Impact of telemedicine on health outcomes in children with medical complexity: an integrative review.

Children with medical complexity (CMC) are a high priority population with chronic illnesses dependent on the use of health services, on technological systems to support their vital functions and characterized by multiple health needs. One of the main challenges linked to chronic conditions is finding solutions to monitor CMC at home, avoiding re-hospitalization and the onset of complications. Telemedicine enables to remotely follow up patients and families. An integrative review was performed to assess whether telemedicine improves health outcomes for CMC. Medline/PubMed, CINAHL, Cochrane Library, Web of Science, and Scopus were searched to identify studies describing the effect of using telemedicine systems on health outcomes for CMC. The PRISMA guidelines were used to select the papers. The methodological quality of the studies was evaluated through the Johanna Briggs Institute critical appraisal tools and the Cochrane Collaboration ROB 2.0. A total of 17 papers met the quality criteria and were included. Specialized telemedicine systems (tele-visits), telehealth, and tele-monitoring have been reported to reduce unplanned hospitalizations and visits, decrease total costs for healthcare services and families, and increase satisfaction for family members. No effect was found on the quality of life in children and their families.Conclusion: Available evidence supporting the use of telemedicine in CMC is favorable but limited. High-quality methodological studies including other unexplored health outcomes such as mental health, hospital readmissions, mortality, caregiver competences, and self-efficacy are needed to confirm the effectiveness of telemedicine systems in improving health outcomes for CMC. What is Known: • CMC are an extremely fragile patient population with frequent access to healthcare services compared with other chronic conditions. • There is conflicting evidence of the effectiveness of telemedicine clinical outcomes, healthcare utilization, and costs in pediatrics. What is New: • There is some evidence that for CMC, telemedicine reduces unplanned hospitalizations, healthcare service costs, and financial burden for families, while increasing caregivers' satisfaction with care. • Further research is needed to confirm the effectiveness of telemedicine systems in improving health for CMC.

Diabetic education in nursing: A Rodgers' evolutionary concept analysis.

AIM: This concept analysis aims to clarify the concept of diabetic education in nursing to provide guidance for the further conceptualization and clarification of diabetic education in nursing. BACKGROUND: Patient education is a fundamental component of diabetes care. Nurses have taken up a major role in educating people with diabetes to manage their conditions. However, the exact meaning of diabetic education in nursing remains challenging. DESIGN: Rodgers' evolutionary method of concept analysis was performed to explore the concept of diabetic education in nursing. DATA SOURCE: We conducted a literature search on Cumulative Index to Nursing and Allied Health Literature (CINAHL), MedLine, and PsycInfo for works published until October 2020 using "patient education," "diabetes," and "nursing" as key terms. RESULTS: The concept analysis revealed that key attributes of diabetic education in nursing include patient-centered and interactive approaches, planning, and problem solving. Antecedents related to individuals with diabetes are their backgrounds, needs, and motivations, while the antecedents related to nurses are experience and attitude. Finally, three different consequences of the concept emerged: an increase in knowledge and skills, a behavioral change, and the improvement of clinical outcomes.

Diagnostic features of SARS-COVID-2-positive patients: A rapid review and meta-analysis.

AIMS: To identify the main diagnostic features of SARS-CoV-2-positive patients at the time of hospitalisation and their prevalence. BACKGROUND: Since the COVID-19 outbreak in China in December of 2019, several studies attempted to identify the epidemiological, viral and clinical characteristics of SARS-CoV-2. Given the rapid widespread transmission of the COVID-19 disease worldwide, a more comprehensive and up-to-date understanding of its features is needed to better inform nurses, clinicians and public health policy makers. METHODS: A rapid review and meta-analysis were carried out to identify the main diagnostic features of SARS-CoV-2-positive patients at the time of hospitalisation. All case series, cross-sectional, case-control and cohort studies published from 01/01/2020 till 30/06/2020 in English and Chinese that stated all or at least two of the outcomes of interest (clinical features, laboratory and radiological findings) were included. We performed a random-effects model meta-analysis to calculate pooled prevalence and 95% confidence intervals. Conduction of the review adheres to the PRISMA checklist. RESULTS: 21 studies involving 8837 patients were included in the quantitative synthesis. Fever, cough and fatigue were the most common clinical features, while the most relevant laboratory abnormalities at the time of hospitalisation were lymphopenia, elevated C-reactive protein and lactate dehydrogenase. CT images showed a bilateral lung involvement, with ground glass infiltrates and patchy shadows on most patients. CONCLUSION: This review provides an up-to-date synthesis of main diagnostic features of SARS-CoV-2-positive patients at the time of hospitalisation. RELEVANCE TO CLINICAL PRACTICE: Our findings could provide guidance for nurses and clinicians to early identification of positive patients at the time of the hospitalisation through a complete definition of main clinical features, laboratory and CT findings.

Meta-Synthesis of the Needs of Women Cared for by Midwives During Childbirth in Hospitals.

OBJECTIVE: To identify and meta-synthesize results of qualitative studies on the needs of women cared for by midwives during childbirth in hospitals. DATA SOURCES: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and the Cochrane Library. STUDY SELECTION: We restricted the bibliographic search to articles published in English to July 31, 2020. The initial search yielded 6,407 articles, and after 2,504 duplicates were removed, we screened the titles and abstracts of 3,903 articles. We conducted a full-text review of 89 articles and included 13 qualitative studies about the needs of women who were hospitalized during childbirth and had midwives as their primary maternity care providers. DATA EXTRACTION: We extracted data (e.g., authors, publication date, type of study, sample size, results, and quotes) from the full text of each article into a standardized table. Two authors reviewed all articles using the Critical Appraisal Skills Programme tool to assess study quality and to independently score each study. DATA SYNTHESIS: We analyzed the findings of each study and synthesized them to develop themes. We found 14 major themes that reflected the needs of women during hospitalization for childbirth: Nutrition, Hygiene, Privacy, Information, Bodily Respect, Respect for Social Role, Family Intimacy, Shelter, Pain Management, Partnership, Movement, Reassurance, Support, and Empowerment. We categorized these themes in Maslow's hierarchy of needs to better understand the phenomenon. CONCLUSION: We identified 14 needs that midwives and nurses can meet when they care for women in hospitals during childbirth. Standardized methods to assess these needs and to link them to specific interventions can be used by midwives and nurses, which will likely affect women's satisfaction with their experience and overall quality of care.

The Nurse Led of stroke patient after discharge from hospital. A Systematic Review and GRADE.

AIM: Stroke is the second cause of death worldwide and the third cause of death in industrialized countries. To investigate the effectiveness of the nurse's role the management for people affected by stroke after discharge from hospital to home. METHOD: A systematic review was performed. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was carried out. MEDLINE, CINAHL, Web of Science and Scopus were searched for studies on the effectiveness of the nurse's role in managing the stroke rehabilitation process after discharge from the home hospital from 2000 to June 2018 in English. The methodological quality was assessed by the Cochrane Collaboration's tool for assessing Risk of Bias (RoB). The GRADE system was used for evaluating evidence quality of each outcome. RESULTS: 7,025 studies were identified, 12 met the inclusion criteria. The outcomes in the literature are quality of life related to the degree of independence and depression, to the perception and health management and to the adaptation and stress tolerance. No primary outcome is reported in the literature with a high degree of confidence. DISCUSSION: The nurse's role the management for people affected by stroke after discharge from hospital to home represent an effective strategy for an improvement in the functional outcome, quality of life and reduction of costs.

[Vaccination, attitudes and perception of parents. Study in the ASL of Salerno]. / Vaccinazioni, attitudini e percezione dei genitori. Indagine nella ASL di Salerno.

OBJECTIVE: Despite the many advances obtained thanks to vaccination, in recent years it has been a marked drop in vaccination coverage. In fact, data show the failure in reaching the 95% of coverage, equal to the safety threshold for almost all vaccinations. This is due to the phenomenon of vaccine hesitancy. Aim of this study is to describe knowledge, attitudes and perceptions respect to childhood vaccinations in a sample of parents of patients of a Free Choice Pediatrician (PLS) in the territory of Salerno Local Healthcare Service, (ASL) to assess what might be the educational needs of parents to decrease the hesitation. METHODS: A quantitative observational descriptive and phenomenological study was conducted, recruiting parents belonging to a PLS in ASL Salerno, through a questionnaire constructed ad hoc. RESULTS: Parents are not always favorable to vaccination and for some vaccine they fear a bond with a pharmaceutical business. All have vaccinated their children but not for all available vaccinations. DISCUSSION AND CONCLUSIONS . Through the educational means of the PLS doubts about vaccinations are minor and the sample of children is vaccinated, although parents appear not totally supportive and considers vaccinations as a warranty by the ASL. The sample has shown a discrepancy between the health workers about the need to vaccinate or not. Hence the need to train the health care professional before and make him responsible and then inform, through a dedicated path, who should receive the vaccine.

[The Adherence's indicators of cancer patients to oral chemotherapy. A sistematic literature review]. / Gli indicatori di aderenza dei pazienti oncologici alla chemioterapia orale. Evidenze empiriche da una revisione sistematica della letteratura.

INTRODUCTION: Adherence has a key role in treating patients as influences the effectiveness of therapeutic treatment for improving overall survival, life expectancy, quality of life and reducing healthcare costs. There are gaps in identifying indicators to be used to evaluate adherence and ways in which these indicators should be adopted. The aim of this paper is to identify adherence's indicators in literature. METHODS: Systematic review was carried out in, Cinhal-EBSCO, Medline-PUBMED and Scopus including studies of measure patient's adherence in English and published from 2010 to 2016. Inclusion and exclusion criteria were used. The quality of the articles was assessed with the NewCastle Ottawa Scale for observational studies and the Cochrane Collaboration Risk of Bias for experimental studies. RESULTS: Of the 7,368 papers initially retrieved, 15 met the inclusion criteria (11 observational studies, 4 RCTs), for a total of 1,396 patients. The indicators found are: self-report tools, pill counts, drug recharge rate, continuous measures, metabolic dosage. A patient is considered adherent to the treatment if he or she assumes a percentage of drugs ≥ 80% of the prescribed medications. DISCUSSION: A better adherence rating is obtained by using multiple instruments at the same time. The objective indicators derive from the direct measurement methods of adherence, the subjective ones from the indirect.

The meaning of empowerment within Italian nursing care settings.

AIM: To examine the current state of empowerment of nurses in Italy. BACKGROUND: Empowerment is a broad concept that is also relevant to the field of nursing practice. Its comprehension and use are important because empowerment allows nurses to take control of their own practice. A clear understanding of empowerment is necessary for nurses to take advantage of this important tool. DESIGN: Focus groups were conducted. METHODS: A literature review was performed, and two focus groups were selected between January and February 2014. RESULTS: Sixteen nurses participated in the research. Empowerment is seen as being strongly connected to autonomy and is not associated with power, as the word itself suggests. Italian nurses define empowerment as the creation of conditions that help to establish the possibility for people to develop and express their value and potential. CONCLUSIONS: Empowerment is defined as a condition in which the individual nurse takes control of his/her own practice and thereby provides awareness and confidence to a group. IMPLICATIONS FOR NURSING MANAGEMENT: Italian nurses need to feel appreciated and supported by their own organisations. If warranted, empowerment would allow them to contribute to enhance care, which is the core of the nursing profession.

Philosophical and theoretical content of the nursing discipline in academic education: A critical interpretive synthesis.

BACKGROUND: Nursing as clinical practice, management and research are based on nursing philosophy and theory. Thus, the philosophical and theoretical content is required to be incorporated in academic education in order to enable nurses' skills for reflection, analysis, and thinking about the profession. OBJECTIVE: The aim of this review was to describe what is known of the philosophical and theoretical content of the nursing discipline within academic education. DESIGN: A critical interpretive synthesis (CIS). METHODS: Electronic searches were performed across four databases, CINAHL, Scopus, Medline, and Web of Science, for papers published in English from 1980 to 2016. The selection of original articles was based on stages, and inclusion and exclusion criteria were used. Quality of the selected papers were evaluated by method sensitive appraisal criteria. The five phases of CIS were used to combine the selected data. RESULTS: The searches resulted 9148 titles, whereas 13 were selected. Nurses need philosophical and theoretical education in order to be aware of human health and explain the complexity of the human experience of illness. The philosophy of science, the philosophy of care, and theory development were highlighted as the key contents in nursing academic education as these subjects are central to the discipline that ensures that nurses acquire advanced skills. A model was developed that linked disciplinary issues the progression nursing science through the influence of advanced skills. CONCLUSIONS: Based on the findings in this study the philosophical and theoretical content of nursing discipline crates a basis for the academic education and enables a professional and exclusive vision for nurses. It provides an overall understanding of people's lives and support nurses to achieve deeper awareness of the meaning of illness and health in a person lifespan what is needed on the evidence-based decision making.

Are community-based nurse-led self-management support interventions effective in chronic patients? Results of a systematic review and meta-analysis.

The expansion of primary care and community-based service delivery systems is intended to meet emerging needs, reduce the costs of hospital-based ambulatory care and prevent avoidable hospital use by the provision of more appropriate care. Great emphasis has been placed on the role of self-management in the complex process of care of patient with long-term conditions. Several studies have determined that nurses, among the health professionals, are more recommended to promote health and deliver preventive programs within the primary care context. The aim of this systematic review and meta-analysis is to assess the efficacy of the nurse-led self-management support versus usual care evaluating patient outcomes in chronic care community programs. Systematic review was carried out in MEDLINE, CINAHL, Scopus and Web of Science including RCTs of nurse-led self-management support interventions performed to improve observer reported outcomes (OROs) and patients reported outcomes (PROs), with any method of communication exchange or education in a community setting on patients >18 years of age with a diagnosis of chronic diseases or multi-morbidity. Of the 7,279 papers initially retrieved, 29 met the inclusion criteria. Meta-analyses on systolic (SBP) and diastolic (DBP) blood pressure reduction (10 studies-3,881 patients) and HbA1c reduction (7 studies-2,669 patients) were carried-out. The pooled MD were: SBP -3.04 (95% CI -5.01--1.06), DBP -1.42 (95% CI -1.42--0.49) and HbA1c -0.15 (95% CI -0.32-0.01) in favor of the experimental groups. Meta-analyses of subgroups showed, among others, a statistically significant effect if the interventions were delivered to patients with diabetes (SBP) or CVD (DBP), if the nurses were specifically trained, if the studies had a sample size higher than 200 patients and if the allocation concealment was not clearly defined. Effects on other OROs and PROs as well as quality of life remain inconclusive.

[Compassionate nursing care: the experience of italian nurses]. / Cure infermieristiche compassionevoli: l'esperienza degli infermieri italiani.

AIM: In international nursing literature compassion and compassionate care has acquired a considerable importance and it's considered to be a growing phenomenon. The approach to the application of compassionate care to patients is clearly not well-defined in Italian nursing. The aim of this study is to define what compassionate care is through the analysis of Italian nurses' experiences. METHOD: The research is based on a qualitative method. Content analysis was used to analyze the transcript data. The research has been carried out by creating three focus groups, for a total of 15 nurses. RESULTS: All the participants expressed their opinions freely. The outcomes of the analysis can be grouped in four areas: definition of compassion and compassionate care; categorisation of patients; provision of care; and formation and training in compassionate care. The survey has shown contrasting opinions, negative opinions such as feelings of rejections and positive opinions such as love, charity, empathy and support. The last one (support) in particular has highlighted the importance of involving the patient's relatives in providing compassionate care. CONCLUSIONS: It is difficult to define exactly the meaning of compassion and compassionate care.This study has contributed to extend and deep the current knowledge in regard of the concept of compas-sionate care applied to assistance entities. Further research is needed in the field of compassionate care to strength the effectiveness of assistance provided by nurses.

[Structural empowerment and job satisfaction among nurses coordinators: a pilot study]. / Empowerment strutturale e soddisfazione sul lavoro tra gli infermieri coordinatori: uno studio pilota.

INTRODUCTION: In literature, the structural empowerment and the job satisfaction have been studied in many different work settings but more need to be done in the setting of Head Nurses. OBJECTIVE: The goal of the study is to evaluate the structural empowerment level of head nurses and if it impacts on the job satisfaction. METHODS: A cross sectional design study was used. We enrolled 125 head nurses from three different hospitals of Rome. To collect the data we used a questionnaire that included both a part of the collection of sociopersonal data and the two scales (job satisfaction and structural empowerment). We used the SPSS19.0 statistical Software for data analysis to detect significant results. RESULTS: Head Nurse declared to be not enough satisfied at work (mean=3.43) and their structural empowerment level resulted moderate (mean=3.16). The structural empowerment of head nurses impacts their job satisfaction especially concerning opportunities for social and professional interactions, praises, awards, audit and responsibilities. CONCLUSIONS: Results underline structural empowerment relevance in head nurses job satisfaction. Healthcare organizations need to address job satisfaction to improve quality of care and more specifically that of head nurses since they directly impact on nurses job satisfaction.

[Educational curriculum and occupational status of nurses and midwives after second level degree (MNsc) at Catholic University of Rome]. / Curriculum formativo del laureato specialista e mondo del lavoro: Indagine su infermieri e ostetriche dell'Università Cattolica.

Our society requires health professionals of increasingly competence, able to modulate their skills according to the needs and the requirements of the context. This survey (cross - sectional) has as primary aim to collect information on employment status of individuals who have a Master degree in Nursing and Midwifery, and as secondary objective to describe if and how the post graduation education has affected the quality and the outcomes of nursing work. A questionnaire devised for the purpose has been used. The survey was conducted from May to August 2011 on all individuals who have a Master in Nursing and Midwifery at the UCSC (from 2004-2005 to 2009-2010). Results show that in 44 cases out of 111 (= 40%) there was a change of employment status after obtaining the Master's Degree and of these 68% (30 out of 44) state that the change is definitely linked to the Post graduation education. All respondents state that the University curriculum has certainly helped to modify some professional behaviors: research utilization (93%), skills in problem solving at work (68%); greater ease to communicate the reasons underlying their organizational choices or decision making (70%); self-training abilities (63%). Within the Italian context, however it seems that those individuals are involved in a managerial progression of their career rather than in the core nursing activities despite the fact that educational programs have important subjects for Advanced Nursing Practice and Nursing Science.

[Nursing Research Project on Management Training (IN.FOR.MA): evaluation of the competencies acquired during Phase 1]. / Progetto di Ricerca INfermieristica sulla FORmazione Manageriale (IN.FOR.MA): costruzione di uno strumento per la valutazione delle competenze acquisite dai professionisti durante il master in management per le funzioni di coordinamento.

The aim of the present study is to define the state of the art in nursing management training in Italy and to assess the effectiveness of training in a working context. The first phase of the IN.FOR.MA project consisted of creating a data collection tool, a questionnaire, based on paradigmatic pedagogic methodology. This was followed by a pilot study to test its effectiveness. Reliability was tested using the Cronbach's alpha test and the values obtained were between 0.79 and 0.82 for the overall scale and between 0.71 and 0.90 for the subscales. The maximum expression of the competencies perceived using the Likert scale was 4 (Fair), with a maximum value of 5 obtained in 53,06% of the total sample in the "Management" area and a minimum value between 3 (discreet) and 4 (fair) in 33.6% of the total in the area "Training and Research". Perception of the working value of the training experience reached 5 (very) , with an average value of 54,08% of the overall sample. The IN.FOR.MA questionnaire made it possible to assess the training course by focusing on the perception of the competencies acquired, with medium to high levels according to the Likert scale. The level of usefulness of these competencies in daily activities was highest in "Management" followed by "Programming and organization" and "Integration".

[Quality of life in people with pacemaker]. / Qualità di vita nelle persone con pacemaker.

The aim of this study was to measure Quality of Life (QOL) before a pacemaker (PM) implantation and 1, 6 and 12 months later. Using a descriptive, comparative and correlative design a sample of 157 patients was studied who were divided in four groups: the group A (43 patients) who had to implant the PM; the group B (38 patients) who had the PM implanted 1 month before; the group C (29 patients) who had the PM implanted 6 months before, and the group C (44 patients) who the PM implanted 12 months before. The SF-36 scale was used. Groups B, C and D had QOL levels significantly higher than group A. In group A QOL was higher in people who were male, older, more educated, with higher income, more cohabitants and children. In group B QOL was higher in patients with ventricular pacing, male, younger, without job and illnesses. In group C QOL was higher in patients with non rate responsive PM, younger, without job and illnesses. In group D QOL was higher in younger and in those without job and illnesses. The present study gives and overview of QOL before and after a PM implantation and highlights the importance to modify nursing care from the preoperative to the immediate and later postoperative period.

Hope and related variables in Italian cancer patients.

Hope, long considered an essential element for life, has been shown to be important among cancer patients in coping, perceived control over the illness, and psychologic adjustment to the illness. The purpose of this study was (a) to describe the level of hope in Italian cancer patients; (b) to compare the levels of hope during and after hospitalization; (c) to determine whether hope was correlated with quality of life and several symptoms; and (d) to determine whether the variables from the international literature also pertain to Italian cancer patients. A descriptive correlational design using repeated measures was chosen to study 80 Italian cancer patients during hospitalization and then at home. The following instruments were used: a Sociodemographic Questionnaire, the Hope Related Variable Questionnaire, the Nowotny Hope Scale, the Rotterdam Symptom Checklist, and the Hospital Anxiety and Depression Scale. Overall, patients were moderately hopeful and the level of hopefulness was similar in the hospital and at home. Hope was positively correlated with quality of life, self-esteem, coping, adjustment to the illness, well-being, comfort in the hospital, satisfaction with information received, relationship with, and support from family, healthcare professional, and friends. Hope was negatively correlated with anxiety, depression, and boredom during hospitalization. Time since diagnosis, illness stage, and knowing or not knowing the diagnosis and treatment were not correlated with hope. Similarities and differences with the international literature are discussed, and implications for caring for Italian cancer patients are drawn.

[Teaching nursing research at bachelor and second level degree: opinions of nursing associate professors and nursing researchers]. / L'insegnamento della ricerca infermieristica nel corso di laurea e laurea specialistica: le opinioni dei professori associati e dei ricercatori di scienze infermieristiche.

Nursing research is a systematic and very important enquiry for improving clients' quality of life and effective and efficient nursing care. National and international literature state that all nurses should have knowledge and responsibilities in research which are different in relation to their educational level. The aim of the present study was to collect opinions of the new professors in nursing about objectives, contents and methods for teaching nursing research at Bachelor and Master Degree. The sample was made of nine participants who were interviewed by twenty questions sent by e-mail. The interviews were analysed using quantitative-descriptive and qualitative-phenomenological methods (triangulation). Interviews revealed that Bachelor students should be educated to retrieve and criticise scientific literature, to apply research finding in practice and to collaborate in research studies; Master students should improve knowledge of Bachelor degree and be able to design and conduct research studies. Participants emphasised the importance of using active methodologies for teaching and to involve students in research. By analysing the literature and the results of the present study educational objectives for teaching nursing research at Bachelor and Master degree are defined.

[The managerial education of nurse coordinator and the educational contract: the experience of the First Level Master in Nursing Management for Coordinational Functions at the Catholic University of Rome]. / La formazione manageriale dell'infermiere coordinatore e il contratto formativo: l'esperienza del Master di primo livello in Management Infermieristico per le Funzioni di Coordinamento dell'Università Cattolica del S. Cuore, sede di Roma.

Changes in the National Health Service (NHS), in nursing laws and education made necessary a first level Master to teach nurses managerial competences for coordinational functions. Nowadays nurse coordinator are important in health organization in order to transform individual knowledges of nurses in effective, efficient and appropriate care practice. The project of the First Level Master in Nursing Management for Coordinational Functions run at the Catholic University of Rome, kept into consideration changes in NHS, nursing laws and education. The Master was made of four modules in order to teach learning specific competences. The Pedagogy of the Contract was used to guide the training. A Form based on the Pedagogy of the Contract was developed. This Form helped in defining the training objectives and their evaluation. The Model of the Reflection about the Experience and the presence of a tutor were used to integrate education with training settings. This Master emphasized the current functions of the nurse coordinator such as problem solving, direction, organization and mainly the management of knowledge of coordinated nurses.