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We present the final analysis of the observational campaign carried out by the PLAN (Pixel Lensing Andromeda) collaboration to detect a dark matter signal in form of MACHOs through the microlensing effect. The campaign consists of about 1 month/year observations carried out over 4 years (2007-2010) at the 1.5 m Cassini telescope in Loiano (Astronomical Observatory of BOLOGNA, OAB) plus 10 days of data taken in 2010 at the 2 m Himalayan Chandra Telescope monitoring the central part of M31 (two fields of about 13′ × 12.′6). We establish a fully automated pipeline for the search and the characterization of microlensing flux variations. As a result, we detect three microlensing candidates. We evaluate the expected signal through a full Monte Carlo simulation of the experiment completed by an analysis of the detection efficiency of our pipeline. We consider both “self lensing” and “MACHO lensing” lens populations, given by M31 stars and dark matter halo MACHOs, in M31 and the Milky Way, respectively. The total number of events is consistent with the expected self-lensing rate. Specifically, we evaluate an expected signal of about two self-lensing events. As for MACHO lensing, for full 0.5(10–2) M☼ MACHO halos, our prediction is for about four (seven) events. The comparatively small number of expected MACHO versus self-lensing events, together with the small number statistics at our disposal, do not enable us to put strong constraints on that population. Rather, the hypothesis, suggested by a previous analysis, on the MACHO nature of OAB-07-N2, one of the microlensing candidates, translates into a sizeable lower limit for the halo mass fraction in form of the would-be MACHO population, f, of about 15% for 0.5 M☼ MACHOs. [ABSTRACT FROM AUTHOR]

Nursing retention is a major challenge globally. Ongoing workforce instability across countries underscores the need to understand the factors influencing turnover and nursing retention. Trust is a crucial element in managing workplace relationships between nurse managers and nurses. Existing studies have shown the direct impact of trust on employees' intention to leave their job but have not explored the effects of potential mediators such as organizational commitment. The aim of this study was to examine the impact of trust in the leader on nurses' intention to leave their job through the mediation of organizational commitment. A cross-sectional study was conducted in Italy. A convenience sample of 1853 nurses completed a self-report survey. The study tested a hypothesis-based mediation model using structural equation modeling, which showed good fit indices. The results indicated that trust in the leader had a significant impact on nurses' intention to leave, and this relationship was partially mediated by organizational commitment. Nurses who trust their leader are more likely to demonstrate higher levels of organizational commitment, resulting in a lower intention to leave their job. Furthermore, organizational commitment and trust emerge as critical factors in reducing nurses' intention to leave their current positions. Therefore, managers can reduce nurses' intention to leave by building trustful relationships that enhance organizational commitment.This study was not registered.

Objectives: This study aimed to translate and test the psychometric properties of the Chase Nurse Manager Competency Instrument (CNMCI) among Italian nurse managers and to provide further support for the scale's validity testing., Methods: An instrument translation and cross-sectional validation study was conducted. The English version was translated into Italian using the translation method, which included pre-translation (establishing equivalence), initial translation, pretesting, review, and administration. From August 2022 to June 2023, 349 nurse managers were recruited through a web survey from 31 public and private healthcare organizations in North, Central, and Southern Italy. Validity assessments included content and structural validity. Reliability was evaluated using Cronbach's α coefficient and test-retest reliability., Results: The content validity confirmed all the items of the CNMCI in the Italian version, including the two measurement sections, "knowledge and understand" and "ability to implement and/or use." The instrument's item-content validity index (I-CVI) ranged from 0.83 to 1.00, while the scale-level content validity index (S-CVI) for both instrument sections was 0.97. The confirmatory factor analysis showed an acceptable fit. In the "knowledge and understand" section, Cronbach's α coefficient was 0.978, and in the "ability to implement and/or use" section, Cronbach's α coefficient was 0.976. The correlation coefficient between each dimension was 0.494-0.908. The test-retest reliability score was 0.82, suggesting good instrument consistency., Conclusions: Overall, the Italian CNMCI demonstrates good reliability and validity for measuring nurse managers' core competencies and supports the construct's multi-dimensionality. Also, our findings support the hierarchical nature of the factors, further supporting the validity of the instrument., Competing Interests: The authors declare that they have no competing interests., (© 2024 The Authors.)

Background: Nursing workload is largely studied but poorly explored under physical, mental, and emotional dimensions. Currently, only a limited number of variables have been linked to nursing workload and work contexts., Purpose: The study aimed to investigate whether it is feasible to identify variables that consistently correlate with nursing workload and others that are specific to the context., Methods: We employed a descriptive correlational analysis and a cross-sectional design. Data were collected through a survey distributed to registered nurses working across Italy, at the conclusion of randomly assigned morning or afternoon shifts., Results: We received 456 surveys from 195 shifts, collected from nurses in four public and two private hospitals. Commonly associated variables with nursing workload dimensions included patient complexity of care, admission/discharge or transfer, informing patients/relatives, contacting physicians, and unscheduled activities. Variables categorized as setting-specific were patient isolation and specialties, nurse-to-patient ratio, adequacy of staff in the shift, peer collaboration, healthcare documentation, educating others, and medical urgency., Conclusions: In summary, certain variables consistently correlate with nursing workload across settings, while others are specific to the context of care. It is imperative for nurses and nurse managers to measure the nursing workload in various dimensions, enabling the prompt implementation of improvement actions., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: Competence is an essential concept for measuring nurses' performance in terms of effectiveness and quality. To this end, our analysis highlighted the process of acquiring competencies, their self-evaluation into clinical practice, and how their proficiency levels change throughout the nursing career. In detail, this research explored nurses' perceived level of competence and the factors that influence it in different contexts., Methods: A cross-sectional survey using a structured questionnaire to assess the nursing participants' perception of their competencies in different clinical settings was accomplished., Results: A descriptive and bivariate analysis was performed on 431 nurses. Most respondents assessed their level of competence to be higher than their roles required. The Kruskal-Wallis test confirmed that nursing experience was a relevant factor influencing nursing competencies., Conclusions: We suggest improving the competence of practicing nurses, using experience as a measurable effect of their development.

Nurse managers play a vital role in healthcare organizations, wielding the ability to substantially enhance work environments, foster nurses' autonomy, and bolster retention within workplaces. In this context, this study focuses on the Nurse Manager Actions scale, aiming to evaluate its items' scalability as well as the scale's validity and reliability among nurses and nurse managers operating within the Italian healthcare context. The study protocol was not registered. To ensure linguistic and cultural alignment, an iterative and collaborative translation process was undertaken. Subsequently, a multi-center cross-sectional design was adopted. Using a web-survey approach, data were collected among 683 nurses and 188 nurse managers between August 2022 and January 2023. The Nurse Manager Actions scale was found to be a valid and reliable instrument in Italian after a Mokken Scale Analysis. For nurses ( H T = 0.630, Molenaar-Sijtsma rho = 0.890), the scale included 6 items, while 11 items were confirmed for nurse managers ( H T = 0.620, Molenaar-Sijtsma rho = 0.830). Nurse Manager Actions scale scores were correlated with increased satisfaction and decreased intention to leave for both nurses and nurse managers. The employed validation process enhanced the scale validity for use in Italy and provided a model for other researchers to follow when assessing similar measures in different populations. Measuring and empowering nurse manager actions in work contexts is essential to improve the general well-being and retention of nurses, especially in the current nursing shortage.

Little is known about which communication strategies nurses carried out and whether the nurse-patient relationship has been altered due to the mandated use of personal protective equipment during the COVID-19 pandemic. This study describes how nurse-patient communication and relationships took place from the point of view of nurses engaged in caring for patients with COVID-19. A qualitative descriptive study design following COREQ guidelines was conducted. Semi-structured telephone interviews with nurses working in the COVID ward of an Italian university hospital were performed between September 2020 and June 2021. Ten nurses were recruited using convenience sampling. One overarching theme, three main themes, and nine sub-themes were identified. The overarching theme 'The in-out relationship: 'in here and out there' and 'inside me and out of me' included the main themes 'A closed system different from normal', 'Uncovering meaningful human gestures', and 'A deep experience to live''. The relational nature of nursing-where 'me and you' and the context are the main elements-leads nurses to find new ways of interacting and communicating with patients, even in a new situation that has never been experienced. Enhancing human gestures, thinking about new contexts of care, and educating new generations to maintain human-to-human interaction, regardless of the context of care, are the directives to be explored for creating the future of nursing care.

For decades, scholars have studied leader-member exchange (LMX) relationships to understand and explain the effects of leadership on follower attitudes and performance outcomes within work settings. One available instrument to measure these aspects is the LMX-7 scale. This measurement has been widely used in empirical studies, but its psychometric properties have been poorly explored. The aim of this study was to test the psychometric characteristics (content, structural and construct validity, and reliability) of the Italian version of the LMX-7 scale and to support its cultural adaptation. We used a cross-sectional multi-center design. The forward-backward translation process was used to develop the Italian version of the scale. The scale was administered through an online survey to 837 nurses and nurse managers working in different settings. The factorial structure was tested using both exploratory and confirmatory factor analyses (EFA and CFA), and reliability was evaluated using Cronbach's alpha. For the construct validity, we used hypothesis testing and differentiation by known groups. The Italian version of the LMX-7 scale presented one dimension. All the psychometric tests performed confirmed its validity and suggested its usefulness for future research.

Background: Standard precautions (SPs) are first-line strategies with a dual goal: to protect health care workers from occupational contamination while providing care to infected patients and to prevent/reduce health care-associated infections (HAIs). This study aimed at (1) identifying the instruments currently available for measuring healthcare professionals' compliance with standard precautions; (2) evaluating their measurement properties; and (3) providing sound evidence for instrument selection for use by researchers, teachers, staff trainers, and clinical tutors., Methods: We carried out a systematic review to examine the psychometric properties of standard precautions self-assessment instruments in conformity with the COSMIN guidelines. The search was conducted on the databases PubMed, CINAHL, and APA PsycInfo., Results: Thirteen instruments were identified. These were classified into four categories of tools assessing: compliance with universal precautions, adherence to standard precautions, compliance with hand hygiene, and adherence to transmission-based guidelines and precautions. The psychometric properties of instruments and methodological approaches of the included studies were often not satisfactory. Only four instruments were classified as high-quality measurements., Conclusions: The available instruments that measure healthcare professionals' compliance with standard precautions are of low-moderate quality. It is necessary that future research completes the validation processes undertaken for long-established and newly developed instruments, using higher-quality methods and estimating all psychometric properties.

Background: The Trust Me Scale is a widely used instrument to measure trust in healthcare providers. However, no Italian version of the scale exists yet, limiting its use in Italian-speaking populations. The aim of this study is to translate and validate the Trust Me Scale for use in Italian-speaking populations in nurses and nurse managers., Methods: The translation process involved methodological steps of collaborative and iterative translation with cultural adaptation. The validation process included a cross-sectional study enrolling a convenience sample of 683 nurses and 188 nurse managers who completed the Italian version of the Trust Me Scale and measures of intention to leave, satisfaction, and organizational commitment., Results: Item 5 was removed for poor factor loading, and items 11 and 13 were removed following an a priori strategy focused on deleting items with correlations between residual variables different than expected based on theoretical expectations derived from previous research. The final model fit well to sample statistics with a three-factor structure (harmony, reliability, and concern) and 13 items. A multiple-indicator multiple-cause model showed a measurement invariance between nurses and nurse coordinators. Construct validity was also supported by the evidence that the measured domains of trust align with the theoretical expectations and are related to the intention to leave, job satisfaction, and organizational commitment. Each dimension showed adequate scale reliability., Conclusions: The Italian version of the Trust Me Scale is a valid and reliable instrument to measure trust in nurses and nurse managers in Italian-speaking contexts. It can be used for research in nursing and leadership and evaluation of interventions aimed at improving trust in healthcare contexts.

Introduction: Work contexts can affect nurses' work and work outcomes. Work context factors of nurses, patients, or workflow can modulate nurses' organization of work and determine increased workloads., Aim: The aim of this research was to analyze relationships between factors regarding the patient, the nurse, workflow, and nurses' work organization, to investigate whether work organization is related to physical, mental, and emotional workloads, and to explore whether one dimension of workload influences the other dimensions., Methods: We used a cross-sectional design based on the Job Demand-Resources theory. We asked registered nurses, working in nine medical-surgical wards across three hospitals in Italy, to self-report on work organization and workloads regarding randomized shifts over three consecutive weeks. Four scales from the QEEW 2.0 questionnaire were used on an online survey for data collection. multivariable linear regressions with structural equation modelling were tested. The study was approved by the three local Ethics Committees., Results: We received 334 questionnaires regarding 125 shifts worked. Patient complexity (β = 0.347), patient specialties (β = 0.127), adequacy of staffing (β = -0.204), collaboration with colleagues (β = -0.155), unscheduled activities (β = 0.213), supply search (β = 0.141), and documentation (β = 0.221) significantly influenced nurses' work organization. Nurses' work organization was significantly related to physical, mental, and emotional nursing workloads., Conclusions: the patient, the nurse, and workflow aspects influence nurses' work organization and workloads. Healthcare organizations, managers, and nurses should explore work settings to identify work turbulences early and implement strategies to improve nursing work conditions and workloads.

Aim: This study aimed to identify determinants of physical, mental and emotional nursing workloads., Background: Workload has a physical, mental and emotional dimension. It influences employees' well-being and quality of care. Nevertheless, studies of specific predictors for each dimension of nurses' workload are scarce., Methods: We used a cross-sectional prospective design based on the Job Demand-Resources theory. We asked nurses to describe workload perceived at the end of every shift over three consecutive weeks. Data were gathered from two academic hospitals, in seven medical-surgical wards. We received 259 responses and tested 2 multivariate regression models., Results: Physical workload was predicted from all variables tested; mental workload was determined by patient complexity or isolation, adequacy of nurse staffing and skill-mix, and unscheduled activities; and emotional workload was predicted by all variables except adequacy of staffing and other people's education., Conclusions: Patient, nurse and workflow aspects influenced nurse's shift workload differently for each specific dimension., Implications for Nursing Management: Measurement and definition of predictors of workload in the work environment are essential. Recognizing the determinants of specific dimensions of workload facilitates identification of the most appropriate interventions to improve nurses' well-being in health care settings., (© 2022 John Wiley & Sons Ltd.)

Introduction: Work-related musculoskeletal disorders (WMSDs) are among the main causes of injury and pain in healthcare professionals. Previous reviews provided a fragmented view of the interventions available for WMSDs. This review aims to provide a comprehensive description of interventions for preventing and reducing work-related musculoskeletal injuries and/or pain among healthcare professionals, and to assess the methodological quality of studies., Methods: A systematic literature review was performed, based on the Effective Public Health Practice Project process. A comprehensive search was conducted on six peer-reviewed databases and manually. The methodological quality of the studies included was rated as weak, moderate, or strong. The studies were organized based on the 2019 classification of the interventions by Oakman and colleagues., Results: Twenty-seven articles were included reporting individual (n = 4), task-specific (n = 4), work organization and job design (n = 2), work environment (n = 1), and multifactorial (n = 16) interventions. Overall quality rating was strong for 6 studies, moderate for 16, and weak for 5. Individual interventions such as neuromuscular and physical exercise were effective in reducing pain. Task-specific and work organization interventions could prevent certain injuries. Significant reduction of both injuries and pain resulted from multifactorial interventions, which were reported by the majority of strong (n = 5) and moderate (n = 10) quality articles., Conclusions: This review provides healthcare professionals with evidence-based information to plan interventions targeted towards reducing WMSDs. In particular, more efforts are needed to implement and extend effective multifactorial interventions. Moreover, studies about each professional healthcare target group are needed., Practical Application: Our results can guide policy-makers, healthcare managers and professionals to choose the best strategies to prevent and reduce WMSDs and to shape continuous education programs. This study prompts clinicians to develop inter-professional collaborations and to practice physical activities in order to reduce WMSDs., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Ltd.)

Introduction: COVID-19 (Coronavirus Disease 19) has rapidly spread all around the world. Vaccination represents one of the most promising counter-pandemic measures. There is still little specific evidence in literature on how to safely and effectively program access and flow through specific healthcare settings to avoid overcrowding in order to prevent SARS-CoV-2 transmission. Literature regarding appointment scheduling in healthcare is vast. Unpunctuality however, especially when targeting healthcare workers during working hours, is always possible. Therefore, when determining how many subjects to book, using a linear method assuming perfect adhesion to scheduled time could lead to organizational problems., Methods: This study proposes a "Queuing theory" based approach. A COVID-19 vaccination site targeting healthcare workers based in a teaching hospital in Rome was studied to determine real-life arrival rate variability. Three simulations using Queueing theory were performed., Results: Queueing theory application reduced subjects queueing over maximum safety requirements by 112 in a real-life based vaccination setting, by 483 in a double-sized setting and by 750 in a mass vaccination model compared with a linear approach. In the 3 settings, respectively, the percentage of station's time utilization was 98.6, 99.4 and 99.8%, while the average waiting time was 27.2, 33.84, and 33.84 min., Conclusions: Queueing theory has already been applied in healthcare. This study, in line with recent literature developments, proposes the adoption of a Queueing theory base approach to vaccination sites modeling, during the COVID-19 pandemic, as this tool enables to quantify ahead of time the outcome of organizational choices on both safety and performance of vaccination sites., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Di Pumpo, Ianni, Miccoli, Di Mattia, Gualandi, Pascucci, Ricciardi, Damiani, Sommella and Laurenti.)

The COVID-19 emergency has led many health facilities to reorganize themselves in a very short time to meet the urgent needs for intensive, semi-intensive or ordinary care of SARS-CoV-2 patients. In this pandemic, characterized by speed of transmission and severity of respiratory symptoms, care has been affected by the increase in volume and clinical complexity of patients, the sudden and unpredictable staff decrease and the lack of support from family members / caregivers. At the same time, experience in the field has shown how "informal" resources have been activated, which enabled to treat the highest possible number of patients above the real availability of resources. The purpose of this study was to explore the experiences of nurses involved in frontline care (COVID Centers) during the pandemic with a particular focus on professional motivation and on the development of technical-professional and personal skills. A study with a qualitative research design using focus group technique was conducted. Two focus groups were held with nine nurses. Data were analyzed with inductive content analysis. The findings can be summarized in five main categories: professional identity; motivation and sense of mission; development of professional and personal skills; spirituality; person-centered care; uniqueness of the lived experience. These findings shed new light on the correlation between motivation, professional identity and value, sense of duty and sense of belonging to the professional group. Moreover, the experience in the COVID Centers represented a valuable opportunity for participants to rediscover some specific issues related to nursing professional identity and to develop new personal and technical-professional skills in a very short time. Finally, nurses experienced once again how the nurse-patient relationship and basic care are essential to provide effective and excellent care, even and especially for patients in critical conditions. Nurses re-discovered, in a careful body care and basic care, irreplaceable elements to give back to patients, often dying, their own dignity, and all the needed closeness and attention necessary also to compensate the absence of the loved ones. These elements represent a way to concretely and deeply express the ethics of a job well done in nursing., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 De Benedictis, Gualandi, Saccoccia, Pensieri, Piredda, De Micco, Marchetti, Facchinetti, Pasquarelli, De Carolis, Di Blasio, Tartaglini and Alloni.)