The role of nurse-patient mutuality on self-care behaviours in patients with chronic illness.

AIM: To examine the role of nurse-patient mutuality on three self-care behaviours in chronic illness patients. DESIGN: A cross-sectional multi-centre study was conducted. METHODS: Mutuality was measured with the Nurse-Patient Mutuality in Chronic Illness scale which has the dimensions of developing and going beyond, being a point of reference and deciding and sharing care, and self-care was measured with the Self-care of Chronic Illness Inventory (SC-CII). Multivariable linear regression analyses were used to assess the contribution of three dimensions of mutuality on self-care maintenance, monitoring and management behaviours controlling for patient gender, age, education, number of medications, and presence of a family caregiver. RESULTS: The sample included 465 inpatients and outpatients with at least one chronic illness. The three dimensions of mutuality had different roles in their influence on the three dimensions of self-care. Developing and going beyond was significantly associated with self-care maintenance and self-care monitoring behaviours. Point of reference was significantly associated with self-care maintenance behaviour. Deciding and sharing care was significantly associated with self-care monitoring and self-care management behaviours. CONCLUSION: The mutuality between nurse and patient may be a novel area of research to support and improve patient self-care behaviours with implications for clinical practice and education. IMPLICATION FOR PROFESSION AND PATIENT CARE: Mutuality between nurse and patient increases patient engagement, symptom recognition, decision-making process and patient-centred approach favouring the development of self-care behaviours. IMPACT: Mutuality between nurse and patient is a new concept and its association with the patient outcomes could bring relevance to the nursing profession. Self-care behaviours are important in the management of chronic diseases, but are difficult to perform. Mutuality between nurse and patient influences the three different behaviours of self-care in chronic illness, for this reason it is important to increase the level of mutuality in this dyad. REPORTING METHOD: STROBE checklist for cross-sectional studies was followed in this study. PATIENT OR PUBLIC CONTRIBUTION: Patients were involved in the sample of the study.

Mutuality between nurses and patients with chronic illnesses: A cross-sectional descriptive study.

BACKGROUND AND AIM: Mutuality is a process in which the patient participates and is involved in decision-making and care interventions. The aim of this study was to measure mutuality in the relationship between nurses and chronic illness patients. METHODS: This study had a cross-sectional design; the sample included 249 patients and 249 nurses. Mutuality was measured with the Nurse-Patient Mutuality in Chronic Illness scale. RESULTS: Patients had higher scores in almost all items (p < 0.001). Patients demonstrate high reciprocity towards nurses and the ability to express and share their emotions. Patients consider nurses their point of reference and share with them their health goals. Nurses show more difficulty in being mutual with the patient, especially in the aspects related to the sharing of emotions, objectives, and planning. The egalitarian relationship score was low in both patients and nurses. CONCLUSION: These findings are important to consider at clinical, educational, organisational, and policy levels. Nurse education and organisation must push towards respect for the wishes of patients, the possibility of expressing their choices, and their involvement in the care plan. PRACTICE IMPLICATIONS: In clinical practice, it is necessary to put the patients more at the centre, involving them in the identification of objectives and in making decisions.

Nurses' role in the management of persons with chronic urogenital pelvic pain syndromes: A scoping review.

BACKGROUND: Pelvic pain has cognitive, behavioral, sexual, and emotional consequences. Nurses involved in pelvic floor rehabilitation clinics have contacts with patients reporting chronic pain and should know the most appropriate service for patient referral, to submit the problem to professionals capable of correctly assessing and managing the condition. Furthermore, in some countries nurses can use conservative methods to treat the painful symptoms inside a multidisciplinary team such as breathing retraining, biofeedback, and noninvasive neuromodulation. This paper aims to provide an overview of the literature regarding the role of rehabilitation nurses in dealing with patients suffering from chronic urogenital pelvic pain or urogenital painful syndromes, inside a multidisciplinary team. METHODS: Scoping review on Pubmed, CINAHL, Embase, Scopus, Web of Science including trials, reviews, case studies or series, and other descriptive studies regarding the role of nurses inside the multidisciplinary team in the management of males and females presenting chronic pelvic pain (CPP) or chronic pelvic pain syndrome (CPPS). RESULTS: The 36 papers included in this review allowed answering research questions in four areas of nursing: collecting basic information, referring the person to appropriate services, evidence-based nursing interventions for CPP and CPPS, and proper documentation. Clinical history and assessment of breathing pattern, Muscular assessment and research of trigger points are the main points of data collection. Techniques for muscular relaxation and breathing retraining are important aspects of treatment, as well as biofeedback and noninvasive neuromodulation where the law allows nurses to practice such techniques. The McGill pain questionnaire and the pain inventory of the International Pain Society allow systematic data collection and handover. CONCLUSION: Rehabilitation nurses work inside multidisciplinary teams when dealing with persons suffering from pelvic pain; further research is needed as our comprehension of the underlying pathophysiological mechanisms of CPP and CPPS evolve.

Development and validation of two versions of the Nurse-Patient Mutuality in Chronic Illness scale.

AIMS: The aim of the study was to develop and psychometrically test the Nurse-Patient Mutuality in Chronic Illness (NPM-CI) scale in two versions, one for nurses and one for patients. METHOD: A multiphase methodological study was conducted. In the first phase, a qualitative investigation was conducted through interviews and an analysis of the content; inductively, the items of two instruments were generated, one for nurses and one for patients. In the second phase, the content and face validity were assessed through the expert consensus method. In the third phase, exploratory factor analysis (EFA), Cronbach's alpha test, intraclass correlation and Pearson correlation coefficients were conducted to estimate construct, criterion validity and instrument reliability. For each phase, the sample included nurses and patients recruited from a large hospital in Northern Italy. Data collection was conducted between June and September 2021. RESULTS: Nurse and patient versions of the NPM-CI scale were developed. Two rounds of consensus reduced the items from 39 to 20; content validity index ranged between 0.78 and 1, content validity ratio was 0.94. Face validity indicated clarity and comprehensibility of the items. EFA identified three latent factors for both the scales. Internal consistency was satisfactory, with Cronbach's alphas ranging between .80 and .90. Test-retest stability was suggested, with an intraclass correlation coefficient of .96 (nurse scale) and .97 (patient scale). Predictive validity was established, with a Pearson correlation coefficient of .43 (nurse scale) and 0.55 (patient scale) between the mutuality scales and satisfaction in providing and receiving care. CONCLUSION: The results suggest that the NPM-CI scales are sufficiently valid and reliable for the clinical practice among chronic illness patients and the nurses caring for them. A more in-depth exploration of this construct in the context of nursing and patient outcomes is warranted. PATIENT OR PUBLIC CONTRIBUTION: Patients were involved in all study phases. IMPACT: Mutuality is fundamental in the relationship between nurse and patient, based on trust, equality, reciprocity, and mutual respect. The NPM-CI scale was developed and psychometric estimated through a multiphase study in both nurse and patient versions. The NPM-CI scale measures the factors of 'developing and going beyond', 'being the point of reference' and 'deciding and sharing care'. The NPM-CI scale allows us to measure mutuality in clinical practice and research. Expected outcomes and influencing factors for patients and nurses could be associated.

Efficacy, effectiveness, usability and acceptability of devices for female urinary incontinence: A scoping review.

AIMS AND OBJECTIVES: Investigate evidence available on the efficacy, safety and acceptability of devices for the management of female urinary incontinence, in which clinical settings and specific female populations they have been tested. Learn more about healthcare professionals' perspectives and experiences regarding female urinary incontinence devices. BACKGROUND: Urinary incontinence is defined as the involuntary leakage of urine, estimated to affect 25%-45% of women. Urinary incontinence predisposes the skin to urinary incontinence dermatitis, it is one of the most common documented causes of inappropriate urinary catheterisation, favouring catheter-associated infection. Several products for managing female urinary incontinence are available, no accurate and systematic data on usability, effectiveness and associated outcomes of these products are available. DESIGN AND METHODS: A scoping review was conducted, using a methodological framework including the following five steps: identification of the research question; identification of relevant documents; selection of documents included in the review; tracking of information and data; synthesis and reporting of results. Twenty-one articles were selected. PRISMA-ScR Checklist was followed. RESULTS: The devices explored in the studies were as follows: female external urinary catheter; disposable sanitary pads, diapers or sanitary pads used to manage urinary incontinence in women; mechanical devices; a new prototype of underwear that tracks where pads lose; reusable underwear for light incontinence; a new intelligent system pad. CONCLUSIONS: New smart pads, urine suction systems and female external catheters appear to be effective in preventing and reducing urinary incontinence dermatitis. The female external catheter reduces the days of indwelling catheterisation and could reduce the incidence of catheter associated urinary tract infection; therefore, it should be recommended.

A qualitative phenomenological study of nurses' experiences in caring for infants and children with life-limiting and life-threatening conditions.

PURPOSE: To understand the experience of nurses caring for infants and children with life limiting and life-threatening conditions. DESIGN AND METHODS: A qualitative phenomenological study was conducted, collecting data through deep interviews. Sample included twenty-seven nurses working in paediatric and neonatal intensive care units. RESULTS: Four themes emerged: suffering, being there, protect yourself and support. The experience of caring for children with limiting and life-threatening conditions affects nurses positively, with personal and professional gratification, but also negatively, as it leads to the development of compartmentalization, avoidance, and high levels of stress. CONCLUSIONS: The organization should make resources available to help nurses build resilience, improve emotional intelligence, and process experiences and emotions, thereby bringing benefits and improvements in infant and childcare. PRACTICE IMPLICATIONS: Comparison between colleagues is one of the most effective tools for supporting each other. Dedicated times and spaces to be able to carry out the debriefings managed by the nurses themselves, guided and mediated by an expert figure, such as a psychologist or a trainer, would be recommended.

Risk of skin tears associated with nursing interventions: A systematic review.

BACKGROUND: Skin tears are a significant problem for patients and healthcare professionals. They can cause pain, impact quality of life, and become chronic and infected. The risk of skin tears is associated with dependence in daily life activities and with nursing interventions. OBJECTIVES: To examine which nursing interventions increase the risk of skin tears. DESIGN: Systematic review. DATA SOURCES: The MEDLINE, CINAHL, Scopus, and Cochrane Library databases were searched in March 2022. PUBLICATION YEARS: Publications included were from 2012 to 2022. RESULTS: Seventeen articles were included in the final analysis reporting nursing interventions associated with the risk of skin tears. Hygiene with cold water and soap, not applying leave-on products to moisten/protect dehydrated skin, and wearing short sleeves were found to be associated with skin tears. Transferring patients into and out of bed in a rough manner and wearing jewelry or long nails can increase the risk of skin tears. Removal of adhesive dressings or bandages can also cause skin tears. CONCLUSION: Nursing staff need to know which interventions put their patients at risk of skin tears and which interventions are recommended to prevent skin tears. Nursing care can affect the health of the patient's skin.

Perceived knowledge on the ICNP© in undergraduate nursing students: the development of a scale.

OBJECTIVES: To develop and validate an instrument to assess nursing students' perceived knowledge on the International Classification for Nursing Practice. METHODS: The study design is an initial development of a scale by a longitudinal, prospective, monocentric study. An instrument, including a final pool of 6 items, was developed and through a Content Validity approved by experts. Cronbach's alpha coefficient, Exploratory Factor Analysis and Confirmatory Factor Analysis were calculated in a sample of nursing students. RESULTS: The instrument demonstrated a CVI of 1.0. Cronbach's alpha coefficient was 0.879. Exploratory Factor Analysis indicated one component, with a saturation of items in the range between 0.594 and 0.856. Confirmatory Factor Analysis confirmed the structure. CONCLUSIONS: Although further studies are needed, the preliminary analyses of the instrument suggest satisfaction in terms of content validity, factorial structure, and reliability. This instrument may rise interest in international nursing educational context.

Clown therapy for procedural pain in children: a systematic review and meta-analysis.

Among the distraction techniques used for the non-pharmacological management of acute pediatric pain, one of the most performed is clown therapy. Despite the presence in the literature of some systematic reviews that evaluate its effectiveness, none of them examines its outcomes on procedural pain which has therefore been investigated in this study. The literature search for randomized controlled trials (RCTs) was performed on the Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and Scopus over a time frame ranging from each database setup date to 31 July 2021. The primary outcome was the procedural pain of children. We used the Cochrane Risk of Bias tool to assess the risk of bias of the included studies. Six RCTs were selected for this review, which included a total of 517 pediatric subjects. Children undergoing clown therapy during the venipuncture or peripheral vein cannulation procedure reported less pain than those exposed to the standard of care (SMD = -0.55; 95% CI: -1.23, 0.13) but the result was not found to be statistically significant. School-aged children and adolescent reported significantly less pain (SMD = -0.51; 95% CI: -0.92, -0.09). Compared to the standard of care, children's anxiety was significantly lower with clown therapy (SMD = -0.97; 95% CI: -1.38, -0.56). CONCLUSION: Clown therapy seems effective in reducing procedural pain in children, particularly for older age groups, but due to poor methodological quality and the high risk of bias of the studies included, the results obtained should be considered with caution. WHAT IS KNOWN: • Clown therapy is one of the most used techniques in the non-pharmacological management of acute pediatric pain. • Laughter physiologically stimulates the production of beta-endorphins, substances with an effect similar to opiates. WHAT IS NEW: • Clown therapy seems effective in reducing procedural pain and anxiety in children. • The intervention in school-age children or adolescents produces a statistically significant decrease in the symptom.

Mutuality in nursing: A conceptual framework on the relationship between patient and nurse.

AIMS: To describe and develop a conceptual framework for the process of mutuality between nurse and patient. DESIGN: This was a qualitative study with a grounded theory (GT) design following the constructivist approach of Charmaz (SAGE handbook of research, 2014). METHODS: A sample of 33 patients with one or more chronic diseases and 35 nurses were interviewed between July and October 2020. Comparative and simultaneous data analyses were conducted. Theoretical sampling and saturation of categories were used to define the sample size. RESULTS: A conceptual framework for mutuality between nurse (mean age 42 SD ±7 years, 89% female) and patient (mean age 63 SD ±8 years, 42% female) was developed, including the mutuality process, potential influencing factors for both nurses and patients, and outcomes. The mutuality process was characterised by three dimensions: developing and going beyond, being a reference, and deciding and sharing care. Influencing factors for nurses were personal characteristics and professional organisation, while for patients these were age and past experiences. Nurse outcomes were satisfaction and quality of life; patient outcomes were improved self-care and reduction of hospitalisation and emergency admissions. CONCLUSION: This study described a new conceptual framework for mutuality between nurse and patient, which could improve our understanding of the relationship between nurses and patients, thus enhancing both nurse and patient outcomes.

Review of literature on instruments measuring health professionals' knowledges, attitudes, and perceptions of antimicrobial stewardship programs. / Revisione della letteratura sugli strumenti che misurano le conoscenze, atteggiamenti e percezioni dei professionisti sanitari rispetto ai programmi di antimicrobial stewardship.

INTRODUCTION: The establishment of multi-disciplinary antimicrobial stewardship programmes means that there is a need to study how well healthcare personnel are able to deal with the problem on a daily basis. This study therefore aimed to identify and critically examine existing tools to measure knowledge, attitudes and practices with respect to antimicrobial stewardship among physicians and nurses. METHODS: After a literature review of biomedical databases such as PUBMED, EMBASE, SCOPUS, CINAHL, a total of 14 instruments were identified between May and November 2021, the purpose, theoretical framework and statistical validity of which were analysed and described. RESULTS: The theoretical framework and validation process vary widely between instruments and are not described in all of them. The pilot study was not always conducted or well detailed. The questionnaires varied in length and were mostly answered on a 5-7 point Likert scale. The work of Baraka et al 2019 together with that of Ashiru-Oredope et al 2021 appear to be the best from the point of view of statistical validity. Baraka has the high number of questions. CONCLUSION: The literature review and the use of already existing instruments, even by the same author, are the basis of all the identified studies even if the explanation with respect to the reason for this choice is missing. The validation process was not described for all instruments. When selecting and adapting instruments, attention should be paid to the domains within the scale, the number of items and the theoretical-cultural fit.

[The use of International Classification for Nursing Practice (ICNP) in pediatric and neonatal settings: literature review]. / L'utilizzo della Classificazione Internazionale per la Pratica Infermieristica (ICNP) in ambito pediatrico e neonatale: revisione della letteratura.

INTRODUCTION: Literature reports that the use of Standardized Nursing Terminology contributes to a better implementation of nursing care and patients' safety and to do research. ICNP is an international and combinatorial standard terminology proposal by ICN, adaptable to different settings, among which paediatric and neonatal. METHODS: A literature review on different databases (Medline/Pubmed, CINAHL, Embase, Web of Science and Scopus) was conducted to investigate the use of ICNP in professional practice in paediatric and neonatal settings. RESULTS: 44 papers were included in the review; 33 of which focused on the paediatric setting while 11 on the neonatal setting. It is evident ICNP is usable in both settings, permitting to describe nursing care to different age groups, in-hospital, out-of-hospital and in specific clinical situations. DISCUSSION: ICNP is up to the task of describing nursing care, implementing nursing care plans, analysing types of nursing care for management aims, studying concepts or specific pediatric or neonatal situations. ICNP is adaptable to different nursing frameworks and models. Few studies analyses ICNP implementation or effectiveness in clinical settings. Additional research is needed to verify ICNP effectiveness in paediatric and neonatal settings and to implement contextual catalogues.

Knowledge, attitudes, and practices related to antibiotic resistance among physicians and nurses in Italian intensive care: A multicenter cross-sectional survey.

OBJECTIVES: The aim of this study is to investigate the knowledge, attitudes and practices of Italian intensive-care physicians and nurses with respect to antibiotic resistance. METHODS: A multicenter cross-sectional survey was conducted of 20 Italian intensive care units, supported by an online validated questionnaire. RESULTS: A total of 143 participants took part, mainly nurses (79.7%). Most respondents were between 26 and 45 y old (62.9%), with more than 6 y of service (about 71%). Some 90% of those who took part stated that they were aware of the problem of antibiotic resistance and had easy access to guidelines and information materials on the subject. On the other hand, a high level of disagreement, mostly among nurses, emerged in relation to knowledge of the existence of national plans for the fight against AMR (62.9%) or the presence of international information campaigns (80%). A majority (76%) said they had received no specific training in the past 12 months. Most physicians (70%-90%) showed faith in their ability to prescribe, trusted guidelines, and recognized their role in antibiotic resistance by considering it while prescribing antimicrobial therapy. CONCLUSIONS: The study highlights the need for targeted training interventions, especially for nurses, and the importance of involving all healthcare professionals in the fight against antibiotic resistance.

Electronic patient-reported outcomes (e-PROMs) in palliative cancer care: a scoping review.

BACKGROUND: In palliative oncology settings, electronic patient-reported outcome (PRO) assessment can play an important role in supporting clinical activities for clinicians and patients. This scoping review aims to map the technological innovation of electronic patient-reported outcome measures (e-PROMs) in cancer palliative care and how PRO data collected through e-PROMs can influence the monitoring and management of symptoms and enable better communication between health professionals and patients. METHODS: A scoping review study was designed according to the Arksey and O'Malley framework. Medline, Embase, Web of Science, SCOPUS, PsycINFO and CINAHL and gray literature sources were consulted. The inclusion criteria were people over 18 years old receiving palliative and/or end-of-life care using e-PROMs. RESULTS: Thirteen primary studies were included: nine quantitative studies, two qualitative studies, and two mixed-method studies. The recently developed software that supports e-PROMs allows patients to receive feedback on their symptoms, helps clinicians prioritize care needs and monitors patients' conditions as their symptoms change. Electronic PRO data prompt difficult, end-of-life communication between clinicians and patients to better organize care in the last phase of life. CONCLUSION: This work shows that electronic PRO data assessment provides valuable tools for patients' well-being and the management of symptoms; only one study reported conflicting results. However, with studies lacking on how clinicians can use these tools to improve communication with patients, more research is needed.

Mutuality in Motor Neuron Disease: A Mixed-Method Study.

ABSTRACT: BACKGROUND: Mutuality, a positive relationship between caregiver and care receiver that affects patient's health and caregiver's burden, stress, and well-being, has never been investigated in motor neuron disease. METHOD: We conducted a mixed-method study with convergent parallel design. Quantitative data were collected with the Mutuality Scale, and qualitative data were collected using deep interviews. The sample was composed of 30 people with motor neuron diseases and 24 family caregivers. RESULTS: Deductive, qualitative content analysis of the interviews confirmed the presence of mutuality and its 4 dimensions. The average score of patients' Mutuality Scale was 3.07 (SD, 0.79; range, 1.3-4), and that of the caregivers was 3.16 (SD, 0.53; range, 2.2-3.9). The dimensions "love" and "shared values" had the highest scores, whereas the dimension "shared pleasurable activities" had the lowest score. Patients' and caregivers' answers correlated. CONCLUSION: Mutuality concept and its 4 dimensions had content validity in motor neuron disease people. Nurses should consider the level of mutuality and adopt strategies to increase and preserve it.

Going inside the relationship between caregiver and care-receiver with Amyotrophic Lateral Sclerosis in Italy, a Grounded Theory study.

People with amyotrophic lateral sclerosis become dependent on caregivers for daily activities and to perform self-care activities at home. The family caregiver has an important role in the care. The patient decides and controls care but depends on the caregiver to implement self-care behaviours. The quality of caregiver-patient relationships could influence clinical outcomes, as it occurs in other illnesses, so the aim of this study was to investigate the relationship between the Amyotrophic Lateral Sclerosis patients and their family caregiver and how it impacts care, and patient and caregiver outcomes. We interviewed 22 patients/caregivers in a Neuromuscular Clinical Center in the South of Europe, between July and October 2018. A Grounded Theory approach was used, comprising line by line 'initial coding', memos writing, 'focused coding', advanced memos and categories definition. From the interviews three main categories emerged: 'reciprocity', 'loving to care' and 'changing to care' and four secondary categories: 'having support', 'sharing suffering', 'protecting each other' and 'thinking positive'. A stable and calm relationship between patient and caregiver, characterised by reciprocity, mutual help and affection affected patient self-care provided at home and the caregiver burden. The concept of mutuality seems to describe this relationship, despite the patient's dependence on the caregiver. The relationship with health professionals and educational interventions could influence the quality of the relationship. Further studies are needed to describe the quality of the relationship in this dyad, to investigate the presence of mutuality and how it affects patient and caregiver outcomes.