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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.)

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.)

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.)

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.)

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.)

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.)

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.)

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 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.)

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.)

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.)

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.)

Aims and Objectives: To synthesise and review literature related to instruments that measure psychosocial aspects of fundamental care in acute hospital care settings., Background: Psychosocial aspects of care often receive less priority in terms of care provision in acute care environments. At the same time, if these elements are overlooked, there may be consequences. Despite the availability of many instruments designed to measure specific aspects of care, these concepts are often not studied within the broader context of fundamentals of care, but rather coexist as isolated explorations of specific subelements., Design: A scoping review was conducted, based on Arksey & O'Malley's (2005) methodological framework and following the PRISMA checklist., Methods: Using the five recommended steps-identifying the research question; identifying relevant studies; study selection; charting the data; and summarising and reporting the results-three databases were searched: MEDLINE/PubMed, CINAHL and EMBASE, in February 2019., Results: Following independent screening by two of the authors, 48 papers were included. From these 48 papers, 33 instruments were identified. Only five of these tools thoroughly assessed psychosocial aspects elements of care (dignity, respect, privacy and patients' choice) through dedicated items., Conclusions: This review provides nurses with a synthesis of 33 instruments that assess the psychosocial aspects of care. This provides an important resource to guide measurement of dignity, respect, privacy and patients' choice. The findings also provide guidance to future research in this field., Relevance to Clinical Practice: This paper reviews and synthesises these instruments to provide a resource to nurses to inform their decisions and practice around measurement and evaluation of these key aspects of care. This provides a useful guide to measure and monitor the improvement of fundamental care delivery in practice and points to strengths and weaknesses of the instruments concerned., (© 2020 John Wiley & Sons Ltd.)

Aims and Objectives: To review and synthesise research studies on surgical and medical inpatients' perceptions on unmet nursing care needs., Background: Missed nursing care is a growing phenomenon that has been shown to adversely affect care outcomes-mainly in adult medical and surgical care settings. However, to date the aggregated and synthesised evidence of missed care comes from research that measures perceptions on missed care in surgical and medical settings from nurses, but not from the patients., Design: Scoping review., Methods: In September 2018, three databases were searched: MEDLINE/PubMed, CINAHL and SCOPUS and papers were selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were as follows: primary studies; published in peer-reviewed journals; in English or Italian; and regarding routine care provided to adult inpatients. Quality appraisal and a thematic analysis were conducted., Results: Of the 1541 abstracts initially identified, 44 papers were included. Five themes emerged: "communication," "self-management, autonomy and education," "personal sphere," "essential physical care" and "emotional and psychological care." The majority of the unmet needs were related to the "personal sphere" and "emotional and psychological care." These unmet needs were not identified in previous literature on nurses' perspectives of missed care. Also, physical care deficits like oral hygiene were identified., Conclusion: It is important to take into account patients' perspectives. The themes focusing on patients' personal sphere, and emotional and psychological care, underline how patients need nurses to pay more attention to their cultural background, consider the person as a whole and for nursing care to be holistic and respectful of patients' dignity., Relevance to Clinical Practice: This study intends to raise awareness amongst nurses and policymakers about the importance of addressing missed nursing care and unmet patients' needs in adult medical or surgical inpatient settings to ensure high-quality care and patient satisfaction., (© 2019 John Wiley & Sons Ltd.)

Background: Developing nursing research skills, awareness and research utilisation are important for improving healthcare outcomes and are key to ensuring the full understanding and knowledge base necessary for optimal delivery of care. Nevertheless, little is known about research awareness in children's nurses., Aims and Objectives: To address this issue, an integrative literature review was conducted for studies published between January 2007 and January 2017 to obtain up-to-date evidence about the extent of research awareness and utilisation among children's nurses., Methods: Using PubMed, Cochrane Library, ILISI and CINAHL databases, 21 studies related to children's nurses' research awareness were included in the final review, which was later developed and structured in keeping with PRISMA checklist and guidelines., Conclusions: The studies isolated show that nurses' knowledge about and utilisation of research vary and that there are many existent barriers to and facilitators of evidence-based practice in the paediatric setting. Some studies report that introducing a cultural and/or change in clinical practice change to improve research utilisation can have positive impacts on healthcare outcomes and the quality of nursing care of children. It is recommended that structured approaches to improving research utilisation be considered and additional research is needed to explore the benefits of these approaches., Relevance to Clinical Practice: Despite more than three decades of the evidence-based practice movement within nursing, barriers still exist among children's nurses in the use of research in practice. If the use of research to improve the delivery of children's nursing care is to become a reality, then nurses' research awareness needs to improve to underpin care delivery with optimal evidence in a cohesive informed manner., (© 2019 John Wiley & Sons Ltd.)

Aims: To synthesize the findings of qualitative research exploring the experiences of being involved in intergenerational interventions in older people's care settings., Design: A meta-synthesis of the qualitative literature, employing Sandelowski and Barroso's method, was conducted., Data Sources: Eight databases were searched in March 2017., Review Methods: The PRISMA statement was used for reporting the different phases of the literature search and the Critical Appraisal Skills Programme (CASP) qualitative research checklist was used as an appraisal framework. Data synthesis was conducted using Sandelowski and Barroso's method., Results: Four qualitative studies were included in the meta-synthesis. Thematic analysis revealed four themes: 'Recreating the family'; 'Building intergenerational empathy and respect'; 'Uplifting and energizing'; and 'Engagement risks and challenges'., Conclusion: The meta-synthesis strengthens the evidence that intergenerational interventions can be positive. However, it also shows that there may also be some negative aspects if not planned or managed carefully., Impact: This review contributes to the body of evidence by synthesizing the experiences of older people and children involved in intergenerational interventions. Although qualitative literature supports the quantitative evidence that intergenerational interventions can have a positive effect, intergenerational interventions could also have negative effects on some participants. Older people may feel tired, or experience feelings of infantilization. Practitioners need to be more aware of the potential negative effects of intergenerational interventions and include risk assessment, possibly by requiring ethical scrutiny., (© 2019 John Wiley & Sons Ltd.)

Aim: To expand knowledge about the predictive factors of nurses' intention to leave their job and consequently to turnover., Background: Nurse turnover is costly and negatively influences quality of care. Understanding the association between intention to leave and modifiable features of hospital organisation may inform strategies to reduce turnover., Methods: A cross-sectional survey of 3,667 medical and surgical nurses was conducted in Italy. Measures included intention to leave; work environment; burnout; job satisfaction; and missed care using the RN4CAST instruments. Descriptive, logistic regression analysis was used., Results: Due to job dissatisfaction, 35.5% of the nurses intended to leave their current job, and of these, 33.1%, the nursing profession. Push factors included the following: understaffing, emotional exhaustion, poor patient safety, performing non-nursing care and being male. Pull factors included the following: positive perception of quality and safety of care, and performing core nursing activities., Conclusion: The present study expands knowledge about the predictive factors of nurses' intention to leave their job and consequently to turnover, which is one of today's major issues contributing to the shortage of nurses., Implications for Nursing Management: Nurses' intention to leave their job is the consequence of a poor work environment, characterized by factors such as understaffing and performance of non-nursing activities., (© 2019 John Wiley & Sons Ltd.)

Aim: Develop and test the validity and reliability of MISSCARE Survey-Ped adapted from previous versions of the MISSCARE Survey, which measures omitted nursing activities and the reasons why they were left undone. Our secondary aim was to pre-test the construct validity using Exploratory Factor Analysis (EFA)., Background: Missed Nursing Care is described as "every care activity necessary for the patient that is not provided or is seriously delayed". Missed Care is correlated with negative patient outcomes, such as mortality and adverse events., Design: A mixed-mode cross-sectional survey., Methods: Participants included registered pediatric nurses and nurses working in pediatric wards. This study was conducted between June and September 2017 and consisted of four phases: (a) analysis of existing surveys and item construction; (b) content and face validity; (c) reliability analysis (acceptability for ease of use, Cronbach's alpha for internal consistency and test-retest to measure stability); and (d) construct validity (EFA)., Results: The MISSCARE Survey-Ped consists of two sections: Section A "Missed Nursing Care Activities" (29 items) and Section B "Reasons for Missed Nursing Care Activities" (17 items). The new survey showed good validity properties and effectively identified Missed Nursing Care activities in pediatric settings., Conclusion: The development and validation of the MISSCARE Survey-Ped made it possible to conduct an objective and standardized study of missed nursing care activities in the field of pediatrics. This new survey offers the opportunity to collect data that enable to design and implement interventions that improve the quality and safety of pediatric nursing., (© 2018 John Wiley & Sons Ltd.)

Aim: This integrative review aims to explore how nursing leadership influences evidence-based practice in contemporary health care settings., Background: Although managers and environmental ward culture have long been identified as being among the main barriers to evidence-based practice, there is little overall conceptualization and understanding of the specific role of nurse leaders in directly influencing and supporting this., Evaluation: The team carried out an integrative literature review (n = 28) utilizing PubMed, CINAHL and the Cochrane Library (2006-2016)., Key Issues: The key role of leadership, the methodology used, and understanding and addressing barriers to or facilitators of the implementation of evidence-based practice emerged as key issues., Conclusion: Nurse managers have a particular influential role on the implementation of evidence-based practice in terms of providing a supportive culture and environment. For this they need to have an underlying knowledge but also to be aware of and address barriers to implementation, and understand the key role of nurse managers in creating and supporting the optimum environment., Implications for Nursing Management: Nurse managers need to facilitate and enhance nurses' use of evidence-based practice. Both managers and nurses need to have the necessary academic preparation, support and resources required for practising using an evidence base., (© 2018 John Wiley & Sons Ltd.)

Aims and Objectives: To explore the experience of patients affected by chronic obstructive pulmonary disease following hospitalisation due to an acute exacerbation event., Background: Chronic obstructive pulmonary disease is a progressively debilitating disease, often with very burdensome symptoms such as acute and chronic breathlessness and fatigue. Acute exacerbation often creates a life-threatening event. Exacerbation can also have substantial psychological effects including anxiety and depression although this aspect is less well researched-especially amongst people with chronic obstructive pulmonary disease recovering from an acute event and facing a return home., Design: A descriptive phenomenological study., Methods: In-depth interviews were conducted with 12 chronic obstructive pulmonary disease patients recently recovering from an acute exacerbation of their chronic obstructive pulmonary disease. Data were analysed using Colaizzi's phenomenological framework., Results: Four themes were identified from the data: a sense of loss and frustration, hopelessness, uncertainty about the future and fear of becoming a burden. Participants expressed quite negative views including a loss of hope, uncertainty about their future care and the burden they may become on their families. They appeared stressed and anxious as a result of the acute event they had experienced., Conclusions: This study shows that an acute episode of illness can generate a sense of hopelessness and uncertainty about their future care in people with chronic obstructive pulmonary disease. This occurs as they recover physically and think about the future, often in quite negative terms., Relevance to Clinical Practice: For healthcare professionals, it is important to take into account the potential feelings of loss, hopelessness and uncertainty that people can experience following an acute exacerbation of their chronic obstructive pulmonary disease and ensure that psychological care is available as physical recovery takes place. Such care to include good discharge planning, giving patients time to express concerns and referral to counselling services if appropriate., (© 2017 John Wiley & Sons Ltd.)

Aims and Objectives: To assess the effects of a texture-modified food program for dysphagia on the nutritional, biochemical and functional profile in a cohort of institutionalised older people in Italy., Background: Dysphagic institutionalised older people, often also affected by dementia, are frequently exposed to malnutrition. Malnutrition in older people has negative effects on mortality, days of hospitalisation, infection, wound healing and risk of pressure injuries. Therefore, it is very important to prevent malnutrition in this frail population., Design: A pre-post study without a control group., Methods: The study included 479 dysphagic institutionalised older people from 20 nursing homes. Anthropometrical, biochemical, nutritional and functional parameters were collected retrospectively, 6 months before the study intervention, at time zero and, prospectively for 6 months after implementing the NUTRICARE food programme, for a total of nine evaluations. The NUTRICARE programme includes meals without nutritional supplementation, and personalised levels of density, viscosity, texture and particle size., Results: The total mean body mass index of our sample passed from 17.88-19.00; body weight averagely improved by 7.19%, as well as their nutritional and biochemical profiles. There was a progressive improvement of total protein and serum albumin values. Nutritional parameters (serum transferrin and lymphocytes) displayed similar changes. Plasma lymphocytes reached normal levels in 98.23% of the sample. Plasma creatinine levels remained steady throughout the study and within the normal range. No side effects were reported., Conclusion: The NUTRICARE food programme with a adequate proteins, calories, balanced nutritional and bromatological properties, and appropriate texture and palatability significantly improved the nutritional, biochemical and functional profile in a cohort of institutionalised dysphagic older people., Relevance to Clinical Practice: The introduction of a balanced nutritional programme, using high-quality natural ingredients, appropriate texture and palatability can significantly improve health and quality of life in dysphagic older people., (© 2017 John Wiley & Sons Ltd.)

Aims and Objectives: To review the use of mixed-methods research in nursing with a particular focus on the extent to which current practice informs nurse researchers. It also aimed to highlight gaps in current knowledge, understanding and reporting of this type of research., Background: Mixed-methods research is becoming increasingly popular among nurses and healthcare professionals. Emergent findings from this type of research are very useful for nurses in practice. The combination of both quantitative and qualitative methods provides a scientific base for practice but also richness from the qualitative enquiry. However, at the same time mixed-methods research is underdeveloped., Methods: This study identified mixed-methods research papers and critically evaluated their usefulness for research practice. To support the analysis, we performed a two-stage search using CINAHL to find papers with titles that included the key term 'mixed method'., Conclusion: An analysis of studies that used mixed-methods research revealed some inconsistencies in application and reporting. Attempts to use two distinct research methods in these studies often meant that one or both aspects had limitations. Overall methods were applied in a less rigorous way. This has implications for providing somewhat limited direction for novice researchers. There is also potential for application of evidence in healthcare practice that limited validity., Relevance to Clinical Practice: This study highlights current gaps in knowledge, understanding and reporting of mixed-methods research. While these methods are useful to gain insight into clinical problems nurses lack guidance with this type of research. This study revealed that the guidance provided by current mixed-methods research is inconsistent and incomplete and this compounds the lack of available direction. There is an urgent need to develop robust guidelines for using mixed-methods research so that findings may be critically implemented in practice., (© 2016 John Wiley & Sons Ltd.)

Aim: To identify items for a new instrument that measures emotional behaviour abilities of meaningful learning, according to Fink's Taxonomy., Background: Meaningful learning is an active process that promotes a wider and deeper understanding of concepts. It is the result of an interaction between new and previous knowledge and produces a long-term change of knowledge and skills. To measure meaningful learning capability, it is very important in the education of health professionals to identify problems or special learning needs. For this reason, it is necessary to create valid instruments., Design: A Delphi Study technique was implemented in four phases by means of e-mail., Methods: The study was conducted from April-September 2015. An expert panel consisting of ten researchers with experience in Fink's Taxonomy was established to identify the items of the instrument. Data were analysed for conceptual description and item characteristics and attributes were rated. Expert consensus was sought in each of these phases. An 87·5% consensus cut-off was established., Results: After four rounds, consensus was obtained for validation of the content of the instrument 'Assessment of Meaningful learning Behavioural and Emotional Abilities'. This instrument consists of 56 items evaluated on a 6-point Likert-type scale. Foundational Knowledge, Application, Integration, Human Dimension, Caring and Learning How to Learn were the six major categories explored., Conclusions: This content validated tool can help educators (teachers, trainers and tutors) to identify and improve the strategies to support students' learning capability, which could increase their awareness of and/or responsibility in the learning process., (© 2017 John Wiley & Sons Ltd.)

Aims and Objectives: To describe the knowledge, attitudes and beliefs of nurses and midwives who have attended to women who suffered violence. This study further analyses the possible changes of attitude that have occurred over the past five years., Background: Gender violence or violence against women is the largest problem with regard to public health and violated human rights all over the world. In Italy, it is estimated that 31·5% of women suffer physical or sexual violence during their life. Healthcare operators play a crucial role in recognising the signs of the violence suffered when taking care of victims., Design: A cross-sectional study was conducted., Methods: A questionnaire was administered; this was used in a previous survey of a convenience sample of 51 nurses and midwives who work in an emergency room or in an obstetrics emergency room and gynaecological ward., Results: Of the respondents, 51 (80·4%) have taken care of women who suffered violence, and 25 (49%) believe they can detect violence. The relational/communicative approach presents the most difficulty, and all the operators believe they need more knowledge. The number of operators who suggest women be observed in an emergency room and file a complaint or who primarily consider listening to women has decreased. A tendency to 'blame' women, although decreasing, persists; it is higher among male nurses and, in general, among male operators., Conclusion: Knowledge of this issue has not been completely recognised among operators despite training and the emergence of the phenomenon in the mass media. Difficulties in receiving and in relational procedures continue to exist, in addition to 'blaming' the woman., Relevance to Clinical Practice: Awareness paths and cultural changes regarding the phenomenon of violence need to be developed, as does a specific training programme on the approach to and assessment of the abused woman., (© 2016 John Wiley & Sons Ltd.)

Aim: To describe staff nurses' perceptions related to the leadership styles adopted by their nurse managers, identify which leadership style ensured job satisfaction in staff nurses and describe which behaviours nurse managers should change., Background: Empirical literature suggests that leadership styles of nurse managers significantly influence staff satisfaction. However, few studies investigate how staff nurses perceive the leadership styles of their nurse managers, and how these impact upon the staff nurses' job satisfaction., Methods: This was a mixed method study, which included the administration of the Multi-factor Leadership Questionnaire and three focus groups., Results: Ward nurse managers mostly adopted a transactional leadership style ('Management by exception active') aimed at monitoring errors and intervening to correct errors and punish, which had a negative impact on staff nurses' levels of job satisfaction. In contrast, the transformational leadership style, which is mostly correlated with satisfaction ('Idealized Influence Attributed', which staff nurses perceived as 'respect', 'caring for others', 'professional development' and 'appreciation'), was rarely practiced by nurse managers., Conclusions: The transformational leadership skills of Italian nurse managers need to be improved through behaviours based on greater respect, caring for others, professional development and appreciation. The present study could also serve as model to improve the leadership style of nurse managers in other countries., Implications for Nursing Management: The themes of transformational leadership could serve as a guide for nurse managers to help them improve their leadership style, and improve the levels of job satisfaction in staff nurses. Owing to the complexity and the importance of this issue, classroom educational interventions would not be sufficient: it should be dealt as a strategic priority by nursing directors., (© 2016 John Wiley & Sons Ltd.)

Aims: To identify patient safety competencies, and determine the clinical learning environments that facilitate the development of patient safety competencies in nursing students., Background: Patient safety in nursing education is of key importance for health professional environments, settings and care systems. To be effective, safe nursing practice requires a good integration between increasing knowledge and the different clinical practice settings. Nurse educators have the responsibility to develop effective learning processes and ensure patient safety., Design: Rapid Evidence Assessment., Data Sources: MEDLINE, CINAHL, SCOPUS and ERIC were searched, yielding 500 citations published between 1 January 2004-30 September 2014., Review Methods: Following the Rapid Evidence Assessment process, 17 studies were included in this review. Hawker's (2002) quality assessment tool was used to assess the quality of the selected studies., Results: Undergraduate nursing students need to develop competencies to ensure patient safety. The quality of the pedagogical atmosphere in the clinical setting has an important impact on the students' overall level of competence. Active student engagement in clinical processes stimulates their critical reasoning, improves interpersonal communication and facilitates adequate supervision and feedback., Conclusion: Few studies describe the nursing students' patient safety competencies and exactly what they need to learn. In addition, studies describe only briefly which clinical learning environments facilitate the development of patient safety competencies in nursing students. Further research is needed to identify additional pedagogical strategies and the specific characteristics of the clinical learning environments that encourage the development of nursing students' patient safety competencies., (© 2016 John Wiley & Sons Ltd.)

Aim: To identify, evaluate and describe the psychometric properties of instruments that measure learning outcomes in healthcare students., Background: Meaningful learning is an active process that enables a wider and deeper understanding of concepts. It is the result of an interaction between new and prior knowledge and produces a long-standing change in knowledge and skills. In the field of education, validated and reliable instruments for assessing meaningful learning are needed., Design: A psychometric systematic review., Data Sources: MEDLINE CINAHL, SCOPUS, ERIC, Cochrane Library, Psychology & Behavioural Sciences Collection Database from 1990-December 2013., Review Method: Using pre-determined inclusion criteria, three reviewers independently identified studies for full-text review. Then they extracted data for quality appraisal and graded instrument validity using the Consensus-based Standards for the selection of the health status Measurement INstruments checklist and the Psychometric Grading Framework., Results: Of the 57 studies identified for full-text review, 16 met the inclusion criteria and 13 different instruments were assessed. Following quality assessment, only one instrument was considered of good quality but it measured meaningful learning only in part; the others were either fair or poor. The Psychometric Grading Framework indicated that one instrument was weak, while the others were very weak. No instrument displayed adequate validity., Conclusions: The systematic review produced a synthesis of the psychometric properties of tools that measure learning outcomes in students of healthcare disciplines. Measuring learning outcomes is very important when educating health professionals. The identified tools may constitute a starting point for the development of other assessment tools., (© 2016 John Wiley & Sons Ltd.)

Aim: To test if the Barrows Cards method improves adherence to immunosuppressive therapy self-management following hematopoietic stem-cell transplantation in adolescents affected by blood cancer and reduce costs., Background: Chronically ill adolescents need to be helped to improve self-management, make sure they can confidently and safely manage therapy at home and reduce readmissions and costs. We identified the Barrows Cards method, originally used to test decision-making skills and critical thinking in medical students. In this pilot study, we tested the efficacy of the Barrows Cards Method in improving adhesion to immunosuppressive therapy in a group of adolescents following hematopoietic stem-cell transplantation and analysed its cost-effectiveness., Design: A mixed-method study., Methods: The Barrows Cards method is an educational intervention based on the theory of problem-based learning that uses at least 15 cards specially designed to teach participants how to manage a specific problem. We piloted the Barrows cards method in terms of adherence to immunosuppressive therapy and self-management in a group of 17 adolescents affected by blood cancer before being discharged. Participants were enrolled between 2013-2015. Activity Based Costing was used to analyse the cost-effectiveness., Results: The Barrows Cards method significantly improved adherence to immunosuppressive therapy in blood cancer adolescents and reduced readmissions. We also showed how this method could significantly reduce healthcare costs., Conclusions: Further research is required, but the Barrows Cards method could be effectively used by nurses to improve self-management in chronic patients and reduce health costs., (© 2016 John Wiley & Sons Ltd.)

Aims: To describe the utility of artificial neural networks in predicting communication risks., Background: In health care, effective communication reduces the risk of error. Therefore, it is important to identify the predictive factors of effective communication. Non-technical skills are needed to achieve effective communication. This study explores how artificial neural networks can be applied to predict the risk of communication failures in emergency departments., Design: A multicentre observational study., Methods: Data were collected between March-May 2011 by observing the communication interactions of 840 nurses with their patients during their routine activities in emergency departments. The tools used for our observation were a questionnaire to collect personal and descriptive data, level of training and experience and Guilbert's observation grid, applying the Situation-Background-Assessment-Recommendation technique to communication in emergency departments., Results: A total of 840 observations were made on the nurses working in the emergency departments. Based on Guilbert's observation grid, the output variables is likely to influence the risk of communication failure were 'terminology'; 'listening'; 'attention' and 'clarity', whereas nurses' personal characteristics were used as input variables in the artificial neural network model. A model based on the multilayer perceptron topology was developed and trained. The receiver operator characteristic analysis confirmed that the artificial neural network model correctly predicted the performance of more than 80% of the communication failures., Conclusion: The application of the artificial neural network model could offer a valid tool to forecast and prevent harmful communication errors in the emergency department., (© 2015 John Wiley & Sons Ltd.)