category "Rearrangement of the patient's units", nurses perform approximately 70% of the tasks. Our study revealed that not employing aids at their fullest affects the problem; overall, our data show that 45% of nurses' everyday working time could be regained, if it were possible to assign to aids and employees all the activities that are not nurses' competence. This would produce a series of positive consequences, such as bringing out of the competences acquired by nurses, a better qualification and a real identification of the contribution given by nurses to the citizenship, other than an adequate employment and usage of human resources.

Intention to leave nursing in a major Milan hospital: current situation and future perspectives

BACKGROUND

European nurses manifest a significant tendency to leave nursing, with Italy in second place after the United Kingdom. It is therefore necessary to address the problem in national and local settings and to identify possible areas of intervention.

OBJECTIVES

This paper discusses the results of a survey carried out in a major hospital in Milan (Italy) aimed at finding solutions to the above problem.

METHODS

In 2004 a questionnaire was administered to the entire nursing staff. Associations between intention to quit, socio-demographic variables and job characteristics were verified by means of Mann-Whitneys's and Kruskall-Wallis' tests, Spearman's correlation coefficients and logistic regression.

RESULTS

Nearly 60% of nurses considered leaving, at least every now and then. The tendency to quit was associated with job dissatisfaction, burnout symptoms and the job market situation. For those for whom nursing had a moral value, the tendency to quit was less marked. Characteristics such as regularity of shifts, type of ward, type of contract and number of working hours did not show any statistically significant association with tendency to quit.

CONCLUSIONS

There are many organizational aspects that may be of importance in influencing nurses' intention to leave the profession. Efforts are needed to re-define the role of nurses in healthcare organization, adjusting salaries to the actual cost of living and preventing conditions that could lead to psychological exhaustion. Mentorship could also be useful for a better integration of nurses in hospital wards.