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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]

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]

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]

Background: In Italy, there are still many barriers to the development of a culture of evidence‐based practice (EBP) and nurses' knowledge of EBP is lacking. Additionally, in Italy there are still very few advanced practice registered nurses to significantly contribute to the development of EBP. Aim: This aims to identify the implications of a wide‐scale nursing education intervention to engage clinical nurses in EBP through the Italian RN4CAST study. Methods: A qualitative study based on a thematic analysis. A total of 800 clinical nurses actively participated in nine training sessions across Italy. At the end of each training session written feedback data were collected and then underwent thematic analysis. Results: All participants were strongly motivated to engage in EBP thanks to their involvement in the RN4CAST project. With regard to the implications of EBP, the thematic analysis produced the following themes: Professional identity; Quality of care; Perceptions of patients and nurses; Research impact; and Organization. Conclusions: The involvement of a large number of clinical nurses in a research project raised their awareness about the advantages of engaging in EBP, and how evidence can be used to raise motivation to change current practice policies. [ABSTRACT FROM AUTHOR]

Background: Prisons are contexts where nurses are required to have specific skills to ensure that, in a setting designed for the expiation of crime, prisoners receive the same type of care as anyone else. But this is not always the case, giving rise to ethical issues. Research questions: 'How do correctional nurses describe their working experience in prisons? What issues emerged?' Methodology: This is a qualitative descriptive study. Following purposive sampling, we conducted five focus groups. Thematic analysis was used to analyse the data. Participants and research context: Our sample included 31 correctional nurses in seven prisons in Northern Italy. Ethical considerations: The scientific merit of this study was recognized by the Academic Board of the University of Genoa. Approval to conduct the study was obtained from the Liguria Regional Government that funded this study and from the Local Health Authority that was the prison nurses'employer. Formal consent was obtained from all the nurses who volunteered to participate in this study. Findings: Five themes emerged from the focus groups: (1) prisoners' healthcare needs, (2) negotiation between custody and care, (3) satisfaction of working in prisons, (4) obstacles to quality care and (5) safety. 'Manipulation'was a transversal theme that emerged from all the focus groups. Discussion: The problems generated by the clash between prison security and nursing care priorities did not enable nurses to practice autonomously and provide the best possible to care prisoners, giving rise to ethical issues andmoral distress.This in turn causes high nursing turnover rates that negatively impact continuum of care. Conclusion: In Italy, correctional nurses urgently require specific education interventions with the participation of all those who work in prisons. Interventions based on the post-modern concept of restorative nursing could offer prison nurses the opportunity to both resolve ethical issues and reduce moral distress. [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 describe staff nurses' perceptions related to the leadership styles adopted by their nurse managers, identify which leadership style ensured job satisfaction in staff nurses and describe which behaviours nurse managers should change. Background Empirical literature suggests that leadership styles of nurse managers significantly influence staff satisfaction. However, few studies investigate how staff nurses perceive the leadership styles of their nurse managers, and how these impact upon the staff nurses' job satisfaction. Methods This was a mixed method study, which included the administration of the Multi-factor Leadership Questionnaire and three focus groups. Results Ward nurse managers mostly adopted a transactional leadership style ('Management by exception active') aimed at monitoring errors and intervening to correct errors and punish, which had a negative impact on staff nurses' levels of job satisfaction. In contrast, the transformational leadership style, which is mostly correlated with satisfaction ('Idealized Influence Attributed', which staff nurses perceived as 'respect', 'caring for others', 'professional development' and 'appreciation'), was rarely practiced by nurse managers. Conclusions The transformational leadership skills of Italian nurse managers need to be improved through behaviours based on greater respect, caring for others, professional development and appreciation. The present study could also serve as model to improve the leadership style of nurse managers in other countries. Implications for nursing management The themes of transformational leadership could serve as a guide for nurse managers to help them improve their leadership style, and improve the levels of job satisfaction in staff nurses. Owing to the complexity and the importance of this issue, classroom educational interventions would not be sufficient: it should be dealt as a strategic priority by nursing directors. [ABSTRACT FROM AUTHOR]

Aims To identify patient safety competencies, and determine the clinical learning environments that facilitate the development of patient safety competencies in nursing students. Background Patient safety in nursing education is of key importance for health professional environments, settings and care systems. To be effective, safe nursing practice requires a good integration between increasing knowledge and the different clinical practice settings. Nurse educators have the responsibility to develop effective learning processes and ensure patient safety. Design Rapid Evidence Assessment. Data Sources MEDLINE, CINAHL, SCOPUS and ERIC were searched, yielding 500 citations published between 1 January 2004-30 September 2014. Review methods Following the Rapid Evidence Assessment process, 17 studies were included in this review. Hawker's (2002) quality assessment tool was used to assess the quality of the selected studies. Results Undergraduate nursing students need to develop competencies to ensure patient safety. The quality of the pedagogical atmosphere in the clinical setting has an important impact on the students' overall level of competence. Active student engagement in clinical processes stimulates their critical reasoning, improves interpersonal communication and facilitates adequate supervision and feedback. Conclusion Few studies describe the nursing students' patient safety competencies and exactly what they need to learn. In addition, studies describe only briefly which clinical learning environments facilitate the development of patient safety competencies in nursing students. Further research is needed to identify additional pedagogical strategies and the specific characteristics of the clinical learning environments that encourage the development of nursing students' patient safety competencies. [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]

In the literature we found many studies that confirmed our concerns about nursing students' poor maths skills that directly impact on their ability to correctly calculate drug dosages with very serious consequences for patient safety. The aim of our study was to explore where students had most difficulty and identify appropriate educational interventions to bridge their mathematical knowledge gaps. This was a quali-quantitative descriptive study that included a sample of 726 undergraduate nursing students. We identified exactly where students had most difficulty and identified appropriate educational interventions to bridge their mathematical knowledge gaps. We found that the undergraduate nursing students mainly had difficulty with basic maths principles. Specific learning interventions are needed to improve their basic maths skills and their dosage calculation skills. For this purpose, we identified safeMedicate and eDose™ (Authentic World Ltd.), only that they are only available in English. In the near future we hope to set up a partnership to work together on the Italian version of these tools. [ABSTRACT FROM AUTHOR]

This article presents a qualitative research protocol to explore and understand the interprofessional collaboration (IPC) preparation process implemented by clinical tutors and students of different professions involved in interprofessional education (IPE). Many studies have shown that IPE initiatives improve students’ understanding of the roles and responsibilities of other professionals. This improves students’ attitudes towards other professions, facilitating mutual respect, and IPC. However, there is limited information about how students are prepared to work collaboratively within interprofessional teams. This is a constructivist grounded theory (GT) study, which will involve data collection through in-depth semi-structured interviews (to 9-15 students and 6-9 clinical tutors), participant observations, and the analysis of documentation. After analysing, coding, integrating, and comparing the data if necessary, a second round of interviews could be conducted to explore any particularly interesting aspects or clarify any issues. This will then be followed by focused and theoretical coding. Qualitative data analysis will be conducted with the support of NVivo 10 software (Victoria, Australia). A better conceptual understanding will help to understand if IPE experiences have contributed to the acquisition of competencies considered important for IPC, and if they have facilitated the development of teamwork attitudes. [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]

An editorial is presented which argues that qualitative research can enhance the quality, rigor, and depth of an randomized controlled trial (RCT.) Topics discussed include information of RCT which involve standard approach to testing the efficacy of medicines; importance of qualitative research with patients which helps to identify several health issues; and information for RCT designs by analysis of risks to trial concordance and the way participants feel about the process of the trial.

International mobility for nursing students is still a relatively new phenomenon. While educators and students are both excited by the opportunity that mobility presents, there are often many challenges inherent within third level organisations and practice organisations. These obstacles not only serve to make international mobility arrangements complex to manage but also mean that these opportunities are only available to very small numbers of students. Furthermore the benefits of undergraduate international exchanges remain largely anecdotal and the elements that facilitate success are not entirely clear. To address these issues, a qualitative study was conducted to identify the elements that characterize a nursing student's successful learning during international clinical placement. Semi-structured interviews were carried out with six students who had completed their international clinical placements experiences in Portugal, Spain, and Italy. Three common themes emerged from the data analysis: relationship with institutions and countries, student's thoughts and feelings and learning outcomes and the role of the nursing student's clinical supervisor. These themes contain seven sub-categories, representing the characterizing elements of the student's experience of mobility in the foreign country. These results are useful to nurse educators internationally to inform clinical learning experiences within exchange programmes. • International clinical placement enables the development of transcultural skills. • Nurses' transcultural skills have an impact on patient safety. • Undergraduate clinical supervisor's crucial role favours learning outcomes. • Our results are important for nursing educators to improve clinical environments. [ABSTRACT FROM AUTHOR]

The author discusses the article, "Data collection and sampling in qualitative research: does size matter?" published in the "Journal of Advanced Nursing." Topics discussed include the importance of the patients' perspectives in qualitative research in health care for a deeper understanding of issues and in humanizing care, gain a concrete understanding of patient and family adherence to treatment and identifies Grounded Theory as the most appropriate for studying healthcare systems.

The author reflects on the difficulties of finding a funding agency to back researches using theoretical sampling in grounded theory strategies. He discussed purposive or purposeful sampling in which sampling is defined before the beginning of data collection. He recalls using the strategy in a study in Northern Italy on the validation and application of standards in the involvement of children and their families in the healthcare process.