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The Self-Care of Heart Failure Index Version 6.2 (SCHFI v.6.2) is widely used, but its psychometric profile is still questioned. In a sample of 659 heart failure patients from Italy, we performed confirmatory factor analysis (CFA) to test the original construct of the SCHFI v.6.2 scales (Self-Care Maintenance, Self-Care Management, and Self-Care Confidence), with limited success. We then used exploratory factor analysis to determine the presence of separate scale dimensions, followed by CFA in a separate sub-sample. Construct validity of individual scales showed excellent fit indices: CFI = .92, RMSEA = .05 for the Self-Care Maintenance Scale; CFI = .95, RMSEA = .07 for the Self-Care Management Scale; CFI = .99, RMSEA = .02 for the Self-Care Confidence scale. Contrasting groups validity, internal consistency, and test-retest reliability were supported as well. This evidence provides a new understanding of the structure of the SCHFI v.6.2 and supports its use in clinical practice and research., (© 2013 Wiley Periodicals, Inc.)

Patient education is recognized as a central component of heart failure care and reduces hospital readmissions. Nurses have an important role in providing patient education and modifying self-care behaviors. The aim of this article is to examine characteristics of educational interventions for heart failure patients, their measured outcomes and the role of nurses in providing education. We conducted a literature review of the last 10 years and considered 30 articles. Multisession motivational interventions, repeated over time and with different follow-up interventions seem to produce the best results. However, some aspects remain controversial.

Objective: Clinicians worldwide seek to educate and support heart failure patients to engage in self-care. We aimed to describe self-care behaviors of patients from 15 countries across three continents., Methods: Data on self-care were pooled from 5964 heart failure patients from the United States, Europe, Australasia and South America. Data on self-care were collected with the Self-care of Heart Failure Index or the European Heart Failure Self-care Behavior Scale., Results: In all the samples, most patients reported taking their medications as prescribed but exercise and weight monitoring were low. In 14 of the 22 samples, more than 50% of the patients reported low exercise levels. In 16 samples, less than half of the patients weighed themselves regularly, with large differences among the countries. Self-care with regard to receiving an annual flu shot and following a low sodium diet varied most across the countries., Conclusion: Self-care behaviors are sub-optimal in heart failure patients and need to be improved worldwide., Practice Implications: Interventions that focus on specific self-care behaviors may be more effective than general educational programs. Changes in some health care systems and national policies are needed to support patients with heart failure to increase their self-care behavior., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: The implementation of adequate clinical information systems helps to deal with the immense flow of health data to ensure the continuity of care and access to a safe and high-quality healthcare system. Currently there is an increasing awareness of the importance of evaluating and measuring the impact of such systems in clinical practice. Implementations often fail, due to inadequate interaction between technology and human elements., Methods: This article describes a research project aimed at evaluating the impact of a clinical nursing information system (CNIS), called Professional Assessment Instrument (PAI), in clinical practice. The study will evaluate PAI Quality, Nurses Satisfaction, PAI Use, Nurses and Environment Characteristics, Net Benefits and Nurses' Experiences related to the PAI use. A theoretical model developed for this research will guide the study. A quali-quantitative longitudinal design will be performed involving two hospitals over a 9-month period. To measure different dimensions that affect the success/failure of CNIS we will use different tools/ methods of data collection (questionnaires, psychometric tools, surveys and focus groups)., Expected Results: This study will evaluate the impact of a CNIS in hospitals providing an overview of the factors which can help and hinder the implementation of an information system., Conclusions: The results of the study will support interventions to improve and implement clinical information systems designed to computerize nursing data, with positive effects on public health and research in general, providing further evidence for health policy.

Background: Caregivers make an important contribution to the self-care of patients with heart failure (HF), but few instruments are available to measure this contribution., Objective: The objective of this study was to test the psychometric properties of the Caregiver Contribution to Self-care of Heart Failure Index (CC-SCHFI), an instrument derived from the Self-care of Heart Failure Index version 6.2. The CC-SCHFI measures the contribution of caregivers to the self-care maintenance and self-care management of HF patients, as well as their confidence in their ability to contribute to the patients' HF self-care., Methods: A cross-sectional design was used to study 291 Italian caregivers whose HF patients were cared for in 17 cardiovascular centers across Italy. Caregivers completed the CC-SCHFI and a sociodemographic questionnaire. Caregivers were retested on the CC-SCHFI 2 weeks later to assess test-retest reliability., Results: Most caregivers were women (66%) with a mean age of 59 years. First- and second-order confirmatory factor analysis (CFA) for each CC-SCHFI scale showed good model fit: χ2 = 37.22, P = .08, Comparative Fit Index (CFI) = 0.97, Non-Normed Fit Index (NNFI) = 0.96 for caregiver contribution to self-care maintenance (second-order CFA); χ2 = 14.05, P = .12, CFI = 0.96, NNFI = 0.93 for caregiver contribution to self-care management (first-order CFA); and χ2 = 10.63, P = .15, CFI = 0.99, NNFI = 0.98 for caregiver confidence in contributing to self-care (second-order CFA). The CC-SCHFI was able to discriminate statistical and clinical differences between 2 groups of caregivers who had received or not received HF self-care education. Internal consistency reliability measured by factor score determinacy was more than .80 for all factors and scales except for 1 factor in the caregiver contribution to self-care management scale (.65). Test-retest reliability computed by intraclass correlation coefficient was high (>0.90) for most factors and scales., Conclusion: The CC-SCHFI showed good psychometric properties of validity and reliability and can be used to measure the contribution of caregiver to HF patient self-care.

Mucositis is a frequent side-effect of chemotherapy and radiotherapy. Assessment of oral cavity is important to detect alterations in the mouth and plan appropriate interventions. A reliable tool can help to have a better assessment of mucositis and a major knowledge about this phenomenon. Since no valid and reliable tool for the assessment of mucositis is still available in Italy, the aim of this study was to establish the validity and reliability of the Italian version of the Oral Assessment Guide (OAG). A panel of health care experts  established the content validity of the tool both for the items and the descriptors. To establish the reliability of the tool, a sample of 14 inpatients with haematological diseases were recruited. Couples of dental hygienists separately performed 60 pairs of assessments (for a total of 120 assessments) on the sample. The Italian version of OAG was found to have an acceptable Content Validity Index (CVI) for items and related descriptors ranging between 0.67 and 1. Cronbach's alpha was 0.84, agreement of assessment ranged between 0.87 and 0.65 with Cohen's Kappa coefficient  ranging from good to very good. This study showed that the Italian version of the OAG has good psychometric properties of validity and reliability to assess mucositis  in patients undergoing chemotherapy. This tool will have a great importance to carry out future research in Italy aimed to  improve the patient's outcomes particularly in terms of functional ability and quality of life.

This study was a retrospective analysis of prospectively collected data that aimed to map patients' care transitions following admission to a specialist palliative care service in Italy called Antea Centre. Patients' data was extracted from the Antea local database from 2007 to 2011. External transitions were defined as a change in the setting of care, with the patient no longer being cared for by Antea staff. Internal transitions were defined as a change in the setting of care, with the care still being provided by Antea staff. A total of 1123 patients out of 5313 admitted to the palliative service (21%) experienced transitions. Patients who experienced no transitions after their admission to the palliative care service were more likely to have a Karnofsky Performance Scale Index <30, to have been referred by a hospital physician, to have a shorter survival time, and to have home as their place of death (P<0.001). Although the patients with no transitions had worse clinical conditions, organisations should pay attention to reducing the possible negative effects of transitions, such as discontinuity of care and poor coordination.

Introduction: Preoperative anxiety is common in patients undergoing surgical interventions. Several international studies have shown the positive effect of music before minor surgery and invasive procedures, but the effect of music before major surgery was not explored., Aim: The aim of this study was to assess the effectiveness of music on anxiety in patients undergoing vascular surgery (aortic aneurism and thromboendarterectomy). Methods. Surgical patients were randomized to listening to music before surgery (music group) or to routine care. Anxiety was measured with the STAI-Y, administered three hours before surgery (Time 1) and before the induction of anesthesia (Time 2). After Time 1, only patients assigned to the music group listened to music., Results: The groups were comparable for the main characteristics. In the Music group (N 50) anxiety decreased after listening to music v the controls (N 50) (STAI-Y mean scores 52.2 and 31.1 respectively; p < 0.001). The differences between the two groups in the two measurements explained the 73% of the variance., Discussion: Listening to music is effective in decreasing anxiety in patients undergoing vascular surgery.

Objective: The introduction of medical humanities (MH) in undergraduate medical education in Italy has been an issue of debate since the 90's and few years later it was extended to other healthcare degrees. The aims of this Italian literature review, after considering the international scene, are: to evaluate the extent to which the interest in this subject has gradually developed throughout the country; which professional groups have contributed to the debate; to identify which theoretical constructs led to the introduction of MH in undergraduate medical education; to identify whether a clear and shared definition of MH exists in Italian literature; to verify what kinds of MH experiences have been accomplished in Italy., Materials and Methods: A comprehensive literature search was conducted, including electronic databases, bibliographies, manual sorting of articles in paper format, congress proceedings., Results: The analysis of the chosen articles underlines that, however limited, Italian literature does not present a very different picture from the international scene. It emerges that teaching MH is believed to be an important feature in undergraduate education of healthcare professionals who intend to propose a bio-psychological-social approach to care, in spite of the difficulty to measure its short and long term effectiveness. The lack of a multidisciplinary, multi-professional approach is also evident., Conclusion: Further research aiming to implement the quantity and quality of MH studies in the curricula of undergraduate healthcare education is desirable.

Introduction: In most countries where Internet is widely used the number of people surfing the web for healthcare information equals (and in some countries is more than) the number of people looking for healthcare assistance. More and more often, all over the world, Internet is integrated by advanced healthcare systems as a cornerstone of their e-health infrastructure, to meet citizens' needs for health information. Therefore, information plays a key role in the relationship between healthcare providers and citizenship. In 2010 the Italian Ministry of Health has worked out a set of guidelines to improve online communication, within the framework of health promotion., Objective: To analyze if the web sites of the Italian public hospitals (PH) and the local healthcare units (LHU) comply with the guidelines of the Italian Ministry of Health (IMH) on the improvement of online communication within the framework of healthcare promotion., Materials and Methods: All Italian PH and LHU web sites have been analyzed using the self evaluation tool of the IMH., Results: The total number of web sites analyzed was 245. Their compliance with the IMH guidelines was low. Web sites linking to other professional sites, such as the College of Physicians, the College of Pharmacists, or the College of Nurses, were 32 (13%). One hundred and forty-two (58%) were the sites that did not offer any kind of health information, such as pathophysiology of diseases, the most relevant pathologic conditions, risky behaviors, primary and secondary prevention's interventions. A web navigation menu organized according to the most relevant life events or according to categories of users (I am ... /dedicated to...) was available only in 53 web sites (22%)., Conclusions: The IMH's guidelines on online communication -- with reference to the aspects here analyzed -- have been in some ways disregarded and the criteria suggested by them have not been fully adopted by PHs and LHUs. Overall, communication is globally meant (and directed) "towards" citizenship and not "together with" the citizens. To reach this type of communication, experts suggest to redirect resources and efforts towards a different context, different tools and different models of communication, such as social networking. Further studies will be needed to fully understand information needs and expectations of users and the way to use social networking on behalf of healthcare providers.

Purpose: In recent years, the number of palliative service providers has increased significantly. This expansion necessitates an evaluation in order to provide the basis for quality improvement of the care. Policymakers, managers of palliative care programs, and others committed to the improvement of end-of-life care need methods and criteria to measure and evaluate the care delivered. As quality measurement is expensive and difficult to undertake, it is fundamental that quality measures evaluate the right things. Quality evaluation in Italy is supported by health authorities who have developed some indicators of palliative care. The aims of this study were to give an overview of these indicators., Methods: We analyzed all palliative care indicators developed by Italian national authorities from 2000 to the present. These indicators have been divided into three different levels of analysis (structure, process, and outcome). Subsequently, two reviewers have independently compared their degree of concordance with domains, and guidelines developed by the NCP for palliative care and after careful discussion an expert panel has elaborated a final consensus document., Results: Most of the quality indicators analyzed deal with the structure and process of palliative care, however they miss outcomes and do not cover domains mainly concerned with spiritual, ethical, cultural, or existential aspects of care., Conclusions: More attention should be paid to the development of outcome indicators of palliative care. The attempt to identify a group of indicators which cover every domain of palliative care represents a challenge for the future in terms of finding new cognitive models more oriented toward subjectivity.

The aim of a nursing data set is to provide useful information for assessing the level of care and the state of health of the population. Currently, both in Italy and in other countries, this data is incomplete due to the lack of a structured nursing documentation , making it indispensible to develop a Nursing Minimum Data Set (NMDS) using standard nursing language to evaluate care, costs and health requirements. The aim of the project described , is to create a computer system using standard nursing terms with a dedicated software which will aid the decision-making process and provide the relative documentation. This will make it possible to monitor nursing activity and costs and their impact on patients' health : adequate training and involvement of nursing staff will play a fundamental role.

Purpose: This study explored the meaning of quality of life (QOL) for Sardinian caregivers of people affected with Alzheimer's disease and factors improving and worsening their QOL., Design: The phenomenological method was used to study 41 Alzheimer's disease caregivers living on the western coast of Sardinia, Italy. Interviews were conducted and analyzed using Cohen, Kahn, and Steeves's approach., Findings: Extracted themes were the following: unity and cooperation in the family; freedom/independence; having time for themselves; serenity/tranquility; and well-being and health. Caregivers identified factors that they believed worsened or improved their QOL. Family was particularly important for these caregivers., Discussion: This study reinforces previous research about cultural influence on QOL and emphasizes the importance of nurses being culturally sensitive. Since Sardinia is a rural region, these findings may be useful for nurses working with caregivers in other rural settings.

Background: The workplace plays a central role in causing stress and different kinds of syndromes and diseases. More generally, organizational procedures and practices could have an impact on nurses' quality of life. Although several studies have investigated this link, none of them considered nurses working in prehospital emergency care., Objectives: To investigate the role of organizational health factors that affect the quality of life and psychosomatic complaints of ambulance nurses., Method: Our sample included 411 ambulance nurses. Workers were administered two questionnaires to assess organizational health and quality of life. Descriptive and correlational analyses were used to test our assumptions., Conclusion: Several organizational health dimensions provided an explanation for the complaints reported by nurses working in prehospital emergency care in terms of quality of life and psychosomatic disorders. The results allowed identification of possible interventions focusing on specific duties and organizational aspects that would improve the quality of nurses' health.

Caregivers represent an important source of care for older adults. Many studies focused on the negative aspects of elder caregiving but few studies have analyzed also the positive effects. In addition, no studies have considered contemporarily the positive and the negative impact of caregiving to elderly people on the same people using a structural equation modeling. The purpose of this study was to examine the contribution of elder care recipient factors, caregiver factors and caregiving factors in determining the positive and negative impact of informal caregiving to older adults using a structural equation model. A cross-sectional design was used to study eighty caregivers of older people. Several instruments were used to measure elder care recipient factors (functionality, cognition, behavior); caregiver factors (socio-demographics, depression, stress, quality of life, and perceived health); caregiving factors (time from caregiving, time of care, social restriction, place of living, expenses, and living with the elder care recipient); and the positive and the negative impact of caregiving. Caregivers were 59.7 years old while elderly people were 84.0. Several factors were significantly correlated with the positive and negative impact of caregiving. However, when these factors were entered in a structural equation model, only female gender and social restriction predicted the negative impact, while caregiver's quality of life and caregiving expenses predicted both the positive and the negative impact. The results of this study suggest a new framework of caregiving to older adults where the outcomes depend more on caregiver and caregiving factors than on older person characteristics. More research is needed with a larger sample to test further the model outlined in this study.

Unlabelled: Reliability of caregivers in assessing the quality of life of stroke survivors: an explorative study. Introduction. Not all stroke survivors are able to assess their quality of life (QOL), thus a caregiver could provide important information on patients' QOL., Objective: To assess caregiver's reliability in measuring QOL in stroke survivors., Method: Fifty (50) patient-caregiver dyads were recruited. Patients, hospitalized in rehabilitation facilities, were administered the Stroke Impact Scale 3.0 (SIS 3.0) patient version, the Barthel Index, the Modified Rankin Scale, and the National Institute of Health Stroke Scale. Caregivers completed the SIS 3.0 proxy version., Results: The mean scores of the SIS 3.0 patient version were very similar to the proxy version and ranged from 19.1 vs 16.2 for the Hand function domain to 83.81 vs 81.85 for the Communication domain. Caregivers tended to underestimate patients' QOL although scores were not significantly different. Intraclass correlations between the patient version and the proxy version of the SIS 3.0 were highly significant (p<0.001), with coefficient over 0.80. Lower coefficients were observed for the Social participation (0.58), Emotion (0.64) and Communication (0.79) domains., Conclusions: Caregivers were more reliable in assessing the physical rather than psychosocial domains.

Background: It is widely recognized that the working environment is crucial in the genesis of stress and other disorders that may affect nurses' health. The specific job context and the tasks performed by nurses in different clinical settings can be positive or negative predictors of organizational health., Objectives: The aim of this study was to describe and compare organizational health among nurses working in operating theaters and medical wards., Methods: For the study 670 nurses from six university hospitals in Italy were asked to participate and a total of 542 nurses constituted the final sample. The Nursing Organizational Health Questionnaire was used to collect the data and was administered from January to March 2010. A descriptive/comparative design was used., Conclusions: The results showed that nurses assigned to medical wards perceived their working environment as healthy and were significantly more satisfied and had less psychosomatic complaints than their colleagues working in operating theaters.

Literature reports several definitions of outcomes sensitive to nursing care. Van Der Bruggen and Groen defined nursing outcomes as observable and measurable aspects in individuals, groups and population that should be objective for clinicians and researchers and subjective for patients and families. Johnson and Maas defined nursing outcomes as variable behaviors or perceptions of family or caregiver after the caring intervention. According to the International Classification for Nursing Practice (ICNP), nursing outcomes are the status of a nursing diagnosis after the intervention. In the IowaOutcome Project, where Nursing Outcomes Classification (NOC) system has been elaborated, nursing outcome is a measurable condition, behavior or perception of the person or family conceptualized as sensitive variable to nursing care. Outcomes of NOC system are focused on individuals, families and community and refers to status, behavior or perceptions. Elements to be considered in nursing outcome definition are four: specific aspects of nursing care, the illness, general aspects of care, patient typology. It is important to identify which system for nursing evaluation outcomes are more suitable for Italy, where the field of action of nurses has faded edge with functions that mix and confuse with other professionals. Studies on the application of NOC taxonomy in Italy could be a starting point for defining and adapting an outcome evaluation system that will allow the objective visibility that nursing care gives to the global improvement of the cared person.

The purpose of this study was to establish the reliability and validity of the Italian version of the Stroke Impact Scale 3.0 (SIS 3.0), a specific and multidimensional instrument that assesses quality of life (QOL) in stroke survivors. Forty-five patients treated in three Rehabilitation Hospitals of the Lazio Region were included in the study. Patients were assessed using the SIS 3.0, the SF-36, the Barthel Index, the Mini Mental State Examination, the Hospital Anxiety and Depression Scale, the NIH Stroke Scale, the Modified Rankin Scale, and the Instrumental Activities of Daily Living. Results showed good internal consistency of the SIS 3.0 (Cronbach's alpha 0.86-0.98), and a good test-retest reliability (r > 0.70, p < 0.000) except for the Emotion and Social Participation subscales. At the re-test, 15 days after the first administration, SIS 3.0 showed a good responsiveness to change, documenting clinical improvement in stroke survivors. Significant correlations between the other instruments and the SIS 3.0 allowed to establish the concurrent validity of the SIS 3.0. Although the small sample size the Italian version of the SIS 3.0 showed good internal consistency and test retest reliability, as well as validity and responsiveness to changes. Since the SIS 3.0 is a specific tool to measure QOL in stroke survivors, its Italian version could be successfully used also in Italian population to better identify predictors of QOL and evaluate the effectiveness of health interventions.

Introduction and Hypothesis: The purpose of this study is to assess the incidence of female urinary incontinence (UI), risk factors, severity, and functional limitation using a cross-sectional survey in an Italian region., Methods: The method employed in this study was a questionnaire-based interview on non-institutionalized women. Outcomes were the UI prevalence, severity, associated factors, and functional limitation (ICIQ score)., Results: From October 2008 to February 2009, 1,346 women were interviewed and 15.3% were affected by UI. Univariate analysis found different risk factors, but multivariate analysis revealed only pelvic floor surgery, diabetes, vaginal deliveries, age, and educational level as significant. The involuntary loss of stools was more common in incontinent patients compared with healthy participants. The ICIQ values were significantly different between healthy and incontinent participants and a positive correlation existed with the estimated daily urine loss (r = 0.885, p < 0.001)., Conclusions: Symptoms of UI affected a substantial proportion of the population investigated. Pelvic floor surgery, diabetes, and vaginal deliveries are the most significant risk factors implicated.

In this article we discuss the implementation of a hospital nursing care unit in a local health authority in Rome (Italy), The hospital involved provides a wide range of healthcare and social services. The project is a very innovative one at the national level, with respect to healthcare services offered to patients with chronic disorders and associated disabilities. Starting from the concept of "centrality of the patient" in the area of healthcare services, we developed an organizational model where nursing care represents one of the basic elements.

Introduction: Instruments that measure job well-being have the aim to evaluate consequences as individual health due to job unsatisfaction but not nurse perception about organizational health. The aim of this study was to assess the psychometric characteristics of the Nursing Organizational Health Questionnaire (MOHQ), an instrument derived from the Multidimensional Organizational Health Questionnaire (MOHQ) that measures nursing organizational health., Methods: The MOHQ underwent to content validity by a group of experts that modified and added new items of the MHQ. Afterward the MOHQ was administered to a sample of 1279 nurses working in several contexts in Lazio and Umbria regions. Dimensionality of each scale of MOHQ, and concurrent validity of the new items were investigated using Exploratory Factor Analysis approach. Therefore Cronbach's alpha was computed for each dimensions of each scale to examine internal consistency., Results: Statistical analysis confirmed the factor structure of each scale and the reliability of the emerged dimensions. Moreover analyses have shown the importance of the new items to investigate specific dimension related to the nurse organizational context., Discussion: The present study showed that the MOHQ has good psychometric properties of validity and reliability and can be used to study organizational health in nursing population.

The aim of this study was to map existing ambulatory care nursing sites in Italy, compare operational and organizational methodologies used, and evaluate visibility of the sites in health institutions and the community. Nurses' level of satisfaction with this work experience was also evaluated. The American Academy of Ambulatory Care Nursing and American Nurses Association definition of ambulatory care nursing (1997) was used to select sites for the study. Two hundred fifty ambulatory care sites meeting this definition were listed, most of which provide clinical and educational services to oncology and cardiology patients. Surgical sites provide treatment of surgical wounds and stomas. Results of the study show that ambulatory care nursing sites are not uniformly distributed across Italy and a greater concentration of sites can be found in northern Italy with respect to central and southern Italy. Nurses report having greater professional autonomy and an excellent level of satisfaction. All interviewed nurses attend specific training and continuing education courses. Ambulatory care sites are managed by nurses; medical consultations are requested when necessary and home assistance is assured through coordination with general practitioners.

Introduction. The evolution of nursing profession in Italy and the modification of university currilula have stimulated the adoption of new didactic methods according to the new educational needs. In the present study the developement of tools and methods for evaluating and measuring clinical competences of undergraduate nursing students at Tor Vergata University of Rome are presented. These methods and tools have been developed by all professionals involved in nursing education.Methods. The new didactic methods have been implemented from the Academic Year 2006/2007. The developed methods and tools have been: the educational web site, the objectives and plans of clinical training for each year of course, the coordinators of clinical activities, the training diary and task, and the in-progress and final evaluation per each year.Results and Discussion. After the two-year experimentation, the distributed training diaries have been 185; all the training tasks with a positive outcome have been 637; students who passed the exam with the new methods and tools have been 294. Conclusion. The preliminary results of the present study do not allow yet to demonstrate all the competencies acquired by the students (this will be possible after November 2009), but show that they more adhere to the clinical education. In addition, the new educational methods and tools implemented in this study demonstrate as the students progress in nursing education.

The aim of this study was to measure Quality of Life (QOL) before a pacemaker (PM) implantation and 1, 6 and 12 months later. Using a descriptive, comparative and correlative design a sample of 157 patients was studied who were divided in four groups: the group A (43 patients) who had to implant the PM; the group B (38 patients) who had the PM implanted 1 month before; the group C (29 patients) who had the PM implanted 6 months before, and the group C (44 patients) who the PM implanted 12 months before. The SF-36 scale was used. Groups B, C and D had QOL levels significantly higher than group A. In group A QOL was higher in people who were male, older, more educated, with higher income, more cohabitants and children. In group B QOL was higher in patients with ventricular pacing, male, younger, without job and illnesses. In group C QOL was higher in patients with non rate responsive PM, younger, without job and illnesses. In group D QOL was higher in younger and in those without job and illnesses. The present study gives and overview of QOL before and after a PM implantation and highlights the importance to modify nursing care from the preoperative to the immediate and later postoperative period.

The process nurses adopt to solve the patients' problems is known as "Problem Solving" in the literature. Problem Solving Abilities include Diagnostic Reasoning, Prognostic Judgment and Decision Making. Nursing students apply the Problem Solving to the Nursing Process that is the mental and operative approach that nurses use to plan the nursing care. The purpose of the present study is to examine if there is a positive relationship between the number of Educational Tutorial Strategies (Briefing, Debriefing and Discussion according to the Objective Structured Clinical Examination Methodology) used for nursing students and their learning of Problem Solving Abilities (Diagnostic Reasoning, Prognostic Judgment and Decision Making). The study design was retrospective, descriptive and comparative. The Problem Solving Instrument, specifically developed for this study and proved for its reliability and validity, was used to collect the data from a sample of 106 nursing care plans elaborated by the second-year students of the Bachelor Degree in Nursing of the University of Udine. Nursing care plans were elaborated during three times consecutively, after students had participated in different Educational Tutorial Strategies. Results showed that the more the students took part in a higher number of Educational Tutorial Strategies the more they significantly increased their Problem Solving Abilities. The results demonstrate that it is important to use Educational Tutorial Strategies in the nursing education to teach skills.

Aim: This paper is a report of a study to describe the meaning of quality of life for caregivers of patients with Alzheimer's disease and to identify factors that affect their quality of life., Background: The burden for informal caregivers and change in their quality of life can lead to patients being placed in nursing homes. Factors found to worsen caregivers' quality of life include strained finances, poor family functioning, difficult patient behaviour, financial burdens and the amount of time caregivers spend caring for family members with Alzheimer's disease., Method: A hermeneutic phenomenological design was used to study 32 informal caregivers of patients with Alzheimer's disease. Data were collected using interviews between November 2004 and June 2005., Findings: Caregivers associated good quality of life with serenity, tranquility, psychological well-being, freedom, general well-being, good health and good financial status. Factors that caregivers said improved their quality of life were good health of the patient, independence from the patient, and more help in caregiving. Factors that worsened their quality of life were worries about the future and progression of the patient's illness and stress., Conclusion: Our findings may help healthcare professionals have a deeper understanding of the meaning caregivers give to quality of life and thereby aid in the design of strategies to maintain or improve quality of life. Intervention research is needed for caregivers in countries where this has not yet been performed. Researchers should also investigate whether different types of caregivers (spouse, adult child and friend) have different needs or problems.

Unlabelled: Current questionnaires for assessing satisfaction of university students are not specific for nursing education., Aim: The aim of this study was to develop an instrument to measure the quality of baccalaureate nursing education., Method: Guidelines by DeVellis were adopted to develop the instrument. After expert review the initial 98 items identified were reduced to 63. The questionnaire was administered to 325 nursing students in Latium and Tuscany regions. A Delphi survey was carried out to validate the contents according to the students' opinions, expressed on a 5 point Likert scale., Results: Three-hundred-ten questionnaires were completed and considered for the present study. The mean age of the students was 25.4 years, 69.3% were females. Items which scored less than 2.5 on average at the Delphi survey were removed, as well as those which correlated less than 0.40 with the total score. Thus, 41 items were definitely considered for the Scale for Quality Evaluation of the Bachelor Degree in Nursing (SQEBDN). Reliability of the Scale resulted in a very high Cronbach's alpha (0.93). The construct validity was tested with factor analysis that showed 10 factors, while criterion-related (divergent) validity showed statistically significant correlations of all the items with those assessing the dissatisfaction for educational activities. Third year students as well as older students had the worst perception the quality of nursing education., Conclusions: The SQEBDN, although requiring further studies, represents a useful instrument to measure the quality of the bachelor nursing degree.

Hope, long considered an essential element for life, has been shown to be important among cancer patients in coping, perceived control over the illness, and psychologic adjustment to the illness. The purpose of this study was (a) to describe the level of hope in Italian cancer patients; (b) to compare the levels of hope during and after hospitalization; (c) to determine whether hope was correlated with quality of life and several symptoms; and (d) to determine whether the variables from the international literature also pertain to Italian cancer patients. A descriptive correlational design using repeated measures was chosen to study 80 Italian cancer patients during hospitalization and then at home. The following instruments were used: a Sociodemographic Questionnaire, the Hope Related Variable Questionnaire, the Nowotny Hope Scale, the Rotterdam Symptom Checklist, and the Hospital Anxiety and Depression Scale. Overall, patients were moderately hopeful and the level of hopefulness was similar in the hospital and at home. Hope was positively correlated with quality of life, self-esteem, coping, adjustment to the illness, well-being, comfort in the hospital, satisfaction with information received, relationship with, and support from family, healthcare professional, and friends. Hope was negatively correlated with anxiety, depression, and boredom during hospitalization. Time since diagnosis, illness stage, and knowing or not knowing the diagnosis and treatment were not correlated with hope. Similarities and differences with the international literature are discussed, and implications for caring for Italian cancer patients are drawn.

Nursing research is a systematic and very important enquiry for improving clients' quality of life and effective and efficient nursing care. National and international literature state that all nurses should have knowledge and responsibilities in research which are different in relation to their educational level. The aim of the present study was to collect opinions of the new professors in nursing about objectives, contents and methods for teaching nursing research at Bachelor and Master Degree. The sample was made of nine participants who were interviewed by twenty questions sent by e-mail. The interviews were analysed using quantitative-descriptive and qualitative-phenomenological methods (triangulation). Interviews revealed that Bachelor students should be educated to retrieve and criticise scientific literature, to apply research finding in practice and to collaborate in research studies; Master students should improve knowledge of Bachelor degree and be able to design and conduct research studies. Participants emphasised the importance of using active methodologies for teaching and to involve students in research. By analysing the literature and the results of the present study educational objectives for teaching nursing research at Bachelor and Master degree are defined.

Changes in the National Health Service (NHS), in nursing laws and education made necessary a first level Master to teach nurses managerial competences for coordinational functions. Nowadays nurse coordinator are important in health organization in order to transform individual knowledges of nurses in effective, efficient and appropriate care practice. The project of the First Level Master in Nursing Management for Coordinational Functions run at the Catholic University of Rome, kept into consideration changes in NHS, nursing laws and education. The Master was made of four modules in order to teach learning specific competences. The Pedagogy of the Contract was used to guide the training. A Form based on the Pedagogy of the Contract was developed. This Form helped in defining the training objectives and their evaluation. The Model of the Reflection about the Experience and the presence of a tutor were used to integrate education with training settings. This Master emphasized the current functions of the nurse coordinator such as problem solving, direction, organization and mainly the management of knowledge of coordinated nurses.

The aim of this study was to investigate the anxiety and depression of cancer patients hospitalized and at home. Using a descriptive, correlational and comparative design and the Roy Adaptation Model, a sample of 80 oncologic patients was studied. Several instruments were used to measure anxiety and depression (HADS), quality of life and symptoms (RSCL), sociodemographic factors, variables connected to the hospitalization, quality of the relationship with health practitioners, family members and friends and the degree of satisfaction for the received information and support. The examined variables were measured on the same patients at hospital and at home. About the 30% of the patients were anxious and depressed. Statistical analysis showed that while anxiety did not change from the hospital to home, depression increased soon after the discharge and decreased over time and after the increasing of the number of hospital access. Anxiety and depression were positively correlated to boredom during the hospitalization, physical symptoms, number of the patients children, and previous anxious and depressive problems. Anxiety and depression were negatively correlated to the ward comfort, the support of health practitioners, family members and friends and the satisfaction for the received information. Differences between this study and the international literature are discussed. Recommendations for the future research and nursing practice are given.

Family caregiving for those who suffer from Alzheimer's disease is an important but understudied area in Italian nursing. Population ageing and the existing burden of care for family caregivers indicate that there will be enormous pressure on families in the future to provide adequate and culturally appropriate care. This study attempted to redress this situation by examining anxiety and depression among 34 female Italian Alzheimer's caregivers over a total of 816 caregiving days. A descriptive, repeated measures design was used, using three instruments to survey caregiving: a General Questionnaire about Caregiving, the Spielberg State-Trait Anxiety Inventory and the Geriatric Depression Scale. Findings indicated that caregivers suffered high levels of anxiety (76%) and depression (42%). Statistical analyses showed that the anxiety and depression scores were positively correlated with hours of care, physical and psychological illness scores, and negatively correlated with level of education and time for leisure activities. However, no significant correlations were found with the Mini Mental State Examination scores, demonstrating that the burden of care is large, irrespective of the extent of mental impairment. Implications of the findings suggest that support and assistance given to Italian caregivers might be inadequate, particularly with respect to respite services and educational support.

The aim of this study was to evaluate the levels of stress, anxiety and depression in women caregivers of Alzheimer's disease patients. A convenience sample of 37 women caregivers living with the patients was studied using a descriptive-correlational design. A sociodemographic questionnaire with scales measuring the variables taken into consideration were utilized. Caregivers were 60 years old, devoted to the patients 17 hours of caring per day and had only 1 hour for their personal needs. The 54, 21 and 29% of the sample had high levels respectively at the stress, anxiety and depression scale. Stress, anxiety and depression were positively correlated with caring hours, sleep problems in caregivers and behavioural disturbances of the patients; and were negatively correlated with free time and time spent out of the home. Implications for nursing care resulting from this study consists in giving more support to caregivers in order to avoid their excessive involvement in caring and in guaranteeing educational interventions to help caregivers to manage the behavioural disturbances of the patients.

Purpose: To obtain a more complete understanding of the experience of Italian caregivers of people with Alzheimer's Disease (AD)., Design and Methods: In this phenomenological study of AD Italian caregivers, the participants were 26 family caregivers (6 men and 20 women, of whom 19 were spouses and 7 were children)., Findings: Six themes were identified in this analysis: changes in relationships, changes in lifestyle, difficulties in caring, hopes and fears for the future, family duty, and respectful treatment. Caregivers experienced profound changes in their lives, including changes in their relationships with patients, in their lifestyles, and in their relationships with other family members. Caregivers experienced difficulties in caring because of their lack of knowledge about the illness and the lack of support from the National Health System. Participants hoped to not see their loved ones' conditions worsen and hoped to see positive results from prescription medications. Moreover, they hoped that God would help them go on. Some caregivers feared that the illness was hereditary and that they would not be able to cope with it. The Italian caregivers' respectful treatment of the patients demonstrated their profound sense of family duty, which included encouraging the patients to do self-care and occupational activities., Conclusions: Similarities and differences among Italian caregivers and those in other countries are discussed, and implications for Italian health professionals and directions for future research are addressed.

Phenomenology is a thought movement the main aim of which is to study human fenomena as they are experienced and lived. Key concepts of phenomenology are: the study of lived experience and subjectivity of human beings, the intentionality of consciousness, perception and interpretation. Phenomenological research method has nine steps: definition of the research topic; superficial literature searching; sample selection; gathering of lived experiences; analysis of lived experiences; written synthesis of lived experiences; validation of written synthesis; deep literature searching; writing of the scientific document. Phenomenology and phenomenological method are useful for nursing either to develop knowledge or to guide practice. Qualitative-phenomenological and quantitative-positivistic research are complementary: the first one guides clinicians towards a person-centered approach, the second one allows the manipulation of phenomena which can damage health, worsen illness or decrease the quality of life of people who rely on nursing care.

The aim of this article is to report the preliminary results from a phenomenological study on the lived experience of Alzheimer's caregivers. Eight caregivers involved in caring for two years at list were interviewed. The analysis of interviews by Giorgi's method showed a multidimensional reality synthesizable in eight spheres of themes: Illness, Patient, Caring, Caregiver's Life and Health, Coping, Spouse/Family, Others, Feelings. Illness has a great impact on the caregivers' life and causes the loss of the affected person even before his/her death. Caring is very hard and emotionally involving. Caregivers mainly complain the lack of support from the National Health System. The continuous involvement in caring produces also health problems, depression, and negative effects within the family. Others are considered as bad. The most common feelings are fear for possible accidents to the patients and remorses. Some caregivers have good coping style putting their faith in God, valuing the closeness of the family and living daily. The utility of the eight spheres of themes are discussed in order to guide the practice toward the caregivers.

Instruments for quantitative nursing research are a mean to objectify and measure a variable or a phenomenon in the scientific research. There are direct instruments to measure concrete variables and indirect instruments to measure abstract concepts (Burns, Grove, 1997). Indirect instruments measure the attributes by which a concept is made of. Furthermore, there are instruments for physiologic variables (e.g. for the weight), observational instruments (Check-lists e Rating Scales), interviews, questionnaires, diaries and the scales (Check-lists, Rating Scales, Likert Scales, Semantic Differential Scales e Visual Anologue Scales). The choice to select an instrument or another one depends on the research question and design. Instruments research are very useful in research both to describe the variables and to see statistical significant relationships. Very carefully should be their use in the clinical practice for diagnostic assessment.

This replication study/Riccio 1996) sets out to explore the Quality of sleep of 34 women primary caregivers of Alzheimer's Disease patients at home. A descriptive, correlational and longitudinal design has been used. Key aspects considered were the quality of nocturnal sleep, the daytime sleepiness, the hours of caring, the educational level, the employment, the time for personal needs and the levels of depression and anxiety. After an initial interview, the caregivers were asked to fill in several instruments to measure the variables taken into consideration. The caregivers presented poor quality in their sleep. Quality of nocturnal sleep was negatively affected by more hours of caring (p < 0.02), high depression and anxiety levels (p < 0.05 and 0.007 respectively). The education level, the employment outside home and the amount of time spent for themselves, positively affected the quality of sleep (p < 0.01, 0.04, 0.05 respectively). This research pointed out that hours of caring, directly and indirectly, cause sleep problem to Alzheimer's Disease caregivers enhancing nursing care implications.

Peplau's theory is one of the early Nursing theories, published in 1952. The nurse-patient relationship consists of four steps (orientation, identification, development and conclusion). In these steps nurse could have the role of foreign, reliable person, teacher, guide in nursing care, substitute and consultant. Nurse-patient relationship is influenced by psychobiological experiences (needs, frustrations, conflicts and anxiety) which need dynamism. Peplau thinks that Nursing care is an important opportunity for nurse because she can help patient to complete the infancy psychological tasks (learning to rely on other people, learning to show satisfaction, self-identifying, and developing ability in sharing) if these are not completed. For these reasons Nursing, by Peplau, is a maturation strength of civilization.