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Purpose: The present study aimed to qualitatively examine the perspectives of nurses about physical activity in cancer patients., Method: A purposive sample of nurses was recruited by email. Based on the Theory of Planned Behavior, focus group interviews were conducted. The discussions were audio-recorded, transcribed verbatim, and analyzed using thematic analysis., Results: Fourteen nurses working in different wards of Verona Hospital participated in the study. Transcripts were categorized according to the Theory of the Planned Behavior in the following themes: attitude, subjective norms, perceived control, and intention. Nurses identified a series of psycho-physical benefits deriving from physical activity for cancer patients. In contrast, the main risk of promoting an active lifestyle was the boomerang effect of making the patients aware of their physical deconditioning. Nurses' colleagues seemed not supportive in the physical activity promotion in cancer, whereas cancer patients and their caregivers could gladly accept the nurse counseling about performing physical activity. Different barriers, such as lack of time, lack of exercise specialists to consult, and the idea that it is a topic out of a nurse's competence, may hamper the physical activity promotion. A teamwork approach, availability of specific tools, and targeted interventions were found important features facilitating the nurse counseling. The nurses' intention to promote physical activity was not so strong and appeared to be influenced by lack of knowledge about physical activity., Conclusion: Educational sessions about physical activity guidelines for cancer patients are required to enhance nurses' confidence and intention towards physical activity promotion., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Despite the worldwide promotion of a "restraint-free" model of care due to the questionable ethical and legal issues and the many adverse physical and psychosocial effects of physical restraints, their use remains relatively high, especially in the intensive care setting. Therefore, the aim of the present study was to explore the experiences of nurses using physical restraints in the intensive care setting. Semi-structured interviews with 20 nurses working in intensive care units for at least three years, were conducted, recorded, and transcribed verbatim. Then, the transcripts were analyzed according to the qualitative descriptive approach by Sandelowsky and Barroso (2002). Six main themes emerged: (1) definition of restraint, (2) who decides to restrain? (3) reasons behind the restraint use, (4) physical restraint used as the last option (5) family involvement, (6) nurses' feelings about restraint. Physical restraint evokes different thoughts and feelings. Nurses, which are the professionals most present at the patient's bedside, have been shown to be the main decision-makers regarding the application of physical restraints. Nurses need to balance the ethical principle of beneficence through this practice, ensuring the safety of the patient, and the principle of autonomy of the person.

Background: Higher rates of delirium have been reported among patients with acute stroke. However, poorly modifiable risk factors have been documented to date while sign and symptoms capable of early detecting its onset and outcomes in this specific population have been largely neglected. The aim of this study was to emerge nurses' clinical knowledge and experiences regarding post-stroke delirium (a) risk factors, (b) signs and symptoms of delirium onset, and (c) outcomes., Method: A qualitative study based upon focus groups have been performed on 2019 and here reported according to the COnsolidated criteria for REporting Qualitative research. A purposeful sample of 28 nurses was invited to participate in focus groups at two Italian hospitals, and 20 participated. A semi-structured question guide was developed; all focus groups were audio recorded and then transcribed verbatim. Two researchers independently analysed, coded and categorised the findings according to the main research question. A member checking with ten nurses was also performed to ensure rigour., Results: Four risk factors emerged (a) at the individual level; (b) associated with previous (e.g., dementia) and the current clinical condition (stroke), (c) associated with the nursing care delivered, and (d) associated with the hospital environment. In their daily practice, nurses suspect the onset of delirium when some motor, verbal or multidimensional signs and symptoms occur. The delirium episodes affect outcomes at the individual, family, and at the system levels., Conclusions: In a field of research in need of study, we have involved expert nurses who shared their tacit knowledge to gain insights regarding risk factors, early signs and symptoms of delirium and its outcomes to address future directions of this research field., Competing Interests: Declaration of Competing Interest I have no conflicts of interest to declare., (Copyright © 2020 Elsevier Inc. All rights reserved.)

. The covid-19 emergency in the words of the nurses . This special issue of AIR is dedicated to the direct professional experiences and personal testimonies of a sample of the nursing personnel during the most dramatic phase of the covid-19 pandemia in the most severely affected regions of Northern Italy (Lombardy, Piedmont, Veneto, Friuli, Trentino, Emilia Romagna Regions). The decision to adopt a research strategy aimed to give visibility and voice to colleagues representing some of the key hospitals of the regions obliged to a radical reorganisation of their structures and organisation of care, was adopted to catch from inside the crisis scenarios the expected mix of intense emotions (from anxiety, to fatigue, to personal and professional uncertainty, to the burden of impotence), and of needed technical creativity and efficiency which were requested to face a totally unexpected situation where guidelines could hardly be of help. The interview/diaries/focus groups were carefully planned not so much in terms of the contents, but with attention to the acceptance of the interviewed to enter in a free dialogue, with no Q&A, to be recorded, and to last for the time felt to be by both sides appropriate. The texts which are reported in this dossier are fragments of the recordings (overall more then 30 hours), without adjustments. It has been agreed that while all the names of the participants are provided as 'authors', the individual contributions are anonymous (not out of privacy consideration!) as they are part of a collective narrative, which reflects the great variability of the languages and of the perceived-expressed experiences and memories. The material has been organised in sections which are conceived as 'verbal snapshots' taken from the networks of care settings, but at the same time of the places and houses where the colleagues were literally full-time living, to assure unaccountable overtime working hours, and the requested 'safety distances' and lockdowns. The titles of the 8 sections coincide somehow with the principal components of the chain of activities and challenges which had to be faced: The changes in everyday's care, How to be prepared to the emergency, The teamwork, The loneliness and the isolation of the patients, The loneliness of the nurses, The difficult choices, The organization of the work and of the wards, change after covid-19. The core of the dossier is framed by boxes which provide also a minimum background of the administrative and epidemiological data on the pandemia in the regions of interest (it is interesting to remind that the central-southern areas of Italy have been far less affected), and a brief concluding reflection on reflection on the post-pandemia from the nursing point of view.

Aim: To elucidate how workgroup commitment and motivation jointly influence nurses' proactive behaviour., Background: The need to offer effective patient care has encouraged health care organisations to promote proactive behaviours among nurses. Longitudinal relationships among motivation, commitment and nurses' proactivity remain unexplored., Methods: A self-reported questionnaire was administered to nurses of an Italian hospital. A cross-lagged panel analysis was carried out., Results: A total of 221 questionnaires were returned at Time 2 (T2). T1 affective workgroup commitment was positively related to T2 autonomous motivation and negatively related to T2 controlled motivation. T1 continuance workgroup commitment was positively related to T2 controlled motivation but unrelated to T2 autonomous motivation. T1 autonomous motivation was positively related to T2 proactive behaviour, while T1 controlled motivation was unrelated to it. Finally, no direct association between T1 commitment variables and T2 proactive behaviour was observed, suggesting that autonomous motivation fully mediated the affective commitment-proactive behaviour relationship., Conclusion: This study highlights the importance of workgroup affective commitment and autonomous motivation to foster nurses' proactive work behaviour., Implications for Nursing Management: Nurse managers may foster affective workgroup commitment and ultimately promote nurse proactivity by creating a shared climate that supports occupational needs and values and encourages a positive affective state towards nursing practice., (© 2019 John Wiley & Sons Ltd.)

The national expenditure limits set by the spending review has required reorganization and streamlining measures. The present study was conducted in 2015, among 2,020 nurses and 861 doctors in the autonomous province of Trento (Italy), to describe their perceptions of the containment measures introduced in healthcare spending, following the spending review. Results show that nurses and doctors were most affected by the measures regarding staff management (staff turnover rate, reducing overtime and changes in training). These measures, however, cannot be adopted for a long period of time without leading to negative effects on organization and quality of care.

Introduction: The change process generally elicits reactions not always positive, although expected., Aim: To describe the reactions to change before and after one year from implementation., Methods: A questionnaire was administered to a group of nurses before and after their wards was moved to a new surgical department with a totally different organization., Results: The nurses remained moderately worried before and after the change. Worries for the impact of the change on the patients and themselves significantly increased. Nurses with 4-14 years of experience expressed higher levels of concern., Conclusions: The worries are a normal reaction but their better understanding may give indications on support strategies.

Aim: The purpose of this study was to test a theoretical model linking the impact of expectations on commitment to change and to explore whether change-related communication is a mediating variable between leader-member exchange and expectations., Background: Expectations for change outcomes are an important condition to increase nurses' commitment to change. To understand the role of leadership and communication in expectations development is crucial to promote commitment to change., Method: A predictive, non-experimental design was used in a random sample of 395 nurses. Structural equation modelling was used to analyse the hypothesized model., Results: Positive expectations had a direct effect on affective commitment to change, whereas negative expectation had a direct effect on continuance commitment to change. Leader-member exchange and communication influenced nurse's expectations about change. Communication partially mediated the relationship between Leader-member exchange and expectations., Conclusion: These findings suggested that nurses' expectation about change were strongly linked to commitment to change. Furthermore, the enhancement of communication and relationship with leader contributed to the development of positive and negative expectations., Implications for Nursing Management: Strategies to promote commitment to change include developing positive expectations about change outcomes and building high-quality leadership style oriented to the communication., (© 2011 Blackwell Publishing Ltd.)