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To evaluate the effectiveness of specialized nurse-led care of patients with chronic wounds, provided both during hospitalization and postdischarge, on wound healing and readmission rates.An unblinded randomized controlled trial was conducted. Participants were patients with chronic wounds, randomly assigned to either the experimental group (cared for by wound care nurses both during hospitalization and postdischarge) or to the control group (cared for according to standard practice). Wound healing was identified as the primary outcome.Overall, 1,570 patients were randomized, 1,298 of whom were included in the per-protocol analysis (707 in the experimental group and 591 in the control group). Nurse-led wound care quadrupled the probability of healing and reduced the number of treatment weeks and hospital readmissions.Chronic wound care that was entrusted to specialized nurses improved outcomes in terms of wound healing, repair and regeneration, length of treatment, and rate of readmission, compared with standard practice. Future studies should evaluate the impact of care provided by specialized wound care nurses on patients' quality of life and healthcare costs. Nurse managers should promote the implementation of chronic wound clinical-care pathways entrusted to specialized nurses to improve patients' clinical outcomes and reduce hospital readmissions.

The aim of this study is to summarize conceptual models of nurses' organizational well-being and identify common variables among them.To understand how the characteristics of an organizational context affect workers' well-being, numerous conceptual models have been developed. Such models have been conceptualized in various working contexts other than health care and not always considering the particularities of the profession of nursing.This integrative review was conducted using the resources of PubMed, CINAHL, Scopus and the Cochrane Library, up until March 2022, and by applying a modified version of Cooper's five-stage methodology, in accordance with the PRISMA guideline.Six reference models focused on different organizational variables and used to evaluate nurses' organizational well-being were identified: the Effort-Reward Imbalance (ERI) model; the Job Demands-Resources (JD-R) model; the Utriainen et al. model; the Demands-Resources and Individual-Effects (DRIVE) model; the Well-Being, Health-Promoting Lifestyle and Work Environment Satisfaction (WHS) model and the Nursing Worklife Model (NWM).There is no consensus in the nursing literature on an all-encompassing conceptual model of nurses' organizational well-being or on working environment characteristics to be studied or monitored for defining nurses' well-being.Coming to a consensus on the definition of a nurses' organizational well-being model and its variables would facilitate nursing management in monitoring and intervening on nurses' work-life quality and in improving nursing performance and caring outcomes.

Objective: To evaluate the influence of a wound healing protocol for stage III and IV pressure ulcers (PUs), and to determine the predictive power of specific sociodemographic and clinical characteristics on wound healing and infection. Method: This longitudinal study included participants with stage III and IV PUs who were recruited from 10 acute care settings of an Italian university hospital, and who were managed with a protocol inspired by the TIMECare model. Data were collected between October 2018 and March 2019. The National Pressure Ulcer Advisory Panel Staging System was used to stage the PUs. Wound healing was assessed with the Pressure Ulcer Scale for Healing (PUSH). Nutritional status was assessed with the Mini Nutritional Assessment Index. Data collection took place at admission and every seven days thereafter—a total of six times before discharge. The outcome and predictors of wound healing were assessed with Student's paired t-tests and multiple linear regressions, respectively. Results: Patients (n=126) were almost equally split between male and female, with a mean age of 78.17 years and who were all retired. Stage III and IV PUs were most prevalent at the sacrum (65.5% and 73.2%, respectively). PUSH wound healing scores improved significantly after six weeks in both stage III and IV PUs (p2=0.12). Conclusion: Our results showed that a good nutritional status and a protocol inspired by the TIMECare model were associated with wound healing improvements in stage III and IV PUs. We recommend this protocol in older patients with stage III and IV PUs.

Problem To preserve vessel health quality, nurses should proactively assess patients’ veins and analyse factors related to anatomical characteristics and the intravenous therapy plan. Although many advantages of proactive approach are acknowledged, no tool is available to evaluate variables related to peripheral vein quality and identify those patients at risk of reduction in vessel health quality. Aim To develop and validate a tool evaluating the risk of vessel quality reduction of patients needing infusion therapy. Methods Instrument development and validation study was carried out: 280 patients aged 18 years or older, hospitalised for the previous 24–48 hours were enrolled. Instrument face and content validity were analysed. The Receiver-operating characteristic analysis was used to choose the best cut-off; specificity, sensitivity, positive, and negative predictive values were calculated. Findings The scale score range was 0–50. The best cut-off was identified as a score ≥ 15 (area under curve 0.91), with 95% sensitivity and 72% specificity. A specialist in placement of vascular devices was requested in the first 3 days since admission for at-risk patients. Discussion The new Vessel Health and Preservation Scale is specific and sensitive in identifying patients at risk of reduction in vessel quality. This study provides nurses with an instrument to preserve their patients’ vein health and guarantee them better outcomes. Conclusion Using the Vessel Health and Preservation Scale at patients’ admission enables nurses to proactively preserve vein quality and decide on choosing and positioning the right device or requesting a vascular access specialist.

Background Healthcare emergency can increase work-related stress and reduce nurses’ job satisfaction and quality of life. Managerial decisions and proactive interventions implemented to react to the emergency ensure the best patient outcomes. Purpose The purpose of this study was to verify whether a proactive organizational approach can limit nurses’ work-related stress and help preserve their job satisfaction and quality of life during a health emergency. Methods A longitudinal mixed methods study was conducted. Data were collected before and after the transformation into a SARS-CoV-2 Hospital and the implementation of organizational interventions. Focus groups were conducted to investigate quantitative data. Findings After the implementation of interventions and as the pandemic progressed, work-related stress decreased and job satisfaction and quality of life increased. Discussion Through proactive organization, even during an emergency, nurses are prepared for working, and work-related stress due to changes is reduced. Nurses are motivated and satisfied with their organization and management, and quality of life increases.

The aim of this study to describe a research protocol for evaluating the relationship between nursing leadership, organisational well-being and nurse and patient outcomes.The head nurses' leadership style influences the organisational context. When an organisation promotes nurses' well-being, they perform better performances and are more satisfied and engaged with their job. This reduces stress levels, burnout and absenteeism and improves physical and psychological health.A multicentre study will be conducted. A self-report questionnaire will be administered to head nurses and nurses they coordinate. Study findings will include nurse-sensitive outcomes (e.g., pressure injuries, infections and mortality). Descriptive and correlational analyses will be conducted, and a structural equation model will be tested.Results might verify that a correctly judged leadership style of the head nurse will enhance the organisational context experienced by nurses and improve nursing sensitive outcomes.This study will demonstrate the organisational role of middle managers and the direct repercussions on their staff and patients, understanding the relationship between organisational, process and outcomes variables.If the results confirmed the hypothesis, health care managers would cultivate and stimulate the head nurses' leadership style, thus increasing nurses' organisational well-being and achieving better patient outcomes. No Patient or Public Contribution.

Background: Wound care nurses are recognised as a key element for improving health outcomes. However, there is still fragmented knowledge of the outcomes associated with their practice in individuals with pressure ulcers. Aims and objectives: To identify, summarise and map all available evidence related to the outcomes of wound care nurses’ practice in individuals with pressure ulcers. Design: Integrative literature review. Review method: To report the review, we followed the modified version of Cooper's five-step methodology, and the PRISMA guidelines. Methods: The search was carried out on CINAHL, PubMed, the Cochrane Library and Scopus, with a time frame ranging from each database inception to December 21, 2019. We included observational or experimental studies of adult individuals affected by (or at risk of) developing pressure ulcers who were also cared for by wound care nurses. Results: Of the 439 peer-reviewed publications, 13 studies met the inclusion criteria. The most frequent outcomes were pressure ulcer incidence, healing rate and time taken for complete healing. Less frequent outcomes were changes in pressure ulcers’ stage, number of completely healed wounds, treatment costs and physical discomfort. No patient-reported outcomes were assessed. Conclusion: This review indicates that clinical-related outcomes were by far the most reported. Future studies should broaden the spectrum of outcomes to include more subjective parameters (e.g. pain, quality of life, stress, etc.), in order to gain a better understanding of the global impact of wound care practice on patients with pressure ulcers. Relevance to clinical practice: There is promising evidence of a positive impact of wound care nurses’ practice on health and economic outcomes. Nonetheless, more robust and rigorous research is needed to provide stronger evidence in the field and support investment in these practitioners.

The Nursing Quality of Life Scale (NQOLS) is a 28-item self-report measure evaluating the four dimensions of nurses’ quality of life, namely, the physical, emotional, working, and social dimensions. The purpose of this study is to assess the psychometric properties, including validity and reliability, of the NQOLS. The study enrolled 1105 nurses who provided direct assistance to patients. The NQOLS factorial structure was tested using a cross-validation approach via Exploratory Structural Equational Modeling, which confirmed the instrument’s four-dimension structure. Reliability was assessed using omega coefficients, proving excellent for all factors. Cluster analysis identified five distinct groups, each composed of participants sharing a substantial similarity with respect to their profile in the NQOLS. These five identifiable clusters presented significant differences not only in the NQOLS but also in the risk of work-related stress, emotional labor, and burnout. The results show that NQOLS is a simple, reliable, lean tool for measuring nurses’ overall QoL, whose various parts can additionally be used to answer specific research questions.

Although there are many methods to confirm vascular device tip, chest x-ray represents the recommended procedure to verify the correct positioning of a central device, but it exposes patients to x-rays, delays treatment, and permits device length to be checked post-procedure.To evaluate the efficacy of Peripherally Inserted Central Catheter positioning through an Integrated System (ultrasound-guided and electrocardiogram confirmation).A case-control study was conducted on a randomized sample of 165 patients, requiring Peripherally Inserted Central Catheter placement for chemotherapy treatment. The case group was composed of patients with vascular device placed through the Integrated System and the control group devices' length was anthropometrically estimated. Chest radiography was performed on both groups to verify tip location.No cases of primary malposition related to the Integrated System were registered. The vascular devices positioned with the Integrated System were all correctly placed and in 91.8% (n=101) the intra-procedural tip location was comparable to the one identified in the x-ray.The Integrated System represented a simple and efficient method to correctly place vascular device, allowing intra-procedural tip confirmation and avoiding primary malposition. It would eliminate the need for performing chest radiography, reduce costs and time for healthcare professionals and patients.Sebbene ci siano differenti metodi per confermare il posizionamento della punta di un catetere venoso centrale, la radiografia del torace rappresenta la procedura più raccomandata, ma espone i pazienti a radiazioni, comporta ritardi nei trattamenti e permette di controllare la posizione della punta solo dopo la procedura di posizionamento del device vascolare. Scopo: Valutare l’efficacia del posizionamento dei cateteri venosi centrali ad inserzione periferica utilizzando un sistema integrato (ecoguidato – elettrocardiogramma intracavitario).È stato condotto uno studio caso-controllo su un campione di 165 pazienti, a cui doveva essere posizionato un catetere venoso centrale ad inserzione periferica per l’esecuzione della chemioterapia. Il gruppo dei casi è composto da pazienti il cui dispositivo vascolare viene posizionato con il sistema integrato mentre nel gruppo di controllo la lunghezza viene stimata antropometricamente, prima del posizionamento. La radiografia del torace è stata eseguita in entrambi i gruppi di soggetti arruolati.Nessun caso di malposizionamento primario è stato registrato utilizzando il sistema integrato per il posizionamento degli accessi venosi centrali ad inserzione periferica. Le punte dei dispositivi erano tutte ben posizionate e nel 92% (n = 101) la localizzazione intra-procedurale della punta è risultata sovrapponibile a quella identificata nella radiografia del torace.Utilizzare un sistema integrato per il posizionamento dei dispositivi venosi centrali ad inserzione periferica permette di verificare e confermare la localizzazione della punta durante la procedura di posizionamento, evitando malposizionamenti primari. Elimina anche la necessità di eseguire la radiografia del torace, riducendo i costi e il tempo per i professionisti sanitari e gli assistiti.

PurposeThe importance of an error management culture (EMC) that integrates error prevention with error management after errors occur has been highlighted in the existing literature. However, few empirical studies currently support the relationship between EMC and errors, while the factors that affect EMC remain underexplored. Drawing on the conceptualisation of organisational cultures, the purpose of this paper is to verify the contribution of authentic leadership in steering EMC, thereby leading to reduced errors.Design/methodology/approachThe authors conducted a cross-sectional survey study. The sample included 280 nurses.FindingsResults of a full structural equation model supported the hypothesised model, showing that authentic leadership is positively associated with EMC, which in turn is negatively associated with the frequency of errors.Practical implicationsThese results provide initial evidence for the role of authentic leadership in enhancing EMC and consequently, fostering error reduction in the workplace. The tested model suggests that the adoption of an authentic style can promote policies and practices to proactively manage errors, paving the way to error reduction in the workplace.Originality/valueThis study was one of the first to investigate the relationship between authentic leadership, error culture and errors. Further, it contributes to the existing literature by demonstrating both the importance of cultural orientation in protecting the organisation from error occurrence and the key role of authentic leaders in creating an environment for EMC development, thus permitting the organisation to learn from errors and reduce their negative consequences.

Aim To test a model to evaluate the influence of emotional labor on burnout and the mediating role of work-related stress reported by nurses. Background Nurses are particularly exposed to work-related stress caused by their relationships with their patients. Even though their emotional involvement can cause work-related stress for professionals, nurses recognize this as a fundamental part of the caring relationship, and it has been proved to be therapeutic for patients. The effects of emotional labor contribute to stress, and prolonged exposure to it contributes to burnout syndrome, with repercussions on nurses' health and quality of life, and patients' quality of care. Methods A multicentre correlational study was conducted on a sample of 207 nurses from different clinical areas in three hospitals in Italy. A self-report questionnaire was used to measure levels of emotional labor, burnout and work-related stress. Results High levels of emotional labor and work-related stress increase burnout syndrome in nurses. Work-related stress mediates the relationship between emotional labor and burnout. The Oncology ward is identified as the major clinical area exposing nurses to emotional labor. Conclusions The results of this study highlight the mediating role of work-related stress in the relationship between emotional labor and burnout, offering a new field for intervention to interrupt this process.

Individuals' quality of life (QoL) is strictly linked with working environment experiences. The peculiarities of nursing profession yield it to be stressful, requiring high emotional engagement.The main aim of this study was to validate a reliable tool to measure nurses' QoL.A panel of experts selected a tool from literature to measure QoL. They also modified it to achieve more specific version for nurses. The developed tool (NQoLs) was tested on 940 nurses.NQoLs was a valid and reliable tool to describe different nuances of QoL. Therefore, four dimensions emerge from psychometrics analysis, which were physical, emotional, social and working QoL. Moreover, the overall nurses' QoL was good but with some significant differences related to the clinical settings of belonging. The working dimension had the major impact on the overall nurses' QoL.NQoLs allows to measure QoL amongst nurses, and that is strategic for both research and management, due to NQoLs can help to face with a number of issues coming from an area with many gaps in knowledge. It should also be helpful to assess QoL in relation with organizational wellbeing amongst nurses.La qualità di vita (QoL) degli individui dipende molto da ciò che accade nei luoghi di lavoro. Le dinamiche e le caratteristiche della professione infermieristica la rendono tra quelle sottoposte a maggiore stress e impegno emotivo.Validare uno strumento per la misurazione della QoL degli infermieri.Dopo aver selezionato dalla letteratura uno strumento di misurazione della QoL, ne è stata rivista la modalità di risposta, quindi è stato avviato uno studio di validazione su un campione di 940 infermieri.Lo strumento si è dimostrato valido ed affidabile per la misurazione della QoL degli Infermieri. Dalle analisi sono emerse quattro diverse dimensioni che sono state nominate QoL Fisica, QoL Emotiva, QoL Sociale e QoL Lavorativa. Complessivamente, gli infermieri riferiscono di essere abbastanza soddisfatti della loro qualità di vita. Sono gli infermieri di specifici ambiti clinici a riferire una minore qualità di vita. La dimensione lavorativa è quella che incide maggiormente sulla QoL degli infermieri.Poter misurare la QoL degli infermieri è importante per la comunità scientifica e per i dirigenti delle professioni infermieristiche perché consente di indagare un costrutto poco studiato prima e insieme ad altre variabili, può rappresentare un importante valore aggiunto per la valutazione del benessere organizzativo vissuto dagli infermieri nelle aziende sanitarie.

Background: Emotional demands may be a significant risk factor for wellbeing in healthcare professionals. Nurses have been considered the most exposed to emotional burden known as emotional labour. Scholars define it as the process by which nurses sometimes hide/fake the real emotion or struggle to display the appropriate emotion to meet the emotional work requirements. Emotional labour can result in physical, psychological and behavioural disorders. A specific tool to measure it among nurses is still missing. Objectives: This study aims to develop and validate an emotional labour scale for nurses. Methods: The design process consisted of three different phases. In the first one, 24 items have been selected from different tools. The second consisted of the assessment of the face and content validity. In the third phase, the Emotional labour scale has been psychometrically evaluated through a cross validation approach, including both exploratory factor analysis performed on a sample of 205 Italian nurses, with the final selection of an 11- items tool, and confirmatory factor analysis. Results: Emotional labour is acted through surface acting, compliance and restraint. The Emotional Labour Nursing scale showed good psychometric properties and was found to be valid and reliable for assessing emotional labour among nurses. The association between emotional labour and burnout was investigated. Conclusions: The Emotional Labour scale may foster a fuller understanding of the consequences of emotional labour. Since emotional demands and emotional labour are not included in the most common psychosocial risk assessment tools currently available, our results point out to their role in work stress prevention.

The main objective of the study was to measure caregiver burden among informal caregivers assisting people with multiple sclerosis (MS).Thirty percent of people with multiple sclerosis require some form of home assistance and 80% of such care is provided by informal caregivers. The quality of life of informal caregivers of patients with multiple sclerosis decreases with increasing physical and depressive symptoms of their loved ones. This can have effects on stress levels, physical and mental health, quality of life, and mortality of informal caregivers.A descriptive correlational study was performed in a sample of informal caregivers of MS patients.The study enrolled 41 informal caregivers of MS patients at a regional reference center in Rome, Italy. Data collection took place in the period between May and September 2016. A paper questionnaire was used, comprising a socio-demographic section and a "Caregiver Burden Inventory" section.The subjective burden perceived by informal caregivers of patients with MS is moderate. Socio-demographic characteristics were not found to influence burden of caregivers.It is important for nursing professionals to consider and evaluate the burden of informal caregivers of MS patients as they are valuable allies in the management of these patients.

Moral distress (MD) has significant implications on individual and organizational health. However there is a lack of an instrument to assess it among Italian nurses.The main aim of this study was to validate a brief instrument to assess MD, developed from the Corley's Moral Distress Scale (MDS).The modified MDS scale was subjected to content and cultural validity. The scale was administered to 347 nurses. Psychometric analysis were performed to assess construct validity.The scale consists of 11 items, investigating MD in nursing practice in different clinical settings. The dimensionality of the scale was investigated through exploratory factor analysis (EFA), which showed a two-dimensional structure labeled futility and potential damage. The futility refers to feelings of powerlessness and ineffectiveness in some clinical situations; the potential damage dimension captures feelings of powerlessness when nurses are forced to tolerate or perform perceived abusive clinical proceedings. Nurses who experienced higher MD, were more lilely to experience burnout.The modified MDS showed good psychometric properties, and it is valid and reliable for assessing moral distress among Italian nurses. Hence, the modified MDS allows to monitor the distress experienced by nurses and it is an important contribution to the scientific community and all those dealing with well-being of health workers.INTRODUZIONE. Lo stress morale (DM) ha implicazioni significative sul benessere individuale e sull’organizzazione lavorativa. Tuttavia allo stato attuale non disponiamo di uno strumento per valutare il DM tra gli infermieri italiani. OBIETTIVO. Lo scopo principale del presente studio è stato quello di validare uno strumento sintetico per la valutazione del MD, sviluppato dalla Scala dello Stress Morale di Corley (MDS). METODO. La MDS modificata è stata sottoposta a validità di contenuto e culturale. La scala è stata quindi somministrata a 347 infermieri. Si è eseguita l’analisi psicometrica per valutare la validità di costrutto. RISULTATI. La scala consta di 11 items che studiano il moral distress nell’assistenza infermieristica in diversi setting clinici. Le dimensioni della Scala sono state studiate con l’analisi fattoriale esplorativa (EFA), che ha evidenziato che essa consta di due dimensioni chiamate futilità e danno potenziale. La futilità si riferisce a sentimenti di impotenza e di inefficacia in alcune situazioni cliniche; a dimensione del danno potenziale cattura invece i sentimenti di impotenza quando si è costretti a tollerare o ad eseguire procedure cliniche ritenute abusive. Gli infermieri che maggiormente sperimentavano MD, erano più probabilmente esposti al burnout. CONCLUSIONI. La MDS modificata ha buone proprietà psicometriche, ed è uno strumento valido e affidabile per la misurazione dello stress morale tra gli infermieri italiani. Quindi la MDS modificata permette di monitorare lo stress morale vissuto dagli infermieri, e fornisce un importante contributo alla comunità scientifica e a tutti coloro che si occupano di benessere e salute dei lavoratori.

The main aim of this study is to examine the influence of the coordinator's ethical leadership on nurses' emotions (i.e., positive and negative) and work behaviours.A questionnaire was administered in paper format, including well-validated scales reported in literature, to a sample of 347 nurses working in a university hospital. A structural equation model has been tested after examining Pearson's correlations among study variables.The coordinator's ethical leadership is strongly related to the implementation of nurses' organisational citizenship behaviour and counterproductive work behaviour, which are influenced by their emotions. Positive emotions fully mediate the relationship between ethical leadership and organisational citizenship behaviour, while negative emotions partially mediate the relationship between ethical leadership and counterproductive work behaviour.Ethical leadership acts on nurses' organisational behaviour, as described in the modelling process. The nurses' organisational behaviour is crucial to the outcome of the health care service. Therefore, the ethical leadership indirectly affects the quality of the care and the cure offered to the patients.L’obiettivo principale di questo studio è quello di esaminare l’influenza della leadership etica del coordinatore sulle emozioni (positive e negative) degli infermieri e sui comportamenti agiti durante la loro attività clinica.E’ stato somministrato un questionario in modalità cartacea, composto da scale validate e presenti in letteratura a un campione di 347 infermieri di una realtà ospedaliera universitaria. I dati sono stati analizzati con il test di correlazione di Pearson e con un modello di equazioni strutturali.Lo stile di leadership etico del coordinatore ha una stretta relazione con la messa in atto di comportamenti di cittadinanza organizzativa e dei comportamenti controprodut- tivi degli infermieri, dove le emozioni giocano un ruolo centrale. Le emozioni positive svol- gono un ruolo di mediazione totale nella relazione tra leadership etica e comportamenti di cittadinanza organizzativa, mentre le emozioni negative sono un mediatore parziale nella relazione tra la leadership etica e comportamenti controproduttivi.La leadership etica agisce sui comportamenti agiti dagli infermieri, come definito nei processi di modeling. I comportamenti organizzativi degli infermieri sono cruciali per gli outcome delle strutture sanitarie. Pertanto la leadership etica del coordinatore condi- ziona indirettamente la qualità dell’assistenza e delle cure offerte ai malati.

The aim of this study was to examine, in a sample of nurses, the relationships between the organizational context variables (i.e., workload, interpersonal conflicts, organizational constraints), the burnout, the moral disengagement, and the counterproductive work behaviors (CWB), within their clinical work settings.A descriptive, correlational study was conducted in a sample of 347 nurses working in different clinical settings in a big university hospital in Central Italy. A self-report questionnaire was used for data collection, using several scales to assess different variables related to the organisational context, the burnout, the interpersonal strain, the moral disengagement, and the CWB.The clinical context was found to influence nurses' organizational wellbeing, which in turn was found to foster CWB. Nurses working in outpatients settings and in day hospitals were those who reported the lowest CWB, in comparison with nurses working in the Emergency Department and in the General Medicine Units.Findings of this study are important for nursing professional chiefs and for any professional involved in the promotion of workers' wellbeing. Our study findings highlight how the clinical work setting and the organizational context variables can lead to CWB. Researchers and managers should keep these aspects in high consideration due to their influence on the quality of the care delivered.

Aim This study describes the development and validation of the Nursing Profession Self-Efficacy Scale. Background Self-efficacy can be useful in predicting performance, job satisfaction or well-being. In the nursing field, there is a shortage of studies on self-efficacy with regard to nurses’ global confidence in coping ability across a range of everyday, challenging work situations. Methods To define the theoretical framework of nursing professional self-efficacy, two focus groups and a literature review were performed. An empirical study was then conducted to test validity and reliability. Face and content validity, construct validity, concurrent validity, internal consistency and test–retest reliability were examined. The content validity index was evaluated by 12 experts who suggested deleting 11 redundant items. The final developed tool was tested for construct analysis using a cross-validation approach, randomly splitting the overall sample of 917 nurses in two sub-groups. Findings The construct validity indicated two dimensions. The face and content validity were adequate. Test–retest reliability displayed a good stability, and internal consistency (Cronbach's α) was acceptable. Moreover, concurrent validity using the Generalized Self-Efficacy Scale was in line with the theoretical framework. Conclusion The scale showed evidence of validity and reliability. The major limitation is the strong influence of the Italian context in the tool development. Implications for nursing and health policy The Nursing Profession Self-Efficacy Scale could be a fruitful tool that facilitates the application of theories (i.e. social-cognitive theory) in the nursing field and even development of interventions. Furthermore, a measurement of self-efficacy could be used to predict nursing clinical performance.

Background: Counterproductive work behaviors are considered an important issue for every workplace. This is particularly the case in the nursing setting, as such behaviors can also be detrimental for patients. However, the reasons underpinning nurses’ counterproductive behavior have been little studied, and the literature from the perspective of perpetrators’ is fragmented. Purpose: The aim of this systematic literature review was to identify and summarize studies concerning antecedents that could lead nurses to display counterproductive work behaviors. Methods: The PRISMA Statement and Flowchart were used to select the studies included in this review. The research was performed in July 2015 using the PubMed, CINAHL, PsycINFO, and Cochrane databases. Data were selected in stages based on inclusion, exclusion and quality criteria, and analyzed using Popay’s method. Results: Fourteen papers were selected. Counterproductive work behaviors in the nursing work environment were observed. The majority of studies were performed in North America (USA and Canada), using quantitative or qualitative designs. These work behaviors were studied in order to delineate predisposing factors and their relationship to Moral Disengagement. When counterproductive work behaviors are not sanctioned, and enforcement policies are not applied, they become an important problem for organizations. From the results of our systematic review, it is possible to identify two main foci: counterproductive work behaviors’ protective factors, and counterproductive work behaviors’ risk factors. Conclusion and implications for practice: This literature review identified specific antecedents that predispose nurses to engaging in counterproductive work behaviors, which negatively affect the quality of assistance and which can result in endangering the patient. This literature review helps to understanding the reasons that lead nurses to display counterproductive work behaviors, and can help prevent and restrict these phenomena.