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Mammalian professional phagocytic cells ingest and kill invading microorganisms and prevent the development of bacterial infections. Our understanding of the sequence of events that results in bacterial killing and permeabilization in phagosomes is still largely incomplete. In this study, we used the Dictyostelium discoideum amoeba as a model phagocyte to study the fate of the bacteria Klebsiella pneumoniae inside phagosomes. Our analysis distinguishes three consecutive phases: bacteria first lose their ability to divide (killing), then their cytosolic content is altered (permeabilization), and finally their DNA is degraded (digestion). Phagosomal acidification and production of free radicals are necessary for rapid killing, membrane-permeabilizing proteins BpiC and AlyL are required for efficient permeabilization. These results illustrate how a combination of genetic and microscopical tools can be used to finely dissect the molecular events leading to bacterial killing and permeabilization in a maturing phagosome.

Aim To explore the experiences of being discharged from hospital of older patients with chronic diseases at time of discharge. Design Multi-centre descriptive qualitative study. Methods Semi-structured interviews were conducted with older patients with chronic diseases discharged from two Italian university hospitals, between March 2017 and October 2019. The interviews were audio-recorded, transcribed verbatim and analysed using inductive content analysis. Several strategies were used to ensure the credibility, dependability, confirmability, authenticity and transferability of the findings. The study was reported in accordance with Standards for Reporting Qualitative Research and Consolidated criteria for reporting qualitative research. Results Sixty-five patients participated in the study. Six main categories emerged: feelings, need for information, time of fragility, need for support, need for trusting relationships, and home as a caring place. Conclusion Older patients with chronic diseases are patients who require quality discharge planning with a patient-centred care vision. Healthcare professionals should intervene more extensively and deeply in the discharge process, balancing the patients' perception of their needs against organizational priorities and the wish to return home with that of not being abandoned. Impact Discharge from hospital remains an area of concern as older people have varying degrees of met and unmet needs during and following hospital discharge. Discharge is characterized by conflicting feelings of patients, who need information and support of healthcare professionals through trusting and continuous relationships. Understanding the experience of discharge is essential to support older patients with chronic diseases, considering that discharge from hospital is not an end point of care but a stage of the process involving care transition. The reframing of discharge as another transition point is crucial for healthcare professionals, who will be responsible for making their patients fit for discharge by preparing them to manage their chronic condition at home.

This review aimed to summarize existing nursing literature to provide an overview of the extent, range, and nature of nurses' involvement in artificial nutrition and hydration (ANH) at the end of life and to map the key concepts underpinning nurses' involvement in ANH. A scoping review was designed following the methodological framework guidelines of Arksey and O'Malley and the recommendations for advancing the methodology by Levac et al. An inductive qualitative content analysis was conducted according to the guidelines by Elo and Kyngäs. Thirty-nine articles were identified. Content analysis revealed 1 main category: "nurses' role in the decision-making process," with the 2 subcategories of "mediator" and "activator." The category and subcategories are influenced by the following generic categories: "being," "feeling," and "knowing," each of them constituted by 2 subcategories in their turn. Nurses perform the roles of activator and mediator. Their ability to establish good relationships and their attitudes enable the creation of teamwork and closeness to patients and family: relationships and attitudes are the subcategories of the "being" category. The category "feeling" represents the ways nurses experience the decision-making process, which can raise ethical and moral dilemmas and cause emotional responses. For these reasons, nurses have to create the right balance between personal-self and professional-self. The category "knowing" includes nurses' clinical and ethical knowledge about ANH. It emerges that deep clinical and ethical knowledge of ANH is necessary to provide consistent, adequate care at end of life.

Aim and objective To test the psychometric properties of the nursing students' version of the 24-item Caring Behaviours Inventory. Background Caring is at the heart of nursing and should also be a core value in nursing education. Caring can be manifested through measurable behaviours. The Caring Behaviors Inventory is a valid and reliable measure of nurses' caring behaviours in clinical settings. It has already been used among nursing students, but it needs more psychometric testing. Design Cross-sectional validation study. Method The questionnaire was filled in by 300 undergraduate nursing students at two Italian universities in May 2016. Exploratory factor analysis was conducted using Mplus maximum likelihood with GEOMIN oblique rotation. A multifaceted approach was used to evaluate the model fit. The STROBE checklist for cross-sectional studies was followed. Results Four dimensions were identified: "being with," "doing with competence," "responding to individual needs" and "providing effective care." Adequate fit indices and high reliability of the factors were found. Correlations between factors were positive and significant. Conclusion This study makes it possible to use the same tool to compare the caring practices perceived by students, nurses and patients. Further studies with bigger samples could be stratified to investigate the associations between caring levels and student characteristics. The Caring Behaviors Inventory can be used to call attention to caring in nursing education, helping to make this concept less elusive. Relevance to clinical practice The effective self-assessment of nursing students' caring behaviours offers opportunities for reflection on their caring practice. This could improve the caring level of their behaviours in clinical practice and help them to become caring nurses in the future.

Aims and objectives To summarise the evidence about patient-related risk factors for difficult intravenous access in adults, and at identifying nurses' beliefs and their consistency with evidence. Background Peripheral intravenous cannulation is a common procedure for nurses, but rates of failure at first attempt of peripheral intravenous cannulation range 10%-40%. Nurses' beliefs about difficult intravenous access factors might influence their clinical practice more than current evidence. Design The study included a literature review of the evidence on patient-related risk factors for difficult intravenous access, the development of an instrument to investigate nurses' beliefs about this topic and a cross-sectional multicentre survey on clinical nurses. Methods The quality of the studies included was evaluated through the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A synthesis of evidence for each risk factor was produced. A survey instrument was developed including 26 risk factors, which were then rated by nurses as perceived predictors of difficult intravenous access. The STROBE guidelines for study reporting were followed. Results Four hundred and fifty clinical nurses working in four hospitals in Italy were surveyed. Nurses' beliefs were in line with evidence in considering body mass index, drug abuse, lymphadenectomy and chemotherapy as difficult intravenous access factors. Beliefs about difficult intravenous access factors were influenced by nurses' work experience and frequency of peripheral intravenous cannulation. Nurses also identified as risk factors for difficult intravenous access oedema, thrombophlebitis, hypovolaemia, skin lesions and irritant therapies, which have been minimally investigated by research. Conclusions An overall congruence between nurses' beliefs and evidence about risk factors for difficult intravenous access was found. With their expertise, nurses may fill the knowledge gap of clinical evidence and open new paths for clinically meaningful research. Relevance to clinical practice Nurses' beliefs about difficult intravenous access factors can be influenced by their work experience and clinical setting. Integrating nurses' beliefs with scientific evidence can increase the quality of care.

Aims and objectives To describe which nursing activities are observed during the discharge of older patients with chronic diseases and to investigate the consistency between the nursing activities actually observed and those documented. Background The discharge from hospital of older patients with chronic diseases is a critical transition that can lead to dissatisfaction, delays in discharge, re-admission, adverse events and increased mortality. Although nurses' interventions during discharge are important for patient outcomes, little is known about the nursing activities actually performed as compared with those documented. Design An observational study of the nursing activities performed during patients' discharge and a retrospective audit of the nursing records of the same patients and nurses. Methods Structured nonparticipant observations were conducted of the activities performed by nurses at discharge. A retrospective audit of the nursing records relating to patient discharge, including the nursing diary and the assessment of critical issues at hospital discharge, was also conducted. The STROBE guidelines were followed (See Supporting Information Appendix S2). Results During hospital discharge of 102 patients, 1,224 nursing activities were observed. The number of activities was not related to patients' age, gender and educational level, nor to nurses' postgraduate education. Statistically significant correlations emerged between the number of activities observed and the nurses' work experience. Conclusions A predefined discharge plan guiding nurses' activities during discharge would enable them to respond better to the care needs of elderly patients. Relevance to clinical practice Results from the study could help clinical nurses to address care priorities of patients at discharge, by using appropriate plans and checklists and improving recording rates. Novice nurses should be supported when caring for elderly patients with chronic disease at discharge.

Historically, the practical work of nursing has been based on a relationship and contact with the human body (Collie re, 2001; Draper, 2014; Lawler, 2006; Pupulim & Sawada, 2005; Sakalys, 2006; Wolf, 2014). Nurses interact with the patient's body so frequently that they touch the patient more than other healthcare professionals do (McCann & McKenna, 1993; Melia, 2014; Ribeiro Souza & Ordones do Nascimento Brandao, 2013). The human body is nursing's "site of labor" (Wolkowitz, 2002, p. 497), and nursing benefits from "privileged access" to the body (Lawler, 2006, p. 11) in states, places, and circumstances in which the body has the same need: to be assisted (Melia, 2014; Twigg, Wolkowitz, Cohen, & Nettleton, 2011; Wilde, 2003).In the literature, the human body is interpreted as a physical, concrete, and material entity to heal, treat, and medicate (body) and as a "lived body," which refers to the sensations, emotions, and feelings experienced through the body, in other words, a way of being and living "in," "with," and "through" one's own body (embodiment; Draper, 2014; James & Hockey, 2007; Lawler, 2006; Mariotti de Santana & Bessa Jorge, 2007; Moreno Altamirano, 2010; Sakalys, 2006; Wilde, 1999; Yakhlef, 2010).Scientific reflection has embraced the Cartesian dualism that sees the body-object as a physical entity, the object of disease treatment, and the body-subject as a subjective experience of illness (Carnevale, 1995; Carr, 2000; Lakoff & Johnson, 1999; Sakalys, 2006; Wilde, 2003; Yakhlef, 2010). This perspective has been questioned by modern antireductionist and antipositivist perspectives, such as that of Merleau-Ponty (Benner, 2000; Thomas, 2005). He contended that a person is an indissoluble unity of the "I" who thinks, his or her body, and his or her embodiment; we do not "have" a body, "we are" a body (Merleau-Ponty, 1945). Consequently, the meanings that we give to body and embodiment are linked to social rules and cultural beliefs (Lawler, 2006; Vannini & Waskul, 2012).However, dichotomous thinking has been strongly established in scientific research, creating a hierarchy in which the body has become the subject of detailed clinical studies, whereas embodiment has a marginal role (Holmes, 1994; Madjar, 1997). This is due to the biomedical model's preference for investigation methods applicable to the body and the objectively measurable knowledge that these methods generate, instead of patients' embodiment (Draper, 2014).Despite the increase in scientific literature and the recognition of the importance of body and embodiment in nursing over the last two decades, international theoretical and empirical research of these concepts is still neglected (Draper, 2014). The terms body and embodiment, although conceptually different, are used interchangeably and are little known and developed within the nursing discipline; researchers in the nursing field have taken very sporadic theoretical interest in the concepts (Sakalys, 2006; Thomas, 2005). Furthermore, the recognition of people's embodiment in the body as an explicit focus of the care process is rare in nursing theories (Lawler, 2006; Sakalys, 2006). Consequently, nurses learn how to work on the body through medicine, science, and practice, but they receive little instruction about the meaning of the "lived body" and the privilege of caring for it (Draper, 2014). Although both concepts are understood and defined differently in various disciplines (philosophy, anthropology, sociology, etc.), the specific contribution of nursing science is missing. The nursing field could provide a coherent representation of body and embodiment as the fundamental conditions of a person, reflecting his or her multiple dimensions and levels of understanding (Sakalys, 2006).Although body care and attention to embodiment are the central focus of nursing practice, these concepts have not yet been openly, explicitly, and theoretically accepted in the nursing discipline. …