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PurposeChronic kidney disease is now considered a major public health problem.Over the past two decades, the number of patients that started dialysis is more than doubled.Patient Management in Peri...

Background: Paediatric nurses often face complex situations requiring decisions that sometimes clash with their own values and beliefs, or with the needs of the children they care for and their families. Paediatric nurses often use new technology that changes the way they provide care, but also reduces their direct interaction with the child. This may generate ethical issues, which nurses should be able to address in the full respect of the child. Research question and objectives: The purpose of this review is to describe the main ethical dimensions of paediatric nursing. Our research question was, ‘What are the most common ethical dimensions and competences related to paediatric nursing?’ Research design: A rapid evidence assessment. Method: According to the principles of the rapid evidence assessment, we searched the PubMed, SCOPUS and CINAHL databases for papers published between January 2001 and March 2015. These papers were then independently read by two researchers and analysed according to the inclusion criteria. Ethical considerations: Since this was a rapid evidence assessment, no approval from the ethics committee was required. Findings: Ten papers met our inclusion criteria. Ethical issues in paediatric nursing were grouped into three areas: (a) ethical issues in paediatric care, (b) social responsibility and (c) decision-making process. Conclusion: Few studies investigate the ethical dimensions and aspects of paediatric nursing, and they are mainly qualitative studies conducted in critical care settings based on nurses’ perceptions and experiences. Paediatric nurses require specific educational interventions to help them resolve ethical issues, contribute to the decision-making process and fulfil their role as advocates of a vulnerable population (i.e. sick children and their families). Further research is needed to investigate how paediatric nurses can improve the involvement of children and their families in decision-making processes related to their care plan.

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Background In patients with head-neck cancer treated with IMRT, immobility of the upper part of the body during radiation is maintained by means of customised immobilisation devices. The main purpose of this study was to determine how the procedures for preparation of customised immobilisation systems and the patients characteristics influence the extent of setup errors. Methods A longitudinal, prospective study involving 29 patients treated with IMRT. Data were collected before CT simulation and during all the treatment sessions (528 setup errors analysed overall); the correlation with possible risk factors for setup errors was explored using a linear mixed model. Results Setup errors were not influenced by the patient’s anxiety and pain. Temporary removal of the thermoplastic mask before carrying out the CT simulation shows statistically borderline, clinically relevant, increase of setup errors (+24.7%, 95% CI: −0.5% - 55.8%). Moreover, a unit increase of radiation therapists who model the customised thermoplastic mask is associated to a −18% (−29.2% - -4.9%) reduction of the errors. The setup error is influenced by the patient’s physical features; in particular, it increases both in patients in whom the treatment position is obtained with ‘Shoulder down’ (+27.9%, 2.2% - 59.7%) and in patients with ‘Scoliosis/kyphosis’ problems (+65.4%, 2.3% - 164.2%). Using a ‘Small size standard plus customized neck support device’ is associated to a −52.3% (−73.7% - -11.2%) reduction. The increase in number of radiation therapists encountered during the entire treatment cycle does not show associations. Increase in the body mass index is associated with a slight reduction in setup error by (−2.8%, −5% - -0.7%). Conclusion The position of the patient obtained by forcing the shoulders downwards, clinically significant scoliosis or kyphosis and the reduction of the number of radiation therapists who model the thermoplastic mask are found to be statistically significant risk factors that can cause an increase in setup errors, while the use of ‘Small size’ neck support device and patient BMI can diminish them.

Nurse-physician collaboration involves healthcare operators from different professions working together. The dual identity model predicts that nurse-physician interprofessional collaboration could improve if these operators feel they belong to both their professional category and care unit. This study tested this prediction by analyzing the effect of professional and team commitments on interprofessional collaboration between nurses and physicians in a hospital based in Northern Italy. A cross-section questionnaire survey was administered to 270 nurses and 95 physicians. Results indicate that interprofessional collaboration is positively affected by team commitment, while professional commitment had no effect. In accordance with the dual identity model, results indicate that interprofessional collaboration is higher when: (i) both professional and team commitment is high, and (ii) when team commitment is high and professional commitment is low. These results support dual identity model predictions and suggest that interprofessional collaboration can be increased by bolstering both team and professional commitment of nurses and physicians.

The pressing need by the health organizations of new-graduate nurses immediately able to take full charge of the ward, together with the radical changes of nursing education, led the professional community to discuss the education of new-graduate nurses.To describe if new-graduate nurses at the Nursing Degree Course in Reggio Emilia, have the competences adequate to the demands of the health care organizations.Fifty ward Nursing Manager of a National health Service, where new-graduate nurses of the 2009-2010 academic year were emploied by at least one month were interviewed by phone. A list of 34 competences were identified and grouped into six skill areas (taking care, technical, managerial, communication, professional ethics, education and professional updating); for each, respondents had to rank the level of compentence on a Likert scale from 1 not able to 5 fully able.According to Nursing Managers new-graduate nurses are able to identify the patient care problems (mean score 4.1+0.8), to perform nursing techniques (mean score 4.4+0.7) and to meet the deadlines of the organizations (mean score 4.2+0.8). All Nursing Managers agree that new-graduate nurses have required skills and knowledge to work in their units.The level of expertise of by new-graduates in the areas investigated appears adequate to fulfill the role of nurse in health care organizations after a short period of coaching by a senior nurse.

Many faculty argue that theory and theorizing are closely related to the clinical practice, that the disciplinary knowledge grows, more relevantly, from the specific care context in which it takes place and, moreover, that knowledge does not proceed only by the application of general principles of the grand theories to specific cases. Every nurse, in fact, have a mental model, of what may or may not be aware, that motivate and substantiate every action and choice of career. The study describes what the nursing theoretical model is; the mental model and the tacit knowledge underlying it. It identifies the explicit theoretical model of the professional group that rapresents nursing partecipants, aspects of continuity with the theoretical model proposed by this degree course in Nursing.. Methods Four focus groups were made which were attended by a total of 22 nurses, rapresentatives of almost every Unit of Reggio Emilia Hospital's. We argue that the theoretical nursing model of each professional group is the result of tacit knowledge, which help to define the personal mental model, and the theoretical model, which explicitly underlying theoretical content learned applied consciously and reverted to / from nursing practice. Reasoning on the use of theory in practice has allowed us to give visibility to a theoretical model explicitly nursing authentically oriented to the needs of the person, in all its complexity in specific contexts.Molti studiosi sostengono che teoria e teorizzazione sono strettamente correlate alla pratica clinica e che il sapere disciplinare non procede solo dall’applicazione dei principi generali di grandi teorie ai casi particolari, ma si sviluppa, in maniera più pertinente, a partire dallo specifico contesto assistenziale nel quale si realizza. Ogni infermiere, infatti, possiede un modello mentale del quale può o meno essere consapevole, che motiva e sostanzia ogni azione e scelta professionale. Il presente studio descrive il modello teorico infermieristico che orienta l’agire professionale, il modello mentale e le conoscenze tacite ad esso sottese. Identifica nel modello teorico esplicito del gruppo professionale che gli infermieri partecipanti rappresentano, aspetti di continuità con il modello teorico proposto da questo Corso di Laurea in Infermieristica, Sono stati realizzati 4 focus group ai quali hanno partecipato complessivamente 22 Infermieri, rappresentanti di quasi tutte le unità operativa dell’Arcispedale Santa Maria Nuova di Reggio Emilia. E’ possibile sostenere che il modello teorico infermieristico di ciascun gruppo professionale è il risultato di conoscenze tacite, che contribuiscono a definire il modello mentale di ciascun professionista e di un modello teorico esplicito cui sono sottesi contenuti teorici appresi applicati consapevolmente e riadattati alla/dalla pratica assistenziale. Ragionare sull’uso della teoria nella pratica ha permesso di dare visibilità a un modello teorico esplicito autenticamente infermieristico orientato ai bisogni della persona, nella sua complessità in specifici contesti.

The aim of this study was to analyze collaboration between nurses and auxiliary staff and it was implemented at the Santa Maria Nuova Hospital of Reggio Emilia. Although this topic is of great interest for the health structures, so far few studies dealing specifically with the interactions between these two categories have been published. The international scenario offers an extremely varied picture of the staff employed in such tasks : in fact, only Italy has a single national legislation which establishes that auxiliary staff are figures supporting the health professions in both a social and healty context. The study assessed the areas susceptible to improvement in terms of nursing-auxiliary staff collaboration , thus improving the quality of care, by promoting negotiation and confrontation between the two categories. In the literture the Jefferson Scale of Attitude Toward Physician Nurse Collaboration was used. Results identified that the priority areas of intervention regarded how the patient was received on hospital entry and during his stay and the safety of the patient throught hospitalization.

Nowadays, an important goal has been reached in recognizing that the client plays a central role in the caring process. The educational relationship that is created between nurses and patients makes it possible to make the patient aware of his health problems and to understand and actively participate in the caring process. The main aim of this study was to assess the effectiveness of the teaching process undertaken by nurses , before discharging surgical patients , for rendering patients autonomous once they returned home and their level of "satisfaction" regarding the information they received. For this purpose they were asked to fill in a questionnaire when they returned for their first outpatient control. Results showed that, on the whole, patients were satisfied with the information they received during hospitalization, particularly in terms of postoperative pain, prevention of infections, medical therapy, mobilization and a return to normal eating and drinking. Some aspects still need to be improved regarding a post-discharge phone contact and better hospital-territorial integration.

Professional risk and security in the health sector is becoming ever more important : the number of accidents in hospital environments during 2005 was 19,000 and nurses were the most frequently involved category. This study deals with clinical risk perception . A questionnaire was issued to 259 student and 100 professional nurses at the Modena and Reggio Emilia University Hospital., comprising 70 questions regarding 5 dimensions: general risk perception, personal risk perception, nursing skills, observed experience and direct experience. Results were evaluated using the ANOVA and t-tests and showed significant differences among the various groups (first, second and third-year students and professional nurses) in relation to each dimension. On the whole , the perception of risk was relatively low in comparison to its real level in the working environment. Therefore, specific training for a correct perception of health risks is required, not only for students but also for trained nurses, so that the culture of risk management becomes a routine issue.