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Aims: With the aim to identify the instruments validated for Italian nursing practice, a systematic review of the literature was undertaken., Results: A total of 101 instruments emerged. The majority (89; 88.1%) were developed in other countries; the remaining (14; 13.9%) were developed and validated in the Italian context. The instruments were developed to measure patient's problems (63/101; 62.4%), outcomes (27/101; 26.7%), risks (4/101; 4%) and others issues (7/101; 6.9%). The majority of participants involved in the validation processes were younger adults (49; 48.5%), older adults (40; 39.5%), children (4; 4%), adolescents (3; 3%), and children/adolescents (1; 1%). The instruments were structured primarily in the form of questionnaires (61; 60.4%), as a grid for direct observation (27; 26.7%) or in other forms (12; 11.9%). Among the 101 instruments emerged, there were 1 to 7 validation measures documented with on average 3.2 (95% CI 2.86-3.54) for each instrument., Conclusions: Developing validation studies giving priority to those instruments widely adopted in the clinical nursing practice is recommended.

Objective: The research studies published on Assistenza Infermieristica e Ricerca along the last 21 years were analysed to identify main trends., Method: Research articles were extracted and each was classified according to the main area, authors, place of origin, design., Results: The number of research papers is progressively increasing and represents 50% of the papers published in 2006-2001. Most papers are focused on clinical practice and deal with issues relevant for the practice such as symptom control, organization or problems of elderly and frail populations. The number of experimental-quasi-experimental studies is limited (12%) but the variety of research designs increased in the last 5 years, with qualitative and validation studies., Conclusions: Although the number good quality research papers is increasing, most studies are monocentric and research needs to be incremented and promoted.

Introduction: Although the concept of complexity of care is widely used and discussed, its meaning is blurred and its characteristics are not well defined., Aims: To identify the words used to define the concept of complexity in the literature and its meaning., Method: A literature search was performed on the following databases: Pubmed, Medline, Ebsco, Cinahl and Cochrane. No temporal limits were set; publications written in English and Italian were included., Results: Several terms are used to define the concept of complexity, often interchangeably notwithstanding their different meaning. Three main concepts were identified: nursing intensity that includes the concepts of dependency, severity and complexity of patients care; nursing workload that comprises the concept of nursing intensity and all the activities not patient-related; and the patient acuity that includes the severity of illness and the caring intensity., Conclusions: A common definition is needed to be able to use the concept of complexity of care to allocate nursing resources.

Introduction: Although night duties cover more than 1/3 of the nursing care during hospitalizations, little attention is paid to activities performed and problems nurses encounter., Methods: A literature review on Medline and Cinahl with the following key-words shift workers, nurses, night, nursing, assessment, night duty was performed to explore activities performed by nurses, and patients and nurses perceptions: 23 studies were included., Results: Nurses perform planned and not planned activities. The most important function is patients vigilance/monitoring during night rounds. Although physically stressing, nurses recognize the value of night duties because they are fully responsible of the patients. Patients' main complaint is the noise that prevents sleep., Conclusions: Research is needed to study night duties and to set standards for an high quality of care during night shifts.

Aim: Patients' death or adverse events appear to be associated with poor healthcare decision‐making. This might be due to an inability to have an adequate representation of the problem or of the connections among problem‐related elements. Changing how a problem is formulated can reduce biases in clinical reasoning. The purpose of this article is to explore the possible contributions of psychoneuroendocrinoimmunology (PNEI) and psychology of reasoning and decision‐making (PRDM) to support a new nursing theoretical frame. Design: Discursive paper. Method: This article discusses the main assumptions about nursing and nurses' ability to face patient's problems, suggesting a new approach that integrates knowledge from PNEI and PRDM. While PNEI explains the complexity of systems, highlighting the importance of systems connections in affecting health, PRDM underlines the importance of the informative context in creating a mental representation of the problem. Furthermore, PRDM suggests the need to pay attention to information that is not immediately explicit and its connections. Conclusion: Nursing recognizes the patient–nurse relationship as the axiom that governs care. The integration of PNEI and PRDM in nursing theoretics allows the expansion of the axiom by providing essential elements to read a new type of relationship: the relationship among information. PNEI explains the relationships between biological systems and the psyche and between the whole individual and the environment; PRDM provides tools for the nurse's analytical thinking system to correctly process information and its connections. Impact on Nursing Practice: A theoretical renewal is mandatory to improve nursing reasoning and nursing priority identification. Integrating PNEI and PRDM into nursing theoretics will modify the way professionals approach patients, reducing cognitive biases and medical errors. No Patient or Public Contribution: There was no patient or public involvement in the design or writing of this discursive article. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether a nurse-led care model with telemonitoring in primary care for patients with stable heart failure and their caregivers is feasible and acceptable.Patients and Methods: A mixed-methods feasibility study was conducted. Patients with stable heart failure and their caregivers were consecutively enrolled from March 2021 to April 2022. Participants were managed by nurses in a community health center through education and monitoring with a mobile app. The outcomes were feasibility outcomes, self-care outcomes, and qualitative acceptability and satisfaction. Quantitative and qualitative outcomes were linked to understanding how the model of care might benefit patients.Results: Twenty-six patients and nine of their caregivers were enrolled. Ten participants used the mobile app. Nineteen patients and eight caregivers were interviewed. Participants who improved their self-care appreciated the help in finding coping strategies, being close to the clinic, and feeling cared for. Participants with fewer improvements in self-care perceived the model of care as useless and were far from the centre. Participants decided to use the app mainly for usefulness prevision, and most of them were satisfied.Conclusion: The model of care was not successful in recruiting patients, and adjustments are needed to improve the recruitment strategy and to engage people who perceive the model of care as not useful or unable to use the app. [ABSTRACT FROM AUTHOR]

Aim: To compare the occurrence and the reasons for unfinished care among coronavirus disease (COVID‐19) and non‐COVID‐19 patients as perceived by nurses. Background: The recent pandemic has imposed tremendous changes in hospitals in all countries. Introduction: Investigating the occurrence of and the reasons for unfinished care as perceived by nurses working in COVID‐19 and non‐COVID‐19 units might help to gain insights and to address future pandemics. Methods: A comparative cross‐sectional study based on the STROBE guideline has been conducted during November 2020–January 2021. The Unfinished Nursing Care Survey, comprising part A (elements) and part B (reasons), was administered online to all 479 nurses working in medical and surgical units converted progressively into COVID‐19 and non‐COVID‐19 units. A total of 90 and 200 nurses participated, respectively. Results: No differences in the unfinished care occurrence have emerged at the overall level between nurses caring for COVID (2.10 out of 5; 95% confidence interval [CI], 1.94–2.27) and non‐COVID‐19 patients (2.16; 95% CI, 2.06–2.26). Reasons for unfinished care reported significant higher averages among nurses caring for COVID (2.21; 95% CI, 2.10–2.31) as compared with those caring for non‐COVID‐19 patients (2.07; 95% CI, 2.01–2.14; p = 0.030). Discussion: The overall occurrence of unfinished care was slightly higher compared with pre‐pandemic data in all patients. Conclusions: Reasons triggering unfinished care were slightly different and were due to priority setting and human resources issues, which were perceived at higher significance among nurses working in COVID‐19 compared with non‐COVID‐19 units. Implication for nursing and health policies: A clear map of action has emerged that might be valid in the post‐COVID‐19 era as well as in the case of future pandemics. [ABSTRACT FROM AUTHOR]

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Chronic diseases are increasing incessantly, and more efforts are needed in order to develop effective organisational models in primary health care, which may address the challenges posed by the consequent multimorbidity. The aim of this study was to assess and map methods, interventions and outcomes investigated over the last decade regarding the effectiveness of chronic care organisational models in primary care settings. We conducted a scoping review including systematic reviews, clinical trials, and observational studies, published from 2010 to 2020, that evaluated the effectiveness of organisational models for chronic conditions in primary care settings, including home care, community, and general practice. We included 67 international studies out of the 6,540 retrieved studies. The prevalent study design was the observational design (25 studies, 37.3%), and 62 studies (92.5%) were conducted on the adult population. Four main models emerged, called complex integrated care models. These included models grounded on the Chronic Care Model framework and similar, case or care management, and models centred on involvement of pharmacists or community health workers. Across the organisational models, self‐management support and multidisciplinary teams were the most common components. Clinical outcomes have been investigated the most, while caregiver outcomes have been detected in the minority of cases. Almost one‐third of the included studies reported only significant effects in the outcomes. No sufficient data were available to determine the most effective models of care. However, more complex models seem to lead to better outcomes. In conclusion, in the development of more comprehensive organisational models to manage chronic conditions in primary health care, more efforts are needed on the paediatric population, on the inclusion of caregiver outcomes in the effectiveness evaluation of organisational models and on the involvement of social community resources. As regarding the studies investigating organisational models, more detailed descriptions should be provided with regard to interventions, and the training, roles and responsibilities of health and lay figures in delivering care. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background Patient satisfaction with nursing care (NC) is an important predictor of overall satisfaction with the hospital experience. However, the concept of patient satisfaction has been criticised both at the theoretical and at the methodological levels, and more attention on patient dissatisfaction has been called for with the aim of identifying strategies to improve the quality of care. Aims To describe dissatisfaction with NC as perceived by acute medical patients and identify predictors. Design and methods A secondary analysis of longitudinal data involving 12 Italian medical units was performed. A consecutive sample of 1016 patients ≥65 years (2012-2013) was included, and their satisfaction with NC was assessed, administering the Italian version of the Patient Satisfaction Scale ( PSS) at the day of discharge. The scale was based on 11 items evaluated on a four-point Likert scale (score ranging from 11 - very dissatisfied to 44 - very satisfied). Patients were defined as 'satisfied with NC' when the score was ≥33, whereas they were considered as 'dissatisfied with NC' when the score was <33. A logistic regression analysis was performed to identify the predictors of patient dissatisfaction with NC. Results There were 788 (77.6%) patients satisfied (≥33 at the PSS) and 228 (22.4%) dissatisfied with NC (<33). The risk of dissatisfaction was likely to be higher in female patients ( RR 1.883, 95% CI 1.359-2.609), in those who developed pressure sores during the in-hospital stay ( RR 1.555, 95% CI 1.021-2.368), who received NC with high skill mix ( RR 1.072, 95% CI 1.034-1.111) and those who were admitted to a large hospital ( RR 1.001, 95% CI 1.001-1.002). In contrast, increased age ( RR 0.987, 95% CI 0.975-0.998), increased amount of care offered by Registered Nurses ( RR 0.984, 95% CI 0.974-0.994), a higher proportion of baccalaureate nurses on staff ( RR 0.975, 95% CI 0.958-0.993) and being admitted to a teaching hospital ( RR 0.497, 95% CI 0.130-0.910) all decreased the likelihood of being dissatisfied with NC. Conclusions Dissatisfaction with NC was affected by individual, NC and hospital variables, such as the amount of staff resources, nurses education and skill mix. The findings emerged may inform clinicians, managers and policymakers regarding strategies that should be designed and implemented to prevent patient dissatisfaction. [ABSTRACT FROM AUTHOR]

Background: Given the progressive demographic ageing of the population and the National Health System reforms affecting care at the bedside, a periodic re-evaluation of in-hospital mortality rates and associated factors is recommended. Aims: To describe the occurrence of in-hospital mortality among patients admitted to acute medical units and associated factors. Two hypotheses (H) were set as the basis of the study: patients have an increased likelihood to die H: at the weekend when less nursing care is offered; H: when they receive nursing care with a skill-mix in favour of Nursing Aides instead of Registered Nurses. Methods: Secondary analysis of a prospective study of patients >65 years consecutively admitted in 12 Italian medical units. Data on individual and nursing care variables were collected and its association with in-hospital mortality was analysed by stepwise logistic regression analysis. Results: In-hospital mortality occurrence was 6.8 %, and 37 % of the patients died during the weekend. The logistic regression model explained 34.3 % ( R ) of the variance of in-hospital mortality: patients were six times (95 % CI = 3.632-10.794) more likely at risk of dying at weekends; those with one or more AEDs admissions in the last 3 months were also at increased risk of dying (RR 1.360, 95 % CI = 1.024-1.806) as well as those receiving more care from family carers (RR = 1.017, 95 % CI = 1.009-1.025). At the nursing care level, those patient receiving less care by RNs at weekends were at increased risk of dying (RR = 2.236, 95 % CI = 1.270-3.937) while those receiving a higher skill-mix, thus indicating that more nursing care was offered by RNs instead of NAs were at less risk of dying (RR = 0.940, 95 % CI = 0.912-0.969). Conclusions: Within the limitations of this secondary analysis, in addition to the role of some clinical factors, findings suggest redesigning acute care at weekends ensuring consistent care both at the hospital and at the nursing care levels. [ABSTRACT FROM AUTHOR]

Background Informal caregiving offered by family members has been widely studied in the community setting, but little attention to date has been dedicated to that offered at the hospital level. Aims To describe the proportion of patients admitted to acute medical units receiving care from informal caregivers as decided by the family and to identify the factors affecting the numbers of care shifts performed by informal caregivers. Design and methods A longitudinal study was performed involving 12 acute medical units located in 12 northern Italian hospitals. Results All patients (N = 1464) admitted to medical units were included, and 77.1% of them received at least one shift of informal care during their in-hospital stay, especially during the mornings and afternoons. At the patient level, those at higher risk of prolonged hospitalisation and difficult discharge at admission, and those reporting higher occurrence of adverse events, such as pressure sores, confusion events and use of physical restraints during hospitalisation, were more likely receiving informal care. At the nursing care level, a higher amount of missed nursing care was associated with an increased number of care shifts offered by informal caregivers during patient hospitalisation, whereas the amount of care offered by staff was a protective factor. Conclusions Families play a care role in the care of older patients admitted to acute medical units. They contribute substantially to the care of patients, especially during morning and afternoon shifts. [ABSTRACT FROM AUTHOR]

Few resources are available to quantify clinical trial-associated workload, needed to guide staffing and budgetary planning. The aim of the study is to describe a tool to measure clinical trials nurses' workload expressed in time spent to complete core activities. Clinical trials nurses drew up a list of nursing core activities, integrating results from literature searches with personal experience. The final 30 core activities were timed for each research nurse by an outside observer during daily practice in May and June 2014. Average times spent by nurses for each activity were calculated. The 'Nursing Time Required by Clinical Trial-Assessment Tool' was created as an electronic sheet that combines the average times per specified activities and mathematic functions to return the total estimated time required by a research nurse for each specific trial. The tool was tested retrospectively on 141 clinical trials. The increasing complexity of clinical research requires structured approaches to determine workforce requirements. This study provides a tool to describe the activities of a clinical trials nurse and to estimate the associated time required to deliver individual trials. The application of the proposed tool in clinical research practice could provide a consistent structure for clinical trials nursing workload estimation internationally. [ABSTRACT FROM AUTHOR]

Rationale There is growing interest in validating tools aimed at supporting the clinical decision-making process and research. However, an increased bureaucratization of clinical practice and redundancies in the measures collected have been reported by clinicians. Redundancies in clinical assessments affect negatively both patients and nurses. Methods To validate a meta-tool measuring the risks/problems currently estimated by multiple tools used in daily practice. A secondary analysis of a database was performed, using a cross-validation and a longitudinal study designs. In total, 1464 patients admitted to 12 medical units in 2012 were assessed at admission with the Brass, Barthel, Conley and Braden tools. Pertinent outcomes such as the occurrence of post-discharge need for resources and functional decline at discharge, as well as falls and pressure sores, were measured. Explorative factor analysis of each tool, inter-tool correlations and a conceptual evaluation of the redundant/similar items across tools were performed. Therefore, the validation of the meta-tool was performed through explorative factor analysis, confirmatory factor analysis and the structural equation model to establish the ability of the meta-tool to predict the outcomes estimated by the original tools. Results High correlations between the tools have emerged (from r 0.428 to 0.867) with a common variance from 18.3% to 75.1%. Through a conceptual evaluation and explorative factor analysis, the items were reduced from 42 to 20, and the three factors that emerged were confirmed by confirmatory factor analysis. According to the structural equation model results, two out of three emerged factors predicted the outcomes. Conclusions From the initial 42 items, the meta-tool is composed of 20 items capable of predicting the outcomes as with the original tools. [ABSTRACT FROM AUTHOR]

The aim of the study was to explore the experiences of night nurses. An interpretative phenomenological study was undertaken, and 35 nurses working in Italian medical, surgical and intensive care units were purposely recruited. Data were gathered in 2010 by semi-structured interviews, collecting nurses' narratives, memorable cases and metaphors, aimed at summarising the essence of work as a nurse during the night. The experience of night nursing is based on four interconnected themes: (i) working in a state of alert, (ii) growing by expanding autonomy and responsibility, (iii) assuring sensitive surveillance and (iv) experiencing deep intimacy. Memorable episodes were polarised along (i) expected/unexpected events; (ii) positive/negative epilogues; and (iii) life/death issues. Many of the emergent metaphors described working during the night as being in the middle of a space where an apparent calm scene takes place, but unpredictable factors may suddenly change the order of events and the outcomes, creating chaos. Working during the night alerts nurses, who increase autonomy, expanding their role and assuming more responsibility with respect to that assumed during daily shifts. The nurses' clinical reasoning is based on data they carefully listen to, and on the meaning that nurses give time by time to different noises and silence. While in the past a sense of companionships was reported, a loneliness or a 'neutral' experience concerning the relationships with colleagues seems to prevail during night nursing. Working night shifts is a complex task, and specific training must be assured to students/novices. [ABSTRACT FROM AUTHOR]

Aim Just as in many countries all over the world, the number of older people in Italy has increased rapidly. Consequently, an increasing number of nurses are engaged in the care of older patients. However, due to a lack of understanding of how nurses and patients perceive caring, nursing care may be compromised. The aim of this study is to explore, describe and compare the perceptions of gerontological nurses and patients related to the dimensions of caring in nursing in an Italian hospital setting. Methods In this qualitative descriptive study, a variety of analytic techniques were used to analyse semi-structured interview data from a purposeful sample of 20 nurses and 20 patients from geriatric units in two different Italian hospitals. Findings Although both nurses and patients gave rich descriptions of caring experiences, patients described features of caring in nursing that were visible (including nurses' caring gestures, giving attention and being competent) while nurses predominantly emphasised aspects of caring that were relatively invisible (such as reflecting on the patient's past needs, evaluating the nursing care rendered, planning for more appropriate future nursing care, taking multiple complex contextual factors into account to protect the patient and being competent). Conclusion Our data revealed more nuanced insight into the meaning of invisible and visible caring in nursing within the gerontological context than has been previously reported in the literature. This has implications for nursing education and practice because it may help nurses meet the actual needs of older patients in hospital settings. [ABSTRACT FROM AUTHOR]

The article offers information on clinical learning environment, an interactive network of forces in the clinical setting. It evaluates the psychometric proprieties of CLES+T Italian version. It further highlights about clinical learning and competency development, which are essential parts of the nursing curriculum and also details nurse teacher factor in the Italian model.

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. [ABSTRACT FROM AUTHOR]

Background: Nursing students report care of the older people as an undesirable career pathway. Positive clinical placement experiences influence students' attitudes and career intentions with respect to nursing home (NH) setting. The clinical environment's quality depends on meaningful learning opportunities, the relationship with the preceptors, and the pedagogical atmosphere as influenced by the staff–student interactions. Aim: The aim of this study was to explore nursing students' perceptions on their clinical learning experience and competence learned in the NH setting as compared to other clinical areas. Methods: A secondary analysis was performed of an Italian national cross‐sectional study involving 9,607 nursing students attending 95 different three‐year bachelor laureate nursing programmes in 27 universities. A questionnaire exploring individual and nursing programme variables was devised. Moreover, students self‐reported the perceived quality of the clinical learning experience using the Clinical Learning Quality Evaluation Index tool and the degree of competence learned using a four‐point Likert‐type scale. Results: Students in the NH setting scored the overall quality of the learning environment significantly higher (p = 0.046) compared to those experiencing other clinical settings, and they scored higher learning occasions (p = 0.002) and self‐directed learning opportunities (p = 0.018). No difference emerged in the perceived mean degree of competences learned at the end of the clinical rotation (p = 0.271). Conclusion: Nursing students perceive the NH setting to be a good quality learning environment with valuable learning opportunities and self‐directed learning opportunities compared to other settings. The nursing home setting provides opportunities to acquire clinical competences comparable to the ones in other clinical settings such as hospital units. Implications for practice: Nursing home settings should be considered by all nursing programmes as a learning environment particularly worthy for students at different levels of their education. [ABSTRACT FROM AUTHOR]