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BACKGROUND: Assessment of workplace violence towards healthcare workers represents a challenge for healthcare organizations worldwide. Workers’ experience and perceived risk of violence may have a serious impact on job satisfaction and retention of workers. To date, no studies have been conducted on nursing students. OBJECTIVES: To assess the prevalence of physical and non-physical violence among nursing students during their clinical experiences and to analyze the perceived risk of violence. METHODS: Multicentre, cross-sectional survey. We enrolled a convenience sample of nursing students of the bachelor’s degree in Nursing of the University of Milan (Italy). The students completed a structured questionnaire prepared in accordance with the available literature on violence in healthcare settings. RESULTS: Out of 1185 questionnaires sent, 603 were collected (50.89%). 35.1% had experience of verbal violence during the clinical internship training period, while 8.1% were victims of physical violence. 202 students (33.5%) reported unsafety, which was related to experience of physical or psychological violence, witnessed episodes of violence, gender, hospital structure and efficacy of the safety policies. CONCLUSIONS: Our findings highlight that nursing students are exposed to the risk of violence which influences their perception of risk.

Background Nursing students' perception of a safe clinical working environment may impact the development of professional skills and progression in the profession. Purpose The aims of this study were to describe to what extent nursing students perceive the working environments as safe during their most recent clinical rotation and to explore factors associated with their perception of a safe workplace environment. Methods A nationwide Italian cross-sectional study involving 9607 students in 27 universities across 95 three-year nursing programs was performed in 2015-2016, and secondary analyses were run in 2019. Results The workplace environment was perceived by students as only a little (n = 2598 [27.0%]), to some extent (n = 4048 [42.1%]), and always (n = 2555 [26.0%]) safe; 406 (4.2%) students reported to have never felt that the workplace as safe. At the multivariate level, factors promoting students' perception of a safe clinical environment were a setting offering higher (a) learning opportunities, (b) safety and nursing care quality, (c) quality of tutorial strategies, and (d) self-directed learning opportunities. Conclusions Nursing faculty should assess the quality of clinical settings before deciding on environments for students' learning experience.

Suicidal acts are a public health problem worldwide and require nurses to have appropriate skills to deal with it. It is important to study the level of knowledge, as well as the perception of nursing students towards suicidal ideation; a tool created for this purpose, the Suicide Behavior Attitude Questionnaire (SBAQ) has proven its validity and reliability in English.To assess the psychometric properties of the Italian version of the SBAQ (SBAQ-ita).Multicentric study. The SBAQ-ita was administered to students of two Nursing schools in two universities in Italy. The CVI-I was calculated to evaluate the validity of the content of the SBAQ-ita. Construct validity was investigated through exploratory factor analysis. Cronbach's alpha coefficient (α) was used to examine the internal consistency of each scale factor. Spearman's rho coefficient was used to test stability.The SBAQ-ita was administered to 205 students from October to November 2019. The analysis showed a four-factor structure with Cronbach's α always ≥0.70. The CVI-I was 0.97. 25 students filled in the scale again after 7 days (test-retest rho=0.92).The SBAQ-ita is a valid and reliable tool for the study of the students' attitude in the Bachelor of Science in Nursing towards caring for the person with suicidal ideation. postoperative settings.Gli atti suicidari costituiscono un problema di sanità pubblica a livello mondiale che richiede il possesso nell’infermiere di adeguate competenze per farvi fronte. È dunque fondamentale studiare il livello di conoscenza e ancor prima la percezione degli studenti di infermieristica nei confronti dell’assistenza alla persona con ideazione suicidaria; uno strumento creato a questo scopo, la Suicide Behavior Attitude Questionnaire (SBAQ) ha dimostrato doti di validità ed affidabilità.Valutare le proprietà psicometriche della versione italiana della SBAQ (SBAQ-ita).Studio multicentrico con somministrazione della SBAQ-ita agli studenti di due sedi italiane del Corso di Laurea in Infermieristica. Il CVI-I è stato calcolato per valutare la validità di contenuto della SBAQ-ita. La validità di costrutto è stata indagata attraverso l’analisi fattoriale esplorativa. Il coefficiente alfa (α) di Cronbach è stato utilizzato per esaminare la consistenza interna di ogni fattore della scala, il coefficiente rho di Spearman per testarne la stabilità.La SBAQ-ita è stata somministrata a 205 studenti da ottobre a novembre 2019. L’analisi ha evidenziato una struttura a quattro fattori con α di Cronbach sempre ≥0.70. Il CVI-I è risultato pari a 0.97. 25 studenti hanno compilato nuovamente la scala dopo 7 giorni (test-retest rho=0.92).La SBAQ-ita è valida ed affidabile per lo studio dell’attitudine dello studente del Corso di Laurea in Infermieristica rispetto all’assistenza alla persona con ideazione suicidaria.

Malnutrition is a debilitating and highly prevalent condition in acute hospital settings especially in older person; however international literature revealed negative attitudes in providing nutritional care among nurses and health professionals. Few studies have investigated attitudes towards nutritional care among nursing students, there are no data regarding the Italian context.The aim of this study was to explore nursing students' attitudes towards nutritional care in older people.A multicentre cross-sectional survey incorporating a pre post design.A convenience sample of nursing students of the bachelor's degree in Nursing in the three hospitals were recruited.Nursing students completed "The Staff Attitudes to Nutritional Nursing Care Geriatric Scale (Italian version) (SANN_G245 students were enrolled (response rate 88.4%). The overall score of sample attitudes was Median(Me) = 66 (IQR = [60; 72]); at the variation of the year the neutral attitudes are prevalent with a significant tendency to increase the positive attitudes (p .003) and there is a statistically significant difference (p .05) in all dimensions except the "habits" dimension "(P = .1126). After two months from the end of the lessons regarding nutritional care there is an increase in subjects with neutral attitudes and a decrease in those with negative attitudes (P = .05).This study revealed a progressive improvement of the attitudes during the three-year course, underling the importance of nutritional contents provided; understanding the most critical aspects about nutritional care can be helpful in understanding in which areas university education should be improved, in order to train nurses able to assess and face with each patients' assistance need.

Dyspnea can be assessed using self-rating scales but, as death approaches, self-reporting becomes difficult. The validated Respiratory Distress Observation Scale measures dyspnea distress. The aim of this study was to develop the Italian version of the Respiratory Distress Observation Scale and to examine its psychometric properties. This was a cross-sectional study, analyzing cultural and linguistic validation, content validity, and psychometric properties. Eighty-nine palliative care subjects were enrolled to validate the Italian version of the Respiratory Distress Observation Scale. Patients had an average age of 74.5 (SD, 11.6) years, and 52% (n = 46) were female. Fourteen experts in palliative care evaluated the Italian Respiratory Distress Observation Scale in terms of the content validity ratio and the content validity index (CVI). The Italian Respiratory Distress Observation Scale was reported with an internal consistency (Cronbach α value) of .72 and an overall substantial interrater reliability (Cohen κ method). The Italian Respiratory Distress Observation Scale achieved a scale-level CVI of 93%, an items-level CVI of greater than 86%, and a minimum content validity ratio value of 0.71. A weak positive correlation was found between the Respiratory Distress Observation Scale and the Dyspnea Visual Analog Scale scores (0.374; P < .001). The Italian Respiratory Distress Observation Scale showed good reliability and validity for patients in palliative care. The Respiratory Distress Observation Scale measured respiratory distress in patients nearest to death.

Context The Cancer Dyspnea Scale (CDS) is a self-reported multidimensional tool used for the assessment of dyspnea, a subjective experience of breathing discomfort, in patients with cancer. The scale describes dyspnea using three distinct factors: physical, psychological, and discomfort at rest. Objectives To crossculturally validate the Italian version of CDS (CDS-IT) and examine its content validity, feasibility, internal consistency, and construct validity in patients with advanced cancer. Methods A cross-sectional study was conducted. CDS-IT was forward-backward translated, and its content was validated among a group of experts. Cronbach's α coefficients were used to assess the internal consistency. Construct validity was examined in terms of structural validity through confirmatory factor analysis, and convergent validity was examined with Visual Analogue Scale Dyspnea through the Pearson's correlation coefficient (r). Cancer Quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care) and Italian Palliative Outcome Scale were also tested. Results The CDS-IT was crossculturally validated and showed satisfactory content validity. A total of 101 patients (mean age = 76 [SD = 12]; 53% females) were recruited in palliative care settings. CDS-IT reported a good internal consistency in the total score and its factors (α = 0.74–0.83). The factor analysis corresponded acceptably but not completely with the original study. CDS-IT strongly correlated with Visual Analogue Scale Dyspnea (r = 0.68) and moderately with Italian Palliative Outcome Scale and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (r = 0.33–0.36, respectively). Conclusion The study findings supported the crosscultural validity of the CDS-IT. Its feasibility, internal consistency, and construct validity are satisfactory for clinical practice. The CDS-IT is available to health care professionals as a useful tool to assess dyspnea in patients with cancer.

Mental disorders can impact on several aspects of the person and therefore also on nutritional models; the literature shows that psychiatric persons are at risk of malnutrition, but the available studies are limited, particularly in Italy.To investigate the prevalence of malnutrition by defect and metabolic syndrome in inpatients in an acute Psychiatric unit. To evaluate the characteristics and food habits of the sample.Assessment of the risk of malnutrition (Mini Nutritional Assessment Scale) and Metabolic Syndrome (APTIII criteria) by administering a new scale to all persons aged 18+ at admission in two inpatient units of a major teaching hospital in Milan, Italy.One Hundred one people were enrolled; 29.70% were malnourished or at risk of malnutrition by defect; Major Depressive Disorder, serum levels of albumin below range and low levels of appetite were significantly associated with malnutrition. 11.88% was suffering from Metabolic Syndrome, which was significantly associated with Psychotic Disorder, high levels of appetite and junk food consumption.The results highlighted the relevance of malnutrition in the psychiatric population and suggest the need for a systematic evaluation, in every clinical context as well as the key role of nurses.Il dist urbo me ntale pu ò impattar e su dive rsi aspetti di vita della persona e dunque anche sui suoi modelli nutrizionali; la letteratura evidenzia come i soggetti affetti dal disturbo siano ad alto rischio di malnutrizione, tuttavia gli studi a disposizione sono limitati, in particolare nel contesto italiano.Indagare la prevalenza del fenomeno della malnutrizione in difetto e della sindrome metabolica nelle persone ricoverate all’interno del Servizio Psichiatrico di Diagnosi e Cura. Valutare caratteristiche ed abitudini alimentari del campione.Valutazione del rischio di malnutrizione in difetto (scala Mini Nutritional Assessment) e di Sindrome Metabolica (criteri ATPIII) in tutti i soggetti maggiorenni ricoverati al momento del ricovero presso i due SPDC di un grande ospedale universitario milanese.Centouno soggetti sono stati valutati; il 29.70% è risultato a rischio o già in condizione di malnutrizione in difetto; sono emerse associazioni significative con diagnosi di Disturbo Depressivo Maggiore, livelli sierici di albumina sotto range e bassi livelli di appetito; l’11,88% ha soddisfatto i criteri definenti la Sindrome Metabolica con associazioni significative con diagnosi di Disturbo Psicotico, alti livelli di appetito e assunzione di cibo spazzatura oltre 4 volte alla settimana.Lo studio ha evidenziato la rilevanza della problematica all’interno della popolazione studiata; i risultati suggeriscono la necessità di una sistematica valutazione, in ogni contesto clinico e della centralità del ruolo infermieristico nella creazione di un piano alimentare personalizzato e condiviso.

Healthcare professionals might play a significant role in tobacco control. The aims of this study were to investigate tobacco cigarette and electronic cigarette (e-cigarette) consumption among university students enrolled in courses of the healthcare area, and to understand whether training in healthcare could induce to smoking cessation.Cross-sectional survey using a self-administered, structured questionnaire.Tobacco smoking habits of 560 students of four different medical area courses at the University of Milan, enrolled both in the first and in the last course year during the 2017-2018 academic year, were collected.The prevalence of smokers was 34.8%, almost the same for males and females, and higher in Italian students compared to foreigners. Smoking prevalence was higher among employed (46.9%) than unemployed (35.1%) students, without differences between healthcare and non-healthcare workers. The influence of family, and particularly friends, is confirmed to be relevant. About 25% of respondents tried e-cigarettes, mainly smokers (44.6%) and former smokers (38.6%) with the goal of quitting smoking. More than 44% were dual users of both tobacco cigarettes and e-cigarettes. Comparing smoking habits between first-year and final-year students, only students of healthcare assistance course showed a significant drop in smoking during the university studies.The implementation of specific educational curricula on smoking dangers and on smoking cessation techniques might have the double effect of supporting students in quitting smoking and of properly preparing them for their future task of helping people to quit smoking.

Depressive disorders are a relevant burden for public health due to their prevalence and high levels of associated disability and mortality. Recent studies suggest that the combination of multiple chronotherapuetic interventions may reveal effective in the rapid improvement of depressive symptoms.This paper describes the protocol of a study that aims to test the efficacy of a triple chronotherapy intervention (combined total sleep deprivation, light therapy and sleep phase advance) in the improvement of depressive symptoms in individuals diagnosed with unipolar or bipolar depression.A randomized controlled trial will be conducted in patients hospitalized with a unipolar or bipolar depression at the Servizio Psichiatrico di Diagnosi e Cura inpatient unit of the San Paolo - ASST Santi Paolo e Carlo Hospital in Milan, Italy. Individuals will be randomly assigned to the intervention (triple chronotherapy add-on to standard pharmacological treatment) or to the "control" group (standard pharmacological treatment).Enrolment began in December 2018 and will end in October 2020, or at any earlier point in which the expected sample size will be reached. The study protocol has already been approved by the local ethics committee and is registered as EudraCT 2019-000892-18. Outcome analyses aim to verify whether triple chronotherapy produces a rapid and stable improvement in depressive symptoms in individuals hospitalized for an acute unipolar or bipolar depressive episode.I disturbi depressivi rappresentano un importante problema di salute pubblica in considerazione della prevalenza, degli elevati tassi di disabilità e di mortalità ad esso associati. Studi recenti suggeriscono che l'uso combinato di differenti interventi di cronoterapia possa rivelarsi efficace nel rapido miglioramento della sintomatologia depressiva.Questo articolo descrive il protocollo di uno studio che si pone l’obiettivo di stabilire l’efficacia di un intervento di tripla cronoterapia (trattamento combinato di privazione totale di sonno, luce terapia e allungamento di fase di sonno) nel miglioramento della sintomatologia depressiva di persone affette da depressione unipolare o bipolare.Verrà condotto un trial clinico randomizzato controllato con arruolamento di pazienti affetti da depressione unipolare o bipolare, ricoverati presso il Servizio Psichiatrico di Diagnosi e Cura dell’Ospedale San Paolo – ASST Santi Paolo e Carlo di Milano. I soggetti saranno assegnati in modo randomizzato all’intervento (Triple Chronotherapy in aggiunta al trattamento farmacologico standard) o al gruppo “controllo” (trattamento farmacologico standard).L’arruolamento, iniziato a dicembre 2018, con previsione di termine ad ottobre 2020, o prima in caso di raggiungimento del campione previsto. Il protocollo di studio ha già ricevuto l’approvazione da parte del comitato etico aziendale ed è stato registrato su EudraCT con N° 2019-000892-18. Le analisi che ne deriveranno mirano a verificare se la tripla cronoterapia produca un rapido e stabile miglioramento della sintomatologia depressiva in persone ricoverate per un episodio depressivo unipolare o bipolare.

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.

Background 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. Objectives To validate a tool measuring UNC as perceived by nursing students. Design A validation study in 2018 by following the COnsensus-based Standards for the selection of health Measurement INstruments guideline. Setting Three nursing programmes in Northern Italy. Participants 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. Methods 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. Results 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. Conclusion 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.

Aim: Handover, in particular between two shifts, is a crucial aspect of nursing for patient safety, aimed at ensuring continuity of care. During this process, several factors can affect quality of care and cause errors. This study aimed to assess quality of handovers, by validating the Handoff CEX-Italian scale. Method: The scale was translated from English into Italian and the content validity index was calculated and internal consistency assessed. The scale was used in several units of the San Paolo Teaching Hospital in Milan, Italy. Results: A total of 48 reports were assessed (192 evaluations). The median score was 6, interquartile range (IQR) [5;7] and was not influenced by specific (p=0.21) or overall working experience (p=0.13). The domains showing the lowest median values (median=6, IQR [4;8]) were context, communication, and organisation. Night to morning handovers obtained the lowest scores. CVI-S was 0.96, Cronbach's alpha was 0.79. Discussion: The Handoff CEX-Italian scale is valid and reliable and it can be used to assess the quality of nurse handovers.

Prejudices on psychiatric disorders frequently turn into stigmatizating attitudes, also among health care providers. The Opening Minds Stigma Scale for Health Care Providers (OMS-HC) was introduced in 2012 to measure stigma. No Italian versions of this tool exist so far. We wanted to investigate stigma among healthcare students in Italy, and to prepare an Italian version of the scale. A multicentric, cross-sectional study was conducted on a sample of Nursing, Physiotherapy, Occupational therapy, and Dietistics students. The Italian version of the scale was obtained through back-translation. 561 students were enrolled, median age 21 years, IQR [20;23], 62.22% females (n = 349). 262 students declared having met subjetcs affected by psychiatric disorders during their training; 50 had one or more psychiatric disorders in their lives. The Italian version proved valid and reliable. Older students had lower stigma scores. No differences existed between stigma scores according to gender and personal experience of mental illness.

Background: Moral distress is an increasingly documented problem in nursing and might foster nurses’ intention to leave their workplace. It has been studied in different settings, but no specific research has been conducted in Italian correctional facilities. A recent Italian study produced a preliminary validation of the Moral Distress Scale for Correctional Nurses, which needs to be completed. Objectives: To investigate the level of moral distress of nurses working in the Italian correctional setting, by completing the validation process of the Moral Distress Scale for Correctional Nurses. Methodology: Multicenter questionnaire survey. All correctional nurses (461) affiliated with the Italian Society of Medicine and Penitentiary Health (also called “Simspe-onlus”) were invited to participate and 238 responded. The survey was conducted between April and November 2017 through SurveyMonkey®. Analysis of covariance was conducted to investigate the relationship between moral distress and the other variables under study. Exploratory factor analysis was conducted on the scale to confirm its dimensions. Ethical considerations: The study was approved by the Italian Society of Medicine and Penitentiary Health (Simspe-onlus). The questionnaire included informed consent, pursuant to the law in force. The software could not accept questionnaires without explicit consent. Data were analyzed anonymously. Findings: The median score was 46.5, indicating moderate moral distress. The only variable affecting moral distress was work experience in correctional facilities. Longer experience was correlated to higher levels of moral distress and intention to leave. Incompetent colleagues and short staffing were related to higher levels of moral distress. The scale confirmed the one-dimensional structure suggested by the original authors. Discussion: This is the first study investigating moral distress among Correctional Nurses. The prison context is a high-risk environment for nurses, increasing the intention to leave the workplace. Conclusion: Corrective and protective measures, such as specific education, are needed to prevent moral distress development and to reduce nurses’ shortage in this area.

ObjectiveTo explore nursing students’ interprofessional educational (IPE) experiences during their most recent clinical rotation and to explore the factors supporting IPE experiences.DesignNational cross-sectional study on data collected in 2016.Setting95 Bachelor of Nursing Sciences programmes; 27 Italian Universities.ParticipantsStudents who (a) were attending or just completed their clinical rotations lasting at least 2 weeks in the same unit, and (b) willing to participate in the study.Primary and secondary outcomesFirst to measure the occurrence of IPE experiences in the most recent clinical rotation; the secondary outcome was to discover factors associated with IPE occurrence.MeasuresThe primary outcome was measured using questions based on a 4-point Likert scale (from 0=‘never’ to 3=‘always’). Explanatory variables were collected at both individual and regional levels with items included in the same questionnaire.Results9607 out of 10 480 students took part in the study. Overall, 666 (6.9%) perceived not having had any IPE experience, while 3248 (33.8%), 3653 (38%) and 2040 (21.3%) reported having experienced IPE opportunities ‘only a little’, to ‘some extent’ or ‘always’, respectively. From the multilevel analysis performed using the generalised linear mixed model, factors promoting the occurrence of IPE experiences were mainly set at (a) the clinical learning environment level (high: learning environment quality, self-directed learning encouragement, learning opportunities, quality of safety and nursing care and quality of tutorial strategies); and (b) the regional level, where significant differences emerged across regions. In contrast, male gender was negatively associated with the perception of having had IPE experiences.ConclusionsA large number of nursing students experienced either ‘never’ or ‘only a little’ IPE opportunities, thus suggesting that nursing education tends to remain within the nursing profession. Limiting students’ interprofessional exposure during education can prevent future collaborative approaches that have been shown to be essential in providing best patient care. In order to increase IPE exposure, it is necessary to develop strategies designed both at the singular unit and regional levels.

People with mental disorders have higher risk of suicide compared to the general population. Assessment of risk factors can help nurses reducing suicidal risk. The Nurses' Global Assessment of Suicide Risk scale (NGASR) has proven valid and reliable in supporting the nursing evaluation of suicidal risk in different studies. The aim of the study was to examine the psychometric properties of the NGASR in the Italian population.We translated the scale and administered it to a sample of 121 patients admitted to acute psychiatric wards.The Content Validity Index-Scale (CVI-S) was 96.7%, the correlation with the Scale for Suicide Ideation (SSI) score was high (r=.98, p.001). Inter-rater reliability (rho=.97, p.001), and test-retest stability (p=.96) were satisfactory. Factor analysis pointed out 5 factors and the 15 items of the NGASR-ita explained 61.29% of total variance. Of the 121 subjects assessed upon admission, 25.62% had average or higher suicidal risk.The use of valid screening tools in support of Suicide risk assessment is recommended. The NGASR-ita is a valid and reliable tool, suitable for nursing assessment of suicidal risk in the acute psychiatric setting.

Background: the need for health care to be safe is increasingly guiding the development of policies to improve clinical practice and education; risk management and patient safety are essential competencies for health professionals. Objective: to examine how students working towards different degrees in Italy perceived their competence in clinical risk management and patient safety when learning in the classroom and the clinical setting. Methods: the Italian version of the H-PEPSS questionnaire was given to 154 students; 78 were studying for a nursing degree and 76 were on the cardio-circulatory pathophysiology and cardiovascular perfusion techniques (CPCPT) degree course. Results: nearly half of the students (46.10%) did not feel confident about their competence in patient safety and risk management during clinical training. Conclusion: significant differences in confidence between the two types of students were found in many areas, including in critical aspects of clinical risk management. However, both types of students had similar levels of confidence in some essential areas.

Background: Undergraduate nursing students have been documented to experience ethical distress during their clinical training and felt poorly supported in discussing the ethical issues they encountered. Research aims: This study was aimed at exploring nursing students’ perceived opportunity to discuss ethical issues that emerged during their clinical learning experience and associated factors. Research design: An Italian national cross-sectional study design was performed in 2015–2016. Participants were invited to answer a questionnaire composed of four sections regarding: (1) socio-demographic data, (2) previous clinical learning experiences, (3) current clinical learning experience quality and outcomes, and (4) the opportunity to discuss ethical issues with nurses in the last clinical learning experience (from 0 – ‘never’ to 3 – ‘very much’). Participants and research context: Participants were 9607 undergraduate nursing students who were attending 95 different three-year Italian baccalaureate nursing programmes, located at 27 universities in 15 Italian regions. Ethical considerations: This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines after the research protocol was approved by an ethics committee. Findings: Overall, 4707 (49%) perceived to have discussed ethical issues ‘much’ or ‘very much’; among the remaining, 3683 (38.3%) and 1217 (12.7%) students reported the perception of having discussed, respectively, ‘enough’ or ‘never’ ethical issues emerged in the clinical practice. At the multivariate logistic regression analysis explaining 38.1% of the overall variance, the factors promoting ethical discussion were mainly set at the clinical learning environment levels (i.e. increased learning opportunities, self-directed learning, safety and nursing care quality, quality of the tutorial strategies, competences learned and supervision by a clinical nurse). In contrast, being male was associated with a perception of less opportunity to discuss ethical issues. Conclusion: Nursing faculties should assess the clinical environment prerequisites of the settings as a context of student experience before deciding on their accreditation. Moreover, the nursing faculty and nurse managers should also enhance competence with regard to discussing ethical issues with students among clinical nurses by identifying factors that hinder this learning opportunity in daily practice.

To investigate the prevalence of metabolic syndrome (MS) among nurses, as well as the organizational impact of work-related stress as a consequence of MS among nurses in Italy. To study the organizational models, turnover rates, and job satisfaction among nurses, in a sample of Italian healthcare facilities.MS is considered an important metabolic disorder in the modern world, responsible for diseases with economic effects on hospitals. Shift work (SW) seems to be a risk factor for MS, while the Mediterranean diet appears to be protective. Work-related stress causes loss of working days, and generates high costs for hospitals.Prospective observational study.The first step will be to create and validate a questionnaire to investigate the prevalence of MS among Italian nurses. The second step will be to estimate the risk of work-related stress. Data regarding absenteeism and turnover will be collected, as indicators of impact on organization.This study is the first to investigate the previously describe SW's factors and their impact on organizing nursing work. This study is relevant for the organizations because it helps to define organizational strategies that permit nurses to remain healthy, to be work efficient and therefore to be able to provide high level care.

Context Error reporting is considered one of the most important mediating factors for patient safety (PS). However, reporting errors can be challenging for health care students. Objectives The aims of the study were: (i) to describe nursing students' opportunity to report errors, near misses or PS issues that emerged during their clinical learning experience; and (ii) to explore associated factors of the process of reporting itself. Methods A national survey was conducted on 9607 (91.7%) undergraduate nursing students. The endpoint was to have reported PS issues in the last clinical learning experience (from 0 'never' to 3 'always'). Explanatory variables were set individual, nursing programme and regional levels. Results A total of 4004 (41.7%) nursing students reported PS issues from 'never/rarely' to 'sometimes'. In the multi-level analysis, factors increasing the likelihood of reporting events affecting PS have been mainly at the nursing programme level: specifically, higher learning opportunities (odds ratio [OR] = 3.040; 95% confidence interval [CI], 2.667-3.466), self-directed learning opportunities (OR = 1.491; 95% CI, 1.364-1.630), safety and nursing care quality (OR = 1.411; 95% CI, 1.250-1.594) and quality of tutorial strategies OR = 1.251; 95% CI, 1.113-1.406). By contrast, being supervised by a nurse teacher (OR = 0.523; 95% CI, 0.359-0.761) prevented the disclosure of PS issues compared with being supervised by a clinical nurse. Students attending their nursing programmes in some Italian regions showed a higher likelihood (OR from 1.346 to 2.938) of reporting PS issues compared with those undertaking their education in other regions. Conclusions Nursing students continue to be reticent to report PS issues. Given that they represent the largest generation of future health care workers, their education regarding PS should be continuously monitored and improved; moreover, strategies aimed at developing a non-blaming culture should be designed and implemented both at the clinical learning setting and regional levels.

Aims and objectives To determine and compare the prevalence of malnutrition in medical and surgical hospital units; to assess quality of nutritional care and patients’ perception about quality of food and nutritional care. Background Hospital malnutrition in older people leads to increased mortality, length of stay, risk of infections and pressure ulcers. Several studies show that malnutrition is often caused by hospitalisation and related to poor nutritional care. Few studies report data on surgical older patients. Design A cross-sectional, multicenter study was conducted in 12 hospitals in northern Italy. Methods Malnutrition prevalence was determined according to the Mini Nutritional Assessment full-version. Head nurses were interviewed in 80 units, through a validated questionnaire regarding quality of nutritional care. Semi-structured interviews were administered to a sample of patients, to investigate their perception about quality of food and nutritional care. Results Two hundred twenty-eight patients of 1,066 were malnourished (21.4%). Medical patients were at higher risk, so were women, patients aged 85 or more, with impaired autonomy, pressure ulcers or taking more than three drugs. The lack of personnel impacts on quality of care: in 55% of the units, no nutritional screening is performed; nutritional history is investigated in 48% only. No protocols for nutritional problems exist in 70% of the wards; hardly ever the intake is measured. Patients are mostly satisfied, even though they report that food has no taste and is not well presented. They remark the need for more personnel. Conclusion Prevalence was high, as found in other studies. Medical patients were at higher risk. Nutritional care was inadequate, and often no measures were adopted to prevent malnutrition. Staffing should be increased during meals. Relevance to clinical practice These findings will provide indications on the strategies needed to overcome such barriers.

The Clinical Learning Quality Evaluation Index for nursing students.The Italian nursing programs, the need to introduce tools evaluating the quality of the clinical learning as perceived by nursing students. Several tools already exist, however, several limitations suggesting the need to develop a new tool.A national project aimed at developing and validating a new instrument capable of measuring the clinical learning quality as experience by nursing students.A validation study design was undertaken from 2015 to 2016. All nursing national programs (n=43) were invited to participate by including all nursing students attending regularly their clinical learning. The tool developed based upon a) literature, b) validated tools already established among other healthcare professionals, and c) consensus expressed by experts and nursing students, was administered to the eligible students.9606 nursing in 27 universities (62.8%) participated. The psychometric properties of the new instrument ranged from good to excellent. According to the findings, the tool consists in 22 items and five factors: a) quality of the tutorial strategies, b) learning opportunities; c) safety and nursing care quality; d) self-direct learning; e) quality of the learning environment.The tool is already used. Its systematic adoption may support comparison among settings and across different programs; moreover, the tool may also support in accrediting new settings as well as in measuring the effects of strategies aimed at improving the quality of the clinical learning.

Validation of the Italian Clinical Learning Environment Instrument (SVIAT): study protocol.Nursing students obtain most of their university credits in internship environments whose quality can affect their clinical learning. Several tools are available to measure the quality of the clinical learning environment (CLE) as perceived by students: these instruments developed in other countries, were validated in Italian but do not discriminate those CLEs capable (or not) to promote significant clinical learning.To validate an instrument to measure the capability of the CLE to generate clinical learning; the secondary aim is to describe the learning environments as perceived by nursing students according to individual course site and tutorial models adopted.The study will be developed in three phases: a) instrument development and pilot phase, b) validation of the psychometric properties of the instrument and c) description of the CLEs as perceived by the students including factors/item confirmed in the validation process. Expected outcomes. A large validation, with more than 8,000 participating students is expected; the construct under lying will be confirmed through exploratory and confirmatory factor analysis and will report high internal consistency; the instrument will report also a high test-retest and inter-rater reliability; in addition, the instrument will demonstrate predictive ability by discriminating those units able (or not) to activate effective learning processes.

Urinary incontinence (UI) has a high prevalence worldwide, in both genders; the available data suggest that the number of incontinent people will dramatically increase in the next few years. The costs generated by UI are similar to those induced by HIV and breast cancer. We aimed to investigate nurses' beliefs, knowledge and educational situation in the field of urinary continence.We performed a narrative review of literature, by searching qualitative and qualitative studies (2006-11) in PubMed, CINAHL and the Cochrane Library. Papers investigating pharmacological and/or surgical intervention were excluded. Only studies referred to adults have been taken into consideration.Prevalence ranges from 25 to 45% in women; in men, post-prostatectomy UI occurs in a median of 10-15% of the total cases. Benign prostatic hyperplasia, which affects 50% of men aged 50 to 60, is often associated with urge incontinence. The yearly individual expense for pads in Italy has been estimated to be as high as 913 euros in 2004. People often do not know about the possible solutions to UI; nurses seem to lack education in continence promotion, notwithstanding the proven effectiveness of the conservative interventions they could perform in autonomy. In Italy, few academic programs offer nursing education in this field.Urinary incontinence seems to be an underestimated problem; nurses often lack proper education in continence promotion. Academic, structured courses would be a solution; however, since education itself is not sufficient to really improve clinical practice, organizational support would be required to effectively promote continence in the broadest possible population. This would be a long-term investment for both quality of care and costs. Further studies are needed, regarding conservative management of UI; research could lead to a strong integration between clinical and academic branches of nursing, resulting in good quality evidence for clinical practice.

In Italy, the National Health System (SSN) grants healthcare to the citizens; its realization is up to the Government, the Regions and local institutions, with the participation of citizens. The Health Ministry determines the essential levels of care, and dictates the general guidelines for the activities of the SSN. On the whole national territory, a network of Local Healthcare Units (ASL) is present; such institutions, although belonging to the SSN, have local autonomy. Their activity is based upon principles of efficacy and efficiency; each one includes one or more Districts, which usually group a minimum of 60,000 citizens. Until 1999, Italian nurses have based their activity on a law that enumerated their tasks (DPR 225/74); nowadays, they work according to the indications of a professional profile (DM 739/94), a code of deontology, a law (L. 42/99) that has eliminated the old DPR, and university programmes. Apart from nurses, both in public and private healthcare facilities it is possible to find aids called OSS; their education consists of a twelve months programme, for which the regional institutions are responsible. Specific laws define their field of activity. For all these reasons, and also because of a major nursing shortage, in Italy it is not possible to talk about tasks delegations from doctors to nurses; we can, however, think about this process from nurses to aids and employees. Italy has the highest number of doctors in the world, with more than 6 every 1000 citizens in 2005 (approximately 370,000 units); nurses suffer from the opposite problem; nurses were 348,415 in 2005 and 360,874 in 2007, that is to say 5.4 nurses each 1000 citizens. This means a shortage of 60,000 nurses.Our research is aimed at: Studying the activities deployed by nurses in outpatients' facilities, that could be assigned to aids,; Identifying the tasks currently deployed by nurses, that are beyond their competence; Estimating how much time nurses could save, if they were not busy with activities that could be assigned to others.Our study sample included only of manager nurses, who were responsible of nursing offices in ASLs which included outpatients. facilities on the whole territory ofl Italy. We choose to make a convenience sampling, choosing a manager nurse for each regional chief town. Our study is an observational, non-experimental quantitative research. To collect our data we used an anonymous questionnaire, based on a reference model, which had already been used in older studies. The model allowed a classification of the tasks performed by nurses in three categories: Nursing activities without chances of delegation; Nursing activities that could be assigned to aids; Activities beyond the competence of nurses. The questionnaire was articulated in 7 categories (general situation, booking, acceptation, preparation of patients' units, nursing care, tasks usually performed in outpatients' services, rearrangement of patients' units). We made a comparison between our data and the reference model. In the studied outpatients' services, nurses take in charge a high percentage of tasks (39%) that should be performed by others. More precisely, there are activities that should be carried out by aids (17%) or employees (22%). For example, in the category "Rearrangement of the patient's units", nurses perform approximately 70% of the tasks. Our study revealed that not employing aids at their fullest affects the problem; overall, our data show that 45% of nurses' everyday working time could be regained, if it were possible to assign to aids and employees all the activities that are not nurses' competence. This would produce a series of positive consequences, such as bringing out of the competences acquired by nurses, a better qualification and a real identification of the contribution given by nurses to the citizenship, other than an adequate employment and usage of human resources.

This article is intended to illustrate the experience of the Medical Faculty of the University of Milan, as regards the Master s Program for Nursing Coordinator funded by the FSE of the European Union for the Academic year 2003/2004. Specifically, this article highlights: Organizational aspects: admission policy, theoretical and practical formative planning Methodology used, as applied to adult education Course evaluation and observations by the participants.

A one day prevalence survey was performed in a University Hospital, with the aim of assessing the risk of developing a pressure sore by patients systematically assessed with the Waterlow Scale. Out of the 141 at risk patients, 16 had a pressure sore (11.3%). For six of them the sore was already present at admission so that the in hospital incidence was 7% (10 patients). Most at risk patients (74.4) were still cared on a standard mattress. The advantages and limits of prevalence surveys are discussed at the end of the three articles that present a prevalence survey, an incidence survey and the study of sentinel events.

UNLABELLED: Workers' experience of violence and perceived unsafety can have a profound impact on job satisfaction, job performance, and workers' decision to leave.OBJECTIVES: The aim of the study was to assess the prevalence of physical and non-physical violence among hospital workers, explore the complaints and reactions of victims, assess the relationship between violence and psychosocial/work factors and analyze the levels of perceived unsafety.METHODS: A cross-sectional study was conducted, via a structured self-administered questionnaire given to all the employees of a major hospital in Italy. Cronbach's alpha coefficient was used to assess the internal consistency of the questionnaire. A logistic regression model was used for data analysis.RESULTS: 903 questionnaires out of 1853 (48.7%) were correctly returned; 11.5% had experience of physical violence and 40.2% had been victims of verbal violence in the previous 12 months. The most common consequences were fear, anger, frustration, and anxiety. Verbal violence was influenced by age, role, department, night/holiday shift work and experience in the current ward. Experiences of physical violence were related to gender, role, and department; 469 responders (51.9%) reported feelings of unsafety, which were related to their professional role, department, shift work, experience of physical or psychological violence, having seen episodes of violence and having received specific training.CONCLUSIONS: Our findings suggest that several factors are associated with workplace violence in health care settings and some of these also influenced the levels of perceived unsafety.

European nurses manifest a significant tendency to leave nursing, with Italy in second place after the United Kingdom. It is therefore necessary to address the problem in national and local settings and to identify possible areas of intervention.This paper discusses the results of a survey carried out in a major hospital in Milan (Italy) aimed at finding solutions to the above problem.In 2004 a questionnaire was administered to the entire nursing staff. Associations between intention to quit, socio-demographic variables and job characteristics were verified by means of Mann-Whitneys's and Kruskall-Wallis' tests, Spearman's correlation coefficients and logistic regression.Nearly 60% of nurses considered leaving, at least every now and then. The tendency to quit was associated with job dissatisfaction, burnout symptoms and the job market situation. For those for whom nursing had a moral value, the tendency to quit was less marked. Characteristics such as regularity of shifts, type of ward, type of contract and number of working hours did not show any statistically significant association with tendency to quit.There are many organizational aspects that may be of importance in influencing nurses' intention to leave the profession. Efforts are needed to re-define the role of nurses in healthcare organization, adjusting salaries to the actual cost of living and preventing conditions that could lead to psychological exhaustion. Mentorship could also be useful for a better integration of nurses in hospital wards.