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Introduction: In recent decades, Italy has been exposed to significant migrant flows resulting from political and economic instability in neighbouring countries. As a result, there has been an increased amount of cultural and linguistic diversity (CALD) among nursing students. The aim of this study was to explore the experience of CALD nursing students as lived in the Italian nursing programmes. Method: A descriptive phenomenological method was used in 2017 with the involvement of a purposeful sample of 21 CALD nursing students in five Italian Bachelor of Nursing Science campuses. Data were collected using semistructured interviews; the subsequent content analysis was conducted by two independent researchers. Results: CALD nursing students reported having lived a transformative experience based on seven themes, from "living in the middle, between belonging and detachment" to "acquiring cultural awareness and cultural sensitivity." Discussion: Dealing with linguistic and cultural differences can affected CALD students' academic success, but also encourages them to develop awareness and cultural sensitivity by influencing their peers and the environment of the nursing programme. Therefore, having CALD students is a great value for nursing programmes. Nursing programmes should embody the values of cultural sensitivity and acceptance, including them as a nursing care value and as a concrete strategy to support CALD students. They should also develop strategies to promote the knowledge and responsibilities of nurses among CALD students and increase cultural sensitivity among faculty members at different levels. [ABSTRACT FROM AUTHOR]

Purpose: To explore nursing students' perceptions of their clinical learning experiences in the mental health (MH) setting. Design and Methods: Secondary analysis of data collected within an Italian national cross‐sectional study involving students (N = 9607) who were attending 95 3‐year baccalaureate nursing programs. Findings: Students in MH settings scored the quality of the learning environment overall significantly higher (P =.008) compared to those who rotated in other clinical settings, specifically with respect to (a) the tutorial strategies' quality; (b) the learning opportunities; and (c) the learning environment's quality. Practice Implications: MH settings emerged as a worthy clinical environment where less pressing rhythms allow preceptors to provide students more learning opportunities that, in turn, affect the perceived degree of competence achieved and the desire to work in these contexts after graduation. [ABSTRACT FROM AUTHOR]

Background: The management of delirium among older in-hospital patients is a challenge, leading to worse outcomes, including death. Specifically, psychomotor agitation, one of the main characteristics of hyperactive delirium, requires a significant amount of medical and nursing surveillance. However, despite its relevance, to date incidence and/or prevalence of psychomotor agitation, its predictors and outcomes have not been studied among Italian older patients admitted in medical units. Aims: To describe the incidence and the prevalence of psychomotor agitation among patients aged > 65 years admitted to medical units and identify predictors at the individual, nursing care and hospital levels. Methods: A longitudinal multicentre study was conducted involving 12 medical units in 12 northern Italian hospitals. Descriptive, bivariate and multivariate logistic regression analyses were performed. Results: Among the 1464 patients included in the study, two hundred (13.6%) have manifested episode(s), with an average of 3.46/patient (95% confidence of interval [CI] 2.73–4.18). In 108 (54.0%) patients, episode(s) were present also in the week prior to hospitalisation: therefore, in-hospital-acquired psychomotor agitation was reported in 92 patients (46%). The multivariate logistic regression analysis explained the 25.4% of the variance and identified the following variables as psychomotor agitation predictors: the risk of falls (relative risk [RR] 1.314, 95% CI 1.218–1.417), the amount of missed nursing care (RR 1.078, 95% CI 1.037–1.12) and the patient's age (RR 1.018, 95% CI 1.002–1.034). Factors preventing the occurrence of episode(s) were: the amount of care received from graduated nurses (RR 0.978; 95% CI 0.965–0.992) and the lower functional dependence at admission (RR 0.987, 95% CI 0.977–0.997). Conclusions: A considerable number of elderly patients admitted in medical units develop psychomotor agitation; its predictors need to be identified early to inform decisions regarding the personal care needed to prevent its occurrence, especially by acting on modifiable factors, such as the risk of falls, missed nursing care and functional dependence. [ABSTRACT FROM AUTHOR]

Background: Undergraduate nursing students have been documented to experience ethical distress during their clinical training and felt poorly supported in discussing the ethical issues they encountered. Research aims: This study was aimed at exploring nursing students' perceived opportunity to discuss ethical issues that emerged during their clinical learning experience and associated factors. Research design: An Italian national cross-sectional study design was performed in 2015–2016. Participants were invited to answer a questionnaire composed of four sections regarding: (1) socio-demographic data, (2) previous clinical learning experiences, (3) current clinical learning experience quality and outcomes, and (4) the opportunity to discuss ethical issues with nurses in the last clinical learning experience (from 0 – 'never' to 3 – 'very much'). Participants and research context: Participants were 9607 undergraduate nursing students who were attending 95 different three-year Italian baccalaureate nursing programmes, located at 27 universities in 15 Italian regions. Ethical considerations: This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines after the research protocol was approved by an ethics committee. Findings: Overall, 4707 (49%) perceived to have discussed ethical issues 'much' or 'very much'; among the remaining, 3683 (38.3%) and 1217 (12.7%) students reported the perception of having discussed, respectively, 'enough' or 'never' ethical issues emerged in the clinical practice. At the multivariate logistic regression analysis explaining 38.1% of the overall variance, the factors promoting ethical discussion were mainly set at the clinical learning environment levels (i.e. increased learning opportunities, self-directed learning, safety and nursing care quality, quality of the tutorial strategies, competences learned and supervision by a clinical nurse). In contrast, being male was associated with a perception of less opportunity to discuss ethical issues. Conclusion: Nursing faculties should assess the clinical environment prerequisites of the settings as a context of student experience before deciding on their accreditation. Moreover, the nursing faculty and nurse managers should also enhance competence with regard to discussing ethical issues with students among clinical nurses by identifying factors that hinder this learning opportunity in daily practice. [ABSTRACT FROM AUTHOR]

Context: Error reporting is considered one of the most important mediating factors for patient safety (PS). However, reporting errors can be challenging for health care students. Objectives: The aims of the study were: (i) to describe nursing students' opportunity to report errors, near misses or PS issues that emerged during their clinical learning experience; and (ii) to explore associated factors of the process of reporting itself. Methods: A national survey was conducted on 9607 (91.7%) undergraduate nursing students. The endpoint was to have reported PS issues in the last clinical learning experience (from 0 'never' to 3 'always'). Explanatory variables were set individual, nursing programme and regional levels. Results: A total of 4004 (41.7%) nursing students reported PS issues from 'never/rarely' to 'sometimes'. In the multi‐level analysis, factors increasing the likelihood of reporting events affecting PS have been mainly at the nursing programme level: specifically, higher learning opportunities (odds ratio [OR] = 3.040; 95% confidence interval [CI], 2.667–3.466), self‐directed learning opportunities (OR = 1.491; 95% CI, 1.364–1.630), safety and nursing care quality (OR = 1.411; 95% CI, 1.250–1.594) and quality of tutorial strategies OR = 1.251; 95% CI, 1.113–1.406). By contrast, being supervised by a nurse teacher (OR = 0.523; 95% CI, 0.359–0.761) prevented the disclosure of PS issues compared with being supervised by a clinical nurse. Students attending their nursing programmes in some Italian regions showed a higher likelihood (OR from 1.346 to 2.938) of reporting PS issues compared with those undertaking their education in other regions. Conclusions: Nursing students continue to be reticent to report PS issues. Given that they represent the largest generation of future health care workers, their education regarding PS should be continuously monitored and improved; moreover, strategies aimed at developing a non‐blaming culture should be designed and implemented both at the clinical learning setting and regional levels. Palese et al. disclose that many nursing students do not discuss safety issues that emerge during their clinical practice, highlighting environmental features that discourage such reporting. [ABSTRACT FROM AUTHOR]

Background: Nursing students report care of the older people as an undesirable career pathway. Positive clinical placement experiences influence students' attitudes and career intentions with respect to nursing home (NH) setting. The clinical environment's quality depends on meaningful learning opportunities, the relationship with the preceptors, and the pedagogical atmosphere as influenced by the staff–student interactions. Aim: The aim of this study was to explore nursing students' perceptions on their clinical learning experience and competence learned in the NH setting as compared to other clinical areas. Methods: A secondary analysis was performed of an Italian national cross‐sectional study involving 9,607 nursing students attending 95 different three‐year bachelor laureate nursing programmes in 27 universities. A questionnaire exploring individual and nursing programme variables was devised. Moreover, students self‐reported the perceived quality of the clinical learning experience using the Clinical Learning Quality Evaluation Index tool and the degree of competence learned using a four‐point Likert‐type scale. Results: Students in the NH setting scored the overall quality of the learning environment significantly higher (p = 0.046) compared to those experiencing other clinical settings, and they scored higher learning occasions (p = 0.002) and self‐directed learning opportunities (p = 0.018). No difference emerged in the perceived mean degree of competences learned at the end of the clinical rotation (p = 0.271). Conclusion: Nursing students perceive the NH setting to be a good quality learning environment with valuable learning opportunities and self‐directed learning opportunities compared to other settings. The nursing home setting provides opportunities to acquire clinical competences comparable to the ones in other clinical settings such as hospital units. Implications for practice: Nursing home settings should be considered by all nursing programmes as a learning environment particularly worthy for students at different levels of their education. [ABSTRACT FROM AUTHOR]

Purpose: to describe nurses' perceptions of using play in a pediatric onco-hematology setting., Design and Methods: A qualitative descriptive study was conducted in the pediatric onco-hematology department of a tertiary hospital in northern Italy. Eleven nurses working in the involved department were recruited via convenience sampling. Data were gathered through face-to-face interviews using a semi-structured guide. Data were analyzed using a descriptive qualitative approach., Results: Four major themes emerged from the analysis: 1) The different purposes in using play, 2) A matter of time, 3) Choosing the most suitable game, and 4) Sharing celebrative moments as moments of interprofessional development. Nurses described play as a means to build trust, relieve parents, serve as an educational tool, and address children's needs. Although nurses recognized the limited time available, they wanted to manage their workload to accommodate play. They emphasized the importance of choosing suitable games and using playful moments as opportunities for fun and professional growth., Conclusions: Therapeutic play should be systematically integrated into pediatric oncology care as it fosters trust, provides joy and relief, and supports the child and their parents., Practice Implications: Play should be incorporated into routine practice, ensuring children can access peer interaction and age-appropriate games. A multidisciplinary approach, with the involvement of trained professionals, should be fostered to support play-based care in pediatric oncology settings., Competing Interests: Declaration of competing interest This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2024. Published by Elsevier Inc.)

Aim: E-learning is increasingly used in education, creating a learning environment that needs to be studied thoroughly for developing new learning opportunities., Background: Drawing from the community of inquiry framework, the present work provides the theoretical foundation and measurement validation of the Self-Perceived E-Learning Environment Scale (SEES). The SEES measures core aspects of the e-learning context: autonomous strategic planning, social interaction, and teacher feedback., Method: Through two studies carried out in sample of nursing students, an exploratory (n = 302) and confirmatory (n = 245) factor analysis revealed a three-factor structure., Result: The results provide empirical evidence of appropriate psychometric properties (i.e., reliability, validity)., Conclusion: The SEES can be used in a higher education context, particularly in nursing education programs. Theoretical, methodological, and practical implications for exploring the e-learning environment in nursing educational settings are discussed., Competing Interests: The authors have declared no conflict of interest., (Copyright © 2023 National League for Nursing.)

. Transitioning Italian nursing education in the post-pandemic period: priorities in the light of lessons learnt., Introduction: Once back to normalcy, many nursing education activities have been restored without an in-depth analysis of which transformations enacted in the pandemic period should be maintained and valued., Aim: To identify priorities to effectively transitioning nursing education in the post-pandemic period., Method: Descriptive qualitative design. A network of nine universities involved 37 faculty members, 28 clinical nurse educators and 65 students/new graduates. Data were collected through semi-structured interviews; the main priorities reported in each university were combined to gain a global view., Results: Nine priorities emerged, including the need to: 1. reflect on distance learning to promote its complementary role to face-to-face teaching; 2. rethinking the rotations of clinical practical training by refocusing their aims, duration, and preferred settings; 3. understanding how to integrate the virtual and the in-presence learning spaces into the educational pathway; 4. continuing with inclusive and sustainable strategies. Considering that nursing education is essential, it is a priority to develop a pandemic education plan capable of guaranteeing its continuity in all circumstances., Conclusions: Nine priorities have emerged all considering the importance of digitalization; the lessons learnt, however, indicate the need to enact an intermediate phase capable of guiding towards the complete transition of the education in the post-pandemic era.

. The TeMP_cardio Model for the district management of heart failure patients: a feasibility study for the implementation of the family nurse., Introduction: The need to enhance primary health nursing care and chronic disease management requires the development of complex and feasible models in local contexts., Aim: To test the feasibility of a complex care model, based on the introduction of the family and community nurse for patients with stable heart failure and their caregivers., Methods: A pre-post six-month feasibility study was conducted in 2021-2022 in the Autonomous Province of Trento. Patients with stable heart failure able to access services were taken in charge with a multidisciplinary model, with the nurse as care manager, and technological and telemonitoring support., Results: 26 patients out of 137 were included and nine of their caregivers. Ten participants accepted to use the mobile app. Twenty-three patients and seven caregivers completed the study, and the app was used regularly by five participants. Self-care skills improved in patients, mostly in self-monitoring, less in caregivers. One access to the emergency department for heart failure exacerbation was detected., Conclusions: The model was evaluated feasible to retain patients, with the need to build effective strategies for the recruitment, and the regular use of telemonitoring tools.

. The covid-19 emergency in the words of the nurses . This special issue of AIR is dedicated to the direct professional experiences and personal testimonies of a sample of the nursing personnel during the most dramatic phase of the covid-19 pandemia in the most severely affected regions of Northern Italy (Lombardy, Piedmont, Veneto, Friuli, Trentino, Emilia Romagna Regions). The decision to adopt a research strategy aimed to give visibility and voice to colleagues representing some of the key hospitals of the regions obliged to a radical reorganisation of their structures and organisation of care, was adopted to catch from inside the crisis scenarios the expected mix of intense emotions (from anxiety, to fatigue, to personal and professional uncertainty, to the burden of impotence), and of needed technical creativity and efficiency which were requested to face a totally unexpected situation where guidelines could hardly be of help. The interview/diaries/focus groups were carefully planned not so much in terms of the contents, but with attention to the acceptance of the interviewed to enter in a free dialogue, with no Q&A, to be recorded, and to last for the time felt to be by both sides appropriate. The texts which are reported in this dossier are fragments of the recordings (overall more then 30 hours), without adjustments. It has been agreed that while all the names of the participants are provided as 'authors', the individual contributions are anonymous (not out of privacy consideration!) as they are part of a collective narrative, which reflects the great variability of the languages and of the perceived-expressed experiences and memories. The material has been organised in sections which are conceived as 'verbal snapshots' taken from the networks of care settings, but at the same time of the places and houses where the colleagues were literally full-time living, to assure unaccountable overtime working hours, and the requested 'safety distances' and lockdowns. The titles of the 8 sections coincide somehow with the principal components of the chain of activities and challenges which had to be faced: The changes in everyday's care, How to be prepared to the emergency, The teamwork, The loneliness and the isolation of the patients, The loneliness of the nurses, The difficult choices, The organization of the work and of the wards, change after covid-19. The core of the dossier is framed by boxes which provide also a minimum background of the administrative and epidemiological data on the pandemia in the regions of interest (it is interesting to remind that the central-southern areas of Italy have been far less affected), and a brief concluding reflection on reflection on the post-pandemia from the nursing point of view.

. The unused peripheral venous catheters in hospital: findings from a cross-sectional study., Introduction: Although the removal of peripheral venous catheters (PVCs) when no longer necessary is recommended, a high number of unused PVCs has been reported., Aims: To describe the prevalence of unused PVCs and associated factors., Methods: A cross-sectional study of patients ≥ 18 years, admitted to the involved units, with a PVC, was conducted. Data on individual, PVC and clinical context was collected and its association with unused PVC was analyzed., Results: The prevalence of unused PVCs was 26.7% (143). Patients with a PVC inserted for several days (OR = 1.08, 95%CI= 1.02-1.14), as well as patients admitted to units with a skill mix of mostly Registered Nurses (OR = 1.06; 95%CI= 1.01-1.10), were more likely to have an unused PVC. On the contrary, patients in intensive care (OR = 0.22, 95% CI= 0.07-0.68), with infectious diseases (OR = 0.33, 95% CI= 0.14-0.82) and small cannula size (OR = 0.44; 95% CI= 0.23-0.86) were less likely to have an unused PVC. The 45% of the patients had an unused PVC for ≥ 3 days., Discussion: One PVC out of four was unused, and a half of the unused PVCs had not been used for at least ≥ 3 days. This data suggests that care teams assign much more importance to other clinical aspects than the risk for infection, in defining risks and benefits associated with PVC.

. The Clinical Learning Quality Evaluation Index for nursing students., Introduction: The Italian nursing programs, the need to introduce tools evaluating the quality of the clinical learning as perceived by nursing students. Several tools already exist, however, several limitations suggesting the need to develop a new tool., Aim: A national project aimed at developing and validating a new instrument capable of measuring the clinical learning quality as experience by nursing students., Methods: A validation study design was undertaken from 2015 to 2016. All nursing national programs (n=43) were invited to participate by including all nursing students attending regularly their clinical learning. The tool developed based upon a) literature, b) validated tools already established among other healthcare professionals, and c) consensus expressed by experts and nursing students, was administered to the eligible students., Results: 9606 nursing in 27 universities (62.8%) participated. The psychometric properties of the new instrument ranged from good to excellent. According to the findings, the tool consists in 22 items and five factors: a) quality of the tutorial strategies, b) learning opportunities; c) safety and nursing care quality; d) self-direct learning; e) quality of the learning environment., Conclusions: The tool is already used. Its systematic adoption may support comparison among settings and across different programs; moreover, the tool may also support in accrediting new settings as well as in measuring the effects of strategies aimed at improving the quality of the clinical learning.

When patients talk about care: a qualitative phenomenological study. Introduction. Caring has been studied so far mainly from the nurses'point of view, but is equally important to elicit the patients' perspective to improve the understanding of actions and behaviors nurses can implement to respond to patients' expectations and idea of caring. Patients and nurses' perspectives may, in fact, be different. Aims. To describe and understand the caring experience of patients admitted to hospital, focusing on behaviors associated to a good caring. Methods. A qualitative, phenomenological hermeneutical research was conducted. Patients were interviewed with semi structured interviews and asked to tell when they had received a good care from nurses. Results. Ninety-three patients from different wards were interviewed. The caring dimensions described refer to the opportunity to experience a relationship of closeness with nurses, of being perceived as unique persons, understood, to relieve the sense of loneliness, sometimes experienced. Patients perceive that they are cared when receiving information consistent with their needs, that they are able to understand, when nurses are attentive and make them feel safe through constant monitoring and surveillance. Conclusions. The organizations should promote caring models oriented to the personalization of care, perceived as an essential element of care.

Introduction to qualitative research: the main approaches and designs. The main methods (phenomenology, ethnography, Grounded, narrative enquiry and case studies) and sampling technique of qualitative research are briefly outlined. A practical example is presented for each method.

Aim: To provide an overview of the debate in the literature on the aging of the nursing profession., Method: Review of the main articles published since year 2000., Results: The rapid aging of the nursing workforce is a new phenomenon that Italian organizations have to face. Many nurses ready for retirement would be willing to remain in a more adequate work environment and salary. The story of a nurse retained at work is presented., Conclusions: A leadership careful of this phenomenon and able to re-plan work environments and supportive mechanisms need to be developed to take on this new challenge.