[Intensity of care during the night shift: a descriptive study of planned and unplanned activities]. / L'intensità dell'assistenza durante la notte tra attività pianificate e non pianificate: studio descrittivo.

INTRODUCTION: The night shift guarantees the continuity of care with activities that may vary across wards, thus the intensity of care and the organization of night activities may vary. AIMS: To describe the night nurses' activities and to analyze their frequency, answer times and activities performed by nurses when answering to patients' needs. METHODS: Nurses on night shift in a neurology and surgical ward were observed for 7 nights. Night activities were recorded (type and time), distinguishing planned and unplanned activities. Data on the number of complex patients, number of calls (time, reason, activities interrupted and time needed to answer) were also collected. RESULTS: Overall 55 patients in neurology and 46 in the surgery ward and 4 nurses per night were observed. In neurology ward nurses were mainly involved in basic care and surveillance, while surveillance and the administration of drug therapy where prevalent in the surgical ward. In neurology, on average patients called once every 50 minutes, mainly in the first hours of the shift while once every 24 minutes in the surgical ward, during tha all night, mainly for pain and drug treatments. Nurses answered to patients calls in less than 2 minutes. CONCLUSIONS: The different intensity of activities is influenced by patient conditions but also by the organization of care. In both wards planned activities and patients calls are distributed during the all night.

[Sensibility and specificity of a screening instrument for patients at risk of difficult discharge]. / Valutazione della sensibilità e specifici di uno strumento di screening dei pazienti a rischio di dimissione difficile.

INTRODUCTION: Planned discharge guarantees continuity of care. The process starts with the identification of patients at risk of post-discharge problems. In Italy no validated screening instruments are available. One of the UK discharge screening instruments is the Blaylock Risk Assessment Screening Score (BRASS), applicable from admission, for the identification of patients that need a discharge plan. AIMS: To assess the validity (sensitivity and specificity) of the BRASS scale on a sample of adult patients admitted to medical wards. METHODS: Patients admitted to medical wards of Trento Hospital from January to March 2006 were screened at admission and discharge and interviewed by phone 45 days after discharge to assess where they had been discharged. RESULTS: One hundred eighty nine patients were assessed at admission and discharge and 145 were available at follow-up after 3 months; 7.5% were at risk for difficult discharge. Sensibility and specificity of the scale were respectively 73.1 and 83.2%. No major differences were observed for risk scores obtained at admission and discharge. CONCLUSIONS: The BRASS scale collects a limited number of information, predictive on the need to organize discharge services. It can therefore be an useful instrument to help health care workers to plan appropriate and timely interventions for guaranteeing continuity of care.

[Not Available]. / Sistemi per la valutazionedella complessità assistenziale a confronto:revisione narrativa della letteratura.

UNLABELLED: . Systems for the assessment of patients' complexity: a narrative review of the literature. INTRODUCTION: An effective and efficient caseload management ensures that patients receive the right care by the right person at the right time. Several systems are used in Italy to measure patients' complexity. AIM: To describe and compare the characteristics of the systems for measuring patients' complexity, used in Italy from 1994 to 2015. METHODS: A search was conducted on PubMed, CINAHL, Medline, Cochrane Library, and on Google, with the same key-words. Systems dedicated to paediatric and intensive care patients were not included. The variables used to define complexity were classified according to 4 dimensions of the Italian model of Complexity of Nursing care (autonomy/dependence, stability/instability; comprehension and choice; context). RESULTS: Eight systems were identified, each using a different set and number of variables to define patients' complexity. For 5 systems the most influential dimension on the final score was the autonomy/dependence (from 74% to 34% of the final score). The Caring professional method (MAP), the Assessment on Nursing Intensity and clinical Complexity (IACC) and the Nursing Assessment of Complexity of Care (Per.V. In.Ca.) assign an higher score to the clinical stability/instability dimension. The dimension that contributes less to the final score is the Comprehension and choice (33% for one system but no more than 11-20% for all the others) and Context (from 0 to 30%). CONCLUSIONS: The systems are evolving from an assessment of nursing activities to the assessment of patients' conditions. The informatization of these systems will offer a valuable support to the definition of the right caring mix.

[Validation of the Italian Clinical Learning Environment Instrument (SVIAT):study protocol]. / Strumento di Valutazione Italiano degli Ambienti di Tirocinio per gli studenti infermieri (SVIAT): protocollo di validazione.

UNLABELLED: . Validation of the Italian Clinical Learning Environment Instrument (SVIAT): study protocol. INTRODUCTION: Nursing students obtain most of their university credits in internship environments whose quality can affect their clinical learning. Several tools are available to measure the quality of the clinical learning environment (CLE) as perceived by students: these instruments developed in other countries, were validated in Italian but do not discriminate those CLEs capable (or not) to promote significant clinical learning. AIM: To validate an instrument to measure the capability of the CLE to generate clinical learning; the secondary aim is to describe the learning environments as perceived by nursing students according to individual course site and tutorial models adopted. METHODS: The study will be developed in three phases: a) instrument development and pilot phase, b) validation of the psychometric properties of the instrument and c) description of the CLEs as perceived by the students including factors/item confirmed in the validation process. Expected outcomes. A large validation, with more than 8,000 participating students is expected; the construct under lying will be confirmed through exploratory and confirmatory factor analysis and will report high internal consistency; the instrument will report also a high test-retest and inter-rater reliability; in addition, the instrument will demonstrate predictive ability by discriminating those units able (or not) to activate effective learning processes.