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This study aimed at (a) exploring how nurses prioritise interventions to prevent delirium among patients identified at risk and (b) describing the underlying prioritisation patterns according to nurses' individual characteristics. There was used the Q-methodology a research process following specific steps: (a) identifying the concourse, (b) the Q-sample, and (c) the population (P-set); (d) collecting data using the Q-sort table; (e) entering the data and performing the factor analysis; and (f) interpreting the factors identified. There were involved 56 nurses working in medical, geriatric and log-term facilities (46; 82.2 %). The preventive intervention receiving the highest priority was 'Monitoring the vital parameters (heart rate, blood pressure, oxygen saturation)' (2.96 out of 4 as the highest priority; CI 95 %: 2.57, 3.36). Two priority patterns emerged among nurses (explained variance 44.78 %), one 'Clinical-oriented' (36.19 %) and one 'Family/caregiver-oriented' (8.60 %) representing 53 nurses out 56. Alongside the overall tendency to prioritise some preventive interventions instead of others, the priorities are polarised in two main patterns expressing two main individual characteristics of nurses. Knowing the existence of individual patterns and their aggregation informs how to shape educational interventions. [ABSTRACT FROM AUTHOR]

• A third of patients admitted to a stroke unit develop delirium, lasting an average of three days. • The episodes occur mainly on the first day of admission, when several risk factors may play a role. • At admission, higher scores in the National Institute of Health Stroke Scale evaluation might suggest which patients are at increased risk of delirium. • Patients with delirium report negative short-term outcomes such as higher mortality, higher functional dependency at discharge and a potential delay in being admitted to rehabilitation units. Delirium is a frequent and serious acute neuropsychiatric syndrome leading to worse prognosis including mortality. Patients with ischaemic and/or haemorrhagic stroke are vulnerable to delirium. However, predisposing and precipitating factors have not been fully discovered to date, leaving this area of practice under-represented in available guidelines. To describe the prevalence, associated factors and main in-hospital outcomes of post-stroke delirium. A multi-centre observational study was conducted from 2019 to 2020 and reported according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Data were collected in stroke units located in two large hospitals in the North-East region of Italy. Consecutive adult patients with ischaemic and/or haemorrhagic stroke with a Glasgow Coma Scale > 5, who were willing to participate, were included. Data at admission, during the in-hospital stay and at discharge were collected by trained nurses, not involved in the care of patients, with (a) validated tools, (b) direct observation, and (c) access of patients' records. A total of 78 patients were enrolled (mean 73.1 years; 59% male), and 70.5% of them had suffered an ischaemic stroke. The mean National Institutes of Health Stroke Scale (NIHSS) at admission was 8.2 ± 7.0. A total of 34.6% of patients developed post-stroke delirium; the onset was mainly on the first day of admission (70.4%) and the condition lasted for an average of 3.7 days (SD 2.6). In the multivariate logistic regression, 64.1% of the delirium variance was explained by the NIHSS scores (RR 1.259, 95%CI 1.035–1.533; p = 0.022). Patients with post-stroke delirium reported higher functional dependence at discharge and the need for more delaying of hospital care to be admitted in rehabilitation units. At admission, higher scores in the NIHSS evaluation might suggest which patients are at an increased risk of delirium. Avoiding interventions that could potentially increase this risk, together with continuous surveillance, become imperative for nurses who are constantly and closely present by their patients' side, in order to prevent this serious complication. [ABSTRACT FROM AUTHOR]

The study aimed to measure and compare differences (a) in the unfinished nursing care interventions overall and the order in which they are left unfinished; and (b) in the underline reasons, as perceived by Italian, Slovak and Turkish nursing students. In recent years, in the nursing education context a novel line of research in the field of unfinished nursing care as those interventions required by patients, but omitted or delayed, has emerged. However, no studies have been conducted at the international level. An international, comparative cross-sectional study was performed in 2022–2023 and reported here according to Strengthening the Reporting of Observational Studies in Epidemiology guidelines. A multinational research network was formed with a convenient sample of 13 universities and 60 campuses (4595 students). The Unfinished Nursing Care Survey for Students (UNCS4S) was administered. A total of 1850 students participated. According to the UNCS4S total score, Italians reported an average 50.9 out of 110 unfinished nursing care interventions (CI95 % 47.6–54.1), Slovakians 54.9 (CI95 % 53.7–56.1) and Turkish students 50.4 (CI95 % 49.2–51.5) (p<0.001). Some interventions were reported more often as unfinished across countries as supervising the task assigned to the nursing aides, going to the patient without being called, spending the required time with the patient and their caregivers and emotionally supporting patients and their caregivers. In terms of reasons, total scores were statistically different across countries (Italy: 45.92 out of 90, CI95 % 43.91–47.9; Slovakia: 62, CI95 % 61.02–62.98; Türkiye: 72.29, CI95 % 71.13–73.45; p<0.001); however, at the factor level, communication issues, lack of material resources and issues in supervision of nursing aides were reported in all countries as the most important reasons of the unfinished nursing care. Students learn to shape and set priorities early in their nursing careers with similar order in what to leave unfinished as first, despite the different educational structures, care cultures and healthcare systems. Among the unfinished nursing care reasons perceived, the most influential were similar across countries, suggesting common areas for improvement. How to better prepare students to be resilient and capable of managing the challenges posed by unfinished nursing care episodes due to the lack of resources and communications issues should be considered as a priority by nurse educators. [ABSTRACT FROM AUTHOR]

The aims were twofold: (a) to map tools documented in the literature to evaluate comfort among patients undergoing high flow nasal cannula (HFNC) treatment; and (b) to assess if the retrieved tools have been validated for this purpose. A scoping review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). In July 2023, PubMed, Scopus, CINAHL and Cochrane Library were consulted. Studies assessing comfort in adult, paediatric, and neonatal patients undergoing HFNC were included. Seventy-four articles were included, among which nine (12.2 %) investigated comfort as the primary aim. Twenty-five different tools were found, classifiable into 14 types, mostly unidimensional and originating from those measuring pain. The most widely used was the Visual Analogic Scale (n = 27, 35.6 %) followed by the Numerical Rating Scale (n = 11, 14.5 %) and less defined generic tools (n = 10, 13.2 %) with different metrics (e.g. 0–5, 0–10, 0–100). Only the General Comfort Questionnaire and the Comfort Scale were specifically validated for the assessment of comfort among adults and children, respectively. Although the comfort of patients undergoing HFNC is widely investigated in the literature, there is a scarcity of tools specifically validated in this field. Those used have been validated mainly to assess pain, suggesting the need to inform patients to prevent confusion while measuring comfort during HFNC and to develop more research in the field. Comfort assessment is an important aspect of nursing care. Given the lack of validation studies in the field, efforts in research are recommended. [ABSTRACT FROM AUTHOR]

To explore the differences, if any, in the competences perceived by newly graduated nurses who attended their education before and during the COrona VIrus Disease 19 (COVID-19) restrictions. Nursing education has undergone significant changes because of the COVID-19 restrictions. However, to date the perceived competences at the point of graduation have not been investigated over the restrictions years compared with the pre-restrictions era. A repeated cross-sectional study followed by a pseudo-panel analysis. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used. Data on individual, nursing programme and perceived competences with Nurse Competence Scale (NCS) were collected and analysed by also using a pseudo-panel approach. Two universities were involved. Those eligible were nursing students who graduated: (1) in 2020 (=323) as the first post-COVID-19 group, who were studying in the 3rd year at the onset of the restrictions; (2) in 2021 (=250) as the second post-COVID-19 graduated group, who were in the 2nd year at the restrictions onset; and (3) in 2022 (=247) as the third post-COVID-19 group, attending the 1st year of nursing education at the onset of the restrictions. Data were compared with those who graduated in 2019 (=336, pre-COVID-19 group). The overall NCS score was higher in the pre-COVID-19 group (68 out of 100, 95 % Confidence of Interval [IC] 66.4–69.5), lower in the first post-COVID-19 graduates (62.9, 95 % CI 60–65.8), higher in the second (66.6, 95 % CI 63.6–69.4) and lower again in the third post-COVID-19 group (63.8, 95 % CI 60.9–66.5). A sinusoidal pattern also emerged for the frequency of use of the competences from the pre-COVID-19 (2.3 out of 3) and the first group (2.1) and increased between the second and the third group (from 2.1 to 2.3) (p< 0.001). These sinusoidal trends are also evident in the pseudo-panel analysis. A different degree of perceived competences at the point of graduation emerged, with higher competences in the pre-restrictions group, lower in the first post-COVID-19 generation, higher again in the second and third group. However, all scores were over 60 points out of 100, thus indicating sufficient competences. The frequency of use of such competences slightly changed over the years with limited practical relevance. The findings may inform reflections regarding innovations in the clinical placements pathways as well as in the strategies supporting newly graduates nurses in their transition from education to health-care settings. • The pandemic has introduced unprecedented structural and process variations in how nursing education is delivered on a large scale. • A comparison between pre- and post-COVID-19 nursing students at the point of graduation regarding their perceived competence and frequency of use of such competency was performed from 2019 to 2022. • The overall Nurse Competence Scale score was higher in the pre-COVID-19 group, lower in the first post-COVID-19 graduates, higher in the second and lower again in the third post-COVID-19 group. • A sinusoidal pattern also emerged for the frequency of use of the competences from the pre-COVID-19 and the first group and increased between the second and the third group. [ABSTRACT FROM AUTHOR]

• Simulation constitutes part of the curriculum in undergraduate nursing programs. • There is no comparative evidence of nursing simulation training across countries. • Significant variability in the implementation and use of simulation training. • Lack of global standards for nursing education accreditation. • Establish a consortium to regulate a framework for simulation education. Nursing education often employs simulation-based education to prepare for clinical practice. However, despite its perceived importance, there is no common practice for its integration into different nursing curricula. This study aimed to describe and compare the levels of implementation of simulation-based education in nursing curricula across different countries. A quantitative and qualitative exploratory study was conducted in 2019 using a questionnaire developed using the Delphi technique. Eight European member institutions participated in this exploratory study. Qualitative data were hand-coded and analyzed using descriptive analysis. Differences were found regarding (a) simulation in nursing programs, (b) the simulation environment, and (c) expert opinions. There exists a wide range of simulation-based education accreditation systems, and the absence of regulatory standards to replace clinical hours in the curriculum is a challenge for international exchange programs. Universities should invest in and guarantee high-quality research to evaluate national and international initiatives and contribute to simulation-based education. [ABSTRACT FROM AUTHOR]

• While individual and nursing care factors have been investigated well, the nursing home environment's role in decreasing eating dependence has been explored only to a limited extent. • Promoting a close family relationship and communal meal consumption, as well as adopting resident-centred interventions, can prevent eating dependence. • However, nursing home managers should consider the quality of the facility environment at the unit level where residents spend a large part of the day in addition to strategies at the individual and dining room levels. • In poor unit environments, residents with severe cognitive impairments demonstrated increased eating dependence; in contrast, in better environments, similar residents showed maximised eating performance. To explore the influence of the Nursing Home (NH) environment on eating independence while taking into account individual and nursing care factors, was the aim of the study. A secondary analysis was performed based on data collected in a multicentre prospective observational study involving 13 NHs. Residents aged >65 were included (n = 1,027). Dependence in eating was measured using the Edinburgh Feeding Evaluation in Dementia scale (EdFED, range 0–20). In addition to individual and nursing care variables, the NHs environments were assessed with the Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH, range 0–149). The mean EdFED score was 2.48 (95% Confidence Interval [CI]=2.22–2.73) and the TESS-NH score was 122.19 (95% CI=115.89−128.49). A linear regression analysis explained 30.8% of the total variance in eating dependence. Alongside individual and nursing care factors, in poor NH unit environments, residents with severe cognitive impairment showed increased eating dependence; in contrast, in better environments, similar residents showed maximal eating performance. [ABSTRACT FROM AUTHOR]

to map (a) methodological features, (b) Haemorrhagic Cystitis (HC) preventive and treatment interventions scrutinized to date, (c) outcomes measured, and (d) trends in effectiveness as documented among Haematopoietic Stem Cell Transplanted (HSCT) adults. A scoping review was performed in 2018. Medline, CINAHL, and Cochrane Systematic Reviews databases were researched using "haemorrhagic cystitis", "prevention", "treatment", "prevent*" and "treat*" as search terms. Handsearching was also performed. Clinical trials, randomized controlled trials, comparative and observational studies, reviews, systematic reviews and meta-analyses published in English and concerning adults were all included. Fifteen primary studies, mainly monocentric, retrospective and with a sample size <200, were identified. Seven focused on preventive (mainly continuous bladder irrigation and mesna) and eight on treatment interventions (mainly intravenous and intravesical cidofovir). The onset of micro and macrohaematuria and the clinical resolution of HC were the main measured outcomes. Positive effectiveness trends were apparent for mesna and cidofovir. In HC prevention and treatment, published primary studies are sparse and further research is required with larger, multicenter, and longitudinal designs conducted at international levels, with standardized methods, interventions, outcome measures, and reported data. • In patients undergoing Haematopoietic Stem Cell Transplantation (HSCT), Haemorrhagic Cystitis (HC) has been documented as a severe complication. • Various reviews have been conducted to date; however, no clinical recommendations have been established in the field. • The aim of the scoping review was to map available studies to inform the development of more focused lines of research on both HC prevention and treatment. • Nurses can have a great role in designing further studies all require methodologically sound studies using homogeneous outcomes, with more standardized approaches in preventive and treatment intervention administration procedures. [ABSTRACT FROM AUTHOR]

To summarise evidence on sleep deprivation and/or poor sleep determinants as experienced by intensive care unit patients. A systematic review of qualitative studies identified through PubMed, CINAHL and Scopus databases published in English up to 2018 was performed following PRISMA guidelines. The included studies were critically evaluated by using the Critical Appraisal Screening Programme tool. Study findings were then subjected to a meta-summary and a meta-synthesis. Intensive Care Units. Critically ill patients' experiences of sleep deprivation. Seven qualitative studies were included documenting the experience of 109 adult patients. A total of 12 codes emerged as causes of sleep deprivation and 'feeling fear/concern' was reported with the greatest frequency (71.4%) in the meta-summary. The 12 codes were categorised into three main themes influencing both directly and also interdependently the quality of sleep: (1) Experiencing complex interactions with the environment (nursing activities, frightening or disturbing sounds, acceptable sounds, time and space disorientation); (2) Undergoing intensive emotions and feelings (fear/concerns, state of abandon, inexplicable insomnia, inability to move, inability to talk) and (3) Receiving an appropriate standard of care (physical pain, feeling safe/unsafe). Despite the increased relevance of sleep deprivation and poor sleep quality, only a few studies have been performed to date aimed at identifying the factors involved in the phenomenon according to patient experience. The majority of determinants as identified from patients' perspective are modifiable. [ABSTRACT FROM AUTHOR]

Abstract Background During their clinical learning experience, students are exposed to the nursing profession as a powerful structural reality, experiencing the so-called professional socialisation, a process recognised as the basis of professional identity. Inside this process, students progressively acknowledge their professional identity as being composed of several competencies and, among these, also non-nursing tasks. Objectives To explore non-nursing tasks in the context of nursing students' clinical learning experiences. Design An interpretative phenomenological study design was performed and carried out in 2016. The COnsolidated criteria for REporting Qualitative (COREQ) research principles were used in reporting study methods and findings. Setting Two Italian Bachelor of Nursing degree programmes located in Northern Italy. Participants Students attending their nursing programmes who a) had successfully passed one or more theoretical examinations; b) had one or more clinical learning experiences in varied contexts (e.g. hospital, community); c) were attending the 1st, 2nd or 3rd year, and d) were willing to participate, were interviewed with an open-ended, face-to-face, audio-recorded interview. Methods A thematic analysis was performed. Results Participating students (n = 18) were between 20 and 25 years old and were attending the 1st to the 3rd (and final) academic year. Non-nursing tasks were experienced by them according to three main themes: a) "Being out of the scope of the learning experience," b) "Being forced by external and internal forces," and c) "Dealing with mixed outcomes by looking for a compromise." All students have reported learning to perform non-nursing tasks by shadowing clinical nurses and also practising these tasks by themselves. Internal and external forces prompted students to perform non-nursing tasks, which were recognised as having positive, negative, and neutral effects on themselves and on their learning outcomes. Conclusions Non-nursing tasks are acquired since the beginning of the clinical experience, thus shaping the nursing students' professional identity. At the undergraduate nursing level, strategies should be implemented to prevent the phenomena that a) threaten the acquisition of more complex nursing competences expected by patients and society, and b) shape future generations to be flexible and to perform different tasks, included those below their role. Highlights • Nursing students learn early in their educational career that performing non-nursing tasks is part of the profession. • In practising non-nursing tasks, students perceive themselves as 'Being out of the scope of their learning clinical experience' as expected personally and by the nursing programme. • Non-nursing tasks are acquired during the clinical experience, suggesting that at these levels strategies aimed at preventing the phenomenon should be designed and implemented. [ABSTRACT FROM AUTHOR]

Abstract Background Effective performance of clinical handovers should be one of the priorities of nursing education to promote efficient communication skills and ensure patient safety. However, to date, no studies have explored to what extent nursing students are involved in handovers. Objective To explore nursing students' handover involvement during their clinical rotations and associated factors. Method This was a secondary analysis of a large national cross-sectional study that involved 9607 undergraduate nursing students in 27 universities across 95 three-year Italian baccalaureate nursing programs. The involvement in the clinical handovers was the end point (from 0, never, to 3, always). A path analysis was performed to identify variables directly and indirectly affecting students' handover involvement. Results Handover involvement was reported as 'only a little', 'to some extent', and 'always' by 1739 (18.1%), 2939 (30.6%), and 4180 (43.5%) students, respectively; only 749 (7.8%) of students reported never being involved. At the path analysis explaining the 19.1% of variance of nursing students' involvement, some variables emerged that directly increased the likelihood of being involved in handovers. These were being female (β = 0.115, p < 0.001); having children (β = 0.107, p = 0.011); being a 3rd-year student (β = 0.142, p < 0.001) and being a 2nd-year student as compared to a 1st-year student (β = 0.050, p = 0.036); and having a longer clinical rotation (β = 0.015, p < 0.001) in units with high 'quality of the learning environment' (β = 0.279, p < 0.001). Moreover, students who were supervised by the nurse teacher (β = −0.279, p < 0.001), or by a nurse on a daily basis (β = −0.253, p = 0.004), or by the staff (β = −0.190, p < 0.001) reported being less involved in handovers as compared to those students supervised by a clinical nurse. Variables with indirect effects also emerged (model of student's supervision adopted at the unit level, and number of previous clinical rotations attended by students). Moreover, handover involvement explained 11.5% of students self-reported degree of competences learned during the clinical experience. Conclusions Limiting students' opportunity to be involved in handover can prevent the development of communication skills and the professional socialization processes. Strategies at different levels are needed to promote handover among undergraduate nursing students. [ABSTRACT FROM AUTHOR]

Background Patients on mechanical ventilation are at risk of experiencing a potentially life-threatening unplanned extubation in the intensive care unit, which can lead to arrhythmias, bronchial aspiration, difficulty in reintubation or even sudden cardiac arrest. Although incidence and outcomes of the phenomenon have been documented in several quantitative studies, no studies have investigated the antecedents as experienced by critical care nurses. Objectives To gain a greater understanding of the antecedents of unplanned extubations. Methods A qualitative study design involving the critical-incident technique. A total of 10 registered nurses who reported one or more episodes of unplanned extubations were involved in an in-depth interview. Findings According to the nurses’ experience, episodes of unplanned extubations are determined by predisposing, precipitating and mediating factors. The predisposing factors have been recognised in the (a) weaning programme (expected/unexpected decreased sedation) and in the (b) patient factors (increased needs due to discomfort, restlessness and desire to communicate). The precipitating factors have been divided into (a) organisational (failures in multi-professional communication), (b) environmental (excessive environmental chaos and barriers preventing direct surveillance) and (c) nursing care factors (ensuring privacy by creating barriers, avoiding disturbing other patients and poor nurse-to-patient ratio). Among the mediating factors, which are affected by the precipitating factors, decreased surveillance and mechanical restraints’ use have been identified. Conclusion Identifying risk factors of unplanned extubation, specifically those that are modifiable, such as increasing interprofessional communication, reducing excessive environment chaos, implementing strategies aimed at overcoming barriers threatening direct surveillance and ensuring appropriate nurse-to-patient ratio, can prevent the occurrence of these events. [ABSTRACT FROM AUTHOR]

Same-day discharge (SDD) is a safe option for several adult urologic surgeries, benefiting patients and hospitals. By decreasing length of stay while maintaining patient safety, SDD is in-line with recent goals to provide high value care while minimizing costs. Literature on SDD in the pediatric population, however, is scarce, and no study has identified the efficacy of SDD for pediatric pyeloplasty (PP) and ureteral reimplantation (UR). The aim of this study was to identify trends in the usage of SDD as well as its efficacy and safety based on surgical outcomes for pediatric PP and UR. The 2012–2020 files of the American College of Surgeon's National Surgical Quality Improvement Project pediatric database were queried for PP and UR. Patients were stratified as SDD or standard-length discharge (SLD). Trends in SDD usage, differences in baseline characteristics, surgical approach, and surgical outcomes including 30-day readmission, complication, and reoperation rates were analyzed between SDD and SLD groups. 8213 PP (SDD: 202 [2.46%]) and 10,866 UR (469 [4.32%]) were included in analysis. There were no significant changes in SDD rates between 2012 and 2020, averaging 2.39% (PP), and 4.39% (UR). For both procedures, SDD was associated with higher rates of open versus minimally invasive (MIS) surgical approach and with shorter operative and anesthesia durations. For PP, there were no differences in readmission, complication, or reoperation rates in the SDD group. For UR, there was a 1.69% increase in CD I/II complications in those receiving SDD, correlating to 1.96-fold higher odds of CD I/II in all SDD patients compared to SLD patients. These results suggest that while the rate of SDD has not increased in recent years, the current screening methods for SDD have been generally effective in maintaining the safety of SDD for pediatric procedures. Though SDD for UR did show a very small increase in minor complications, this may be due to less strict screening protocols, and may be alleviated via MIS surgical approach. While this is the first paper to investigate SDD for pediatric urology procedures, these results are similar to those found for adult procedures. This study is limited by the lack of clinical data reported in the database. SDD is a generally safe option for pediatric PP and UR, and further research should identify proper screening protocols to continue to allow for safe SDD. [ABSTRACT FROM AUTHOR]

One of cannabis' most iconic effects is the stimulation of hedonic high-calorie eating—the "munchies"—yet habitual cannabis users are, on average, leaner than non-users. We asked whether this phenotype might result from lasting changes in energy balance established during adolescence, when use of the drug often begins. We found that daily low-dose administration of cannabis' intoxicating constituent, Δ9-tetrahydrocannabinol (THC), to adolescent male mice causes an adult metabolic phenotype characterized by reduced fat mass, increased lean mass and utilization of fat as fuel, partial resistance to diet-induced obesity and dyslipidemia, enhanced thermogenesis, and impaired cold- and β-adrenergic receptor-stimulated lipolysis. Further analyses revealed that this phenotype is associated with molecular anomalies in the adipose organ, including ectopic overexpression of muscle-associated proteins and heightened anabolic processing. Thus, adolescent exposure to THC may promote an enduring "pseudo-lean" state that superficially resembles healthy leanness but might in fact be rooted in adipose organ dysfunction. [Display omitted] • Exposing adolescent mice to low-dose THC alters their adult energy metabolism • CB 1 receptor activation in differentiated adipocytes mediates this effect • THC-treated mice are leaner than controls • Molecular and functional adipose abnormalities identify this state as pseudo-lean Lin et al. report that treating adolescent mice with low-dose THC produces an adult metabolic phenotype in which apparently healthy features, such as leanness and an improved lipid panel, are accompanied by profound molecular and functional abnormalities, including the presence in fat of proteins that are normally found in muscle. [ABSTRACT FROM AUTHOR]

Purpose To explore the emotional concerns and coping strategies of patients with Low Grade Glioma (LGG) and whether or not their caregivers are reliable in reporting these concerns as surrogate informants. Methods An explorative cross-sectional study. Patients who had undergone a neurosurgical procedure at least one year before this study for LGG and who were capable of participating in a face-to-face interview were included. Each patient nominated a reference caregiver. Both the patient and the caregiver were interviewed independently, using the Beck Depression Inventory Scale, the State – Trait Anxiety Inventory, and the Jalowiec Coping Scale. Main results Forty-six patients and 46 caregivers were included. The average scores of the Beck scale were homogeneous between patients and caregivers (7.76 [CI 95% 5.76–9.75] vs. 6.23 [CI 95% 4.57–7.90]; p = 0.102). Patients reported significantly greater state and trait anxiety (44.26 [CI 95% 40.21–48.31] and 37.95 [CI 95% 34.97–40.94]), respectively compared to their caregivers (40.28 [CI 95% 36.64–43.91] and 35.17 [CI 95% 32.16–38.18]). The coping strategies enacted were homogeneous between patients and caregivers (82.78 [CI 95% 77.21–88.35] vs (80.93 [CI 95% 76.32–85.55]; p = 0.102) while the kind of strategies adopted were significantly diverse. Conclusions Patients suffer from depression and greater state anxiety as compared to trait anxiety; moreover, they enact less than half of the available coping strategies. Caregivers may be involved as surrogate informants when necessary for health-care professionals to detect depression while more caution is advised for what concerns anxiety and the coping strategies enacted by patients. [ABSTRACT FROM AUTHOR]

To describe the prevalence and incidence density of hospital-acquired unavoidable pressure sores among patients aged ≥65 years admitted to acute medical units. A secondary analysis of longitudinal study data collected in 2012 and 2013 from 12 acute medical units located in 12 Italian hospitals was performed. Unavoidable pressure ulcers were defined as those that occurred in haemodynamically unstable patients, suffering from cachexia and/or terminally ill and were acquired after hospital admission. Data at patient and at pressure ulcer levels were collected on a daily basis at the bedside by trained researchers. A total of 1464 patients out of 2080 eligible (70.4%) were included. Among these, 96 patients (6.5%) hospital-acquired a pressure ulcer and, among 19 (19.7%) were judged as unavoidable. The incidence of unavoidable pressure ulcer was 8.5/ 100 in hospital-patient days. No statistically significant differences at patient and pressure ulcers levels have emerged between those patients that acquired unavoidable and avoidable pressure sores. Although limited, evidence on unavoidable pressure ulcer is increasing. More research in the field is recommended to support clinicians, managers and policymakers in the several implications of unavoidable pressure ulcers both at the patient and at the system levels. [ABSTRACT FROM AUTHOR]

Background Some nursing programmes offer night shifts for students while others do not, mainly due to the lack of evidence regarding their effectiveness on clinical learning. Objectives The principal aims of the study were to describe nursing students' perceptions and to explore conditions influencing effectiveness on learning processes during night shifts. Design An explanatory mixed-method study design composed of a cross-sectional study (primary method, first phase) followed by a descriptive phenomenological study design (secondary method, second phase) in 2015. Setting Two bachelor of nursing degree programmes located in Northern Italy, three years in length and requiring night shifts for students starting in the second semester of the 1st year, were involved. Participants First phase: all nursing students ending their last clinical placement of the academic year attended were eligible; 352 out the 370 participated. Second phase: a purposeful sample of nine students among those included in the first phase and who attended the highest amount of night shifts were interviewed. Methods First phase: a questionnaire composed of closed and open-ended questions was adopted; data was analyzed through descriptive statistical methods. Second phase: an open-ended face-to-face audio-recorded interview was adopted and data was analyzed through content analysis. Results Findings from the quantitative phase, showed that students who attended night shifts reported satisfaction (44.7%) less frequently than those who attended only day shifts (55.9%). They also reported boredom (23.5%) significantly more often compared to day shift students (p = 0001). Understanding of the nursing role and learning competence was significantly inferior among night shift students as compared to day shift students, while the perception of wasting time was significantly higher among night shift students compared to their counterparts. Night shift students performed nursing rounds (288; 98.2%), non-nursing tasks (247; 84.3%) and/or less often managed clinical problems (insomnia 37; 12.6% and disorientation/confusion 32; 10.9%). Findings from the qualitative phase showed night shifts are experienced by students as a “time potentially capable of generating clinical learning”: learning is maximized when students play an active role, encounter patients' clinical problems and develop relationships with patients, caregivers and staff. Conclusions Night shifts remains ambiguous from the students' perspective and their introduction in nursing education should be approached with care, considering the learning aims expected by students in their clinical placements and the education of clinical mentors education who should be capable of effectively involving students in the process of night care by avoiding non-nursing tasks. [ABSTRACT FROM AUTHOR]

Background Assessing clinical competence in nursing students abroad is a challenge, and requires both methods and instruments capable of capturing the multidimensional nature of the clinical competences acquired. Objectives The aim of the study was to compare the clinical competence assessment processes and instruments adopted for nursing students during their clinical placement abroad. Design A case study design was adopted in 2015. Setting and Participants A purposeful sample of eight nursing programmes located in seven countries (Belgium, Denmark, Greece, Norway, Poland, Portugal and Italy) were approached. Methods Tools as instruments for evaluating competences developed in clinical training by international nursing students, and written procedures aimed at guiding the evaluation process, were scrutinised through a content analysis method. Findings All clinical competence evaluation procedures and instruments used in the nursing programmes involved were provided in English. A final evaluation of the competences was expected by all nursing programmes at the end of the clinical placement, while only four provided an intermediate evaluation. Great variability emerged in the tools, with between five and 88 items included. Through content analysis, 196 items emerged, classified into 12 different core competence categories, the majority were categorised as ‘Technical skills’ (= 60), ‘Self-learning and critical thinking’ (= 27) and ‘Nursing care process’ (= 25) competences. Little emphasis was given in the tools to competences involving ‘Self-adaptation’, ‘Inter-professional skills’, ‘Clinical documentation’, ‘Managing nursing care’, ‘Patient communication’, and ‘Theory and practice integration’. Conclusions Institutions signing Bilateral Agreements should agree upon the competences expected from students during their clinical education abroad. The tools used in the process, as well as the role expected by the student, should also be agreed upon. Intercultural competences should be further addressed in the process of evaluation, in addition to adaptation to different settings. There is also a need to establish those competences achievable or not in the host country, aiming at increasing transparency in learning expectations and evaluation. [ABSTRACT FROM AUTHOR]

We shall construct a class of nonlinear reaction-diffusion equations starting from an infinitesimal algebraic skeleton. Our aim is to explore the possibility of an algebraic foundation of integrability properties and of stability of equilibrium states associated with nonlinear models describing patterns formation. [ABSTRACT FROM AUTHOR]

Introduction For clinical nurses, especially those working in emergency departments, it is crucial to measure blood glucose (BG) in an accurate, timely, and safe manner. Many differences in practice exist with regard to use of the first or second drop of blood for testing, and no consistent guidelines are available for capillary BG testing at home or in ED settings. The purpose of this study is to evaluate the BG differences between the first and second drop of capillary blood collected from the same site in patients with type 1 diabetes. Methods A consecutive sample of 195 persons with type 1 diabetes who had washed their hands and were not suspected of having hypoglycemia were included in the study. Descriptive and inferential statistical analysis for non-normal distributed variables was performed. Results A strong correlation emerged between the BG reported in the first and the second drops (Spearman’s rho test [r s ] 0.979, P < .001; Pearson r 0.978, P < .001). The average BG values obtained from the first and second drops were 184.30 mg/dL (median, 166) and 187.6 mg/dL (median, 172), respectively, and thus the second drop showed higher glucose values compared with the first drop. However, BG values of the second drop were not higher in all occasions: whereas some evaluations reported higher BG values in the second drop capillary sample (n = 123), others reported higher values in the first drop (n = 65), and still others reported identical measurements in the first and second drops (n = 7). Five outliers were present with a BG difference from − 39 to − 53 mg/dL in the first drop compared with the second drop, and 3 outliers were present with a BG difference from + 46 to + 57 mg/dL in the first drop compared with the second drop. However, the differences that emerged were not affected by glucose concentration ( P = .221). Discussion Using the first drop of blood in a patient with clean hands allows emergency nurses to perform the test more quickly, resulting in immediate information. Findings indicate that the first drop of blood is adequate for clinical decision making, but the clinician should use judgment if using protocols in which small values (eg, 6 mg/dL) are important, because the first drop is more likely to have a slightly lower value. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe the experiences of postoperative cardio-thoracic surgical patients experiencing nursing bedside handover. A descriptive qualitative approach was undertaken. A purposeful sampling technique was adopted, including 14 patients who went through cardio-thoracic surgery and witnessed at least two bedside handovers. The study was performed in a Cardio-thoracic ICU localised in a Joint Commission International accredited Academic Hospital in north-eastern Italy from August to November 2014. The experience of patients participating at the bedside handover is based on four main themes: (1) 'discovering a new nursing identity', (2) 'being apparently engaged in a bedside handover', (3) 'experiencing the paradox of confidentiality' and (4) 'having the situation under control'. With the handover performed at the bedside in a postoperative setting, two interconnected potential effects may be achieved with regard to patients, nurses and the nursing profession. Nurses have a great opportunity to express their closeness to patients and to promote awareness of the important growth that nursing has achieved over the years as a profession and discipline. Therefore, patients may better perceive nursing competence and feel safer during the postoperative care pathway. They can appreciate nurses' humanity in caring and trust their competence and professionalism. [ABSTRACT FROM AUTHOR]

Describing the trajectories of hospital-associated functional decline in older patients admitted to acute medical units and identifying predictors at the individual, nursing, and hospital levels, were the aims of the study. A longitudinal survey among 12 acute medical units in which 1464 patients were consecutively enrolled and evaluated using the Barthel Index (Bl), was performed. Functional decline was defined as a decrease in the BI of at least 5 points from admission to discharge, in all, 17.1% participants (n = 251) demonstrated functional decline. In accordance with multiple logistic regression analysis, 28.8% (R²) of the variance in the functional decline was explained by: confusion/disorientation (RR = 4.684; 95% CI = 3.144-6.978), admission from nursing homes (RR = 2.464; 95% CI = 1.642-3.697), daily care expressed in minutes offered by nursing aides (RR = 1.535; 95% CI = 1.275-1.849), higher workforce skill-mix (RR = 2.221; 95% CI = 1.763-2.797), bladder catheter insertion (RR = 1.599; 95% CI = 1.128 -2.268), and higher BI score at admission (RR = 1.019; 95% CI = 1.014-1.024). Increasing the amount of care delivered by competent nurses--having a bachelors degree--providing and supervising direct-care activities, may reduce the occurrence of functional decline in older patients admitted to medical units. [ABSTRACT FROM AUTHOR]

Femicide is the intentional killing of a woman because she is female, and often occurs when there are pre-existing relations, intimate or otherwise, between the victim and the murderer. A retrospective epidemiological study was made of 34 female homicides recorded in a university departmental register of post-mortems, pertaining to a judicial district of about 700,000 inhabitants in north eastern Italy, during a 21-year period from January 1st 1993 to December 31st 2013. The temporal trend, the socio-demographic characteristics of victims and perpetrators, the circumstances surrounding the crime and the risk factors for femicide were studied with the aim of identifying and developing preventive strategies. [ABSTRACT FROM AUTHOR]

Background: To date, few studies have investigated the occurrence of phlebitis related to insertion of a peripheral venous cannula (PVC) in an emergency department (ED).Aim: To describe the natural history of ED-inserted PVC site use; the occurrence and severity of PVC-related phlebitis; and associations with patient, PVC and nursing care factors.Methods: A prospective study was undertaken of 1262 patients treated as urgent cases in EDs who remained in a medical unit for at least 24h. The first PVC inserted was observed daily until its removal; phlebitis was measured using the Visual Infusion Phlebitis Scale. Data on patient, PVC, nursing care and organizational variables were collected, and a time-to-event analysis was performed.Findings: The prevalence of PVC-related phlebitis was 31%. The cumulative incidence (78/391) was almost 20% three days after insertion, and reached >50% (231/391) five days after insertion. Being in a specialized hospital [hazard ratio (HR) 0.583, 95% confidence interval (CI) 0.366-0.928] and receiving more nursing care (HR 0.988, 95% CI 0.983-0.993) were protective against PVC-related phlebitis at all time points. Missed nursing care increased the incidence of PVC-related phlebitis by approximately 4% (HR 1.038, 95% CI 1.001-1.077).Conclusions: Missed nursing care and expertise of the nurses caring for the patient after PVC insertion affected the incidence of phlebitis; receiving more nursing care and being in a specialized hospital were associated with lower risk of PVC-related phlebitis. These are modifiable risk factors of phlebitis, suggesting areas for intervention at both hospital and unit level. [ABSTRACT FROM AUTHOR]

Summary Background In the European context regulated by the Bologna Process principles, there is little evidence to date on the different profiles, if any, of nursing students enrolled in the 1st academic year and their academic outcomes. Aims To describe and compare the nursing student profiles and their academic outcomes at the end of the 1st year across European Bachelor of Nursing Science (BNS) courses. Design An exploratory multicentre cohort study involving five countries: Nursing students who were enrolled in nursing programmes for the academic year 2011/2012 in the participating BNS courses, willing to participate and regularly admitted to the 2nd academic year, were included in this study undertaken in 2013. Individual and faculty level variables were collected after having ensured the validity of the tools developed in English and then appropriately translated into the language of each participating country. Findings A total of 378/710 (53.2%) students participated in the study. They attended from 390 to 810 h of lessons, while clinical experience ranged from 162 to 536 h. The students reported a mean average age of 21.4 (Confidence of Interval [CI] 95%, 21.0–22.3) and foreign students were limited in number (on average 3.7%). The students reported adopting mainly individual learning strategies (92.9%), duplicating notes or lecture notes prepared by professors (74.4%), and concentrating their study before exams (74.6%). The majority reported experiencing learning difficulties (49.7%) and a lack of academic support (84.9%). Around 33.2% reported economic difficulties and the need to work while studying nursing on average for 24 h/week. Personal expectations regarding the nursing role were different (45.6%) than the role encountered during the 1st year, as learning workloads were higher (57.2%) with regard to expectations. Around one-third of students reported the intention to leave nursing education while the proportion of those reporting early academic failure was on average 5.6%. Conclusions More strategies aimed at harmonising nursing education across Europe, at supporting nursing students' learning processes during 1st year, and identifying factors influencing their intention to leave and their academic failure, are recommended. [ABSTRACT FROM AUTHOR]

Purpose to develop a tool for measuring the difficulty of intravenous line insertion in cancer patients (DIVA-CP) receiving peripheral chemotherapy. Methods a pilot-validation study divided into two phases was performed in a north-eastern Italian outpatient chemotherapy centre. In the first phase, a review of the literature and brainstorming sessions/direct discussions among expert oncology nurses were used to develop items on the DIVA-CP tool, and a panel of expert oncology nurses assessed the tool face and content validity. In the second phase, 260 adult patients undergoing single chemotherapy cycles were consecutively enrolled. Data was analysed for construct validity (explorative factor analysis) and inter-rater reliability (Cohen's Kappa). Results a 10-item tool was developed with four factors that were identified through factor analysis, explaining a total variance of 61.578%: accessibility to first choice veins (23.057%), venous fragility (15.197%), probable difficulties during the procedure (12.642%), and repeated exposure (10.691%). The tool demonstrated excellent inter-rater reliability (κ > 0.61 for 7 out of 10 items). Conclusions the DIVA-CP tool is still a pilot instrument that needs to be improved through future studies. The tool has great potential and may perform an important role in oncological settings, allowing for easier venous assessment of patients receiving peripheral chemotherapy who are at risk of difficult intravenous access insertion. In addition, this instrument may help nurses to identify patients that may benefit from a central catheter promptly. [ABSTRACT FROM AUTHOR]

Purpose The primary end-point was to describe the clinical course of monoclonal antibody-induced papulopustular rash (mAB-induced PPR), when patients alert health-care providers and the subsequent reactive measures employed. Exploring the predictors affecting PPR grading was the secondary end-point. Methods A multicentre retrospective study involving six Italian oncology outpatient departments was conducted. Thirty-nine patients with cancer undergoing cetuximab or panitumumab treatment were included. Information was collected through medical records and face-to-face interviews. mAB-induced PPR was scored by patients' self-reported Common Terminology Criteria for Adverse Eventsv4.02 and was defined as severe when the grade ≥3. Results Thirty-five (89.7%) patients developed a rash, which was severe in nine cases. The rash usually appeared within the first week after starting the drug (22, 62.8%), peaked in severity during the first month (26, 74.3%) and resolved 4–8 weeks after the end of mABs therapy (15, 45.7%). At the time of the interviews, the rash was not still resolved in almost half (n = 16) of the patients. Twenty-six (74.3%) patients reported sequelae and the mostly common were erythema (21, 81%) and dry skin (14, 54%). Only half of the patients informed health-care professionals as soon as the rash appeared. All the patients treated the rash topically and mAB therapy was modified in 16 (45.7%) cases (reduction, n = 10; discontinuation, n = 9; withdrawal, n = 2). No association between male gender, age, fair skin, current smokers during therapy and PPR grading escalation was found. Conclusions The clinical course of the rash was pathognomonic. Patients should be further encouraged to communicate the onset of a rash to health-care professionals as soon as it appears to avoid grading escalation and sequelae. The adoption of CTCAE as a patient-reported outcome may become an instrument to help health-care providers in tailoring treatment measures. [ABSTRACT FROM AUTHOR]

The study sought to validate the Italian version of the Health Professional Education in Patient Safety Survey (H-PEPSS), an instrument used to assess the perceptions of health professionals regarding patient safety competence. The H-PEPSS was administered to a sample of 574 bachelor degree nursing students in two north-eastern Italian universities. Its factor structure, validity and reliability were examined using explorative factor analysis. The internal consistency of the Italian version of H-PEPSS (H-PEPSSIta) measured with Cronbach's alpha (α) was higher for both classroom (.938) and clinical training (.942) dimensions. The six factors that emerged from the analysis were composed of three to five items loading ≥.55 and explaining 69.344% of the classroomtotal variance and 70.425% of the clinical training total variance of the H-PEPSSIta. The H-PEPSSIta is a valid tool capable of evaluating the self-perception of nursing students regarding patient safety knowledge and competence. Therefore, the instrument could be adopted in educational settings as a periodic nursing student report. This may help students reflect on PS related-issues, and evaluate gaps in knowledge and competences; furthermore, data emerging from periodic self-reports may offer the opportunity to tailor educational strategies to fill the gaps in PS knowledge and competences that emerge. [ABSTRACT FROM AUTHOR]

Summary Background In spite of the number of studies available in the field and policy documents developed both at the national and the international levels, there is no reliable data available regarding the variation of roles occupied by clinical mentors (CMs) across countries. Objectives To describe and compare the CM's role; responsibilities; qualifications; employment requirements and experience in undergraduate nurse education as enacted in 11 European Union (EU) and non- EU countries. Design A case study design. Participants and Setting A panel of expert nurse educators from 11 countries within and outside of the EU (Croatia, Czech Republic, England, Iceland, Ireland, Italy, Poland, Serbia, Slovenia, Spain, and the USA). Methods A questionnaire containing both quantitative and qualitative questions was developed and agreed by the panel using a Nominal Group Technique (NGT); four cycles of data collection and analysis were conducted involving key experts in nursing education in each country. Results In all countries, there are at least two types of clinical mentorship dedicated to undergraduate nursing students: the first is offered by higher education institutions, and the second is offered by health care providers. Variation was noted in terms of profile, responsibilities and professional requirements to act as a CM; however, the CM role is mainly carried out by registered nurses, and in most countries there are no special requirements in terms of education and experience. Those who act as CMs at the bedside continue to manage their usual caseload, thus the role adds to their work burden. Conclusions Whilst it is imperative to have respect for the different national traditions in undergraduate nurse education, the globalisation of the nursing workforce and greater opportunities for student mobility during the course of their undergraduate education suggests that in areas such as clinical mentorship, jurisdictions, particularly within the EU, should work towards greater system harmonisation. [ABSTRACT FROM AUTHOR]

The primary aim was to describe differences, if any, between learned and practiced competences among a convenience sample of Italian and Slovenian nursing staff; the secondary aim was to validate an instrument capable of measuring internationally such competences. The distance between competences learned and those practiced as a source of under- or over-education has not been investigated to date at the international level. A explorative observational investigation was performed in 2019 by involving 426 Italian and Slovenian members of the nursing staff working in medical and surgical departments. The study was conducted according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Members of the nursing staff (health care assistants, general nurses, specialist nurses and advanced nurses) were invited to complete the Nursing Competence Instrument based on the European Federation of Nursing Association's four categories of the nursing care continuum, from health care assistants to advanced practice nurses. The construct validity of the Nursing Competence Instrument indicated the presence of four identifiable dimensions (internal consistency ranging from 0.82 to 0.93). On average, the scores of the competences practiced were interestingly slightly higher than those learned among general care nurses. In contrast, health care assistants, specialist nurses and advanced practice nurses, reported to have learned importantly slightly lower as that practiced. At the overall levels, nurses tend to apply what they had been thought; additionally, all profiles seem to rate at low ranges both the competences practiced and those learned, suggesting the need to maximise nursing competences, both in the classroom and in the daily practice. Mapping the degree of competences acquired in education, as applied in the clinical practice, might assist clinical nurses, nurse educators and health care managers to identify areas at need of improvement. Moreover, mapping differences (if any) across countries might have research, managerial and educational implications. [ABSTRACT FROM AUTHOR]

Summary Background Ensuring safety in health-care settings is provoking improvements both in education and clinical practice. However, the studies available have not offered to date information regarding knowledge and competence on patient safety (PS) developed by nursing students over their academic career. There is no documentation of the amount of close calls and/or adverse events that students may have witnessed and the degree of safety perceived in the attended clinical settings. Objectives To describe the perception of nursing students regarding their own knowledge and competence on PS and describe differences, if any, among students attending the first, second and third academic year. Design A cross-sectional study design was undertaken in 2013. Participants and Setting A convenience sample of 621 nursing students of two bachelors nursing degrees located in two Italian universities, was the population target of the study. Students attending the first, second and third academic year, obtaining admission to the annual clinical competence examination, were eligible. Methods The Italian version of the Health Professional Education in Patient Safety Survey (H-PEPSS Ita ) and open-ended questions was administered to the students after having obtained their informed written consent. Results A total of 573 students (response rate 92.4%) participated. Around a quarter (28.8%) of students reported having experienced an adverse event or close call during their clinical experience. The settings where they learn were perceived as unsafe by 46.9% of students. PS knowledge and competence as perceived by students, was high (Median = 4) in all factors and dimensions of the H-PEPSS Ita tool. High PS knowledge and competence was reported by first-year students, moderate by second-year students and higher at the end of the third-year. Conclusions Faculties and health-care institutions offering clinical placements have to share the responsibility of well-prepared future nurses, working together to improve PS through dialogue when issues are identified by students. [ABSTRACT FROM AUTHOR]

Summary Background In accordance with Knowles's theory, self-directed learning (SDL) may be improved with tutorial strategies focused on guided reflection and critical analysis of the learning process. No evidence on effects on SDL abilities of different tutorial strategies offered to nursing students during the 1st clinical experience is available. Objectives To evaluate the effect of different tutorial strategies offered to nursing students on their SDL abilities. Design A pre–post intervention non-equivalent control group design was adopted in 2013. For the treatment group, structured and intensive tutorial interventions including different strategies such as briefing, debriefing, peer support, Socratic questioning, performed by university tutors were offered during the 1st clinical experience; for the control group, unstructured and non-intensive tutorial strategies were instead offered. Setting Two Bachelor of Nursing Degree. Participants Students awaiting their clinical experience (n = 238) were the target sample. Those students who have completed the pre- and the post-intervention evaluation (201; 84.4%) were included in the analysis. Methods SDL abilities were measured with the SRSSDL_ ITA (Self Rating Scale of Self Directed Learning-Italian Version). A multiple linear regression analysis was developed to explore the predictive effect of individual, contextual and intervention variables. Results Three main factors explained the 36.8% of the adjusted variance in SDL scores have emerged: a) having received a lower clinical nurse-to-student supervision (B 9.086, β 2.874), b) having received higher level and structured tutorial intervention by university tutors (B 8.011, β 2.741), and c) having reported higher SDL scores at the baseline (B .550, β .556). Conclusions A lower clinical nurse-to-student ratio (1:4), accompanied by unstructured and non-intensive tutorial intervention adopted by university tutors, seemed to be equivalent to an intensive clinical supervision (1:1) accompanied by higher level and structured tutorial strategies activated by the university tutors. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To evaluate the effectiveness of irrigating totally implantable venous access devices (TIVADs) every eight weeks instead of every four in maintaining the patency of the device. Methods: An explorative, pragmatic, prospective study design was conducted in two day hospital centres located in the northeast of Italy, from January 2011 to September 2012. Twenty patients who had skipped an appointment and were thus washing their TIVAD every eight weeks (exposed) were included, as were 17 patients following the typical wash regimen of every four weeks (controls). TIVAD occlusion—defined as the inability of the device to aspirate blood and/or the inability to properly irrigate the device—was the principal study end-point. Results: A total of six occlusions were documented in six patients. Four cases were observed among the exposed group (4/20; 20.0%), while two were observed among the control group (2/17; 11.7%). No statistically significant differences were observed in the occurrence of occlusion between the groups (RR: 1.29, 95%CI: 0.67–2.50, p = 0.49). No statistically significant differences emerged between groups in the time that elapsed from study inclusion to occlusion occurrence according to the time-to-event analysis performed using the Kaplan–Meier estimation model (Log Rank [Mantel–Cox] = χ 2 0.284, df 1, p = 0.594). Conclusions: Within the limitations of the study which should be addressed with further research based on double-blinded randomised clinical trials, postponing the irrigation regimen of TIVADs to eight weeks seems to be sufficient to maintain device patency. [Copyright &y& Elsevier]

Summary: Background: The development of self-directed learning (SDL) is a growing priority among nurses and other health care workers: they need to be prepared in order for their university education to be effective and relevant to their lifelong learning. To learn in a self-directed manner, it is necessary to develop an awareness of one's ability to self-learn and then to implement appropriate and effective strategies; progress must be assessed using validated measurement tools. Objectives: The aim of this study was to examine the factor structure of the Italian version of the Self-Rating Scale of Self-directed Learning (SRSSDLIta), and to provide evidence of its validity. Design: A cross-sectional design was undertaken. Participants: Given that the instrument is composed of 60 items, a total of 600 to 900 participants were targeted. In addition, according to the theoretical assumption that self-directed learning — as a crucial component of lifelong learning — is a measurable skill that is developed across the individual's professional life, a maximum variation sample was examined. Therefore, 847 participants were involved, including 453 nurses, 141 radiology technicians, 182 nursing students and 68 radiology technician students. Methods: Principal component analysis and factor analysis were performed. Results: The Italian version of the SRSSDL Scale consists of 40 items composed of eight factors: Awareness (α=0.805), Attitudes (α=0.778), Motivation (α=0.789), Learning Strategies (α=0.789), Learning Methods (α=0.781), Learning Activities (α=0.676), Interpersonal Skills (α=0.684), and Constructing Knowledge (α=0.732). Conclusions: The SRSSDLIta consists of 40 items across eight factors. The shorter Italian version might reduce the time needed to complete, thereby making the tool faster and easier to use. [Copyright &y& Elsevier]

Highlights: [•] Hemagglutinin stalk-reactive monoclonal antibodies are able to neutralize divergent influenza virus strains. [•] Stalk-reactive antibodies are currently being tested in clinical studies for their potential as anti-influenza therapeutics. [•] Vaccine constructs based on the conserved hemagglutinin stalk domain are able to protect mice from heterosubtypic challenge. [•] Stalk-based vaccines could be further developed into human universal influenza virus vaccines. [Copyright &y& Elsevier]

Abstract: Purpose: The main aim of this study was to present the hidden Clinical Nursing Minimum Data Set adopted by Italian nurses in outpatient oncology settings. Methods: A multi-method study design articulated in three phases was conducted from November 2009 to December 2010. A cross-sectional study design involving outpatient oncology centres located in the 20 Italian regions was undertaken in order to collect structured nursing records used by nurses in the documentation of daily nursing care. An evaluation of the items contained in each nursing record was performed in order to individuate homogeneities. A content analysis of the items was therefore undertaken in order to categorise them in assessment, problems, intervention, and outcomes. Results: A total of 1080 different items from the structured nursing records were counted, comprising on average 29 items (range 8–175; ±40.4) for each record. A total of 330 (30.6%) out of 1080 were categorised as assessment items, 146 (13.5%) as problems, 583 (54.0%) as interventions and 21 (1.9%) as outcomes items. Conclusion: Italian nurses have developed a micro-system Clinical Nursing Minimum Data Set capturing and documenting several types of clinical data, following their implicit representation of what it is important to document: much consideration is given to nursing surveillance/monitoring and to at-risk problems, indicating the importance of the nursing role in the prevention and early recognition of a patient's clinical deterioration. However, there is a need to develop a macro-system national NMDS which will be useful for evaluating nursing outcomes and making decisions on workforce resources. [Copyright &y& Elsevier]

Abstract: Traditional olive growing can survive only by improving olive farmer income and recognizing its multifunctional role. In this study, we propose a sustainable management model which entails the recycling of urban wastewater and its distribution by drip irrigation and the use of soil management techniques based on the recycling of polygenic carbon sources internal to the olive orchard (cover crops, pruning material). The model was applied for a 8-year period in an olive orchard located in a semi-arid marginal area of Southern Italy. An analysis is performed to evaluate the economical sustainability of the proposed model in comparison to the conventional management system (rainfed conditions, tillage, empirical fertilization, biennial pruning and pruned material burning). Furthermore, the study assesses the environmental benefits coming from the application of the examined orchard management systems focusing especially on CO2 stocks in plants and soil, and anthropogenic and natural CO2 emissions. The sustainable model appears productive and profitable, socially and environmentally sustainable. The significant income received every year by olive growers can persuade them to remain in the territory limiting the urgent phenomena of orchard abandonment, preserving typical landscape, and carrying out an ecological control role against land degradation processes. [Copyright &y& Elsevier]

In the last few years the significance of life-long learning skills has been greatly realised with regard to adult learning, which is based on self-motivation, engagement in learning and making full use of a person's resources. In this context, it is paramount that healthcare professionals take responsibility for their profession by being innovative, creative and flexible to change in order to facilitate the adaptation process and encourage responsiveness to change. The main principles can be summarized as lifelong learning, which are strictly linked to self-directed learning. The aims of this study were to describe (a) the self-directed learning competence of Nurses (Registered Nurse, RN) and Radiologist Technicians (RT); (b) the self-directed learning competence of RN and RT students before their graduation. A comparative cross-sectional study approach was adopted; a consecutive sample of RNs and RTs attending continuing education seminars, workshops and other initiatives from 2009 to 2010 were considered for this study. Moreover, all Nursing and Radiology Technicians students about to graduate in the same course and studying in the same region were included. The Self-Rating Scale of Self-Directed Learning (SRSSDL) was used to collect data for the purpose of the study. Eight hundred and forty-seven participants were involved (453 RNs, 141 RTs, 182 RN students and 68 RT students) who obtained an average SRSSDL score of 224.7 (±25.0). RNs and RTs got on average a medium-high score (229.1 ± 22.9 and 219.6 ± 29.2, respectively) and the majority of them (63.8-51.1%) reached a high level of self-directed learning. In order to promote tailored continuing education programs and interprofessional continuing education strategies, and identify the support to offer to healthcare workers according to their needs, educators should be aware of their self-directed learning skills. Therefore, individuals with high competence should adopt different strategies from those who have limited skills. Reflecting on self-directed learning competence of students before their graduation incorporates self-directed learning into the professional continuum and clarifies the University's contribution in developing this important skill. [ABSTRACT FROM AUTHOR]

Summary: The OSCE (Objective Structured Clinical Examination) is considered the most valid and reliable method for assessing the clinical skills of students training for health professions, but its use is limited by the related high costs. We analyzed the cost retrospectively of using an OSCE designed for second-year students (2009) in our degree course, adopting the Reznick et al. guidelines (1993), which recommend assessing both high-end costs and low-end costs. The high-end costs adopting the OSCE amounted to €145.23 per student, while the low-end costs were €31.51 per student. Considering the economic crisis and the cost-containment measures applied also in nursing education, strategies for further reducing costs are discussed. [Copyright &y& Elsevier]

Abstract: Purpose: Although the profile of the problems and risks associated with cancer patients has expanded over the past few years, and so has our available knowledge on the concordance between patients and nurses, there is a lack of evidence concerning neurosurgical patients. In comparison with patients who have neoplasm located in other lobes, those with frontal lobe cancer can suffer from personality changes, disinhibition, apathy, and higher-order attentional difficulties. Such behavior may give rise to a stigma, and consequently, pose a risk to have their problems misunderstood by caregivers, and be at greater risk than they are perceived to be. Objective: To explore the risk of nurses underestimating the problems of patients who were operated on for frontal neoplasm, compared to patients suffering from neoplasms located in other cerebral lobes. Methods: A prospective study was undertaken in 2008 in Italy. Patients admitted to the hospital with brain neoplasm were eligible for the study. For each patient with a frontal lobe neoplasm, a corresponding patient with a cerebral neoplasm located in either the temporal, parietal or occipital lobes was also included. Nurses working in the units involved and providing care to these patients were also included. On the afternoon of the 2nd postoperative day, the researcher interviewed both the patients, and the registered nurses (RNs) responsible for the patients’ care, in regards to pain intensity, dependence in activities of daily living, anxiety and depression, and fear of falling, as each was perceived by patients and nurses. The level of concordance between the patients’ and nurses’ responses was calculated. Results: Forty-six patients were considered (mean age 53.5 years); 23 had surgery for a frontal brain neoplasm and 23 for brain neoplasms located in either the temporal, parietal, or occipital areas. Overall, patients operated on for frontal lobe neoplasms had much of the same risks of underestimation of their problems, as patients with other cerebral neoplasms. Conclusions: Patients with frontal lobe neoplasms seemed, overall, to run the same risk of their problems being underestimated as patients with cerebral neoplasms located at other sites. Neurosurgical nurses tended to overestimate patients’ problems, particularly in cases with neoplasms not located in the frontal lobe. This unexpected finding needs to be addressed with further research, and might warrant a different approach to caring for patients with frontal lobe neoplasms, whose problems are overestimated less, so that they might receive less supportive care. [Copyright &y& Elsevier]

Summary: Background: Despite the fact that Italian nurses have only recently gained autonomy when making health-care decisions, there is little evidence available regarding the decisions actually taken in clinical practice. Objectives: Exploring the patterns that guide the nurses’ decision-making process in weaning and extubating the patient after cardiac surgery. Methods: We have adopted a qualitative ethnographic approach. The study was conducted in the Cardiosurgical Intensive Care Unit (CICU) in a Teaching and Research Hospital (Milan) and was first created using participant non-directive observation in which decisions about weaning and extubation were observed. Through aimed sampling until saturation, 18 nurses at both expert and novice professional stages, the nurse manager and the anaesthesiologist director were interviewed. Results: The pattern of a nurse''s decision-making process in weaning and extubation is based on three themes: (a) collect data and suggest a decision, (b) standardise the competence and (c) maintain adherence to unwritten rules. The nurses would never take the initiative to start weaning and extubating the patient by themselves: they collect data, consult with other nurses and then propose decisions which are ultimately authorised by the physicians. Conclusions: The near-decision-making process of nurses expressed a pattern determined by personal factors, clinicians, organisations, structures and cultural reported unwritten rules. To ensure that the nurses become responsible and independent decision makers, it is necessary to pay particular attention to structural and cultural conditions in order to help them reach their full potential in the future. [ABSTRACT FROM AUTHOR]

SUMMARY: With the increasing standardization of nursing education in Europe under the Bologna Process Declaration (1999), there is a growing interest in defining a common concept of academic success and/or failure, measuring associated factors and comparing differences and similarities between different countries. While there is literature available on these issues from other countries, the phenomenon has not been studied in Italy. The aim of this study was to define the factors associated with academic success or failure in an Italian cohort of nursing students on a bachelor''s degree course. A retrospective multicenter study design was adopted. All students enrolling in the academic year 2004–05 on two different bachelor''s courses in the north of Italy were interviewed. Only 81 of the 117 students considered (69.2%) concluded their course in three years. Multivariate analysis identified two factors determining academic success/failure: good results in the entry examination for the bachelor''s degree in nursing sciences were associated with academic success (OR 4.217, IC95% 1.501–11.84), while family commitments, e.g. caring for children or elderly people were associated with academic failure (OR 0.120, IC95% 0.03–0.471). Academic failure has a strong impact on students, their families, the teaching faculties and the community, and its prevention is a challenge in the countries with a shortage of nurses. [Copyright &y& Elsevier]

To explore students' perceived quality of the intensive care unit learning environment during their rotations; to compare these perceptions with that reported by students attending other settings and to assess correlations between the perceptions regarding the quality of the environment and the competences learned. A secondary analysis of data collected by a national cross-sectional study carried out in Italy. A total of 9607 nursing students participated; they ranked the intensive care units' quality, as assessed by the Clinical Learning Quality Evaluation Index; the perceived competences learned were also ranked with a Likert scale; from 0 = None to 3 = Very much. A total of 323 (3.5%) participants attended their rotation in an intensive care unit. They perceived the quality of the environment to be significantly higher (n = 2.11 out of 3) than those rotating in non-intensive care unit wards (n = 1.91; p < 0.001). The competences learned by intensive care unit students were significantly higher than that reported by students attending non-intensive care unit wards (n = 2.31 out of 3 vs 2.06 out of 3; p < 0.001). Intensive care units are highly appreciated by students, both in terms of their quality learning environment and their capacity to promote learning compared to other settings. Therefore, intensive care units should be considered as a place for clinical rotation to promote positive attitudes regarding critical care patients. [ABSTRACT FROM AUTHOR]

Systems beyond firm control are information systems neither designed nor commissioned by an organization, that the firm must use to compete. We extend Effective Use Theory (EUT) to theorize how hotels can leverage systems beyond firm control within the constraints they impose. Specifically, we study the competitive effect of managerial responses to online reviews in the lodging industry. Writing managerial responses is the only action hotels can take in response to customer comments within online review systems. We use an advanced text mining technique, topic modeling, to develop a non-perceptual measure of informed action: review-response congruence. We then empirically test the association between informed action and performance. Our work shows that specific responses are more effective than generic responses and that the degree of review-response congruence positively affects hotel's competitive performance. • The mere presence of responses does not fully explain their impact hotels performance. • Specific responses are more effective than generic responses. • Congruent responses positively affect hotels competitive performance. [ABSTRACT FROM AUTHOR]

Unfinished Nursing Care (UNC) indicates required interventions that are delayed or omitted. Nursing students are also exposed to UNC during their clinical rotations. However, no tools have been validated to date to collect UNC as perceived by them. To validate a tool measuring UNC as perceived by nursing students. A validation study in 2018 by following the COnsensus-based Standards for the selection of health Measurement INstruments guideline. Three nursing programmes in Northern Italy. All 1190 students who were attending their clinical rotation in hospital or community settings, were eligible. To assess the criterion validity, 30 clinical nurse supervisors in a random sample of units were involved. Content and face validity of the Unfinished Nursing Care Survey tool (UNCS) were assessed; then the tool, divided into part A (unfinished interventions) and B (reasons) was administered via Google and paper-pencil. Acceptability, construct validity (Mokken Scale Analysis, Exploratory and Confirmatory Factor Analyses), hypothesis testing, and criterion validity were assessed. 737 students (61.9%) and 30 (100%) clinical nurse supervisors participated. On the Mokken Scale, with regard to part A, nursing interventions were ordered in higher and lower priority, reflecting different degrees of difficulty in terms of leaving the interventions unfinished. In the Confirmatory Factor Analyses, reasons for UNC were categorised into 'Communication', 'Priority setting', 'Nurses' aides' supervision', 'Material resources', 'Human resources', and 'Workload unpredictability'. Students in the second year perceived higher UNC occurrence; only some individual and nursing programme variables were significantly correlated with the UNC. No statistical differences emerged between the UNC perceptions of students and that of their clinical supervisors. The Unfinished Nursing Care Survey for Students is composed of part A (22 items) and part B (18 items) seems to be valid in terms of acceptability, construct validity, hypothesis testing, and criterion validity. • Listening to the voice of nursing students has been underlined as crucial, since they are not yet influenced by previous experiences and they are in an excellent position to identify areas for improvements. • No tools to date have been established as capable of capturing their perceptions regarding the unfinished Nursing care that might help in identifying areas of improvements. • The Unfinished Nursing Care Survey for Students is composed of part A (22 items) and part B (18 items) and is valid in terms of acceptability, construct validity, hypothesis testing, and criterion validity. [ABSTRACT FROM AUTHOR]

Haemorrhagic cystitis (HC) is a severe complication of haematopoietic stem cell transplantation (HSCT), which significantly affects patients' quality of life. However, no qualitative studies have described to date the experience of patients who have developed this complication. Therefore, the aim of this interpretative phenomenological study performed on 2019 was to explore the experience of patients who developed HC after HSCT. A purposeful sample of nine patients who had experienced at least one episode of HC after the HSCT were approached. The audio-recorded interviews were transcribed verbatim and then analysed according to Giorgi's method. Member checking of the findings was also performed. The experience of the participants with HC after HSCT has been summarised around three main themes: "Being alerted", "It has arrived" and "It has been overcome. " Patients reported to have been informed regarding the HC; after the first devastating symptoms, they reported fear and in searching for causes and strategies to alleviate the problem, which seemed to be never resolved. Patients' experience with HC is complex and experienced dramatically due to the pain and the discomforting consequences of the treatments received; they develop a sense of exhaustion that can further increase both their physical and emotional burden. The process of recovery from the huge impact, required time over the end of the HC symptoms. Patients' experience of HC is complex, and varies according to the various phases of the complication. HC creates an increased physical and psychological stresses that demand additional coping strategies: therefore, the emotional support of patients is crucial. Moreover, strategies used autonomously by patients to alleviate symptoms are at merit of consideration in future studies. • Haemorrhagic cystitis (HC) is a severe complication of hematopoietic stem cell transplantation (HSCT), which significantly affects patients' quality of life. • Patients' experience of HC is complex, and varies according to the various phases of the complication. • Haemorrhagic cystitis is experienced dramatically by the patient because of its very discomforting and painful symptoms. • Its closeness with the underlying disease condition causes a sense of exhaustion that can further increase both the physiological and emotional burden. [ABSTRACT FROM AUTHOR]

With the recent challenges due to the Coronavirus 2019 outbreak, distance learning has been largely introduced in healthcare sciences curricula, and universities have been called upon to share learning opportunities with each other to ensure continuity of education and delivery of new graduates to the health system. However, decisions about its introduction should be supported by up-to-date evidence capable of providing an overview of available knowledge. To map the (a) state of research on massive open online courses in undergraduate and postgraduate health sciences education, (b) evaluation methods and tools used to measure learning outcomes, and (c) factors increasing their effectiveness as documented to date. A rapid review following the preferred reporting items for systematic reviews and meta-analysis guidelines. PubMed, the Cumulative Index to Nursing and Allied Health Literature, Cochrane, Scopus, PsycInfo and Medline (via Ovid) were searched. Primary studies reporting one or more massive open online course (1) devoted to undergraduate and/or postgraduate students in nursing and healthcare sciences (2), written in English (3) with abstract available (4) and published up to February 18th, 2020 were all included. After having assessed the need for a review and the topic itself (a), the literature search was performed (b), studies were screened and selected (c), data was extracted (d), and the findings were summarised (e). Thirty-six studies emerged with mainly an explorative/descriptive or case study design. The courses have been developed mainly by universities alone or in collaboration with institutions mainly in US, Sweden and the UK. Their delivery has been performed at multi-national levels, mainly in English, and with a number of participants ranging from 45 to >23,000. The duration spanned from two weeks to six months on clinical topics (e.g., emergency medicine) to methods (e.g., statistics). The target audience has been mainly mixed, including students, healthcare professionals, and lay citizens. Evaluation methods and tools have been described in 28 studies, and multiple-choice questions were most frequently adopted. Factors affecting the effectiveness of massive open online courses have been identified analysing the courses themselves and the participants. Massive open online courses have recently started to be studied in healthcare sciences: these can be useful to educate students, mainly as elective courses, and to educate a massive audience, thus embodying the third mission of the university. The complexity of factors increasing effectiveness suggests the need for a multidisciplinary approach both in their design and implementation. • With the recent challenge faced by universities due to the COVID-19 outbreak universities have been called to cooperate and share online learning opportunities with each other to ensure the continuity of the academic year and new graduates in the healthcare system. • However, no summarise of the state of the knowledge on Massive Open Online Courses (MOOCs) in nursing and health science education has been published to date. • MOOCs are capable of targeting different audiences with different needs and backgrounds, as well as with different learning expectations by also ensuring transferable credits both for university and continuing education. • However, more robust systems of competence evaluation should be introduced and analytically reported in studies aimed at assessing MOOCs' contribution to the acquisition of skills expected by graduate students. [ABSTRACT FROM AUTHOR]

To describe rates and types of critical incidents in Intensive Care Units. A retrospective study in four intensive care units of an Academic Hospital located in the North-East of Italy. All critical incidents recorded in an incident reporting system database from 2013 to 2017 were collected. 160 critical incidents emerged. The rate was 1.7/100 intensive care-patient admissions, and 2.86/1000 in intensive care-patient days. Nurses reported most of the critical incidents (n = 113, 70.6%). In 2013 there were 19 (11.9%) critical incidents which significantly increased by 2017 (n = 38, 23.7%; p = 0.034). The most frequent critical incidents were medication/intravenous fluids issues (n = 35, 21.9%) and resources and organisational management (n = 35, 21.9%). Less frequently occurring incidents concerned medical devices/equipment (n = 29, 18.1%), clinical processes/procedures (n = 18, 11.3%), documentation (n = 14, 8.8%) and patient accidents (n = 13, 8.1%). Rare incidents included behaviour, clinical administration, nutrition, blood products and healthcare associated infection. Over a five-year period, documented incidents were steadily increasing in four Italian intensive care units. A voluntary incident reporting system might provide precious information on safety issues occurring in units. at both policy and professional levels. [ABSTRACT FROM AUTHOR]

Defining patients as 'terminally-ill' may be difficult. Therefore, determining when to shift the goal of care from curative to comfort care may be extremely challenging. The aim of this study was to merge when and how Registered Nurses (RNs) and Nurses' Assistants (NAs) adjust end-of-life care to pursue patient comfort at the end of their lives. A descriptive qualitative study based on multiple focus groups was performed in 2017 according to the COnsolidated criteria for REporting Qualitative research guidelines. In all, 25 RNs and 16 NAs across seven north-east Italian facilities that provide end-of-life care, voluntarily participated in the study. Each focus group was conducted following the same interview guide with open-ended questions, and was audiotaped. A thematic analysis was applied to interview transcripts. The process of nursing care plan adjustment is based upon two main themes, around ' when' and ' how' to adjust it. Regarding when , 'Detecting the turning point', and 'Being ready to change continuously until the end' emerged as the main sub-themes. Regarding how , 'Weighing harms and benefits of nursing care interventions'; 'Advocating for patients' wishes', 'Sharing the adjustments inside the team at different levels', 'Involving family in the adjustments of nursing care'; and 'Allowing care to move away from evidence-based practice' were the sub-themes emerged. Shedding light on the implicit decisional processes that inform care adjustments and the implementation of related strategies is essential to improve the quality of end-of-life care given that an early detection of the terminal phase has been reported to result in changes of care improving outcomes. • Defining patients as "terminally-ill" or "dying" may be difficult; therefore, nurses often report challenging end-of-life decision-making processes. • At a certain point, nurses adjust the care plane according to the end-of-life stage: however, when and how this turning point occur in the practice has not been documented to date. • Merging implicit reasoning informing this decision-making process as undertaken by nurses in their daily care, might render transparent the underling criteria and move forward both the research and the process of transition from novice to expert nurses. [ABSTRACT FROM AUTHOR]