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In this study we compare expenditures by families and students for Nursing Education in five european countries using PPP method

Background: Randomized controlled trials (RCTs)may be categorized as either effectiveness trials or efficacy trials, which may be categorized by the Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) tool. However, no data regarding the application of the PRECIS tool in a cluster of RCTs belonging to a specific discipline such as nursing are available. Purpose: The principal aim of this study was to assess the prevailing nature (pragmatic vs. explanatory) of a cluster of clinical nursing RCTs. Evaluating the suitability of the PRECIS in the analysis of nursing RCTs was the secondary aim. Methods: All nursing RCTs published in 2010 were identified through a systematic review and extracted in full-text form. An explanatory-pragmatic (E-P) group consisting of 11 researchers trained in the use of the PRECIS tool evaluated each RCT in terms of 10 domains, respectively scored on a scale ranging from 5 (pragmatic) to 1 (explanatory). The E-P group further scored the feasibility of the PRECIS tool using a numerical rating scale (0 = not at all, 10 = entirely feasible). Results: Along the pragmatic-explanatory continuum, assuming 50 as the highest degree of pragmatism and 10 as the highest degree of explanatory, the evaluation of nursing RCTs returned an average of 31.1 (median = 31, SD = 7.18, range = 13Y44). On the pragmatic-explanatory continuum, the evaluated nursing RCTs ended to be pragmatic, which seems to be consistent with the purposes of the nursing discipline. The feasibility of the PRECIS tool in the evaluation of nursing trials as perceived by the EYP Group was, on average, 7.09 (SD = 1.09, 95% CI [6.35, 7.82]). Conclusions/Implications for Practice: Applying the PRECIS tool is perceived to be highly feasible in the critical appraisal of a cluster of RCTs in a specific discipline such as nursing.

Background Caring for patients with COVID-19 requires wearing a full set of personal protective equipment (PPE) to avoid contamination. Personal discomfort has been associated with use of PPE, and anecdotal reports describe pressure injuries related to wearing PPE. Objectives To investigate the occurrence of device-related pressure injuries due to wearing PPE among Italian nurses caring for patients with COVID-19 in critical care settings. Methods This descriptive study used an online survey investigating both the demographic characteristics of respondents and complications related to wearing PPE, including the development of pressure injuries. Results A total of 266 nurses throughout Italy completed the survey; 32% of respondents were men. Nurses’ median age was 36 years (range 22-59 years), and the median time spent working in their current clinical setting (an intensive care or high-dependency unit) was 3 years (range 0-32 years). Personal protective equipment was worn for a median duration of 5 hours (range 2-12 hours). While wearing PPE, 92.8% of nurses experienced pain and 77.1% developed device-related pressure injuries, mainly on the nose, ears, and forehead. Pain was more frequent among nurses with such injuries. Transparent dressings, emollient cream, and no dressing were associated with development of device-related pressure injury. Conclusions Pressure injuries related to PPE represent an important adverse effect for nurses caring for patients with COVID-19. This topic deserves study to determine adequate solutions for preventing and treating such injuries and their potential influence on nurses’ work tolerance.

Intravascular catheters are widely used in ICU, both for monitoring and therapeutic purposes (fluid, drugs, parenteral nutrition, blood and blood components administration, hemodialysis, and renal replacement therapy). Among indwelling catheter complications, infections represent probably the most challenging one and account for increased length of hospitals and ICU stay, costs, and related mortality. Several guidelines have been edited and disseminated to allow a more homogeneous and evidence-based approach to intravascular catheter management. Nurses apply these approaches in daily interventions, such as catheter dressing, hub disinfection, and line replacement. Whenever an intravascular catheter is in place, a team approach should always be adopted, including the daily evaluation for catheter need. Adherence to guidelines should be monitored, and educational interventions are provided to staff. Therefore, each team should identify and promote the application of bundled interventions for catheter management.

The basic care involves all those activities performed in each context of care and in intensive care units that characterize the nurses’ job, drawing attention to sensitive outcomes such as infection prevention and patients’ safety.In this chapter, we will discuss how the basic nursing care to the person in the intensive care unit (ICU) is widely different if compared to other departments, and, especially, the eye, mouth, and skin care management and the bed bath will be highlighted. In particular, oral hygiene care, using either a mouthrinse, gel, toothbrush, or combination, together with aspiration of secretions, may reduce the risk of Ventilator-associated pneumonia (VAP) in critically ill patients. Using chlorhexidine gluconate (CHG) for body hygiene allows to reduce the transmission of infections, but it is still debated if it contributes completely to the reduction in infections in ICU. Hygiene care in critical care patients may significantly alter vital signs, therefore a strict haemodinamic and respiratory monitoring.

Indwelling bladder catheters are widely used in intensive care units to monitor the hourly urine output in critically ill patients. In-hospital patients are frequently catheterized (15–25%), but catheterization is often unappropriated. A 30-day cutoff is used to differentiate between short- and long-term (or chronic) catheterization. Recent data confirmed that CAUTIs represent 23% of HAIs in ICU. In ICU patients, female gender (HR 2.67, 95% CI 1.03–6.91; p 0.043) and duration of urinary catheterization (HR 1.07 (per day), 95% CI 1.01–1.13; p 0.019) were identified as risk factors for CAUTI acquisition alone. Bundles’ implementation relates with a significant reduction in CAUTI incidence. The urinary catheter bundle includes five interventions: perform hand hygiene before insertion and manipulation of UC; keep collection bag lower than the bladder level; maintain unobstructed urine flow; empty collecting bag regularly and avoid allowing the draining spigot to touch the collection catheter; and monitor CAUTIs using standardized criteria to identify patients with CAUTIs and to collect UC days as denominators. No other routine interventions (such as catheter or collection bag changing, bladder irrigation, systemic and bladder antimicrobial administration) are recommended to prevent CAUTIs. Although CAUTIs have a strong impact on hospitalized patients’ outcomes, studies concerning the prevention of this problem are generally affected by poor-quality evidences and methodological issues. Therefore several research questions remain unresolved.

There is evidence that nursing workload is associated with the quality of patient care and the health of workers. Workloads and resource allocation can be measured by scoring systems. To provide a real-time assessment of nurse allocation and workloads, the Nursing Activities Score (NAS) was developed as a means to measure patient care. The items examine specific activities: patient monitoring, medication, hygiene procedures, care of drains, patient mobilization and positioning, admission and discharge procedures, administrative and managerial tasks, research activity and renal, invasive and non invasive ventilation, cardiovascular, metabolic and nutritional support. There is also the possibility to weigh those specific interventions in intensive care which are the exclusive competence of nurses. The authors maintain that the score wholly reflects 81% of nursing time. The remaining 19% comes from nursing activities deriving from medical interventions, related exclusively to the severity of illness of the patient. NAS was created in order to better define nursing activities in relation to continuous patient monitoring, performing hygiene procedures, mobilization procedures, data handling and caring for relatives. The appropriate application of NAS will support the taking up of real measures in response to the working demands of nurses and will allow for improved investment in human and material resources at the ICU.

Aim To re-evaluate the face and content validity of the Nursing Activity Score currently adopted in evaluating activities that best describe workloads in intensive care units and their weight in describing average nursing time consumption. Background The Nursing Activity Score calculates the amount of nursing time that each patient will require over the next 24 hours. It has been widely used around the world since its first validation in 2003. However, no re-evaluation of its validity with regard to the advancements achieved in intensive care units nursing care has been documented to date. Method A research project was undertaken from 2012 to 2015, aimed at critically evaluating and validating this tool in the current context of Italian intensive care units nursing care. The 23 items were translated forward and backward into the Italian language, then a panel of 10 experts in critical care evaluated the face validity. Content validity was evaluated through focus groups involving seven critical care expert registered nurses. Findings The Nursing Activity Score instrument has been considered as not fully adequate to measure current intensive care units nursing activities and their weightings have been considered not fully adequate to score average nursing time consumption. From the content validity process, lack of adequacy has emerged with respect to the concept of nursing care underpinning the tool, the interventions included, its capability to predict the nursing resources needed, advancements achieved in intensive care units nurses' roles and competences, and the contextual factors that may influence consumption of nursing time. Conclusions Development of the Nursing Activity Score tool both conceptually and in its structure, in view of the innovations that have occurred in the context of intensive care units, is necessary to continue to have a common tool to help clinicians and managers to capture accurately and compare nursing care required by patients in critical care settings. Implications for nursing management There is a need to revise the Nursing Activity Score tool, enabling its use in estimating nursing workloads in current Italian intensive care units practice. A taskforce of clinical nurses and nursing managers, capable of protecting the valuable original Nursing Activity Score project and to advance its further development is recommended.