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Factors associated to patients' outcomes in medical units: lessons learnt from an Italian multicentric longitudinal study design (ESAMED study).Research on nursing outcomes attempted to identify the associated factors, however, with mainly retrospective or descriptive studies. In 2011, an Italian network was established and a multicentric longitudinal study aimed at exploring factors associated with nursing outcomes among in-hospital medical patients was started.To summarise (a) how the research project was originated, (b) which patients have been involved, variables and instruments used, (c) the main findings, and (d) the lessons learnt.12 acute medical units from 11 Italian hospitals were involved. A consecutive sample was adopted: on a daily basis, data has been collected at the (a) patient; (b) nursing care, and (c) hospital levels.The effect of the variability in the amount of nursing care and skill mix in medical units was explored on the following outcomes: (a) hospital-acquired functional dependence, (b) prevalence and incidence of (i) episodes of hyperactive delirium, (ii) avoidable pressure ulcers; (iii) peripheral venous catheter phlebitis; (c) dissatisfaction with the nursing care; and (d) in-hospital mortality; 1464 out of 2082 eligible patients were involved. The frequency and reasons of Missed Nursing Care (MNC), as well as the presence of family caregivers at the bedside were also measured.The study confirmed that (a) the amount of nursing care provided by graduate nurses improves patient outcomes; (b) a skill mix in favour of nursing aides, negatively impacts on patients' outcomes; and (c) a higher frequency of MNC threatens patient outcomes.

The management of delirium among older in-hospital patients is a challenge, leading to worse outcomes, including death. Specifically, psychomotor agitation, one of the main characteristics of hyperactive delirium, requires a significant amount of medical and nursing surveillance. However, despite its relevance, to date incidence and/or prevalence of psychomotor agitation, its predictors and outcomes have not been studied among Italian older patients admitted in medical units. To describe the incidence and the prevalence of psychomotor agitation among patients aged > 65 years admitted to medical units and identify predictors at the individual, nursing care and hospital levels. A longitudinal multicentre study was conducted involving 12 medical units in 12 northern Italian hospitals. Descriptive, bivariate and multivariate logistic regression analyses were performed. Among the 1464 patients included in the study, two hundred (13.6%) have manifested episode(s), with an average of 3.46/patient (95% confidence of interval [CI] 2.73–4.18). In 108 (54.0%) patients, episode(s) were present also in the week prior to hospitalisation: therefore, in-hospital-acquired psychomotor agitation was reported in 92 patients (46%). The multivariate logistic regression analysis explained the 25.4% of the variance and identified the following variables as psychomotor agitation predictors: the risk of falls (relative risk [RR] 1.314, 95% CI 1.218–1.417), the amount of missed nursing care (RR 1.078, 95% CI 1.037–1.12) and the patient’s age (RR 1.018, 95% CI 1.002–1.034). Factors preventing the occurrence of episode(s) were: the amount of care received from graduated nurses (RR 0.978; 95% CI 0.965–0.992) and the lower functional dependence at admission (RR 0.987, 95% CI 0.977–0.997). A considerable number of elderly patients admitted in medical units develop psychomotor agitation; its predictors need to be identified early to inform decisions regarding the personal care needed to prevent its occurrence, especially by acting on modifiable factors, such as the risk of falls, missed nursing care and functional dependence.

ObjectiveTo explore nursing students’ interprofessional educational (IPE) experiences during their most recent clinical rotation and to explore the factors supporting IPE experiences.DesignNational cross-sectional study on data collected in 2016.Setting95 Bachelor of Nursing Sciences programmes; 27 Italian Universities.ParticipantsStudents who (a) were attending or just completed their clinical rotations lasting at least 2 weeks in the same unit, and (b) willing to participate in the study.Primary and secondary outcomesFirst to measure the occurrence of IPE experiences in the most recent clinical rotation; the secondary outcome was to discover factors associated with IPE occurrence.MeasuresThe primary outcome was measured using questions based on a 4-point Likert scale (from 0=‘never’ to 3=‘always’). Explanatory variables were collected at both individual and regional levels with items included in the same questionnaire.Results9607 out of 10 480 students took part in the study. Overall, 666 (6.9%) perceived not having had any IPE experience, while 3248 (33.8%), 3653 (38%) and 2040 (21.3%) reported having experienced IPE opportunities ‘only a little’, to ‘some extent’ or ‘always’, respectively. From the multilevel analysis performed using the generalised linear mixed model, factors promoting the occurrence of IPE experiences were mainly set at (a) the clinical learning environment level (high: learning environment quality, self-directed learning encouragement, learning opportunities, quality of safety and nursing care and quality of tutorial strategies); and (b) the regional level, where significant differences emerged across regions. In contrast, male gender was negatively associated with the perception of having had IPE experiences.ConclusionsA large number of nursing students experienced either ‘never’ or ‘only a little’ IPE opportunities, thus suggesting that nursing education tends to remain within the nursing profession. Limiting students’ interprofessional exposure during education can prevent future collaborative approaches that have been shown to be essential in providing best patient care. In order to increase IPE exposure, it is necessary to develop strategies designed both at the singular unit and regional levels.

Questionnaire, English version. (PDF 351 kb)

An overview of education models for nursing students clinical practice: a literature review.In the past decade the nursing education research developed and tested a number of clinical educational models.To describe the most used clinical educational models and to analyze their strengths and weaknesses in fostering the learning processes of nursing students.A literature review of studies on clinical education models for undergraduate nursing student, published in English, was performed. Electronic database Pubmed and Cinhal were searched until November 2016.Nineteen studies were included in the review and five clinical education model identified: 1) the university tutor supervises a group of students and selects learning opportunities; 2) a clinical expert/tutor nurse works side by side with one student; 3) the student is responsible of his/her learning process with the supervision of the ward staff; 4) a clinical tutor of the ward is dedicated to the students' supervision; 5) the student is not assigned to a ward but clinical learning opportunities matched with his/her needs are selected by the university.All the clinical education models shared the focus on students' learning needs. Their specific characteristics better suit them for different stages of students' education and to different clinical settings.

Validation of the Italian Clinical Learning Environment Instrument (SVIAT): study protocol.Nursing students obtain most of their university credits in internship environments whose quality can affect their clinical learning. Several tools are available to measure the quality of the clinical learning environment (CLE) as perceived by students: these instruments developed in other countries, were validated in Italian but do not discriminate those CLEs capable (or not) to promote significant clinical learning.To validate an instrument to measure the capability of the CLE to generate clinical learning; the secondary aim is to describe the learning environments as perceived by nursing students according to individual course site and tutorial models adopted.The study will be developed in three phases: a) instrument development and pilot phase, b) validation of the psychometric properties of the instrument and c) description of the CLEs as perceived by the students including factors/item confirmed in the validation process. Expected outcomes. A large validation, with more than 8,000 participating students is expected; the construct under lying will be confirmed through exploratory and confirmatory factor analysis and will report high internal consistency; the instrument will report also a high test-retest and inter-rater reliability; in addition, the instrument will demonstrate predictive ability by discriminating those units able (or not) to activate effective learning processes.

Background Patient satisfaction with nursing care (NC) is an important predictor of overall satisfaction with the hospital experience. However, the concept of patient satisfaction has been criticised both at the theoretical and at the methodological levels, and more attention on patient dissatisfaction has been called for with the aim of identifying strategies to improve the quality of care. Aims To describe dissatisfaction with NC as perceived by acute medical patients and identify predictors. Design and methods A secondary analysis of longitudinal data involving 12 Italian medical units was performed. A consecutive sample of 1016 patients ≥65 years (2012–2013) was included, and their satisfaction with NC was assessed, administering the Italian version of the Patient Satisfaction Scale (PSS) at the day of discharge. The scale was based on 11 items evaluated on a four-point Likert scale (score ranging from 11 – very dissatisfied to 44 – very satisfied). Patients were defined as ‘satisfied with NC’ when the score was ≥33, whereas they were considered as ‘dissatisfied with NC’ when the score was

To describe the prevalence and incidence density of hospital-acquired unavoidable pressure sores among patients aged ≥65 years admitted to acute medical units. A secondary analysis of longitudinal study data collected in 2012 and 2013 from 12 acute medical units located in 12 Italian hospitals was performed. Unavoidable pressure ulcers were defined as those that occurred in haemodynamically unstable patients, suffering from cachexia and/or terminally ill and were acquired after hospital admission. Data at patient and at pressure ulcer levels were collected on a daily basis at the bedside by trained researchers. A total of 1464 patients out of 2080 eligible (70.4%) were included. Among these, 96 patients (6.5%) hospital-acquired a pressure ulcer and, among 19 (19.7%) were judged as unavoidable. The incidence of unavoidable pressure ulcer was 8.5/100 in hospital-patient days. No statistically significant differences at patient and pressure ulcers levels have emerged between those patients that acquired unavoidable and avoidable pressure sores. Although limited, evidence on unavoidable pressure ulcer is increasing. More research in the field is recommended to support clinicians, managers and policymakers in the several implications of unavoidable pressure ulcers both at the patient and at the system levels.

Describing the trajectories of hospital-associated functional decline in older patients admitted to acute medical units and identifying predictors at the individual, nursing, and hospital levels, were the aims of the study. A longitudinal survey among 12 acute medical units in which 1464 patients were consecutively enrolled and evaluated using the Barthel Index (BI), was performed. Functional decline was defined as a decrease in the BI of at least 5 points from admission to discharge. In all, 17.1% participants (n = 251) demonstrated functional decline. In accordance with multiple logistic regression analysis, 28.8% (R(2)) of the variance in the functional decline was explained by: confusion/disorientation (RR = 4.684; 95% CI = 3.144-6.978), admission from nursing homes (RR = 2.464; 95% CI = 1.642-3.697), daily care expressed in minutes offered by nursing aides (RR = 1.535; 95% CI = 1.275-1.849), higher workforce skill-mix (RR = 2.221; 95% CI = 1.763-2.797), bladder catheter insertion (RR = 1.599; 95% CI = 1.128-2.268), and higher BI score at admission (RR = 1.019; 95% CI = 1.014-1.024). Increasing the amount of care delivered by competent nurses-having a bachelors degree-providing and supervising direct-care activities, may reduce the occurrence of functional decline in older patients admitted to medical units.