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Aim: To test a model of clinical learning that focuses on the role of the ward manager. Background: The ward manager's role in supporting clinical learning indirectly focuses on the ward climate connected to students' clinical placements. In this way, the ward manager influences both nursing care and the pedagogical atmosphere in the ward. Design: Cross-sectional, secondary analysis. Methods: The sample included nursing and midwifery students (N = 5,776, n = 1,900) who had completed their clinical placement. Data were collected with the Clinical Learning Environment, Supervision and Nurse Teacher scale. Structural equation modelling was adopted to test the hypotheses. Results: Estimates of the model parameters demonstrated that a ward manager's leadership style influences both the premises of nursing at the ward (0.84, p

Background\ud The number of people with chronic and long-term conditions has increased during recent decades; this has been addressed by leveraging information and communication technology (ICT) to develop new self-care solutions. However, many of the developed technological solutions have not been tested in terms of impact(s) on patients' quality of care.\ud \ud Objectives\ud This systematic review aimed to identify the current best evidence on the types of interventions that have been developed to improve the quality of patient care through the clinical application of ICT in primary, tertiary or home care.\ud \ud Design\ud A systematic review, including a meta-analysis, was conducted according to the JBI Manual for Evidence Synthesis guidelines.\ud \ud Data sources\ud Relevant data were identified from four electronic databases: CINAHL, PUBMED, SCOPUS and MEDIC.\ud \ud Review methods\ud The eligibility criteria were formatted according to PICOS inclusion and exclusion criteria. At least two researchers performed the screening process separately, after which they agreed upon the results. The Cochrane Risk of Bias Assessment and JBI Critical Appraisal tool for randomised controlled studies (RCTs) were used to assess research quality. Data were extracted, and a meta-analysis was performed if the research met quantitative requirements.\ud \ud Results\ud Of the 528 initially identified studies, 11 studies were chosen for final data synthesis. All of the interventions integrated ICT solutions into patient care to improve the quality of care. Patients across all of the RCTs were educated through direct training, the provision of information relevant to their disease or one-to-one educational coaching. The interventions included various interactions, e.g. nurse expert visits and support, and support provided by peers, groups or family members. These interactions occurred through face-to-face coaching, virtual human coaching or virtual coaching that relied on an algorithm. The performed meta-analysis included 6 of the 11 identified studies. The overall effect was nonsignificant, with three studies demonstrating a significant postintervention effect on patients' quality of care and quality of life and three studies a nonsignificant effect.\ud \ud Conclusions\ud The presented results suggest that ICT-based care should be developed in collaboration with nurses and other health care professionals, involve patients in decision-making and combine ICT solutions with human interaction and coaching. ICT education was found to be essential to the success of an intervention.

Aims\ud To investigate which morality traits are more important for nurses to determine positive opinions of their nurse manager.\ud \ud Background\ud People selected morality more often than sociability and competence when forming a positive opinion towards an ideal or a newcomer manager.\ud \ud Methods\ud A multicentre, cross-sectional study was carried out by administering two questionnaires to 775 nurses on the influence of morality, sociability and competence traits on their impression formation processes.\ud \ud Results\ud Regarding nurses' perceptions about the morality, sociability and competence traits of an ideal nurse manager, the total score for morality was 20.0; for sociability, it was 14.2; and for competence, it was 19.6. For nurses' opinions about a new nurse manager, the total score of the morality section was 16.2, which was very similar to the total score of the competence section (mean = 16.1).\ud \ud Conclusion\ud Morality positively influences nurses' initial impression of an ideal manager, and though it seems to be a necessary condition, it is not sufficient by itself to support the nursing staff's perception towards a new manager.\ud \ud Implications for Nursing Management\ud Our findings could be useful in better understanding the role of morality in social perceptions and behavioural consequences of staff nurses towards their nurse manager.

Background\ud The pandemic and its related social restrictions have led to many uncertainties in nursing education, including the fear of infection in clinical learning settings and the challenge of remote learning. The modification of clinical and academic environments generated anxiety and academic concerns among nursing students.\ud \ud Objectives\ud To explore the main determinants of anxiety related to the clinical and classroom environments in nursing education after the second wave of the COVID-19 Pandemic.\ud \ud Design\ud Multicentre cross-sectional study.\ud \ud Settings\ud Ten Universities offering nursing bachelor programs in central and southern Italy.\ud \ud Participants\ud A convenience sample of 842 nursing students.\ud \ud Methods\ud From April to July 2021, the Self-Rating Anxiety Scale and the Altered Student Study Environment Tool were administered to assess, respectively, students' anxiety and their concerns about the study environment. A regression model was tested.\ud \ud Results\ud Most of the nursing students were female (76.6 %), living with family (70.9 %), and full-time students (85.7 %); 44.6 % were third-year of Bachelor in Nursing students. The majority of the participants (88.5 %) showed a level of anxiety. The statistically significant predictors of anxiety levels were concerns about grade attainment (β=0.42, p

Aims: This study aimed to explore mentoring competence in nursing student mentors during clinical practice by identifying different mentor profiles and connections between different competence areas among five European countries and Japan. Methods: The study implemented a cross-sectional design in Finland, Italy, Lithuania, Slovenia, Spain, and Japan during 2016 and 2019. In total, 6208 mentors were invited, and 1862 participated from 58 healthcare organizations. The data were collected with a survey questionnaire by including background question items with the Mentor Competence Instrument. K-clustering and structural equation modeling were used for data analysis. Results: Four mentor profiles, A (43%), B (30%), C (18%), and D (9%), were identified according to the seven mentoring competence areas with high statistical significance (p 3.50) was observed among Finnish, Lithuanian, and Slovenian mentors with university education in nursing, older ages, more work experience, and previous education in mentoring. Lower competence (mean

Background The Trust in Nurses Scale (TNS) was developed and psychometrically assessed so that patients' trust could be accurately and reliably measured. The TNS has been translated, assessed and administered to patients in Europe, Asia and North America. Aim This descriptive, cross-sectional, correlational study aimed to assess the psychometric characteristics of the Italian version of the Trust in Nurses Scale. Methods An Italian version of the TNS was developed. We used a forward-backward translation methodology to establish semantic and conceptual equivalence within the Italian context. The scale was then administered to a convenience sample of 200 hospitalised patients in medical, surgical or oncology units. Internal consistency and construct validity were assessed performing Cronbach's alpha and confirmatory factor analysis (CFA). Both a 4-item and a 5-item TNS were assessed. Results The 4-item TNS demonstrated better construct validity than the 5-item version. Similarly, the internal consistency reliability was better with 4 items than 5 (0.83 and 0.79, respectively). Conclusion The Italian version of the scale has acceptable reliability and validity and may be used to assess this aspect of the nurse-patient relationship. Being tested in different settings, it may be used with all patients admitted to hospital. Trust in nurses is critically important to patient outcomes; however, it is rarely measured quantitatively on a wide scale. The use of the Italian validated scale could be useful to increase evidences on this important topic, as it represents a core component of nursing care.

This study aimed to explore nursing and midwifery students' evaluation of the clinical learning environment and mentoring and to identify distinct student profiles relating to their perceptions.This study employed a cross-sectional design.The study population included nursing and midwifery students in a university hospital in Finland.All nursing and midwifery students who completed their clinical placement were invited to take part in the study in the academic year 2017-2018.The data (N = 2,609) were gathered through an online survey using the Clinical Learning Environment, Supervision and Nurse Teacher scale. The data were analysed using a K-mean cluster algorithm to identify nursing and midwifery students' profiles.The findings from this study indicate four distinct profiles (A, B, C,D) of nursing and midwifery students in relation to the clinical learning environment and mentoring. Profile A (N = 1,352) students evaluated their clinical learning environment and mentoring to the highest level (mean varied from 9.44-8.38); and Profile D (N = 151)- to the lowest (mean varied from 5.93-4.00).The findings highlight that nursing and midwifery students evaluate their clinical learning environment and mentoring more highly when: they have a named mentor, student and mentor discuss learning goals, there is a final assessment in clinical learning, the mentor's guidance skills support student learning, the clinical learning supports the student's professional development and pre-clinical teaching in an educational institution supports learning in the clinical placement.Clinical learning plays an important role in nurse and midwifery education. Mentoring of clinical practice was shown to have a great influence on students' perceptions of their success in clinical learning. We suggest that clinical practice should be strengthened by the building of collaboration between nursing teachers and registered nurses.目的: 该研究旨在探讨护理和助产专业学生对临床学习环境和指导的评价,并确定与他们看法有关的不同学生情况。 设计: 该研究采用横断面设计。 背景: 研究对象包括芬兰一所大学医院的护理和助产专业学生。 参与者: 受邀参与研究的所有完成临床实习的2017-2018级护理和助产专业学生。 方法: 通过使用临床学习环境、监督和护士教师评估表的在线调查收集数据(N = 2,609)。使用K-均值聚类算法对数据进行分析,以确定护理和助产专业学生的情况。 结果: 该研究结果表明,护理和助产专业学生对临床学习环境和指导有四种不同的评价(A、B、C、D)。评价A(N = 1,352)表示学生对其临床学习环境和指导的评价最高(平均值范围:9.44-8.38);评价D(N = 151)表示学生对其临床学习环境和指导的评价最低(平均值范围:5.93-4.00)。 结论: 调查结果强调,护理和助产专业的学生在以下情况下对其临床学习环境和指导的评价较高:学生有指定的导师、学生和导师讨论学习目标、临床学习中有期末评估、导师的辅导技能支持学生的学习、临床学习支持学生的专业发展以及教育机构的临床前教学支持临床实习方面的学习。 影响: 临床学习在护士和助产士教育中发挥着重要作用。研究表明,临床实践的指导对学生临床学习的成就感有很大影响。我们建议,应加强护理教师与注册护士之间的合作建设,进而加强临床实践。.

Background: Caregiver contributions (CC) to heart failure (HF) self-care maintenance (ie, CC to maintaining HF stability) and management (ie, CC to dealing with HF signs and symptoms) improve patient outcomes, but it is unknown whether caregiver preparedness influences CC to self-care and whether caregiver confidence mediates this process. Objectives: We evaluated the influence of caregiver preparedness on CC to HF self-care maintenance and management and the mediating role of caregiver confidence. Methods: This is a secondary analysis of the MOTIVATE-HF study. Patients were 18 years or older, with a diagnosis of HF in New York Heart Association classes II to IV, who had insufficient self-care and did not have severe cognitive impairment. Patients’ informal caregivers were those people inside or outside the family who gave most of the informal care to the patients. We used the Caregiver Preparedness Scale and the Caregiver Contribution to Self-Care of HF Index. We tested a path analysis model and the indirect effects. Results: Caregivers (n = 323) were 55 (SD, 15) years old on average and predominantly female (77%). The path analysis showed that higher scores in caregiver preparedness were associated with higher scores in caregiver confidence. In turn, higher caregiver confidence was associated with higher CC to self-care maintenance and management. Caregiver confidence mediated the association between caregiver preparedness and CC to self-care maintenance and management. Conclusions: Caregiver confidence may play a role in CC to self-care. Interventions to improve CC to HF self-care should not only be focused on improving caregiver preparedness but also should consider the role of caregiver confidence.

Aims\ud To determine coronavirus disease 2019 (COVID-19) vaccination hesitancy in healthcare professionals and healthcare students in Italy across four generations (baby boomers, generations X, Y and Z).\ud \ud Design\ud A cross-sectional descriptive study was performed through an online survey conducted from May to June 2021. The STROBE guidelines were adopted for reporting.\ud \ud Methods\ud Data were collected by initially sending a survey link to a convenience sample of healthcare professionals and students, which was followed by snowball sampling. The VAX scale was validated and adopted. An ANOVA was performed to detect differences in vaccine-hesitancy beliefs between the four generational groups.\ud \ud Results\ud The survey was completed by 1226 healthcare professionals and students. Worries about unforeseen future effects accounted for the higher vaccination hesitancy factor across generations. More positive attitudes towards COVID-19 vaccination were expressed by members of generation Z than by members of generation Y and baby boomers. Members of generation X had the highest vaccination hesitancy scores in the overall scale.\ud \ud Conclusion\ud The results suggest that public health campaigns should take into account the generational differences in COVID-19 vaccination hesitancy to achieve higher levels of vaccine acceptance, including amongst healthcare professionals and students.\ud \ud Impact\ud Vaccination is the most effective strategy to tackle the COVID-19 pandemic. The advice of health professionals strongly influences vaccination willingness in the general population. A consideration of the generational patterns in the COVID-19 vaccination hesitancy of healthcare workers and students may increase vaccination uptake in these populations, which in turn may lead to greater public acceptance of the vaccine.

Aims: To describe the mentoring competence of clinical practice nurse mentors and identify different mentor profiles. Design: Cross-sectional research design, secondary analysis. Methods: An international, cross-sectional study design was performed in five European countries. A total of 1 604 mentors from 33 healthcare organizations participated in the study between 2016–2019. The Mentors' Competence Instrument (MCI), which includes seven sub-dimensions and 44 items, was used to collect data. K-means cluster and binary regression analyses were performed to detect mentor profiles and determine how various factors affect competence, respectively. Results: The K-means cluster analysis identified three distinct profiles: A (n = 926); B (n = 566); and C (n = 85). The profiles showed significantly different values (p < .001) across all seven areas of mentoring competence. In comparison with the other profiles, nurses in profile A were older, had more work experience and were more probably to have completed mentoring-specific training. We would like to acknowledge European Commission, Erasmus+and KA2: Strategic partnership for providing funding for the project Quality mentorship for developing competent nursing students (QualMent).

Background\ud Those who mentor nursing students from diverse backgrounds should be educationally prepared to provide safe, culturally appropriate mentoring in clinical learning environments.\ud \ud Objective\ud To evaluate the effects of an educational intervention on mentors' competence in mentoring culturally and linguistically diverse nursing students during clinical placement.\ud \ud Design\ud Nonrandomised, quasi-experimental study.\ud \ud Settings.\ud \ud The study was conducted at two hospitals located in Finland.\ud \ud Participants\ud Mentors responsible for mentoring nursing students during clinical placements.\ud \ud Methods\ud The intervention group (n = 49) completed blended learning mentoring education containing a cultural competence component. The control group (n = 62) completed online mentoring education lacking a cultural competence component. Data were collected from both groups at baseline, immediately after education, and at six-months follow-up using the Mentors' Competence Instrument and Mentors' Cultural Competence Instrument. Wilcoxon signed-rank test and Mann-Whitney U test were used to determine differences before and after education. Mixed model for repeated measures was used to compare the differences between the two groups.\ud \ud Results\ud Pretest-posttest results revealed statistically significant improvements in both groups on general mentoring competences. Both groups evaluated their competence in cultural sensitivity and awareness highly throughout the study period. Following education, competence in cultural interaction and safety and cultural skills increased statistically significantly in the intervention group. The intervention group was statistically significantly more satisfied with mentoring education, and reported that it had statistically significantly higher impact on their ability and willingness to mentor students. Comparison between groups revealed statistically nonsignificant differences in mentors' competence in mentoring culturally and linguistically diverse nursing students following education.\ud \ud Conclusions\ud The study provides evidence on the development and evaluation of education designed to improve mentors' competence in mentoring, which may help nursing students from diverse backgrounds overcome challenges faced during clinical placements. Reinforcement strategies following education are needed in order to facilitate the maintenance of competence over time.

The nursing shortage is a global and ongoing phenomenon that is expected to worsen. In many countries, imbalances in the nursing workforce will require international recruitment and plans to increase domestic and international nursing graduates. Nurses from culturally and linguistically diverse backgrounds have been reported to experience challenges while integrating into the workforce.To describe culturally and linguistically diverse registered nurses' experiences of their integration into the Finnish nursing workforce.The study adopted a qualitative descriptive design. Data were collected during the spring of 2021 from 24 culturally and linguistically diverse registered nurses working in various healthcare settings in Finland. Data were analyzed using content analysis, which resulted in 596 open codes, 21 sub-categories, and 8 categories.According to the performed analysis, culturally and linguistically diverse nurses in Finland face cultural, ethnic and linguistic challenges. Organizational acceptance and acknowledgement of culturally and linguistically diverse nurses' competence can help decrease the practice of deskilling and the perception that foreign nurses have purely opportunistic goals. Cultural and language learning support, tailored orientation programs, and mentorship are the most common organizational strategies for supporting integration and competence development. The role of the nurse manager and organizational strategies were also identified as essential components of smooth integration, work wellbeing and retention.Finnish healthcare organizations need to implement strategies that support culturally and linguistically diverse nurses' integration into the workforce. Nurse managers are important leaders that can foster culturally and linguistically diverse nurses' competence development, ensure the efficient use of their specialized skills, promote work wellbeing, and improve nurse retention.

The aim of this umbrella review was to establish recent evidence on integration strategies and models to support transition and adaptation of culturally and linguistically diverse nursing staff into healthcare environments.Umbrella review conducted according to Joanna Briggs institute guidelines.Data were collected from CINAHL, PubMed, Medic, ProQuest and Scopus electronic databases in 2021.Two researchers simultaneously screened studies' eligibility by title, abstract and full text. Quality appraisal for the selected studies was assessed according to Joanna Briggs institute critical appraisal. Data were synthesized by conducting content analysis.Twenty-seven reviews were included in the final synthesis. Strategies and models for supporting the transition and adaptation of culturally and linguistically diverse nursing staff into healthcare environments were structured as intra-organizational, sociocultural, and professional development. Intra-organizational strategies and models were unique to a particular organization and included policies and support, diversity, collegial and peer support, employee treatment and workplace environment. Sociocultural strategies and models addressed social, cultural and group dynamics using cultural training, learning and support, social support and friendships, language and communication, and personal skills development. Professional development enhanced nursing competence, ability to practice and workplace professional development. This was supported through licensure and orientation to work, career and competence development, and workplace mentorship and preceptorship.There is a need to understand culturally and linguistically diverse nurses' needs and motivation to integrate, which is essential toward developing efficient integrational strategies and models. Strategies and models also need to support cultural and personal competence development of native nurses to aid efficient integration of culturally and linguistically diverse colleagues. Future studies can evaluate nursing workforce shortages and their implications on integration process.

to investigate the role of gender, age, province of residence, and nursing home residency on the risk of death for residents in the Friuli Venezia Giulia (FVG) Region (Northern Italy) tested positive for Covid-19, considering recovery as a competing event. The secondary objective is to describe the impact of the Covid-19 epidemic in FVG and in the Regions of Northern and Central Italy in terms of incidence and mortality compared to the national data.retrospective cohort study.resident population in FVG in the period between 29 February and 25 June 2020.in order to describe the impact of the Covid-19 outbreak in FVG, in terms of incidence and mortality compared to the national data, the standardized incidence (SIR) and mortality (SMR) ratios and their respective 95% confidence intervals (95%CI) were calculated compared to the Italian population for the northern and central Regions of Italy and the autonomous Provinces (PA) of Trento and Bolzano. A retrospective cohort study was conducted on subjects residing in FVG to whom at least one naso-oropharyngeal swab (hereafter, named swab) resulted positive for Covid-19. For each subject included in the cohort, the observation period started with the first positive swab and ended with the first of the following events: death, recovery or censored, which means that at the end of the observation period the subject was still alive and positive. The cause of death was assigned to Covid-19 if a subject had not yet recovered at the time when the event occurred. Cohort members were considered recovered after two negative consecutive swabs. The sub-hazard ratio (SHR) was estimated by applying the regression model of competing risks by Fine and Gray, in which the event of interest was the death caused by Covid-19 and the competing event was recovery. The explanatory variables included in the multiple models are: gender, age at the beginning of the observation period, the Province of residence, and nursing home residency. The cause-specific hazard was estimated using Cox proportional hazard regression.during the observation period, 3,305 cases and 345 deaths were recorded in FVG; SIR and SMR resulted, respectively, equal to 0.64 (95%CI 0.61-0.68) and 0.43 (95%CI 0.37-0.50). The FVG was the Northern Region one with the lowest incidence and mortality. The cohort consisted of 3,121 residents in FVG with at least one swab with a positive Covid-19 result during the study period. The SHR of dying for Covid-19 is equal to 16.13 (95%CI 9.73-26.74) for people with age 70-79 years and 35.58 (95%CI 21.77-58.15) with age=80 years respect those with age70 years. It is higher in males (SHR 1.71; 95%CI 1.34-2.17). There is no evidence that being resident in a nursing home affects the SHR (SHR 0.91 and 95%CI 0.69-1.20). As regards the province as an explanatory variable, the sub-hazard of death in the province of Trieste appears to overlap to the sub-hazard of Pordenone used as a reference; for the provinces of Udine and Gorizia the sub-hazards seem lower than the reference.while other Northern Regions and autonomous Provinces show higher standardized incidence and mortality compared with Italy, FVG and Veneto do not. In FVG, male gender and age are important determinants of death while there is no evidence that the condition of guest in a nursing home increases the sub-hazard of death.

Aims and objectives: To evaluate the effectiveness of a Family Nurse Practitioner (FNP)-led programme on the degree of adherence of current recommendations on home blood pressure self-measurement (HBPM) as compared to routine care and management. Background: HBPM plays an important role for monitoring hypertensive patients; however, patients’ adherence to current guidelines is unsatisfactory. A nurse-led training programme in the community setting could be an effective strategy to achieve high level of patients’ adherence to recommendations. Design: A multicentre randomised controlled trial was carried out from September 2016 to September 2017.MethodsIn total, 170 patients were randomly allocated into the intervention group (n = 83) and the usual care (n = 87). All participants received usual care (written and verbal information on HBPM recommendations); subjects in the intervention group also received 1-hour training session on how to correctly self-measure BP. Clinical trial registration was done (ClinicalTrials.gov.: NCT04681703). The CONSORT checklist for randomised controlled trials was used in this study. Results: At baseline, the level of adherence to the recommendation was similar in the two groups (p < .05). After 1 month, the adherence significantly increased in the intervention group, where patients were more likely to measure BP at the same hour and from the same arm, in a quiet environment, with the back and uncovered arm supported and the legs uncrossed; recording BP more than once in each measurement session; keeping a diary of blood pressure measurements; use of the appropriate cuff and proper placement of the cuff; and resting for >5 min before performing the measurement (all p < .05). Conclusions: The FNP-led programme is effective in improving patients’ adherence to guidelines on the correct technique to self-measure BP at home. \ud Relevance to clinical practice: This programme may be added to the existing interventions in the community setting or considered into specifically nurse-led hypertension management models.

The COVID-19 outbreak deeply changed our lives on different levels. Social restrictions and distancing shaped in a different way our view of social relationships and behaviours. Like many aspects of daily life, also education has undergone radical changes. Nursing care was strongly affected by the outbreak, not only due to the risks in everyday practice, the heavy workload or the impact on nurses' daily lives outside the healthcare settings, but also because nursing is caring profession and it embeds in its roots the close relationship with the patient, the touch, the patients' body proximity as a way to communicate and to deliver an effective nursing care. All these issues, when brought in nursing education are also a learning opportunity for students and a way to develop their professional identity and to focusing on the nursing role. The COVID-19 outbreak heavily hit the clinical learning environments, as they are healthcare settings. The situation affected students' learning opportunities, since clinical placements were suspended, Universities closed and in-person courses moved into online teaching. While lessons and courses rapidly switched into online teaching, in order to safeguard students' education and faculty's activity, it was not possible to manage the pre-clinical activities, such as simulations and labs, in order to support technical and relational competences. Most of all, it was not possible to arrange the clinical placements due to the uncertainty of the healthcare settings and the social and organizational restrictions to limiting unnecessary accesses to the services, as recommended by the American Association of Colleges of Nursing in 2020.Recently, many authors have explored the issues related to the future of nursing education. In detail, an emerging issue is how it will be possible to educating nurses in a society facing isolation and social distance measures, but at the same time, in a society that needs more and more prepared clinical nurses.

Purpose Neonatal palliative care becomes an option for critically ill neonates when death is inevitable. Assessing nurses' attitudes towards, barriers to, and facilitators of neonatal palliative care is essential to delivering effective nursing care. Methods This study was conducted from January to September 2015 and involved Italian nurses employed in Level III neonatal intensive care units in 14 hospitals in northern, central, and southern Italy. A modified version of the Neonatal Palliative Care Attitudes Scale (NiPCAS) was adopted to assess nurses' attitudes. Findings A total of 347 neonatal nurses filled out the questionnaire. The majority were female (87.6%), with a mean age of 40.38 (±8.3) years. The mean score in the "organization" factor was 2.71 (±0.96). The "resources" factor had a mean score of 2.44 (±1.00), while the "clinician" factor had a mean score of 3.36 (±0.90), indicating the main barriers to and facilitators of implementing palliative nursing care. Conclusions Italian neonatal nurses may face different obstacles to delivering neonatal palliative care and to improve their attitudes in this field. In the Italian context, no facilitators of, only barriers to, palliative care delivery were identified. Clinical relevance Nurses' attitudes towards neonatal palliative care are essential to supporting nurses, who are constantly exposed to the emotional and moral distress connected with this field of end-of-life nursing care.

Aims and objectives\ud To develop and test an empirical model of clinical learning environment and mentoring of culturally and linguistically diverse nursing students.\ud \ud Background\ud Clinical learning is an essential part of nursing education; nursing students are required to master clinical competences and build a professional identity during their education. The global mobility of nurses requires high proficiency in cultural adaptability as well as the successful integration of cultural diversity into the healthcare system on a national level.\ud \ud Design\ud The research design was a quantitative cross-sectional study. STROBE statement was used to enhance the quality and transparency of research.\ud \ud Methods\ud Data were collected from eight universities during the 2015–2016. The analysis included data from 187 participants, collected using the CLES+T scale and CALDs. Instrument validity was tested with confirmatory factor analysis, while the hypotheses were tested with a structural equation model.\ud \ud Results\ud Pedagogical atmosphere was shown to be positively related to cultural diversity (0.66), orientation into the clinical placement (0.54) and the role of the student (0.25), and all of these relationships were statistically significant. These dimensions—with the exception of the role of the student—also showed a significantly positive influence on the mentoring relationship (respectively, 0.32, 0.71, 0.18). Fit indexes demonstrate an adequate model's fit.\ud \ud Conclusions\ud The model needs to be further piloted and tested in organisational structures of clinical practice of culturally and linguistically diverse nursing students. The dimensions that explain mentoring in clinical learning needed to be further addressed in a theoretically consistent and empirically driven approach, according to these findings.\ud \ud Relevance to clinical practice\ud In our study, we found that environmental and relational aspects are the most important for building an effective clinical learning environment. Universities and healthcare organisations can jointly leverage the model to foster clinical learning environments in clinical practice.

Clinical placements are an important part of nursing education to developing nursing students' competencies. In enhancing clinical learning, to focus on mentors' competences is pivotal as they are the main role models and experts in guiding. This study is validated the Italian version of the Mentors' Competence Instrument. A sampling frame of 648 mentors was involved. The final sample included 291 mentors (response rate 45%). Confirmatory Factor Analysis was performed. Fit indices were also calculated to evaluate validity. The scale demonstrated optimal fit indexes and its validity was confirmed by psychometrical testing. In detail, Root Mean Square Error of Approximation is 0.058, Standardized Root Mean Residual is 0.046, Comparative Fit Index is 0.893 and Tucker-Lewis Index 0.886. Cronbach's alpha ranges from 0.77 to 0.95 among factors. This is the first validation of the scale performed in a different country from the original study. The performed psychometric testing showed that the scale is valid and reliable, as well as consistent with the theoretical structure reported for a different national context. This scale can be beneficial for comparing mentors' competencies across different clinical learning environments and could be used to build a broader model of mentors' competencies.

Background: Mentoring in clinical settings is an important factor in the development of nursing students' professional knowledge and competences, but more knowledge of mentors' current and required competences is needed to improve nursing students' clinical learning. Objectives: This study aimed to develop and test an evidence-based model of mentoring nursing students in clinical practice. Design: An international cross-sectional survey coordinated in five European countries: Finland, Italy, Lithuania, Slovenia and Spain. Methods: Mentors, 4980 registered nurses working in both primary and specialist healthcare organizations, were invited to participate in the study during 2016–2019. The final sample consisted of 1360 mentors (mean age 41.9 ± 11). Data were collected with background questions and the Mentor Competence Instrument. The instrument was psychometrically validated then the data were used to construct a Structural Equation Model (SEM) with Full Imputation Maximum Likelihood (FIML) estimation. Results: All of six hypotheses were verified. In summary: mentors' characteristics related to their motivation and reflection are positively related to mentoring practices in the workplace, which (together with constructive feedback) are positively related to and foster goal-orientation in students' clinical learning and student-centered evaluation. All parameters in the SEM model were significant and the model's fit indexes were verified (RMSEA = 0.055; SRMR = 0.083; CFI = 0.914, TLI = 0.909). Conclusion: Our evidence-based modeling confirms the research hypotheses about mentorship, and identifies focal competences for designing mentors' education to improve students' clinical learning and establish a common European mentoring model. Mentorship is important for both healthcare organizations and educational systems to enhance students' clinical competences, professional growth and commitment to the nursing profession and organizational environments. We would like to acknowledge European Commission, Erasmus+, KA2: Strategic partnership for providing funding for the project Quality mentorship for developing competent nursing students (QualMent).

Background: Children undergoing surgery generally experience anxiety during the perioperative period, which could impact the surgical outcome, cause long-term psychological consequences and result in later healthcare avoidance. Preoperative anxiety in children is managed using both pharmacological and non-pharmacological therapies. The latter include distraction, a tour of the operating room and parental presence until the induction of anaesthesia. A novel and effective non-pharmacological therapies is the use of virtual reality to reduce anxiety and pain in children scheduled for medical procedures. However, the effectiveness of virtual reality in paediatric surgery has yet to be evaluated in a systematic review. Objective: To evaluate the effectiveness of virtual reality in the management of anxiety in paediatric patients during the perioperative period. Design: Both a systematic review and a meta-analysis of randomised controlled trials were performed according to the methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions Section 8.5 and in accordance with the Cochrane Effective Practice and Organisation of Care. The results are reported as prescribed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Data sources: A systematic search of randomised controlled trials was conducted using Medline, SCOPUS, Web of Science, Ovid MEDLINE and CINAHL. Review methods: Two researchers screened potentially eligible articles and then assessed the quality of the reported studies using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions Section 8.5 and according to Cochrane Effective Practice and Organisation of Care. The data were synthesised using the random-effects models to incorporate the estimated heterogeneity in the weighting. Heterogeneity was tested using the Q and I 2 statistics. The τ 2 statistic, an estimate of the amount of variation between the included studies, was also determined. Studies whose heterogeneity with respect to primary outcome measurements hindered pooling of the results for meta-analysis were summarised narratively. Results: Seven studies were eligible for inclusion in this systematic review. An effect size for anxiety could be determined in six. The results support the effectiveness of virtual reality in reducing anxiety in paediatric patients undergoing elective surgery. The overall effect was supported by a confidence interval < 0 (PL = −0.341, 95% confidence interval: −0.620 to −0.107) and by heterogenity indexes that were non significant (Q = 9.49, p = 0.091) or not important (I 2 = 38.64%). Conclusions: Paediatric patients undergoing elective surgery may benefit from virtual reality as a distraction method that can reduce anxiety. PROSPERO register, number: (blinded for Referee).

INTRODUCTION This study explored children's perceptions about the quality of nursing care and the determinants of their evaluations according to different categories of children's ages. DESIGN Multicenter cross-sectional study carried out on 692 pediatric patients in eight large Italian regional hospitals. METHODS We used a validated questionnaire, translated and adapted to the Italian context, consisting of 49 items (5-point Likert scale) exploring nurse characteristics, nursing activities, and nursing environment. FINDINGS The mean score of children's perceptions of their overall experience of hospitalization was 3.96; the nurse characteristics factor obtained the highest score (mean = 3.79), and it was in positive correlation with the satisfaction level across different age categories: 4 to 6 years, β = .37; 7 to 11 years, β = .31; and 12 to 14 years, β = .32. CONCLUSIONS Nurse characteristics is the only significant factor contributing to children's satisfaction across the three different age categories. CLINICAL RELEVANCE In pediatric nursing care, it is important to emphasize that nurses' personal characteristics and the ability to connect with children are essential compared to the ability to perform tasks.

Aim To explore the relationship between the anatomical site of peripheral venous catheterization and risk of catheter-related phlebitis. Background Peripheral venous catheterization is frequently associated with phlebitis. Recent guidelines, recommend the use of an upper-extremity site for catheter insertion but no univocal consensus exists on the anatomical site with lower risk of phlebitis. Design Systematic review. Methods We searched Medline (PubMed) and CINAHL (EBSCOhost) databases until the end of January 2017. We also reviewed the reference lists of retrieved articles and gray literature was excluded. Searches were limited to articles published in English with no restriction imposed to date of publication. The primary outcome was the incidence of phlebitis associated with anatomical site of peripheral catheterization. We included randomized controlled trials and observational studies on adult patients who required a peripheral catheter for the administration of medi- cation, intermittent or continuous fluid infusion. Results Antecubital fossa veins are associated with lower phlebitis rates, while hands veins are the most risky sites to develop phlebitis. There is no consensus regarding vein in forearm. Conclusion Choosing the right anatomical site to insert a peripheral venous catheter is important to decrease phlebitis rate. Further studies should compare indwelling time in different anatomical sites with phlebitis rate. A more standardized approach in defining and assessing phlebitis among studies is recommended.

To identify current best evidence on the types of interventions that have been developed to improve job satisfaction among nurses and on the effectiveness of these interventions.The systematic review is a quantitative systematic review and meta-analysis following a profile-likelihood random-effects model.CINAHL, Medic, and Pubmed (Medline).PICOS eligibility criteria were used to select original studies published between 2003-2019. The articles were screened by title (N = 489), abstract (N = 61), and full-text (N = 47). A total of 20 articles remained after the full-text screening process and further assess on risk of bias. The screening process was conducted by two authors independently and finally agreed together. A meta-analysis was performed to determine how the identified interventions influence nurses' job satisfaction.The interventions were primarily educational and consisted of workshops, educational sessions, lessons, and training sessions. The postintervention differences between intervention and control groups in meta-analysis revealed that two interventions significantly improved nurses' job satisfaction. Notably, the spiritual intelligence training protocol and Professional Identity Development Program were found to be effective in improving job satisfaction.Healthcare organizations and managers should consider implementing effective interventions to improve nurses' job satisfaction and reduce turnover. The results reported in this study highlight that nurse managers should focus on organizational strategies that will foster the intrinsic motivation of employees.The current nursing shortage and increased turnover intentions are proving to be a global problem. For this reason, it is imperative that nurse managers plan strategies to improve nurses´ job satisfaction. The effective interventions detected in this study are a first step for developing human resource strategies for healthcare organizations. These findings propose that extrinsic factors (e.g., salary and rewards) will never be as effective in maintaining job satisfaction as intrinsic factors (e.g., spiritual intelligence, professional identity, and awareness).目的: 识别提高护士工作满意度的介入治疗类型及其有效性的现有最佳证据。 设计: 系统综述指的是遵循子集似然随机效应模型的定量系统综述与荟萃分析。 数据来源: CINAHL护理学数据库、Medic国际医疗器械展览会和Pubmed文献服务检索系统(Medline联机医学文献分析和检索系统)。 审查方法: 采用PICOS合格标准用于甄选2003年至2019年期间发表的原创研究。按照标题(N=489)、摘要(N=61)和全文(N=47)对文章进行筛选。在完成全文筛选后,留下20篇文章,进一步评估偏倚风险。由两位作者独立进行筛选过程,并最终达成一致。并且还要进行荟萃分析,以探讨所确定的介入治疗对护士工作满意度的影响。 结果: 介入治疗以教育为主,包括讲习班、教育班、上课和培训班。通过荟萃分析,从干预后介入治疗组与对照组的差异可以看出,两种介入治疗显著提高了护士的工作满意度。值得注意的是,灵性智力训练方案和职业认同发展计划能够行之有效地提高工作满意度。 结论: 医疗机构和管理者应考虑实施有效的介入治疗,以提高护士的工作满意度,减少离职率。本研究报告的结果强调,护士部门的管理人员应当侧重能够培养护士内在动机的组织策略。 影响: 当下医护人员的短缺和离职意愿的攀升被证明是一个全球普遍化的问题。为此,护士部门的管理人员制定提高护士工作满意度的策略势在必行。本研究中发现的有效介入治疗是制定医疗机构人力资源战略的第一步。这些发现表明,在维持护士的工作满意度方面,外在因素(如工资和报酬)永远不及内在因素(如灵性智力、职业认同和认识)来得有效。.

Aim To correlate workgroup engagement in nursing teams and the clinical learning experience of nursing students. Background Work engagement plays a pivotal role in explaining motivational dynamics. Nursing education is workplace-based and, through their clinical placements, nursing students develop both their clinical competences and their professional identity. However, there is currently a lack of evidence on the role of work engagement related to students’ learning experiences. Methods A total of 519 nurses and 519 nursing students were enrolled in hospital settings. The Utrecht Work Engagement Scale (UWES) was used to assess work engagement, and the Clinical Learning Environment and Supervision plus nurse Teacher (CLES+T) scale was used to assess students’ learning experience. A multilevel linear regression analysis was performed. Results Group-level work engagement of nurses correlated with students’ clinical learning experience (β = 0.11, P

Background Due to a steady rise in cultural and linguistic diversity in healthcare settings and evident challenges associated with this diversity, there is an urgent need to address cultural competency of nurses. Ongoing, continuing professional development is needed to ensure nurses can provide culturally congruent nursing care. Objectives The aim of this systematic review was to identify current best evidence on the types of educational interventions that have been developed to improve nurses’ self-assessed cultural competence and on the effectiveness of these interventions. Design A systematic literature review. Data sources Four electronic databases (PubMed, CINAHL, Medic, Eric) were searched for studies using a quasi-experimental design or randomised controlled trial published between January 2000 and June 2018. Review methods Guidelines from the Centre for Review and Dissemination and the Joanna Briggs Institute guided the review. Two researchers independently assessed the eligibility of the studies by title, abstract and full-text and the methodological quality of the studies. Data tabulation and narrative analysis of study findings was performed. Results Six studies met criteria for inclusion in the review. Studies used a quasi-experimental study design (n = 5) and a randomised controlled trial (n = 1). The participants (n = 334) were mainly nurses and interventions were conducted in various healthcare settings. Cultural competence education was offered through traditional contact teaching (n = 5) or web-based modules (n = 1) and ranged from one to 17 hours in length. Learning was enhanced through lectures, group discussions, case studies, reflective exercises and simulations. In two studies, following cultural competence interventions, participants in the intervention group had statistically significantly increased levels of competence in culture-related outcomes when compared to the control group. The four remaining studies did not include control group comparisons. Effect sizes (Cohen’s d) of the studies varied from small (d = 0.22) to very large (d = 1.47). Conclusions There continues to be a need for high quality studies investigating educational interventions to develop nurses’ cultural competence. Further research should focus on reporting specific components of interventions that result in an increase in cultural competence.

The study aims are (a) to test a model developed to estimate the impact of work engagement on work ability as it is perceived by nurses; (b) to test the parameters between work ability and job satisfaction and between job satisfaction and turnover intention.Cross-sectional.This study involved 1,024 nurses from January - May 2018. The response rate was 70.7%. The Work Ability Index and the Utrecht Work Engagement Scale were used. Path analysis was performed, both in the whole sample and in age categories (45yy-≥45yy). Model's parameters and fit indexes were estimated.The comprehensive model was validated through the multi-group approach. Fit indexes were adequate in the general model and in the multi-group testing. Parameters confirmed the association between work engagement and work ability and between work ability and job satisfaction and turnover intention. Parameters highlighted different age-dependent patterns.This study states the contribution of work engagement to enhance work ability in nursing profession. Findings contribute in understanding motivational dynamics in nurses and they suggest the use of tailored strategies for different age categories. Further research could address the model to deepen generational patterns in work engagement, work ability, and organizational outcomes.The study highlights how to address nursing management to improve nurses' motivation and work ability and to improve organizational outcomes. Main findings point out different age-dependent patterns to tailor managerial strategies. Healthcare organizations have new elements to design human resources management and to improve job satisfaction and nurses' retention.目的: 本研究的目的是:(a)测试一个模型,以评估工作投入对护士工作能力的影响;(b)测试工作能力与工作满意度之间、工作满意度与离职意愿之间的参数。 设计: 分类排列。 方法: 本研究从2018年1月至5月共有1024名护士参与。有效率为70.7%。使用工作能力指数和Utrecht 工作投入量表。对整个样本和年龄段(45YY-≥45YY)进行了路径分析。对模型参数和拟合指标进行了估计。 结果: 综合模型通过多组方法进行验证。拟合指数在一般模型和多组测试中都是足够的。参数确定了工作投入与工作能力、工作能力与工作满意度、离职意愿之间的关系。参数突出显示了不同的年龄依赖模式。 结论: 本研究阐述了投入对提高护理行业工作能力的贡献。研究结果有助于理解护士的动机动力,并建议针对不同年龄类别使用量身定制的策略。进一步的研究可以解决该模型,以加深工作投入、工作能力和组织结果方面的代际模式。 影响: 本研究重点探讨如何解决护理管理问题,以提高护士的工作积极性和工作能力,改善组织绩效。主要发现指出了不同的年龄依赖模式来调整管理策略。医疗保健机构在人力资源管理设计、提高工作满意度和护士留用率等方面有了新的参考因素。.

Growing ethnic and cultural diversity is widely recognized (Schim, Doorenbos, & Borse, 2005; Schim, Doorenbos, Miller, & Benkert, 2003). The increasing number of people moving from one country to another (OECD, 2011) highlights the need for culturally competent health care. Healthcare organizations have to face complex differences in patients' communication styles, attitudes, expectations, and worldviews, multiple languages, different socioeconomic classes, gender, and sexual orientation have become equally important (Abrums & Leppa, 2001; Fortier & Bishop, 2003). Health professionals need to be adequately trained and prepared to care for immigrant patients (European Intercultural Workplace, 2007). Cultural competence in nursing is defined as the incorporation of personal cultural diversity experience, awareness, and sensitivity into everyday clinical practice (Schim & Doorenbos, 2010; Schim, Doorenbos, Benkert, & Miller, 2007). In addition to sensitivity to self and others, competence behaviors are dependent on personal exposure, work experience with people from different ethnical groups, and awareness of individual and group similarities and differences (Schim, Doorenbos, & Borse, 2006). Providing culturally competent care has been associated with improved provider-client communication (Kelly & Papadopoulos, 2009), higher satisfaction with care (Bussema & Nemec, 2006), and health status improvement, as full comprehension of health status, adherence to medications and lifestyle recommendations, and appropriate utilization of the health system (Fortier & Bishop, 2003; Weech-Maldonado et al., 2012).Research suggests that cultural competence training impacts intermediate outcomes such as knowledge, attitudes, and skills of health workers (Beach et al., 2005), and patients' satisfaction (Beach et al., 2006). Nurses who regularly practice culturally competent care can effect positive healthcare changes for clients (Casillas et al., 2014; Leininger & McFarland, 2006; van Ryn, 2002), while the lack of knowledge can lead to prejudice and discrimination (Betancourt, Green, Carrillo, & AnanehFirempog, 2003; Fortier & Bishop, 2003; Hamilton & Essat, 2008), difficulties in planning care, and participation to the individualized care process (Helms & Cook, 1999). The lack of knowledge can also lead to a misinterpretation of patients' needs, with risks for diagnostic and therapeutic errors (Alpers & Hanssen, 2014; Canto et al., 2000; Dias, Gama, Gargaleiro, & Martins, 2012). Several studies among nurses showed a positive correlation between educational training and cultural competence in different multi-ethnic countries such as the United States and Canada (Delgado et al., 2013; Doorenbos & Schim, 2004; Schim et al., 2005, 2006; Starr & Wallace, 2009, 2011; Weech-Maldonado et al., 2012), the United Kingdom (Gerrish, 2001), Switzerland (Casillas et al., 2014), and Sweden (Berlin, Johansson, & Tornkvist, 2006; Berlin, Nilsson, & Tornkvist, 2010). Recently, in Italy, the number of immigrants has been increasing, and foreign residents account for 8% of the entire registered Italian population (OECD, 2013). It is becoming increasingly common and frequent for Italian nurses to establish relationships with patients with different cultural backgrounds (Manara, Isernia, & Buzzetti, 2013), but no studies have been carried out to assess Italian nurses' cultural competence. This study was aimed at evaluating the level of cultural competence among Italian nurses.MethodsDesignA multicentric, cross-sectional study was carried out from September 2013 to May 2014.Sample SizeThe primary end point of the study was to assess nurses' cultural competence. Because we did not know the percentage of participation and in order to ensure that all Italian areas (North, Center, South, and Islands) were represented, we estimated that 450 questionnaires per area would be sufficient to ensure an adequate assessment (Doorenbos & Schim, 2004; Schim et al. …

Mastery of the basic competences in the clinical practicum is pivotal in undergraduate healthcare education. Clinical learning is also a lifelong process. Each workplace transition from one clinical setting to another involves a new clinical learning cycle for the health professional and the same holds for every change in healthcare practices during the professional career. Clinical learning is not only a question of mastering clinical competences but also one of mastering such competences within an organizational environment. This process involves many variables at the individual, group, and organizational levels. All three levels contribute to define the organizational environment and determine whether clinical learning will be effective or not in the real-life context. Thus, the organizational climate has a profound effect on students’ clinical learning experience. In this chapter, clinical learning is explored as an organizational variable and from a psychosocial perspective.

Background: The assessment of nursing students’ nursing competence is a matter of concern worldwide and the complexity of assessing students’ clinical competence has challenged educators for decades. It has been recognized that there is inconsistency among assessment methods and tools between countries and institutions. Objective: To identify the current best evidence on the assessment of nursing students’ competence in clinical practice. Design: Systematic review of reviews. Data sources: The electronic databases CINAHL, PubMed, Eric, Medic and the JBI Database of Systematic Reviews and Implementation Reports were searched in autumn 2018. Review methods: Two researchers independently assessed the eligibility of the studies by title, abstract and full-text, and then assessed the methodological quality of the included studies. Analysis of study findings was conducted using the thematic synthesis approach. Results: Six reviews were included following critical appraisal. Assessment tools used to assess students’ nursing competence commonly focus on the domains of professional attributes, ethical practices, communication and interpersonal relationships, nursing processes, critical thinking and reason. Clinical learning environments and mentoring provide important support structures and guide the learning of students. The availability of assessment tools and criteria along with providing individualized feedback and time for reflection strengthen the objectivity and reliability of assessment. Conclusions: There continues to be a need to develop consistent and systematic approaches in assessment, and to use reliable and valid instruments in assessment. Mentors find assessment of students’ competence to be particularly challenging and emphasize the importance of clear assessment criteria, support from nurse educators and further education on assessment. Further development in feedback practices and providing students with opportunities for reflection are important in supporting the continuous learning process of students. We would like to acknowledge European Commission, Erasmus +, KA2: Strategic partnership for providing funding for the project Quality mentorship for developing competent nursing students (QualMent).

To explore the first year midwifery students' clinical learning experience and satisfaction; to analyse the association between students' satisfaction and individual motivation.The multicentre cross-sectional study was carried out in four Italian midwifery degree courses. A convenience sample of 61 students filled out the Italian version of the "Clinical Learning Environment and Supervision plus Nurse Teacher (CLES+T) scale" after the conclusion of their first clinical placement.The mean values of the main sub-dimensions of CLES+T varied from 3.53 (peda- gogical atmosphere) to 3.08 (supervisory relationship). Students (68.9%) were mainly sati- sfied with their clinical placement. With regard to individual motivation, 27 students (44.3%) were motivated at the beginning of the clinical placement, and 31 students (50.8%) were highly motivated. Highly motivated students showed higher satisfaction levels (␣2 = 11,712, p = 0.019).The findings expand knowledge on the first year midwifery students' clinical learning experience Moreover, the results showed an association between initial student moti- vation and satisfaction that should be investigated through further multicenter studies.Esplorare il livello di soddisfazione e l'esperienza di apprendimento clinico degli studenti in Ostetricia del primo anno di corso dopo il primo tirocinio clinico; analizzare l’associazione tra motivazione individuale e soddisfazione complessiva degli studenti.Lo studio, trasversale multicentrico, è stato condotto in quattro sedi universitarie italiane del Corso di Laurea in Ostetricia. Un campione di convenienza di 61 studenti ha compilato la versione italiana del questionario "Clinical Learning Environment, Supervision and plus Nurse Teacher (CLES+T) scale" al termine del primo tirocinio clinico.I punteggi medi assegnati alle dimensioni della scala variano da 3.53 (clima di apprendimento) a 3.08 (relazione di tutorato). Gli studenti (68.9%) sono complessivamente soddisfatti della propria esperienza di tirocinio. Rispetto alla motivazione individuale, 27 studenti (44.3%) erano motivati all'inizio del tirocinio e 31 studenti (50.8%) altamente moti- vati. Coloro che hanno dichiarato di essere maggiormente motivati all’inizio del tirocinio manifestano anche un livello di soddisfazione superiore (␣2=11.712, p=0.019).I risultati di questo studio contribuiscono ad ampliare le conoscenze sulla prima esperienza di tirocinio clinico degli studenti in Ostetricia. Inoltre, i risultati hanno eviden- ziato un’associazione tra motivazione iniziale degli studenti e soddisfazione che dovrebbe essere approfondita attraverso ulteriori studi multicentrici.

Tomietto M., Sartor A. , Mazzocoli E. & Palese A. (2012) Journal of Nursing Management 20, 335–343 Paradoxical effects of a hospital-based, multi-intervention programme aimed at reducing medication round interruptions Aim The main aim of the present study was to evaluate interruptions that occurred during medication rounds within a hospital-based, multi-intervention programme. Background There are no standardized ways to reduce medication interruptions during medication rounds and no guidelines or standards on the use of tabards during medication rounds. Materials and methods In 2006, a preliminary baseline evaluation (T0) was conducted at the hospital level observing the occurrence of interruptions during medication rounds in daily practice. Subsequently, a hospital-based policy for a multi-intervention medication round programme was implemented at of the beginning of 2008 (T1). After 18 months, an evaluation of the frequency of interruptions was repeated (T2). Results At T0, 298 interruptions were observed for 945 medications administered, or one for every 3.2 medications given. At T2, 385 interruptions were observed for 895 medications given, an interruption for every 2.3 medications administered (P = 0.041). At T0, the mean interruption duration per medication round was 10.48 min whereas at T2 it was 5.08 min. Patient interruptions were reduced (26.5–14.0%, P = 0.05); in spite of this effect, staff member interruptions increased (15.8–40.5%, P = 0.01). Conclusions With the implementation of the multi-intervention programme, the interruptions changed their pattern. While wearing the red tabard was paradoxically effective with patients, it was ineffective with other staff members. Implications for Nursing Management Before introducing new strategies, an evaluation of their appropriateness with regard to the culture of the patients and nurses is recommended: in the present study, patients seem to have considered the warning message worn by nurses as mainly intended for them.

papastavrou e., efstathiou g., tsangari h., suhonen r., leino-kilpi h., patiraki e., karlou c., balogh z., palese a., tomietto m., jarosova d. & merkouris a. (2011) A cross-cultural study of the concept of caring through behaviours: patients’ and nurses’ perspectives in six different EU countries. Journal of Advanced Nursing 68(5), 1026–1037. Abstract Aim. This paper is a report of an international study of patients’ and nurses’ perceptions of nurse caring behaviours. Background. Current economic constraints on healthcare systems, demand to increase the quality of care and the incorporation of the consumers’ perspective into care, have created a need to develop a clear understanding of nursing behaviours which convey caring. Patients in different areas of the world report different expectations of nurses’ caring actions when compared to nurses’ views. Method. A descriptive comparative survey design was used to analyse a sample of surgical patients (n = 1659) and their nurses (n = 1195) in 88 wards of 34 hospitals in Cyprus, the Czech Republic, Finland, Greece, Hungary and Italy. Data were collected in autumn 2009 using the Caring Behaviours Inventory-24. Nurses’ and patients’ responses were compared using both inferential and descriptive statistics. Results. Independent samples t-tests showed important differences between nurses’ and patients’ views. Although both groups perceived knowledge and skill as being the most important sub-scale, the nurses’ responses were higher compared to patients (P

Aims and objectives The aims of the study were to describe which of the core techniques of the physical assessment are regularly performed by a sample of Italian nurses, and to investigate the potential predictors of a more complete examination. Background Physical examination is among the essential tasks of nursing professionals, who are requested to perform a correct and complete physical assessment. Design Cross-sectional survey. Methods The study was performed between August 2013 and January 2014 in 17 Italian regions. A total of 1182 questionnaires were collected. Results Most participants were females (age range 41–50 years), and worked in Internal Medicine, Intensive Care and Surgical hospital units. Of the 30 core techniques that are currently taught and performed according to the Italian Baccalaureate degree requirements, 20 were routinely performed, 6 were seldom used and 4 were learnt but almost never performed (auscultation of lung, heart and bowel sounds and spine inspection). Graduate and postgraduate nurses, working in Intensive Care Units and Nursing Homes, were more prone than the others to carry out a more complete physical assessment. Conclusions The skills to perform a physical assessment are suboptimal among this sample of Italian nurses. Health and educational providers should pose more attention and efforts to provide nurses with an acceptable training in physical examination practice. Relevance to clinical practice This study describes the specific physical techniques performed by nurses in real practice and provides information on which skills require more attention in nursing educational programmes.

In the first years of nursing profession, new-graduate nurses' turnover intention is a relevant issue due to both the tangible and intangible costs it generates to health care organizations, such as selection and recruitment costs, ward team burden in the onboarding process and the possibility to enhance ward team stability in order to provide an effective and safe nusing care. Organizational socialization is the main factor involved in these dynamics of turnover intention in the first years of nursing profession.This study aims to identify the main factors involved in the organizational socialization process to reduce turnover intention in the first 3 years of nursing profession.101 new-graduate nurses have been enrolled within the first three years of nursing profession. They have been stratified looking at tenure and years in nursing. Organizational Socialization Inventory scale has been used to assess the onboarding process and 4 items to assess turnover intention.Turnover intention is of 23% in the first year in nursing, and it's over the 26% starting from the second year. The onboarding process explains over the 26% of the variance in turnover intention, and over the 36% in the sub-sample with a stable tenure. Unstable tenured nurses prefer to acquire those competences useful to perform their work, while stable tenure nurses aim to search for professional growth opportunities and integration in the ward-team, in order to reduce turnover intention.Turnover intention is relevant in the first three years of nursing profession. According to the different tenure, different strategies are necessary to plan an effective onboarding process and enhance nursing retention.L'intenzione di turnover nei primi anni di professione infermieristica è un fenomeno rilevante che determina instabilità organizzativa e genera costi tangibili e intangibili per le organizzazioni sanitarie: costi di selezione e reclutamento, impegno dei team nell’inserimento del neo-assunto e possibilità di garantire stabilità nel reparto al fine di erogare l’assistenza in modo efficiente e sicuro. La socializzazione organizzativa è il principale determinante delle dinamiche di intenzione di turnover nei primi anni di professione infermieristica.Questo studio vuole identificare i fattori di socializzazione organizzativa che possono ridurre l'intenzione di turnover nei primi tre anni di professione infermieristica.Sono stati coinvolti 101 infermieri nei primi tre anni di professione, suddivisi per tipologia contrattuale (a tempo determinato e indeterminato) e per anno di ingresso nella professione. Sono stati utilizzati la Organizational Socialization Inventory, per rilevare i fattori del processo di inserimento, e quattro item per l’intenzione di turnover.L’intenzione di turnover è del 23% al primo anno e supera il 26% dal secondo anno di professione. Il processo di inserimento spiega il 26% della varianza dell’intenzione di turnover e raggiunge il 36% negli infermieri assunti a tempo indeterminato. Tuttavia, mentre chi ha un contratto a tempo determinato privilegia l’acquisizione delle competenze necessarie a svolgere il proprio lavoro, coloro che hanno un contratto a tempo indeterminato sono più sensibili alle prospettive di crescita professionale e all’integrazione nel reparto, in relazione all’intenzione di turnover.L’intenzione di turnover è rilevante nei primi tre anni di professione. In base al tipo di contratto, sono necessarie strategie diverse nella gestione dell’inserimento lavorativo al fine di migliorarne la stabilità nell’organizzazione.

Background: Clinical learning in nursing education is workplace-based and it involves both learning and organizational factors. Students could experience these factors both at individual and at group level. This study aimed to assess clinical learning environment as a multilevel phenomenon, by grouping students’ perceptions at different organizational levels. Method: A cross-sectional multilevel design has been conducted. 3 Italian Universities, 6 Hospitals and 73 wards have been involved in the study during 2013. Wards with at least 3 attending nursing students have been included. The sample involved 597 nursing students (average age 23.1 years, SD = 4.67 years; 72.6% females; 27.2% attending first year; 31.7% second year; 41.1% third year). Clinical Learning Environment and Supervision plus Nurse teacher ( CLES+T ) scale has been administered. Intraclass Correlation Coefficients (ICC) have been estimated at ward, at hospital and at University level. Results: All ICCs scores were above 0.10 and they indicated clinical learning environment as a multilevel phenomenon. The most pertinent level to multilevel research was the ward level. The nurse teacher scale was pertinent to Hospital and University level. Conclusions: Clinical learning environment is a multilevel phenomenon. These findings could enhance research develop ment in this field of studies. Practical implications suggest multilevel approach in order to detect the most effective organizational level to improve educational intervention.