Heel Pressure Injuries: Consensus-Based Recommendations for Assessment and Management.

Significance: A systematic approach to develop experts-based recommendations could have a favorable impact on clinical problems characterized by scarce and low-quality evidence as heel pressure ulcers. Recent Advances: A systematic approach was used to conduce a formal consensus initiative. A multidisciplinary panel of experts identified relevant clinical questions, performed a systematic search of the literature, and created a list of statements. GRADE Working Group guidelines were followed. An independent international jury reviewed and voted recommendations for clinical practice. Consent was developed according to Delphi rules and GRADE method was used to attribute grade of strength. Critical Issues: The extensive search of the literature retrieved 42 pertinent articles (26 clinical studies, 7 systematic reviews or meta-analysis, 5 other reviews, 2 consensus-based articles, and 2 in vitro studies). Thirty-five recommendations and statements were created. Only 1 of 35, concerning ankle-brachial pressure index reliability in diabetic patients, was rejected by the panel. No sufficient agreement was achieved on toe brachial index test to rule out the orphan heel syndrome, removing dry eschar in adult patients without vascular impairment, and using an antimicrobial dressing in children with infected heel pressure injuries. Eleven recommendations were approved with a weak grade of strength. Experts strongly endorsed 20 recommendations. Offloading, stages I and II pressure injuries, and referral criteria were areas characterized by higher level of agreement. Future Directions: We believe that the results of our effort could improve practice, especially in areas where clear and shared opinions emerged. Barriers and limits that could hinder implementation are also discussed in the article.

Policy proposals for a new welfare: the development of the family and community nurse in Italy as the key to promote social capital and social innovation.

AIM: To discuss the development of the family and community health nurse (FCHN) in Italy by focusing on three levels: organisational, political and theoretical. BACKGROUND: The role of the FCHN in Italy is not yet embedded evenly across the Italian National Health System (INHS) and does not have formal recognition, either contractually or organisationally. Although complementary post-basic training has been available for over a decade, the FCHN's role in Italy currently exists only in pilot form. In some regions, the FCHN has operated for longer, thanks to which a clearer understanding of the functions and responsibilities required by the FCHN has emerged. Proposals for professional and social policies have emerged, as the FCHN's role may be an answer to health problems and a contributor to the construction of social capital, capable of influencing both individual and collective well-being. METHODS: A mixed method investigation via a parallel concurrent design to identify the organisational models for the FCHN was conducted across Italy. In this paper, two profiles are discussed - family and community health nursing and FCHN - but each with its different connotations. The former refers to the practice of nursing and the latter to the nursing practitioners working with family and the community. CONCLUSION: We describe the expected future outcomes for FCHNs as elements of social innovation for the development of a new welfare system.