An Observational Cross-Sectional Analysis of the Correlation between Clinical Competencies and Clinical Reasoning among Italian Registered Nurses.

Ability, knowledge, aptitude, and skill are the terms identified in the literature as the attributes of the concept of clinical competence. This implies that in order to act competently in their own context, the nurse must be able to make decisions which mainly depend on the ability to put clinical reasoning into practice. However, the evaluation of clinical reasoning in the various clinical-care activities of nursing competence is a necessary operation to prevent routine attitudes. From the perspective of an assessment of nursing competences, the aim of this study is to validate the relationship between the degree of competence recognized in a specific clinical setting and the amount of clinical reasoning executed by nurses. The study design was a cross-sectional observational design, following the guidelines of the Strengthening Reporting of Observational Studies in Epidemiology (STROBE) of observational studies. Both the Italian Nurse Competence Scale and the Nurse Clinical Reasoning Scale were used. The data was collected between 25 January and 5 March 2022. Four hundred twenty-four clinical nurses participated by completing and returning the questionnaires. The instruments underwent assessment to ensure internal consistency and test-retest reliability. Their validity was tested with the validity of known content, construct, and groups. This is supported by statistically significant correlations between the different variables examined and the scores of the different dimensions of the Italian Nurse Competence Scale and the Italian Nurse Clinical Reasoning Scale. The data collected showed an excellent average level of competencies and clinical reasoning, M = range of 72.24 and 63.93, respectively. In addition, we observed satisfactory scores across all dimensions of I-NCS (significance range: 0.000-0.014) and I-NCRS (significance range: 0.000-0.004). The understanding and development of clinical reasoning has also brought out new aspects that require further research. This study provides a fresh perspective on the correlation between clinical competences and clinical reasoning, representing a novel attempt to analyze their relationship.

Decoding Nursing Job Demands: A Multicenter Cross-Sectional Descriptive Study Assessing Nursing Workload in Hospital Medical-Surgical Wards.

Background: Nursing workload is largely studied but poorly explored under physical, mental, and emotional dimensions. Currently, only a limited number of variables have been linked to nursing workload and work contexts. Purpose: The study aimed to investigate whether it is feasible to identify variables that consistently correlate with nursing workload and others that are specific to the context. Methods: We employed a descriptive correlational analysis and a cross-sectional design. Data were collected through a survey distributed to registered nurses working across Italy, at the conclusion of randomly assigned morning or afternoon shifts. Results: We received 456 surveys from 195 shifts, collected from nurses in four public and two private hospitals. Commonly associated variables with nursing workload dimensions included patient complexity of care, admission/discharge or transfer, informing patients/relatives, contacting physicians, and unscheduled activities. Variables categorized as setting-specific were patient isolation and specialties, nurse-to-patient ratio, adequacy of staff in the shift, peer collaboration, healthcare documentation, educating others, and medical urgency. Conclusions: In summary, certain variables consistently correlate with nursing workload across settings, while others are specific to the context of care. It is imperative for nurses and nurse managers to measure the nursing workload in various dimensions, enabling the prompt implementation of improvement actions.

Trust in the Leader, Organizational Commitment, and Nurses' Intention to Leave-Insights from a Nationwide Study Using Structural Equation Modeling.

Nursing retention is a major challenge globally. Ongoing workforce instability across countries underscores the need to understand the factors influencing turnover and nursing retention. Trust is a crucial element in managing workplace relationships between nurse managers and nurses. Existing studies have shown the direct impact of trust on employees' intention to leave their job but have not explored the effects of potential mediators such as organizational commitment. The aim of this study was to examine the impact of trust in the leader on nurses' intention to leave their job through the mediation of organizational commitment. A cross-sectional study was conducted in Italy. A convenience sample of 1853 nurses completed a self-report survey. The study tested a hypothesis-based mediation model using structural equation modeling, which showed good fit indices. The results indicated that trust in the leader had a significant impact on nurses' intention to leave, and this relationship was partially mediated by organizational commitment. Nurses who trust their leader are more likely to demonstrate higher levels of organizational commitment, resulting in a lower intention to leave their job. Furthermore, organizational commitment and trust emerge as critical factors in reducing nurses' intention to leave their current positions. Therefore, managers can reduce nurses' intention to leave by building trustful relationships that enhance organizational commitment.This study was not registered.

Factors Influencing Generation Z Bachelor of Nursing Students' Decision to Choose Nursing as a Career: A Pilot Study.

Introduction: Despite nurses representing the largest healthcare professional group, the number is not enough for global health coverage. Understanding Generation Z students' intrinsic and extrinsic motivations, internal and external influences, and beliefs in choosing nursing education is crucial. This knowledge empowers universities to enhance nursing program enrollment through targeted promotion and recruitment strategies. Objective: The aim was to understand why Italian students of Generation Z choose the Nursing Degree Course. Methods: In this pilot study, a cross-sectional design was used. A survey with closed and open answers analyzing demographics, opinions, and motivations among new enrolled nursing students was administered on the first day of the Bachelor of Nursing Degree course. Descriptive statistics were used. Quantitative data were analyzed with Chi-square and ANOVA tests and qualitative data underwent content analysis and coding. Correlation analysis explored relationships between qualitative and quantitative results. Results: Forty first-year students (85% female, average age 22) completed the questionnaire. The choice of the degree pathway, as the first or second option, is influenced by intrinsic and extrinsic motivations, the student's opinions, and family and social influences. Significant positive and negative associations were evidenced. Negative factors affecting choice included location and the responsibility for nursing care, while positive factors included role models, family advice, passion, curiosity for healthcare, the desire to help others, and family influences on decision-making. Conclusions: Among Italian generation Z students, the choice of the nursing degree pathway is influenced by social models, family advice, passion, the desire to help others, and curiosity. Universities should be more proactive in their recruitment and promotion efforts, transforming these events into vibrant meeting points for professionals from diverse nursing specialties. They should also implement robust information policies that highlight career possibilities spanning clinical practice, management, education, and research areas within the field.

Self-Perceived Clinical Competence of Nurses in Different Working Experiences: A Cross-Sectional Study.

BACKGROUND: Competence is an essential concept for measuring nurses' performance in terms of effectiveness and quality. To this end, our analysis highlighted the process of acquiring competencies, their self-evaluation into clinical practice, and how their proficiency levels change throughout the nursing career. In detail, this research explored nurses' perceived level of competence and the factors that influence it in different contexts. METHODS: A cross-sectional survey using a structured questionnaire to assess the nursing participants' perception of their competencies in different clinical settings was accomplished. RESULTS: A descriptive and bivariate analysis was performed on 431 nurses. Most respondents assessed their level of competence to be higher than their roles required. The Kruskal-Wallis test confirmed that nursing experience was a relevant factor influencing nursing competencies. CONCLUSIONS: We suggest improving the competence of practicing nurses, using experience as a measurable effect of their development.

Assessment of the Psychometric Characteristics of the Italian Version of the Nurse Manager Actions Scale.

Nurse managers play a vital role in healthcare organizations, wielding the ability to substantially enhance work environments, foster nurses' autonomy, and bolster retention within workplaces. In this context, this study focuses on the Nurse Manager Actions scale, aiming to evaluate its items' scalability as well as the scale's validity and reliability among nurses and nurse managers operating within the Italian healthcare context. The study protocol was not registered. To ensure linguistic and cultural alignment, an iterative and collaborative translation process was undertaken. Subsequently, a multi-center cross-sectional design was adopted. Using a web-survey approach, data were collected among 683 nurses and 188 nurse managers between August 2022 and January 2023. The Nurse Manager Actions scale was found to be a valid and reliable instrument in Italian after a Mokken Scale Analysis. For nurses (HT= 0.630, Molenaar-Sijtsma rho = 0.890), the scale included 6 items, while 11 items were confirmed for nurse managers (HT= 0.620, Molenaar-Sijtsma rho = 0.830). Nurse Manager Actions scale scores were correlated with increased satisfaction and decreased intention to leave for both nurses and nurse managers. The employed validation process enhanced the scale validity for use in Italy and provided a model for other researchers to follow when assessing similar measures in different populations. Measuring and empowering nurse manager actions in work contexts is essential to improve the general well-being and retention of nurses, especially in the current nursing shortage.

Continuing Education through the Campus Game: A Sustainable Gamification Project to Improve Doctors' and Nurses' Knowledge of Quality and Clinical Risk Management.

The COVID-19 disease has dramatically changed lives worldwide, including education. This is a challenge for traditional learning. In fact, the European Higher Education Area poses the challenge of boosting the quality of teaching through active methodologies supported by digital pedagogy. Gamification is one of these tools and it has considerable attention in the healthcare literature. We aimed to create a game in the Campus Bio-Medico University Hospital Foundation in order to offer continuing education on Quality and Clinical Risk procedures to our staff. The 2021 "Campus Game" (178 players) introduced the "Badge Challenge" (Team Building, Procedures, and Security) and 73 questions. The leaderboard of every single match was posted in some of the hospital's strategic areas and also published online on the company intranet to ensure engagement and competitiveness. Gamification has spontaneously promoted teamworking and a virtuous process of multiprofessional education. We found that, during the Campus Game, there was a 4.9% increase in access to the intranet page containing information on Quality and Patient Safety and an 8% increase in access to the Hospital Policies and Procedures. In the near future, we wish to expand this game, involving hospitals with similar types of activity and levels of attention to quality and safety issues, and also to enhance the network of partners and the principles of Q&S management itself.

Psychometric Properties of the Italian Version of the Leader Member Exchange Scale (LMX-7): A Validation Study.

For decades, scholars have studied leader-member exchange (LMX) relationships to understand and explain the effects of leadership on follower attitudes and performance outcomes within work settings. One available instrument to measure these aspects is the LMX-7 scale. This measurement has been widely used in empirical studies, but its psychometric properties have been poorly explored. The aim of this study was to test the psychometric characteristics (content, structural and construct validity, and reliability) of the Italian version of the LMX-7 scale and to support its cultural adaptation. We used a cross-sectional multi-center design. The forward-backward translation process was used to develop the Italian version of the scale. The scale was administered through an online survey to 837 nurses and nurse managers working in different settings. The factorial structure was tested using both exploratory and confirmatory factor analyses (EFA and CFA), and reliability was evaluated using Cronbach's alpha. For the construct validity, we used hypothesis testing and differentiation by known groups. The Italian version of the LMX-7 scale presented one dimension. All the psychometric tests performed confirmed its validity and suggested its usefulness for future research.

Nurse-Patient Communication and Relationship When Wearing Personal Protective Equipment: Nurses' Experience in a COVID-19 Ward.

Little is known about which communication strategies nurses carried out and whether the nurse-patient relationship has been altered due to the mandated use of personal protective equipment during the COVID-19 pandemic. This study describes how nurse-patient communication and relationships took place from the point of view of nurses engaged in caring for patients with COVID-19. A qualitative descriptive study design following COREQ guidelines was conducted. Semi-structured telephone interviews with nurses working in the COVID ward of an Italian university hospital were performed between September 2020 and June 2021. Ten nurses were recruited using convenience sampling. One overarching theme, three main themes, and nine sub-themes were identified. The overarching theme 'The in-out relationship: 'in here and out there' and 'inside me and out of me' included the main themes 'A closed system different from normal', 'Uncovering meaningful human gestures', and 'A deep experience to live''. The relational nature of nursing-where 'me and you' and the context are the main elements-leads nurses to find new ways of interacting and communicating with patients, even in a new situation that has never been experienced. Enhancing human gestures, thinking about new contexts of care, and educating new generations to maintain human-to-human interaction, regardless of the context of care, are the directives to be explored for creating the future of nursing care.

Evaluation of Standard Precautions Compliance Instruments: A Systematic Review Using COSMIN Methodology.

BACKGROUND: Standard precautions (SPs) are first-line strategies with a dual goal: to protect health care workers from occupational contamination while providing care to infected patients and to prevent/reduce health care-associated infections (HAIs). This study aimed at (1) identifying the instruments currently available for measuring healthcare professionals' compliance with standard precautions; (2) evaluating their measurement properties; and (3) providing sound evidence for instrument selection for use by researchers, teachers, staff trainers, and clinical tutors. METHODS: We carried out a systematic review to examine the psychometric properties of standard precautions self-assessment instruments in conformity with the COSMIN guidelines. The search was conducted on the databases PubMed, CINAHL, and APA PsycInfo. RESULTS: Thirteen instruments were identified. These were classified into four categories of tools assessing: compliance with universal precautions, adherence to standard precautions, compliance with hand hygiene, and adherence to transmission-based guidelines and precautions. The psychometric properties of instruments and methodological approaches of the included studies were often not satisfactory. Only four instruments were classified as high-quality measurements. CONCLUSIONS: The available instruments that measure healthcare professionals' compliance with standard precautions are of low-moderate quality. It is necessary that future research completes the validation processes undertaken for long-established and newly developed instruments, using higher-quality methods and estimating all psychometric properties.

Cultural Adaptation and Psychometric Properties of the Trust Me Scale-Italian Version: A Validation Study.

BACKGROUND: The Trust Me Scale is a widely used instrument to measure trust in healthcare providers. However, no Italian version of the scale exists yet, limiting its use in Italian-speaking populations. The aim of this study is to translate and validate the Trust Me Scale for use in Italian-speaking populations in nurses and nurse managers. METHODS: The translation process involved methodological steps of collaborative and iterative translation with cultural adaptation. The validation process included a cross-sectional study enrolling a convenience sample of 683 nurses and 188 nurse managers who completed the Italian version of the Trust Me Scale and measures of intention to leave, satisfaction, and organizational commitment. RESULTS: Item 5 was removed for poor factor loading, and items 11 and 13 were removed following an a priori strategy focused on deleting items with correlations between residual variables different than expected based on theoretical expectations derived from previous research. The final model fit well to sample statistics with a three-factor structure (harmony, reliability, and concern) and 13 items. A multiple-indicator multiple-cause model showed a measurement invariance between nurses and nurse coordinators. Construct validity was also supported by the evidence that the measured domains of trust align with the theoretical expectations and are related to the intention to leave, job satisfaction, and organizational commitment. Each dimension showed adequate scale reliability. CONCLUSIONS: The Italian version of the Trust Me Scale is a valid and reliable instrument to measure trust in nurses and nurse managers in Italian-speaking contexts. It can be used for research in nursing and leadership and evaluation of interventions aimed at improving trust in healthcare contexts.

Appraisal and Evaluation of the Learning Environment Instruments of the Student Nurse: A Systematic Review Using COSMIN Methodology.

BACKGROUND: Nursing education consists of theory and practice, and student nurses' perception of the learning environment, both educational and clinical, is one of the elements that determines the success or failure of their university study path. This study aimed to identify the currently available tools for measuring the clinical and educational learning environments of student nurses and to evaluate their measurement properties in order to provide solid evidence for researchers, educators, and clinical tutors to use in the selection of tools. METHODS: We conducted a systematic review to evaluate the psychometric properties of self-reported learning environment tools in accordance with the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) Guidelines of 2018. The research was conducted on the following databases: PubMed, CINAHL, APA PsycInfo, and ERIC. RESULTS: In the literature, 14 instruments were found that evaluate both the traditional and simulated clinical learning environments and the educational learning environments of student nurses. These tools can be ideally divided into first-generation tools developed from different learning theories and second-generation tools developed by mixing, reviewing, and integrating different already-validated tools. CONCLUSION: Not all the relevant psychometric properties of the instruments were evaluated, and the methodological approaches used were often doubtful or inadequate, thus threatening the instruments' external validity. Further research is needed to complete the validation processes undertaken for both new and already developed instruments, using higher-quality methods and evaluating all psychometric properties.

Nurses' Organization of Work and Its Relation to Workload in Medical Surgical Units: A Cross-Sectional Observational Multi-Center Study.

INTRODUCTION: Work contexts can affect nurses' work and work outcomes. Work context factors of nurses, patients, or workflow can modulate nurses' organization of work and determine increased workloads. AIM: The aim of this research was to analyze relationships between factors regarding the patient, the nurse, workflow, and nurses' work organization, to investigate whether work organization is related to physical, mental, and emotional workloads, and to explore whether one dimension of workload influences the other dimensions. METHODS: We used a cross-sectional design based on the Job Demand-Resources theory. We asked registered nurses, working in nine medical-surgical wards across three hospitals in Italy, to self-report on work organization and workloads regarding randomized shifts over three consecutive weeks. Four scales from the QEEW 2.0 questionnaire were used on an online survey for data collection. multivariable linear regressions with structural equation modelling were tested. The study was approved by the three local Ethics Committees. RESULTS: We received 334 questionnaires regarding 125 shifts worked. Patient complexity (ß = 0.347), patient specialties (ß = 0.127), adequacy of staffing (ß = -0.204), collaboration with colleagues (ß = -0.155), unscheduled activities (ß = 0.213), supply search (ß = 0.141), and documentation (ß = 0.221) significantly influenced nurses' work organization. Nurses' work organization was significantly related to physical, mental, and emotional nursing workloads. CONCLUSIONS: the patient, the nurse, and workflow aspects influence nurses' work organization and workloads. Healthcare organizations, managers, and nurses should explore work settings to identify work turbulences early and implement strategies to improve nursing work conditions and workloads.

Nursing outcomes in wound care management: A mixed method study.

AIM: The aim of the study was to analyse the management of chronic wound outcomes and the experience of patients with chronic ulcers. DESIGN: Explanatory mixed method. METHODS: This study consisted in a sequential explanatory mixed method with a quantitative and a qualitative phase. In the first phase, quantitative data were collected during a longitudinal study, in a convenience sample of 44 patients presenting at a nursing outpatients' clinic. Linear regression was conducted to evaluate the associations between variables. In phase two, 14 patients from the initial sample were interviewed, and the data were analysed using Giorgi's descriptive phenomenological method. RESULTS: The participants, mostly males, in conditions of comorbidity and polypharmacotherapy, were mainly affected by venous leg ulcers. An association between the quality of life of patients (both physical and mental) and some socio-demographic and clinical factors has been confirmed. I Variance analysis showed a significant wound improvement across all the measurement times. The themes identified through the qualitative analysis were: "Cared by self," "Cared by Healthcare Providers" and "Quality of life".

Development and Initial Validation of the Adolescents' Ageism Toward Older Adults Scale.

BACKGROUND AND OBJECTIVES: Ageism toward older adults, prevalent in contemporary societies, seems to be internalized during childhood and consolidated during adolescence. Although several instruments have been developed to measure adolescents' ageism, they present a number of limitations. The study aimed at developing a new instrument, the Adolescents' Ageism Toward Older Adults Scale, and testing its psychometric properties. RESEARCH DESIGN AND METHODS: A three-phase process was followed: The instrument's items were developed empirically from focus groups of adolescents; its content validity was evaluated; and finally, its psychometric properties were tested through a multicenter cross-sectional study involving 575 adolescents. RESULTS: Exploratory factor analysis of the new scale retained 33 items grouped into 6 factors: moodiness, traditionalism, physical deterioration, antitechnologism, sageness, and sociability. Confirmatory factor analysis evidenced a second-order factor structure. Omega coefficients measuring internal consistency were above the cutoff of 0.60 for the 6 factors except for antitechnologism. Intraclass correlation coefficients for the entire scale and for the 6 factors were greater than 0.70, again excepting antitechnologism. DISCUSSION AND IMPLICATIONS: The Adolescents' Ageism Toward Older Adults Scale is a promising measure of adolescents' negative and positive attitudes toward older adults. Its validation highlighted some criticalities that can be resolved by a few modifications. Further testing of the scale should be conducted after these modifications.

Effectiveness of dyadic interventions to improve stroke patient-caregiver dyads' outcomes after discharge: A systematic review and meta-analysis study.

BACKGROUND: Because of the importance of a dyadic approach, it is necessary to conduct a systematic review to identify which dyadic intervention could be implemented for stroke survivor-caregiver dyads after discharge from the rehabilitation hospital to improve outcomes. AIMS: The aims were to systematically review the evidence to identify which dyadic interventions have been implemented in stroke survivor-caregiver dyads to improve stroke survivor-caregiver dyads' outcomes and to analyse, through a meta-analysis, which intervention was found to be the most effective. METHODS: A systematic review and meta-analysis were conducted using the following electronic databases: PubMed, CINAHL and PsycInfo. Randomized controlled trials (RCTs) and quasi-RCT studies published within the last 10 years were included. Quantitative data were extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI. Pooled effects were analysed between the experimental and control groups for each outcome. RESULTS: Sixteen studies involving 2997 stroke survivors (male gender=58%) and 2187 caregivers (male gender=25%) were included in this review. In 16 studies, which were subdivided into three quasi-RCTs and 13 RCTs, the application of dyadic interventions for stroke survivors and caregivers was systematically reviewed, but only a few of these identified a significant improvement in the stroke survivors' and caregivers' outcomes of its intervention group. Dyadic interventions showed a significant effect on stroke survivors' physical functioning (p=0.05), memory (p<0.01) and quality of life (p=0.01) and on caregivers' depression (p=0.05). CONCLUSIONS: This study provides moderate support for the use of a dyadic intervention to improve stroke survivors' physical functioning, memory and quality of life and caregiver depression.

Undergraduate healthcare students' personal experiences with older adults : A qualitative description study.

BACKGROUND: Understanding students' experiences with regard to older adults is important for educators in developing specific educational strategies to encourage future healthcare professionals to consider the geriatric field as a career choice. OBJECTIVES: The study explored Italian university healthcare students' experiences with older people and their perceptions of them at the beginning of their course. DESIGN: A qualitative descriptive design. SETTINGS: A Faculty of Medicine in Italy. PARTICIPANTS: A sample of 15 students enrolled in healthcare courses was included. METHODS: Semistructured interviews were conducted. The data were analyzed using inductive content analysis. RESULTS: Six categories were identified. The young Italian students' first experiences with older adults were with their grandparents, representing their first models of aging. Grandparents were sources of emotional support. Older adults were seen as custodians of collective memory and as a guide for younger generations. The intergenerational relationship was characterized by respect and reciprocity. Young adults recognize the frailty and vulnerability of older adults and view intergenerational solidarity as a way to protect them. They imagined their own old age as characterized by strong family relationships and by active aging, due to their personal experience with their grandparents. CONCLUSIONS: This study revealed mainly positive experiences and attitudes of healthcare students toward older adults. The students' relationships with their grandparents contributed greatly to this outcome.

[Knowledge and attitudes of health workers' hands hygiene during Covid-19's pandemic: an observational study]. / Conoscenze e atteggiamenti nell'igiene delle mani del personale sanitario durante la pandemia Covid-19: uno studio osservazionale.

INTRODUCTION: the infections correlated to the assistance represent the most common adverse events and sets up a world public sanity problem. Preventative behaviour, such as proper hand hygiene, are based on the knowledge and attitudes of care staff. Valuing health workers' knowledge and attitudes becomes fundamental for the individuation of any cognitive gaps. METHODS: a cross sectional study has been conducted in a healthcare authority, during the first lockdown of Covid-19 pandemic. The knowledge's' data have been collected using the World Health Organization's Hand Hygiene Knowledge Questionnaire in its italian version and, for exploring attitudes, questions have been created on the basis of scientific literature. RESULTS: a sample of 363 healthcare workers was enrolled in this study. The 60% of respondent showed a sufficient level and 26.3% were at a good level of knowledge and all the personnel present good attitudes. There has been found an association between knowledge, gender and work area and between attitude, work area and presence of the alcoholic product in the structure. CONCLUSIONS: healthcare workers showed a knowledge level from sufficient to good, and positive attitudes towards hands hygiene. There still remains some cognitive gaps that have to be fixed with formative courses for prevent infections according to the principles of the patient safety program "Clinic Care in Safer Care" of the World Health Organization.

Outcomes of wound care nurses' practice in patients with pressure ulcers: An integrative review.

BACKGROUND: Wound care nurses are recognised as a key element for improving health outcomes. However, there is still fragmented knowledge of the outcomes associated with their practice in individuals with pressure ulcers. AIMS AND OBJECTIVES: To identify, summarise and map all available evidence related to the outcomes of wound care nurses' practice in individuals with pressure ulcers. DESIGN: Integrative literature review. REVIEW METHOD: To report the review, we followed the modified version of Cooper's five-step methodology, and the PRISMA guidelines. METHODS: The search was carried out on CINAHL, PubMed, the Cochrane Library and Scopus, with a time frame ranging from each database inception to December 21, 2019. We included observational or experimental studies of adult individuals affected by (or at risk of) developing pressure ulcers who were also cared for by wound care nurses. RESULTS: Of the 439 peer-reviewed publications, 13 studies met the inclusion criteria. The most frequent outcomes were pressure ulcer incidence, healing rate and time taken for complete healing. Less frequent outcomes were changes in pressure ulcers' stage, number of completely healed wounds, treatment costs and physical discomfort. No patient-reported outcomes were assessed. CONCLUSION: This review indicates that clinical-related outcomes were by far the most reported. Future studies should broaden the spectrum of outcomes to include more subjective parameters (e.g. pain, quality of life, stress, etc.), in order to gain a better understanding of the global impact of wound care practice on patients with pressure ulcers. RELEVANCE TO CLINICAL PRACTICE: There is promising evidence of a positive impact of wound care nurses' practice on health and economic outcomes. Nonetheless, more robust and rigorous research is needed to provide stronger evidence in the field and support investment in these practitioners.

"Where would I prefer to work after graduation?" Career preferences of students attending Italian nursing schools.

BACKGROUND: Worldwide, nursing students have reported a preference for working in intensive care, paediatrics, and operating theatres after graduation, disregarding psychiatry and geriatrics. Many factors can influence student choices. Educators need to know students' preferences and influencing factors in order to plan appropriate interventions to orient future nurses towards the clinical areas that are most in need of trained and motivated nurses. OBJECTIVES: To identify career preferences and student-related factors that influence the career intentions of students attending Italian nursing schools. DESIGN: A cross sectional design. SETTING: The study was conducted in 14 Italian nursing schools. PARTICIPANTS: Students enrolled on a three-year undergraduate nursing program were invited to participate. METHODS: A questionnaire was used to collect sociodemographic data and clinical area preferences. A multivariate binary logistic regression was performed to identify the student characteristics influencing career choices. RESULTS: 1534 students were enrolled in the study. Students preferred working in paediatrics, emergency departments and operating theatres, and these preferences were consistent in all of the three years. Psychiatry and geriatrics were the clinical areas least preferred in all the three years. Age, gender, nationality, and university attended were the factors that predicted students' preferences for specific clinical areas. CONCLUSIONS: In line with international literature, students attending Italian nursing schools expressed preferences for working in some clinical areas and to disregard others. Nursing curricula and internships need to be reviewed in terms of declared and hidden curriculum in order to enable students to view all areas of practice as equally valuable.