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Background: During the CoronaVIrus-19 (COVID-19) pandemic, nursing education has been dramatically transformed and shaped according to the restrictions imposed by national rules. Restoring educational activities as delivered in the pre-pandemic era without making a critical evaluation of the transformations implemented, may sacrifice the extraordinary learning opportunity that this event has offered. The aim of this study was to identify a set of recommendations that can guide the Italian nursing education to move forward in the post-pandemic era. Methods: A qualitative descriptive design was undertaken in 2022–2023 and reported here according to the COnsolidated criteria for REporting Qualitative research guidelines. A network was established of nine Italian universities offering a bachelor’s degree in nursing for a total of 6135 students. A purposeful sample of 37 Faculty Members, 28 Clinical Nurse Educators and 65 Students/new graduates were involved. A data collection was conducted with a form including open-ended questions concerning which transformations in nursing education had been implemented during the pandemic, which of these should be maintained and valued, and what recommendations should address the transition of nursing education in the post-pandemic era. Results: Nine main recommendations embodying 18 specific recommendations have emerged, all transversally influenced by the role of the digital transformation, as a complementary and strengthening strategy for face-to-face teaching. The findings also suggest the need to rethink clinical rotations and their supervision models, to refocus the clinical learning aims, to pay attention towards the student community and its social needs, and to define a pandemic educational plan to be ready for unexpected, but possible, future events. Conclusions: A multidimensional set of recommendations emerged, shaping a strategic map of action, where the main message is the need to rethink the whole nursing education, where digitalization is embodied. Preparing and moving nursing education forward by following the emerged recommendations may promote common standards of education and create the basis on for how to deal with future pandemic/catastrophic events by making ready and prepared the educational systems.

Unlabelled: . Transitioning Italian nursing education in the post-pandemic period: priorities in the light of lessons learnt. Introduction: Once back to normalcy, many nursing education activities have been restored without an in-depth analysis of which transformations enacted in the pandemic period should be maintained and valued. Aim: To identify priorities to effectively transitioning nursing education in the post-pandemic period. Method: Descriptive qualitative design. A network of nine universities involved 37 faculty members, 28 clinical nurse educators and 65 students/new graduates. Data were collected through semi-structured interviews; the main priorities reported in each university were combined to gain a global view. Results: Nine priorities emerged, including the need to: 1. reflect on distance learning to promote its complementary role to face-to-face teaching; 2. rethinking the rotations of clinical practical training by refocusing their aims, duration, and preferred settings; 3. understanding how to integrate the virtual and the in-presence learning spaces into the educational pathway; 4. continuing with inclusive and sustainable strategies. Considering that nursing education is essential, it is a priority to develop a pandemic education plan capable of guaranteeing its continuity in all circumstances. Conclusions: Nine priorities have emerged all considering the importance of digitalization; the lessons learnt, however, indicate the need to enact an intermediate phase capable of guiding towards the complete transition of the education in the post-pandemic era.

Many Italian universities during the COVID-19 pandemic had numerous students attending hospital wards. The training of health care students was necessary to prepare for good practices in implementing knowledge about COVID-19 and minimizing contagion among students who carried out the internship. In February 2020, a course aiming to guide health personnel so that they can appropriately address the health emergency posed by the new coronavirus was created, making use of the scientific evidence currently available as well as official sources of information and updates. The aim of this study was the development and validation of a useful tool to evaluate the progress in knowledge regarding COVID-19 of students in degree courses for the health care professions. The reliability of the test was assessed using Cronbach's alpha (α) coefficient, while the responsiveness of the test between T0 and T1 was measured with a student t test. The standard error of measurement was used to calculate the minimal detectable change of the tool. The test is made up of 31 items with four multiple-choice answers, one of which is correct. Fifteen bachelor's degree courses at the Sapienza University of Rome were enrolled, for a total population of 1,017 students from different course years. The test showed good internal consistency, with Cronbach's α values of 0.82. The item-total analysis also showed good results, with homogeneous α values from 0.80 to 0.82 for each item. The student t test showed a difference of 3.59 between T0 and T1 (p0.001). The minimal detectable change was 0.47. The test is a useful tool for assessing progress in skills regarding COVID-19 for students from bachelor's degree courses in the health professions. It allows the improvement and acquisition of skills as well as a qualitative analysis of the organization of internship degree courses.

Multi-centre mixed-method study design organised into several phases.The Veneto region has recently defined a set of policies on nursing care by determining the needed amount of daily care in minutes and by initiating a systematic measurement of nursing outcomes; also, with a more recent policy, missed nursing care (MNC) has been established as a process measure of interest. To measure the effect of these policies, a research protocol - aimed at evaluating several end points - has been designed, involving a large target population and hospital units. The aim of this manuscript is to briefly present the research protocol and to discuss the public health implications of its expected end-points.The endpoints of the protocol are: (a) to describe the frequency of MNC as perceived by nurses; (b) to identify contributing factors; (c) to identify practices adopted in low-occurrence MNC units and to assess the effectiveness of implementing them in units with higher levels of MNC; (d) to explore the relationship between the amount of nursing care provided, MNC, and patient outcomes; and (e) to validate a tool that measures MNC as perceived by patients/caregivers. A total of 3,460 nurses, 5,000 patient/day and 160 nursing coordinators of the medical and surgical units of public hospitals in the Veneto Region will be included.Measuring the association between the amount of nursing care and patient outcomes, as well as evaluating the role of MNC as perceived by nurses and patients in hindering or increasing the risk of some patient outcomes can provide a body of evidence capable of further informing policies in the field, both at the national and at the international level. Moreover, emerging good practices capable of preventing or minimising MNC, sharing and implementing them in other units where high levels of missed care are reported and evaluating their effectiveness, can also inform public health policies.

Introduzione. Negli ultimi decenni la ricerca educativa in ambito infermieristico ha concettualizzato e sperimentato diversi modelli di insegnamento clinico. Obiettivo. Descrivere i modelli di insegnamento e tutorato clinico più utilizzati a livello internazionale e analizzarne vantaggi e limiti. Metodi. Revisione della letteratura sui modelli di insegnamento clinico nella formazione infermieristica di primo livello, pubblicati in lingua inglese fino a novembre 2016 e indicizzati nelle banche dati Medline e Cinhal. Risultati. Sono stati inclusi 19 articoli ed individuati 5 modelli di insegnamento clinico: 1) un tutor universitario supervisiona un gruppo di studenti e seleziona le esperienze formative; 2) un infermiere esperto/tutor clinico supervisiona lo studente con un rapporto one to one; 3) lo studente è responsabile del proprio percorso formativo e viene supervisionato da tutto il team della sede di tirocinio; 4) un tutor clinico della sede di tirocinio è dedicato alla supervisione degli studenti; 5) lo studente non viene assegnato ad una sede di tirocinio ma vengono selezionate dall'Università opportunità/ sedi di apprendimento in base ai bisogni dello studente. Conclusioni. I cinque i modelli di insegnamento clinico sono centrati sui bisogni di apprendimento dello studente, ma per le loro caratteristiche si adattano a stadi diversi del percorso formativo e a diversi contesti clinici/organizzativi. Summary. An overview of education models for nursing students clinical practice: a literature review. Introduction. In the past decade the nursing education research developed and tested a number of clinical educational models. Aim. To describe the most used clinical educational models and to analyze their strengths and weaknesses in fostering the learning processes of nursing students. Methods. 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. Results. 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. Conclusions. 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.

Introduction. The Italian nursing programs, the need to introduce tools evaluating the quality of the clinical learning as perceived by nursing students. Several tools already exist, however, several limitations suggesting the need to develop a new tool. Aim. A national project aimed at developing and validating a new instrument capable of measuring the clinical learning quality as experience by nursing students. Methods. A validation study design was undertaken from 2015 to 2016. All nursing national programs (n=43) were invited to participate by including all nursing students attending regularly their clinical learning. The tool developed based upon a) literature, b) validated tools already established among other healthcare professionals, and c) consensus expressed by experts and nursing students, was administered to the eligible students. Results. 9606 nursing in 27 universities (62.8%) participated. The psychometric properties of the new instrument ranged from good to excellent. According to the findings, the tool consists in 22 items and five factors: a) quality of the tutorial strategies, b) learning opportunities; c) safety and nursing care quality; d) self-direct learning; e) quality of the learning environment. Conclusions. The tool is already used. Its systematic adoption may support comparison among settings and across different programs; moreover, the tool may also support in accrediting new settings as well as in measuring the effects of strategies aimed at improving the quality of the clinical learning.

Context Error reporting is considered one of the most important mediating factors for patient safety (PS). However, reporting errors can be challenging for health care students. Objectives The aims of the study were: (i) to describe nursing students' opportunity to report errors, near misses or PS issues that emerged during their clinical learning experience; and (ii) to explore associated factors of the process of reporting itself. Methods A national survey was conducted on 9607 (91.7%) undergraduate nursing students. The endpoint was to have reported PS issues in the last clinical learning experience (from 0 'never' to 3 'always'). Explanatory variables were set individual, nursing programme and regional levels. Results A total of 4004 (41.7%) nursing students reported PS issues from 'never/rarely' to 'sometimes'. In the multi-level analysis, factors increasing the likelihood of reporting events affecting PS have been mainly at the nursing programme level: specifically, higher learning opportunities (odds ratio [OR] = 3.040; 95% confidence interval [CI], 2.667-3.466), self-directed learning opportunities (OR = 1.491; 95% CI, 1.364-1.630), safety and nursing care quality (OR = 1.411; 95% CI, 1.250-1.594) and quality of tutorial strategies OR = 1.251; 95% CI, 1.113-1.406). By contrast, being supervised by a nurse teacher (OR = 0.523; 95% CI, 0.359-0.761) prevented the disclosure of PS issues compared with being supervised by a clinical nurse. Students attending their nursing programmes in some Italian regions showed a higher likelihood (OR from 1.346 to 2.938) of reporting PS issues compared with those undertaking their education in other regions. Conclusions Nursing students continue to be reticent to report PS issues. Given that they represent the largest generation of future health care workers, their education regarding PS should be continuously monitored and improved; moreover, strategies aimed at developing a non-blaming culture should be designed and implemented both at the clinical learning setting and regional levels.

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Background Informal caregiving offered by family members has been widely studied in the community setting, but little attention to date has been dedicated to that offered at the hospital level. Aims To describe the proportion of patients admitted to acute medical units receiving care from informal caregivers as decided by the family and to identify the factors affecting the numbers of care shifts performed by informal caregivers. Design and methods A longitudinal study was performed involving 12 acute medical units located in 12 northern Italian hospitals. Results All patients (N = 1464) admitted to medical units were included, and 77.1% of them received at least one shift of informal care during their in-hospital stay, especially during the mornings and afternoons. At the patient level, those at higher risk of prolonged hospitalisation and difficult discharge at admission, and those reporting higher occurrence of adverse events, such as pressure sores, confusion events and use of physical restraints during hospitalisation, were more likely receiving informal care. At the nursing care level, a higher amount of missed nursing care was associated with an increased number of care shifts offered by informal caregivers during patient hospitalisation, whereas the amount of care offered by staff was a protective factor. Conclusions Families play a care role in the care of older patients admitted to acute medical units. They contribute substantially to the care of patients, especially during morning and afternoon shifts.

BACKGROUND: The Conley Scale is one of the most widespread fall-risk screening tools in medical unit settings, despite the lack of data regarding its validity in patients currently admitted to these units. AIMS: Establishing the validity of the Conley Scale in identifying patients at risk of falling in an acute medical setting. METHODS: A 6-months longitudinal study in 12 acute medical units from September 2012 to March 2013, a total of 1464 patients with ≥65 years of age were consecutively enrolled and evaluated with the Conley Scale within 24 h of admission. A construct validity, internal consistency, and a priori and a posteriori predictive validity study was performed. RESULTS: The explorative factor analysis showed a two-factor structure explaining a total variance of 48.3 %: previous history (30.41 %), and physical and cognitive impairment (17.9 %). The scale reported a poor internal consistency (Cronbach's α = 0.465) and the capability to correctly identify 18/649 patients as being at risk of falling, whereas the negative predictive value was 98.5 %. The sensitivity and specificity values were 60.0 and 55.9 %, respectively. No difference emerged between patients scored as at risk and those scored as not at risk in the time elapsed from admission to the first fall (HR = 0.600, 95 % CI 0.289-2.247 p = .166). DISCUSSION: The Conley Scale is not able to predict falls in elderly acute medical patients, and has reported poor internal consistency and accuracy. CONCLUSIONS: More studies are needed to develop appropriate tools to predict the risk of falling in elderly individuals admitted to an acute medical setting.

Objectives: To establish the most effective securing devices and techniques for preventing nasogastric tube displacement or inadvertent extubation, mucosa and skin lesions, discomfort, and complications (ab ingestis pneumonia, reduced caloric intake, mortality) in adult patients. Design: Systematic review of published and unpublished reports in any language, identified by searching 5 electronic databases, websites, reference lists, and existing systematic reviews and papers identified by experts in the field. Eligibility criteria for selecting studies: Systematic reviews, randomised controlled trials, and comparative studies that compared 2 techniques or devices to secure nasogastric tubes in patients 18 years old or older. Results: Five studies (of which two were randomised controlled trials) were included. Four studies reported on bridle versus the tape technique (unbridled). The studies’ population was comprised of mostly Intensive Care Unit patients. Four studies measured unintentional dislodgement or removal and found a statistically significant advantage in favour of the bridle. Three studies measured time until failure: two studies compared the bridle versus tape technique whereas the other compared different types of tape. One study did not find any significant difference between the two groups of patients whereas the second demonstrated a significantly longer time until failure in the bridled patients. Three studies comparing bridled and unbridled patients measured adverse events such as external nasal ulceration, epistaxis and sinusitis, and there was no agreement between their results. One study measured caloric intake and found that bridled patients received a higher percentage of their caloric goal than unbridled patients. Only one study analysed the cost-effectiveness of the bridle versus the tape technique and found a cost saving by implementing routine bridling of nasoenteric feeding tubes. Discomfort was not measured in the included studies. Conclusions: Despite the large number of patients receiving this intervention, there is insufficient evidence to suggest one securing technique or device over another. Data are lacking on the beneficial effects of the various methods or systems. There is little or no statistically significant evidence regarding bridling of nasogastric tubes but more research is needed. There is a need for more well-designed studies conducted in various clinical settings.

Riassunto. Introduzione. Il fenomeno dell’aver cura (caring) è stato studiato soprattutto dal punto di vista degli infermieri, ma è fondamentale mettere in luce anche il punto di vista dei pazienti per comprendere le azioni e i comportamenti che l’infermiere può adattare per avvicinarsi alle attese dei pazienti. I due punti di vista infatti possono essere diversi. Obiettivi. Descrivere e comprendere l’esperienza di caring infermieristico dei pazienti ricoverati in ospedale, focalizzandosi sulle azioni degli infermieri. Metodo. È stata condotta una ricerca qualitativa fenomenologico-ermeneutica. I dati sono stati raccolti attraverso interviste semi- strutturate, chiedendo ai pazienti di narrare un episodio in cui avevano sentito che l’infermiere si era preso cura di loro. Risultati. Sono stati intervistati 93 pazienti, in diversi reparti. Le dimensioni di caring si riferiscono alla possibilità di vivere una relazione di vicinanza con l’infermiere che li faccia sentire compresi attenuando il senso si solitudine che talvolta provano. Il caring si concretizza quando ricevono informazioni coerenti al loro bisogno e comprensibili, quando l’infermiere presta loro attenzione e li fa sentire al sicuro attraverso una vigilanza costante. Conclusioni. Le organizzazioni dovrebbero promuovere modelli assistenziali che favoriscano la personalizzazione dell’assistenza, pensando al significato dei pazienti attribuiscono al caring. Summary. When patients talk about care: a qualitative phenomenological study. Introduction. Caring has been studied so far mainly from the nurses’point of view, but is equally important to elicit the patients’ perspective to improve the understanding of actions and behaviors nurses can implement to respond to patients’ expectations and idea of caring. Patients and nurses’ perspectives may, in fact, be different. Aims. To describe and understand the caring experience of patients admitted to hospital, focusing on behaviors associated to a good caring. Methods. A qualitative, phenomenological hermeneutical research was conducted. Patients were interviewed with semi structured interviews and asked to tell when they had received a good care from nurses. Results. Ninety-three patients from different wards were interviewed. The caring dimensions described refer to the opportunity to experience a relationship of closeness with nurses, of being perceived as unique persons, understood, to relieve the sense of loneliness, sometimes experienced. Patients perceive that they are cared when receiving information consistent with their needs, that they are able to understand, when nurses are attentive and make them feel safe through constant monitoring and surveillance. Conclusions. The organizations should promote caring models oriented to the personalization of care, perceived as an essential element of care.

Turnover represents a problematic phenomenon due to both staff management and costs related to the quality of care. Turnover is quite studied in other Countries, but it is still little studied in Italy. The aim of this study was to analyzing psychosocial factors related to intention to leave the hospital, by using theoretical models from literature and applying them in the health context. The study involved 1295 nurses from North-Italy. The results showed that intention to leave may be considered the most direct predictor of turnover behavior. In fact, the demand for mobility to another hospital was requested by nurses with high level of intention to leave. Among examined individual and organizational characteristics, we found that young nurses with high education had higher turnover intention than old nurses. Moreover, nurses with high level of intention to leave not only perceived a low affective commitment to the unit, but also a low quality of relationship with both supersiors and physicians. The findings have important implications for both nurses and hospitals by helping to promote effective work environments, thus reducing turnover intention.

Pressure ulcers (PrUs) remain a concern for clinicians, patients, caregivers, and researchers. Although data on prevalence and incidence are available, as well as evidence-based prevention and management intervention, PrU healing time is underreported. OBJECTIVE: The objective of this study was to evaluate the healing time of Stage II PrUs. METHODS: Secondary analysis of data collected from a multicenter randomized clinical trial was undertaken. Patients (a) with a Stage II PrU, (b) older than 18 years, and (c) who had given informed consent were included. The endpoints of the study were complete re-epithelialization of the PrU measured with the Pressure Ulcer Scale for Healing Tool 3.0 and the healing time. A network of 46 healthcare centers located in northern Italy participated in the study. RESULTS: Two hundred seventy patients with an average age of 83.9 years (95% confidence interval [CI], 82.71Y85.10) were recruited. Among 270 Stage II PrUs included, 153 lesions healed (56.7%), whereas 74 (27.4%) were still present after 10 weeks of follow-up. For 43 lesions (15.9%), the follow-up evaluation was interrupted because of patient death or transfer to units not included in the study. The PrUs healed on an average of 22.9 days (95% CI, 20.47Y25.37 days), with a median of 18 days. The average healing time for PrUs of less than 3.1 cm2 was significantly shorter (19.2 days; 95% CI, 16.6Y21.8) compared with those 3.1 cm2 or greater (31.0 days; 95% CI, 26.4Y35.6 days) (P = .000). CONCLUSIONS: To achieve complete re-epithelialization in Stage II PrUs, it takes approximately 23 days. This is quite a long time if we consider that pressures of only 60 to 70mmHg for between 30 and 240minutes are needed to cause tissue damage. On average, a small ulcer heals 12 days faster compared with those with a surface of 3.1 cm2 or greater. KEYWORDS: Stage II pressure ulcer, healing time, re-epithelialization

Concept analysis is a research method in which concepts are examined in a logical and systematic fashion to form clear and rigorous conceptual definitions. To describe the concept analyses published between 1994 and 2008 and identify the emerging tendencies in the Nursing discipline, a two-staged study has been developed. In the first stage a systematic review of the literature was conducted: research published in the journals indexed in the MedLine, CINAHL and Cochrane databases were judged eligible, if they reported the theme of 'concept analysis' and 'nursing' in the title or in their key words and were published in English language. In the second stage, the articles that emerged were subjected to a content analysis. Some 158 concept analyses emerged, on average 10/year (range 1-22, median 11, +/- 5.6): these regarded 129 different concepts. Ninety-one (57.6%) concepts were focused on the nursing profession, while 67 (42.4%) were focused on the patients. Although in a few cases the effort made by the researchers moved toward the definition of new concepts, in others it appeared oriented toward including in Nursing some typical concepts from other disciplines, thus tracing an expansion of the domain of the Nursing discipline. Monitoring over time the concepts analysed constitutes an important research area to comprehend, both at a national and international level, the progressive evolution of the Nursing discipline.

Riassunto. Obiettivo. Fornire una sintesi del dibattito in letteratura sull’invecchiamento della professione infermieristica. Metodi. Revisione dei principali articoli pubblicati dal 2000. Risultati. Avere una forza lavoro che sta rapidamente invecchiando è una realtà nuova, a cui le nostre organizzazioni devono prepararsi. Molti infermieri in età prossima alla quiescenza rimarrebbero nella professione se l’ambiente lavorativo e il sistema di riconoscimento retributivo fossero adeguati. Viene presentata la testimonianza di un infermiere “trattenuto” al lavoro. Conclusioni. Per affrontare questa importante sfida è necessario sviluppare una leadership attenta all’invecchiamento degli operatori e riprogettare la logistica e le strutture di supporto. Summary. The effects of the aging of the nursing profession and the strategies to effectively retain senior nurses. Aim. To provide an overview of the debate in the literature on the aging of the nursing profession. Method. Review of the main articles published since year 2000. Results. The rapid aging of the nursing workforce is a new phenomenon that Italian organizations have to face. Many nurses ready for retirement would be willing to remain in a more adequate work environment and salary. The story of a nurse retained at work is presented. Conclusions. A leadership careful of this phenomenon and able to re-plan work environments and supportive mechanisms need to be developed to take on this new challenge.

Introduzione. La ritenzione degli infermieri è una sfida per i Dirigenti e i Coordinatori infermieristici e gli infermieri all’inizio della carriera professionale e lavorativa rappresentano un gruppo particolarmente instabile, infatti l'anzianità di servizio è inversamente correlata con la probabilità di turnover. Comprendere le ragioni per cui dichiarano di voler lasciare l’ospedale in cui sono inseriti è essenziale per poterli trattenere. Obiettivo. Esplorare i fattori che influenzano l'intenzione di turnover dall'ospedale degli infermieri con anzianità lavorativa ≤3 anni. In particolare analizzare la relazione tra intenzione a lasciare e soddisfazione lavorativa, senso di appartenenza all’organizzazione, coinvolgimento lavorativo, percezione di competenza professionale e di supporto da parte dell'organizzazione. Metodo. È stato somministrato a tutti gli infermieri di 3 ospedali del Nord Italia un questionario che indagava la loro percezione rispetto alla soddisfazione lavorativa, al senso di appartenenza all’organizzazione, al coinvolgimento lavorativo, alla competenza professionale e al supporto da parte dell'organizzazione secondo una scala di disaccordo/accordo da 1 a 5. Risultati. Il 34.4% degli infermieri con anzianità lavorativa ≤ 3 anni ha intenzione di lasciare l’ospedale entro 1 anno, il 43.8% di questi ha già inoltrato domanda di trasferimento (ad un altro ospedale).Gli infermieri che hanno intenzione di lasciare sono prevalentemente maschi, con un contratto a tempo indeterminato ed abitano ad una distanza maggiore di 30 km dalla sede lavorativa. Inoltre sono meno soddisfatti per il lavoro, il rapporto con i colleghi, il Coordinatore e il personale medico, si percepiscono meno competenti, meno legati al proprio reparto e meno supportati dall’organizzazione. Conclusioni. Lo studio indica il bisogno di migliorare la soddisfazione lavorativa e il senso di attaccamento al reparto dei giovani infermieri per trattenerli nell’ospedale.

Nurse staffing levels have always heea an issue and the optimal level and mix of nurses required to deliver quality care as cost-effectively as possible continues to be discussed at both national and international levels. In Italy, a network of experts rom ten local health and hospital authorities was set up in June 2010. The, main objectives of the network were to define, validate and approve a panel of relevant indicators, identity minimum standards of safety and develop recommendation to guide decision-making regarding hospital nurse staffing levels. The indicators and recommendation developed by the network are presented in this paper.