Transgender people's experiences of hospitalization: A qualitative metasynthesis.

AIM: To identify, synthesize, and interpret the scientific literature on the experience, perspectives, and feelings of transgender people during hospitalization. DESIGN: A qualitative metasynthesis. DATA SOURCES: PubMed, CINAHL and PSYCHINFO were consulted in March 2024. METHODS: A literature review was conducted following Sandelowski and Barroso's four-step metasynthesis methodology. The article selection process was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies were selected based on the objectives of the review, pre-established criteria and quality appraisal. A thematic analysis was conducted after extracting relevant quotations and a metasynthesis table was created to compare quotations and analyse overarching themes. RESULTS: Twenty-two studies were included after screening titles and abstracts, full texts, and references. Three themes were identified: 'Perception of self-identity'; 'Misgendering' and 'Lack of staff training and awareness'. CONCLUSION: Transgender people's healthcare experiences during hospitalization were mainly negative, delayed or uncomfortable. Misgendering and lack of awareness of transgender issues among healthcare workers generated anxiety and frustration. Key aspects of care for transgender people need to be included in all training programs for health professionals. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: There is a need to increase education and awareness among healthcare professionals towards transgender people's needs during hospitalization ensure high quality care. IMPACT: This study addressed the negative experience, perspectives and feelings of transgender people during hospitalization. Misgendering and unawareness of transgender peoples' issues create anxiety and frustration among nurses. Elements to improve care for transgender people need to be integrated into all nursing curricula and training programs. REPORTING METHOD: The authors adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and the Critical Appraisal Skills Programme (CASP). PATIENT OR PUBLIC CONTRIBUTION: Since this was a metasynthesis, no patient or public contribution was required.

Being a nurse between research and clinic: What challenges and opportunities for a PhD-prepared nurse? Overview from an Italian paediatric hospital.

AIM: To report a reflection on the role, challenges and opportunities for nurses with advanced education in research outside the academic field. DESIGN: A discursive paper. DATA SOURCES: We reported the case of an Italian paediatric research hospital where PhD-prepared nurses started to apply their knowledge and competencies in different fields, both in clinical and organizational settings. From this experience, an overview of the possible barriers and challenges that PhD-prepared nurses may face up within the hospital setting. DISCUSSION: The application of PhD-prepared nurses in hospital settings could be an opportunity to advance high standards of quality of care in managerial and clinical areas and to create networks between highly specialized professional figures and different clinical-care realities. CONCLUSION: More research is needed to explore how to apply the advanced competencies of PhD-prepared nurses within healthcare organizations to provide high-quality and safe care and services. This paper can provide insights for a reflection on applying and developing PhD-prepared nurses' skills and competencies within the hospital setting in clinical, research and managerial areas. This can enhance the effective application of highly competent nursing professional figures. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution, due to study design.

Informal carers' experiences with their children's care during hospitalization in Italy: Child HCAHPS results from RN4CAST@IT-Ped cross-sectional study.

PURPOSE: To examine informal carers' experiences during their child's hospitalization and evaluate the associations with care received and care context. DESIGN AND METHODS: What is described in this article is only a part of the larger study, RN4CAST@IT-Ped, a multicenter cross-sectional study, with multi-level data collection through convenience sampling, the Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was used to collect data from informal carers of pediatric patients, applying the "top box" approach. RESULTS: Nine hospitals, 1472 nurses, and 635 children's parents were involved. A correlation was found between patient safety and satisfaction outcomes and nursing staff characteristics. Adequate workloads for nurses improved carers' assessment of their experience in the hospital. CONCLUSION: Adequate staffing management could significantly improve informal carers' satisfaction with the care provided to their children during hospitalization. PRACTICE IMPLICATIONS: Children's informal carers greatly value the care they receive in pediatric hospitals. Adequate workloads for nurses improve carers' overall evaluation of the care their children receive during hospitalization. Nursing management should consider improving these aspects to ensure high-quality care in children's hospitals.

A qualitative exploration of undergraduate nursing students' experience of emotional safety for learning during their clinical practice.

BACKGROUND: During their clinical practice, nursing students learn to manage patient safety through their experiences, emotions, and interpersonal relationships. OBJECTIVES: To explore contextual and mechanistic factors that facilitate a sense of emotional safety for learning in nursing students, particularly regarding patient safety events experienced during their placements. DESIGN: A descriptive qualitative study using narratives and thematic analysis. SETTINGS: A university in Northern Italy. PARTICIPANTS: Undergraduate nursing students recruited through purposive sampling. METHODS: Twenty cases relevant to the present study were selected from the "Sharing LearnIng from Practice for Patient Safety" (SLIPPS) project database containing 100 narratives collected using the patient safety learning Event Recording Tool. The data were analysed using thematic analysis according to Braun & Clarke's methodology. The themes that emerged from the thematic analysis were rearranged in Context-Mechanism-Outcomes. RESULTS: Students identified clinical practice experiences as important occasions for their personal and professional development. Emotional safety and tutoring were the elements that effectively "govern" the students' learning and development process. CONCLUSIONS: Emotional safety is key for nursing students because it enables them to constructively overcome any relational and emotional tensions that may develop during their clinical placements.

How do undergraduate nursing students learn about the fundamentals of care? A pilot cross-sectional attitudinal study.

Introduction: Despite the growing importance of nursing fundamentals of care, nurses often overlook these aspects of care. In this study, we explored why this happens precisely where nursing education is initially provided. In fact, little is known about how undergraduate nursing students perceive the teaching of fundamentals of care and how they value them. Methods: This pilot cross-sectional study used a questionnaire adapted and validated in Italian to assess the perceptions of first, second, and third-year undergraduate nursing students (n=150) in an Italian university about the teaching of fundamentals of care during theoretical lessons and clinical practice. Results: In the first section of the tool, on general fundamentals of care (nutrition, hygiene, mobility, rest and sleep, the expression of sexuality, safety, etc), students reported high levels of agreement for all items: range between 61.2% (95% CI: 57.1-65.3) and 100%.In the section on nutrition, divided into nutrition, oral intake of fluids, and malnutrition high percentages of agreement from 53.1% (95% CI: 46.0-60.2) to 91.8% (95% CI: 87.9-95.7%) were obtained, but for questions regarding 'learning how to document food and fluid intake', first-year students reported low levels of agreement.With regard to the 'Communication Section', the item about 'learning how to inform minor patients' presented low percentages of agreement throughout the three-year programOf the first-year students, between 71.4% (95% CI: 64.9-77.9) and 77.6% (95% CI: 71.6-83.6) declared they had not received instructions about this. Conclusions: Understanding how nursing students perceive the importance of learning of fundamentals of care during their curriculum and how their multidimensional nature is highlighted by teachers and clinical supervisors, will enable educators to address the gaps in the way they taught and prioritized within the curriculum.

Exploring Care Left Undone in Pediatric Nursing.

OBJECTIVES: This study aimed to investigate the association between nursing care left undone in pediatrics and factors related to nursing staff characteristics and work environment. METHODS: The data of the present study were extracted from our RN4CAST@IT-Ped database, a cross-sectional observational study, which included 13 hospitals belonging to the Italian Association of Paediatric Hospitals. Through convenience sampling, nurses and pediatric nurses providing direct care in routine pediatric wards were enrolled in the study. Data aggregated by clinical care area were analyzed, through descriptive and inferential statistics methods using IBM SPSS 22.0 software. RESULTS: We collected data from 399 pediatric nurses working in surgical wards, 1208 in medical wards, and 631 in critical care units. Some of the investigated factors have shown an association with the risk of omitting essential nursing activities, like health care judged of poor quality, patient safety judged as poor, and nurses' intention-to-leave the job. For every nursing activity under investigation, we found some significant statistical associations. CONCLUSIONS: Our results are consistent with the international literature showing that nurses miss some activities more frequently. Understanding the associations underpinning care left undone could be a starting point for the implementation of patient-centered care and the improvement of the quality and safety of care in pediatric settings, as well as the work environment.

Learning From Student Experience: Development of an International Multimodal Patient Safety Education Package.

BACKGROUND: Patient safety is a global concern. Learning to provide safe, high-quality care is core to nursing education. PROBLEM: Students are exposed to diverse clinical practices, and experiences may vary between placements and across countries. Student experience is seldom used as an educational resource. APPROACH: An international, European Union-funded project, Sharing Learning from Practice for Patient Safety (SLIPPs), aimed to develop an innovative online educational package to assist patient safety learning. Based on student reported data and educational theory, multiple elements were iteratively developed by a multicountry, multidisciplinary group. OUTCOMES: The educational package is freely available on the SLIPPs Web site. Materials include a student reporting and reflection tool, virtual seminars, student reports data set, pedagogical game, high-fidelity simulation scenarios, scenario development and use guidelines, debriefing session model, and videos of simulations already performed. CONCLUSIONS: E-learning enables removal of physical barriers, allowing educators, professionals, and students from all over the world to collaborate, interact, and learn from each other.

[COVID 19: Nursing Leadership and innovations on the field to face the pandemic]. / COVID 19: Leadership infermieristica e innovazioni sul campo per affrontare la pandemia.

INTRODUCTION: In the Italian and European literature there are still few studies describing the impact of the COVID-19 pandemic on the organization of nursing care in hospitals, on the actions taken by nursing leaders to contain it, and on the outcomes of these interventions. AIM: To describe nursing leaders' experiences with reorganizing healthcare pathways, through management data and personal accounts. METHODS: A retrospective quali-quantitative observational study was conducted at the Mauriziano Hospital in Turin, with 484 beds and over 1,700 workers. Quantitative data were analyzed through descriptive statistical indices and integrated with qualitative data collected through semi-structured telephone interviews. The analysis of the quantitative and qualitative data provided an objective and experiential representation of the implemented interventions. RESULTS: We described the impact of interventions introduced by the nursing leadership during the pandemic on hospital services. In particular, the reorganization of the emergency department and of the prevention and psychological support services for the hospital's health workers. In addition, specific initiatives to support the discharge of COVID-19 positive patients, and to support and manage contacts with family members both during the hospitalization of their loved ones and following death are described. DISCUSSION AND CONCLUSION: This study contributes to the discussion on some crucial issues: the increasingly clear relationship between adequate staffing and safety of patients and professionals, the importance of a good working environment and a solid leadership, the importance of continuing education for professionals and adequate skill mixes; all highlighted by the pandemic.

Impact of COVID-19 on the parent-nurse relationship in NICU: a phenomenological study of nurses lived experience.

BACKGROUND: During the Covid-19 pandemic, the family presence in hospital was reduced, or excluded, to limit the contagiousness, but that could impact negatively on the quality of communication, family education, and the best development outcome for the newborn. AIM: This study aims to explore and describe if and how the pandemic influenced the relationship and care provided to the family in NICU (Neonatal Intensive Care Unit). METHODS: This is a descriptive qualitative study. The data were collected through a questionnaire and semi-structured interviews with 7 NICU nurses from different Italian Regions in the period June-August 2021, by snowball sampling. Thematic analysis by Braun and Clarke method was conducted. RESULTS: The data show an overview of the hospitals' choices about parents' access to NICUs, from total to partial closure. The thematic analysis revealed how some nurses have boycotted corporate choices in favor of child's and family's well-being, while others have consolidated the idea that NICUs must remain closed. Moreover, nurses report that they standardized their practice rather than individualize care. CONCLUSIONS: The Covid-19 limitations created many inconveniences and negatively impacted the quality of the care provided, as the safety of the discharge of these fragile patients. NURSING IMPLICATIONS: It is important to evaluate how this situation impacts long-term patient outcomes, but also how some organizational decisions influence the well-being of professionals, who facing difficult choices, during a health emergency. This study aims to give leadership data to understand the value that the family has in the care process in NICU and that parents cannot be considered "visitors".

Italian nurses' COVID-19 experiences from mass media interviews: a qualitative study.

Introduction: The COVID-19 pandemic is heavily hitting healthcare systems around the world, and nurses are battling in the front line. Previous studies have reported nurses' responses to catastrophic situations, but also interviews released by Italian nurses to the main mass media channels could bear important messages for policy makers and stakeholders. This study describes Italian front-line nurses' experiences during the COVID-19 pandemic through television interviews. Methods: This is a descriptive qualitative study. Data were collected through purposive sampling from Italian front-line nurses' interviews during the COVID-19 pandemic. Publicly available interviews between 7th and 29th March 2020 were collected from the websites of national and regional television stations. Thematic content analysis was used to describe, summarize, and classify data into macro themes. The study is compliant with Standards for Reporting Qualitative Research. Results: A total of 21 television interviews were collected from front-line clinical nurses, nursing managers, nursing trade union representatives and representatives of the Nursing Regulator. Thematic analysis yielded four macro-themes: psycho-social effects of the COVID-19 pandemic on health professionals; altered patient relationships; personal safety; recognition and promotion of the profession. Conclusions: The COVID-19 pandemic has exacerbated some problems already present, such as the shortage of nurses, but has also turned the spotlight on the nursing profession. Highly involved and affected by the pandemic, nurses have become better known by the public and often also protagonists of public discussions. It is important that nurses' value as allies of the public emerges stronger from this dramatic situation.

Lessons from Italian front-line nurses' experiences during the COVID-19 pandemic: A qualitative descriptive study.

AIM: To explore nursing management issues within COVID-19 narratives of Italian front-line nurses. BACKGROUND: The COVID-19 pandemic has dramatically affected health systems and professionals worldwide. Italian nurses have key messages for nursing leaders following their acute experiences in the pandemic. METHOD: A descriptive qualitative study with thematic analysis. RESULTS: Twenty-three testimonies from clinical nurses were analysed. Six macrothemes were identified as follows: organisational and logistic change; leadership models adopted to manage the emergency; changes in nursing approaches; personal protective equipment issues; physical and psychological impact on nurses; and team value/spirit. CONCLUSIONS: Our testimonies highlighted the huge impact of COVID-19 on the Italian nursing workforce, especially in terms of the high risks associated with caring for COVID-19 patients, exacerbated by the shortage of appropriate personal protective equipment. Nurses had to care for their colleagues and live separately from their families to avoid infecting them, revealing nurses' resilience and the important role of effective and sensitive management. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers must be prepared for the impact of pandemics on staff and need to ensure availability and replacement of quality personal protective equipment, rehearse strategies for communicating with patients while wearing personal protective equipment and establish protocols for communicating with relatives.

Caring for patients at home after acute exacerbation of chronic obstructive pulmonary disease: A phenomenological study of family caregivers' experiences.

AIMS AND OBJECTIVES: To understand the experiences and support needs of informal caregivers of patients with chronic obstructive pulmonary diseases chronic obstructive pulmonary disease who return home following an acute exacerbation. BACKGROUND: The presence of an informal caregiver is important to provide practical and emotional support after an episode of acute exacerbation of chronic obstructive pulmonary disease. However, caregiving in such circumstances can be challenging and stressful. DESIGN: Phenomenology. METHODS: This is a phenomenological study based on semi-structured interviews with sixteen primary caregivers of chronic obstructive pulmonary disease patients. Interview data were analysed using Colaizzi's descriptive analysis framework, to identify significant themes and sub-themes. Data were collected between April-December 2017 in a Teaching Hospital in Italy. The study was designed and reported following the COREQ guidelines and checklist. RESULTS: Analysis elicited five themes embracing various aspects of the caregivers' lived experiences: (a) a home disrupted, (b) living with constant vigilance and anxiety, (c) feeling the need to escape (d) self-justifications for caregiving role/duty, and (e) feeling abandoned by professionals. CONCLUSIONS: Our results show that carers experience a range of difficulties when caring for their relative at home with chronic obstructive pulmonary disease. Some of these are linked to the physical disruption of their home but many are linked to feelings of inability to cope and the psycho-social impact of the caring role. The study also shows how participants felt unsupported by professionals. Focused support for carers is required to enable them to meet these challenges. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals should be trained to provide technical and psychological support to caregivers especially during the phases of disease that may involve episodes of exacerbation. Home care and continuity of care can work if there is excellent communication and collaboration between healthcare professionals and caregivers. Developing appropriate support for family caregivers is essential to address the problems they can face.

Are data on missed nursing care useful for nursing leaders? The RN4CAST@IT cross-sectional study.

AIM: To describe nurses' reported missed nursing care activities among hospitalized adult patients medical and surgical wards and explore gaps in service provision. BACKGROUND: In 2015, Italy replicated the RN4CAST study, which heralded the exposition of missed care as an international phenomenon. In Italy, nurse-patient workload is high, with high levels of burnout and dissatisfaction reported, all factors associated with missed care. METHODS: A cross-sectional study (n = 3,590) was conducted using the 13-item online Task Left Undone Tool aimed at collecting data on missed nursing care. RESULTS: The frequency of omission of activities ranged between 7% and 50%. There were significant differences between morning, afternoon and night shifts and the various clinical settings. Oral care was the most frequently missed care activity. CONCLUSIONS: This study takes step forward in identifying and reducing missed care on medical and surgical wards, both in Italy and also internationally, which needs to take into account the specific organisational characteristics of each setting. IMPLICATIONS FOR NURSING MANAGEMENT: Although more essential activities are missed less frequently, much is known about the relational deficits such as information giving, education, communication and discharge advice, which managers ought to spearhead through local initiatives to improve these practices.

Predicting needlestick and sharps injuries in nursing students: Development of the SNNIP scale.

Aim: To develop an instrument to investigate knowledge and predictive factors of needlestick and sharps injuries (NSIs) in nursing students during clinical placements. Design: Instrument development and cross-sectional study for psychometric testing. Methods: A self-administered instrument including demographic data, injury epidemiology and predictive factors of NSIs was developed between October 2018-January 2019. Content validity was assessed by a panel of experts. The instrument's factor structure and discriminant validity were explored using principal components analysis. The STROBE guidelines were followed. Results: Evidence of content validity was found (S-CVI 0.75; I-CVI 0.50-1.00). A three-factor structure was shown by exploratory factor analysis. Of the 238 participants, 39% had been injured at least once, of which 67.3% in the second year. Higher perceptions of "personal exposure" (4.06, SD 3.78) were reported by third-year students. Higher scores for "perceived benefits" of preventive behaviours (13.6, SD 1.46) were reported by second-year students.

Dermatological diseases, sexuality and intimate relationships: A qualitative meta-synthesis.

AIMS AND OBJECTIVES: To conduct a systematic review and meta-synthesis of findings from qualitative research about sexuality and intimate relationship among patients with dermatological diseases. BACKGROUND: Over the last few decades, there has been an increase in clinical research investigating aspects related to sex and sexuality in patients living with dermatological diseases. In fact, studies recognise a negative impact on various aspects of intimacy, such as sexual function, self-esteem and romantic relationships. The body of qualitative literature about sexuality in the context of dermatological diseases is emerging but consists mainly of small studies that would benefit from aggregation, synthesis and interpretation to highlight and summarise the overarching dimensions to this clinical issue. DESIGN: A systematic review and meta-synthesis of qualitative studies. METHODS: BioMed Central, Cochrane Library, MEDLINE, CINAHL, PsycINFO, PsycARTICLES, ERIC, Scopus, and Web of Science were searched between June-November 2017 with no publication date limits. Screening and selection of studies was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). After retrieval, the qualitative data were subject to meta-synthesis to identify overarching themes. RESULTS: Ten qualitative studies were found. We identified four themes: (a) Embarrassment and shame; (b) Impaired sense of attractiveness and sexual avoidance; (c) Relationship issues; and (d) Lack of professional support. The patients in these studies adopted negative coping styles, such as avoidance and hiding their bodies. CONCLUSION: When assessing and evaluating patient care in dermatology, it is important that sexuality and the impact the disease could have on relationships is included. RELEVANCE TO CLINICAL PRACTICE: An important part of nursing care is ensuring that patients are helped to develop positive coping strategies rather than negative ones. Patients with dermatological conditions also need advice and treatment to address any physically related sexual problems. Nurses need to be the initiators of these sensitive conversations to put patients at ease and work together to implement positive measures to reduce the sexuality-related issues patients face.

A cross-sectional multisite exploration of Italian paediatric nurses' reported burnout and its relationship to perceptions of clinical safety and adverse events using the RN4CAST@IT-Ped.

AIM: To explore Italian paediatric nurses' reported burnout and its relationship to their perceptions of safety and adverse events. DESIGN: A cross-sectional study using the RN4CAST@IT-Ped database with a web-based survey design. METHODS: The RN4CAST@IT-Ped questionnaire was used to collect data in 2017. This comprised three main components: three dimensions (22 items) of the Maslach Burnout Inventory including emotional exhaustion, depersonalization and personal accomplishment. Participants also scored an overall grade of patient safety and estimated the occurrence of adverse clinical events. RESULTS: Nurses (N = 2,243) reported high levels of burnout. Most rated clinical safety as high. The risk of adverse events ranged from 1.3-12.4%. The degree of burnout appeared to influence the perception of safety and adverse events. CONCLUSION: The association between nurses' burnout and perceptions of higher rates of adverse events and reduced safety in clinical practice is an important finding. However, it is unclear whether this was influenced by a negative state of mind, and whether reduced safety and increased adverse events negatively influenced nurses' well-being, thus leading to burnout. Regardless, the association between nurses' burnout and these quality concepts needs further exploration to examine the effect, if any, on burnout and safety, and identify supportive mechanisms for nurses. IMPACT: The association between reported burnout and perception of safety and risk of adverse events in Italian paediatric nurses has been reported for the first time. Nurses reporting burnout are at greater risk of intensely negative perceptions of clinical safety and adverse events. This is an important finding as perceptions can influence practice and behaviours. Quality measures in children's clinical environments need to go beyond obvious indicators to examine nurses' well-being as this also influences quality and safety.

Dignity, privacy, respect and choice-A scoping review of measurement of these concepts within acute healthcare practice.

AIMS AND OBJECTIVES: To synthesise and review literature related to instruments that measure psychosocial aspects of fundamental care in acute hospital care settings. BACKGROUND: Psychosocial aspects of care often receive less priority in terms of care provision in acute care environments. At the same time, if these elements are overlooked, there may be consequences. Despite the availability of many instruments designed to measure specific aspects of care, these concepts are often not studied within the broader context of fundamentals of care, but rather coexist as isolated explorations of specific subelements. DESIGN: A scoping review was conducted, based on Arksey & O'Malley's (2005) methodological framework and following the PRISMA checklist. METHODS: Using the five recommended steps-identifying the research question; identifying relevant studies; study selection; charting the data; and summarising and reporting the results-three databases were searched: MEDLINE/PubMed, CINAHL and EMBASE, in February 2019. RESULTS: Following independent screening by two of the authors, 48 papers were included. From these 48 papers, 33 instruments were identified. Only five of these tools thoroughly assessed psychosocial aspects elements of care (dignity, respect, privacy and patients' choice) through dedicated items. CONCLUSIONS: This review provides nurses with a synthesis of 33 instruments that assess the psychosocial aspects of care. This provides an important resource to guide measurement of dignity, respect, privacy and patients' choice. The findings also provide guidance to future research in this field. RELEVANCE TO CLINICAL PRACTICE: This paper reviews and synthesises these instruments to provide a resource to nurses to inform their decisions and practice around measurement and evaluation of these key aspects of care. This provides a useful guide to measure and monitor the improvement of fundamental care delivery in practice and points to strengths and weaknesses of the instruments concerned.

A qualitative descriptive enquiry of nursing students' perceptions of international clinical placement experiences.

International mobility for nursing students is still a relatively new phenomenon. While educators and students are both excited by the opportunity that mobility presents, there are often many challenges inherent within third level organisations and practice organisations. These obstacles not only serve to make international mobility arrangements complex to manage but also mean that these opportunities are only available to very small numbers of students. Furthermore the benefits of undergraduate international exchanges remain largely anecdotal and the elements that facilitate success are not entirely clear. To address these issues, a qualitative study was conducted to identify the elements that characterize a nursing student's successful learning during international clinical placement. Semi-structured interviews were carried out with six students who had completed their international clinical placements experiences in Portugal, Spain, and Italy. Three common themes emerged from the data analysis: relationship with institutions and countries, student's thoughts and feelings and learning outcomes and the role of the nursing student's clinical supervisor. These themes contain seven sub-categories, representing the characterizing elements of the student's experience of mobility in the foreign country. These results are useful to nurse educators internationally to inform clinical learning experiences within exchange programmes.

Unmet nursing care needs on medical and surgical wards: A scoping review of patients' perspectives.

AIMS AND OBJECTIVES: To review and synthesise research studies on surgical and medical inpatients' perceptions on unmet nursing care needs. BACKGROUND: Missed nursing care is a growing phenomenon that has been shown to adversely affect care outcomes-mainly in adult medical and surgical care settings. However, to date the aggregated and synthesised evidence of missed care comes from research that measures perceptions on missed care in surgical and medical settings from nurses, but not from the patients. DESIGN: Scoping review. METHODS: In September 2018, three databases were searched: MEDLINE/PubMed, CINAHL and SCOPUS and papers were selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were as follows: primary studies; published in peer-reviewed journals; in English or Italian; and regarding routine care provided to adult inpatients. Quality appraisal and a thematic analysis were conducted. RESULTS: Of the 1541 abstracts initially identified, 44 papers were included. Five themes emerged: "communication," "self-management, autonomy and education," "personal sphere," "essential physical care" and "emotional and psychological care." The majority of the unmet needs were related to the "personal sphere" and "emotional and psychological care." These unmet needs were not identified in previous literature on nurses' perspectives of missed care. Also, physical care deficits like oral hygiene were identified. CONCLUSION: It is important to take into account patients' perspectives. The themes focusing on patients' personal sphere, and emotional and psychological care, underline how patients need nurses to pay more attention to their cultural background, consider the person as a whole and for nursing care to be holistic and respectful of patients' dignity. RELEVANCE TO CLINICAL PRACTICE: This study intends to raise awareness amongst nurses and policymakers about the importance of addressing missed nursing care and unmet patients' needs in adult medical or surgical inpatient settings to ensure high-quality care and patient satisfaction.

A qualitative descriptive inquiry of the influences on nurses' missed care decision-making processes in acute hospital paediatric care.

AIM: To explore influences on nurses' missed care decision-making processes in acute hospital paediatric care. BACKGROUND: Many contemporary studies describe the phenomenon of missed care. It is clear that environment and organizational culture influence the nursing activities; however, what influences their decision-making processes has not been investigated. METHOD: A descriptive qualitative inquiry was performed using semi-structured interviews with paediatric nurses (n = 20) from one Italian paediatric hospital. FINDINGS: Thematic analysis revealed four themes: nurses' value system; hospital logistics, structures and resources; prioritization processes; and the informal caregiver's role. CONCLUSION: This paper offers insights into the various factors involved in nurses' decision-making process when contemplating missed care that will be of use to managers when planning care or addressing missed care in the paediatric clinical setting. IMPLICATIONS FOR NURSING MANAGEMENT: Knowledge and awareness of missed care in children's nursing needs greater exploration, especially in relation to what influences nurses' decision-making choices around missed care. Overall, a greater understanding of this will help managers to manage situations effectively and ethically so that missed care does not impact on outcomes for children in health care.