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Nurses' decision making in triage code assignment: a qualitative descriptive study.Given the importance of improving Emergency Department (ED) quality of care and patient satisfaction and safety, analyzing how nurses make decisions in the triage process may help healthcare organizations in developing effective and safe EDs and in supporting healthcare staff. The present study was therefore conducted to explore factors that contribute to nurses' decision-making in the triage process.Two Focus groups with 20 nurses have been conducted and content data analyses performed following a descriptive qualitative approach.Three main aspects tend to affect nurses' decision making in the triage process and therefore influence priority code assignment: the patient's condition (signs and symptoms, risk of adverse clinical evolution, presence of frailty conditions), the organizational setting (patients flow, relationship with medical staff, stressful environment, support from the organization) and the nurse's experience (experience with similar situations, intuition, burden of responsibility). Nurses tend to balance adherence to protocols with appropriate responsiveness of the ED department and tend to seek peer feedback regarding to the priority code assigned.Triage is a complex process, consisting of many factors, resulting from contingent situations that vary continuously. These elements intersect in a process that continuously tends to affect the decision.

Factors associated to patients' outcomes in medical units: lessons learnt from an Italian multicentric longitudinal study design (ESAMED study).Research on nursing outcomes attempted to identify the associated factors, however, with mainly retrospective or descriptive studies. In 2011, an Italian network was established and a multicentric longitudinal study aimed at exploring factors associated with nursing outcomes among in-hospital medical patients was started.To summarise (a) how the research project was originated, (b) which patients have been involved, variables and instruments used, (c) the main findings, and (d) the lessons learnt.12 acute medical units from 11 Italian hospitals were involved. A consecutive sample was adopted: on a daily basis, data has been collected at the (a) patient; (b) nursing care, and (c) hospital levels.The effect of the variability in the amount of nursing care and skill mix in medical units was explored on the following outcomes: (a) hospital-acquired functional dependence, (b) prevalence and incidence of (i) episodes of hyperactive delirium, (ii) avoidable pressure ulcers; (iii) peripheral venous catheter phlebitis; (c) dissatisfaction with the nursing care; and (d) in-hospital mortality; 1464 out of 2082 eligible patients were involved. The frequency and reasons of Missed Nursing Care (MNC), as well as the presence of family caregivers at the bedside were also measured.The study confirmed that (a) the amount of nursing care provided by graduate nurses improves patient outcomes; (b) a skill mix in favour of nursing aides, negatively impacts on patients' outcomes; and (c) a higher frequency of MNC threatens patient outcomes.

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. 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. A longitudinal multicentre study was conducted involving 12 medical units in 12 northern Italian hospitals. Descriptive, bivariate and multivariate logistic regression analyses were performed. 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). 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.

ObjectiveTo explore nursing students’ interprofessional educational (IPE) experiences during their most recent clinical rotation and to explore the factors supporting IPE experiences.DesignNational cross-sectional study on data collected in 2016.Setting95 Bachelor of Nursing Sciences programmes; 27 Italian Universities.ParticipantsStudents who (a) were attending or just completed their clinical rotations lasting at least 2 weeks in the same unit, and (b) willing to participate in the study.Primary and secondary outcomesFirst to measure the occurrence of IPE experiences in the most recent clinical rotation; the secondary outcome was to discover factors associated with IPE occurrence.MeasuresThe primary outcome was measured using questions based on a 4-point Likert scale (from 0=‘never’ to 3=‘always’). Explanatory variables were collected at both individual and regional levels with items included in the same questionnaire.Results9607 out of 10 480 students took part in the study. Overall, 666 (6.9%) perceived not having had any IPE experience, while 3248 (33.8%), 3653 (38%) and 2040 (21.3%) reported having experienced IPE opportunities ‘only a little’, to ‘some extent’ or ‘always’, respectively. From the multilevel analysis performed using the generalised linear mixed model, factors promoting the occurrence of IPE experiences were mainly set at (a) the clinical learning environment level (high: learning environment quality, self-directed learning encouragement, learning opportunities, quality of safety and nursing care and quality of tutorial strategies); and (b) the regional level, where significant differences emerged across regions. In contrast, male gender was negatively associated with the perception of having had IPE experiences.ConclusionsA large number of nursing students experienced either ‘never’ or ‘only a little’ IPE opportunities, thus suggesting that nursing education tends to remain within the nursing profession. Limiting students’ interprofessional exposure during education can prevent future collaborative approaches that have been shown to be essential in providing best patient care. In order to increase IPE exposure, it is necessary to develop strategies designed both at the singular unit and regional levels.

Questionnaire, English version. (PDF 351 kb)

Elderly Quality of life (QoL) is vulnerable because of the decline in physical and mental capacity, discharge from work, rupture of the family and isolation. Many QoL Scales are made for adults: there is little research investigating how older people perceive QOL.This study aims to explore and understand the perceptions that older people have about their QOL.A qualitative research hermeneutics-phenomenological was done. Narratives were analyzed by mixed method phenomenological-grounded (Mortari, 2007).16 elderly were interviewed (aged between 80 and 93 years), residents in their home. The analysis of the interviews confirm that QoL is a multidimensional concept that encompasses several components of life. There were 7 shared themes, reflecting the experience of well-being in older people living at home. The dimensions are: living relationships that drive away loneliness, fill the time with activities that follow their own interests, accept themselves as elderly person, choose how and where to live, think about death.The results of the study show that older people perceive QOL as made of multiple components and variables. Elderly are focused on the remaining capacities, on the acceptance of the positive aspects of their lives rather than on what they can no longer do. This study help to identify some social and health strategies to guarantee the best way to live the last part of life.INTRODUZIONE. La qualità di vita (QoL) degli anziani è vulnerabile a causa del declino delle capacità fisiche e mentali, dell’uscita dal lavoro, della frantumazione della famiglia e dell’isola- mento. Molti strumenti che la rilevano sono costruiti per adulti: poche ricerche indagano come le persone anziane intendono la propria QOL. SCOPO. Questo studio ha l’obiettivo di esplorare e comprendere le percezioni delle persone anziane riguardo la QOL. METODO. È stata condotta una ricerca qualitativa, fenomenologico-ermeneutica. Le narra- zioni sono state analizzate attraverso il metodo fenomenologico-grounded (Mortari, 2007). RISULTATI. Sono stati intervistati 16 anziani (età compresa tra 80 e 93 anni), residenti a domicilio. L’analisi conferma che la QOL è un concetto multifattoriale e multidimensionale, che racchiude in sé diverse componenti della vita. Dalle interviste, sono emersi 7 temi condivisi e ricorrenti, che riflettono l’esperienza di benessere nelle persone anziane che vivono a domicilio. Le dimensioni emerse sono: vivere relazioni che allontanino la solitudine, occupare il tempo con attività che assecondano i propri interessi, accettarsi come persona anziana, poter scegliere come e dove vivere, riflettere sulla propria morte. CONCLUSIONI. I risultati dello studio mostrano che gli anziani percepiscono la QOL formata da più componenti e variabili. Gli anziani si focalizzano sulle capacità residue, sull’accettazione degli aspetti positivi della propria vita piuttosto che su quello che non riescono più a fare o che manca. Questo studio può aiutare ad individuare alcune strategie sociali e sanitarie da applicare per garantire agli anziani il modo migliore di vivere l’ultima parte della vita.