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Background: The Heart Failure Somatic Perception Scale (HFSPS) is a four-factor instrument used to assess how bothersome are 18 physical signs and symptoms of heart failure. To date, construct validity and reliability of the HFSPS have been evaluated in only one American study and never in a European population., Aim: To evaluate psychometric properties (validity and reliability) of the HFSPS in a European heart failure population., Methods: This was an Italian multicentre study in which the HFSPS factorial structure was assessed using confirmatory factor analysis. Criterion related validity of the HFSPS was evaluated by correlating its factor scores with the Kansas City Cardiomyopathy Questionnaire (KCCQ) scores using Pearson's r . The HFSPS internal consistency reliability was evaluated using the factor score determinacy coefficient, Cronbach's α and model-based internal consistency index., Results: Most of the participants ( n =321) were male (56.6%), with a mean age of 71.48 years (SD, 12.75) and in New York Heart Association class II (61.8%). The confirmatory factor analysis, testing the original HFSPS four-factor structure (dyspnoea, chest discomfort, early and subtle, and oedema), resulted in the following supportive fit indices: χ 2 (126, N =321)=337.612, p <0.001, comparative fit index =0.920, Tucker-Lewis index =0.903, root mean square error of approximation =0.072 and standardized root mean square residual =0.045. With regard to the criterion related validity, all the correlations with the KCCQ were statistically significant. The HFSPS reliability resulted in factor score determinacy coefficients ⩾ 0.87 and Cronbach's α ⩾ 0.75, with the exception of the two-item chest discomfort subscale; the model-based reliability coefficient was 0.914., Conclusion: The validity and reliability of the HFSPS were supportive in this European sample. The HFSPS can be used to assess how bothersome heart failure signs and symptoms are in order to improve their management.

Objectives: Testing the influence of heart failure (HF) caregiver preparedness on anxiety and depression, and the influence of HF caregiver anxiety and depression on caregiver physical and mental QOL., Methods: In this cross-sectional study, we used the Caregiver Preparedness Scale (CPS), the Hospital Anxiety and Depression Scale (HADS) with the anxiety (HADS-A) and depression (HADS-D) subscales, and the Short-Form 12 (SF-12) measuring the physical component summary (PCS) and the mental component summary (MCS) of QOL. Socio-demographic data and patients' clinic data were also collected. Data analysis was conducted with descriptive statistics, correlations, and path analysis., Results: A total of 366 HF caregiver and patient dyads were enrolled. Caregivers were mostly females (73.3%) with a mean age of 58.61 (SD = 15.66) years. The tested model showed excellent fit indices with the following significant paths: CPS scores predicted HADS-D scores; HADS-A scores predicted MCS scores; and HADS-D scores predicted both PCS and MCS scores. Also, HADS-D mediated the relationship between CPS and MCS scores., Conclusion: Preparedness influences HF caregiver depression and depression influences caregiver physical and mental QOL. Depression mediates between preparedness and HF caregiver mental QOL., Practice Implications: Interventions focused on improving HF caregiver preparedness may improve caregivers' depression and QOL., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Mortality is the most considered outcome for assessing the quality of hospital care. However, hospital mortality depends on diverse patient characteristics; thus, complete risk stratification is crucial to correctly estimate a patient's prognosis. Electronic health records include standard medical data; however, standard nursing data, such as nursing diagnoses (which were considered essential for a complete picture of the patient condition) are seldom included., Objective: To explore the independent predictive power of nursing diagnoses on patient hospital mortality and to investigate whether the inclusion of this variable in addition to medical diagnostic data can enhance the performance of risk adjustment tools., Methods: Prospective observational study in one Italian university hospital. Data were collected for six months from a clinical nursing information system and the hospital discharge register. The number of nursing diagnoses identified by nurses within 24 h after admission was used to express the nursing dependency index (NDI). Eight logistic regression models were tested to predict patient mortality, by adding to a first basic model considering patient's age, sex, and modality of hospital admission, the level of comorbidity (CCI), and the nursing and medical condition as expressed by the NDI and the All Patient Refined-Diagnosis Related Group weight (APR-DRGw), respectively., Results: Overall, 2301 patients were included. The addition of the NDI to the model increased the explained variance by 20%. The explained variance increased by 56% when the APR-DRGw, CCI, and NDI were included. Thus, the latter model was nearly highly accurate (c = 0.89, 95% confidence interval: 0.87-0.92)., Conclusion: Nursing diagnoses have an independent power in predicting hospital mortality. The explained variance in the predictive models improved when nursing data were included in addition to medical data. These findings strengthen the need to include standardized nursing data in electronic health records., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Heart failure (HF) dyadic self-care science is advancing rapidly, as evidenced by recent theoretical work, literature reviews, and multiple empiric studies. Typologies, once considered archaic, are now viewed as person-oriented classification systems that allow a whole-system view of information patterns. This whole-system view is particularly needed to understand complex tasks like dyadic HF self-care., Purpose: The purpose of this article is to review the initial conceptualization of an HF care dyadic typology and the present advances in our thinking and suggest future directions for this clinically relevant classification system., Conclusions: Development and testing of the typology across 5 studies resulted in a well-characterized, pragmatic and parsimonious, person-oriented classification system for understanding how patients and informal caregivers conduct patients' HF self-care at home. The 4 types are characterized as 2 individually oriented types-type I, patient oriented; type II, caregiver oriented; and 2 relationally oriented types-type III, collaboratively oriented; and type IV, incongruently oriented. We have devised a single-item measure of typology group that can be assessed in the clinical setting. Once this information is ascertained, the clinician can personalize the plan of care to the realities of the dyad., Implications: Dyads that disagree on who is responsible for self-care may forego or delay action, resulting in self-care failures with subsequent HF advancement, hospitalization, and mortality. As the HF dyadic self-care science has advanced, we have come to appreciate the complexity that arises when 2 individuals work together on 1 complex task-HF self-care.

Background: Oncological diseases affect the biopsychosocial aspects of a person's health, resulting in the need for complex multidisciplinary care. The quality and outcomes of healthcare cannot be adequately assessed without considering the contribution of nursing care, whose essential elements such as the nursing diagnoses (NDs), nursing interventions (NIs), and nursing activities (NAs) can be recorded in the Nursing Minimum Data Set (NMDS). There has been little research using the NMDS in oncology setting., Objective: The aim of this study was to describe the prevalence and distribution of NDs, NIs, and NAs and their relationship across patient age and medical diagnoses., Methods: This was a prospective observational study. Data were collected between July and December 2014 through an NMDS and the hospital discharge register in an Italian hospital oncology unit., Results: On average, for each of 435 enrolled patients, 5.7 NDs were identified on admission; the most frequent ND was risk for infection. During the hospital stay, 16.2 NIs per patient were planned, from which 25.2 NAs per day per patient were delivered. Only a third of NAs were based on a medical order, being the highest percentage delivered on nursing prescriptions. The number of NDs, NIs, and NAs was not related to patient age, but differed significantly among medical diagnoses., Conclusions: An NMDS can depict patient needs and nursing care delivered in oncology patients. Such data can effectively describe nursing contribution to patient care., Implications for Practice: The use of an NMDS raises the visibility of nursing care in the clinical records. Such data enable comparison and benchmarking with other healthcare professions and international data.

Background: Self-care is essential in people with chronic heart failure (HF). The process of self-care was refined in the revised situation specific theory of HF self-care, so we updated the instrument measuring self-care to match the updated theory. The aim of this study was to test the psychometric properties of the revised 29-item Self-Care of Heart Failure Index (SCHFI)., Methods: A cross-sectional design was used in the primary psychometric analysis using data collected at 5 sites in the United States. A longitudinal design was used at the site collecting test-retest data. We tested SCHFI validity with confirmatory factor analysis and predictive validity in relation to health-related quality of life. We tested SCHFI reliability with Cronbach α, global reliability index, and test-retest reliability., Results: Participants included 631 adults with HF (mean age, 65 ± 14.3 years; 63% male). A series of confirmatory factor analyses supported the factorial structure of the SCHFI with 3 scales: Self-Care Maintenance (with consulting behavior and dietary behavior dimensions), Symptom Perception (with monitoring behavior and symptom recognition dimensions), and Self-Care Management (with recommended behavior and problem-solving behavior dimensions). Reliability estimates were 0.70 or greater for all scales. Predictive validity was supportive with significant correlations between SCHFI scores and health-related quality-of-life scores., Conclusions: Our analysis supports validity and reliability of the SCHFI v7.2. It is freely available to users on the website: www.self-care-measures.com.

Objectives: To identify the distinct quality of life (QOL) trajectories among stroke survivors, and to evaluate the associations with their caregivers' burden, anxiety, and depression., Design: This was a longitudinal dyadic study., Settings: Stroke survivors and their informal caregivers were enrolled upon discharge from several rehabilitation hospitals, and they were followed during this multisite longitudinal study., Participants: The stroke survivors (N=405, mean age=70.7y) included older adult men (52.0%), most of whom (80.9%) had had ischemic strokes. The caregivers (n=244, mean age=52.7y) included mostly women (65.2%), most of whom were the survivors' children (50.0%) or spouses (36.1%)., Interventions: Not applicable., Main Outcome Measures: Latent growth mixture modeling was used to identify the distinct QOL trajectories among the stroke survivors over the course of 12 months of recovery. The longitudinal associations between the stroke survivor QOL trajectories and the caregivers' burden, anxiety, and depression were evaluated. A multinomial regression was then used to identify the predictors of the various survivor QOL trajectories., Results: Three distinct survivor QOL trajectories were identified: high and slightly improving QOL, moderate and slightly worsening QOL, and markedly improving QOL. The caregivers' burden, anxiety, and depression mirrored the survivors' QOL trajectories. In the multinomial models, an older survivor age, hemorrhagic stroke, lower education, and coexisting chronic obstructive pulmonary disease or thyroid disease were significantly associated with a moderate and slightly worsening QOL trajectory. Women and blindness were associated with a markedly improving QOL survivor trajectory., Conclusions: A survivor's QOL trajectory after a stroke was associated with their caregiver's burden, anxiety, and depression. Those survivors belonging to the moderate and slightly worsening QOL trajectory and their caregivers, in particular, need special care, because they are at risk for the worst outcomes., (Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Caregiver contribution to heart failure (HF) self-care maintenance and management is important in HF care. Literature remains unclear regarding which practices caregivers perform to contribute to self-care for patients with HF, especially in Southern Europe., Objective: The objective of this study was to describe caregiver contributions to HF self-care maintenance (ie, treatment adherence and symptom monitoring) and management (ie, managing HF symptoms when they occur)., Methods: Forty HF caregivers were enrolled from 3 outpatient clinics in Italy for a qualitative descriptive study. Data were collected with a semistructured interview and analyzed using content analysis., Results: Caregivers were 53.6 years old on average and mostly female (63.5%). Caregiver contributions to self-care maintenance included practices related to (1) monitoring medication adherence, (2) educating patients about HF symptom monitoring, (3) motivating patients to perform physical activity, and (4) reinforcing dietary restrictions. However, some of these practices were incorrect (eg, weighing the patient only once a week). Caregiver contributions to self-care management included practices related to (1) symptom recognition and (2) treatment implementation. Caregivers were able to recognize symptoms of HF exacerbation (eg, breathlessness) but lacked confidence regarding treatment implementation (eg, administering an extra diuretic)., Conclusions: Although caregivers described contributing to patients' HF self-care maintenance and management, some of their practices were incorrect. Because the caregiver contributions to HF self-care can improve patient outcomes, clinicians should routinely assess caregiver HF self-care practices and provide education and reinforcement regarding evidence-based practices.

Background: The literature on caregiver contributions to heart failure (HF) patient self-care has grown rapidly during the last few years, but theory guiding this growth is lacking., Objective: The purpose of this article is to describe a Situation-Specific Theory of Caregiver Contributions to HF Self-care., Results: We describe theoretical assumptions, the process by which caregivers contribute to HF self-care, factors influencing caregiver contributions to HF self-care, known predictors (caregiver, patient, and dyadic related) and outcomes of caregiver contributions to HF. These outcomes may be caregiver and patient related and positive and/or negative. Caregiver contributions to HF self-care include interacting processes of self-care maintenance, symptom monitoring and perception, and self-care management. Caregiver confidence and cultural values are discussed as important influences on caregiver contributions to HF self-care. Recursive pathways are hypothesized between processes and outcomes. Ten theoretical propositions are proposed., Conclusions: The Situation-Specific Theory of Caregiver Contributions to HF Self-care is still in its infancy, and more research is needed to strengthen the evidence supporting the theory. But at this point, the theory may help to guide future studies addressing caregiver contributions to HF self-care and clinical practice aimed at improving caregiver and patient outcomes.

Aim: To describe a research protocol for a study designed to examine self-care in patient and caregiver dyads in coping with multiple chronic conditions, to evaluate the influence of dyad self-care on: (a) patient mortality, quality of life, hospital admissions, and the unplanned access of care; and (b) the positive aspects of caregiving. The specific conceptual framework that we developed for this study considers the predictors of self-care (at patient, caregiver, and dyadic levels), the process of self-care and the outcomes of self-care in patient and caregiver dyads with multiple chronic conditions. These elements in patient and caregiver dyads have not been well-studied to date., Design: This is a multicentre longitudinal study with data collection at 0, 6, and 12 months., Methods: We will use generic and specific tools to assess the predictors of self-care, the process of self-care and the outcomes of self-care in the dyads. The data will be analysed with descriptive and inferential statistics and multilevel modelling to control for the interdependent nature of dyadic data. The study was approved by an ethics committee and was funded by a grant from the Centre of Excellence for Nursing Scholarship Rome, in November 2015., Discussion: This study seeks to determine the predictors and outcomes of self-care in patient and caregiver dyads within the context of multiple chronic conditions., Impact: The results of this study will inform clinical practice and research by identifying variables that are modifiable and therefore amenable to interventions., (© 2018 John Wiley & Sons Ltd.)

Purpose: To investigate whether the number of nursing diagnoses on hospital admission is an independent predictor of the hospital length of stay., Design: A prospective observational study was carried out. A sample of 2,190 patients consecutively admitted (from July to December 2014) in four inpatient units (two medical, two surgical) of a 1,547-bed university hospital were enrolled for the study., Methods: Data were collected from a clinical nursing information system and the hospital discharge register. Two regression analyses were performed to investigate if the number of nursing diagnoses on hospital admission was an independent predictor of length of stay and length of stay deviation after controlling for patients' sociodemographic characteristics (age, gender), clinical variables (disease groupers, disease severity morbidity indexes), and organizational hospital variables (admitting inpatient unit, modality of admission)., Findings: The number of nursing diagnoses was shown to be an independent predictor of both the length of stay (β = .15; p < .001) and the length of stay deviation (β = .19; p < .001)., Conclusions: The number of nursing diagnoses is a strong independent predictor of an effective hospital length of stay and of a length of stay longer than expected., Clinical Relevance: The systematic inclusion of standard nursing care data in electronic health records can improve the predictive ability on hospital outcomes and describe the patient complexity more comprehensively, improving hospital management efficiency., (© 2018 Sigma Theta Tau International.)

Design: Validation cross-sectional study., Objectives: Even though caregiver burden (CB) represents a well-recognised concern among caregivers of people with a spinal cord injury (SCI), there are no specific questionnaires designed for its evaluation. This study aimed to assess the psychometric properties of the Caregiver Burden Inventory in Spinal Cord Injury (CBI-SCI), which was modified from its original version, and specifically its construct and reliability., Setting: Multicentre study in four urban spinal units across Italy. The CBI-SCI was administered to family caregivers in outpatient clinics., Methods: CBI-SCI was administered in a toolset composed of a sociodemographic questionnaire, the Family Strain Questionnaire-Short Form (FSQ-SF), the Short Form-36 (SF-36), and the Modified Barthel Index (MBI). The CBI-SCI construct validity was assessed through an exploratory factor analysis. The internal consistency of the questionnaire was examined using Cronbach's alpha (α) coefficient for the total scale and its subscales. Concurrent validity was evaluated performing Pearson's correlation coefficient with all instruments included in the toolset., Results: The CBI-SCI was administered to 176 participants from February 2016 to September 2017. Factor analysis highlighted the five-factored structure of the questionnaire. The total scale Cronbach's α was 0.91 (p < 0.001). All the five subscales of CBI-SCI showed an acceptable internal consistency, ranging from 0.76 to 0.91 (p < 0.001). Pearson's correlation coefficients of the CBI-SCI with all the administered instruments were statistically significant (p < 0.001), showing congruent relations., Conclusion: The CBI-SCI, due to its validity and reliability, may represent a valuable instrument to evaluate the CB longitudinally in SCI.

Background: Higher patient-caregiver mutuality is associated with improved patient and caregiver outcomes, but no studies have tested the psychometric characteristics of the mutuality scale (MS) in heart failure (HF) patient and caregiver population., Objectives: To test the validity and reliability of the MS., Methods: A cross-sectional design. The MS validity and reliability were tested with confirmatory factor analysis (CFA) and hypothesis testing, and with Cronbach's alpha and model-based internal consistency index, respectively., Results: CFA supported the validity of the MS in the HF patient and caregiver versions. Hypothesis testing showed significant correlations between both versions of the MS and anxiety, depression, quality of life, and self-care. Also, MS caregiver version scores correlated significantly with caregiver preparedness. Cronbach's alphas and the model-based internal consistency index ranged between 0.72 and 0.94 in both versions., Conclusions: The Mutuality Scale showed supportive validity and reliability for HF patients and caregivers., (Copyright © 2018. Published by Elsevier Inc.)

Mutuality in patient-caregiver dyad may improve heart failure (HF) patient self-care and caregiver contribution to self-care, but literature is scarce. We evaluated the influence of mutuality and its dimensions on patient-caregiver dyad self-care. A sample of 366 HF patient-caregiver dyads was enrolled. The Actor-Partner Interdependence Model was used to identify the influence of individual patient and caregiver mutuality on their own self-care (actor effect) and on partner self-care (partner effect). The total mutuality score had an actor effect on patient self-care maintenance (i.e., behaviors aimed at maintaining HF stability) and on patient and caregiver self-care confidence. Total score of patient mutuality also had a partner effect on caregiver self-care management (i.e., responses to symptoms of HF exacerbation). Specific mutuality dimensions had different actor and partner effects on patient and caregiver self-care. Interventions to improve mutuality in HF patient-caregiver dyads may influence patient self-care and caregiver contribution to self-care.

Purpose: This study aimed to evaluate the psychometric characteristics of the Multidimensional Scale of Perceived Social Support (MSPSS) in patients with chronic diseases., Methods: Patients (n = 236) with chronic diseases completed the MSPSS and the 36-item Short Form Health Survey (SF-36) questionnaire. The MSPSS factorial structure was analysed using confirmatory factor analysis (CFA), and internal consistency reliability was evaluated with Cronbach's alpha, the factor score determinacy coefficient and the model-based internal consistency index. Concurrent validity was performed to correlate the MSPSS scores with the SF-36 scores., Results: CFA supported the three-factor structure of the MSPSS with optimal fit indexes. Cronbach's alpha, the factor score determinacy coefficient and the model-based internal consistency index were equal to or greater than 0.89. Concurrent validity supported the significant correlations between the MSPSS and SF-36 scores., Conclusions: The MSPSS has supportive validity and reliability and can be used to evaluate the perceived social support received by chronic patients.

Background: Symptoms of anxiety, depression, and cognitive impairment are common in heart failure (HF) patients, but there are inconsistencies in the literature regarding their relationship and effects on exercise capacity., Objectives: The aim of this study was to explore the relationships between exercise capacity and anxiety, depression, and cognition in HF patients., Methods: This was a secondary analysis on the baseline data of the Italian subsample (n = 96) of HF patients enrolled in the HF-Wii study. Data was collected with the 6-minute walk test (6MWT), Hospital Anxiety and Depression Scale, and Montreal Cognitive Assessment., Results: The HF patients walked an average of 222 (SD 114) meters on the 6MWT. Patients exhibited clinically elevated anxiety (48%), depression (49%), and severe cognitive impairment (48%). Depression was independently associated with the distance walked on the 6MWT., Conclusions: The results of this study reinforced the role of depression in relation to exercise capacity and call for considering strategies to reduce depressive symptoms to improve outcomes of HF patients., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: The complexity of care can be described through a clinical nursing information system, in particular through the Professional Assessment Instrument -PAI-, encoding each health care activity in time units and analysing the relationship of observed time to patient characteristics in relation to the functional models of care needs., Designs: Observational study., Methods: Data were collected for 11 months in 2016-17 in four inpatient units of an Italian hospital using the Professional Assessment Instrument, and a survey grid to measure the time of the nursing activities delivered. All activities with a frequency of 20 or more have been included. The Work Sampling technique was used for time-tracking., Results: The sample included 2765 nursing activities. The mean times for each care activity were compared showing significant differences. A statistically significant correlation (Sperman's correlation coefficient) was observed both between the observed time and the level of illness severity and between time and functional models., Conclusions: Patient complexity, both in terms of illness severity and level of dependence, can be coded through a clinical nursing information system. This facilitates the classification and measurement of nursing care delivered, which includes the entire care process.

Purpose: Heart failure (HF) affects up to 14% of the elderly population and its prevalence is increasing. Self-care is fundamental to living successfully with this syndrome, but little is known about how self-care evolves over time. The present study aimed to (a) identify longitudinal trajectories of self-care confidence and maintenance among HF patients, (b) investigate whether each trajectory is characterized by specific sociodemographic and clinical patients' characteristics, and (c) assess the association between the self-care confidence and maintenance trajectories., Method: We conducted a prospective descriptive study of 225 HF patients followed for 6 months with data collected at baseline and 3 and 6 months. Latent class growth analysis (LCGA) was used to identify longitudinal trajectories. ANOVA and contingency tables were used to characterize trajectories and investigate their association., Results: Three self-care confidence (persistently poor, increasingly adequate, and increasingly optimal) and three self-care maintenance (persistently poor, borderline but improving, and increasingly good) trajectories were identified. Married individuals were less likely to be in the persistently poor trajectory of self-care confidence. Patients with persistently poor self-care maintenance took fewer medications than patients with one of the better self-care maintenance trajectories. The two sets of trajectories were significantly and meaningfully associated., Conclusion: Patients in a poor self-care trajectory (confidence or maintenance) are at high risk to stay there without improving over time. These results can be used to develop tailored and potentially more effective health care interventions.

Aims: To describe self-care as defined by the Middle Range Theory of Self-Care of Chronic Illness and to identify clinical and socio-demographic determinants in a T2DM population., Methods: A multicentre observational cross-sectional study was conducted involving 540 adults with a confirmed diagnosis of T2DM from six outpatient diabetes services in Italy. Socio-demographic and clinical data were collected from medical records. The Self-Care of Diabetes Inventory (SCODI) was used to measure self-care maintenance, monitoring, management, and confidence dimensions. For each separate scale, scores were standardized 0-100 with higher SCODI scores indicating better self-care; a score ≥ 70 is adequate. Multiple quantile regression models were performed to identify determinants of each self-care dimension., Results: Self-care maintenance (median = 81.3) and self-care confidence (median = 79.5) were adequate in most of the subjects. Self-care monitoring was adequate in only half of the sample (median = 70.6). Self-care management was poor (median = 59.4). Lower self-care maintenance was associated with lower self-care confidence (p < 0.001). Lower self-care monitoring was associated with being male (p < 0.001), having lower self-care confidence (p < 001), and having diabetes for < 10 years (p < 0.001). Lower self-care management was associated with being male (p = 0.002), being older (p = 0.005), having a low income (p = 0.030), being employed (p = 0.008), having missed diabetes education in the last year (p = 0.002), and lower self-care confidence (p < 0.0001). Lower self-care confidence was associated with having diabetes for < 10 years (p = 0.008), and having at least one comorbid condition (p = 0.006)., Conclusions: Determinants of self-care maintenance, monitoring, management and confidence include both clinical and socio-demographic variables. Modifiable determinants such as self-care confidence and diabetes self-care management education could be used to tailor interventions to improve diabetes self-care.

Chronic diseases require continuous healthcare that is not fully guaranteed by the Italian Health System which is more oriented towards acute care. In the Lazio region (city of Palombara Sabina), a Nursing-Led in-patient unit is present with the aim to care for patients affected by chronic diseases. The aim of this study was to describe the type of healthcare delivered by this unit. A descriptive-comparative design was used. All 290 patients admitted to the Nursing-Led Unit, during 2014 and 2015 participated in the study. The following variables were analyzed: socio-demographic characteristics of patients, reasons for admission, nursing diagnoses and interventions, medical diagnoses and interventions, Barthel index, length of stay, mortality rate, and discharge rate to acute care hospitals. The mean age of participants was 78 years old (SD 11,4) and the most frequent reason for admission was the need to receive a medium-high intensity nursing care (14,5%). The most frequent nursing diagnoses were bathing/hygiene self-care deficit (78,3%) and impaired physical mobility (74,8%). Hypertensive heart disease was the most frequent medical diagnosis (32,4%). The mean length of stay was 19 days, the mortality rate was 2,1% and the discharge rate to an acute care hospital was 9%. Significant improvements in patient dependency levels, as measured by the Barthel index, were observed at discharge with respect to admission (p &lt; 0,001). The NursingLed Unit seems to be strategic in the delivery of care to older adults affected by multiple chronic diseases, in some phases of their condition. The results of this study indicate that the Palombara Sabina's nursing-led unit may contribute in reducing hospital admissions and achieving favorable patient outcomes when additional nursing interventions are needed.

Aim: To assess the caregiver burden (CB) of caregivers for people with Spinal Cord Injury (SCI) and to examine the psychological impact of the burden of caregiving., Materials and Methods: Cross-sectional study. A set of structured questionnaires was administered to 55 family caregivers of individuals with SCI. The Modified Barthel Index was used to evaluate the independence of care recipients. The Caregiver Burden Inventory was modified and used to assess the CB. The Family Strain Questionnaire - Short Form was administered to measure the psychological impact of CB. The Short Form 36 was used to assess the health status of the participants., Results: CB affects mainly the domains related to time management, the physical condition of caregivers and their sense of personal failure. An increased level of CB and the dependency level of SCI survivors is significantly correlated (p < 0.01) with an increase in the need of psychological support and a decrease in perceived health and quality of life., Conclusions: Caregiving for people with SCI implies the occurrence of CB. The contribution of caregivers should be recognised and supported with tailored relief interventions.

The Professional Assessment Instrument (PAI) is a clinical nursing information system used in the adult inpatient units of the A. Gemelli university hospital in Rome (Italy). The PAI allows for the systematic collection of nursing care data in order to improve the quality of care. So far, few clinical nursing information systems have been developed in the neonatal and pediatric care setting. The aim of this study is to describe the development and implementation of a clinical nursing information system (PAIped) for the neonatal and pediatric care setting., Methods: The Patient-and Family-Centered Care model was used to develop the contents of the PAIped. A web platform application was developed for the PAIped. The standard nursing terminology Clinical Care Classification System was used. A decisionmaking support system was developed within the PAIped to support nurses in making diagnoses and in selecting the most appropriate nursing interventions., Results: A clinical nursing information system using a standard nursing terminology was developed in the pediatric and neonatal care setting. After a test phase, the PAIped was implemented in all the pediatric and neonatal inpatient units of the A. Gemelli university hospital., Conclusion: The development and implementation of the PAIped in the A. Gemelli university hospital allowed the monitoring of nursing care processes and accurate nursing documentation.

Aims: To identify clusters of nurses in relation to their beliefs about nursing diagnosis among two populations (Italian and Spanish); to investigate differences among clusters of nurses in each population considering the nurses' socio-demographic data, attitudes towards nursing diagnosis, intentions to make nursing diagnosis and actual behaviours in making nursing diagnosis., Background: Nurses' beliefs concerning nursing diagnosis can influence its use in practice but this is still unclear., Design: A cross-sectional design., Methods: A convenience sample of nurses in Italy and Spain was enrolled. Data were collected between 2014-2015 using tools, that is, a socio-demographic questionnaire and behavioural, normative and control beliefs, attitudes, intentions and behaviours scales., Results: The sample included 499 nurses (272 Italians & 227 Spanish). Of these, 66.5% of the Italian and 90.7% of the Spanish sample were female. The mean age was 36.5 and 45.2 years old in the Italian and Spanish sample respectively. Six clusters of nurses were identified in Spain and four in Italy. Three clusters were similar among the two populations. Similar significant associations between age, years of work, attitudes towards nursing diagnosis, intentions to make nursing diagnosis and behaviours in making nursing diagnosis and cluster membership in each population were identified., Conclusion: Belief profiles identified unique subsets of nurses that have distinct characteristics. Categorizing nurses by belief patterns may help administrators and educators to tailor interventions aimed at improving nursing diagnosis use in practice., (© 2018 John Wiley & Sons Ltd.)

Aim: To longitudinally describe stroke caregivers' quality of life, anxiety, depression and burden and to identify predictors of stroke caregivers' quality of life, anxiety, depression and burden., Background: Caregivers have a key role in stroke survivor care and the first year of caregiving is the most challenging. To give tailored interventions, it is important to capture changes and identify predictors of caregiver quality of life, anxiety, depression and burden during the first year., Design: A 12-month longitudinal study. Data were collected between June 2013-May 2016., Methods: Changes in stroke caregiver quality of life, anxiety and depression and burden and their predictors were identified using linear mixed-effects models., Results: The caregivers (N = 244) were 53 years old and mostly female. Caregiver quality of life did not change significantly over the 12 months, anxiety and depression decreased up to 9 months and caregiver burden decreased from baseline to 3 months, then increased up to 9 months. Higher caregiver quality of life was predicted by caregiver younger age, higher education, living with a stroke survivor, survivor older age and higher physical functioning; higher anxiety and depression were predicted by older caregiver age and younger survivor age; higher burden was predicted by caregiver male gender, the caregiver not living with survivor and survivor lower physical functioning., Conclusion: The first 9 months of caregiving are particularly problematic for caregivers. The trajectories of the above variables and their predictors may be useful for policy makers, clinicians, investigators and educators to give better care to stroke caregivers and their survivors., (© 2018 John Wiley & Sons Ltd.)

Aim: To explore the experiences of self-care of patients with urostomy and to identify the influencing factors of self-care., Background: The creation of a urostomy results in the loss of an important bodily function and an alteration of the body image and causes physical, psychological, and social changes in the lifestyle through the adjustment and management of the new condition. In literature, there are few studies that analyze the lifestyle of people with urostomy., Methods: In this qualitative design, an interpretative phenomenological analysis was used. Eleven people living with urostomies took part in semi-structured interviews consisting of open-ended questions about their self-care experience. Data were collected between March and September 2016., Results: Six themes and twelve subthemes emerged from the data analysis. The themes were: Surgery impact, body image, daily and social-life activities, stoma and sexuality, managing stoma education, family and friends' support., Conclusions: This study highlights the impact a stoma has on people's lives. This impact should be absorbed with personalized education before the surgery with the eventual need of a continuous and planned educational course respecting the patients' needs. This study shows that a continuous and planned educational plan is crucial for patients living with urostomies. Therefore, nurses should provide patients an adequate support and a personalized education program to cope with ostomy., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Heart failure (HF) self-care is important in reducing clinical events (all-cause mortality, emergency room visits and hospitalizations). HF self-care behaviors are multidimensional and include maintenance (i.e. daily adherence behaviors), management (i.e. symptom response behaviors) and consulting behaviors (i.e. contacting a provider when appropriate). Across these dimensions, patterns of successful patient engagement in self-care have been observed (e.g. successful in one dimension but not in others), but no previous studies have linked patterns of HF self-care to clinical events., Objectives: To identify patterns of self-care behaviors in HF patients and their association with clinical events., Methods: This was a prospective, non-experimental, cohort study. Community-dwelling HF patients (n = 459) were enrolled across Italy, and clinical events were collected one year after enrollment. We measured dimensions of self-care behavior with the Self-Care of HF Index (maintenance, management, and confidence) and the European HF Self-care Behavior Scale (consulting behaviors). We used latent class mixture modeling to identify patterns of HF self-care across dimensions, and Cox proportional hazards modeling to quantify event-free survival over 12 months of follow-up., Results: Patients (mean age 71.8 ± 12.1 years) were mostly males (54.9%). Three patterns of self-care behavior were identified; we labeled each by their most prominent dimensional characteristic: poor symptom response, good symptom response, and maintenance-focused behaviors. Patients with good symptom response behaviors had fewer clinical events compared with those who had poor symptom response behaviors (adjusted hazard ratio = 0.66 [0.46-0.96], p = 0.03). Patients with poor symptom response behaviors had the most frequent clinical events. Patients with poor symptom response and those with maintenance-focused behaviors had a similar frequency of clinical events., Conclusions: Self-care is significantly associated with clinical events. Routine assessment, mitigation of barriers, and interventions targeting self-care are needed to reduce clinical events in HF patients., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Preventing hospitalization and improving event-free survival are primary goals of heart failure (HF) treatment according to current European Society of Cardiology guidelines; however, substantial uncertainty remains in our ability to predict risk and improve outcomes. Although caregivers often assist patients to manage their HF, little is known about their influence on clinical outcomes., Aims: To quantify the influence of patient and caregiver characteristics on patient clinical event risk in HF., Methods: This was a secondary analysis of data using a sample of Italian adults with HF and their informal caregivers ( n = 183 patient-caregiver dyads). HF patients were followed over 12 months for the following clinical events: hospitalization for HF, emergency room visit for HF or all-cause mortality. Influence of baseline caregiver- and patient-level factors (patient and caregiver age; dyad relationship type; patient New York Heart Association (NYHA) Class, cognition, and comorbidities; and caregiver strain, mental health status, and contributions to HF self-care) on patient risk of death or hospitalization/emergency room use was quantified using Cox proportional hazards regression., Results: Over the course of follow up, 32.8% of patients died, 19.7% were hospitalized for HF and 10.4% visited the emergency room. Higher caregiver strain, better caregiver mental health status and greater caregiver contributions to HF self-care maintenance were associated with significantly better event-free survival. Worse patient functional class and greater caregiver contributions to patient self-care management were associated with significantly worse patient event-free survival., Conclusion: Considering caregiving factors together with patient factors significantly increases our understanding of patient clinical event risk in HF.

Aims and Objectives: To investigate the impact of nursing diagnoses on patient and organisational outcomes in any field of health care where nurses are involved., Background: In healthcare systems, descriptions of patient complexity and outcomes and payment criteria are primarily based on medical diagnoses and procedures. Other aspects of patient care are rarely considered. Nursing diagnoses are believed to be related to healthcare outcomes, but comprehensive evidence for this association is missing., Design: Systematic literature review., Methods: The search was conducted in PubMed, CINAHL and Scopus databases without year or language limitations. The studies were categorised according to their methodological quality (low, good or high) and classified based on their levels of evidence on a scale of 1 (strongest evidence) to 5 (weakest evidence)., Results: Seventeen of 3426 potentially relevant studies met the eligibility criteria. Eleven studies were classified as low, five as good and one as high quality. The levels of evidence were rated as 2 for one study, three for two studies, four for nine studies and five for five studies. Nursing diagnoses were found to predict patient (quality of life, mortality) and organisational (length of hospital stay, hospital charges, amount of nursing care, discharge dispositions) outcomes. Patient care plans based on nursing diagnoses improved sleep quality, quality of life and glycaemic control. When added to information from disease-based classification systems (e.g. diagnosis-related groups), nursing diagnoses improved the predictions of the above outcomes., Conclusions: Nursing diagnoses have a great potential to predict patient and organisational outcomes. High-quality research is required to better investigate the existence and strength of these relationships., Relevance to Clinical Practice: The systematic use of nursing diagnoses in clinical practice, as well as the sharing of high-quality nursing data in large databases, may provide a considerable boost to the contribution of nursing to healthcare outcomes., (© 2017 John Wiley & Sons Ltd.)

Introduction: Breastfeeding training has a crucial role in increasing healthcare professionals' attitudes and in improving professional support for breastfeeding. The collaboration between the Italian National Institute of Health, UNICEF, and the Local Health Authority of Milan has led to the development of an online course on lactation and infant feeding practices., Aim: To assess if the course was effective in improving healthcare professionals' attitudes and practices (APs)., Methods: We conducted a prestudy-poststudy, comparing users' APs before (T0) and after (T1) the course through a 20-item questionnaire. Changes in APs were analyzed using paired t-test. Lower mean differences indicated more positive attitudes and more frequent professional practices favoring breastfeeding. Statistical analysis was carried out using SPSS version 15.0., Results: The course had 26,009 registrants and was successfully completed by 91.3% of users. The dropout rate was 8.7%. The final cohort was composed of 15,004 participants. The course improved attitudes, while minor changes were observed on practices (p < 0.05). Mean total attitude scores were 2.4 at T0 and 1.9 at T1, while mean total practice scores were 2.2 and 2.1, respectively. The main effects regarded the use of medications during breastfeeding (3.02 ± 1.29 at T0 and 1.88 ± 1.08 at T1) and the self-reported compliance with the International Code of Marketing of Breast Milk Substitutes (2.29 ± 1.24 at T0, 2.03 ± 1.21 at T1)., Conclusion: The noninteractive, high-coverage e-learning approach seems to be a useful tool for improving awareness and positive attitudes toward breastfeeding among healthcare professionals.

Background: Clinical experience is an essential component of nursing education since it provides students with the opportunity to construct and develop clinical competencies. Instructor caring is a pivotal facilitator at the forefront of clinical education, playing a key and complex educating role in clinical sectors. For these reasons the aims of this study was to assess the validity and reliability of the Italian version of NSPIC (I-NSPIC)., Methods: A validation multicentre study was conducted in three different Italian universities. A total of 333 nursing students were enrolled in the 2014/2015 academic year. Exploratory factor analysis (EFA) with oblique rotation was performed to test the construct validity of I-NSPIC. The Cronbach's alpha coefficient and test retest via Intraclass Correlation Coefficient (ICC) analyses were done to assess the internal consistency and stability of the scale. A Spearman's correlation with another scale (CLES-T) was used to examine the concurrent validities., Results: Four factors (control versus flexibility, supportive learning climate, confidence through caring, appreciation of life meaning and respectful sharing) were identified in EFA. The Cronbach's alpha value showed that I-NSPIC was a reliable instrument (α = 0.94) and the ICC coefficient was satisfactory., Conclusion: The I-NSPIC is a valid instrument for assessing the perception of instructor caring in Italian nursing students. It may also prove helpful in promoting the caring ability of nursing students and in increasing the caring interactions in the relationship between instructor and nursing students. The knowledge emerged from this study provide important insight in developing effective training strategies in the clinical training of undergraduate nursing students.

Background: Self-care is essential for patients with diabetes mellitus. Both clinicians and researchers must be able to assess the quality of that self-care. Available tools have various limitations and none are theoretically based. The aims of this study were to develop and to test the psychometric properties of a new instrument based on the middle range-theory of self-care of chronic illness: the Self-Care of Diabetes Inventory (SCODI)., Methods: Forty SCODI items (5 point Likert type scale) were developed based on clinical recommendations and grouped into 4 dimensions: self-care maintenance, self-care monitoring, self-care management and self-care confidence based on the theory. Content validity was assessed by a multidisciplinary panel of experts. A multi-centre cross-sectional study was conducted in a consecutive sample of 200 type 1 and type 2 diabetes patients. Dimensionality was evaluated by exploratory factor analyses. Multidimensional model based reliability was estimated for each scale. Multiple regression models estimating associations between SCODI scores and glycated haemoglobin (HbA1c), body mass index, and diabetes complications, were used for construct validity., Results: Content validity ratio was 100%. A multidimensional structure emerged for the 4 scales. Multidimensional model-based reliabilities were between 0.81 (maintenance) and 0.89 (confidence). Significant associations were found between self-care maintenance and HbA1c (p = 0.02) and between self-care monitoring and diabetes complications (p = 0.04). Self-care management was associated with BMI (p = 0.004) and diabetes complications (p = 0.03). Self-care confidence was a significant predictor of self-care maintenance, monitoring and management (all p < 0.0001)., Conclusion: The SCODI is a valid and reliable theoretically-grounded tool to measure self-care in type 1 and type 2 DM patients.

Competing Interests: Competing interests: None declared.

Background: Heart failure (HF) patients need to follow a strict pharmacological and nonpharmacological regimen in order to counteract the burden of the disease, and informal caregivers are an important resource for HF patients in managing and coping with their disease. Few studies have examined the lived experience of these caregivers with a rigorous phenomenological approach, and none have been conducted in Italy., Aim: To describe the lived experience of the caregivers of HF patients., Methods: A hermeneutic phenomenological method was used. Caregivers were enrolled in a HF clinic in central Italy. Interviews were analysed using a phenomenological approach. Credibility, dependability, confirmability and transferability were adopted in order to strengthen trustworthiness., Findings: Thirty HF caregivers (mean age: 53 years) were enrolled. Of these, 63% of the caregivers were female and 80% were patients' spouses or children. Six themes emerged: (1) fear and worry related to the illness; (2) life changes and restrictions; (3) burden due to caregiving; (4) uncertainty about illness management; (5) helping patients to cope with the illness; and (6) love and affection towards the patient., Conclusion: The findings of our study may help providers to guide interventions for HF caregivers. Providers should be supportive of caregivers and provide them with education in order to reduce their fears and worries about the illness and to handle the course of HF and its symptoms. An empathetic and practical approach with caregivers that considers the patient-caregiver relationship may help caregivers to cope with the changes and restrictions that caregiving brings to their lives and to reduce their burden.

Well-prepared informal caregivers play an important role in heart failure (HF) care, so an instrument to evaluate their preparedness to care is important. To date, HF caregiver preparedness has been rarely investigated quantitatively. The Caregiver Preparedness Scale (CPS) has been used in other chronic condition populations, but its psychometric characteristics have never been tested in HF caregivers. The purpose of this study was to test the validity and reliability of the 8-item CPS in HF caregivers. In a convenience sample of 317 HF caregivers (72.4% female, mean age 54), we tested the CPS' factorial structure with confirmatory factor analysis (CFA) and its concurrent validity with the Caregiver Contribution to Self-Care of HF Index (CC-SCHFI), and the Hospital Anxiety and Depression Scale (HADS). We also tested CPS' reliability with composite reliability indicators, Cronbach's alpha, factor score determinacy coefficient, and intraclass correlation coefficient (ICC). The CFA for a one-factor model resulted in supportive fit indices (e.g., comparative fit index .97). Significant correlations (p < .05) of the CPS with both the CC-SCHFI and the HADS supported concurrent validity. The composite reliability index, Cronbach's alpha, factor score determinacy coefficient, and ICC were .89, .91, .96, .91, respectively, supporting reliability. Our study provides evidence that the CPS is a valid and reliable instrument to measure HF caregiver preparedness, enabling clinicians, and researchers to target specific interventions to HF caregivers., (© 2017 Wiley Periodicals, Inc.)

Aims and Objectives: To describe cardiac patients' perceptions of their responsibilities in adherence to care., Background: The responsibilities of cardiac patients' adherence to care is a topical issue because of the increasing prevalence of noncommunicable diseases in Western countries, including cardiovascular disease (CVD). Responsibilities for cardiac patients' care have been studied, but little is described about patients' perspectives in this study., Design: A qualitative, hermeneutic inquiry., Methods: We used face-to-face individual semistructured interviews with 21 cardiac patients (76% male) aged 58-86 in an urban area of Finland in winter 2013. The data were analysed hermeneutically with inductive content analysis., Results: Based on our results, patients with cardiac disease understood that autonomy provided a basis for their responsibility in adherence to care. It included being able to make independent decisions, in collaboration with health professionals, or even to entrust that responsibility to healthcare professionals. Responsibilities were understood to be an expression of adherence, perceived to benefit the patient and included the duty to adopt a healthy lifestyle and care for their own medical condition. The main factors that influenced patients' responsibilities around adherence to care were their individual resources and motivation, relationships with healthcare professionals and the resources of the healthcare system., Conclusion: Autonomy is an inherent part of cardiac patients' adherence to care, but there has been little focus on their responsibilities in the literature. More attention needs to be paid to the healthcare providers' abilities to support patients' duties and responsibilities in clinical practice and to future research., (© 2016 John Wiley & Sons Ltd.)

Purpose: The Minnesota Living With Heart Failure Questionnaire (MLHFQ) is the leading method for assessing quality of life in patients with heart failure (HF) around the world. However, unique, culture-specific variations in factorial structure have been identified. The current study examined the cross-cultural equivalence of an Italian version of the MLHFQ., Design: Cross-sectional assessment as part of an HF study in Italy. Patients (n = 1,192; mean age = 72 years, SD = 11) completed demographics, the MLHFQ, and the Short-Form 12 (SF-12)., Methods: A series of exploratory and confirmatory factor analyses were used to develop an appropriate factor model in the current sample., Findings: We initially fit a confirmatory factor analysis based on published psychometric work validating the MLHFQ. This did not provide adequate fit, and the sample was then randomly split into equivalent subsets to conduct factor analyses with cross-validation. In the first subsample, an exploratory factor analysis uncovered slight modifications to the proposed factor structure that resulted in much improved model fit. The final model included a higher order factor and three subscales: physical, emotional, and social. A cross-validation confirmatory factor analysis using this structure was conducted in the remaining subset to ensure broader applicability of the results. Correlations with the SF-12 were consistent with previous work using these measures., Conclusions: Some items of the MLHFQ are sensitive to differences across cultures, and factor structures vary based on where the scale is administered. In spite of these differences, the total score remains a valid and reliable indicator of quality of life in HF patients across cultures., Clinical Relevance: Cultural influences on quality of life are important to consider when assessing patients' well-being in HF., (© 2017 Sigma Theta Tau International.)

Aims: To describe the prevalence of nursing diagnoses on admission among inpatient units and medical diagnoses and to analyse the relationship of nursing diagnoses to patient characteristics and hospital outcomes., Background: Nursing diagnoses classify patients according to nursing dependency and can be a measure of nursing complexity. Knowledge regarding the prevalence of nursing diagnoses on admission and their relationship with hospital outcomes is lacking., Design: Prospective observational study., Methods: Data were collected for 6 months in 2014 in four inpatient units of an Italian hospital using a nursing information system and the hospital discharge register. Nursing diagnoses with prevalence higher or equal to 20% were considered as 'high frequency.' Nursing diagnoses with statistically significant relationships with either higher mortality or length of stay were considered as 'high risk.' The high-frequency/high-risk category of nursing diagnoses was identified., Results: The sample included 2283 patients. A mean of 4·5 nursing diagnoses per patient was identified; this number showed a statistically significant difference among inpatient units and medical diagnoses. Six nursing diagnoses were classified as high frequency/high risk. Nursing diagnoses were not correlated with patient gender and age. A statistically significant perfect linear association (Spearman's correlation coefficient) was observed between the number of nursing diagnoses and both the length of stay and the mortality rate., Conclusion: Nursing complexity, as described by nursing diagnoses, was shown to be associated with length of stay and mortality. These results should be confirmed after considering other variables through multivariate analyses. The concept of high-frequency/high-risk nursing diagnoses should be expanded in further studies., (© 2017 John Wiley & Sons Ltd.)

Background: A better understanding of caregiver burden and its determinants is essential to support caregivers. Many instruments have been developed to measure caregiver burden in various illness contexts, but few have been psychometrically tested for caregivers of heart failure patients., Aims: The aim of this study was to test the validity (factorial and concurrent validity) and reliability (internal consistency) of the caregiver burden inventory (CBI) in a cohort of caregivers of heart failure patients., Methods: This was a secondary analysis from a cross-sectional study on heart failure patients and their caregivers enrolled from various Italian outpatient centres. The factorial validity of the CBI was tested with confirmatory factor analysis, and concurrent validity was tested correlating CBI scores with the short form-12 health survey scores. The internal consistency reliability was assessed with Cronbach's alpha., Results: In total, 505 caregivers of heart failure patients (52.2% women, mean age 56.59±14.9 years) were enrolled. Confirmatory factor analyses confirmed the original five-factor model: time-dependence, developmental, physical, social and emotional burden. This model fits the data better than the single-factor model, and the dimensions showed high internal consistency reliability (Cronbach's alpha 0.91 for time-dependence burden, 0.92 for developmental burden, 0.88 for physical burden, 0.89 for social burden and 0.93 for emotional burden; 0.96 for the total score of burden)., Conclusion: The CBI proved to be a good multidimensional instrument for evaluating the burden in caregivers of heart failure patients and can be used in clinical practice and research. This tool can be considered to tailor interventions aimed at improving caregiver outcomes.

Purpose: To evaluate the psychometric properties of the D-Catch instrument., Methods: A cross-sectional methodological study. Validity and reliability were estimated with confirmatory factor analysis (CFA) and internal consistency and inter-rater reliability, respectively., Findings: A sample of 250 nursing documentations was selected. CFA showed the adequacy of a 1-factor model (chronologically descriptive accuracy) with an outlier item (nursing diagnosis accuracy). Internal consistency and inter-rater reliability were adequate., Conclusions: The D-Catch is a valid and reliable instrument for measuring the accuracy of nursing documentation. Caution is needed when measuring diagnostic accuracy since only one item measures this dimension., Implications for Nursing Practice: The D-Catch can be used as an indicator of the accuracy of nursing documentation and the quality of nursing care., (© 2015 NANDA International, Inc.)

Introduction: midwifery records currently do not systematically collect data regarding midwifery care provided. Midwifery Minimum Data Sets (MMDS) have been developed to perform uniform and standardized data collection., Aim: to describe features, purposes and use of MMDSs in obstetrical care., Method: a literature review was conducted using Medline, CINAHL and Scopus databases. The following key words were used: "data set", "midwifery" and "maternity care., Results: twelve of 752 potentially eligible articles were included. Six MMDS were identified: Nurse - Midwifery Clinical Data Set, Optimality Index-United States, ACNM Benchmarking Data Collection Form, Midwives Alliance of North America Data Set, American Association of Birth Centers Uniform Data Set, Women's Health Care Minimum Data Set. Overall, the purpose of the different MMDSs was to record systematically the midwifery care provided and patient outcomes. The various MMDS had differing features; different data were collected related to women (e.g. socio-demographic data, anamnesis), their newborns (e.g. Apgar score, weight) and the midwifery care provided in different phases (e.g. antepartum, intrapartum). Generally, MMDS were used in north-American countries and their use showed the efficacy of midwifery interventions and the importance of systematic data collection., Discussion: an organized and standardized approach is needed to provide accurate data collection of maternal and neonatal health outcomes and midwifery care. The development and validation of MMDS in the Italian context is needed.

Aim: To test an explanatory model of nurses' intention to report adverse drug reactions in hospital settings, based on the theory of planned behaviour., Background: Under-reporting of adverse drug reactions is an important problem among nurses., Methods: A cross-sectional design was used. Data were collected with the adverse drug reporting nurses' questionnaire. Confirmatory factor analysis was performed to test the factor validity of the adverse drug reporting nurses' questionnaire, and structural equation modelling was used to test the explanatory model., Results: The convenience sample comprised 500 Italian hospital nurses (mean age = 43.52). Confirmatory factor analysis supported the factor validity of the adverse drug reporting nurses' questionnaire. The structural equation modelling showed a good fit with the data. Nurses' intention to report adverse drug reactions was significantly predicted by attitudes, subjective norms and perceived behavioural control (R² = 0.16)., Conclusions: The theory of planned behaviour effectively explained the mechanisms behind nurses' intention to report adverse drug reactions, showing how several factors come into play., Implications for Nursing Management: In a scenario of organisational empowerment towards adverse drug reaction reporting, the major predictors of the intention to report are support for the decision to report adverse drug reactions from other health care practitioners, perceptions about the value of adverse drug reaction reporting and nurses' favourable self-assessment of their adverse drug reaction reporting skills., (© 2017 John Wiley & Sons Ltd.)

Aims: Heart Failure (HF) self-care improves patient outcomes but trials designed to improve HF self-care have shown inconsistent results. Interventions may be more effective in improving self-care if they mobilize support from providers, promote self-efficacy, increase understanding of HF, increase the family involvement, and are individualized. All of these elements are emphasized in motivational interviewing (MI); few trials have been conducted using MI in HF patients and rarely have caregivers been involved in MI interventions. The aim of this study will be to evaluate if MI improves self-care maintenance in HF patients, and to determine if MI improves the following secondary outcomes: a) in HF patients: self-care management, self-care confidence, symptom perception, quality of life, anxiety/depression, cognition, sleep quality, mutuality with caregiver, hospitalizations, use of emergency services, and mortality; b) in caregivers: caregiver contribution to self-care, quality of life, anxiety/depression, sleep, mutuality with patient, preparedness, and social support., Methods: A three-arm randomized controlled trial will be conducted in a sample of 240 HF patients and caregivers. Patients and caregivers will be randomized to the following arms: 1) MI intervention to patients only; 2) MI intervention to patients and caregivers; 3) standard of care to patients and caregivers. The primary outcome will be measured in patients 3months after enrollment. Primary and secondary outcomes also will be evaluated 6, 9 and 12months after enrollment., Conclusion: This study will contribute to understand if MI provided to patients and caregivers can improve self-care. Because HF is rising in prevalence, findings can be useful to reduce the burden of the disease., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background and Purpose: The purpose of this study was to examine changes in stroke survivor and caregiver quality of life (QOL) and to determine whether changes in survivor physical functioning and caregiver burden (ie, the impact of the physical, psychological, and social demands of caregiving) influence changes in QOL., Methods: Longitudinal design with 226 stroke survivor-caregiver dyads enrolled at survivor discharge from rehabilitation hospitals. Data collection was performed over 12 months. We measured survivor physical functioning, caregiver burden, and QOL (physical, psychological, social, and environmental) in both survivor and caregiver. Multilevel modeling was used to control for the interdependence of the data., Results: Survivors (50% male sex) and caregivers (66% female sex) were 70.8 (SD=11.9) and 52.4 (SD=13.1) years old, respectively. Over the 12 months, stroke survivor's physical (γ=1.59; P <0.001) and psychological (γ=0.86; P <0.05) QOL significantly improved; social and environmental QOL did not P >0.05. Caregiver QOL, on average, did not significantly change over time P >0.05. Improvements in survivor physical functioning were associated with increases in survivor and caregiver physical and psychological QOL and survivor environmental QOL. Decreases in caregiver burden were significantly associated with improvements in caregiver physical, psychological, and environmental QOL but not with survivor QOL., Conclusions: QOL of stroke survivors and caregivers covaries and is greatly impacted by the physical function changes of the survivor. Dyadic approaches to stroke rehabilitation that acknowledge the interdependence of dyads are needed., (© 2017 American Heart Association, Inc.)

Considering the ethical issues related to nursing and that Ethics is an integral part of the nursing education in the degree course, one would suppose that academic dishonesty might be less frequent in nursing students than in students of other disciplines. However, several studies show that this trend of deceitful behaviour seems to be similar among the university nursing students and those of other disciplines. The aim of this study is to investigate the phenomenon of academic dishonesty in the classroom from a longitudinal perspective within a cohort of Italian nursing students. A non-experimental longitudinal design was used. All nursing students were recruited from the Nursing Science Bachelor Degree Program of a big Italian university in the centre of Italy and participants were part of an ongoing longitudinal research project which started in 2011 on nursing students' wellbeing. The results show that students get accustomed to taking academically deceitful actions. They come to consider their behaviours acceptable and normal, thereby stabilizing them, which increases the probability of stabilizing subsequent deceitful behaviours. The stability through time of academic cheating behaviours committed during higher education, within the study's timeframe, provides important perspectives into the establishment of rigorous standards of ethical and moral behaviours by the students., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Self-care is important in heart failure (HF) treatment, but patients may have difficulties and be inconsistent in its performance. Inconsistencies in self-care behaviors may mirror patterns of self-care in HF patients that are worth identifying to provide interventions tailored to patients., Objectives: The aims of this study are to identify clusters of HF patients in relation to self-care behaviors and to examine and compare the profile of each HF patient cluster considering the patient's sociodemographics, clinical variables, quality of life, and hospitalizations., Methods: This was a secondary analysis of data from a cross-sectional study in which we enrolled 1192 HF patients across Italy. A cluster analysis was used to identify clusters of patients based on the European Heart Failure Self-care Behaviour Scale factor scores. Analysis of variance and χ test were used to examine the characteristics of each cluster., Results: Patients were 72.4 years old on average, and 58% were men. Four clusters of patients were identified: (1) high consistent adherence with high consulting behaviors, characterized by younger patients, with higher formal education and higher income, less clinically compromised, with the best physical and mental quality of life (QOL) and lowest hospitalization rates; (2) low consistent adherence with low consulting behaviors, characterized mainly by male patients, with lower formal education and lowest income, more clinically compromised, and worse mental QOL; (3) inconsistent adherence with low consulting behaviors, characterized by patients who were less likely to have a caregiver, with the longest illness duration, the highest number of prescribed medications, and the best mental QOL; (4) and inconsistent adherence with high consulting behaviors, characterized by patients who were mostly female, with lower formal education, worst cognitive impairment, worst physical and mental QOL, and higher hospitalization rates., Conclusion: The 4 clusters identified in this study and their associated characteristics could be used to tailor interventions aimed at improving self-care behaviors in HF patients.