[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.

A new D-dimer cutoff in bedridden hospitalized elderly patients.

Asymptomatic deep vein thrombosis (DVT) and pulmonary embolism are leading causes of morbidity following the hospitalization of elderly people. The diagnosis of DVT is supported by the D-dimer laboratory assay. The concentration of D-dimer increases in patients with DVT, but may be high in other conditions too (i.e. cancer, infections and inflammation). Old age coincides with a physiological increase in D-dimer values, and that is why D-dimer assay in the elderly is characteristically highly sensitive but scarcely specific. The aim of our study was to explore the reliability of different D-dimer cutoffs for the diagnosis of asymptomatic DVT in a population of bedridden hospitalized elderly patients. We studied 199 patients who were a mean 86.3 ±â€Š6.7 years old. All participants underwent lower limb Doppler ultrasound (DUS) and D-dimer venous blood sampling on admission. In our cohort, the usual cutoff proved highly sensitive (100%), but its specificity was very poor (20.1%). To find a higher cutoff that could improve the method's specificity, we analyzed our data using a receiver operating characteristic curve analysis. The resulting D-dimer cutoff of 492 µg/l enabled us to retain the same sensitivity while improving the test's specificity to 39.1%, with a consequent improvement in its positive predictive value and accuracy. In addition to improving the method's reliability, this result may be helpful in clinical practice, in both medical wards and nursing homes. By adopting a cutoff of 492 µg/l, clinicians could significantly increase the proportion of older patients in whom DVT can be safely ruled out, reducing referrals for DUS and administration of heparin, with consequent clinical, practical and economic advantages.