The ABCDE bundle implementation in an intensive care unit: Facilitators and barriers perceived by nurses and doctors.

AIM: To describe the facilitators and barriers perceived by healthcare teams after the implementation of the Awakening, Breathing, Coordination, Delirium monitoring/management and Early mobility bundle in an intensive care unit in Italy. This multicomponent intervention strategy has been associated with lower probabilities of delirium, improved functional outcomes and shorter duration of mechanical ventilation. METHODS: A survey study conducted between June 2015 and May 2016 explored variables related to intensive care unit team members: perceptions of delirium; knowledge of the Awakening, Breathing, Coordination, Delirium monitoring/management and Early mobility bundle; teamwork perception and resource availability. RESULTS: Most of the participants affirmed having reasonable knowledge of delirium, outcomes of delirious episodes, Awakening, Breathing, Coordination, Delirium monitoring/management and Early mobility bundle components and their effectiveness. Low coordination between healthcare professionals was identified as a barrier. Overall, the time elapsing from the beginning of implementation of the bundle determined an increase in levels of awareness and confidence in the application of the bundle protocol and the Confusion Assessment Method Intensive Care Unit scale. CONCLUSION: Issues with the Awakening, Breathing, Coordination, Delirium monitoring/management and Early mobility bundle relating to coordination, management and interdisciplinary ward rounds are critical and should be remedied and monitored. This study could provide the basis for improving bundle implementation strategies and surveying levels of progression in other intensive care units.

Predictors of Adjustment to Living with an Ostomy: Results of a Cross-sectional Study.

OBJECTIVE: To describe predictors of adjustment to living with an ostomy among Italian adults with an enterostomy or a colostomy. METHODS: A multicenter, cross-sectional design was performed, sampling 403 patients with an ostomy in three different outpatient clinics of northern Italy between April 2018 and December 2020. Data were collected by stoma therapists in ambulatory settings using the Italian version of the Ostomy Adjustment Inventory-23 and patient medical records. RESULTS: Acceptance was lower among women, patients who underwent emergency surgery, those with a urostomy, and those with a body mass index of less than or equal to 25 kg/m2. Negative feelings were associated with higher body mass index, colostomies, shorter length of time of living with an ostomy, and emergency ostomy creation. CONCLUSIONS: Being young and having a high level of education are protective against psychosocial problems and help promote acceptance and social engagement. The findings of this study help identify patients who are likely to be more vulnerable and need greater support through specific educational and motivational interventions.

Diaries in intensive care units: An Italian qualitative study.

BACKGROUND: The literature emphasizes the importance of the intensive care unit (ICU) diary to fill the gaps and recover the delusional memories of patients admitted to ICU in order to build the history of their illness. The ICU diary is a measure originally intended to support the severely ill patient, but it would also seem to be useful for family members and carers. According to our analysis of the literature, this study is the first description of the contents of ICU diaries in the Italian context. AIM: The aim of the study was to describe the contents of ICU patients' diaries filled in by their caregivers, in order to explore the experience and significance attributed to the diaries. DESIGN: A qualitative longitudinal narrative investigation was conducted at an ICU during the period from April 2016 to April 2017 with a sample composed of 32 families. METHODS: The participants were caregivers selected through purposive sampling. An ICU nurse explained the study to caregivers and offered the opportunity to participate. RESULTS: The sample included 32 diaries. Through the analysis we identified seven themes: future plans and memories; the people who care for the patient and the context; the love surrounding the patient; the clinical progression of the patient and the passage of time; what happens outside the patient's life; references to the usefulness/non-usefulness of the diary; communication/reflection on the likely death of the patient. CONCLUSIONS: Some themes emerged that have never explored in the literature, and it would be necessary to understand whether the themes that emerged depend on cultural issues. RELEVANCE TO CLINICAL PRACTICE: The diaries could be adapted to the Italian context and this could make the diary a common practice in Italy as well.

Determinants of health-related quality of life: a cross-sectional investigation in physician-managed anticoagulated patients using vitamin K antagonists.

BACKGROUND: Literature has paid little attention in describing the specific contribution of each modifiable and non-modifiable characteristics on health-related quality of life (HRQoL) in physician-managed anticoagulated patients using vitamin K antagonists (VKAs). To describe how patients' treatment-specific knowledge, health literacy, treatment beliefs, clinical, and socio-demographic characteristics influence HRQoL in Italian physician-managed anticoagulated patients using VKAs. METHODS: Cross-sectional multicentre study with a consecutive sampling strategy, enrolling 164 long-term anticoagulated patients. Clinical and socio-demographic characteristics were collected from electronic medical records. Valid and reliable questionnaires were used to collect patients' treatment-specific knowledge, health literacy, beliefs about VKAs, physical and health perceptions. RESULTS: Obtaining and understanding health information (i.e., communicative health literacy) positively predicts both adequate mental (ORadjusted = 10.9; 95%CI = 1.99-19.10) and physical (ORadjusted = 11.54; 95%CI = 1.99-34.45) health perceptions. Conversely, the ability to perform proper health decision making (i.e., critical health literacy) was associated with lower rates of adequate mental health perception (ORadjusted = 0.13; 95%CI = 0.03-0.63). Further, age negatively predicted physical health perception (ORadjusted = 0.87; 95%CI = 0.81-0.93). CONCLUSIONS: Health literacy plays an interesting role in predicting HRQoL. The relationship between critical health literacy and mental health perception could be influenced by some psychological variables, such as distress and frustration, which could be present in patients with higher levels of critical health literacy, as they could be more inclined for self-monitoring. For this reason, future research are needed to identify the most suitable patients' profile for each OAC-management model, by longitudinally describing the predictive performance of each modifiable and non-modifiable determinant of HRQoL.

Violence versus gratitude: Courses of recognition in caring situations.

Pandemic infection by COVID-19 could be changing the public image of the nursing profession in Italy. Recently, as in any western country, we were being registered with an increase in the number of violence against healthcare professionals. Nevertheless, due to pandemic in the social media, the nursing profession is remembered for competence, determination, courage, and humanity, and it is continually remercied by people, politicians, and journalists. In this paper, we will conduct a phenomenological argument that proposes both phenomena can be explained by Paul Ricoeur's courses of recognition. In cases of violence, patients and their family members reacting because they feel betrayed for a real or alleged injustice-primarily not to be listened to by health professionals. Nurses and other professionals are often unable to take the right grade of involvement for understanding patient's needs. On the other hand, during COVID-19 pandemic, patients and family members perceive the extraordinary daily work of caring, and they react thanking. The principle of the gift is implicated in both cases: the crisis of gift received or donated can be explaining violence; gratitude and thanks can be explaining by gratuitousness of care.

Life with a urostomy: A phenomenological study.

AIM: To explore the experiences of self-care of patients with urostomy and to identify the influencing factors of self-care. BACKGROUND: The creation of a urostomy results in the loss of an important bodily function and an alteration of the body image and causes physical, psychological, and social changes in the lifestyle through the adjustment and management of the new condition. In literature, there are few studies that analyze the lifestyle of people with urostomy. METHODS: In this qualitative design, an interpretative phenomenological analysis was used. Eleven people living with urostomies took part in semi-structured interviews consisting of open-ended questions about their self-care experience. Data were collected between March and September 2016. RESULTS: Six themes and twelve subthemes emerged from the data analysis. The themes were: Surgery impact, body image, daily and social-life activities, stoma and sexuality, managing stoma education, family and friends' support. CONCLUSIONS: This study highlights the impact a stoma has on people's lives. This impact should be absorbed with personalized education before the surgery with the eventual need of a continuous and planned educational course respecting the patients' needs. This study shows that a continuous and planned educational plan is crucial for patients living with urostomies. Therefore, nurses should provide patients an adequate support and a personalized education program to cope with ostomy.

In search of salience: phenomenological analysis of moral distress.

The nurse's moral competences in the management of situations which present ethical implications are less investigated in literature than other ethical problems related to clinical nursing. Phenomenology affirms that emotional warmth is the first fundamental attitude as well as the premise of any ethical reasoning. Nevertheless, it is not clear how and when this could be confirmed in situations where the effect of emotions on the nurse's decisional process is undiscovered. To explore the processes through which situations of moral distress are determined for the nurses involved in nursing situations, a phenomenological-hermeneutic analysis of a nurse's report of an experience lived by her as a moral distress situation has been conducted. Nursing emerges as a relational doctrine that requires the nurse to have different degrees of personal involvement, the integration between logical-formal thinking and narrative thinking, the perception of the salience of the given situation also through the interpretation and management of one's own emotions, and the capacity to undergo a process of co-construction of shared meanings that the others might consider adequate for the resolution of her problem. Moral action requires the nurse to think constantly about the important things that are happening in a nursing situation. Commitment towards practical situations is directed to training in order to promote the nurse's reflective ability towards finding salience in nursing situations, but it is also directed to the management of nursing assistance and human resources for the initial impact that this reflexive ability has on patients' and their families' lives and on their need to be heard and assisted. The only case analysed does not allow generalizations. Further research is needed to investigate how feelings generated by emotional acceptance influence ethical decision making and moral distress in nursing situations.

[New educational approaches to the patient. A scoping review of systematic reviews.] / Gamification: un nuovo approccio educativo al paziente. Una scoping review di revisioni sistematiche.

INTRODUCTION: New educational approaches are emerging to assist healthcare professionals in better personalizing patient's educational pathways. Specifically, "gamification" - the incorporation of game elements into non-game contexts - appears to be a novel and affordable approach. This scoping review aims to explore and map the literature that evaluates the efficacy of gamification in healthcare contexts. METHODS: A scoping review of reviews was conducted in MEDLINE, CINAHL, and PsycINFO using the JBI Manual for Evidence Synthesis guidelines and the PRISMA ScR checklist. RESULTS: A total of four systematic reviews and four meta-analyses were included. It appears that gamification, when used in conjunction with other conventional educational tools, improves physical activity, facilitates better self-management of type 2 diabetes, improves cognitive functions, and improves the quality of life, particularly among specific groups like the elderly. DISCUSSIONS: Gamification is an innovative educational approach that could be useful in patient's educational pathways. However, it seems that gamification is effective only in particular subgroups, and therefore the generalization of the results should also be assessed with caution due to the high risk of bias in the included studies and the small sample sizes considered. CONCLUSION: More randomized controlled trials and meta-analysis studies should be conducted to better understand the role and efficacy of gamification in patient education.

Non-Pharmacological Management of Urge Urinary Incontinence in Women between 40 and 65 Years Old: A Systematic Review.

BACKGROUND: Urinary incontinence (UI) has been identified as a World Health Organization health priority. In particular, urge UI (UUI) refers to urine leakage associated with a sudden and compelling desire to void urine. It affects quality of life more than other kinds of UI, but it is not always treated adequately. For these reasons, this study aimed to evaluate the effectiveness of conservative treatment practices to counteract UUI in women aged 40-65 years old. METHODS: This systematic review was conducted following the Joanna Briggs Institute (JBI) methodology. According to the protocol registered in PROSPERO, a systematic search was carried out in the CINAHL, Embase, PubMed, PsycInfo, Scopus and Web of Science databases up to October 2022, to find primary studies meeting the inclusion criteria. RESULTS: Fourteen studies were included. The scientific literature reported different strategies dealing with the problem of UUI, some purely physical, others physical and psycho-educational and others exclusively psychological. CONCLUSION: Conservative treatments are useful to aid the reduction in UUI episodes in middle-aged women. However, none of them can be considered more effective than others due to the impossibility of conducting meta-analytical analyses. Further studies comparing the effectiveness of conservative treatments for UUI are needed.

[Intercultural nursing: analysis of changes in the perception of relational problems with foreign patients]. / Assistenza infermieristica interculturale: analisi delle variazioni nella percezione delle problematiche relazionali con i pazienti stranieri.

Today's society is highly impacted by immigration, as well as healthcare system. It is becoming increasingly common and frequent to establish relationships with patients with different cultural backgrounds. The aim of this study is analyzing Italian nurses' perception of the relational dynamics with foreign patients, to determine its evolution, and to identify the variables which can affect the quality of care. The study is both qualitative and quantitative with descriptive aim, using a questionnaire that assesses the theoretical-practical level of preparation, both perceptive and effective, of nurses when assisting foreign patients. To evaluate the emotional and experiential impact of the relationship with foreign patients, the difficulties encountered while establishing such relationship, and the resolution strategies - both effective and potential. The sample, composed of 101 Italian nurses employed at SanRaffaele Hospital in 6 specific Operational Units, resulted in a total of 91 returned questionnaires during the period May-June 2011. The data was analyzed through statistical instruments and compared to the results of a similar study done in 2004. The experience of intercultural nursing is seen by the sample as interesting and rewarding. The vast majority of nurses have positive responses. The more frequent issues are those connected with communication with foreign patients, and those connected with the increase workload due the presence of foreign patients. Nurses responded to difficulties more with human skills than with specific abilities, and tend to delegate the problem to the Cultural Mediation service. This new issue has a very high impact on nurses. The emerged difficulties have not decreased over time, this due to the lack of a proper policy within health care facilities in recent years, with the exception of a little improvement on the academic education. However the current academic education does not provide solutions useful in the everyday routing. This study, despite the small sample and a rather narrow degree of analysis, likes to draw attention on the topic both of nurses and on health care facilities managerial team in order to develop a effective startegie to deal with the emerged issues.

Gamification as an Educational Approach for Oncological Patients: A Systematic Scoping Review.

BACKGROUND: Education plays a pivotal role in the care of oncological patients, reducing health costs, hospital readmission, and disease relapses. Education can be supportive in achieving multiple outcomes, improving symptom control and quality of life. A new approach is emerging in patient education: gamification. Gamification was defined as the "use of game elements in non-game contexts", including the application of games in serious contexts. The aim of this review is to explore the use of gamification in the oncology setting. METHODS: A systematic scoping review was conducted in the MEDLINE, CINAHL, PsychINFO, Embase, Scopus, and Cochrane Library databases using the JBI guidelines. RESULTS: The 13 included reports were critically appraised by two reviewers independently. It seems that gamification could be effective both in prevention and cancer treatments. Gamification also seems to improve chemotherapy-induced nausea and vomiting management, quality of life, and reduced anxiety levels in different cancer groups. Moreover, gamification seems effective in improving self-care in cancer patients, regardless of gender, age, and ethnicity. CONCLUSIONS: Gamification improves patient engagement and biopsychosocial outcomes and could represent a valid approach to cancer patient education; however, it is not a substitute for healthcare professionals, who remain the leaders in the education process.

Self-care and type 1 diabetes mellitus: systematic review of sex-related differences.

INTRODUCTION: Self-care is associated with clinical outcomes of adults with T1DM. Some evidence highlighted significant sex-related differences in self-care behaviors in this population. However, the literature on this topic has not been synthesized before. This study aimed to summarize, critically review, and interpret evidence regarding sex-related differences in adults' self-care behaviors with type 1 diabetes mellitus (T1DM). EVIDENCE ACQUISITION: A systematic search of articles in the following databases was performed: PubMed, Scopus, Embase, and CINAHL. Articles published from 2009 to 2019 were reviewed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and flowchart were used to support the systematic review and study reporting. Two reviewers independently screened and extracted data from the included articles. EVIDENCE SYNTHESIS: From the 596 identified records, only 15 articles were included because pertinent to this review. Both females and males with T1DM must improve their ability to respond to signs and symptoms when they occur. Females are more likely to perform adequate blood glucose monitoring and adequate diet than males. In contrast, males are more likely to show more adequate levels of physical activity. CONCLUSIONS: Clinicians should pay greater attention to supporting females with T1DM to enhance their behaviors for maintaining an adequate health status and glycemic control. Likely, greater attention is required to sustain males to monitor changes in their signs and symptoms. Self-care management should be improved in both sexes.

[The FRASNET study: identification of clinical and social factors of renal failure in an elderly population].

Background. Chronic renal failure is an epidemic in elderly patients. Older population have an increased prevalence of frailty and sarcopenia, associated with a wide range of adverse health outcomes such as falls, hospitalization, disability. Aim. Describe the sociodemographic and clinical variables of an elderly Lombard population and identify predictors of renal insufficiency. Materials and methods. Cross-sectional observational study conducted in hospitals, in recreational centers for the elderly, in the Universities of the Third Age of the provinces of Milan and Monza-Brianza conducted through a convenience sampling of 1250 subjects over the age of 65. Results. The study identified living alone, annual individual income < € 10,000, polypharmacy, sarcopenia and frailty as predictors of chronic kidney failure. The sample has a mean eGFR of 71.74 mL/min/1.73m2 (SD ± 16.56). Older people living alone are more likely to develop CRI (P = 0.031, confidence interval, CI [1.031-1.905]) as well as having an income < € 10,000 (P = 0.002, CI [0.392-0.923]). Taking more than 11 drugs a day increases the probability of having chronic renal failure by 16 times (P = 0.012, CI [1.155-3.16]). Sarcopenia and frailty increase the likelihood of having chronic renal failure (CRI) (P = 0.001, CI [1.198-2.095]). Conclusions. Identifying predictors of chronic kidney failure is a key step in introducing preventive measures and providing better care to the elderly population.

Risk factors and pooled incidence of intestinal stoma complications: systematic review and Meta-analysis.

OBJECTIVE: The present systematic review aimed to identify, critically assess and summarize which risk factors might determine the onset of ostomy complications, describing a pooled incidence and stratified incidences by each identified risk factor. METHODS: A systematic literature review with a meta-analysis of observational studies was performed by following the PRISMA statement and flow chart. The quality assessment of the included articles was performed through the Newcastle-Ottawa Scale (NOS). RESULTS: Sixteen articles published between 1990 and 2018 focused on the risk factors related to intestinal stomal complications, and the performed analysis led to identifying influenceable and non-influenceable risk factors. The median of the NOS evaluation was 6 (IQR = 5.75-6). Among 10,520 included patients, the pooled incidence of stomal complications was 35%, ranging from 9% to 63%, regardless of the nature of the complications. Analysis of the sub-groups highlighted obesity and ostomy surgery performed via laparoscopy or emergency conditions have significant incidences, respectively, of 66% and 68%. CONCLUSIONS: The pooled incidence of stomal complications requires greater attention for its relevant epidemiology. From the clinical point of view, patients with obesity and chronic conditions require more attention to prevent complications, possibly employing accurate educational interventions to enhance proper stoma management.

One-week longitudinal daily description of moral distress, coping, and general health in healthcare workers during the first wave of the COVID-19 outbreak in Italy: A quantitative diary study.

Background and aim of the work .The fluctuation from day to day within a working week of moral distress, coping, and general health of frontline healthcare workers (HCWs) in facing the challenges of the COVID-19 pandemic has been poorly studied. This study described the weekly fluctuation from day to day of moral distress, coping, and general health in frontline HCWs who worked during the first epidemic wave (May-June 2020) of the COVID-19 pandemic in Italy. METHODS: This study has an intensive longitudinal design, and a convenience sampling procedure was employed to enroll physicians, nurses, allied health professions, and healthcare assistants. Data collection was performed using diary encompassed four sections: a socio-demographic form (required only at the baseline data collection) and three scales to assess moral distress, coping, and general health. RESULTS: Results confirmed poor perceived health and mild moral distress in frontline HCWs, especially in HCWs with offspring, during the initial phases of the COVID-19 pandemic and the stability of their daily perception over a working week regarding moral distress, general health, and avoidant coping strategy, while approach coping strategy reported a slight fluctuation over time. CONCLUSIONS: Accordingly, on the one hand, these results confirm that outcomes regarding mental health and moral distress are pretty stable and provide insights, on the other hand, regarding the possible organizational interventions to support approach coping strategy as it seems more susceptible to variation over time.

[Times and spaces of care: home, hospital]. / Tempi e luoghi di cura: la casa, l'ospedale.

In this article times and spaces of care offer the opportunity to reflect on nursing moving from an hermeneutic perspective. Our focus has been placed on what always undergo the tie that exists between every doing and the context in which it happens, rather that on the differences of practices in the various places and times of nursing activities--home care, hospital, the outpatients' department, and so on. According to the hermeneutic perspective, the outcome of nursing relation is not exclusively the re-solution of the nursing problem of the patient, but also--together with all of that--the possible experience of identity new construction (and re-birth) that every experience of disease represents.