Nurses' attitudes towards COVID-19 vaccines: A qualitative study (PROACTIVE-study).

AIM: To explore the attitudes of healthcare workers towards COVID-19 vaccines. DESIGN: A qualitative descriptive design was used. METHODS: Five focus groups were conducted between October and November 2021, with a total of 30 nurses from different contexts in Northern Italy. Thematic analysis was used to analyse the transcripts. RESULTS: Three main themes were identified: 'favourable', 'unsure' and 'contrary to' COVID-19 vaccines. The favourable position was underpinned by trust in science, research and vaccination; protection for themselves, their families, patients and the population; duty as professionals; necessity to set an example for others. Participants who were unsure had doubts about the composition, safety and efficacy of the vaccine and were sometimes afraid that media provided incomplete information. The main reason why nurses were against was the feeling that being forced to vaccinate perceived as blackmail. Favourable or unsure nurses struggled to deal with those who were against and developed a series of emotions that ranged from respect and attempt to rationalize, to frustration and defeat. CONCLUSIONS: Identifying the areas of hesitation is essential to understand what affects the choices of acceptance, delay or refusal of vaccination. The issues that emerged regarding proper communication within the vaccination campaign highlights the key importance of adequate vaccination strategies. IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE: Understanding attitudes towards vaccine and related motivations among healthcare workers could help develop more specific and targeted vaccination campaigns that can ensure proper vaccination coverage rates and avoid hesitancy or refusal. IMPACT: Healthcare workers experiences of COVID-19 vaccines, their views and know how they feel during COVID-19 vaccinations. Healthcare workers had three different positions in COVID-19 vaccination. This research will guide and target future vaccination campaigns. REPORTING METHOD: The study is reported using the Standards for Reporting Qualitative Research (SRQR). PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Protective and risk factors of workplace violence against nurses: A cross-sectional study.

AIMS: To describe how workplace violence (WPV) is experienced by nurses in hospitals and community services and identify protective and risk factors. METHODS: An online cross-sectional national study was conducted from January to April 2021 in Italy. Hospitals and community services were involved in the study. The survey combined the adapted and validated Italian version of the Violence in Emergency Nursing and Triage (VENT) questionnaire, which explores the episodes of WPV experienced during the previous 12 months, the Practice Environment Scale of the Nursing Work Index (PES-NWI) and some additional questions about staffing levels extracted from a previous RN4CAST study. Nurses working in all clinical settings and community services were invited to participate in the survey. Descriptive and inferential statistics were used for data analysis. We adhered to the STROBE reporting guidelines. RESULTS: A total of 6079 nurses completed the survey, 32.4% (n = 1969) had experienced WPV in the previous 12 months, and 46% (n = 920) reported WPV only in the previous week. The most significant protective factors were nurses' age, patients' use of illegal substances, attitude of individual nurses and considering effective the organization's procedures for preventing and managing episodes of violence. The most significant risk factors included workload, recognizing violence as an inevitable part of the job, patients' cultural aspects and patients' agitated behaviour. The frequency of WPV was significantly higher in certain areas, such as the emergency department and in mental health wards. CONCLUSION: Workplace violence (WPV) against nurses is a very frequent and concerning issue, especially in hospitals and community services. Based on our findings, integrated and multimodal programmes for prevention and management of WPV are recommended. More attention and resources need to be allocated to reduce WPV by improving the quality of nurses' workplace environment and implementing violence-free policies for hospitals. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Impact Workplace verbal and physical violence is a widespread phenomenon, both in hospital and community settings, and even during COVID-19 pandemic. This problem is exacerbated by the lack of effective reporting systems, fear of retaliation and the tendency to consider violence as an inevitable part of the job. The characteristics of professionals, patients, work environment and organizational factors are involved in the spread of workplace violence, determining its multifactorial nature. Integrated and multimodal programmes to prevent and manage of workplace violence are probably the only way to effectively counteract workplace violence against nurses. Healthcare policymakers, managers of hospital and community services need to proactively prevent and effectively manage and monitor episodes of violence. Nurses need to feel protected and safeguarded against any form of verbal or physical violence, to provide high-quality care in a totally safe environment. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

The effectiveness of learning strategies for the development of Emotional Intelligence in undergraduate nursing students: A systematic review protocol.

AIM: This protocol proposes a systematic review to identify and disclose learning strategies and evaluation tools to improve Emotion Intelligence (EI) in undergraduate nursing students. BACKGROUND: EI improves the ability to manage emotions and their consequences. Management of emotions is fundamental in nursing both at inter- and intra-professional levels, and with the patients and their family carers. DESIGN: Systematic review protocol of effectiveness based on the Joanna Briggs Institute (JBI) guidelines. REVIEW METHODS: All articles based on educational programmes and/or activities to develop EI in nursing curricula will be included in the review. It will analyse the principle EI attributes and outcomes such as burnout, intention to leave and problem-solving skills. Based on the review question, seven databases will be searched: MEDLINE, The Cochrane Library, SCOPUS, CINAHL, EMBASE, PsycINFO and ERIC. Also, grey literature (Google Scholar and Open Gray) will be searched. Since no similar systematic reviews are present in the literature, no time limits will be set. To establish the quality of studies JBI tools will be used. When appropriate, we will meta-analyse prevalence and incidence estimates or we will meta-synthesize themes and findings. EXPECTED RESULTS: This systematic review is expected to provide an overview of educational and training methods, pedagogical strategies and evaluation tools to address EI in nursing and provide high-quality care to patients and their families. Results of the review will support nursing educators and leaders in implementing teaching and learning strategies to improve the Emotional Intelligence of undergraduate nursing students. CONCLUSIONS: Mastering emotions is fundamental for nurses. Implementing education courses based on EI according to the best training methods and pedagogical strategies could become key for nursing curricula. Moreover, after the review, it will be possible to identify the best training methods and pedagogical strategies for implementing continuing professional development (CPD) courses in EI in the courses of following graduation.

Nursing management of emergency department violence-Can we do more?

BACKGROUND: Emergency departments are the services with the highest risk of violence for nurses. Reports of violence in health care have increased exponentially in the last decade. Front line hospital services are more at risk, and worldwide there are attempts to quantify, manage and prevent episodes of violence, but no consistent solutions have yet been identified. AIMS: To stimulate reflection on causal factors of violence against nurses in emergency departments and discuss potential solutions and strategies for aspects that largely remain unresolved. DESIGN: A position paper underpinned by experiences and evidence reported in the literature. METHODS: A search of Scopus and CINAHL using the term 'violence' provided information concerning the prevalence of the term 'violence' in contemporary literature and enabled to capture a general overview of contributing factors of violence and current approaches to its management and prevention. CONCLUSIONS: However, while risk factors have been identified, there is a tendency to over accentuate the extent of their contribution. The main risk factors present conditions related to or accompanied by mental illness and the impact of overcrowding and long waiting times. RELEVANCE TO CLINICAL PRACTICE: More is needed in terms of implementation of more far-reaching, holistic, practical and effective management solutions to promote nurses' safety and adequately support vulnerable patients.

Fundamental care: An evolutionary concept analysis.

AIM: To report an analysis of the concept of fundamental care in the literature. DESIGN: An evolutionary concept analysis. DATA SOURCES: PubMed and CINAHL Complete databases were consulted using the key terms: fundamental care, fundamentals of care, essential care, basic nursing care and basic care revised. Articles published from 2008 to 2022, in English and Italian, in scholarly/peer-reviewed nursing journals were included. METHODS: Rodgers's Evolutionary Method of concept analysis was used. Our thematic analysis yielded common themes related to the concept, antecedents, attributes and consequences of fundamental care. RESULTS: A total of 50 articles were analysed. Thirty-eight attributes were identified, such as integration of care, patient and family centred care and trusting relationship; eight antecedents including nursing care, nursing practice and care context; and 17 consequences including the safety, quality and consistency of care. CONCLUSION: This review of literature reveals that there is no consistent definition of the concept of 'fundamental care'. Findings from this exploration of the literature emphasized the importance of communication, the contextual environment, leadership influence and nurse-patient relationship in providing effective and high-quality fundamental care. Our definition of this concept may help nurse leaders in practice, research, education, management and policy to promote and enhance the application of fundamental care. IMPACT: What problem did the study address? While numerous studies examine fundamental nursing care, various terms are used with no consensus on definitions emerging. Given the relevance of this topic, reaching a clear and agreed definition of fundamental care is essential. What were the main findings? Fundamental care encompasses the importance of communication, the contextual environment, leadership influence and nurse-patient relationship in providing effective and high-quality care. Where and on whom will the research have an impact? This definition of fundamental care will assist nurse leaders and researchers to promote and enhance the examination and application of fundamental care in clinical practice to ensure better care outcomes across all healthcare settings.

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.

Implementation and analysis of a LGBTQ cultural competency module on pharmacy student knowledge.

INTRODUCTION: This study describes the implementation and assessment of a cultural competency module on caring for patients who identify as lesbian, gay, bisexual, transgender, and/or queer (LGBTQ). The module was delivered to first professional year pharmacy students, and focused on student knowledge and application of LGBTQ-specific definitions, inclusive language, and health disparities. METHODS: A mixed-methods design captured data to assess the effect of a LGBTQ module on student knowledge and confidence. For the pre- and post-assessment, descriptive statistics were calculated and mean differences were compared using the paired sample t-test. The number of correct choices for multiple-select questions were compared using the Pearson chi-square test. Post-laboratory (lab) reflections were analyzed via percentages of agreement for Likert-scale questions and thematic analysis of free-response questions. RESULTS: Average pre- and post-assessment scores (n = 74 students) were 47.84% and 53.51% (P = .02). Sub-analysis of the multiple-select questions indicated statistically significant improvement in student performance on health disparities and culturally-competent communication (P values < .05). Likert-scale questions from 71 student's post-lab reflections indicated agreement of improved knowledge of health disparities (95.77%) and LGBTQ terminology (92.96%). Agreement in student's confidence using inclusive language and competent communication improved from 64.79% pre- to 95.67% post-module. Reflection themes included respect, inclusivity, awareness, and avoiding assumptions. CONCLUSIONS: The module slightly improved student knowledge via assessment performance; however, student-reported knowledge and confidence regarding LGBTQ competency significantly improved. This module can be utilized by schools of pharmacy as a model educational activity on LGBTQ cultural competency with lab-based application.

Validation of the Italian version of the SexContraKnow instrument.

Introduction: A large proportion of all pregnancies worldwide occur in young adolescent women, and almost all these pregnancies are unintentional. To address effective educational interventions, it is necessary to assess adolescents' literacy on this topic. The aim of this study was to translate and validate the Italian version of the SexContraKnow instrument. Methods: This was a methodological study. The validation of the instrument was performed following the EORTC Quality of Life Group translation procedure. The process consisted of four phases: translation, content validation, face validation, and pilot test. Data were collected between May and September 2021. The STROBE guidelines were followed for this study. Results: After performing forward and backward translations, we evaluated content validity (Scale-Content Validity Index = 0.91) and face validity. We then conducted a pilot test, test re-test, with 10 students (Cronbach α = 0.928; Pearson's R = 0.991). Conclusion: The Italian Version of the SexContraKnow instrument has a good level of validation and reliability and can be effectively used by nurses to assess adolescents' literacy about the use of contraceptives and to develop targeted educational interventions. This instrument will help to evaluate the effectiveness of education programmes about health literacy about safe sex and contraception. The attention of nurses should be actively directed towards the process of health literacy among adolescents, in the perspective of a society focused on the empowerment of the population.

In-House, Fast FDM Prototyping of a Custom Cutting Guide for a Lower-Risk Pediatric Femoral Osteotomy.

Three-dimensional printed custom cutting guides (CCGs) are becoming more and more investigated in medical literature, as a patient-specific approach is often desired and very much needed in today's surgical practice. Three-dimensional printing applications and computer-aided surgical simulations (CASS) allow for meticulous preoperatory planning and substantial reductions of operating time and risk of human error. However, several limitations seem to slow the large-scale adoption of 3D printed CCGs. CAD designing and 3D printing skills are inevitably needed to develop workflow and address the study; therefore, hospitals are pushed to include third-party collaboration, from highly specialized medical centers to industrial engineering companies, thus increasing the time and cost of labor. The aim of this study was to move towards the feasibility of an in-house, low-cost CCG 3D printing methodology for pediatric orthopedic (PO) surgery. The prototype of a femoral cutting guide was developed for its application at the IOR-Rizzoli Orthopedic Institute of Bologna. The element was printed with an entry-level 3D printer with a high-temperature PLA fiber, whose thermomechanical properties can withstand common steam heat sterilization without bending or losing the original geometry. This methodology allowed for extensive preoperatory planning that would likewise reduce the overall surgery time, whilst reducing the risks related to the intervention.

Analysis of quality palliative care in a specialized medicine setting: an observational study.

BACKGROUND: Recently health economic expenditure has increased considerably determining an increased awareness of excessive use of "low-value care" treatments, especially for chronic-degenerative diseases. AIM: Describing Quality of life (QoL) of patients and palliative care's skills of nurses in internal medicine unit. METHODS: Observational study conducted in an internal medicine unit that admit patients with chronic critical illness. Patients' QoL was measured with the integrated Palliative Care Outcome Scale (IPOS), and nursing staff skills regarding palliative care with the Questionnaire of Professional Skills Nurses in Palliative Care (QVPICP). IPOS was administered at admission and one week later. RESULTS: All the patients (n=13) accepted to participate to the study (mean age 80 years; SD 15). Eight (61%) were female. All the nurses invited (n=17) completed the QCPICP. Most of them was female (70%). The mean age was 40 years SD 14. Nurses perceived they have skills, knowledge, and abilities to approach patient's palliative care path (mean QVPICP: 7). IPOS means scores were worse in the following variables: pain (before: 3; after: 4); lack of mobility (before: 3; after: 4); sleepiness (before: 3; after: 4); depression (before: 3; after: 4). CONCLUSION: Patient's QoL showed a worsening in the after assessment. Although nurses perceived themselves skilled in taking care of patients with palliative care needs, organizations may not allow nurses to perform their role to the best of their competencies. NURSING IMPLICATION: Team briefing and debriefings in internal medicine unit may promote a holistic approach aimed at improving patients' QoL.

Sexual and reproductive health in adolescents: validation of the questionnaire SexContraKnow instrument in Italian.

BACKGROUND: Adolescents have an inadequate level of health literacy, particularly regarding sexual and reproductive health and the use of birth control methods. This contributes to a high percentage of unintentional pregnancies and sexual behaviors that endanger the entire population. AIM: The purpose of this study is to validate the questionnaire, Sexcontraknow Instrument, in Italian, in order to evaluate the health literacy of adolescents, aged 14 to 19, regarding sexual and reproductive health, particularly on the use of contraceptive methods. METHODS: This is a quantitative research study that aims to validate a knowledge tool on sexual and reproductive health in the adolescent population. RESULTS: The Sexcontraknow Instrument questionnaire has been translated according to the process indicated by the EORTC Quality of Life Group validation criteria. The linguistic validation of the questionnaire in Italian was carried out using the forward-backward translation method. The content validity process was carried out by a group of 9 experts in the area of sexual education addressed to the study population, such as: doctors, midwives, gynecologists, teachers and health assistants. The face validity process, however, was carried out with a sample of convenience made up of 12 students aged 14 to 19 years, homogeneous in the gender. CONCLUSIONS: The SexContraKnow Instrument questionnaire has been transalated in Italiana and face and content validity has been performed. NURSING IMPLICATIONS: Having a tool that help evaluate the knowledge of young people, aids the nurse in preparing and making up for shortcomings through proper education, reducing the negative effects of poor literacy.

Assessing patients' self-efficacy in Chronic Obstructive Pulmonary Disease: translation, content and face validation of the "Understanding COPD Questionnaire".

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a condition that badly influences patients' quality of life. The self-efficacy reached by educational programs is related to the patient's satisfaction, as active participation is fundamental to physical improvement and learning new skills. AIM: To translate in Italian and assess the content and face validity of the "Understanding COPD (UCOPD) Questionnaire" pourposed by Dr. B. O'Neill in 2012. METHODS: Once author's consent was gained, the forward Italian translation was independently performed by two native speakers. The reconciliated Italian version was then backward translated by two english speakers with comments, according to the "European Organisation for Research and Treatment of Cancer quality of life" guidelines. The final version was analyzed by experts to evaluate the level of relevance of each item using a 4-point Likert Scale. From these results we calculated the Item and Scale Content Validity Index (I-CVI; S-CVI). Subsequently, face validity was conducted by asking non-experts, using semi-structured interviews, if the survey was clear and easy to understand. RESULTS: For the content validity analysis were enrolled 5 physicians, 4 nurses, 2 physiotherapists ). The survey showed a good level of content validity (S-CVI 0.90, I-CVI 0.63-1). The face validity analysis was conducted on 7 people affected by COPD. They declared to understand and clearly read all the items of the questionnaire. CONCLUSIONS: The translated UCOPD Questionnaire was confirmed in its content and face validity. NURSING IMPLICATIONS: Further perspectives are the use of the questionnaire to assess the level of self-efficacy and satisfaction in a cohort of Italian patients.