Self-care behaviours and their determinants in people affected by coronary heart disease.

OBJECTIVE: To describe self-care in Italian adults with coronary heart disease and to identify sociodemographic and clinical determinants of self-care. DESIGN: This is a cross-sectional analysis of data from the Italian multicentre longitudinal study. METHODS: We used the follow instruments: Self-Care of coronary heart disease inventory, Self-care Self Efficacy Scale, Charlson Comorbidity Index and Sociodemographic questionnaire. Descriptive statistics including absolute numbers, percentages, means and standard deviations were used to describe the sociodemographic and clinical characteristics of the sample, and the items. A structural equation model was fitted to understand sociodemographic and clinical variables associated with self-care, and possible effects mediated by self-efficacy. RESULTS: We enrolled 427 patients. Self-care maintenance, monitoring, management and self-care self-efficacy means scores were 58.27 (SD = 20.07), 48.53 (SD = 26.97), 65.34 (SD = 22.85) and 77.16 (SD = 20.76), respectively. Except for the self-care self-efficacy scale, all the scores lay below the cut off 70 for adequacy. Older age, higher comorbidities, a higher number of stents placed, and the presence of a caregiver predicted poor self-care. CONCLUSION: Self-care in Italian CHD populations is poor. Several associations were found between the dimensions of self-care and sociodemographic factors. Implications for the profession these findings are important for health care providers to plan interventions to improve self-care behaviour. IMPACT: The study addressed self-care behaviours of coronary heart disease patients. Self-care was poor in this population; several associations were found between the dimensions of self-care and sociodemographic and clinical determinants. Our results can be used to support health professionals in planning interventions to improve specific self-care domains. REPORTING METHOD: STROBE checklist was followed.

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.

Moving forward the Italian nursing education into the post-pandemic era: findings from a national qualitative research study.

BACKGROUND: During the CoronaVIrus-19 (COVID-19) pandemic, nursing education has been dramatically transformed and shaped according to the restrictions imposed by national rules. Restoring educational activities as delivered in the pre-pandemic era without making a critical evaluation of the transformations implemented, may sacrifice the extraordinary learning opportunity that this event has offered. The aim of this study was to identify a set of recommendations that can guide the Italian nursing education to move forward in the post-pandemic era. METHODS: A qualitative descriptive design was undertaken in 2022-2023 and reported here according to the COnsolidated criteria for REporting Qualitative research guidelines. A network was established of nine Italian universities offering a bachelor's degree in nursing for a total of 6135 students. A purposeful sample of 37 Faculty Members, 28 Clinical Nurse Educators and 65 Students/new graduates were involved. A data collection was conducted with a form including open-ended questions concerning which transformations in nursing education had been implemented during the pandemic, which of these should be maintained and valued, and what recommendations should address the transition of nursing education in the post-pandemic era. RESULTS: Nine main recommendations embodying 18 specific recommendations have emerged, all transversally influenced by the role of the digital transformation, as a complementary and strengthening strategy for face-to-face teaching. The findings also suggest the need to rethink clinical rotations and their supervision models, to refocus the clinical learning aims, to pay attention towards the student community and its social needs, and to define a pandemic educational plan to be ready for unexpected, but possible, future events. CONCLUSIONS: A multidimensional set of recommendations emerged, shaping a strategic map of action, where the main message is the need to rethink the whole nursing education, where digitalization is embodied. Preparing and moving nursing education forward by following the emerged recommendations may promote common standards of education and create the basis on for how to deal with future pandemic/catastrophic events by making ready and prepared the educational systems.

Gait Monitoring and Analysis: A Mathematical Approach.

Gait abnormalities are common in the elderly and individuals diagnosed with Parkinson's, often leading to reduced mobility and increased fall risk. Monitoring and assessing gait patterns in these populations play a crucial role in understanding disease progression, early detection of motor impairments, and developing personalized rehabilitation strategies. In particular, by identifying gait irregularities at an early stage, healthcare professionals can implement timely interventions and personalized therapeutic approaches, potentially delaying the onset of severe motor symptoms and improving overall patient outcomes. In this paper, we studied older adults affected by chronic diseases and/or Parkinson's disease by monitoring their gait due to wearable devices that can accurately detect a person's movements. In our study, about 50 people were involved in the trial (20 with Parkinson's disease and 30 people with chronic diseases) who have worn our device for at least 6 months. During the experimentation, each device collected 25 samples from the accelerometer sensor for each second. By analyzing those data, we propose a metric for the "gait quality" based on the measure of entropy obtained by applying the Fourier transform.

Specialized Nurse-led Care of Chronic Wounds During Hospitalization and After Discharge: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effectiveness of specialized nurse-led care of patients with chronic wounds, provided both during hospitalization and postdischarge, on wound healing and readmission rates. METHODS: An unblinded randomized controlled trial was conducted. Participants were patients with chronic wounds, randomly assigned to either the experimental group (cared for by wound care nurses both during hospitalization and postdischarge) or to the control group (cared for according to standard practice). Wound healing was identified as the primary outcome. RESULTS: Overall, 1,570 patients were randomized, 1,298 of whom were included in the per-protocol analysis (707 in the experimental group and 591 in the control group). Nurse-led wound care quadrupled the probability of healing and reduced the number of treatment weeks and hospital readmissions. CONCLUSIONS: Chronic wound care that was entrusted to specialized nurses improved outcomes in terms of wound healing, repair and regeneration, length of treatment, and rate of readmission, compared with standard practice. Future studies should evaluate the impact of care provided by specialized wound care nurses on patients' quality of life and healthcare costs. Nurse managers should promote the implementation of chronic wound clinical-care pathways entrusted to specialized nurses to improve patients' clinical outcomes and reduce hospital readmissions.

The prevention of falls in patients with Parkinson's disease with in-home monitoring using a wearable system: a pilot study protocol.

BACKGROUND: Parkinson's disease (PD) is a chronic, progressive neurodegenerative condition that gradually worsens motor function and leads to postural instability and, eventually, falls. Several factors may influence the frequency of future falls, such as slowness, freezing of gait, loss of balance, and mobility problems, cognitive impairments, and the number of previous falls. The TED bracelet is an advanced technological wearable device able to predict falls. AIMS: This principal aim is to investigate the feasibility of a full-scale research project that uses the TED bracelet to identify whether individuals with PD are at risk of falling. METHODS: This study will involve a pilot prospective observational study design; the subjects will include 26 patients suffering from mild PD and 26 others with no PD and no gait problems. Data will be collected from the TED bracelet and then compared to a paper-based fall diary. The enrolled participants will have a scheduled outpatient evaluation to collect both clinical and instrumental data as well as biological samples. DISCUSSION: This pilot study could then be implemented in a larger form to further evaluate the effectiveness of the TED device. Finally, it will help further develop gait monitoring systems for people with Parkinson's disease and other neurodegenerative diseases that can affect physical function and mobility, such as dementia and Alzheimer's. CONCLUSIONS: Preventing falls and their complications could lead to major advancements in the quality of home care for patients with PD, which would significantly impact the quality of life of both these patients and their caregivers.

Psychometric Testing of the Self-Care of Coronary Heart Disease Inventory Version 3.0.

BACKGROUND: In this updated Self-Care of Coronary Heart Disease Inventory (SC-CHDI) v3.0, items were added to better reflect the theory of self-care of chronic illness and revised based on recent research. The expanded SC-CHDI now reflects the theoretical concepts of self-care maintenance, monitoring, and management. OBJECTIVE: The aim of this study was to evaluate the psychometric properties of the SC-CHDI v3.0. METHODS: In a sample of adults with coronary heart disease, we tested the SC-CHDI v3.0 validity with confirmatory factor analysis. Reliability was calculated using Cronbach α, factor score determinacy coefficient, and global reliability index for multidimensional scales, with values > 0.70 considered adequate. RESULTS: The sample (n = 205) was predominantly male (79%) with a mean age of 65.3 ± 11.1 years. The self-care maintenance scale encompassed 2 distinct behaviors, namely, "illness related behaviors" and "health promoting behaviors," which reflect consulting and autonomous dimensions, respectively. The goodness-of-fit indices were adequate: χ2(25, N = 205) =31.86, P = .16, comparative fit index = 0.97, Tucker-Lewis Index = 0.95, root mean square error of approximation = 0.04 (90% confidence interval, 0.00-0.07), P = .705, and standardized root mean square residual = 0.045. Analysis of the new self-care monitoring scale yielded a single factor; goodness-of-fit indices were excellent: χ2(12, N = 205) =11.56, P = .48, comparative fit index = 1.00, Tucker-Lewis Index = 1.00, root mean square error of approximation < 0.001 (90% confidence interval, 0.000-0.07), P = .86, and standardized root mean square residual = 0.02. The self-care management scale had 2 dimensions of autonomous and consulting behavior with strong goodness-of-fit indices: χ2(7, N = 205) =6.57, P = .47, comparative fit index = 1.00, Tucker-Lewis Index = 1.00, root mean square error of approximation ≤ 0.001 (90% confidence interval, 0.00-0.08), P = .76, and standardized root mean square residual = 0.02. Reliability estimates were ≥0.80 for all scales. CONCLUSIONS: Our testing suggests that the SC-CHDI v3.0 is a sound measure of the essential elements of self-care for adults with coronary heart disease.

Nursing evaluation during treatment with helmet continuous positive airway pressure in patients with respiratory failure due to COVID-19 pneumonia: A case series.

BACKGROUND: During COVID-19 outbreak, with the increasing number of patients presenting with acute respiratory failure, a large use of non invasive positive pressure ventilation was done in the emergency departments and medical wards despite the lack of recommendations. OBJECTIVES: This study describes the clinical characteristics of patients presenting to the hospital with acute respiratory failure due to COVID-19 related pneumonia undergoing treatment with helmet continuous positive airway pressure (CPAP) with a strict nursing evaluation and monitoring. METHODS: A case series study enrolling adult patients admitted to an emergency department of an Italian hospital with acute respiratory failure due to COVID-19 pneumonia from March 18th to April 18th, 2020, was conducted. Only patients who strictly followed a local CPAP protocol were enrolled. RESULTS: A total of 52 patients were included in this study. Thirty-eight patients (73%) were judged eligible for endotracheal intubation (ETI). Eighteen (34.6%) were intubated. Sixteen (30.8%) patients died: seven (38.9%) and nine (26.5%) in the eligible-for-ETI and non eligible-for-ETI group, respectively. The median hospital length of stay was different in the ETI and non-ETI group: 26 days (interquartile range [IQR]: 16-37) vs 15 days [IQR 9-17] (p = 0.005). The median invasive mechanical ventilation time was 11 days [IQR 7-21] with an ICU length of stay of 14.5 days [IQR 10-28]. During the CPAP trial, among patients eligible for ETI variations over time for positive end-expiratory pressure (p = 0.003) and respiratory rate (p = 0.059) were found between intubated and non-intubated patients. CONCLUSIONS: A short closed monitored CPAP trial could be considered for acute respiratory failure due to COVID-19 pneumonia before considering ETI. A progressive positive end-expiratory pressure titration should target reduction in a patient's respiratory rate. More studies are needed to evaluate the efficacy and predictors of failure of CPAP and non-invasive positive pressure ventilation in patients with acute respiratory failure due to COVID-19 pneumonia.

Chronic pain in in survivors of critical illness: prevalence and associated psychological disorders. / Il dolore cronico nei pazienti dimessi dalla Terapia Intensiva: prevalenza e disturbi psicologici associati.

AIM: To investigate the prevalence and characteristics of chronic postICU pain in survivors of critical illness and to examine the association between pain and psychological disorders. METHODS: The study was carried out in an Italian ICU. Six months after ICU discharge, patients were called back for an interview for assessed chronic pain (CP), pain intensity, pain location and interference of pain with activities of daily living. During the interview a battery of psychometric test was administered for evaluate anxiety, depression, insomnia, fatigue and posttraumatic stress disorder (PTSD). RESULTS: A total of 143 patients were interviewed and 34 patients (23.8%) reported pain. Nearly 70.6% of respondents suffering from CP were females (p<.001). The most common sites of pain were the shoulder (16.1%), lower limb (11.9%) and the lumbar spine (11.2%). The largest number of CP patients (n= 14) had pain at 4 or more anatomical regions. The prevalence for chronic pain, anxiety, depression, insomnia, fatigue and PTSD were 23.8%, 9.1%, 13.3%, 4.2%, 5.6% and 2.1% respectively. The multivariable analysis indicated significant associations between chronic pain and anxiety (p= .003), depression (p=.015) and insomnia (p= .027). There was a great use of analgesics and nonsteroidal antiinflammatory drugs (NSAIDs) for the pain treatment in 19 patients (55.9%). DISCUSSION: Cronic pain seems associated with some psychological disorders observed 6 months after an ICU stay. In future, studies that investigate interventions to prevent chronic postICU pain are needed.

The social and professional image of the nurse: results of a survey during the Covid-19 pandemic. / L'immagine sociale e professionale dell'infermiere: risultati di una survey durante la Pandemia Covid-19.

INTRODUCTION: Although nursing today is an intellectual profession to all intents and purposes, thesocial and professional image gap has not yet been bridged. Also, in the rest of the world, the social image of the nurse suffers from some stereotypes, not only perpetuated by a wrong knowledge on the part of the population but also fostered by the mass media (commentary, cinema, television series). OBJECTIVE: To investigate the perception of students at the University of Piemonte Orientale about the nursing profession. METHODS: A survey was conducted using an online questionnaire sent during the period of the health emergency linked to COVID-19 (from 18 August to 15 September 2020). RESULTS: 662 questionnaires were analysed. It was investigated how students describe nurses and whether that description would have been the same even before the COVID-19 health emergency. Furthermore, it was assessed which gender they consider most suited for the profession and whether the mass media has influenced their view of nurses. The students described the nurse with adjectives such as "expert / capable", "courteous / polite" and "welcoming / listening oriented" and stated that they would use the same terms even before the health emergency. The majority of the sample then believed that there is no more suitable gender to fill the role of nurse and that TV series or news reports have positively influenced their perception. However, only a small percentage of the sample would have considered the idea of becoming a nurse. DISCUSSION: A positive view of nurses emerged to overcome gender stereotype and a greater confidence in their technical-professional abilities. The data also highlight that the positive view of the nursing profession is not a consequence of the "publicity" provided by the media during COVID-19 emergency, which represented nurses as "heroes" of the National Health System.

Remote monitoring heart failure patients with implanted heart devices: a descriptive exploratory qualitative study of nurses' experiences and competences in Italy. / Il monitoraggio in remoto nei pazienti con scompenso cardiaco impiantati di device cardiaco: uno studio qualitativo esplorativo descrittivo sulle esperienze e competenze degli infermieri in Italia.

INTRODUCTION: Heart failure has an enormous impact in terms of mortality, morbidity, and costs for healthcare organizations. Indications for implanted heart devices, such as pacemakers or implantable cardioverter defibrillators (ICDs) are constantly increasing. With the arrival of the telemedicine, nurses play an important role in the remote management of chronic heart diseases. The purpose of this study was to describe the experiences of nurses who remotely monitor patients with an implanted heart device in Italy. METHODS: A qualitative study with a phenomenological approach was conducted. The sample consisted of 7 nurses dedicated to remote monitoring (RM), from three cardiology clinics in Northern Italy. We conducted semi-structured interviews to understand the experience and training nurses received to conduct RM. RESULTS: From the analysis of the interviews, six themes were identified: 'Specialized knowledge and skills', 'Learn through practice', 'Organization of work', 'Decision making', 'Trust', and 'Need for information'. The majority of our sample developed their competencies directly on the field, in absence of a certified recognized pathway, on RM in patients with heart failure implanted with cardiac devices. Therefore, nurses performing RM activities do not receive the same type of education and training. CONCLUSION: Currently, in Italy, there is no standardised training for nurses who perform RM activities for heart failure patients with implanted heart device, and yet it is instrumental to have appropriate knowledge and training to effectively perform this type of activity and care.

Effective, sustainable, and transferable physical exercise interventions for fall prevention among older people.

INTRODUCTION: Falls among older people are preventable through exercise-based programs. However, scientific evidence must be translated into practice to support professionals who implement such programs. AIM: This study aimed to identify physical exercise interventions for fall prevention and to determine the best practice for implementing them in local community-dwelling older adults. METHOD: We used a narrative synthesis method to produce Effective, Sustainable, and Transferable Preventive Interventions. We reviewed guidelines, systematic reviews, and randomized controlled trials (RCT) to find the best evidence supporting physical exercises to prevent falls, followed by discussing the evidence with clinical experts to evaluate the best strategy for implementing them into the local context. These steps resulted in the development of a user manual. RESULTS: We included two guidelines, one systematic review with a meta-analysis, and one RCT. The developed draft manual includes activities, methods, infrastructural resources, human capital, stakeholders, frequency, and duration of the intervention, information, and educational materials, and implementation models. Our discussion of the intervention with a panel of experts considered resources, barriers, and similar experiences to ensure effectiveness and economic, social, and time sustainability. CONCLUSION: The developed manual could be implemented in the local context and adapted to the needs of the population while considering available resources.

Barriers and facilitators to the implementation of nurse's role in primary care settings: an integrative review.

BACKGROUND: The rapid evolution of the epidemiological picture and the recent SARS-COV-2 pandemic has expressed the vulnerabilities of health systems and focuses attention on the population's needs. The nurse's figure in the care teams is universally identified; however, the implementation of the role within some care settings turns out to be complex and challenging. This integrative review aims to identify the barriers and facilitators in implementing the role of the nurse in primary care settings. METHODS: An integrative review was conducted on the Medline and Cinahl databases until 9 June 2020. Qualitative, quantitative, and Mixed-method research studies were selected to identify studies related to the barriers and facilitators of the nurse's role in nursing facilities' primary care. For the extraction of the results, the Consolidating Framework for Research Implementation (CFIR) was used to identify the factors that influence implementation in health care. RESULTS: Following the duplicates' removal, the search identified 18,257 articles, of which 56 were relevant to the inclusion criteria; therefore, they were included in the summary. The selected studies were conducted in thirteen countries, most from Oceania, Europe, North America, Latin America, and the Caribbean. The barriers reported most frequently concern the nursing profession's regulatory and regulatory aspects within the contexts of care, cultural and organizational aspects, training, and the transfer of specific skills, which were previously designated to doctors. The facilitators are mainly linked to the nurse's adaptability to the various contexts of care, recognizing the patient's role, and the desire to develop multidisciplinary and effective working groups to respond to the health needs of the population in primary care contexts. CONCLUSION: This review highlighted the main barriers and facilitators in implementing the nurse's role in primary care settings. These results offer useful elements for stakeholders to identify effective strategies in preparing programs and activities for implementing the nurse's role, acting on the elements identified as barriers and favouring the aspects that emerge as facilitators.

Physical exercise and fall prevention: A systematic review and meta-analysis of experimental studies included in Cochrane reviews.

The aim of this systematic review (SR) and meta-analysis was to assess what type of exercise is associated with fall risk reduction among apparently healthy adults aged 50 and older. We conducted a SR by searching for randomized controlled trials (RCTs) included in Cochrane SRs published until October 2019. Five SRs that compared exercise versus any type of control included 32 RCTs. The outcomes examined were falls, fallers, fractures, and fear of falling. A random effects-based meta-analysis by type of exercise was performed. Almost all the interventions were effective for fall rate reduction, with a major effect for three-dimensional exercise, strength/resistance exercises, and mixed exercises. The number of fallers was reduced by three-dimensional exercise and mixed exercises. Fall-related fractures were generally reduced by all types of exercises considered all together, but none singly resulted in statistically effective fracture prevention. Fear of falling was slightly decreased with endurance exercises.

[The effects of a clinical therapeutic intervention in pain assessment and management in surgical ICU patients: a before-and-after intervention study on pain intensity and use of analgesia]. / Gli effetti di un intervento clinico organizzativo sulla valutazione e gestione del dolore postoperatorio in terapia intensiva: studio before-after sull'intensità di dolore e uso dell'analgesia.

AIMS: the aims of this study were to test the efficacy of a training program in order to reduce pain intensity in surgical ICU patients and improving postoperative pain assessment and management. METHODS: longitudinal, before and after experimental study. A total of 261 patients, 126 in Group A (before intervention) and 135 in Group B (after intervention) were included. Data were collected prospectively before and after a training intervention and the implementation of a pain management protocol. RESULTS: a significant reduction was observed in pain intensity scores collected at 6 hours (p=.016) 12 hours (p -.001) and 48 hours (p=.005) postoperatively. Intense pain was most observed in Group A than Group B (RR=1.98; 95% CI= 1.05-3.71, p=.0302). A significantly smaller proportion of patients treated after intervention received morphine (p=.036) and propofol (p=.045). Although there has been no increase in pain assessments, the interval (hours/minutes) between drugs administrations was reduced (Group A 6.35 +1.19 vs Group B 6.21 +0.5) (p=.006). Mechanical ventilation lasted longer in Group A (3.67 days + 6.6 vs 2.44 days + 4.45) (MD = 1.23; 95% CI= -0.1541- 2.6141) (p=.0415). CONCLUSION: the implementation of the organizational changes on pain prevention in this ICU, using standardized education, led to less pain in surgical ICU patients. However further randomized studies and with larger patient samples are needed.

Impact of a Clinical Therapeutic Intervention on Pain Assessment, Management, and Nursing Practices in an Intensive Care Unit: A before-and-after Study.

BACKGROUND: Accurate pain assessment and management constitute a major challenge for medical and nursing staff in intensive care units (ICUs). A distinct recollection of pain is reported by high proportions of ICU patients. PURPOSE: A clinical therapeutic intervention directed at improving pain assessment and management in critically ill patients who are unable to communicate was implemented at an Italian ICU. METHODS: In this before-and-after study, data were collected before (T0) and after (T1) the adoption of a protocol involving pain assessment with an ad hoc behavioral pain scale and the administration of analgesics, rather than sedatives, to patients with intermediate to high pain scores. RESULTS: The main outcome measure was pain recollection a year after discharge; secondary outcome measures were the use and doses of sedatives and analgesics. A significantly (p = .037) smaller proportion of patients treated after protocol adoption recollected feeling severe pain compared with patients treated before the protocol was introduced. This group also received significantly (p < .001) fewer sedatives and significantly (p = .0028) more anti-inflammatory drugs and analgesics on an "as needed" basis. The administration of strong analgesics was similar in the two groups. The intervention was implemented in 70.5% of patients with intermediate to high pain scores. CONCLUSIONS: Appropriately trained ICU nurses have the potential to help adopt pain relief and prevention measures during nursing care and to contribute to the successful management of sedation and analgesia. Further studies of larger patient samples are needed to monitor the stability of results over time and to explore the efficacy of the approach in other populations, such as pediatric and neonatal ICU patients.

The impact of primary nursing care pattern: Results from a before-after study.

AIMS AND OBJECTIVES: To explore the effect of "Primary Nursing" on nursing-sensitive patient outcomes, staff-related outcomes and organisation-related outcomes. BACKGROUND: Primary nursing is one example of a care pattern that has recently been implemented in many countries. DESIGN: Before-after study. METHODS: This study was conducted in an Italian hospital. We observed patient-related outcomes (pressure ulcers, falls, urinary tract infection and venous catheter infection) in 2,857 inpatients before the implementation of primary nursing and in 3,169 inpatients after its implementation. Staff-related outcomes (nursing competence and diagnostic thinking) and organisation-related outcomes (empowerment and team climate) were collected from 369 nurses. From a subgroup of inpatients, we collected data regarding their satisfaction with the care provided. RESULTS: After the implementation of primary nursing, some nursing competencies and diagnostic thinking were improved, so were organisation-related outcomes. Our data showed that the number of inpatients with urinary catheter infections (5.5% vs. 4.3%) and venous catheter infections (peripheral: 2.2% vs. 1%; central: 5.6% vs. 1%) was significantly decreased; also, the numbers of falls (2.4% vs. 1.9%) and pressure ulcers (4.8% vs. 4%) decreased, although these decreases were not statistically significant. Overall, the implementation of primary nursing increased patient satisfaction with nursing care (193.57 vs. 210.21). CONCLUSIONS: Primary nursing improved staff-related outcomes, nursing-sensitive patient outcomes and organisation outcomes. RELEVANCE TO CLINICAL PRACTICE: Our results show that primary nursing has the potential to positively impact on inpatients, nurses and organisations. Moreover, the implementation of this care pattern is feasible.

Efficacy of Non-pharmacological Methods of Pain Management in Children Undergoing Venipuncture in a Pediatric Outpatient Clinic: A Randomized Controlled Trial of Audiovisual Distraction and External Cold and Vibration.

PURPOSE: Venipuncture generates anxiety and pain in children. The primary aim of the study was to evaluate two non-pharmacological techniques, vibration combined with cryotherapeutic topical analgesia by means of the Buzzy® device and animated cartoons, in terms of pain and anxiety relief during venipuncture in children. DESIGNS AND METHODS: 150 children undergoing venipuncture were randomized into four groups: the 'no method' group, the Buzzy® device group, the animated cartoon group and the combination of Buzzy® and an animated cartoon group. Children's pain and anxiety levels along with parents' and nurses' anxiety levels were evaluated by means of validated grading scales. RESULTS: Overall children's pain increased less in the non-pharmacological intervention groups as compared to the group without intervention. Notably, the difference was statistically significant in the animated cartoon group for children's perception of pain. Children's anxiety and parents' anxiety decreased more in non-pharmacological interventions groups as compared to the group without intervention. CONCLUSIONS: The study showed the effectiveness of non-pharmacological methods of pain management during venipuncture. Notably, distraction with animated cartoons was superior in terms of children's perception of pain when compared to Buzzy®, and to the combination of cartoons and Buzzy®. Buzzy® was significantly effective at the secondary analysis for children younger than 9. Children's and parents' anxiety is decreased by non-pharmacological methods. Furthermore, nurses' involvement in pediatric care can be enhanced. PRACTICE IMPLICATIONS: Non-pharmacological methods of pain management during venipuncture represent an easy way to achieve an increased level of compliance among children and parents.

Effects of prolonged flushing interval in totally implantable venous access devices (TIVADs).

Totally implantable venous access device (TIVAD) lumen occlusion is a long-term complication of central venous catheters, associated with risks of infection, therapy interruptions and increased healthcare costs. The role of flushing and locking in maintaining TIVAD patency is paramount. Most flushing protocols are based on manufacturers' recommendations, which indicate that 4 weeks is the safest interval between two consecutive flushing procedures during periods when TIVADs are not in use. Conversely, results of several studies suggest that extended flushing intervals (FIs) do not increase the rate of obstructive or infective complications. The study aimed to describe the effects of prolonged FIs in a cohort of 317 patients with cancer. The authors found no significant difference in terms of TIVAD problems between long (>45 days) and short (≤45 days) FI groups, which raises questions over the validity of current practice.

Quit attempts and smoking cessation in Italian adults (25-64 years): factors associated with attempts and successes.

Background: Over the past 50 years there was a substantial decrease in the prevalence of smoking in Italy. The objective of this work is to describe attempts to quit and cessation success in Italian smokers. Methods: A surveillance on health-related behaviors (PASSI) was conducted in 2007-13 on a sample of 203 610 Italian adults 25-64 years of age. An analysis of smokers' characteristics and behaviors was performed, focusing on attempts to quit and quit success. Data from national surveys (ISTAT) from 1983 to 2013 (Italian adults, 25-64 years of age, 1983: 46 634; 1987: 40 915; 1990: 36 622; 2000: 77 531; 2005: 71 032; 2013: 64 205) were used to explore if a cessation trend in Italy exists. Results: Smokers who quit in the previous year and were still abstinent when interviewed increased from 1990 to 2013. In the years 2011-13, 38% of people who had smoked in the last 12 months reported at least a quit attempt during the same period and 7% were still abstinent when interviewed. An association of successful recent quit attempts with higher educational level, absence of economic difficulties and younger age was found. In the years 2007-13, the great majority tried to stop unaided. Having received assistance from a cessation program did not increase the probability of enduring abstinence. Conclusions: In Italy interventions to drive more smokers to quit should be focused in particular on disadvantaged groups. Initiatives have to be studied not only to incentive more smokers to try to quit, but also to maintain abstinence over time.