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Background: Nursing, between healthcare professions, is the most at risk of violence and aggression. Most healthcare organizations rely on training as the primary strategy for the prevention of violence. Very little is known about the key factors for prevention against nurses: staff education, training and risk assessment. Objectives: The aim is to verify if the number of observed episodes of violence and aggression in renal units are associated with structural and prevention managerial strategies. Design: An observational, cross‐sectional study. Participants: They were part of a convention sample of participants in the European Dialysis and Transplant Nurses Association/European Renal Care Association Conference of 2019, who understood the English Language and had a smartphone or tablet. Measurements: The tool used was a questionnaire developed by Zampieron in 2010, with closed questions, focused on violence and aggression's prevention and management. Conclusions: In conclusion our study found that organizational and managerial strategies to address violence and aggression are highly correlated with observed violence in unit. Nurses are encouraged to become proactive by participating in prevention committees and policies, attending prevention training offered by unit, and reporting all incidents including those witnessed. [ABSTRACT FROM AUTHOR]

Background: The palliative care phenomenon is increasingly invested in all medicine and nursing fields, as care for people with kidney disease who do not wish to embark on dialysis: it encompasses a palliative approach to shared decision‐making. To deliver patient‐centred optimal care, nephrology healthcare staff should be knowledgeable about palliative care and the appropriate conservative management approach. Objective: This paper aimed to explore, using a Delphi survey, the barriers and facilitators to palliative care in patients with kidney disease. Design: An e‐Delphi technique with three questionnaire rounds was performed; statements were generated using Likert scales. Participants and Measurements: A list of 80 statements related to palliative care in patients with kidney disease was divided into facilitators and barriers. Questionnaires were administered to 13 nephrology nurse experts in some European countries. Results: Seven items were removed from the list of 80 statements after the first round of the Delphi study; eight items achieved a significant change of the mean between round two and three, whereas internal stability emerged in all the remaining items. Conclusions: Specific training and education in palliative care emerged as a facilitator, as well as the role of spiritual and beliefs and the role of family and caregiver. The main barriers were represented by the differences in cultures, beliefs, and practices and by the lack of experience in the role of the staff in palliative care. These statements provide a platform for future research to improve palliative care practice in patients with kidney disease. [ABSTRACT FROM AUTHOR]

Background: Children who develop Acute Kidney Injury may start renal replacement therapy (RRT) in Paediatric or Neonatal Intensive Care Units (hereafter PICU or NICU); RRT can be delivered either by paediatric dialysis nurses or by critical care nurses. In both case, nurses devoted to this task must have a high level of competence in providing care to children receiving haemodialytic treatment in a specific technological environment. Aim: The objective of this research was to investigate which models have been adopted to organize nursing care in RRT management in different Italian PICU and NICU, and to explore the training of ICU nurses on the management of RRT. Methods: A multi‐centre survey was conducted through an online questionnaire directed to the Italian PICU and NICU nurse coordinators. Results: A total of 15 Intensive Care Units (12 PICU and 3 NICU) in 12 hospitals were involved. The mean nurse/patient ratio in these units is 1:3. In 72.7% of critical care units, dialysis treatment is delivered by critical care nurses belonging to the unit itself, while in 27.3% of units paediatric dialysis nurses are in charge of dialysis treatment in collaboration with critical care nurses. In 25% of surveyed units there is some structured form of collaboration between Paediatric Dialysis nurses and critical care nurses. However, 75% of units did not respond to this specific question. The different units adopt various forms of RRT training for nursing staff. Conclusion: The scenario resulting from this analysis showed how in our sample of Italian hospitals there is no standard practice for RRT nursing management. In addition, although various forms of training for nursing staff exist, a proper educational programme and/or a standardized specific training about RRT management for nursing staff is not in place in the surveyed hospitals. Relevance to clinical practice: The lack of standardized protocols or guidelines for RRT delivery to critically ill children can compromise their safety. The structuring of these protocols and the production of best clinical practice guidelines would allow standardization of the nursing management of the RRT and of the corresponding training. This may help to provide the proper care and to guarantee the patients' safety. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: Cachexia is a wasting syndrome found within a range of chronic illnesses/life‐limiting conditions, however awareness and understanding of cachexia amongst renal Health Care Professionals has not been investigated. Objectives: To ascertain the awareness, understanding and treatment practices of Health Care Professionals who provide care for people with cachexia and end‐stage renal disease. Methods: Health Care Professionals were recruited via the European Dialysis and Transplant Nurses Association/European Renal Care Association in September 2018. This was an exploratory study using a mixed‐methods approach with those who provide care for patients with end‐stage renal disease and cachexia. An online survey and two focus groups were conducted. Descriptive statistics and inductive thematic analysis were used to explore current knowledge and practices in renal cachexia. Results: A total of 93 participants from 30 countries completed the online survey. Twelve Health Care Professionals agreed to participate in the focus groups. Reduced appetite, weight loss and muscle loss in relation to cachexia were accurately described, but the percentage of weight loss was unknown. The importance of multi‐professional collaboration was recognised, however, the current management of cachexia was wide‐ranging. Quality of life, patient‐clinician communication and specialist support for carers were regarded as vital. Conclusion: Timely identification and management of cachexia are needed to improve the quality of life for patients and appropriately support families. In order for these goals to be achieved, there is a need to increase awareness and understanding of cachexia amongst renal nurses. [ABSTRACT FROM AUTHOR]

Cases of dementia have increased significantly in recent years. The family represents the main cornerstone of assistance to the elderly suffering from dementia, in particular the caregiver. Family members who take on the role of caregiver are subjected to physical, psychological, emotional, social and financial stress, which can be conceptualised with the term "burden". The aim of this study was to investigate which tools are best suited to measure the type of burden based on the type of dementia for each caregiver. A literature search was undertaken in MEDLINE, CINHAL and The Cochrane Database in September 2022, including articles from the last 20 years and using a combination of keywords and defined inclusion criteria. This literature review has been performed according to the PRISMA statement. From a total of 116 articles regarding the use of burden rating scales for caregivers, 18 scales were selected. The review provides a useful overview of burden assessment scales, classified into three categories, one-dimensional, multidimensional, or distinct concept with a subjective and objective component, in order to adopt appropriate strategies to assess caregiver burden and improve the quality of their health, both in the community and in hospitals. Indeed, the domestic context is the most studied as there is a greater risk of developing the burden of the caregiver: for this reason, some scales include the assessment of both the caregiver and the patient receiving treatment., (© 2023 Universit a di Salerno.)

Background: diabetes mellitus is a chronic disease of the endocrine system, characterized by an increase in the concentration of glucose in the blood. For patients with diabetes, it is possible to cover the need for insulin through the use of an insulin pump, a subcutaneous implantable device, which aims to simulate the action of the Langherans islets. Therapy with an insulin pump allows patients who use it to have a greater flexibility in the long-term management of diabetes., Objective: to investigate in the literature the perceptions and experiences of patients subjected to the use of the insulin pump., Methods: this review was carried out using the international databases Pubmed, CINAHL and COCHRANE. The mesh terms "Insulin infusion system, attitude to health, experiences, emotions, perceptions, activities of daily living" were used combined with the Boolean operator AND. Age limits  and language were set and literature was investigated from 2008 to 2018, respecting specific inclusion and exclusion criteria., Results: 260 articles from the Pubmed database were analyzed, 26 articles from Cinhal, no articles by COCHRANE; of these 188 excluded based on the reading of the abstract and because they were duplicate articles, 7 because they did not meet the inclusion criteria. 15 articles were included in the review., Discussion: four main themes emerged regarding the personal experience of patients with insulin pumps: perceptions deriving from the use of the insulin pump, behaviour deriving from therapy, obstacles to adequate glycemic control and discrepancy between education received and reality., Conclusions: different moods and behaviors have been reported in people who use the insulin pump: one above all the fear of hypoglycemia. There are different expectations from patients and nurses. In addition to adequate training with respect to direct patient care, training is also required for nursing staff in emotional support and in technological development.

Background: The transition of medical care from a pediatric to an adult environment is a psychological change, a new orientation that requires a self-redefinition of the individual, to understand that changes are taking place in his life. Up to 60 percent of pediatric patients who transition to adult services will experience one or more disease or treatment-related complication as they become adults. A nurse who knows how to recognize potential barriers at an early stage can play a pivotal role in the educational plan for the transition process., Materials and Methods: A literature search was undertaken of PUBMED, CINAHL and The Cochrane Library, with specific inclusion and exclusion criteria, including articles published in the lasts ten years.This literature review has been performed according to the PRISMA statement., Results: Using the keywords in different combination 38 articles were found in The Cochrane Library, 5877 in PUBMED, 274 in CINAHL. 88 articles were selected after the abstract screening. 31 after removing the duplicates and reading the full text., Discussion: The main themes surrounding transition of care that emerged from the synthesis are the organization of care within common models of transition, innovative clinical approaches to transition, and the experience of patients and caregivers. The transition from pediatric to adult care of cancer or SCD survivors is an emerging topic in pediatric nursing. The organization of care is affected by the lack of clear and well-structured organizational models. Further research is needed to deepen the understanding of some aspects of the transition.

Background and Aim: Hospital discharge should be planned during the first days of stay to avoid an inappropriate length of stay and an early rehospitalization. Blaylock Risk Assessment Screening Score Index (BRASS index) evaluates the risk of difficult discharge, Barthel Index the level of autonomy in "activities of daily living" (ADL). This is a prospective observational study, performed in Padua's Hospital (Italy), with the purpose of validating two cut-offs in the Barthel Index using the BRASS Index, in order to find three bands for difficult discharges: low, medium and high risk., Methods: Two studies have been conducted: a pilot study in 2017 with 153 patients and a validation study in 2018 with 253 patients, in order to validate data emerged from the pilot study. Using a statistical method, two cut-offs have been identified in the Barthel Index., Results: Both of study showed that the grade of autonomy is correlated with the risk of difficult discharge. A Barthel score between 0 and 35 corresponds to a high risk, between 35 and 70 to a medium and over 75 to a low., Discussion: This study suggests that, by the use of only Barthel Index, it may be possible to identify patients who may have difficulty in early discharge. This result suggests that the degree of functional dependence is predictive of the risk of difficult discharge. Further studies are needed to confirm the correlation between these data also in other realities (e.g. outside hospital departments)., Conclusion: Nurses could use a single instrument to evaluate the autonomy and the risk of difficult discharge in order to identify early patients that need a discharge plan. (www.actabiomedica.it).

. Assessment instruments for frail elders: a literature review., Introduction: The frail patient is a usually elderly person, chronically affected by multiple illnesses, with an unstable and frequently disabled state of health, whose care needs are determined by factors linked to clinical conditions, socio-family status, environment, accessibility to care. The evaluation of frailty, allows the development of care plans aimed at the real needs of the patient., Aims: Identify the tools for assessing frailty in the elderly based on information collected by nurses., Methods: Use of the databases Pubmed, CINAHL and COCHRANE, with the mesh terms "frailty, weights and measures, scale". Age limits (65+ years) and language (English and Italian) were set and the references of the selected articles were analyzed. The items of each tool were classified by domain (cognitive, psychological, physical and social). The main characteristics of each instrument were studied, assessing their potential use in nursing care, both of the original scale and of any modified versions., Results: From the 115 selected articles, 13 frailty assessment tools were identified. The tools were classified as one and multidimensional. The one-dimensional instruments are oriented to the physical domain of functioning and biological / physiological state, while multidimensional evaluations are based on the analysis of the interactions of the physical, psychological and social domains of human functioning., Conclusion: There is no standard and internationally agreed on measure for assessing frailty; some measurements are more adequate for screening frailty at the community level, others for a hospital context.

Aim: The purpose of this review is to describe acoustic pollution in neonatal and paediatric intensive care units, sources and effects of noise on patients and health care professions and interventions to reduce it., Method: The literature review was carried out using four main databanks from November 2016 to December 2016 through variously combined keywords and Mesh. 237 papers were detected. Presence of full text and pertinence were selection criteria., Outcome: 43 papers and 2 guidelines were selected. The issue of acoustic pollution was more intensely investigated in neonatal intensive care settings since 2008-2009; research was present in quite numerous countries, although the majority of the studies were carried out in the USA. Most studies show acoustic levels above recommended levels. Many researches attempt to identify the source of noise (monitor, incubators, ventilatory circuits, conversations) and the effects of intense noise like stress, loss of hearing, alterations of vital signs. Interventions to address the issue involve some changes in the staff behaviour through education, drawing the attention of the caregivers to the problem, through modifications of the settings and the use of specific materials to limit noise., Conclusions: A prolonged exposure to noise can cause serious damage to the patients in the short and long term; the contribution of the nursing staff to limit and control acoustic pollution is thus important.