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Competing Interests: Competing interests: None declared.

Aim: Evaluate nurses' attitudes towards nutritional assistance in elderly hospitalized individuals, using the scale "The Staff Attitudes To Nutritional Geriatric Nursing Care Scale (SANN-G Scale)", recently validated in Italian., Methods: A descriptive survey was carried out, involving all head nurses and nurses of wards within University Hospital San Martino Hospital in Genoa and ASL3 Genovese Villa Scassi. A comparison was carried out using the Kruscall-Wallis test between wards, in order to determine whether there were significant differences in attitudes with respect to nutritional assistance. Results were compared between individuals who had follow a lecture on nutritional assistance and those who had not, using the test Mann Whitney., Results: 110 questionnaires were delivered of these 103 were filled in (94%). Only 26% of the sample shows to have a strong positive attitude with respect nutritional assitance in elderly people. No significant differences were found either between wards and the other or between those who nurse had lecturer and those who have not., Conclusions: The study revealed a substantial negative attitude with respect to nutritional assitance and malnutrition in the elderly, confirming that aspects related to nutrition of the elderly are not properly taken into account in comparison to other nursing care activities. Our results are similar to those of the internationl literature. There is therefore a need also in Italy to increase awareness of professionals on these issues.

Effectiveness of the implementation of Modular Nursing in a medical ward: an experimental study. Introduction. Modular nursing (MN) is recognised as an ideal model of care to improve the quality of care and nurses' satisfaction, far from being optimal with Functional Nursing (FN). Aim. To assess the effectivenes of MN on quality of care and nurses' satisfaction. Methods. The ward was divided in two sections, each with dedicated personnel, in one the MN was implemented while in the other the routine care (FN). The quality of care was assessed with QUALPACS, with structured, non participant observations, on a sample of patients before and after the implementation of the MN; the satisfaction was assessed with focus groups. Results. 244 nurse-patient interactions were observed (83 before and 161 after the implementation of the MN); each observation lasted at least 3 hours. Both teams achieved an improvement, though not significant of QUALPACS scores (MN from 2.12 to 2.30; FN from 2.13 to 2.27), thus the implementation of MN did not improve the quality of care. Health professionals were very satisfied of MN because of the better organization, continuity of care in spite of an extra workload related to completion and updating of clinical and nursing records. Conclusions. The implementation of MN, increased health professionals satisfaction but not the quality of care. The implementation of a different organizative model should be assessed with objective and observable outcomes.

Copyright of L'Infermiere is the property of IPASVI - Italian Nursing Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of L'Infermiere is the property of IPASVI - Italian Nursing Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of L'Infermiere is the property of IPASVI - Italian Nursing Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To report an analysis of the concept of fundamental care in the literature. Design: An evolutionary concept analysis. Data sources PubMed and CINAHL Complete databases were consulted using the key terms: fundamental care, fundamentals of care, essential care, basic nursing care and basic care revised. Articles published from 2008 to 2022, in English and Italian, in scholarly/peer‐reviewed nursing journals were included. Methods: Rodgers's Evolutionary Method of concept analysis was used. Our thematic analysis yielded common themes related to the concept, antecedents, attributes and consequences of fundamental care. Results: A total of 50 articles were analysed. Thirty‐eight attributes were identified, such as integration of care, patient and family centred care and trusting relationship; eight antecedents including nursing care, nursing practice and care context; and 17 consequences including the safety, quality and consistency of care. Conclusion: This review of literature reveals that there is no consistent definition of the concept of 'fundamental care'. Findings from this exploration of the literature emphasized the importance of communication, the contextual environment, leadership influence and nurse–patient relationship in providing effective and high‐quality fundamental care. Our definition of this concept may help nurse leaders in practice, research, education, management and policy to promote and enhance the application of fundamental care. Impact: What problem did the study address? While numerous studies examine fundamental nursing care, various terms are used with no consensus on definitions emerging. Given the relevance of this topic, reaching a clear and agreed definition of fundamental care is essential. What were the main findings? Fundamental care encompasses the importance of communication, the contextual environment, leadership influence and nurse‐patient relationship in providing effective and high‐quality care. Where and on whom will the research have an impact? This definition of fundamental care will assist nurse leaders and researchers to promote and enhance the examination and application of fundamental care in clinical practice to ensure better care outcomes across all healthcare settings. [ABSTRACT FROM AUTHOR]

Aim: To discuss the possible contribution of nurses to the Silver Economy. Background: Older people constitute a growing sector of the population of developed countries and there is increasing interest in the concept of the Silver Economy which is the contribution older people can and do make to the general economies of their communities and countries. Sources of evidence: We obtained a range of relevant documents from international organisations and related academic literature. Discussion: There is a range of interrelated health promotion aspects of ageing related to physical health, mental health and cognitive health. Promoting activities related to these could have both direct and indirect impact on the economy in addition to improving the health and well‐being of older people. Conclusions: Nurses have a responsibility to understand the health promotion related aspects of ageing and the contribution they can make to improving the health and well‐being of older people. Nurses could, specifically, promote activities amongst older people that will have an impact on health and on the economy. Implications for nursing: Nurses need to integrate more health promotion related aspects of ageing into their practice and to be able to evaluate the health‐related improvements they make and also to evaluate and indicate the contribution this makes to the health of older people and to the economy. [ABSTRACT FROM AUTHOR]

Copyright of L'Infermiere is the property of IPASVI - Italian Nursing Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To investigate the factor structure of an Italian translation of the Practice Environment Scale of the Nursing Work Index (PES‐NWI). Background: Italy suffers from high turnover rates, yet validated tools in Italian to study and manage the problem are lacking. The PES‐NWI measures aspects of nurses' working environment. This study reports on the translation and investigation of the structure of the translated PES‐NWI scale. Methods: A survey was conducted with 3667 nurses from 182 hospitals across 13 Italian regions using the PES‐NWI. The structure of this scale was investigated using principal components analysis and other properties, including internal consistency (Cronbach's alpha). Construct validity was investigated using logistic regression. Results: The Italian translation of the PES‐NWI showed a five‐factor structure, and Cronbach's alpha of the factors ranged between 0.80 and 0.92. Logistic regression showed that the PES‐NWI was positively related to job satisfaction (odds ratio = 10.3; CI 8.62–12.35) and negatively related to intention to leave (odds ratio = 0.14; CI 0.12–0.16). Conclusions: The original five‐factor structure of the PES‐NWI was evident in the present study, albeit with some different factor loadings. Implications for Nursing Management: The Italian version of the PES‐NWI can be used by nurse managers to tackle the workforce issues related to nurses' work environments in a major European country. [ABSTRACT FROM AUTHOR]

Copyright of L'Infermiere is the property of IPASVI - Italian Nursing Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: The aim of this study is to explore how a nutritional intervention that improves the biochemical and functional profile of dysphagic older people impacts on nursing workload and costs for nursing homes. Background: Dysphagic institutionalized older people particularly at risk of malnutrition require more intensive support from nursing staff and higher costs for nursing homes. Method: This is an open pre–post longitudinal multicentre quasi‐experimental study without a control group. Results: There is a significant reduction in the number of enemas (from 3.51 to 1.11 enemas), with an average nursing workload reduction from 52 to 16 min per patient every month. Each nurse also spent 20 h less per patient every month spoon‐feeding. This resulted in nursing staff cost savings. Conclusions: The nutritional intervention led to a significantly better quality of life for the patients manifested through increased independence and social engagement. This reduced workload for nursing staff and costs for nursing home administrators. Implications for Nursing Management: Sensitive, targeted nutritional interventions have the potential to improve nursing home residents' quality of life and enable a more efficient use of resources. This study revealed reduced workload and cost savings due to less time spent administering enemas and spoon‐feeding, in addition to reduced malnutritional consequences. [ABSTRACT FROM AUTHOR]

Aims The management of cardiovascular patients requires increasingly competent nursing professionals. In Italy, there are no specific postgraduate courses focused on specialist cardiac skills development for nurses. To develop such courses, content incorporating appropriate competencies is required and this study was designed to meet this. To delineate a set of core competencies to develop national educational interventions to ensure cardiac nurses in Italy achieve international standards. Methods and results A three-round e-Delphi study including a panel of 32 expert cardiac nurses from the UK, Canada, Australia, New Zealand, and Italy was conducted; 26 respondents completed all three rounds. The first round sought a list of five competencies from each participant which they were asked to prioritize in Round 2. In Round 3, they were asked to prioritize again with the knowledge of the priorities identified in Round 2. The final list of competencies was those achieving 70% agreement among participants. We identified 14 core competencies spanning a range of areas of competence including technical, interpersonal, health promotion, use of evidence, and management. Only minor differences were evident between the Italian and the international panel regarding the priority given to some core competences, such a leadership and taking patient history. Conclusion This is the first study in Italy to delineate cardiac nurses' core competencies. As such, it provides a foundation for the development of postgraduate educational programmes for cardiac nurses including competencies that are congruent with international standards. [ABSTRACT FROM AUTHOR]

Aims and objectives: To understand the experiences and support needs of informal caregivers of patients with chronic obstructive pulmonary diseases chronic obstructive pulmonary disease who return home following an acute exacerbation. Background: The presence of an informal caregiver is important to provide practical and emotional support after an episode of acute exacerbation of chronic obstructive pulmonary disease. However, caregiving in such circumstances can be challenging and stressful. Design: Phenomenology. Methods: This is a phenomenological study based on semi‐structured interviews with sixteen primary caregivers of chronic obstructive pulmonary disease patients. Interview data were analysed using Colaizzi's descriptive analysis framework, to identify significant themes and sub‐themes. Data were collected between April‐December 2017 in a Teaching Hospital in Italy. The study was designed and reported following the COREQ guidelines and checklist. Results: Analysis elicited five themes embracing various aspects of the caregivers' lived experiences: (a) a home disrupted, (b) living with constant vigilance and anxiety, (c) feeling the need to escape (d) self‐justifications for caregiving role/duty, and (e) feeling abandoned by professionals. Conclusions: Our results show that carers experience a range of difficulties when caring for their relative at home with chronic obstructive pulmonary disease. Some of these are linked to the physical disruption of their home but many are linked to feelings of inability to cope and the psycho‐social impact of the caring role. The study also shows how participants felt unsupported by professionals. Focused support for carers is required to enable them to meet these challenges. Relevance to clinical practice: Healthcare professionals should be trained to provide technical and psychological support to caregivers especially during the phases of disease that may involve episodes of exacerbation. Home care and continuity of care can work if there is excellent communication and collaboration between healthcare professionals and caregivers. Developing appropriate support for family caregivers is essential to address the problems they can face. [ABSTRACT FROM AUTHOR]

Aim: To explore nursing management issues within COVID‐19 narratives of Italian front‐line nurses. Background: The COVID‐19 pandemic has dramatically affected health systems and professionals worldwide. Italian nurses have key messages for nursing leaders following their acute experiences in the pandemic. Method: A descriptive qualitative study with thematic analysis. Results: Twenty‐three testimonies from clinical nurses were analysed. Six macrothemes were identified as follows: organisational and logistic change; leadership models adopted to manage the emergency; changes in nursing approaches; personal protective equipment issues; physical and psychological impact on nurses; and team value/spirit. Conclusions: Our testimonies highlighted the huge impact of COVID‐19 on the Italian nursing workforce, especially in terms of the high risks associated with caring for COVID‐19 patients, exacerbated by the shortage of appropriate personal protective equipment. Nurses had to care for their colleagues and live separately from their families to avoid infecting them, revealing nurses' resilience and the important role of effective and sensitive management. Implications for Nursing Management: Nurse managers must be prepared for the impact of pandemics on staff and need to ensure availability and replacement of quality personal protective equipment, rehearse strategies for communicating with patients while wearing personal protective equipment and establish protocols for communicating with relatives. [ABSTRACT FROM AUTHOR]

Aim: To explore influences on nurses' missed care decision‐making processes in acute hospital paediatric care. Background: Many contemporary studies describe the phenomenon of missed care. It is clear that environment and organizational culture influence the nursing activities; however, what influences their decision‐making processes has not been investigated. Method: A descriptive qualitative inquiry was performed using semi‐structured interviews with paediatric nurses (n = 20) from one Italian paediatric hospital. Findings: Thematic analysis revealed four themes: nurses' value system; hospital logistics, structures and resources; prioritization processes; and the informal caregiver's role. Conclusion: This paper offers insights into the various factors involved in nurses' decision‐making process when contemplating missed care that will be of use to managers when planning care or addressing missed care in the paediatric clinical setting. Implications for Nursing Management: Knowledge and awareness of missed care in children's nursing needs greater exploration, especially in relation to what influences nurses' decision‐making choices around missed care. Overall, a greater understanding of this will help managers to manage situations effectively and ethically so that missed care does not impact on outcomes for children in health care. [ABSTRACT FROM AUTHOR]

Copyright of L'Infermiere is the property of IPASVI - Italian Nursing Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims and objectives: To conduct a systematic review and meta‐synthesis of findings from qualitative research about sexuality and intimate relationship among patients with dermatological diseases. Background: Over the last few decades, there has been an increase in clinical research investigating aspects related to sex and sexuality in patients living with dermatological diseases. In fact, studies recognise a negative impact on various aspects of intimacy, such as sexual function, self‐esteem and romantic relationships. The body of qualitative literature about sexuality in the context of dermatological diseases is emerging but consists mainly of small studies that would benefit from aggregation, synthesis and interpretation to highlight and summarise the overarching dimensions to this clinical issue. Design: A systematic review and meta‐synthesis of qualitative studies. Methods: BioMed Central, Cochrane Library, MEDLINE, CINAHL, PsycINFO, PsycARTICLES, ERIC, Scopus, and Web of Science were searched between June–November 2017 with no publication date limits. Screening and selection of studies was performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines (PRISMA). After retrieval, the qualitative data were subject to meta‐synthesis to identify overarching themes. Results: Ten qualitative studies were found. We identified four themes: (a) Embarrassment and shame; (b) Impaired sense of attractiveness and sexual avoidance; (c) Relationship issues; and (d) Lack of professional support. The patients in these studies adopted negative coping styles, such as avoidance and hiding their bodies. Conclusion: When assessing and evaluating patient care in dermatology, it is important that sexuality and the impact the disease could have on relationships is included. Relevance to clinical practice: An important part of nursing care is ensuring that patients are helped to develop positive coping strategies rather than negative ones. Patients with dermatological conditions also need advice and treatment to address any physically related sexual problems. Nurses need to be the initiators of these sensitive conversations to put patients at ease and work together to implement positive measures to reduce the sexuality‐related issues patients face. [ABSTRACT FROM AUTHOR]

Copyright of L'Infermiere is the property of IPASVI - Italian Nursing Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims and objectives: To review and synthesise research studies on surgical and medical inpatients' perceptions on unmet nursing care needs. Background: Missed nursing care is a growing phenomenon that has been shown to adversely affect care outcomes—mainly in adult medical and surgical care settings. However, to date the aggregated and synthesised evidence of missed care comes from research that measures perceptions on missed care in surgical and medical settings from nurses, but not from the patients. Design: Scoping review. Methods: In September 2018, three databases were searched: MEDLINE/PubMed, CINAHL and SCOPUS and papers were selected using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Inclusion criteria were as follows: primary studies; published in peer‐reviewed journals; in English or Italian; and regarding routine care provided to adult inpatients. Quality appraisal and a thematic analysis were conducted. Results: Of the 1541 abstracts initially identified, 44 papers were included. Five themes emerged: "communication," "self‐management, autonomy and education," "personal sphere," "essential physical care" and "emotional and psychological care." The majority of the unmet needs were related to the "personal sphere" and "emotional and psychological care." These unmet needs were not identified in previous literature on nurses' perspectives of missed care. Also, physical care deficits like oral hygiene were identified. Conclusion: It is important to take into account patients' perspectives. The themes focusing on patients' personal sphere, and emotional and psychological care, underline how patients need nurses to pay more attention to their cultural background, consider the person as a whole and for nursing care to be holistic and respectful of patients' dignity. Relevance to Clinical Practice: This study intends to raise awareness amongst nurses and policymakers about the importance of addressing missed nursing care and unmet patients' needs in adult medical or surgical inpatient settings to ensure high‐quality care and patient satisfaction. [ABSTRACT FROM AUTHOR]

Background: Developing nursing research skills, awareness and research utilisation are important for improving healthcare outcomes and are key to ensuring the full understanding and knowledge base necessary for optimal delivery of care. Nevertheless, little is known about research awareness in children's nurses. Aims and objectives: To address this issue, an integrative literature review was conducted for studies published between January 2007 and January 2017 to obtain up‐to‐date evidence about the extent of research awareness and utilisation among children's nurses. Methods: Using PubMed, Cochrane Library, ILISI and CINAHL databases, 21 studies related to children's nurses' research awareness were included in the final review, which was later developed and structured in keeping with PRISMA checklist and guidelines. Conclusions: The studies isolated show that nurses' knowledge about and utilisation of research vary and that there are many existent barriers to and facilitators of evidence‐based practice in the paediatric setting. Some studies report that introducing a cultural and/or change in clinical practice change to improve research utilisation can have positive impacts on healthcare outcomes and the quality of nursing care of children. It is recommended that structured approaches to improving research utilisation be considered and additional research is needed to explore the benefits of these approaches. Relevance to clinical practice: Despite more than three decades of the evidence‐based practice movement within nursing, barriers still exist among children's nurses in the use of research in practice. If the use of research to improve the delivery of children's nursing care is to become a reality, then nurses' research awareness needs to improve to underpin care delivery with optimal evidence in a cohesive informed manner. [ABSTRACT FROM AUTHOR]

This protocol proposes a systematic review to identify and disclose learning strategies and evaluation tools to improve Emotion Intelligence (EI) in undergraduate nursing students. EI improves the ability to manage emotions and their consequences. Management of emotions is fundamental in nursing both at inter- and intra-professional levels, and with the patients and their family carers. Systematic review protocol of effectiveness based on the Joanna Briggs Institute (JBI) guidelines. All articles based on educational programmes and/or activities to develop EI in nursing curricula will be included in the review. It will analyse the principle EI attributes and outcomes such as burnout, intention to leave and problem-solving skills. Based on the review question, seven databases will be searched: MEDLINE, The Cochrane Library, SCOPUS, CINAHL, EMBASE, PsycINFO and ERIC. Also, grey literature (Google Scholar and Open Gray) will be searched. Since no similar systematic reviews are present in the literature, no time limits will be set. To establish the quality of studies JBI tools will be used. When appropriate, we will meta-analyse prevalence and incidence estimates or we will meta-synthesize themes and findings. This systematic review is expected to provide an overview of educational and training methods, pedagogical strategies and evaluation tools to address EI in nursing and provide high-quality care to patients and their families. Results of the review will support nursing educators and leaders in implementing teaching and learning strategies to improve the Emotional Intelligence of undergraduate nursing students. Mastering emotions is fundamental for nurses. Implementing education courses based on EI according to the best training methods and pedagogical strategies could become key for nursing curricula. Moreover, after the review, it will be possible to identify the best training methods and pedagogical strategies for implementing continuing professional development (CPD) courses in EI in the courses of following graduation. [ABSTRACT FROM AUTHOR]

Aim: To expand knowledge about the predictive factors of nurses' intention to leave their job and consequently to turnover. Background: Nurse turnover is costly and negatively influences quality of care. Understanding the association between intention to leave and modifiable features of hospital organisation may inform strategies to reduce turnover. Methods: A cross‐sectional survey of 3,667 medical and surgical nurses was conducted in Italy. Measures included intention to leave; work environment; burnout; job satisfaction; and missed care using the RN4CAST instruments. Descriptive, logistic regression analysis was used. Results: Due to job dissatisfaction, 35.5% of the nurses intended to leave their current job, and of these, 33.1%, the nursing profession. Push factors included the following: understaffing, emotional exhaustion, poor patient safety, performing non‐nursing care and being male. Pull factors included the following: positive perception of quality and safety of care, and performing core nursing activities. Conclusion: The present study expands knowledge about the predictive factors of nurses' intention to leave their job and consequently to turnover, which is one of today's major issues contributing to the shortage of nurses. Implications for Nursing Management: Nurses' intention to leave their job is the consequence of a poor work environment, characterized by factors such as understaffing and performance of non‐nursing activities. [ABSTRACT FROM AUTHOR]

Web-based learning, on its own or in combination with traditional teaching methods, has become a consolidated practice in many countries, and has been described as a valid and effective method that supports practical learning in undergraduate nursing students. The aim of this study was to explore the perception and effectiveness of web-based learning in facilitating the development of clinical skills in undergraduate nursing students. A qualitative descriptive study was conducted including online videos in three nursing schools of a university in Northern Italy. The participants were 26 undergraduate nursing students. A dedicated website was built including four videos and the respective checklists of four nursing techniques: insertion of a urinary catheter; insertion of a nasogastric tube; taking a blood sample; and the insertion of a peripheral intravenous line. Three Focus Groups were conducted, one for each nursing school. Thanks to its ease of use and unlimited access, web-based learning effectively supported students' clinical learning process by offering additional virtual visual support. Web-based learning could be effectively used to reduce the gap between theory and practice, and even as an upgrade for already qualified nurses. • Web-based learning in nursing is growing, but its use is still limited. • Few studies have explored how web-based learning can improve clinical skills. • Web-based learning impacts on patient safety and the quality of nursing practice. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims and objectives: To explore the experience of patients affected by chronic obstructive pulmonary disease following hospitalisation due to an acute exacerbation event. Background: Chronic obstructive pulmonary disease is a progressively debilitating disease, often with very burdensome symptoms such as acute and chronic breathlessness and fatigue. Acute exacerbation often creates a life‐threatening event. Exacerbation can also have substantial psychological effects including anxiety and depression although this aspect is less well researched—especially amongst people with chronic obstructive pulmonary disease recovering from an acute event and facing a return home. Design: A descriptive phenomenological study. Methods: In‐depth interviews were conducted with 12 chronic obstructive pulmonary disease patients recently recovering from an acute exacerbation of their chronic obstructive pulmonary disease. Data were analysed using Colaizzi's phenomenological framework. Results: Four themes were identified from the data: a sense of loss and frustration, hopelessness, uncertainty about the future and fear of becoming a burden. Participants expressed quite negative views including a loss of hope, uncertainty about their future care and the burden they may become on their families. They appeared stressed and anxious as a result of the acute event they had experienced. Conclusions: This study shows that an acute episode of illness can generate a sense of hopelessness and uncertainty about their future care in people with chronic obstructive pulmonary disease. This occurs as they recover physically and think about the future, often in quite negative terms. Relevance to clinical practice: For healthcare professionals, it is important to take into account the potential feelings of loss, hopelessness and uncertainty that people can experience following an acute exacerbation of their chronic obstructive pulmonary disease and ensure that psychological care is available as physical recovery takes place. Such care to include good discharge planning, giving patients time to express concerns and referral to counselling services if appropriate. [ABSTRACT FROM AUTHOR]

Aims and objectives To review the use of mixed-methods research in nursing with a particular focus on the extent to which current practice informs nurse researchers. It also aimed to highlight gaps in current knowledge, understanding and reporting of this type of research. Background Mixed-methods research is becoming increasingly popular among nurses and healthcare professionals. Emergent findings from this type of research are very useful for nurses in practice. The combination of both quantitative and qualitative methods provides a scientific base for practice but also richness from the qualitative enquiry. However, at the same time mixed-methods research is underdeveloped. Methods This study identified mixed-methods research papers and critically evaluated their usefulness for research practice. To support the analysis, we performed a two-stage search using CINAHL to find papers with titles that included the key term 'mixed method'. Conclusion An analysis of studies that used mixed-methods research revealed some inconsistencies in application and reporting. Attempts to use two distinct research methods in these studies often meant that one or both aspects had limitations. Overall methods were applied in a less rigorous way. This has implications for providing somewhat limited direction for novice researchers. There is also potential for application of evidence in healthcare practice that limited validity. Relevance to clinical practice This study highlights current gaps in knowledge, understanding and reporting of mixed-methods research. While these methods are useful to gain insight into clinical problems nurses lack guidance with this type of research. This study revealed that the guidance provided by current mixed-methods research is inconsistent and incomplete and this compounds the lack of available direction. There is an urgent need to develop robust guidelines for using mixed-methods research so that findings may be critically implemented in practice. [ABSTRACT FROM AUTHOR]

Aim To identify items for a new instrument that measures emotional behaviour abilities of meaningful learning, according to Fink's Taxonomy. Background Meaningful learning is an active process that promotes a wider and deeper understanding of concepts. It is the result of an interaction between new and previous knowledge and produces a long-term change of knowledge and skills. To measure meaningful learning capability, it is very important in the education of health professionals to identify problems or special learning needs. For this reason, it is necessary to create valid instruments. Design A Delphi Study technique was implemented in four phases by means of e-mail. Methods The study was conducted from April-September 2015. An expert panel consisting of ten researchers with experience in Fink's Taxonomy was established to identify the items of the instrument. Data were analysed for conceptual description and item characteristics and attributes were rated. Expert consensus was sought in each of these phases. An 87·5% consensus cut-off was established. Results After four rounds, consensus was obtained for validation of the content of the instrument 'Assessment of Meaningful learning Behavioural and Emotional Abilities'. This instrument consists of 56 items evaluated on a 6-point Likert-type scale. Foundational Knowledge, Application, Integration, Human Dimension, Caring and Learning How to Learn were the six major categories explored. Conclusions This content validated tool can help educators (teachers, trainers and tutors) to identify and improve the strategies to support students' learning capability, which could increase their awareness of and/or responsibility in the learning process. [ABSTRACT FROM AUTHOR]

The article discusses concerns regarding missed care, which is defined as unfinished care or implicitly rationalized care, in children's nursing. It explains that missed care is an error of omission in the care process that has three major influencing factors including labour resources, material resources, and communication, which influence the nurses' internal processes such as team norms, priority decision making, internal values, and beliefs determining whether or not care is missed.

The authors discuss a work being performed in Italy on nurse forecasting showing that nurses will make judicious choices about the work to leave undone, which is referred at as missed care or omitted care. Missed care is said to be a consequence of austerity measures due to world recession. Community nursing has been observed as a particular omission in the work on missed care to date. There has been little focus on missed care in older populations.

Aim To test if the Barrows Cards method improves adherence to immunosuppressive therapy self-management following hematopoietic stem-cell transplantation in adolescents affected by blood cancer and reduce costs. Background Chronically ill adolescents need to be helped to improve self-management, make sure they can confidently and safely manage therapy at home and reduce readmissions and costs. We identified the Barrows Cards method, originally used to test decision-making skills and critical thinking in medical students. In this pilot study, we tested the efficacy of the Barrows Cards Method in improving adhesion to immunosuppressive therapy in a group of adolescents following hematopoietic stem-cell transplantation and analysed its cost-effectiveness. Design A mixed-method study. Methods The Barrows Cards method is an educational intervention based on the theory of problem-based learning that uses at least 15 cards specially designed to teach participants how to manage a specific problem. We piloted the Barrows cards method in terms of adherence to immunosuppressive therapy and self-management in a group of 17 adolescents affected by blood cancer before being discharged. Participants were enrolled between 2013-2015. Activity Based Costing was used to analyse the cost-effectiveness. Results The Barrows Cards method significantly improved adherence to immunosuppressive therapy in blood cancer adolescents and reduced readmissions. We also showed how this method could significantly reduce healthcare costs. Conclusions Further research is required, but the Barrows Cards method could be effectively used by nurses to improve self-management in chronic patients and reduce health costs. [ABSTRACT FROM AUTHOR]

The aim of this paper is to discuss the development of modern nursing in Italy. Specifically, the paper aims to draw attention to the fact that while nursing in Italy has mirrored developments in Europe, in many respects the advancement of the profession is much less accelerated. The paper considers the reasons for this and the contributing factors and explores possible solutions. [ABSTRACT FROM AUTHOR]

In the literature, there is evidence about the importance of ensuring a Family-Centered approach for foreign patients to provide culturally competent care. The Italian context shows a lack of studies concerning nurses’ perceptions regarding factors that influence foreign patients’ daily care. In addition, the number of pediatric patients coming to Italian hospitals to be cured has increased dramatically in the last few years. This study aims to investigate the pediatric nurses’ perception of the factors influencing nursing care for foreign pediatric patients who have undergone a stem cell transplant (SCT) and their families. A qualitative approach is used. Semi-structured interviews were recorded, transcribed verbatim, and analyzed using qualitative techniques for recurrent themes. Italian SCT pediatric nurses were interviewed until data saturation was achieved. Four themes emerged from the analysis: ‘‘Respect for other cultural traditions,’’ ‘‘Different roles,’’ ‘‘Communication,’’ ‘‘Equal treatment and different opportunities.’’ Communication was seen as a barrier in caring for foreign patients. Nurses perceived a lack in their training and knowledge when caring for foreign patients. The hospital supports nurses when caring for foreign patients. We found that pediatric nurses do not feel they are caring for foreign patients in the same way as they do for Italians, but adopt strategies to improve their relationships with them. Semi-structured interviews proved to be useful in highlighting the nurses’ perceptions. These data were confirmed by the results of the audit conducted with the ‘‘Children and Young People’s Audit Policy Tool,’’ The tool suggests specific interventions when foreign patients are admitted. [ABSTRACT FROM PUBLISHER]

Prisons are a unique context where nurses are required to have specific skills to ensure that prisoners receive the same type of holistic care as anyone else out of prison, including spiritual care. This discussion paper focuses on understanding how nurses deliver spiritual care in Italian prisons where there are often limited resources and where organizational priorities hinder the provision of holistic nursing. This paper draws from a previous qualitative research study that we had conducted. In this study, we observed that prison nurses reported that they experienced many difficulties related to the provision of holistic care to prisoners. This was particularly true for spiritual care in vulnerable forensic patients, such as older individuals, and physically andmentally frail prisoners. Prison officers did not allow nurses to just "listen and talk" to their patients in prison, because they considered it a waste of time. The conflict between prison organizational constraints and nursing goals, along with limited resources placed barriers to the development of therapeutic relationships between nurses and prisoners, whose holistic and spiritual care needs remained totally unattended. Therefore, prison organizational needs prevailed over prisoners' needs for spiritual care, which, while fundamental, are nevertheless often underestimated and left unattended. Educational interventions are needed to reaffirm nurses' role as providers of spiritual care. [ABSTRACT FROM AUTHOR]

Aims To describe the utility of artificial neural networks in predicting communication risks. Background In health care, effective communication reduces the risk of error. Therefore, it is important to identify the predictive factors of effective communication. Non-technical skills are needed to achieve effective communication. This study explores how artificial neural networks can be applied to predict the risk of communication failures in emergency departments. Design A multicentre observational study. Methods Data were collected between March-May 2011 by observing the communication interactions of 840 nurses with their patients during their routine activities in emergency departments. The tools used for our observation were a questionnaire to collect personal and descriptive data, level of training and experience and Guilbert's observation grid, applying the Situation-Background-Assessment-Recommendation technique to communication in emergency departments. Results A total of 840 observations were made on the nurses working in the emergency departments. Based on Guilbert's observation grid, the output variables is likely to influence the risk of communication failure were 'terminology'; 'listening'; 'attention' and 'clarity', whereas nurses' personal characteristics were used as input variables in the artificial neural network model. A model based on the multilayer perceptron topology was developed and trained. The receiver operator characteristic analysis confirmed that the artificial neural network model correctly predicted the performance of more than 80% of the communication failures. Conclusion The application of the artificial neural network model could offer a valid tool to forecast and prevent harmful communication errors in the emergency department. [ABSTRACT FROM AUTHOR]

Aim To establish the psychometric properties of instruments to measure learning outcomes in healthcare students. Background Meaningful learning is an active process that promotes a wider and deeper understanding of concepts. It is the result of an interaction between new and previous knowledge. Meaningful learning produces a long-term change in knowledge and skills, which is underpinned by willingness to learn and experience and it is exclusively built by the learner. Design Systematic psychometric review protocol developed from Cochrane Effective Practice and Organization of Care guidance. Method Searches of MEDLINE, CINAHL, SCOPUS, ERIC, Psyc INFO, Cochrane Library, Psychology & Behavioral Sciences Collection Database between 1990-2013. Selected studies will be evaluated with the Consensus-based Standards for the selection of health status Measurement INstruments ( COSMIN) checklist. Funding for the review was confirmed on January 2011 by the Centre of Excellence for Nursing Scholarship in Rome. Results The systematic review will produce a synthesis of the data related to the instruments that measure learning outcomes. These data will help us decide which tools to use and identify the state of knowledge in this field. Conclusions Measuring learning outcomes is very important for the large amount of human and financial resources employed in educating and training health professionals and this requires reliable and valid instruments. [ABSTRACT FROM AUTHOR]

The article presents the study which examines the impact of adequate nurse-patient ratios and work environment on patient safety and the quality of nursing care in Italy. It highlights the finding of the study which shows a certain percentage of patient care activities that are left undone and the tendency of nurses in the country to leave undone relational, communication, educational and planning activities.

The article discusses barriers to research awareness among nurses in Italy. Topics discussed include spread of evidence-based practice, Italian study revealing 41percent of care that nurses were expected to perform was missed and barrier due to refusal of regional research ethics committees for applications made by nurse researchers.

Aim To describe a protocol for a quantitative systematic review, to identify critique and summarize factors that influence self-management education. Background Self-management education enables patients to manage their condition successfully and it is associated with better self-care, good control over lifestyle and leading the best possible quality of life, notwithstanding the presence of a chronic disease. Type II Diabetes is a chronic disease that requires lifestyle adjustments and disease management to keep glycaemia and long-term complications under control. Education has to be customized and based on an assessment that includes factors influencing self-management, such as personal characteristics that can optimize the educational intervention. Design The protocol for the systematic review was conducted according to the guidelines of the Centre for Reviews and Dissemination, York ( UK). Method The review question was defined in terms of population, interventions, comparators, outcomes and study designs. The protocol included decisions about the review question, inclusion criteria, search strategy, study selection, data extraction, quality assessment, data synthesis and plans for dissemination. Funding for the review was confirmed on January 2011 by the Centre of Excellence for Nursing Scholarship in Rome. Discussion An initial summary will be made by tabulating the data; the review will be reported in a narrative style and be developed according to the PRISMA guidelines. The protocol for the systematic review will allow us to identify, among the factors influencing self-management in people with Type II diabetes, the personal characteristics most relevant to the factors of motivation and empowerment. In addition, the systematic review will also identify an appropriate self-management model. [ABSTRACT FROM AUTHOR]

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To identify the core competencies of family and community nurses. The European Union is facing common health challenges in the field of primary care, according to European health policies and the World Health Organization, which need to be addressed through better and innovative ways of working that require joint actions. There is evidence that 'Family and Community Nurses' play a key role in the field of primary care, but there is no agreement on which core competencies they are required to have. An e-Delphi study A 4-round e-Delphi study was conducted from March to July 2018 as part of the Erasmus+ Project "EuropeaN curriculum for fAmily aNd Community nursE" (ENhANCE). A panel of 23 experts from 10 European countries were asked to approve, modify, or add items and then prioritize each skill. This e-Delphi, as part of the ENhANCE project, produced core 28 competencies, which were used by the "ENhANCE" partners to develop the European Core Curriculum for Family and Community Nurses. The ENhANCE partners ensured that the core competencies were consistent with World Health Organization recommendations, the European Skills/Competencies, Qualifications and Occupations (ESCO) and with the European Credit System for Vocational Education and Training (ECVET). The results of this study will provide the basis for universities across Europe to develop their own post-graduate teaching programs with common educational goals for Family and Community Nurses and a cadre of nurse practitioners with transferrable skills across the continent. This e-Delphi, as part of the ENhANCE project, produced 28 competencies for the European Core Curriculum for Family and Community Nurses. • First European study on core competencies for Family and Community Nurses. • Family and Community Nurses core competencies used to develop European curricula. • European common curricula will facilitate recognition and mobility of these nurses. • Family and Community Nurses will improve the primary care of the European Union. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2013; 27; 440-448 'The transit of the food trolley'- malnutrition in older people and nurses' perception of the problem Aims: To investigate how the issue of malnutrition in institutionalised older people is perceived by nurses in a Teaching Hospital in Italy and how some aspects that can prevent malnutrition are dealt with. Background: Malnutrition in institutionalised older people is still a significant and unresolved problem. Many studies have been published on the inadequacy of nutritional care. Nurses play a strategic and key role in the prevention of malnutrition. Knowing how nurses perceive the problem of malnutrition and how they deal with aspects that can prevent malnutrition can be an important starting point for implementing strategies that will improve overall nutritional care. Methods: A Focus Group (FGs) study was conducted in a Teaching Hospital in the north-west of Italy with 33 nurses, who were still working or had worked with older people. The FGs were audio-taped and transcribed verbatim. Data collection was stopped when we achieved saturation. Two researchers independently analysed the transcription for content analysis and negotiated the emerging categories. Results: Although nurses perceived malnutrition as a significant issue, it was often considered of secondary importance compared with other aspects of care. Food choice, although available, is often limited to very few options, diets are standardised and monotonous and patients must choose 'sight unseen'. Time constraints and understaffing were the obstacles for the identification of the need for nutritional care. Organisational and managerial decision-making did not ensure the provision of high-quality nutritional care. Patients' nutritional status was often not assessed, and tools such as the Mini Nutritional Assessment were not mentioned by the participants. Conclusion: Our study substantially confirmed what is reported in the literature. However, it is necessary to raise nurses' awareness around poor nutritional care to prevent malnutrition in institutionalised older people. [ABSTRACT FROM AUTHOR]