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Background: International studies have shown that laboratory training, particularly through the application of the principles of simulation learning, is an effective means of developing the communication and gestural skills of healthcare professionals. At the Advanced Simulation Center of the University of Genoa we have therefore established the first clinical skill laboratory with medical school students and an interprofessional team of trainers, as the first step towards developing simulation training of both medical and nursing students at our University.The aim of this study was to assess student satisfaction with laboratory training in an Advanced Simulation Center., Methods: All of the third-year students of the Medical School (n = 261) were invited to participate in the laboratory sessions at the Advanced Simulation Center. They were divided into groups and attended the Center for one week. The team of trainers included medical doctors and nurses involved in teaching at the University Medicine and Nursing programs. At the end of the week, the students were administered an anonymous questionnaire made up of two sections: the first one was on the content of individual laboratory sessions; the second on the training methods, materials used and the trainers. A five-point Likert scale was used to measure satisfaction., Results: According to the students all of the topics covered by the laboratory sessions were irreplaceable. Questionnaire results showed a high level of satisfaction with the methods used, the instruments developed, and with the expertise and approachability of the educators. Almost all of the students wanted to participate in similar laboratory activities in the future., Conclusions: The study highlighted the need to permanently integrate laboratory training sessions into the curriculum of medical students, who found them very useful and stimulating. The limit of this study was that only the teaching staff was interprofessional, and the students were only 3rd Year students of medicine.In the future, we hope to include also nursing students because they will need to learn how to deal with aspects of their clinical practice that require an interprofessional approach.

Background: Mathematical and calculation skills are widely acknowledged as being key nursing competences if patients are to receive care that is both effective and safe. Indeed, weaknesses in mathematical competence may lead to the administration of miscalculated drug doses, which in turn may harm or endanger patients' lives. However, little attention has been given to identifying appropriate teaching and learning strategies that will effectively facilitate the development of these skills in nurses. One such approach may be simulation., Objectives: To evaluate the effectiveness of a Clinical Skills Workshop on drug administration that focused on improving the drug-dosage calculation skills of second-year nursing students, with a view to promoting safety in drugs administration., Design: A descriptive pre-post test design., Settings: Educational. Simulation center., Participants: The sample population included 77 nursing students from a Northern Italian University who attended a 30-hour Clinical Skills Workshop over a period of two weeks., Methods: The workshop covered integrated teaching strategies and innovative drug-calculation methodologies which have been described to improve psychomotor skills and build cognitive abilities through a greater understanding of mathematics linked to clinical practice., Results: Study results showed a significant improvement between the pre- and the post-test phases, after the intervention. Pre-test scores ranged between 0 and 25 out of a maximum of 30 points, with a mean score of 15.96 (SD 4.85), and a median score of 17. Post-test scores ranged between 15 and 30 out of 30, with a mean score of 25.2 (SD 3.63) and a median score of 26 (p<0.001)., Conclusions: Our study shows that Clinical Skills Workshops may be tailored to include teaching techniques that encourage the development of drug-dosage calculation skills, and that training strategies implemented during a Clinical skills Workshop can enhance students' comprehension of mathematical calculations., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Aim: To describe a protocol for a quantitative systematic review, to identify critique and summarize factors that influence self-management education., Background: Self-management education enables patients to manage their condition successfully and it is associated with better self-care, good control over lifestyle and leading the best possible quality of life, notwithstanding the presence of a chronic disease. Type II Diabetes is a chronic disease that requires lifestyle adjustments and disease management to keep glycaemia and long-term complications under control. Education has to be customized and based on an assessment that includes factors influencing self-management, such as personal characteristics that can optimize the educational intervention., Design: The protocol for the systematic review was conducted according to the guidelines of the Centre for Reviews and Dissemination, York (UK)., Method: The review question was defined in terms of population, interventions, comparators, outcomes and study designs. The protocol included decisions about the review question, inclusion criteria, search strategy, study selection, data extraction, quality assessment, data synthesis and plans for dissemination. Funding for the review was confirmed on January 2011 by the Centre of Excellence for Nursing Scholarship in Rome., Discussion: An initial summary will be made by tabulating the data; the review will be reported in a narrative style and be developed according to the PRISMA guidelines. The protocol for the systematic review will allow us to identify, among the factors influencing self-management in people with Type II diabetes, the personal characteristics most relevant to the factors of motivation and empowerment. In addition, the systematic review will also identify an appropriate self-management model., (© 2013 John Wiley & Sons Ltd.)

Aims and Objectives: To describe what puerperal women know about postpartum contraception and to identify their related needs and expectations., Background: Puerperal women face the problem of beginning or resuming contraception, the choice of the right method of contraception and the right time to start it. This choice becomes particularly important in case they breastfeed since the contraceptive method should not interfere with breastfeeding. Different factors, such as the level of knowledge women have about various contraceptive methods, their individual preferences or their desire to have a baby, can strongly influence this choice., Design: A cross-sectional study had been carried out within the period of six months, from November 2011-February 2012., Methods: Three hundred puerperal women were interviewed before their discharge from a Maternity Home. The women were asked for their personal characteristics, their maternity history, the information they had received, their knowledge and expectations about postpartum contraception and their intention to use contraception., Results: During pregnancy and postpartum, 45.5% of the women reported that they had received adequate information about contraception. Of these ones, 64.3% reported their intention to use contraception either to avoid pregnancy or to space out future births, even if they did not always have appropriate knowledge about fertility and the use of contraceptive methods during postpartum. During this study, we also discovered that women's intention to use contraception was proportional to their level of education., Conclusion: Women need more and appropriate information about postpartum contraception, to make a conscious choice in relation to their needs and without putting their health at risk., Relevance to Clinical Practice: To promote awareness of the choices related to postpartum contraception, it is important to understand the personal characteristics that influence or hinder this choice. Midwives can play a very important role in informing women and in developing educational interventions to support a safe contraceptive choice., (© 2013 John Wiley & Sons Ltd.)

Aim: To validate the Staff Attitudes to Nutritional Nursing Care Geriatric scale in Italian, a tool created in Sweden to measure nurses' attitudes towards nutritional care in older people., Background: Malnutrition in institutionalized older people is a serious problem having negative impact on patient outcomes. It is reported in the literature that nurses have negative attitudes towards nutritional care., Methods: Forward and back-translation were carried out to build the Italian version of the tool. Content and face validity were then examined by pilot study. Test-retest reliability with Spearman's rho (rs) correlation, intraclass correlation (ICC) and internal consistency reliability with Cronbach's α were assessed. Differences between test-rest were assessed by t-test., Results: Linguistic and semantic adaptation of the tool into Italian was successful. Thirty-three nurses skilled in caring for older patients did pilot testing and 46 test-retesting. SANN-G GITA-scale achieved good content and face validity, good internal consistency reliability (Cronbach's α = 0.85) and acceptable stability [rs = 0.75, P = 0.001; ICC = 0.76, 95% confidence interval (CI) 0.63-0.86; P = 0.001]. The t-test showed no significant difference between test and retest results, confirming stability of the tool (t(64) = -0.98; P = 0.33)., Discussion: The process of adaptation of the scale from Swedish to Italian language was successful. Thus, the SANN-GITA scale can be useful to assess attitudes of nursing staff to nutritional care in the Italian context., Conclusions: This tool will allow the identification of areas where Italian nurses have negative attitudes and where to implement strategies to improve overall nutritional care., (© 2013 International Council of Nurses.)

Objective: The aim of this study was to identify effective corrective measures to ensure patient safety in the Paediatric Emergency Department (ED)., Methods: In order to outline a clear picture of these risks, we conducted a Failure Mode and Effects Analysis (FMEA) and a Failure Mode, Effects, and Criticality Analysis (FMECA), at a Emergency Department of a Children's Teaching Hospital in Northern Italy. The Error Modes were categorised according to Vincent's Taxonomy of Causal Factors and correlated with the Risk Priority Number (RPN) to determine the priority criteria for the implementation of corrective actions., Results: The analysis of the process and outlining the risks allowed to identify 22 possible failures of the process. We came up with a mean RPN of 182, and values >100 were considered to have a high impact and therefore entailed a corrective action., Conclusions: Mapping the process allowed to identify risks linked to health professionals' non-technical skills. In particular, we found that the most dangerous Failure Modes for their frequency and harmfulness were those related to communication among health professionals., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Aims: To investigate how the issue of malnutrition in institutionalised older people is perceived by nurses in a Teaching Hospital in Italy and how some aspects that can prevent malnutrition are dealt with., Background: Malnutrition in institutionalised older people is still a significant and unresolved problem. Many studies have been published on the inadequacy of nutritional care. Nurses play a strategic and key role in the prevention of malnutrition. Knowing how nurses perceive the problem of malnutrition and how they deal with aspects that can prevent malnutrition can be an important starting point for implementing strategies that will improve overall nutritional care., Methods: A Focus Group (FGs) study was conducted in a Teaching Hospital in the north-west of Italy with 33 nurses, who were still working or had worked with older people. The FGs were audio-taped and transcribed verbatim. Data collection was stopped when we achieved saturation. Two researchers independently analysed the transcription for content analysis and negotiated the emerging categories., Results: Although nurses perceived malnutrition as a significant issue, it was often considered of secondary importance compared with other aspects of care. Food choice, although available, is often limited to very few options, diets are standardised and monotonous and patients must choose 'sight unseen'. Time constraints and understaffing were the obstacles for the identification of the need for nutritional care. Organisational and managerial decision-making did not ensure the provision of high-quality nutritional care. Patients' nutritional status was often not assessed, and tools such as the Mini Nutritional Assessment were not mentioned by the participants., Conclusion: Our study substantially confirmed what is reported in the literature. However, it is necessary to raise nurses' awareness around poor nutritional care to prevent malnutrition in institutionalised older people., (© 2012 Nordic College of Caring Science.)

Background: Palliative Care (PC) is an approach that improves the Quality of Life (QoL). A number of QoL assessment tools have been developed and validated in PC. It is not clear how QoL should be measured in PC practice. A procedure of QoL assessment in clinical practice can be defined as a clinical intervention focused on QoL assessment. This is a typical complex intervention that should be appropriately developed and described in all its components and assessed for its effectiveness. The aim of this study is to define a framework to help researchers to develop and evaluate clinical interventions focused on QoL assessment in PC., Methods: A study group of experts in PC and in research methodology was set up to define a framework that would describe the principles of clinical interventions focused on QoL assessment in PC. The study group discussed the WHO Population Screening Principles as a possible useful framework. The new principles had to be developed taking into account the following criteria: 1) specific to PC practice; 2) address a single underlying characteristic; 3) anchored to relevant literature; 4) consistent with the WHO PC definition.With regard to contents and the format of the principles, discussions occurred among the study group members through a cognitive process., Results: We reviewed each of the WHO Population Screening Principles and adapted them to QoL assessment, taking into account the defined criteria. As a result, a new framework, the QoL Assessment Principles in Palliative Care was developed. It consisted of 4 sections, for a total of 11 principles., Conclusions: The WHO Screening Principles framework was used to outline the eleven essential principles to be considered in developing and/or evaluating clinical interventions focused on QoL assessment in PC. The QoL Assessment Principles in Palliative Care identified could represent a methodological and ethical standard to be considered when developing and evaluating a clinical intervention focused on QoL assessment in PC.

Falls can be considered as the most relevant accident for frequency and severity among in-hospital paediatric accidents (0-18 years). There is still a lack of a common framework in defining and categorizing paediatric falls across European and Italian paediatric centres. The aim of this survey was to explore key aspects of paediatric in-hospital falls in a number of Italian paediatric facilities. In 2010, a questionnaire was sent to 15 paediatric centres selected through convenience sampling. Fourteen questionnaires (93.3%) were returned, six centres (42.9%) define clearly the term "fall", while 8 (57.1%) declare to track falls frequency; three (21.4%) trace the consequences of falls. Four centres (28.6%) track the impact of falls on care plans. Usually information on falls and on children are collected (10 centres, 71.4%) and reporting procedures are frequently in place (10, 71.4%); whereas, fall management procedures (5 centres, 35.7%) are rarely in place. Five centres (35.7%) use a paediatric fall risk assessment tool (devised by the centre itself, and not validated); none of the implemented prevention measures for high-risk patients evaluate effectiveness. Data show a lack or no consistency of paediatric fall-related practices in Italian paediatric facilities, this phenomenon its impact on care plans and healthcare costs is therefore difficult to evaluate, as well as making a comparison between facilities. Collaboration among major paediatric centres should be encouraged in order to establish a common framework and share approaches.

Aim: The aim of this study was to assess the number of falls that occurred among children admitted to a children's hospital and explore their characteristics., Method: A descriptive, longitudinal, prospective design was chosen. Data were collected from records of a children's hospital over six months and analysed using descriptive statistics., Results: Fifty eight falls were investigated. Most of these involved children, mainly boys, aged between one and three years, and most occurred in the evenings. All but one child was injured and 30 received medical interventions. In most cases an adult was present but was not paying sufficient attention to the child., Conclusion: Falls among children admitted to a children's hospital are increasingly recognised as an issue to be addressed by health organisations. Further investigation is required on a larger scale to agree definitions, classifications and preventive measures concerning children falling in hospital.

Aims: To understand what level of awareness health professionals working in a hospital of Northern Italy had of the patient safety culture by using the Italian version of the Hospital Survey on Patient Safety Culture questionnaire and also validate its use in this setting., Background: The Hospital Survey on Patient Safety Culture questionnaire was developed by the Agency for Health Research and Quality in 2008 and validated by several studies. Therefore, we decided to test the Italian version of this tool to see if it could be used effectively to measure and appraise patient safety culture also in Italy., Design: Survey., Methods: To check the validity of the questionnaire, we applied the continued comparison and the global data treatment methods., Results: Of the 1008 questionnaires we administered, 724 (71%) were returned. The majority of the questions were answered (mean 98, SD 3·4%). From a Chi-square test on the consistency of the answers, we found that six of the 12 perspectives we explored had a high level of significance, whereas in the other six, the differences in the answers were just casual., Conclusions: The Italian version of the Hospital Survey on Patient Safety Culture questionnaire allowed us to assess health professionals' awareness of patient safety culture and thus validate the effectiveness of this tool., Relevance to Clinical Practice: The findings of our survey could be useful to design an objective tool that would allow the five health professional groups involved in the study (directors/coordinators, physicians, nurses/midwives, physiotherapists and technicians) gain a better knowledge of the patient safety culture and thus improve the quality of clinical practice., (© 2011 Blackwell Publishing Ltd.)

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

Purpose: Ensuring safe healthcare services is one of today's most challenging issues, especially in light of the increasing mobility of health professionals and patients. In the last few years, nursing research has contributed to the creation of a culture of safety that is an integral part of clinical care and a cornerstone of healthcare systems., Organizing Constructs: European institutions continue to discuss methods and tools that would best contribute to ensuring safe and high-quality care, as well as ensuring access to healthcare services. According to the European Commission between 8% and 12% of patients admitted to hospitals in the European Union member states suffer from adverse events while receiving care, although some of these events are part of the intrinsic risk linked to receiving care. However, most of these adverse events are caused by such avoidable healthcare errors as, for instance, diagnosis mistakes, inability to act on the results of tests, medication errors, failures of healthcare equipment and hospital infections. Nosocomial infections alone are estimated to affect 4.1 million inpatients, that is, about 1 of every 20 inpatients, causing avoidable suffering and mortality, as well as an enormous loss of financial resources (at least euro5.48 billion a year)., Conclusions: The Internal Market Information (IMI) System, developed by the European Commission, aims at contributing to patient safety by means of a timely and updated exchange of information among nursing regulatory bodies on the good standing and scope of practice of their registrants. Through the IMI System, the European Federation of Nursing Regulators will improve its electronic database on nurses to allow national nursing regulatory bodies to exchange the information needed to recognize the nurses' educational and professional qualifications and competencies. This process both facilitates the mobility of professionals and ensures high-quality nursing practice in an even and consistent way across the European Union., Clinical Relevance: On a national basis, nursing regulatory bodies play an important role in ensuring patient safety through high standards of nursing education and competence, whereas on an international basis, patient safety can assured by a better exchange of information between national regulatory bodies on the good professional standing of nurses.

A main identifying factor of professions is professionals' willingness to comply with ethical and professional standards, often defined in a code of ethics and conduct. In a period of intense nursing mobility, if the public are aware that health professionals have committed themselves to the drawing up of a code of ethics and conduct, they will have more trust in the health professional they choose, especially if this person comes from another European Member State. The Code of Ethics and Conduct for European Nursing is a programmatic document for the nursing profession constructed by the FEPI (European Federation of Nursing Regulators) according to Directive 2005/36/EC On recognition of professional qualifications , and Directive 2006/123/EC On services in the internal market, set out by the European Commission. This article describes the construction of the Code and gives an overview of some specific areas of importance. The main text of the Code is reproduced in Appendix 1.

Background: In this study, bibliometric methods were used to investigate prevention and control of infectious diseases (IDs). The aim was to gain an overall view of published research on IDs in Europe as part of the collaborative study SPHERE (Strengthening Public Health Research in Europe)., Methods: A framework for research on IDs and public health was developed with definitions, keywords, inclusion and exclusion criteria. A detailed web search strategy based on the framework was designed, piloted and refined. The PubMed electronic database was searched for 'infectious diseases' as a whole, and for several subtopic areas, across July 1995 and June 2005. Numbers of publications by year, country, population and Gross Domestic Product were calculated., Results: Nearly 21,000 publications on the main topic and sub-topics were found, with a progressive increase particularly since 2000. There was a marked heterogeneity between countries. France, Italy, The Netherlands, Spain, Germany, Switzerland, Sweden, UK and Belgium were the most prolific, and Eastern European countries less so. 'Vaccine-preventable diseases', 'Sexually transmitted diseases', 'Drug-resistant infections', 'Insect-arthropod-related diseases' and 'Childhood diseases' were the main fields of scientific production. Research on 'Epidemiology and Surveillance' appeared, in general, to be better represented than research on 'Prevention and Control'., Discussion: This is the first time such a broad approach has been used to describe public health research on IDs across Europe. A priority should be cooperation between European states where there is little or no, scientific production. Bibliometrics has limitations, but is of value to indicate a general pattern.