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Objectives: To reveal the effectiveness of didactic architectures and pedagogical strategies to be implemented in nursing curricula to develop and improve Emotional Competencies (EC) in undergraduate nursing students., Design: Systematic review of effectiveness conducted according to Joanna Briggs Institute (JBI) guidelines. We followed the PRISMA statement to guarantee the transparency of the review and the GRADE to report the strength of evidence., Data Sources: Seven databases were searched: MEDLINE, The Cochrane Library, SCOPUS, CINAHL, EMBASE, PsycINFO and ERIC. Grey literature was also searched through the OpenGrey database., Review Methods: Studies focusing on educational programmes and/or activities to develop EC in nursing curricula, published in English or Italian were included. Quality assessment of the studies was evaluated using JBI critical evaluation tools and the Mixed Methods Appraisal Tool (MAAT). Following JBI guidelines, a narrative synthesis was performed., Results: A total of 19 studies from 8 countries were included. The population varied from first to fourth-year students in relation to the duration of the undergraduate nursing program across the various countries. Most of the students were females. The age of the participants ranged between18 and 56 years. The most common pedagogical strategies were simulation, role playing, and face-to-face lessons. In some cases, studies combined two or three pedagogical strategies in the same intervention. The most effective strategy was simulation, which improved EC, compassion, self-awareness, self-efficacy, empathy, critical thinking, clinical practice skills, and teamwork skills. Furthermore, the combination of lessons, simulation, and literature exploration effectively developed communication skills, and improved students' satisfaction., Conclusions: Investing in simulation, role-playing activities, and lessons regarding the importance of EI, empathy and compassion, and the role of an emotionally competent nurse leads to improved nursing care and wellbeing., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The aim of this study was to adapt the National Aeronautics and Space Administration Task Load Index (NASA-TLX) to the home care setting and translate and validate it in Italian. An online questionnaire containing the Italian version of the NASA-TLX adapted to the home care setting was administered to home care nurses to measure workload. Content Validity Index, Exploratory, and Confirmatory Factor Analyses were used to measure the psychometric characteristics of the modified NASA-TLX. The modified Italian version of NASA-TLX_HC-IT showed good psychometric characteristics in measuring the workload of home care nurses, with excellent fit indices. The reliability, calculated with Cronbach's alpha, was 0.73, indicating adequate reliability. A negative correlation between workload and job satisfaction among home care nurses, as well as a positive association between high workload and intention to leave the workplace, was verified. The modified Italian version of the NASA-TLX_HC-IT was confirmed to be a valid and reliable instrument to measure workload in home care nursing. Furthermore, the correlation between workload and the intention to leave the workplace among home care nurses was an important result that community nursing managers should consider preventing the shortage of home care nurses., (© 2024 The Author(s). Public Health Nursing published by Wiley Periodicals LLC.)

Background: To meet the population's needs, community care should be customized and continuous, adequately equipped, and monitored., Introduction: Considering their fragmented and heterogeneous nature, a summary of community healthcare services described in European literature is needed. The aim of this study was to summarize their organizational models, outcomes, nursing contribution to care, and nursing-related determinants of outcomes., Methods: A systematic review was performed by searching PubMed, CINAHL, Scopus, and Embase in October 2022 and October 2023 (for updated results). Quantitative studies investigating the effects of community care, including nursing contribution, on patient outcomes were included and summarized. Reporting followed the PRISMA checklist. The review protocol was registered on PROSPERO (CRD42022383856)., Results: Twenty-three studies describing six types of community care services were included, which are heterogeneous in terms of target population, country, interventions, organizational characteristics, and investigated outcomes. Heterogeneous services' effects were observed for access to emergency services, satisfaction, and compliance with treatment. Services revealed a potential to reduce rehospitalizations of people with long-term conditions, frail or older persons, children, and heart failure patients. Models are mainly multidisciplinary and, although staffing and workload may also have an impact on provided care, this was not enough investigated., Discussion: Community health services described in European literature in the last decade are in line with population needs and suggest different suitable models and settings according to different care needs. Community care should be strengthened in health systems, although the influence of staffing, workload, and work environment on nursing care should be investigated by developing new management models., Conclusions and Implications for Health Policy: Community care models are heterogeneous across Europe, and the optimum organizational structure is not clear yet. Future policies should consider the impact of community care on both health and economic outcomes and enhance nursing contributions to care., (© 2024 The Author(s). International Nursing Review published by John Wiley & Sons Ltd on behalf of International Council of Nurses.)

Aim: To identify, synthesize, and interpret the scientific literature on the experience, perspectives, and feelings of transgender people during hospitalization., Design: A qualitative metasynthesis., Data Sources: PubMed, CINAHL and PSYCHINFO were consulted in March 2024., Methods: A literature review was conducted following Sandelowski and Barroso's four-step metasynthesis methodology. The article selection process was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies were selected based on the objectives of the review, pre-established criteria and quality appraisal. A thematic analysis was conducted after extracting relevant quotations and a metasynthesis table was created to compare quotations and analyse overarching themes., Results: Twenty-two studies were included after screening titles and abstracts, full texts, and references. Three themes were identified: 'Perception of self-identity'; 'Misgendering' and 'Lack of staff training and awareness'., Conclusion: Transgender people's healthcare experiences during hospitalization were mainly negative, delayed or uncomfortable. Misgendering and lack of awareness of transgender issues among healthcare workers generated anxiety and frustration. Key aspects of care for transgender people need to be included in all training programs for health professionals., Implications for the Profession And/or Patient Care: There is a need to increase education and awareness among healthcare professionals towards transgender people's needs during hospitalization ensure high quality care., Impact: This study addressed the negative experience, perspectives and feelings of transgender people during hospitalization. Misgendering and unawareness of transgender peoples' issues create anxiety and frustration among nurses. Elements to improve care for transgender people need to be integrated into all nursing curricula and training programs., Reporting Method: The authors adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and the Critical Appraisal Skills Programme (CASP)., Patient or Public Contribution: Since this was a metasynthesis, no patient or public contribution was required., (© 2024 John Wiley & Sons Ltd.)

Introduction: The aging of the population requires an appropriate knowledge of the type of care that needs to be provided to inform healthcare policies. In Italy, neither home care nursing, nor the patient experiences have ever been described., Objectives: To describe the characteristics of nurses and care recipients involved in home care., Methods: A descriptive cross-sectional study conducted in 18 Italian Regions. Between April and October 2023, data from nurses and patients involved in home care were collected through two surveys. Psychosocial conditions in workplaces, missed care, and care experiences were assessed using validated tools. Descriptive statistics and Pearson's correlations were performed., Results: A total of 46 local healthcare units were included in this study, with a total of 2549 nurses and 4709 care recipients. Nurses (mean age 46.60; 79.48% female; 44.68% regional nursing diploma as the highest qualification) reported good working conditions (42.37; SD = 12.25; range = 0-100) and a high mean number of missed care activities (5.11; SD = 3.19; range 0-9). Most nurses (83.41%) reported high levels of job satisfaction, while 20.28% intended to leave their job. Patients (mean age 75.18; 57.57% female; 36.95% primary school), on the other hand, rated positively the care they had received (8.23; range = 0-10)., Conclusions: Despite the perception of critical issues at work and some missed care, satisfaction in nurses and patients was high. These data constitute a preliminary snapshot of the studied phenomena, which will be investigated through more in-depth analyses., (© 2024 Wiley Periodicals LLC.)

Aim: To explore the attitudes of healthcare workers towards COVID-19 vaccines., Design: A qualitative descriptive design was used., Methods: Five focus groups were conducted between October and November 2021, with a total of 30 nurses from different contexts in Northern Italy. Thematic analysis was used to analyse the transcripts., Results: Three main themes were identified: 'favourable', 'unsure' and 'contrary to' COVID-19 vaccines. The favourable position was underpinned by trust in science, research and vaccination; protection for themselves, their families, patients and the population; duty as professionals; necessity to set an example for others. Participants who were unsure had doubts about the composition, safety and efficacy of the vaccine and were sometimes afraid that media provided incomplete information. The main reason why nurses were against was the feeling that being forced to vaccinate perceived as blackmail. Favourable or unsure nurses struggled to deal with those who were against and developed a series of emotions that ranged from respect and attempt to rationalize, to frustration and defeat., Conclusions: Identifying the areas of hesitation is essential to understand what affects the choices of acceptance, delay or refusal of vaccination. The issues that emerged regarding proper communication within the vaccination campaign highlights the key importance of adequate vaccination strategies., Implication for the Profession And/or Patient Care: Understanding attitudes towards vaccine and related motivations among healthcare workers could help develop more specific and targeted vaccination campaigns that can ensure proper vaccination coverage rates and avoid hesitancy or refusal., Impact: Healthcare workers experiences of COVID-19 vaccines, their views and know how they feel during COVID-19 vaccinations. Healthcare workers had three different positions in COVID-19 vaccination. This research will guide and target future vaccination campaigns., Reporting Method: The study is reported using the Standards for Reporting Qualitative Research (SRQR)., Patient or Public Contribution: No Patient or Public Contribution., (© 2024 John Wiley & Sons Ltd.)

Higher nurse-to-patient ratios are associated with poor patient care and adverse nurse outcomes, including emotional exhaustion and intention to leave. We examined the effect of nurses' intention to leave and nurse-patient workload on in-hospital patient mortality in Italy. A multicentered descriptive and regression study using clinical data of patients aged 50 years or older with a hospital stay of at least two days admitted to surgical wards linked with nurse variables including workload and education levels, work environment, job satisfaction, intention to leave, nurses' perception of quality and safety of care, and emotional exhaustion. The final dataset included 15 hospitals, 1046 nurses, and 37,494 patients. A 10 % increase in intention to leave and an increase of one unit in nurse-patient workload increased likelihood of inpatient hospital mortality by 14 % (odds ratio 1.14; 1.02-1.27 95 % CI) and 3.4 % (odds ratio 1.03; 1.00-1.06 95 % CI), respectively. No other studies have reported a significant association between intention to leave and patient mortality. To improve patient outcomes, the healthcare system in Italy needs to implement policies on safe human resources policy stewardship, leadership, and governance to ensure nurse wellbeing, higher levels of safety, and quality nursing care., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Aims: To describe how workplace violence (WPV) is experienced by nurses in hospitals and community services and identify protective and risk factors., Methods: An online cross-sectional national study was conducted from January to April 2021 in Italy. Hospitals and community services were involved in the study. The survey combined the adapted and validated Italian version of the Violence in Emergency Nursing and Triage (VENT) questionnaire, which explores the episodes of WPV experienced during the previous 12 months, the Practice Environment Scale of the Nursing Work Index (PES-NWI) and some additional questions about staffing levels extracted from a previous RN4CAST study. Nurses working in all clinical settings and community services were invited to participate in the survey. Descriptive and inferential statistics were used for data analysis. We adhered to the STROBE reporting guidelines., Results: A total of 6079 nurses completed the survey, 32.4% (n = 1969) had experienced WPV in the previous 12 months, and 46% (n = 920) reported WPV only in the previous week. The most significant protective factors were nurses' age, patients' use of illegal substances, attitude of individual nurses and considering effective the organization's procedures for preventing and managing episodes of violence. The most significant risk factors included workload, recognizing violence as an inevitable part of the job, patients' cultural aspects and patients' agitated behaviour. The frequency of WPV was significantly higher in certain areas, such as the emergency department and in mental health wards., Conclusion: Workplace violence (WPV) against nurses is a very frequent and concerning issue, especially in hospitals and community services. Based on our findings, integrated and multimodal programmes for prevention and management of WPV are recommended. More attention and resources need to be allocated to reduce WPV by improving the quality of nurses' workplace environment and implementing violence-free policies for hospitals., Implications for the Profession And/or Patient Care: Impact Workplace verbal and physical violence is a widespread phenomenon, both in hospital and community settings, and even during COVID-19 pandemic. This problem is exacerbated by the lack of effective reporting systems, fear of retaliation and the tendency to consider violence as an inevitable part of the job. The characteristics of professionals, patients, work environment and organizational factors are involved in the spread of workplace violence, determining its multifactorial nature. Integrated and multimodal programmes to prevent and manage of workplace violence are probably the only way to effectively counteract workplace violence against nurses. Healthcare policymakers, managers of hospital and community services need to proactively prevent and effectively manage and monitor episodes of violence. Nurses need to feel protected and safeguarded against any form of verbal or physical violence, to provide high-quality care in a totally safe environment., Patient or Public Contribution: No patient or public contribution., (© 2024 John Wiley & Sons Ltd.)

Purpose: To examine informal carers' experiences during their child's hospitalization and evaluate the associations with care received and care context., Design and Methods: What is described in this article is only a part of the larger study, RN4CAST@IT-Ped, a multicenter cross-sectional study, with multi-level data collection through convenience sampling, the Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was used to collect data from informal carers of pediatric patients, applying the "top box" approach., Results: Nine hospitals, 1472 nurses, and 635 children's parents were involved. A correlation was found between patient safety and satisfaction outcomes and nursing staff characteristics. Adequate workloads for nurses improved carers' assessment of their experience in the hospital., Conclusion: Adequate staffing management could significantly improve informal carers' satisfaction with the care provided to their children during hospitalization., Practice Implications: Children's informal carers greatly value the care they receive in pediatric hospitals. Adequate workloads for nurses improve carers' overall evaluation of the care their children receive during hospitalization. Nursing management should consider improving these aspects to ensure high-quality care in children's hospitals., Competing Interests: Declaration of Competing Interest The authors of this manuscript have no competing interests as defined by the editorial policy of Journal of Pediatric Nursing. They moreover have no other interests that may have influenced the results and discussion of this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Aim: This protocol proposes a systematic review to identify and disclose learning strategies and evaluation tools to improve Emotion Intelligence (EI) in undergraduate nursing students., Background: EI improves the ability to manage emotions and their consequences. Management of emotions is fundamental in nursing both at inter- and intra-professional levels, and with the patients and their family carers., Design: Systematic review protocol of effectiveness based on the Joanna Briggs Institute (JBI) guidelines., Review Methods: All articles based on educational programmes and/or activities to develop EI in nursing curricula will be included in the review. It will analyse the principle EI attributes and outcomes such as burnout, intention to leave and problem-solving skills. Based on the review question, seven databases will be searched: MEDLINE, The Cochrane Library, SCOPUS, CINAHL, EMBASE, PsycINFO and ERIC. Also, grey literature (Google Scholar and Open Gray) will be searched. Since no similar systematic reviews are present in the literature, no time limits will be set. To establish the quality of studies JBI tools will be used. When appropriate, we will meta-analyse prevalence and incidence estimates or we will meta-synthesize themes and findings., Expected Results: This systematic review is expected to provide an overview of educational and training methods, pedagogical strategies and evaluation tools to address EI in nursing and provide high-quality care to patients and their families. Results of the review will support nursing educators and leaders in implementing teaching and learning strategies to improve the Emotional Intelligence of undergraduate nursing students., Conclusions: Mastering emotions is fundamental for nurses. Implementing education courses based on EI according to the best training methods and pedagogical strategies could become key for nursing curricula. Moreover, after the review, it will be possible to identify the best training methods and pedagogical strategies for implementing continuing professional development (CPD) courses in EI in the courses of following graduation., Competing Interests: Declaration of Competing Interest All the other authors declare that they have no conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2023. Published by Elsevier Ltd.)

Purpose: Total laryngectomy followed by radiotherapy is a life-preserving treatment for patients with locally advanced laryngeal cancer. This study explored how persons who had undergone total laryngectomy perceived themselves as cancer survivors in the follow-up phase., Methods: A descriptive phenomenological approach was adopted. We employed a purposive sampling strategy to collect data through interviews at the otorhinolaryngology outpatient clinics of two research hospitals in northern Italy. The interviews were transcribed verbatim and analysed, following the seven analytical steps of Colaizzi's descriptive analysis., Results: The final sample included 19 patients. The following main themes were identified: (i) accepting a life with the "without" to survive; (ii) feeling unpleasant emotions; (iii) getting the hang of communication again; and (iv) reclaiming one's role. Together, they highlight the lived experiences of laryngectomised patients during the follow-up phase and how they perceived themselves as cancer survivors., Conclusion: Laryngectomised patients are a uniquely vulnerable population. This study provides insights into how surgical procedures change and affect their lives over time to improve care models, patient education, and support systems. Survivors must be adequately prepared to transition from treatment and return to the community. This preparation should begin before treatment is started. Functional education, accurate information, and psychological support must be arranged and provided before surgery. Regarding the post-treatment phase, it is essential to support voice rehabilitation and peer support, and improve the family network, to ensure these patients' reintegration into society and social recognition., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aim: To discuss the possible contribution of nurses to the Silver Economy., Background: Older people constitute a growing sector of the population of developed countries and there is increasing interest in the concept of the Silver Economy which is the contribution older people can and do make to the general economies of their communities and countries., Sources of Evidence: We obtained a range of relevant documents from international organisations and related academic literature., Discussion: There is a range of interrelated health promotion aspects of ageing related to physical health, mental health and cognitive health. Promoting activities related to these could have both direct and indirect impact on the economy in addition to improving the health and well-being of older people., Conclusions: Nurses have a responsibility to understand the health promotion related aspects of ageing and the contribution they can make to improving the health and well-being of older people. Nurses could, specifically, promote activities amongst older people that will have an impact on health and on the economy., Implications for Nursing: Nurses need to integrate more health promotion related aspects of ageing into their practice and to be able to evaluate the health-related improvements they make and also to evaluate and indicate the contribution this makes to the health of older people and to the economy., (© 2022 International Council of Nurses.)

Aim: To report an analysis of the concept of fundamental care in the literature., Design: An evolutionary concept analysis., Data Sources: PubMed and CINAHL Complete databases were consulted using the key terms: fundamental care, fundamentals of care, essential care, basic nursing care and basic care revised. Articles published from 2008 to 2022, in English and Italian, in scholarly/peer-reviewed nursing journals were included., Methods: Rodgers's Evolutionary Method of concept analysis was used. Our thematic analysis yielded common themes related to the concept, antecedents, attributes and consequences of fundamental care., Results: A total of 50 articles were analysed. Thirty-eight attributes were identified, such as integration of care, patient and family centred care and trusting relationship; eight antecedents including nursing care, nursing practice and care context; and 17 consequences including the safety, quality and consistency of care., Conclusion: This review of literature reveals that there is no consistent definition of the concept of 'fundamental care'. Findings from this exploration of the literature emphasized the importance of communication, the contextual environment, leadership influence and nurse-patient relationship in providing effective and high-quality fundamental care. Our definition of this concept may help nurse leaders in practice, research, education, management and policy to promote and enhance the application of fundamental care., Impact: What problem did the study address? While numerous studies examine fundamental nursing care, various terms are used with no consensus on definitions emerging. Given the relevance of this topic, reaching a clear and agreed definition of fundamental care is essential. What were the main findings? Fundamental care encompasses the importance of communication, the contextual environment, leadership influence and nurse-patient relationship in providing effective and high-quality care. Where and on whom will the research have an impact? This definition of fundamental care will assist nurse leaders and researchers to promote and enhance the examination and application of fundamental care in clinical practice to ensure better care outcomes across all healthcare settings., (© 2022 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Introduction: Considering the increasing complexity of care and workload for home care nurses due to the ageing of the population, it is crucial to describe the work environment and the community care setting. The aim of this study protocol is to map the characteristics and identify gaps of home care in the community to design future interventions aimed at ensuring quality and safety., Methods and Analysis: This is a national cross-sectional descriptive observational study using the survey method. Nurses from all participating community care centres will be recruited through convenience sampling by the coordinators of each centre, who will act as facilitators for this study. All community care recipients and their informal carers during the study period will be invited to complete a survey.To map the characteristics and identify gaps of home care in the community, three sources of data will be collected: (1) organisational characteristics, professional satisfaction, intention to leave and burn-out; (2) experience of care recipients and their informal carers and (3) improper access to the emergency department, readmission to hospital, comorbidities, services offered and users' level of autonomy, and main and secondary diagnoses.Considering the total Italian nursing population of approximately 450 000 registered nurses, a sample size of 1% of this population, equal to approximately 4600 nurses, was hypothesised.This study started in July 2022 and is planned to end in December 2023.Data will be analysed using descriptive and inferential statistics., Ethics and Dissemination: This study protocol was approved by the Liguria Regional Ethics Committee in November 2022. Informed consent will be obtained from participants and confidentiality will be ensured. Data collected for this study will be kept anonymised in a protected database.The results of the study will be disseminated mainly through conferences, publications and meetings with government representatives., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Emergency departments are the services with the highest risk of violence for nurses. Reports of violence in health care have increased exponentially in the last decade. Front line hospital services are more at risk, and worldwide there are attempts to quantify, manage and prevent episodes of violence, but no consistent solutions have yet been identified., Aims: To stimulate reflection on causal factors of violence against nurses in emergency departments and discuss potential solutions and strategies for aspects that largely remain unresolved., Design: A position paper underpinned by experiences and evidence reported in the literature., Methods: A search of Scopus and CINAHL using the term 'violence' provided information concerning the prevalence of the term 'violence' in contemporary literature and enabled to capture a general overview of contributing factors of violence and current approaches to its management and prevention., Conclusions: However, while risk factors have been identified, there is a tendency to over accentuate the extent of their contribution. The main risk factors present conditions related to or accompanied by mental illness and the impact of overcrowding and long waiting times., Relevance to Clinical Practice: More is needed in terms of implementation of more far-reaching, holistic, practical and effective management solutions to promote nurses' safety and adequately support vulnerable patients., (© 2022 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Background: During their clinical practice, nursing students learn to manage patient safety through their experiences, emotions, and interpersonal relationships., Objectives: To explore contextual and mechanistic factors that facilitate a sense of emotional safety for learning in nursing students, particularly regarding patient safety events experienced during their placements., Design: A descriptive qualitative study using narratives and thematic analysis., Settings: A university in Northern Italy., Participants: Undergraduate nursing students recruited through purposive sampling., Methods: Twenty cases relevant to the present study were selected from the "Sharing LearnIng from Practice for Patient Safety" (SLIPPS) project database containing 100 narratives collected using the patient safety learning Event Recording Tool. The data were analysed using thematic analysis according to Braun & Clarke's methodology. The themes that emerged from the thematic analysis were rearranged in Context-Mechanism-Outcomes., Results: Students identified clinical practice experiences as important occasions for their personal and professional development. Emotional safety and tutoring were the elements that effectively "govern" the students' learning and development process., Conclusions: Emotional safety is key for nursing students because it enables them to constructively overcome any relational and emotional tensions that may develop during their clinical placements., Competing Interests: Declaration of competing interest The authors have no conflict of interest to declare., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Acute Renal Failure is an essential condition frequently encountered in intensive care units and requires targeted treatment. The critical care nursing team must be adequately trained to manage patients undergoing Continuous Renal Replacement Therapy., Objectives: To develop and validate the Continuous Renal Replacement Therapy - Measurement Competency Tool, aimed at measuring nursing competence in managing patients undergoing renal replacement techniques., Methods: A cross-sectional tool validation study with a test-retest.A total of 30 critical care nurses participated in this study. The study examined content and face validity. Test-retest reliability with Pearson's r correlation and internal consistency reliability was assessed using Cronbach's α. Current guidelines for Continuous Renal Replacement Therapy techniques were used to develop an instrument to measure nursing competence through an online survey. A pool of 10 experts evaluated this tool., Results: The Continuous Renal Replacement Therapy - Measurement Competency Tool achieved good content and face validity (S-CVI= 0.97; I-CVI=87%-100%), and good internal consistency reliability (Cronbach's α= 0.799). Pilot testing and test-retesting was conducted with 30 critical care nurses. The intraclass correlation for the test-retest analysis indicates excellent test-retest reliability, confirming the stability of the tool., Conclusion: The tool assesses nursing competence concerning Continuous Renal Replacement Therapy techniques in the intensive care unit, which proved to be valid and reliable. This new tool will make it possible to measure the competence of nurses with respect to Continuous Renal Replacement Therapy techniques., (CNAI.)

Introduction: A large proportion of all pregnancies worldwide occur in young adolescent women, and almost all these pregnancies are unintentional. To address effective educational interventions, it is necessary to assess adolescents' literacy on this topic. The aim of this study was to translate and validate the Italian version of the SexContraKnow instrument., Methods: This was a methodological study. The validation of the instrument was performed following the EORTC Quality of Life Group translation procedure. The process consisted of four phases: translation, content validation, face validation, and pilot test. Data were collected between May and September 2021. The STROBE guidelines were followed for this study., Results: After performing forward and backward translations, we evaluated content validity (Scale-Content Validity Index = 0.91) and face validity. We then conducted a pilot test, test re-test, with 10 students (Cronbach α = 0.928; Pearson's R = 0.991)., Conclusion: The Italian Version of the SexContraKnow instrument has a good level of validation and reliability and can be effectively used by nurses to assess adolescents' literacy about the use of contraceptives and to develop targeted educational interventions. This instrument will help to evaluate the effectiveness of education programmes about health literacy about safe sex and contraception. The attention of nurses should be actively directed towards the process of health literacy among adolescents, in the perspective of a society focused on the empowerment of the population., (©2022 Pacini Editore SRL, Pisa, Italy.)

Introduction: Despite the growing importance of nursing fundamentals of care, nurses often overlook these aspects of care. In this study, we explored why this happens precisely where nursing education is initially provided. In fact, little is known about how undergraduate nursing students perceive the teaching of fundamentals of care and how they value them., Methods: This pilot cross-sectional study used a questionnaire adapted and validated in Italian to assess the perceptions of first, second, and third-year undergraduate nursing students (n=150) in an Italian university about the teaching of fundamentals of care during theoretical lessons and clinical practice., Results: In the first section of the tool, on general fundamentals of care (nutrition, hygiene, mobility, rest and sleep, the expression of sexuality, safety, etc), students reported high levels of agreement for all items: range between 61.2% (95% CI: 57.1-65.3) and 100%.In the section on nutrition, divided into nutrition, oral intake of fluids, and malnutrition high percentages of agreement from 53.1% (95% CI: 46.0-60.2) to 91.8% (95% CI: 87.9-95.7%) were obtained, but for questions regarding 'learning how to document food and fluid intake', first-year students reported low levels of agreement.With regard to the 'Communication Section', the item about 'learning how to inform minor patients' presented low percentages of agreement throughout the three-year programOf the first-year students, between 71.4% (95% CI: 64.9-77.9) and 77.6% (95% CI: 71.6-83.6) declared they had not received instructions about this., Conclusions: Understanding how nursing students perceive the importance of learning of fundamentals of care during their curriculum and how their multidimensional nature is highlighted by teachers and clinical supervisors, will enable educators to address the gaps in the way they taught and prioritized within the curriculum., (©2022 Pacini Editore SRL, Pisa, Italy.)

Background: The indication for implantable cardioverter-defibrillators (ICDs) to prevent sudden death is now consolidated. However, there is no unanimous agreement on how patients experience certain aspects of their lives after an ICD implant. Various clinical studies have evaluated the impact of ICDs on patient mortality, survival, and their beneficial effects. Given the growing number of qualitative studies, a synthesis of qualitative evidence became desirable., Aims: To explore and synthesize the results of qualitative studies addressing the experiences of patients with an ICD., Methods: We employed a systematic review and meta-synthesis. PubMed, CINAHL, and PsycINFO were systematically searched to identify qualitative studies published between January 2005 and October 2020, which investigate the experience of patients living with an ICD. Selected studies were assessed for quality by two reviewers independently., Results: A total of 24 papers were selected. Six themes emerged: fear and insecurity, the need for information, new impacts on life, living with ICD shocks, gender differences, and the role of the family. These results could help clinicians and researchers to develop new strategies and interventions to improve the quality of life in these patients., Conclusion: This meta-synthesis underlines the difficulties experienced by patients with ICD implants. Despite the advanced therapeutic management programmes for this type of intervention, it is necessary to adopt and implement the current post-discharge care plans, where the family's involvement is essential to help patients adapt to their new lifestyle., Competing Interests: Conflict of interest: The authors declare that they have no conflicts of interest with respect to the research, authorship, and/or publication of this article and that they all agree with the final versions of this manuscript., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2022. For permissions, please email: journals.permissions@oup.com.)

Aim: To investigate the factor structure of an Italian translation of the Practice Environment Scale of the Nursing Work Index (PES-NWI)., Background: Italy suffers from high turnover rates, yet validated tools in Italian to study and manage the problem are lacking. The PES-NWI measures aspects of nurses' working environment. This study reports on the translation and investigation of the structure of the translated PES-NWI scale., Methods: A survey was conducted with 3667 nurses from 182 hospitals across 13 Italian regions using the PES-NWI. The structure of this scale was investigated using principal components analysis and other properties, including internal consistency (Cronbach's alpha). Construct validity was investigated using logistic regression., Results: The Italian translation of the PES-NWI showed a five-factor structure, and Cronbach's alpha of the factors ranged between 0.80 and 0.92. Logistic regression showed that the PES-NWI was positively related to job satisfaction (odds ratio = 10.3; CI 8.62-12.35) and negatively related to intention to leave (odds ratio = 0.14; CI 0.12-0.16)., Conclusions: The original five-factor structure of the PES-NWI was evident in the present study, albeit with some different factor loadings., Implications for Nursing Management: The Italian version of the PES-NWI can be used by nurse managers to tackle the workforce issues related to nurses' work environments in a major European country., (© 2022 John Wiley & Sons Ltd.)

Objectives: This study aimed to investigate the association between nursing care left undone in pediatrics and factors related to nursing staff characteristics and work environment., Methods: The data of the present study were extracted from our RN4CAST@IT-Ped database, a cross-sectional observational study, which included 13 hospitals belonging to the Italian Association of Paediatric Hospitals. Through convenience sampling, nurses and pediatric nurses providing direct care in routine pediatric wards were enrolled in the study. Data aggregated by clinical care area were analyzed, through descriptive and inferential statistics methods using IBM SPSS 22.0 software., Results: We collected data from 399 pediatric nurses working in surgical wards, 1208 in medical wards, and 631 in critical care units. Some of the investigated factors have shown an association with the risk of omitting essential nursing activities, like health care judged of poor quality, patient safety judged as poor, and nurses' intention-to-leave the job. For every nursing activity under investigation, we found some significant statistical associations., Conclusions: Our results are consistent with the international literature showing that nurses miss some activities more frequently. Understanding the associations underpinning care left undone could be a starting point for the implementation of patient-centered care and the improvement of the quality and safety of care in pediatric settings, as well as the work environment., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: To identify predictors and consequences of violence or aggression events against nurses and nursing students in different work contexts., Background: Workplace violence against nurses and nursing students is a very common and widespread phenomenon. Actions to manage or prevent violent events could be implemented knowing the risk factors and consequences. However, there is a lack of systematic reviews that summarize knowledge on the predictors and consequences of workplace violence., Evaluation: A scoping review was conducted using electronic databases including APA PsycInfo, CINAHL, Cochrane, Ovid Medline, PubMed and Scopus., Key Issues: After full text analysis, 87 papers were included in the current scoping review. Risk factors of horizontal violence were grouped into 'personal' and 'Environmental and organizational', and for violence perpetrated by patients into 'personal', 'Environmental and organizational' and 'Characteristics of the perpetrators'., Conclusions: The results of this scoping review uncover problems that often remain unaddressed, especially where these episodes are very frequent. Workplace violence prevention and management programmes are essential to counter it., Implications for Nursing Management: The predictors and the consequents identified constitute the body of knowledge necessary for nurse managers to develop and implement policy and system actions to effectively manage or prevent violent events., (© 2022 The Authors. Journal of Nursing Management published by John Wiley & Sons Ltd.)

Introduction: Due to the impact on the public health systems of the ageing and the increasing frailty of the population, the European Union and the World Health Organisation have emphasised how family and community nurses (FCNs) could play an important role in supporting the ageing process through prevention, promotion, and protection in the territory., Methods: This study describes the first experience in Italy of a one-year postgraduate blended-learning master course divided into 5 modules for FCNs piloted as part of the EuropeaN curriculum for fAmily aNd Community nursE (ENhANCE) 2018-2020 project, funded by the European Commission. The 5 modules focused on: Epidemiology and Prevention (14 ECTS); Fundamentals of care (19 ECTS); Organisational Models and Priority Health Problems (12 ECTS); Communication Models and Continuity of Care (5 ECTS); and Nursing Research (10 ECTS). Participants included a total of 45 students and 23 lecturers and a team of clinical tutors., Results: The Italian pilot course for the FCNs proved to be a successful example of innovative teaching methods using blended didactic methods, which enabled participants to achieve high-standard learning outcomes and competencies in the field of family and community nursing., Conclusions: The pilot course is well suited to preparing competent family and community nurses to meet the growing healthcare needs of the population. Therefore, we have planned to replicate this course to increase the workforce of family and community nurses, who through their healthcare services aimed at prevention, promotion and protection, will ensure high quality services to the public and consequently relieve the burden on acute hospitals., Competing Interests: Conflict of interest statement The authors declare that there are no existing or potential conflicts of interest of financial, personal or any other nature that could affect or bias the results of this study., (©2022 Pacini Editore SRL, Pisa, Italy.)

Background: Patient safety is a global concern. Learning to provide safe, high-quality care is core to nursing education., Problem: Students are exposed to diverse clinical practices, and experiences may vary between placements and across countries. Student experience is seldom used as an educational resource., Approach: An international, European Union-funded project, Sharing Learning from Practice for Patient Safety (SLIPPs), aimed to develop an innovative online educational package to assist patient safety learning. Based on student reported data and educational theory, multiple elements were iteratively developed by a multicountry, multidisciplinary group., Outcomes: The educational package is freely available on the SLIPPs Web site. Materials include a student reporting and reflection tool, virtual seminars, student reports data set, pedagogical game, high-fidelity simulation scenarios, scenario development and use guidelines, debriefing session model, and videos of simulations already performed., Conclusions: E-learning enables removal of physical barriers, allowing educators, professionals, and students from all over the world to collaborate, interact, and learn from each other., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Heart failure has an enormous impact in terms of mortality, morbidity, and costs for healthcare organizations. Indications for implanted heart devices, such as pacemakers or implantable cardioverter defibrillators (ICDs) are constantly increasing. With the arrival of the telemedicine, nurses play an important role in the remote management of chronic heart diseases. The purpose of this study was to describe the experiences of nurses who remotely monitor patients with an implanted heart device in Italy., Methods: A qualitative study with a phenomenological approach was conducted. The sample consisted of 7 nurses dedicated to remote monitoring (RM), from three cardiology clinics in Northern Italy. We conducted semi-structured interviews to understand the experience and training nurses received to conduct RM., Results: From the analysis of the interviews, six themes were identified: 'Specialized knowledge and skills', 'Learn through practice', 'Organization of work', 'Decision making', 'Trust', and 'Need for information'. The majority of our sample developed their competencies directly on the field, in absence of a certified recognized pathway, on RM in patients with heart failure implanted with cardiac devices. Therefore, nurses performing RM activities do not receive the same type of education and training., Conclusion: Currently, in Italy, there is no standardised training for nurses who perform RM activities for heart failure patients with implanted heart device, and yet it is instrumental to have appropriate knowledge and training to effectively perform this type of activity and care.

Background: Underpinning all nursing education is the development of safe practitioners who provide quality care. Learning in practice settings is important, but student experiences vary., Purpose: This study aimed to systematically develop a robust multilingual, multiprofessional data collection tool, which prompts students to describe and reflect on patient safety experiences., Approach: Core to a 3-year, 5-country, European project was development of the SLIPPS (Sharing Learning from Practice for Patient Safety) Learning Event Recording Tool (SLERT). Tool construction drew on literature, theory, multinational and multidisciplinary experience, and involved pretesting and translation. Piloting included assessing usability and an initial exploration of impact via student interviews., Outcomes: The final SLERT (provided for readers) is freely available in 5 languages and has face validity for nursing across 5 countries. Student reports (n = 368) were collected using the tool., Conclusions: The tool functions well in assisting student learning and for collecting data. Interviews indicated the tool promoted individual learning and has potential for wider clinical teams., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: To identify the core competencies of family and community nurses., Background: The European Union is facing common health challenges in the field of primary care, according to European health policies and the World Health Organization, which need to be addressed through better and innovative ways of working that require joint actions. There is evidence that 'Family and Community Nurses' play a key role in the field of primary care, but there is no agreement on which core competencies they are required to have., Design: An e-Delphi study METHODS: A 4-round e-Delphi study was conducted from March to July 2018 as part of the Erasmus+ Project "EuropeaN curriculum for fAmily aNd Community nursE" (ENhANCE). A panel of 23 experts from 10 European countries were asked to approve, modify, or add items and then prioritize each skill., Results: This e-Delphi, as part of the ENhANCE project, produced core 28 competencies, which were used by the "ENhANCE" partners to develop the European Core Curriculum for Family and Community Nurses. The ENhANCE partners ensured that the core competencies were consistent with World Health Organization recommendations, the European Skills/Competencies, Qualifications and Occupations (ESCO) and with the European Credit System for Vocational Education and Training (ECVET)., Conclusions: The results of this study will provide the basis for universities across Europe to develop their own post-graduate teaching programs with common educational goals for Family and Community Nurses and a cadre of nurse practitioners with transferrable skills across the continent., Tweetable Abstract: This e-Delphi, as part of the ENhANCE project, produced 28 competencies for the European Core Curriculum for Family and Community Nurses., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: The COVID-19 pandemic is heavily hitting healthcare systems around the world, and nurses are battling in the front line. Previous studies have reported nurses' responses to catastrophic situations, but also interviews released by Italian nurses to the main mass media channels could bear important messages for policy makers and stakeholders. This study describes Italian front-line nurses' experiences during the COVID-19 pandemic through television interviews., Methods: This is a descriptive qualitative study. Data were collected through purposive sampling from Italian front-line nurses' interviews during the COVID-19 pandemic. Publicly available interviews between 7th and 29th March 2020 were collected from the websites of national and regional television stations. Thematic content analysis was used to describe, summarize, and classify data into macro themes. The study is compliant with Standards for Reporting Qualitative Research., Results: A total of 21 television interviews were collected from front-line clinical nurses, nursing managers, nursing trade union representatives and representatives of the Nursing Regulator. Thematic analysis yielded four macro-themes: psycho-social effects of the COVID-19 pandemic on health professionals; altered patient relationships; personal safety; recognition and promotion of the profession., Conclusions: The COVID-19 pandemic has exacerbated some problems already present, such as the shortage of nurses, but has also turned the spotlight on the nursing profession. Highly involved and affected by the pandemic, nurses have become better known by the public and often also protagonists of public discussions. It is important that nurses' value as allies of the public emerges stronger from this dramatic situation., Competing Interests: Conflict of interest statement The authors declare no conflict of interest., (©2021 Pacini Editore SRL, Pisa, Italy.)

Aim: The aim of this study is to explore how a nutritional intervention that improves the biochemical and functional profile of dysphagic older people impacts on nursing workload and costs for nursing homes., Background: Dysphagic institutionalized older people particularly at risk of malnutrition require more intensive support from nursing staff and higher costs for nursing homes., Method: This is an open pre-post longitudinal multicentre quasi-experimental study without a control group., Results: There is a significant reduction in the number of enemas (from 3.51 to 1.11 enemas), with an average nursing workload reduction from 52 to 16 min per patient every month. Each nurse also spent 20 h less per patient every month spoon-feeding. This resulted in nursing staff cost savings., Conclusions: The nutritional intervention led to a significantly better quality of life for the patients manifested through increased independence and social engagement. This reduced workload for nursing staff and costs for nursing home administrators., Implications for Nursing Management: Sensitive, targeted nutritional interventions have the potential to improve nursing home residents' quality of life and enable a more efficient use of resources. This study revealed reduced workload and cost savings due to less time spent administering enemas and spoon-feeding, in addition to reduced malnutritional consequences., (© 2021 The Authors. Journal of Nursing Management published by John Wiley & Sons Ltd.)

Aims: The management of cardiovascular patients requires increasingly competent nursing professionals. In Italy, there are no specific postgraduate courses focused on specialist cardiac skills development for nurses. To develop such courses, content incorporating appropriate competencies is required and this study was designed to meet this. To delineate a set of core competencies to develop national educational interventions to ensure cardiac nurses in Italy achieve international standards., Methods and Results: A three-round e-Delphi study including a panel of 32 expert cardiac nurses from the UK, Canada, Australia, New Zealand, and Italy was conducted; 26 respondents completed all three rounds. The first round sought a list of five competencies from each participant which they were asked to prioritize in Round 2. In Round 3, they were asked to prioritize again with the knowledge of the priorities identified in Round 2. The final list of competencies was those achieving 70% agreement among participants. We identified 14 core competencies spanning a range of areas of competence including technical, interpersonal, health promotion, use of evidence, and management. Only minor differences were evident between the Italian and the international panel regarding the priority given to some core competences, such a leadership and taking patient history., Conclusion: This is the first study in Italy to delineate cardiac nurses' core competencies. As such, it provides a foundation for the development of postgraduate educational programmes for cardiac nurses including competencies that are congruent with international standards., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.)

Aims and Objectives: To understand the experiences and support needs of informal caregivers of patients with chronic obstructive pulmonary diseases chronic obstructive pulmonary disease who return home following an acute exacerbation., Background: The presence of an informal caregiver is important to provide practical and emotional support after an episode of acute exacerbation of chronic obstructive pulmonary disease. However, caregiving in such circumstances can be challenging and stressful., Design: Phenomenology., Methods: This is a phenomenological study based on semi-structured interviews with sixteen primary caregivers of chronic obstructive pulmonary disease patients. Interview data were analysed using Colaizzi's descriptive analysis framework, to identify significant themes and sub-themes. Data were collected between April-December 2017 in a Teaching Hospital in Italy. The study was designed and reported following the COREQ guidelines and checklist., Results: Analysis elicited five themes embracing various aspects of the caregivers' lived experiences: (a) a home disrupted, (b) living with constant vigilance and anxiety, (c) feeling the need to escape (d) self-justifications for caregiving role/duty, and (e) feeling abandoned by professionals., Conclusions: Our results show that carers experience a range of difficulties when caring for their relative at home with chronic obstructive pulmonary disease. Some of these are linked to the physical disruption of their home but many are linked to feelings of inability to cope and the psycho-social impact of the caring role. The study also shows how participants felt unsupported by professionals. Focused support for carers is required to enable them to meet these challenges., Relevance to Clinical Practice: Healthcare professionals should be trained to provide technical and psychological support to caregivers especially during the phases of disease that may involve episodes of exacerbation. Home care and continuity of care can work if there is excellent communication and collaboration between healthcare professionals and caregivers. Developing appropriate support for family caregivers is essential to address the problems they can face., (© 2020 John Wiley & Sons Ltd.)

Introduction: Nursing theories are essential for orienting nursing practice. To date, three models for nursing practice have been developed in Italy. In addition, significant epistemological reflections have been published, sparking a rich professional debate regarding the theoretical foundations of nursing in Italy. However, conceptual models from other countries are often still used, despite many difficulties associated with applying them in practice. In order to investigate and redress this 'theoretical gap' and related implications for intervention, three scoping reviews of the Italian nursing literature were conducted to examine three categories of nursing knowledge: (a) nursing practice in Italy; (b) the basic nursing concepts of person, health, environment and nursing; and (c) regulatory/normative statements regarding what nursing practice should be in Italy., Aim: The purpose of this investigation was to identify how nursing is conceptualized in the Italian literature through an integrative narrative analysis of three scoping reviews., Methods: The Scoping Review according to the recommendations published by Arksey and O'Malley and subsequently implemented by Levac et al. has been selected as the optimal methodology for mapping nursing knowledge. At the end of the reviews carried out to answer the three research questions, the researchers integrated the results by conducting a coding of the results., Results: The narrative synthesis highlighted a systemic conception of persons in their social context, 'incorporated' within relational systems. Persons are imagined as active agents with self-determination toward promoting their own health. Health, derived from levels of equilibrium between multiple systemic components and based on the person's holistic view, is a fundamental right and a collective social interest. Maintaining or promoting a person's health requires careful consideration of all these constitutive and integral elements. The nursing process is implemented through technical acts as well as relational and caring skills. Professional autonomy, influenced by clinical and organizational contexts, is expressed in collaboration with other professionals who contribute to the healthcare process. The results of this integrative narrative analysis suggest the need for a holistic vision of persons, with an active role in their health management, indissociable from the system of relationships in which this is contextualized, within which nurses are embedded., Conclusion: In light of the results of our investigation, the promotion of a conceptualization of nursing based on the centrality of the person-social relational system and on the active role of persons that nurses work with, this could guide approaches used in nursing education and administration. This could help enhance care provided by nurses and persons' participation in decisions regarding their own health.

Purpose: Unmet needs for advanced-disease cancer patients are fatigue, pain, and emotional support. Little information is available about the feasibility of interventions focused on patient-reported outcome measurement developed according to the Medical Research Council (MRC) Framework in advanced-disease cancer patients. We aimed to pilot a nurse-led complex intervention focused on QoL assessment in advanced-disease cancer patients., Methods: The INFO-QoL study was based on an exploratory, nonequivalent comparison group, pre-test-post-test design. Study sites received either the INFO-QoL intervention or usual care. Adult advanced-disease cancer patients admitted to hospice inpatient units that gave their informed consent were included in the study. Subjects were 187 patients and their families and 19 healthcare professionals. We evaluated feasibility, acceptability, and patients' outcomes using the Integrated Palliative Care Outcome Scale., Results: Nineteen healthcare professionals were included. The mean competence score increased significantly over time (p < 0.001) and the mean usefulness score was high 8.63 (±1.36). In the post-test phase, 54 patients were allocated to the experimental unit and 36 in the comparison unit. Compared to the comparison unit, in the experimental unit anxiety (R2 = 0.07; 95% CI = -0.06; 0.19), family anxiety (R2 = 0.22; 95% CI = -0.03; 0.41), depression (R2 = 0.31; 95% CI = -0.05; 0.56) and sharing feelings (R2 = 0.09; 95% CI = -0.05; 0.23), were improved between pre-test and post-test phase., Conclusions: The INFO-QoL was feasible and potentially improved psychological outcomes. Despite the high attrition rate, the INFO-QoL improved the quality and safety culture for patients in palliative care settings., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: To explore nursing management issues within COVID-19 narratives of Italian front-line nurses., Background: The COVID-19 pandemic has dramatically affected health systems and professionals worldwide. Italian nurses have key messages for nursing leaders following their acute experiences in the pandemic., Method: A descriptive qualitative study with thematic analysis., Results: Twenty-three testimonies from clinical nurses were analysed. Six macrothemes were identified as follows: organisational and logistic change; leadership models adopted to manage the emergency; changes in nursing approaches; personal protective equipment issues; physical and psychological impact on nurses; and team value/spirit., Conclusions: Our testimonies highlighted the huge impact of COVID-19 on the Italian nursing workforce, especially in terms of the high risks associated with caring for COVID-19 patients, exacerbated by the shortage of appropriate personal protective equipment. Nurses had to care for their colleagues and live separately from their families to avoid infecting them, revealing nurses' resilience and the important role of effective and sensitive management., Implications for Nursing Management: Nurse managers must be prepared for the impact of pandemics on staff and need to ensure availability and replacement of quality personal protective equipment, rehearse strategies for communicating with patients while wearing personal protective equipment and establish protocols for communicating with relatives., (© 2020 John Wiley & Sons Ltd.)

Aim: The aim of this study was to explore and understand the interprofessional collaboration preparation processes implemented by clinical tutors and students, in various professions, involved in interprofessional education experiences., Design: A constructivist grounded theory approach. The study was carried out between 2015-#2017., Method: Semi-structured interviews were conducted with a total of ten undergraduate students and the seven clinical tutors who supervised them from three undergraduate courses in a university of applied sciences and arts in Switzerland. Students were sampled during their clinical placement. Data were analysed and coded using constant comparative analysis with the support of Nvivo 10 software., Results: A substantive theory "Practicing contextual models of interprofessional care" was generated. It explains how the whole process takes place, the tutor-student interactions, and how together they gradually build models of interprofessional care, linked to their clinical context and to the patients/families who are part of it., Conclusion: The process describes a journey to comprehensively explain the roles played by the two main actors (student and tutor) who build a relationship of interaction., Impact: This theory provides an understanding of the complex process set up by students and how they are prepared for collaboration with other professionals. Its importance is mainly expressed in the educational field because it reveals a different vision from the one present so far and enables a thorough reflection from the pedagogical point of view. Teachers will be able to observe and approach the students' training curricula from a different point of view by evaluating any changes to favour it and rethink the organizational and training models of current programs., (© 2020 John Wiley & Sons Ltd.)

Introduction: In the Italian and European literature there are still few studies describing the impact of the COVID-19 pandemic on the organization of nursing care in hospitals, on the actions taken by nursing leaders to contain it, and on the outcomes of these interventions., Aim: To describe nursing leaders' experiences with reorganizing healthcare pathways, through management data and personal accounts., Methods: A retrospective quali-quantitative observational study was conducted at the Mauriziano Hospital in Turin, with 484 beds and over 1,700 workers. Quantitative data were analyzed through descriptive statistical indices and integrated with qualitative data collected through semi-structured telephone interviews. The analysis of the quantitative and qualitative data provided an objective and experiential representation of the implemented interventions., Results: We described the impact of interventions introduced by the nursing leadership during the pandemic on hospital services. In particular, the reorganization of the emergency department and of the prevention and psychological support services for the hospital's health workers. In addition, specific initiatives to support the discharge of COVID-19 positive patients, and to support and manage contacts with family members both during the hospitalization of their loved ones and following death are described., Discussion and Conclusion: This study contributes to the discussion on some crucial issues: the increasingly clear relationship between adequate staffing and safety of patients and professionals, the importance of a good working environment and a solid leadership, the importance of continuing education for professionals and adequate skill mixes; all highlighted by the pandemic.

Aim: To explore influences on nurses' missed care decision-making processes in acute hospital paediatric care., Background: Many contemporary studies describe the phenomenon of missed care. It is clear that environment and organizational culture influence the nursing activities; however, what influences their decision-making processes has not been investigated., Method: A descriptive qualitative inquiry was performed using semi-structured interviews with paediatric nurses (n = 20) from one Italian paediatric hospital., Findings: Thematic analysis revealed four themes: nurses' value system; hospital logistics, structures and resources; prioritization processes; and the informal caregiver's role., Conclusion: This paper offers insights into the various factors involved in nurses' decision-making process when contemplating missed care that will be of use to managers when planning care or addressing missed care in the paediatric clinical setting., Implications for Nursing Management: Knowledge and awareness of missed care in children's nursing needs greater exploration, especially in relation to what influences nurses' decision-making choices around missed care. Overall, a greater understanding of this will help managers to manage situations effectively and ethically so that missed care does not impact on outcomes for children in health care., (© 2020 John Wiley & Sons Ltd.)

Background: The terms critical incident technique and reflection are widely used but often not fully explained, resulting in ambiguity., Purpose: The aims of this review were to map and describe existing approaches to recording or using critical incidents and reflection in nursing and health professions literature over the last decade; identify challenges, facilitating factors, strengths, and weaknesses; and discuss relevance for nursing education., Methods: A systematic narrative review was undertaken. MEDLINE and the Cumulative Index to Nursing and Allied Health Literature were searched using MeSH terms, returning 223 articles (2006-2017). After exclusions, 41 were reviewed., Results: Articles were categorized into 3 areas: descriptions of the development of an original tool or model, critical incidents or reflection on events used as a learning tool, and personal reflections on critical incidents., Conclusions: Benefits have been identified in all areas. More attention is needed to the pedagogy of reflection and the role of educators in reflection.

Aim: To describe nurses' reported missed nursing care activities among hospitalized adult patients medical and surgical wards and explore gaps in service provision., Background: In 2015, Italy replicated the RN4CAST study, which heralded the exposition of missed care as an international phenomenon. In Italy, nurse-patient workload is high, with high levels of burnout and dissatisfaction reported, all factors associated with missed care., Methods: A cross-sectional study (n = 3,590) was conducted using the 13-item online Task Left Undone Tool aimed at collecting data on missed nursing care., Results: The frequency of omission of activities ranged between 7% and 50%. There were significant differences between morning, afternoon and night shifts and the various clinical settings. Oral care was the most frequently missed care activity., Conclusions: This study takes step forward in identifying and reducing missed care on medical and surgical wards, both in Italy and also internationally, which needs to take into account the specific organisational characteristics of each setting., Implications for Nursing Management: Although more essential activities are missed less frequently, much is known about the relational deficits such as information giving, education, communication and discharge advice, which managers ought to spearhead through local initiatives to improve these practices., (© 2020 John Wiley & Sons Ltd.)

Aims and Objectives: To conduct a systematic review and meta-synthesis of findings from qualitative research about sexuality and intimate relationship among patients with dermatological diseases., Background: Over the last few decades, there has been an increase in clinical research investigating aspects related to sex and sexuality in patients living with dermatological diseases. In fact, studies recognise a negative impact on various aspects of intimacy, such as sexual function, self-esteem and romantic relationships. The body of qualitative literature about sexuality in the context of dermatological diseases is emerging but consists mainly of small studies that would benefit from aggregation, synthesis and interpretation to highlight and summarise the overarching dimensions to this clinical issue., Design: A systematic review and meta-synthesis of qualitative studies., Methods: BioMed Central, Cochrane Library, MEDLINE, CINAHL, PsycINFO, PsycARTICLES, ERIC, Scopus, and Web of Science were searched between June-November 2017 with no publication date limits. Screening and selection of studies was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). After retrieval, the qualitative data were subject to meta-synthesis to identify overarching themes., Results: Ten qualitative studies were found. We identified four themes: (a) Embarrassment and shame; (b) Impaired sense of attractiveness and sexual avoidance; (c) Relationship issues; and (d) Lack of professional support. The patients in these studies adopted negative coping styles, such as avoidance and hiding their bodies., Conclusion: When assessing and evaluating patient care in dermatology, it is important that sexuality and the impact the disease could have on relationships is included., Relevance to Clinical Practice: An important part of nursing care is ensuring that patients are helped to develop positive coping strategies rather than negative ones. Patients with dermatological conditions also need advice and treatment to address any physically related sexual problems. Nurses need to be the initiators of these sensitive conversations to put patients at ease and work together to implement positive measures to reduce the sexuality-related issues patients face., (© 2020 John Wiley & Sons Ltd.)

Aim: To explore Italian paediatric nurses' reported burnout and its relationship to their perceptions of safety and adverse events., Design: A cross-sectional study using the RN4CAST@IT-Ped database with a web-based survey design., Methods: The RN4CAST@IT-Ped questionnaire was used to collect data in 2017. This comprised three main components: three dimensions (22 items) of the Maslach Burnout Inventory including emotional exhaustion, depersonalization and personal accomplishment. Participants also scored an overall grade of patient safety and estimated the occurrence of adverse clinical events., Results: Nurses (N = 2,243) reported high levels of burnout. Most rated clinical safety as high. The risk of adverse events ranged from 1.3-12.4%. The degree of burnout appeared to influence the perception of safety and adverse events., Conclusion: The association between nurses' burnout and perceptions of higher rates of adverse events and reduced safety in clinical practice is an important finding. However, it is unclear whether this was influenced by a negative state of mind, and whether reduced safety and increased adverse events negatively influenced nurses' well-being, thus leading to burnout. Regardless, the association between nurses' burnout and these quality concepts needs further exploration to examine the effect, if any, on burnout and safety, and identify supportive mechanisms for nurses., Impact: The association between reported burnout and perception of safety and risk of adverse events in Italian paediatric nurses has been reported for the first time. Nurses reporting burnout are at greater risk of intensely negative perceptions of clinical safety and adverse events. This is an important finding as perceptions can influence practice and behaviours. Quality measures in children's clinical environments need to go beyond obvious indicators to examine nurses' well-being as this also influences quality and safety., (© 2020 John Wiley & Sons Ltd.)

Aim: To develop an instrument to investigate knowledge and predictive factors of needlestick and sharps injuries (NSIs) in nursing students during clinical placements., Design: Instrument development and cross-sectional study for psychometric testing., Methods: A self-administered instrument including demographic data, injury epidemiology and predictive factors of NSIs was developed between October 2018-January 2019. Content validity was assessed by a panel of experts. The instrument's factor structure and discriminant validity were explored using principal components analysis. The STROBE guidelines were followed., Results: Evidence of content validity was found (S-CVI 0.75; I-CVI 0.50-1.00). A three-factor structure was shown by exploratory factor analysis. Of the 238 participants, 39% had been injured at least once, of which 67.3% in the second year. Higher perceptions of "personal exposure" (4.06, SD 3.78) were reported by third-year students. Higher scores for "perceived benefits" of preventive behaviours (13.6, SD 1.46) were reported by second-year students., Competing Interests: Roger Watson, Editor in Chief, and Mark Hayter, Editor of the Journal of Advanced Nursing, hold honorary positions at the University of Genoa where the study was conducted., (© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd.)