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Nurses' perception of the organisational context of nursing homes: a descriptive study.The increasing number of the elders admitted to nursing homes (NH) requires a particular emphasis on improving the quality of nursing care. The evaluation of the organizational context has recently received growing interest, for its contribution to understanding of care outcomes and staff's needs.To describe the characteristics and the nurses'perception of organizational context of NHs in which they work.A cross-sectional study was conducted in 50 NHs in the Piedmont and Aosta Valley regions. The following data were collected: sociodemographic information on nurses, years of work experience, contract type, and work-hour profile; organizational information included ownership, size, occupancy rate; and for the organizational context, the Alberta Context Tool was administered.Of the 312 nurses, 266 (85%) participated in the study; 79% had a university degree. Perceived organisational context scored low (median values 2.5) in terms of the availability of Interactions (Formal and Informal), Resources, Personnel and time, but good with median values above 3.5/5 on Leadership, Culture, Evaluation, Social Capital and Space, with differences according to years of experience, type and size of facility; for example, nurses working in private facilities perceived their organisational context as better than those working in public facilities.NHs are workplaces that are still not frequently chosen by nurses and essentially considered as places of transition or end of the career. In spite of organizational contexts perceived as positive, tangible efforts are needed to improve working conditions and the perception of nurses' role.

Supplemental material, sj-pdf-1-cnr-10.1177_1054773820986916 for Effects of a Video-Based Preoperative Educational Intervention Plus Nurse-Led Reinforcement Discussion on Knowledge, Self-Efficacy, and Resilience in Patients Undergoing Major Surgery by Silvia Gonella, Cristina Delfino, Monica Rolfo, Alessio Rizzo, Valeria Esposito, Paola Berchialla and Sara Campagna in Clinical Nursing Research

Supplemental material, Supplemental_files for Good end-of-life care in nursing home according to the family carers’ perspective: A systematic review of qualitative findings by Silvia Gonella, Ines Basso, Maria Grazia De Marinis, Sara Campagna and Paola Di Giulio in Palliative Medicine

The Emergency Department visits of Nursing Home residents: descriptive study in a Nursing Home.Many Emergency Departments (ED) transfers of Nursing Home (NH) residents are potentially avoidable or even inappropriate since problems could be prevented or managed in the NH.To describe characteristics and outcomes of NH residents transferred to ED for respiratory, cardiovascular and neurological problems and symptoms of infection.A retrospective descriptive study using clinical records data from 2013-2016 of a NH was conducted.In 4 years (2013-2016), 143 ED accesses occurred, 55 (38.6%) for medical problems in 48 residents. The residents were mainly women, with advanced age. Forty-two/55 accesses (76.4%) resulted in an hospital admission and 16 residents (38.1%) died in hospital; of the 13 discharged, 3 died the NH after a few days. The most frequent reason for hospitalization was an infection (22): respiratory (18), urinary (2) or both (2). The week before ED admission 1/3 of residents was asymptomatic, 1/3 had only one typical symptom accompained by drowsiness or agitation (7), gastrointestinal problems (5), or other non-specific symptoms. On ED admission prevalent signs and symptoms were desaturation (13), dyspnea (10) and fever (9). Six/22 residents had started an antibiotic treatment in the NH.Proactive management policies need to be promoted for residents with infections, based on explicit criteria to promptly monitor changes in clinical conditions and on the education educate professionals to suspect an infection even with non-specific symptoms.

Cancer-related breakthrough pain (BTP) is a common and quite challenging pain syndrome, with significant impact on quality of life. To date, no widely recognized and validated tool for the diagnosis and evaluation of BTP exists. The Alberta Breakthrough Pain Assessment Tool (ABPAT) underwent a validation process during its development, but no experience of its implementation in clinical practice has been reported.ABPAT was tested in a cohort of cancer patients suffering from chronic severe cancer-related pain in order to assess its acceptability and efficacy as a tool for the characterization of BTP.A total of consecutive 249 patients from seven different centres were included in a 2-month study period and all completed the questionnaire; 231 out of the 249 (92.8%) stated that questions were easily understandable and 217 out of the 249 (87.1%) stated that the tool allowed to explain extensively the BTP problem. Physician-patient correlation tests about baseline BTP intensity and BTP relief by medication showed statistical significance at the level of p = 0.001 and p = 0.0001, respectively. Evaluation of the efficacy of BPT medication revealed a 78.2% of patients declaring a good relief from BTP, with a significant reduction of mean BTP numeric rating scale score (p = 0.0001), but only 55.9% of patients responded to be satisfied about time for onset of the relief.In this study, ABPAT resulted to be a well-accepted tool for BTP assessment and characterization in a relatively large cohort of cancer patients. It is effective in discovering the unmet needs of cancer patients and in exploring the outcomes of BTP treatment.

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.