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Quality measurement of the intensive care unit (ICU) should include families’ perspectives, their satisfaction with the care process and outcomes, and the evaluation of actions to improve their psychological health and wellbeing. The current study was designed to validate the Italian version of the Family Satisfaction in the Intensive Care Unit (FS-ICU) using the Rasch model. Results included reliability and separation for items and persons, item fit statistics, unidimensionality, and item characteristic curve. The study was conducted between August 2022 and February 2023. A total of 108 family members (mean age 54.9 years) completed the FS-ICU questionnaire. The instrument had a moderate discrimination ability and only five items (#21, #23, #10, #22, and #24) exhibited a misfit. The Rasch dimension explained 52.1% of the variance in the data, while the unexplained variance in the first contrast is 7.2%, which indicates a possible second dimension. FS-ICU was shown to be beneficial as an assessment instrument for family member satisfaction in the ICU, despite some flaws that need to further be addressed to improve the scale.

To identify the profile of time restrictions and their justifications as reported on a set of published reviews.There is a body of methodological knowledge addressing how to design and perform reviews in their different designs. However, how the time restrictions should be set and the justifications that should be provided have received limited attention to date.A Focused Mapping Review and Synthesis following three steps (Focus, Mapping and Synthesis) was performed on 2021. The ENTREQ checklist was followed to report methods and findings.All Journal of Clinical Nursing reviews published in online or printed version on 2020 (n = 85). Time limits imposed in the literature search, and justifications provided were mapped and synthetised with quantitative and a qualitative analysis.Time restrictions in reviews are not always reported and, when available, reflect three different profiles: (a) including all studies, to provide a comprehensive review; (b) selecting a period, to provide reviews for a contemporary practice; and (b) including only recent studies for reviews reflecting current practice. Reasons justifying time restrictions are not always reported; when documented, justifications regard changes in the practice, in the research or in the theory occurred over time, recent or ongoing.In exploring the date restrictions applied in reviews published over the course of a year, it emerged that the time of access to the sources and the justifications are not always indicated. The attributes of the emerging concepts of "comprehensive reviews," "contemporary practice reviews" and "current practice reviews" might be further developed to support researchers in selecting an appropriate time frame.Reviews require improvements regarding the time restrictions and their justifications. Methodological efforts to standardise the approach ensuring transparency in review protocols and in the following review publication are recommended.

Patient isolation during Sars-CoV-2 pandemic: the caregivers' experience in a neuro-rehabilitation unit.During the Covid-19 pandemic, caregiver visits were suspended in many health care facilities and, even today, limitations remain. These restrictions have impacted not only the patients but also caregivers.To explore the life experience of caregivers of hospitalized patients, during the pandemic and the impact of visit limitations in a rehabilitation unit.An exploratory qualitative study was conducted, following the COREQ guidelines. Caregivers of inpatients were purposefully sampled and interviewed, until data saturation. A qualitative thematic analysis with an inductive approach was performed.Fifteen caregivers were interviewed. The themes emerged were: 1. perception of the illness as a sudden change; 2. concerns for their loved one (i.e. the loneliness or the suffering); 3. critical (difficult to organize and perceived too short) and positive aspects of the visits; 4. barriers to communication (for example, masks when in presence; or the difficult use of technologies by elders); 5. patient's protection and support (thinking that the relative's presence may improve the rehabilitation); 6. emotions (from discouragement when visits were not allowed, to joy when meeting their loved one).Caregivers experienced uncertainty, worry, anxiety, fear, and lack of understanding of their loved one's clinical situation. Alternatives to the visits or the visits with physical barriers were helpful but not always effective.

Aims: In pandemics, infection exposure and quarantine represent critical occupational risks for healthcare workers (HCWs). However, while the psychological consequences of HCWs’ quarantine have been reviewed, other potential implications of quarantine on HCWs, such as those that are work-, professional-, social- and private-related, have not been summarised to date. Summarising quarantined HCWs’ experiences in the current and past pandemics, as investigated with qualitative studies, might improve awareness of their needs, concerns, and the consequences of quarantine on their personal lives. Therefore, the lived experience of quarantined HCWs was reviewed and subjected to meta-synthesis and -summary. Methods: A systematic review of qualitative studies followed by a meta-synthesis and -summary allowing an interpretative integration of the findings of qualitative studies, was performed. PubMed, CINHAL and Scopus databases were explored up to 31 January, 2021, without any limitation in time. The methodological quality of the studies was assessed using the Critical Appraisal Skills Programme. Methods and findings are reported according to the Enhancing transparency in reporting the synthesis of qualitative research statement. Results: A total of 635 records were retrieved and five studies were included. Overall, five themes summarised the lived experience of quarantined HCWs: 1) Being emotionally challenged; 2) Living the quarantine limitations; 3) Losing freedom; 4) Accepting the quarantine; and 5) Staying away from me. The most frequent categories across studies were ‘Feeling stressed’ and ‘Being constrained’ (both 100%). The least frequent were ‘Feeling sad’ (20%), ‘Enjoying my family’ (20%) and ‘Being refused as a family member’ (20%). Conclusions: The lived experience of HCWs is multidimensional, the implications of which also affect private spheres of life: the immediate family and wider relatives. Understanding and learning from HCWs’ lived experiences might support policymakers, public health authorities and managers with the goal of maintaining the highest physical and mental health of staff during outbreaks. Timely services supporting HCWs, both during and after episode(s) of quarantine, are suggested to prevent additional burdens on frontline professionals.

Aim To describe the experiences of Italian nurses who have been urgently and compulsorily allocated to a newly established COVID-19 sub-intensive care unit. Background In the context of the COVID-19 pandemic, no studies have documented the experience of nurses urgently reallocated to a newly created unit. Method A qualitative descriptive study. Twenty-four nurses working in a sub-intensive care unit created for COVID-19 patients participated in four focus groups. Audio-recorded interviews were verbatim-transcribed; then, a thematic analysis was performed. Results The experience of nurses was summarized along three lines: (a) 'becoming a frontline nurse', (b) 'living a double-faced professional experience' and (c) 'advancing in nursing practice'. Conclusions Nurses who experienced being mandatorily recruited and urgently reallocated to a COVID-19 unit lived through a mix of negative feelings in the early stages, a double-faced situation during the episode and, at the end, the perception of global growth as a person, as a team and as a professional. Implication for nursing management Nurse managers could play a key role in identifying and preparing nurses in advance to mitigate their concerns and their sense of unpreparedness. The value attributed to nursing care should be promoted both during and after the current COVID-19 pandemic.

Aims To highlight (a) trends common to all nurses on priorities attributed to interventions, and (b) whether there are profiles of nurses working in the same context who prioritize interventions in a similar way. Background The underlying prioritization of interventions leading to unfinished nursing care has been minimally investigated. Methods A 2017 pilot Q methodology study. Full-time nurses, with at least 6 months of experience in a surgical unit, were involved. Eleven nurses rated the priority given in daily practice (from -3 as the lowest to +3 as the highest) to 35 Q-sample statements representing nursing care, non-nursing and organisational interventions. Results Overall, the intervention receiving the lowest priority was 'Providing patient hygiene', while the highest was 'Answering phone calls'. In the by-person factor analysis (total variance = 60.79%), three profiles of nurses emerged, (a) 'Patient safety-oriented' (variance = 31.66%); (b) 'Nursing task-oriented' (=16.32%); and (c) 'Team process-oriented' (=12.81%). Conclusions Three profiles of nurses emerged in the same setting with significant differences both in the statistical order of priorities and in their practical implications. Implications for nursing management Understanding levels of prioritization, which are not only affected by the unit but also by sub-groups of nurses who rank priorities in a similar way, can support nurse managers in their role.

The Productive Ward programme to provide high quality care: findings from a scoping review.The Productive Ward: Releasing Time to CareTM is a ward processes- and environments- improvement program intended to help nurses to spend more time on patient care, thus promoting patient safety.To define the state-of-science in research on the Productive Ward (PW) program, the set of outcomes documented to date, as well as the factors facilitating or hindering its implementation in practice.A scoping review based on the framework proposed by Levac et al. in 2010, further refined by the Joanna Briggs Institute in 2017, was performed on 2021. Methods and findings have been reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses - Scoping Reviews statement.11 studies have been published from 2014 to 2021, mainly in Europe and England. According to the findings, the PW program has an impact on nurses, patients and the organization. Factors facilitating the PW programme implementation rely on engaging communication, the leadership, the organizational and the managerial support, the additional human and financial resources as well as on the feature of the context and its culture. Resistance to change is the most investigated barrier of PW implementation.Although limited, the evidence suggests that the PW experiences are positive. Factors facilitating and hindering the implementation suggest a map of possible elements to consider before and during the implementation process.

The use of physical restraints (PRs) varies across countries and clinical settings, with intensive care units having the highest frequency. Although many investigations on the use of PRs have been conducted worldwide, few studies are reported in the Italian context.The aims of this study were to describe PR rates and types and to observe the factors associated with PR use.In this observational study, 2 methods were used to collect data: direct observation and review of patients' documentations.We performed 328 observations on 146 critically ill patients. Physical restraints were applied in 56.7% (n = 186) of these observations. Bilateral wrist ties were used for most PR episodes (n = 135, 72.6%), followed by unilateral wrist ties (12.9%). The most documented reasons were preventing patients from self-extubation (n = 93, 50.0%) and preserving indwelling lines and tubes (n = 60, 32.2%). In the multivariate logistic regression analysis, patients who were cared for during the night shift were almost 4 times more likely to be restrained than patients in the morning shifts (odds ratio, 3.84; P = .001) and patients with endotracheal tube were 3.5 times more likely to be restricted than spontaneously breathing patients (odds ratio, 3.59; P.001).Physical restraints are commonly used among critically ill patients in Italian intensive care units. There is a need to share the metrics for an efficient and accurate measurement of PR usage and trends and to document the reason for restraints, type of restraints, timeframe, and decision-making criteria.

Background The novel coronavirus brought Intensive Care Units (ICUs) back to their past when they were closed to family members. The difficulties of family caregivers encountered after the ICU discharge might have been increased during the coronavirus disease 2019 (COVID-19) pandemic. However, no traces of their experience have been documented to date. The objective of this study is to explore the everyday life experience of relatives in the first three months after a non-COVID-19 ICU discharge. Methods A descriptive qualitative study was conducted in 2020–2021. Two Italian general non-COVID-19 ICUs were approached. Follow-up telephone interviews were conducted three months after the ICU discharge. The study has been conducted according to the COnsolidated criteria for REporting Qualitative research principles. Results A total of 14 family members were interviewed. Participants were mostly females (n = 11; 78.6%), with an average age of 53.9 years. After three months of care of their beloved at home, relatives’ experience is summarised in three themes: “Being shaken following the ICU discharge”, as experiencing negative and positive feelings; “Returning to our life that is no longer the same”, as realising that nothing can be as before; and “Feeling powerless due to the COVID-19 pandemic”, given the missed care from community services and the restrictions imposed. Conclusions Relatives seem to have experienced a bilateral restriction of opportunities – at the hospital without any engagement in care activities and their limited possibility to visit the ICU, and at home in terms of formal and informal care.

Although quarantine has been largely used in the recent period of novel coronavirus disease (COVID-19), there has to date been no summary of the available literature regarding its implications among health care workers (HCWs). A scoping review was performed, following The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review and the Joanna Briggs Institute Critical Appraisal Checklist. The CINAHL, PubMed, and SCOPUS databases were queried up to 31 January 2021. Nine studies ranging from low to high methodological quality, were included. These were conducted in diverse countries, predominantly regarding the Severe Acute Respiratory Syndrome and using cross-sectional designs. Quarantine was found to have multifaceted negative consequences that affected HCWs psychologically, professionally, personally, socially and economically. These findings could be useful as a framework for researchers while designing future study protocols, and for policy-makers or managers while establishing multidimensional effective strategies increasing HCWs’ resilience and wellness.

BACKGROUND To date, few studies have explored cases of implantable cardioverter defibrillator (ICD) shock delivery with the intent of understanding patients' educational and supportive needs. AIMS AND OBJECTIVES To explore patient experiences as lived before, during and after one or more shocks. DESIGN A descriptive qualitative study carried out between 2016 and 2017. METHODS Semi-structured face-to-face audio-recorded interviews were performed and analysed using a content analysis methodology. RESULTS A total of 50 patients (average age = 68.3 years; largely male = 49; 98%) were interviewed. Four themes emerged: (a) "Feeling surprised vs. alerted by the changes inside me"; (b) "Living an intense, mono-dimensional vs. living a multidimensional storm experience", (c) "Facing the event vs. being supported"; and (d) "Living a drama vs. being used to it". CONCLUSIONS Findings suggest that ICD use can trigger negative physical and emotional effects in patients. Moreover, nurses should recognize patients' educational needs according to the stage of adaptation that each patient is experiencing with the aim of tailoring appropriate supportive interventions. RELEVANCE TO CLINICAL PRACTICE Therefore, it is necessary to consider the psychological needs of patients by integrating these into clinical care at different levels (emergency department, hospital ward, home). Specific structured support aimed at helping patients overcome intense negative experiences is suggested, especially in the first stage of the adaptation process. Nurses should also ensure that appropriate education programmes with adequate follow-up interventions are offered to improve the experience of living with an ICD. In addition, patient-reported outcomes should be routinely collected from patients with an ICD.

Background Medical emergency teams (METs), which have been established in several countries, contribute to a reported decrease in deteriorated patients' in-hospital mortality. To date, no data have been published on critical incidents that occurred in METs affecting patients' safety. Objectives The aim of the study was to identify and describe critical incidents that occurred during METs' activities in a large academic Italian hospital. Methods The data, which were stored in the official incident reporting system of the hospital and included all critical incidents that occurred and were reported in anonymous and voluntary forms over a 5-year period, were retrospectively analyzed. Results Overall, 17 critical incidents emerged, during both the team alert stage (n = 10) and its performance (n = 7), with approximately 3 events per year and an incident rate of 1.7 for every 1000 MET interventions. Discussion Medical emergency teams' critical incidents are rare and mainly due to the lack of compliance with protocols and of training and supplies, which require appropriate educational and organizational strategies.

Aims To examine the nursing care factors investigated regarding their influence on outcomes of critically ill patients. Background A large number of studies have considered patients' outcomes as sensitive to nursing practice in intensive care unit environments. However, no summary of nursing factors influencing these outcomes has been provided. Design Rapid review, following the seven-stage process outlined by Tricco and colleagues. Data sources Articles published up to March 2020 were identified in MEDLINE (via PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus databases. Review methods Eligibility of studies was first assessed at the title and abstracts level. Study inclusion was then established by two researchers by analysing the full texts. Results A total of 93 studies were included, with a total of 21 nursing care factors documented. At the structural level, nursing factors have been investigated at the organizational and at the personnel level. At the process level, nurse-led programmes, independent nursing interventions and nurse behaviours have been investigated to date. Conclusion The set of nursing factors that emerged can be used in future research to improve poorly developed areas and to accumulate further evidence through additional studies, both at managerial and practice levels.

Objective To summarize the experience of individuals placed in quarantine during an outbreak. Design A meta‐summary and a meta‐synthesis based upon a systematic review of qualitative studies. Sample The Cumulative Index of Nursing and Allied Health Literature, MEDLINE, and Scopus databases were all searched up to April 2020. Measurements The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines were followed; then, the methodological quality of the studies included was assessed with the Critical Appraisal Screening Programme tool for qualitative studies. Results Five studies have been included documenting the experience of 125 adult individuals. A total of 16 codes emerged: in the meta‐summary, the most and least frequent codes were “Thinking about quarantine” (80%) and “Emotional roller coaster,” “Being alert for any symptom,” “Trusting or not?,” “Knowing who brought the infection,” and “Living in a surreal world” (20%). The codes which emerged were categorized into three main themes which summarized the whole experience of being placed in quarantine: (a) “Being swamped with a thousand emotions”; (b) “Being restrained”; and (c) “Needing to be considered.” Conclusions The experience of quarantine for people is a long journey which can feel chaotic due to uncertainty about the consequences on health, work, and the future. The findings of this study can help nurses in caring for quarantined individuals by enabling them to understand people's need for educational and emotional support. Ensuring the supply of consistent information is also important to increase people's compliance.

Even if health care professionals should take into account the active involvement of families in Intensive Care Units (ICUs), little research that investigates family member’s contributions to care and includes its outcomes on both the family itself and the patient care, is available. The aim of this research project is to assess the effects of a family engagement program on family members’ satisfaction and on patients’ well-being and quality of life. A quasiexperimental study with two non-randomized groups (94 per each group) will be performed in two general ICUs of an Academic Italian Hospital. The intervention will be carried out in a single ICU and it consists of family members’ involvement in the care of their loved ones by means of bed physical exercises and simple care tasks. Participants will be evaluated through manifold outcomes: family satisfaction, assessed with the FS-ICU tool within 48 hours after ICU discharge; patients’ sense of well-being, measured with a visual analogue scale within 30 minutes after the time period of a visit; and the quality of life, investigated with the SF- 12 questionnaire within the first 48 hours after admission to ICU, at three and six months after ICU discharge by telephone. From July 2020, 188 subjects are going to be enrolled throughout the year. The latest data will be collected in December 2021 to allow the completion of the follow-ups of all participants. First, this study constitutes a significant step in a research agenda aimed at deepening the nursing sensitive outcomes in ICUs and the quality of hospital care. Secondly, the results of this study might have the potential to provide a better understanding of how families may modify patients’ outcomes and whether family members would benefit from an involvement program.

How hospitals, Intensive Care Units and nursing care of critically ill patients have changed during the COVID-19 outbreak? Results from an exploratory research in some European countries.During the Covid-19 outbreak, the health care institutions and the Intensive Care Units (ICUs) have been reorganized with significant consequences at both organizational and clinical levels.To investigate (1) the organizational changes of hospitals and ICUs in dealing with the Covid-19 outbreak; (2) the characteristics of the nursing care; (3) the most important challenges perceived by nurses in caring for Covid-19 patients.Cross-sectional online survey, available from May 11th and July 10th, 2020. Participants were nurses caring for Covid-19 patients in European ICUs.A total of 62 nurses responded to the survey; average age 37.5 years, 31 (60.8%) were female, mostly from Italy, France and United Kingdom. All hospitals underwent many changes, such as the opening of new dedicated wards and the restriction of family visits. The number of ICU beds doubled during the pandemic (p0.01), as well as the number of nurses per shift from 10.2 (SD 7.3) before to 17.9 (SD 13.6) during the pandemic (p0.01). However, changes in the nurse-to-patient ratio were not significant: from 1:1.5 to 1:2 (p=0.05). Among nursing care activities, clinical risk management (n=14, 22.6%), psychological support for patients (n=22, 35.5%) and family's involvement (n=31, 50%) resulted as more challenging; 64.5% of nurses suffered from protective equipment shortages, and 66.1% experienced psychological burden.These findings can help to reflect on how to better prepare both nurses and health care institutions for other events that may threaten clinical practice and require major and innovative efforts.

Missed nursing care and physical restraint have been identified as indicators of patient safety, but no studies to date have explored their relation. To explore the relation between these two phenomena, a secondary analysis of a longitudinal study on 1464 in-hospital patients and 314 registered nurses was performed. The use of physical restraint was assessed at the bedside on a daily basis; missed care was assessed with the MISSCARE survey. Individual, nursing care, and hospital-level variables were measured. A total of 184 (12.6%) patients were restrained for 20.33% of their in-hospital stay. No significant differences emerged in the occurrence of missed care between restrained and unrestrained patients. However, some common antecedents of these two phenomena emerged: in units where there is a lack of personnel, both an increase in missed care and physical restraint duration should be expected. As a consequence, patients are threatened in their right to receive the required care and they are at risk of being restrained. Moreover, a higher skill mix is a preventive factor, which suggests that the increased numbers of registered nurses on the team, may prevent routine forms of physical restraint use by analyzing the physical restraint in place critically and removing them as soon as possible, thus reducing the duration of the restraints.

Aims and objectives To synthesise the evidence reported in qualitative studies concerning the lived experiences of adult patients receiving mechanical ventilation in Intensive Care Unit (ICU). Background Critically ill patients receiving mechanical ventilation in the ICU have been reported to suffer from severe physical and emotional responses such as hopelessness, anxiety, high levels of frustration and stress. Recent improvements in the field of mechanical ventilation and sedative medications as experienced by patients that can inform nursing care have not been summarised to date. Design A systematic review of qualitative studies followed by a meta-synthesis and a meta-summary was performed. Methods Four electronic databases were searched by two authors in June 2019. A total of nine studies were included and evaluated based on their methodological quality using the Critical Appraisal Skills Programme checklist. Results A total of 24 codes emerged from the abstraction process, which were categorised into 11 categories and four themes: (a) "The effect of the intense stress on the body's systems," (b) "The induced negative emotional situations," (c) "The feeling of being cared for in a hospital setting" and (d) "The perceived support from the family and loved ones." Furthermore, the most frequent codes across studies were "Being afraid," "Feeling supervised," "Feeling comforted," "Failing to communicate," and "Experiencing difficulties in breathing," with an intensity of 66.6%. Conclusion Patients receiving mechanical ventilation have expressed a general sense of vulnerability, of which critical care nurses need to be aware. Relevance to clinical practice Findings suggest the need for improvements at the nursing, unit, educational and policy levels; furthermore, more research is also required at the international levels given the current trends towards no sedation protocols for the management of ICU patients: listening to their experiences becomes imperative, in order to ensure an awake, comfortable and ventilator-tolerant patient.

To understand what nursing education activities are missed in the daily life of nursing programmes, by also identifying antecedents and consequences of missed educational activities.A descriptive qualitative study according to the COnsolidated criteria for REporting Qualitative research guidelines.A purposeful sample of 32 participants with different roles (nurse educators, clinical nurses, students, and administrative personnel) and working in different settings (university, administrative, healthcare service levels) were involved in three focus groups and nine face-to-face interviews from 2019-2020. Both focus groups and face-to-face interviews were audio-recorded and transcribed verbatim. The data that emerged were thematically categorized by induction.Missed Nursing Education reflects those educational activities needed in the process of nursing education that are missed or delayed. Direct educational activities missed include clinical rotations, classroom teaching and students' overall learning experience. Indirect missed educational activities concern continuing professional development of nursing faculty members, nursing discipline development and the organizational processes of the nursing programme. As antecedents, missed nursing education is triggered by factors at the organizational, nursing faculty, and student levels. Consequences have been reported for students, nursing faculty, clinical nurses, and patients.Missed Nursing Education can be considered a multifaceted, multicausal phenomenon, with multitargeted consequences.To date, missed nursing care has only been investigated in clinical practice. However, care also permeates the relationship between nurse educators and students. Thus, at the point of 'educational care' delivery, aspects can also be omitted. Educational activities at risk of being missed or delayed affect the quality of nursing education and, in the short- and in the long- terms, also the quality of patient care. Some Missed Nursing Education antecedents can be modified by appropriate strategies that should be addressed by policy, health care and academic institutions.目的: 了解日常护理课程中错过的护理教育活动,同时明确措施该教育活动的前因后果。 设计: 根据报告定性研究指南中的综合标准开展描述性定性研究。 方法: 在2019年到2020年间,有目的地筛选32名不同职位(护士教育者、临床护士、学生和管理人员)且在不同环境(大学、行政机构、医疗服务机构)下工作的参与者,将这些参与者分为三个焦点小组,展开九次面对面访谈。焦点小组和面对面访谈内容都是通过录音和逐字转录的形式记录。相关数据应该按主题归纳和分类。 调查结果: 护理教育缺失是指护理教育过程中所需要的教育活动遭到错过或延误。错过的直接教育活动包括临床实习、课堂教学和学生的整体学习经历。错过的间接教育活动包括护理人员的持续专业发展、护理学科的发展和护理课程的组织过程。护理教育缺失是组织、护理人员和学生三个层面的因素所引发。现已对学生、护理人员、临床护士和患者所面临的后果进行报道。 结论: 护理教育缺失涉及多方面,因多个因素造成,可能造成多种后果。 影响: 截止目前,仅在临床实践中对护理教育缺失进行调查。然而,护理教育者与学生之间存在一定感情。因此,在提供“教育关怀”的同时,也可以省略部分方面。教育活动的错过或延迟可能对护理教育的质量产生影响,并且,从短期和长期来看,可能影响患者护理质量。部分护理教育缺失的前因可以通过适当的策略加以修正,此类策略应该由政策机构、卫生保健机构和学术机构制定。.

Different tools have been developed and validated to measure unfinished nursing care. However, no systematic review of the psychometric properties has been performed describing the quality of the methods used to estimate their validity.(a) To identify tools measuring unfinished nursing care that have undergone validation processes; (b) to evaluate critically the quality of the methods used in ascertaining their psychometric properties; and (c) to compare the estimated psychometric properties of these tools.A systematic review of the psychometric properties also evaluating their methodological quality was performed by following the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guideline for systematic reviews.The databases Medline, the Cumulative Index to Nursing and Allied Health Literature, PubMed, Google and Google Scholar were searched up to 30 June 2018.Data extraction was performed following the predetermined eligibility criteria. Eight properties and their methodological quality were assessed using the COnsensus-based Standards for the selection of health Measurement INstruments criteria.A total of 20 studies reported validation data regarding three family of tools: the Missed Care Survey (MISSCARE), the Basal Extent of Rationing of Nursing Care (BERNCA) and the Task Undone scale (TU-7). The most estimated psychometric properties across studies were internal consistency, followed by structural validity, content validity, and cross-cultural validity. The less evaluated psychometric properties were reliability, hypothesis testing and convergent and criterion validity.The psychometric properties of the investigated tools showed a more than acceptable quality, as did the methodologies used to estimate these properties.The MISSCARE survey is the most widely used tool validated across countries to date. Evaluating the concurrent reliability of the tools available is strongly recommended to assess their effectiveness in measuring the same phenomenon.背景: 已开发并验证了多种工具,可用来测量未完成的护理工作。但是,尚未进行心理测量特性的系统评估来说明有效性评估方法的质量。 目的: (a)为确定已通过验证的未完成护理的测量工具;(b)着重评估用于确定其心理测量特性的方法质量;和(c)比较这些工具的估计心理测量特性。 设计: 按照关于选择健康测量仪器(COSMIN)指南进行系统评估的共识标准,进行心理测量特性的系统评估,其还可用来评估方法学质量。 数据来源: 查询Medline、护理和联合卫生文献累积索引、 PubMed、谷歌和谷歌学术数据库中截至2018年6月30日的数据。 评估方法: 采用预先确定的合格标准进行数据提取,利用共识标准,评估八大特性及其方法学质量,并选择适当的健康测量仪器标准。 结果: 共有20项研究报告了涉及下列三大工具类别的验证数据:护理缺失研究(MISSCARE)、护理服务受限程度(BERNC)以及未完任务量表(TU-7)。各项研究中涉及最多的估计心理测量特性为内部一致性,随后是结构效度、内容效度和跨文化效度。较少评估的心理测量特性为可靠性、假设检验和聚合以及标准效度。 结论: 研究工具的心理测量特性超出可接受质量,同时用于估计这些特性的方法论也超出可接受质量水平。 影响: MISSCARE调查应用最广泛,已经过多国验证。强烈建议评估可用工具的同期可靠性,进而评估其在测量相同现象方面的有效性。.

Background No studies have assessed the differences in the incidences of falls and other patient safety events (PSEs) during handovers performed away from patients compared with when nurses are on the unit. Purpose The primary aim was to explore the incidence of falls and their severity during handovers compared with during nonhandover times; the secondary aim was to explore the occurrence of other PSEs during handover versus nonhandover times. Methods This was a retrospective study of all PSEs that occurred from 2013 to 2017 in a large Italian academic trust. Results There were 1966 falls and 1523 other PSEs. The incidence of falls per 100 hours was 4.9 during handovers and 4.4 during nonhandover times. The incidences of other PSEs were 2.9 and 3.5, respectively. No significant differences in fall outcome severity emerged. Conclusions No differences emerged in the occurrence of falls during handovers performed away from patients and when nurses were on the unit. Other PSEs decreased in occurrence during handovers as compared with other times during the shifts.

Aims and objectives To establish whether, and to what extent, tools measuring Unfinished Nursing Care (UNC) that have been validated to date have the ability to detect the discrete elements of the 'Integration of care' dimension of The Fundamentals of Care Framework (The Framework). Background UNC and The Framework have been established as two separate research lines, focused on (a) omitted care and related tools, and (b) on how to improve patient care, respectively. However, no attempts have been made to date to establish whether, and to what extent, tools measuring UNC have the ability to represent the discrete elements of The Framework. Design A two-step study: (a) a secondary analysis of a systematic review up to June 2018 later updated in May 2020, followed by (b) a comparative analysis. Methods A systematic review of studies on validated tools measuring UNC was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Then, researchers independently performed a comparative analysis between the extracted (a) discrete elements of The Framework and (b) items of the UNC tools retrieved. Results A total of 14 tools were analysed. The physical dimension of The Framework was the one mostly covered by UNC tools (up to 87.5% with the Perceived Implicit Rationing of Nursing Care). The Norwegian Basel Extent of Rationing of Nursing Care showed the highest level of representation (41.6%) for the psychosocial dimension. Only the Perceived Implicit Rationing of Nursing Care and the Unfinished Care tool measure the relational dimension (22.2%, respectively). By considering all elements of the 'Integration of care' dimension, the Perceived Implicit Rationing of Care had the highest percentage of convergence (41%). Conclusion Not all UNC tools have the same ability to represent the discrete elements of The Framework. Moreover, physical needs are more often detected in UNC tools compared to the relational and psychological ones. Relevance to clinical practice Unfinished care tools validated to date can represent a body of knowledge on which to build The Framework metrics, especially for the physical dimensions.

Objective To describe rates and types of critical incidents in Intensive Care Units. Research methodology A retrospective study in four intensive care units of an Academic Hospital located in the North-East of Italy. All critical incidents recorded in an incident reporting system database from 2013 to 2017 were collected. Results 160 critical incidents emerged. The rate was 1.7/100 intensive care-patient admissions, and 2.86/1000 in intensive care-patient days. Nurses reported most of the critical incidents (n = 113, 70.6%). In 2013 there were 19 (11.9%) critical incidents which significantly increased by 2017 (n = 38, 23.7%; p = 0.034). The most frequent critical incidents were medication/intravenous fluids issues (n = 35, 21.9%) and resources and organisational management (n = 35, 21.9%). Less frequently occurring incidents concerned medical devices/equipment (n = 29, 18.1%), clinical processes/procedures (n = 18, 11.3%), documentation (n = 14, 8.8%) and patient accidents (n = 13, 8.1%). Rare incidents included behaviour, clinical administration, nutrition, blood products and healthcare associated infection. Conclusion Over a five-year period, documented incidents were steadily increasing in four Italian intensive care units. A voluntary incident reporting system might provide precious information on safety issues occurring in units. at both policy and professional levels.

Objectives: This study explores the evidence available on Nursing Minimum Data Sets (NMDSs) by summarising: (a) the main methodological and reporting features of the reviews published in this field to date; (b) the recommendations developed and published in such reviews regarding the NMDSs, and (c) the categories and items that should be included in the NMDSs according to the available reviews. Methods: An Umbrella Review was performed. A search of secondary studies published up to November 2021 that were focused on NMDSs for adult hospitalised patients was conducted using MEDLINE (via PubMed), CINAHL and Scopus databases. The included studies were critically evaluated by using the Checklist for Systematic Review and Research Syntheses. The full review process was performed according to the Preferred Reporting Items for Systematic reviews and the Meta-Analyses statement. Results: From the initial 1311 studies that were retrieved, a total of eight reviews published from 1995 to 2018 were included. Their methodological quality was variable; these reviews offered four types of recommendations, namely at the overall, clinical, research and management levels. Additionally, seven NMDSs emerged with different purposes, elements, target populations and taxonomies. A list of categories and items that should be included in NMDSs have been summarised. Conclusions: Nurses are daily involved in the nursing care documentation; however, which elements are recorded is mainly defined at the local levels and relies on paper and pencil. NMDS might provide a point of reference, specifically in the time of health digitalisation. Alongside other priorities as underlined in available recommendations, and the need to improve the quality of the reviews in this field, there is a need to develop a common NMDS by establishing its core elements, deciding on a standardised language and identifying linkages with other datasets.

To explore students' perceived quality of the intensive care unit learning environment during their rotations; to compare these perceptions with that reported by students attending other settings and to assess correlations between the perceptions regarding the quality of the environment and the competences learned.A secondary analysis of data collected by a national cross-sectional study carried out in Italy. A total of 9607 nursing students participated; they ranked the intensive care units' quality, as assessed by the Clinical Learning Quality Evaluation Index; the perceived competences learned were also ranked with a Likert scale; from 0 = None to 3 = Very much.A total of 323 (3.5%) participants attended their rotation in an intensive care unit. They perceived the quality of the environment to be significantly higher (n = 2.11 out of 3) than those rotating in non-intensive care unit wards (n = 1.91; p 0.001). The competences learned by intensive care unit students were significantly higher than that reported by students attending non-intensive care unit wards (n = 2.31 out of 3 vs 2.06 out of 3; p 0.001).Intensive care units are highly appreciated by students, both in terms of their quality learning environment and their capacity to promote learning compared to other settings. Therefore, intensive care units should be considered as a place for clinical rotation to promote positive attitudes regarding critical care patients.

Measuring the effectiveness of nursing interventions in intensive care units has been established as a priority. However, little is reported about the paediatric population. The aims of this study were (a) to map the state of the art of the science in the field of nursing-sensitive outcomes (NSOs) in paediatric intensive care units (PICUs) and (b) to identify all reported NSOs documented to date in PICUs by also describing their metrics. A scoping review was conducted by following the framework proposed by Arksey and O’Malley. Fifty-eight articles were included. Publications were mainly authored in the United States and Canada (n = 28, 48.3%), and the majority (n = 30, 51.7%) had an observational design. A total of 46 NSOs were documented. The most reported were related to the clinical (n = 83), followed by safety (n = 41) and functional (n = 18) domains. Regarding their metrics, the majority of NSOs were measured in their occurrence using quantitative single measures, and a few validated tools were used to a lesser extent. No NSOs were reported in the perceptual domain. Nursing care of critically ill children encompasses three levels: improvement in clinical performance, as measured by clinical outcomes; assurance of patient care safety, as measured by safety outcomes; and promotion of fundamental care needs, as measured by functional outcomes. Perceptual outcomes deserve to be explored.

Nitrogen balance (NB) is considered a good marker of adequate protein intake and it has been suggested to be a good predictor of patients&rsquo, health outcomes. However, in literature, there is a lack of large randomized trials examining NB-guided protein intake in patients in intensive care units (ICUs). A randomized controlled trial enrolling patients admitted to ICU was done to compare changes in NB. Participants were randomized to a standard or protein-fortified diet (protein intake of 1.8 g/kg/day according to the guidelines of the Society of Critical Care Medicine and the American Society for Parenteral and Enteral Nutrition). The primary endpoint was represented by the NB on Day 1, 3, and study exit. Forty patients were enrolled in the study (19 in the protein-fortified group). The longitudinal analysis showed that, on Day 3, patients randomized to the protein-fortified diet were more likely (p &lt, 0.001) to present better NB (at 3 days, patients in the protein-fortified diet were estimated to have a nitrate value of 5.22 g more than patients in the standard diet, 95% CI 3.86&ndash, 6.58). The protein-fortified diet was found to be significantly and directly associated with changes in NB in critically ill patients admitted to ICU.

Objectives To summarise evidence on sleep deprivation and/or poor sleep determinants as experienced by intensive care unit patients. Research methodology/design A systematic review of qualitative studies identified through PubMed, CINAHL and Scopus databases published in English up to 2018 was performed following PRISMA guidelines. The included studies were critically evaluated by using the Critical Appraisal Screening Programme tool. Study findings were then subjected to a meta-summary and a meta-synthesis. Setting Intensive Care Units. Main outcome measures Critically ill patients’ experiences of sleep deprivation. Results Seven qualitative studies were included documenting the experience of 109 adult patients. A total of 12 codes emerged as causes of sleep deprivation and ‘feeling fear/concern’ was reported with the greatest frequency (71.4%) in the meta-summary. The 12 codes were categorised into three main themes influencing both directly and also interdependently the quality of sleep: (1) Experiencing complex interactions with the environment (nursing activities, frightening or disturbing sounds, acceptable sounds, time and space disorientation); (2) Undergoing intensive emotions and feelings (fear/concerns, state of abandon, inexplicable insomnia, inability to move, inability to talk) and (3) Receiving an appropriate standard of care (physical pain, feeling safe/unsafe). Conclusions Despite the increased relevance of sleep deprivation and poor sleep quality, only a few studies have been performed to date aimed at identifying the factors involved in the phenomenon according to patient experience. The majority of determinants as identified from patients’ perspective are modifiable.

Background Although many studies have considered mortality and adverse effects as outcomes sensitive to nursing practice, it seems that other outcomes of nursing care in intensive care units have been explored less commonly. Objectives To describe the state-of-science in research in the field of nursing sensitive outcomes in intensive care units and to synthesize outcomes that have been documented to date as being influenced by nursing care. Design A scoping review study based on the framework proposed by Arksey and O'Malley, further refined by the Levac and Joanna Briggs Institute was performed in 2019. Data sources The Medline, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Scopus, and Google Scholar electronic databases were searched. In addition, the reference list of included articles was screened. Review methods Two researchers independently identified publications on the basis of the following criteria: (a) articles that reported nursing sensitive outcomes on critically-ill adult patients admitted to the intensive care unit, (b) as primary and secondary studies, (c) written in English, and (d) without any time frame limitation. Results Of the 4,231 records, 112 fully met the inclusion criteria and were included. Publications were mainly authored in the US and Canada (n = 44, 39.2%), and the majority (n = 62, 55.3%) had an observational design. A total of 233 nursing sensitive outcomes emerged, categorized in 35 outcomes, with, on average, two per study included. The most often measured outcomes were pressure ulcers (20 studies) and ventilator-associated pneumonias (19 studies); the less studied outcomes were quality of life, secretion clearance, patient-ventilator dysynchrony, and post-extubation dysphagia. When categorizing outcomes, the ones concerning safety (n = 77, 33.1%) were represented the most, followed by those concerning the clinical (n = 72, 30.9%), functional (n = 70, 30.0%), and perceptual (n = 14, 6.0%) domains. The interdependent outcomes linked to multi-professional interventions (e.g., ventilator-associated pneumonias) were the most frequently studied nursing sensitive outcomes (n = 20, 57.1%), while independent outcomes resulting from autonomous interventions performed by nurses were less often studied (n = 8, 22.9%). Conclusions From a clinical point of view, a large heterogeneity of outcomes influenced by nursing care emerged. However, identified outcomes have been studied with different approaches and metrics, so that future efforts will need to establish homogeneous conceptual and operative definitions. Moreover, increasing efforts in establishing perceptual outcomes, or those close to the fundamentals of nursing care, are suggested in order to better depict the contribution of critical care nurses in the field.

Background: Adequate nutrition of critically ill patients plays a key role in the modulation of metabolic response to stress. Objective: This paper presents the development of a protocol for a randomized controlled trial (RCT) aimed at comparing clinical outcomes of patients in the intensive care unit (ICU) administered with standard and protein-fortified diet. Together with the RCT study protocol, the results of the observational analysis conducted to assess the feasibility of the RCT are presented. Methods: An RCT on adult patients admitted to ICU and undergoing mechanical ventilation in the absence of renal or hepatic failure will be conducted. Patients enrolled will be randomized with an allocation rate of 1:1 at standard diet versus protein-fortified diet. The estimated sample size is 19 per arm, for a total of 38 patients to be randomized. Results: Enrollment began in January 2017. In the feasibility study, 14 patients were enrolled. Protein administration increased significantly (P

The endotracheal tube cuff pressure must be maintained within an optimal range of 20-30 cmH2O, which ensures ventilation, prevents aspiration of secretions and guarantees a good tracheal perfusion.To describe changes in the endotracheal tube cuff pressure over time through a continuous monitoring device, and assess the number of nursing actions.Observation of 72 patients admitted to a general ICU and monitored for 12 hours, with a continuos monitoring device of endotracheal tube cuff pressure (PressureEasy(®)).During the first four hours 4 cases (5.6%) of underinflated cuff were observed, and 5 (6.9%) of overinflation. From the fifth to the eighth hour 7 (9.7%) patients showed a pressure20 cmH2O, and 3 (4.2%)30 cmH2O. During the last four hours 22 cases (30.5%) of underinflated cuff, and 4 (5.6%) of overinflation were observed. More than half of the patients (n=38, 52.8%) did not require any intervention of inflation or deflation of the cuff, 25 (34.7%) only one and 7 (9.7%) patients two, and twe patients, three. The majority of patients required the inflation of the cuff.Our study supports the need of continuous endotracheal tube cuff pressure monitoring to promptly identify deviations from the pressure ranges, allowing their rapid correction.

Hemolysis is one of the main factors that can damage a blood sample. The availability of an intravenous line already placed pushes many nurses to use this route for blood drawing, even if it is known that this technique is associated with an increased rate of hemolysis compared to blood sampling with a needle. The aim of this work is to identify interventions that reduce risk of hemolysis if the blood sample is from a peripheral IV catheter.A review of relevant literature was conducted through the databases MEDLINE, CINAHL and Cochrane database of Systematic Reviews.Fifteen studies were retrieved. Factors such as the material and the caliber of the IV catheter, the presence of obstructions, the anatomical site, the permanence of the tourniquet, the difficulty of positioning of the catheter, the volume of the tube used and the skills of the operator are decisive in the risk of hemolysis of the sample. In term of cost and preferences of the patient, the technique of blood sampling from a peripheral IV catheter is preferable.Sample collection through intravenous catheters is associated with significant higher risk of hemolysis. Take a sample of blood from a peripheral catheter to carry out an analysis and, at the same time, reduce the risk of hemolysis is possible if some precautions are followed.SCOPO. L’emolisi è uno dei fattori principali in grado di compromettere un campione di sangue. La disponibilità di un accesso venoso già posizionato spinge molti infermieri ad utilizzare questa via per il prelievo ematico, anche se è noto come questa tecnica sia associata a maggior incidenza di emolisi rispetto al prelievo con ago diretto. L’intento di questo lavoro è individuare gli interventi che prevengono il rischio di emolisi qualora il campione di sangue provenga da un ago cannula periferico. METODO. E’ stata condotta una revisione della letteratura attraverso la consultazione delle banche dati MEDLINE, CINAHL e Cochrane database of Systematic Reviews. RISULTATI. Sono stati selezionati 15 articoli. Fattori quali il materiale e il calibro del catetere venoso periferico (CVP), la presenza di ostruzioni, la sede anatomica, la permanenza del laccio emostatico, la difficoltà di posizionamento dell’ago cannula, il volume della provetta utilizzata e le abilità dell’operatore sono determinanti nel rischio di emolisi del campione di sangue ottenuto dalla cannula periferica. In termine di costi e di preferenze del paziente, la tecnica del prelievo ematico da CVP è da preferirsi. CONCLUSIONI. I prelievi di sangue ottenuti da cannula periferica sono associati a maggiore rischio di emolisi. Tuttavia, prelevare un campione di sangue da CVP per effettuare un’analisi e, nel contempo, ridurre il rischio di emolisi è possibile se vengono seguiti alcuni accorgimenti.