Valuing dignity in patients in a vegetative state on an intensive rehabilitation ward: improvement project.

AIM: To identify the causes that could hinder the provision of dignified care to patients in a vegetative state. BACKGROUND: In Italy, the incidence and prevalence of people in a vegetative state are increasing. The team members have a clear understanding of the meaning of being mortal and the value of human dignity. METHODS: A descriptive study design was used in an intensive care ward in Northern Italy. An anonymous list with negative factors must be drawn up. RESULTS: Thirty-two team members participated in the study. A lack of time and specific knowledge regarding the care of patients in a vegetative state, involvement of the family and repetition in assistance delivery were the most frequent causes that hinder provision of care to patients in a vegetative state. DISCUSSION AND CONCLUSIONS: The provision of dignity for patients is not an issue related only to the staff in direct contact with patients/clients, but also concerns the entire health care facility (physical structure and organisation). IMPLICATIONS FOR NURSING MANAGEMENT: The nursing coordinator has an important role in the promotion of care based on the respect for the patient's dignity, in the active involvement of staff and in the delivery of quality services to users.

Paediatric emergency department utilisation: is it necessary an educational intervention?

Over the past ten years there has been a progressive increase in accesses to services for paediatric emergency room, documented in Italy and abroad. The aim of the study is describe the sociodemographic, cultural, subjective and objective factors for non-urgent access to paediatric emergency service in an Italian region. It was adopted a descriptive survey of a sample of non-urgent accesses to two paediatric emergency room services in an Italian region during the period from February-March 2009, through the administration of questionnaires and the consultation of facilities databases. Half of the accesses to the paediatric emergency room are not urgent and are to be referred to the paediatric primary care. 80% of the users do not call for advice before coming to the emergency room. The convenience of the service, which accounts for more than 50% of the case, and the proximity from home are reasons to go to the emergency room. Approximately half of the accesses to the paediatric emergency department could be managed by primary care services. The convenience of the service, the self-referred and the proximity to home are emerging as the only influential factors reported by literature. In the future it should become crucial providing strategies for education/health information focused on non-urgent paediatric problems and offering people a call center phone service in order to filter and prevent the inappropriate accesses.

Second Victim Symptoms and Desired Support Strategies Among Italian Health Care Workers in Friuli-Venezia Giulia: Cross-Sectional Survey and Latent Profile Analysis.

BACKGROUND AND OBJECTIVE: The second victim (SV) phenomenon concerns health care workers (HCWs) whose involvement in a medical error, as well as non-error patient safety events, has affected their well-being. Its prevalence ranges from 10% to 75% and can predispose HCWs to burnout, increasing the probability of committing errors. The primary aim of our study was to determine the prevalence of HCWs involved in an adverse patient safety event in Friuli Venezia Giulia Region (Italy). The secondary aims were to use latent profile analysis to identify profiles of SVs and factors influencing profile membership, and to evaluate the relationship between the severity of symptoms and desired support options. METHODS: A cross-sectional survey through the Italian version of the Second Victim Experience and Support Tool tool was conducted in 5 local health authorities. Descriptive statistics were conducted for all variables. Associations and correlations were assessed with statistical tests, as appropriate. Latent profile analysis was based on the scores of dimensions measuring SVs' symptoms. Factors affecting profile membership were assessed through multinomial logistic regression. RESULTS: A total of 733 HCWs participated. Of them, 305 (41.6%) experienced at least 1 adverse event. Among dimensions measuring SVs' symptoms, psychological distress had the highest percentage of agreement (30.2%). Three latent profiles were identified: mild (58.7%), moderate (24.3%), and severe (17.0%) symptoms. Severe symptoms profile was positively associated with the agreement for extraoccupational support and negatively associated with the agreement for organizational support. A respected colleague with whom to discuss the details of the incident (78.7%) and free counseling outside of work (71.2%) were the support options most desired by HCWs. The severity of symptoms was directly associated with the desire for support strategies. CONCLUSIONS: The prevalence of HCWs involved in adverse events is consistent with the literature. Three latent profiles have been identified according to SV symptoms, and the higher the severity of symptoms, the greater the reliance on extraoccupational support.

General Surgery Training and One Year of COVID-19. What Has Been the Impact on Residents' Operating Room Surgical Activity? A Report From an Italian Academic Hospital.

BACKGROUND: In the last year and a half, the COVID-19 pandemic has put great pressure on the healthcare systems of many countries, Italy included, leading to a reorganization of hospital activities and a dramatic reduction in surgical activity. Our study aimed to evaluate, from a quantitative and qualitative perspective, the impact of this reduction on the formation of surgery residents at the Academic Hospital of Udine. METHODS: We compared the resident's surgical activity during the pandemic year (March 2020-2021) with the one during the pre-pandemic year, declining the surgical procedures by timing, type, and complexity and categorizing the residents by postgraduate year (PGY) and surgical role. RESULTS: Our analysis highlighted how the main reductions occurred in the elective and medium complexity surgery due to the procrastination of benign pathologies such as hernias, cholelithiasis, and hemorrhoids, which also appeared to be the more frequent cases where the residents are first operators. On the other hand, the residents of the last PGY still maintained a good exposure to neoplasm and high complexity interventions, which are cardinal aspects in the last year of formation. CONCLUSIONS: These results mostly confirmed the critical points noted by the resident surgeons themselves, highlighting however the specific impact on different PGY and surgical activities, offering a starting point to better understand how to challenge the negative effect that the COVID-19 pandemic has had on the surgical resident formation.

Avoidable interruptions during drug administration in an intensive rehabilitation ward: improvement project.

AIMS: To record the frequency of interruptions and their causes, to identify 'avoidable' interruptions and to build an improvement project to reduce 'avoidable' interruptions. BACKGROUND: In Italy each year 30,000-35,000 deaths per year are attributed to health-care system errors, of which 19% are caused by medication errors. The factors that contribute to drug management error also include interruptions and carelessness during treatment administration. METHODS: A descriptive study design was used to record the frequency of interruptions and their causes and to identify 'avoidable' interruptions in an intensive rehabilitation ward in Northern Italy. A data collection grid was used to record the data over a 6-month period. RESULTS: A total of 3000 work hours were observed. During the study period 1170 interruptions were observed. The study identified 14 causes of interruption. CONCLUSIONS: The study shows that of the 14 cases of interruptions at least nine can be defined as 'avoidable'. An improvement project has been proposed to reduce unnecessary interruptions and distractions to avoid making errors. IMPLICATIONS FOR NURSING MANAGEMENT: An additional useful step to reduce the incidence of treatment errors would be to implement the use of a single patient medication sheet for the recording of drug prescription, preparation and administration and also the incident reporting.

Cholecystectomy in the elderly: clinical outcomes and risk factors.

AIM OF THE STUDY: Recent decades have seen a steady increase in the number of elderly patients undergoing cholecystectomy surgery. The objective of this study is to evaluate clinical outcomes in this cohort of patients and to identify any predictive factors correlative with adverse outcomes arising in the postoperative period. METHOD: A retrospective study was conducted regarding patients aged ≥65 years who underwent cholecystectomy surgery. The independent variables considered to be related to the patient were: age, gender, co-morbidities, and severity of cholelithiasis. The clinical variables were type of procedure, length of stay and hospitalization. The outcomes considered were mortality, re-intervention, transfer to intensive care and post-operative complications. RESULTS: 778 patients with an age between 65 and 74 and 508 patients with an age above 75 were reviewed. With the increase of age, patients who underwent cholecystectomy presented greater co-morbidity, more accesses in emergency, more cases of cholecystitis, which led to a higher number of interventions in open surgery. Considering postoperative outcomes: the need for intensive care, postoperative complications and mortality significantly increase in older patients. Negative predictive factors are the presence of co-morbidities, emergency access and cholecystectomy performed in open. CONCLUSIONS: Elderly patients undergoing cholecystectomy are an increased surgical risk group in particular because of the presence of co-morbidities and because of the frequent need to perform an emergency procedure often for complicated lithiasis pathology. This implies a special attention towards these patients, and towards those over 75 considering, when possible, alternative treatments such as percutaneous drainage. KEY WORDS: Cholecystectomy, Elderly, Outcomes, Risk factors.

The Second Victim Experience and Support Tool: A Cross-Cultural Adaptation and Psychometric Evaluation in Italy (IT-SVEST).

OBJECTIVE: Second victims are defined as healthcare workers involved in an unanticipated adverse patient event, who experienced professional and psychological distress. The Second Victim Experience and Support Tool (SVEST) is a survey developed and validated in the United States, which describes the experience of second victims. This study aims to perform the cross-cultural adaptation of the SVEST and to evaluate its psychometric characteristics in the Italian context. METHODS: Translation and cross-cultural adaptation process was performed according to the World Health Organization guidelines. Then, 349 healthcare workers, including nurses, doctors, residents, and technicians, involved in direct patient care-a potential second victim-completed the Italian version of SVEST in a validation survey at the Academic Hospital of Udine. The SVEST consists of 29 items, divided into 7 dimensions, 2 outcome variables, and 7 support options. The Italian version was assessed for internal consistency through Cronbach α, for content validity with content validity index for scales and for item and for construct validity with Confirmatory Factor Analysis. RESULTS: The internal consistency of the instrument was adequate in its overall evaluation with Cronbach α value of 0.88 (95% confidence interval = 0.86). The content validity index for scales was 0.94 and that for item was 0.70. The confirmatory factor analysis results showed a good model fit for the 9-factor structure (χ2 = 676.18, df = 327, P < 0.001). Root mean squared error of approximation, Akaike information criterion, and comparative fix index Tucker-Lewis index values also suggested a good fit to the data. CONCLUSIONS: The Italian version of the SVEST can be used to evaluate second victim experiences, demonstrating adequate validity, reliability, and good psychometric properties.

Predictors of nursing student success in an Italian school of Nursing.

Aims of the study was To define predictor factors of academic success of student in an Italian Nursing School. The recent introduction of the first level nursing education at university in Italy primed many changes processes and required to think new methods and contents. The study was descriptive and retrospective. The setting is an Italian School of Nursing. It was considered a sample constituted by 2 three years. Academic success was defined such as the capability of the student to finish formative pathway in three years with a final mark >90/110. An half of sample (53.7%, 66/123) finished the studies in three years. Variables that more influenced academic success were age, nationality, admission mark, evaluations obtained in professionals and tutorship formative activity. To know factors influenced academic success provides some indications that should be useful to define "at risk" students for which to plan formative pathways and specific supports.

Predictive Factors for Drain Placement After Laparoscopic Cholecystectomy.

PURPOSE: Currently, surgical drainage during a laparoscopic cholecystectomy (LC) is still placed in selected patients. Evidence of the non-beneficial effect of the surgical drain comes from studies with a heterogeneous population. This preliminary study aims to identify any clinical, demographic, or intraoperative predictive factors for a surgical drain placement during LC as the first step to identify population for a prospective randomized study. METHOD: The study was conducted in a single referral center and academic hospital between 2014 and 2018. Patients who underwent unconverted LC were divided into two groups: Group A (drain) and Group B (no drain). We explored baseline, preoperative, intraoperative characteristics, and postoperative outcomes. RESULTS: Between 409 patients who underwent LC: 90 (22%) patients were in Group A (drain). Age >64 years, male sex, cholecystitis, Charlson comorbidity index (CCI) ≥ 1, experienced surgeon, intraoperative technical difficulties, need for an additional trocar, operative time >60 min, and estimated blood loss >10 ml were predictive factors at univariate analysis. While at multivariate analysis, cholecystitis (odds ratio [OR]: 2.8, 95% CI:1.5-5.1; p < 0.001), CCI ≥ 1 (OR:1.9, 95% CI:1.0-3.5; p = 0.05), intraoperative technical difficulties (OR: 3.6, 95% CI:1.8-6.2; p < 0.001), need of an additional trocar (OR: 2.5, 95% CI: 1.4-4.4; p < 0.005), and estimated blood loss >10 ml (OR: 3.0, 95% CI:1.7-5.3; p < 0.0001) were predictive factors for a surgical drain placement during LC. CONCLUSIONS: This study identified predictive factors that currently drive the surgeons to a surgical drain placement after LC. Randomized prospective studies are needed to define the use of drain placement in these selected patients.

The tracheotomy tube weaning in patients with severe acquired brain injury: comparison of two operative procedures in a postacute rehabilitation hospital.

BACKGROUND: Despite the high frequency of tracheotomy in severe acquired brain injury (sABI) patients, available literature about the weaning procedure is mainly represented by expert opinions with no standardized and evidence-based criteria. AIM: The Institute of Physical and Rehabilitation Medicine "Gervasutta" adopted a new decannulation procedure, recommended by the Italian Society of Physical Medicine and Rehabilitation (SIMFER). This study evaluates whether the new procedure helps to improve the decannulation process of sABI patients. DESIGN: A prospective observational with historical control was performed by dividing sABI patients into two groups depending on whether they were treated with or without the new procedure. SETTING: The Department of Neurorehabilitation of the Institute of Physical and Rehabilitation Medicine "Gervasutta" in Udine, Italy. POPULATION: sABI patients with tracheal cannula admitted to the Institute of Physical and Rehabilitation Medicine "Gervasutta" from January 2015 to March 2019. METHODS: Clinical data were collected as both process and outcome indicators before and after the adoption of the new procedure. Data have been processed with Simple Interactive Statistical Analysis (SISA; Irving, TX, USA) software. RESULTS: A sample of 141 patients was analysed. Among the 141 patients, 57 (40.4%) were treated with the new procedure. No differences were found between the two groups in terms of complications, functional independence measure (FIM), or level of cognitive functioning (LCF) at the admission. When the new procedure was applied, the decannulation rate was significantly higher (OR=1.8; 95% CI=1.2-9.8; P=0.01) and the time (days) between admission and oral feeding resumption was significantly lower (P<0.001; 95% CI=-10, -34 days). CONCLUSIONS: The introduction of the new protocol allowed the safe achievement of both oral feeding resumption and decannulation, which are two of the main early rehabilitation goals. CLINICAL REHABILITATION IMPACT: The standardization of the decannulation process has determined the achievement of a significantly faster oral feeding resumption and an increase in the decannulation rate during the rehabilitation of sABI patients.

Italian clinical guides' perceptions of their role in student nurses' clinical practicum.

The focus of this article is an examination of the clinical guides' views and their role in student nurses' learning. The descriptive survey was conducted in July-September 2006. The sample was composed of 120 clinical guides who answered a questionnaire regarding the last student nurses' clinical practice experience during 2006. Clinical guides are nurses working in the wards who are available to supervise the clinical practice of nursing students, similar to preceptors in the United States. Clinical guides used different teaching strategies to stimulate students in various activities. The study revealed that the role of clinical guide is very important for the students as they develop into professional nurses.

Italian nurse students' and clinical preceptors' perceptions about clinical practice experiences: a questionnaire survey.

Aims of the study was to compare perception of both clinical preceptors and nursing students in relation to clinical nursing practice in Italy. The recent introduction of primary level nursing education to Italian University primed many changes in processes and required to think new methods and contents. Special attention was adopted on revaluation of clinical practice. The study was part of a large investigation conducted from 2005 until 2006 as prevalence survey throughout two questionnaire addressed to nurses student and to clinical guides. Participants were all students (tot. 172) from one School of Nursing and their clinical guides (tot.120) working in a high specialization hospital located in a large urban area in Northern Italy. Students' and nurses' perceptions differed in these fields: knowledge of students' learning objectives, explanation of students' competences and objectives already reached, prevalence execution of assistance activity, organization of briefing/debriefing meetings, planning of a learning programme with students at the beginning of tutorship, choosing occasions related to nursing subjects discussed in classroom, filling an intermediate evaluation of the student tutorship in addiction to the final. The perceptions of the students and preceptors were opposite on several factors. This means that students and clinical guides approach the clinical experience from individualized viewpoints.

Errors and omissions in hospital prescriptions: a survey of prescription writing in a hospital.

BACKGROUND: The frequency of drug prescription errors is high. Excluding errors in decision making, the remaining are mainly due to order ambiguity, non standard nomenclature and writing illegibility. The aim of this study is to analyse, as a part of a continuous quality improvement program, the quality of prescriptions writing for antibiotics, in an Italian University Hospital as a risk factor for prescription errors. METHODS: The point prevalence survey, carried out in May 26-30 2008, involved 41 inpatient Units. Every parenteral or oral antibiotic prescription was analysed for legibility (generic or brand drug name, dose, frequency of administration) and completeness (generic or brand name, dose, frequency of administration, route of administration, date of prescription and signature of the prescriber). Eight doctors (residents in Hygiene and Preventive Medicine) and two pharmacists performed the survey by reviewing the clinical records of medical, surgical or intensive care section inpatients. The antibiotics drug category was chosen because its use is widespread in the setting considered. RESULTS: Out of 756 inpatients included in the study, 408 antibiotic prescriptions were found in 298 patients (mean prescriptions per patient 1.4; SD +/- 0.6). Overall 92.7% (38/41) of the Units had at least one patient with antibiotic prescription. Legibility was in compliance with 78.9% of generic or brand names, 69.4% of doses, 80.1% of frequency of administration, whereas completeness was fulfilled for 95.6% of generic or brand names, 76.7% of doses, 83.6% of frequency of administration, 87% of routes of administration, 43.9% of dates of prescription and 33.3% of physician's signature. Overall 23.9% of prescriptions were illegible and 29.9% of prescriptions were incomplete. Legibility and completeness are higher in unusual drugs prescriptions. CONCLUSION: The Intensive Care Section performed best as far as quality of prescription writing was concerned when compared with the Medical and Surgical Sections.Nevertheless the overall illegibility and incompleteness (above 20%) are unacceptably high. Values need to be improved by enhancing the safety culture and in particular the awareness of the professionals on the consequences that a bad prescription writing can produce.

Study on the impact of caregivers in an Italian high specialization hospital: presence, costs and nurse's perception.

The study analysed two key questions: (i) the prevalence of informal caregiving in medical and surgical wards of a high specialization hospital; (ii) the reasonable cost for the structure that would have to pay to replace informal caregiving? The study was conducted in June 2006 as a prevalence survey, using a questionnaire administered to informal caregivers and nurses working in medical and surgical wards of a high specialization hospital by ad hoc trained personnel. Questionnaire consisted in three sections: the first focused on patient's characteristics, the second on caregivers and the third on nurses' perception on caregiving phenomenon. One hundred and twenty-four eligible caregivers were identified. During the study patients admitted to hospital medical and surgery wards were 520. Among these 16.5% (86/520) was assisted by one or more caregivers. Caregivers' response rate was 69.4% (86/124), corresponding to 66 patients. This study yielded an average of 455.9 minutes per day (SD = 370.2; range = 120-1440) or 52.9 hours per week. Caregiver's presence was recognized in 88.9% (56/63) of patients. Despite the societal perspective, the costs and effects of informal caregiving to the informal caregiver are often ignored in economic evaluation. The costs of informal care are an important extent related to time inputs by relatives and friends of the care recipients. Our approach has been to monetize the informal activity care contribution of family members and/or caregivers.

Effectiveness of music therapy for anxiety reduction in women with breast cancer in chemotherapy treatment.

In the last decade, the public use of complementary and alternative therapies for the solution of various health problems has increased dramatically. Listening to music can be considered a support to the traditional medical practice for the reduction of anxiety and stress related to chemotherapy.

Italian public school: a survey to estimate teachers' knowledge and perception on prevention and management of nutrition related pathologies.

AIMS: This study aims to estimate the current knowledge of nursery and primary school reference teachers about nutrition related pathologies, their prevention and control. METHODS: The study was conducted during April-June 2006 sending a questionnaire to 24 School Directions of nursery and primary schools in a Northern Italian region (Friuli Venezia Giulia). RESULTS: Considering all the schools we obtained a global response rate of 82.3% (115/142): 73.7% (42/57) of nursery schools and 85.9% (73/85) of primary school. 86.1% (99/115) of teachers thought that doing programmes aimed to improve nutrition behaviours is effective. 98.3% (113/115) of teachers answered that favourite fats in the diet are vegetables, 23.5% (27/115) that 55%-60% of the total caloric intake in children diet should consist in carbohydrates, 37.4% (43/115) ticked correct definition of diabetes. 75.7% (87/115) of interviewed teachers explain the term Body Mass Index correctly and 42.6% (49/115) know the cut-off between normal weight and overweight. CONCLUSION: analysing the levels of importance attributed by teachers to nutrition issues, it emerges a noteworthy interest on this topic. This should be a stimulus to promote projects and training courses on this topic.

Factors predicting influenza vaccination adherence among patients in dialysis: an Italian survey.

Introduction: The aim of this study was to investigate knowledge and practices about influenza among patients on dialysis services of Italian hospitals at risk of severe influenza infection and vaccine and to identify predictive factors to vaccination adherence. Methods: A cross-sectional observational study was carried out from January 2017 to July 2017 after the 2016/2017 influenza vaccination campaign. The questionnaire was administered to all patients treated in seven large Italian dialysis services. It consisted of influenza vaccination coverage, knowledge about influenza and its vaccination, perceived risk of influenza complications, recommendations on influenza uptake received by general practitioner (GP) and nephrologist. Results: Response rate was 90% (703/781). Patients' knowledge about influenza infection and vaccine were detected by nine closed questions: 35.6% of responders answered correctly to ≥ 6 sentences, 47.5% of them reported that "influenza vaccine can cause influenza" and 45.7% believed that "antibiotics are a correct strategy to treat influenza". Levels of perceived risks of hospitalisation and death were low in 39.3% and 16.5% of patients respectively. The adherence to the last seasonal influenza vaccination was 57.5%. The multivariate predictors of influenza vaccination uptake resulted: age ≥65, male, consulting TV/radio, asking information to GP and/or nephrologist. Conclusions: The study reveals the low adherence to influenza vaccination and the subotpimal level of knowledge in dialysis patients. Different strategies, including a greater alliance among nephrologists and GPs to prevent influenza should be encouraged to improve the adherence to influenza vaccination in this at risk group.

Italian public school: a pilot study about disorders related to nutrition and their management.

OBJECTIVE: To know how Italian nursery and primary schools survey and manage children with food-related problems. DESIGN: A pilot study during the period March-May 2005, filling out a questionnaire. SETTING: All nursery and primary schools in a Northern Italian region (Friuli Venezia Giulia). SUBJECTS: There were 479 eligible schools RESULTS: Global response rate was of 29.6%. In 77.5% (110/142) of the schools there were children with food-related pathologies. Programs about nutrition were carried out by 44.4% (63/142) of the schools in the previous two years; 9.5% (6/63) dealt with food-related pathologies and 57.1% (36/63) required the intervention of outside experts to have these projects realized. In the same period training courses about nutrition for teachers were conducted in 9.2% (13/142) of the schools. CONCLUSIONS: Data provide a first overview of the situation in Italy on food-related topics in children attending nursery and primary schools. Therefore many programs could not rely on funds to be developed, but had to use internal resources of the school.

Italian oncology nurses' knowledge of complementary and alternative therapies: national survey.

AIM: This paper is a report of a study to investigate the knowledge of Italian oncology nurses in relation to complementary and alternative therapies. BACKGROUND: In the last decade, the use of complementary and alternative therapies by the general public has increased dramatically. As primary care providers who play a key role in healthcare delivery, it is likely that nurses will be asked about these therapies by their patients. Only if they have an adequate knowledge base, however, can nurses give useful information and counsel patients effectively to allow them to make informed healthcare decisions. METHOD: A survey was carried out in 2007 with, 270 nurses registered with the Italian Association of Oncology Nursing. A self-administered questionnaire was used and the response rate was of 57.4% (155/270). FINDINGS: Ninety-four (60.6%) nurses claimed to have knowledge about complementary and alternative therapies. Over two-thirds (60.6%, 57/94) reported that books were a primary source of their knowledge. Other common sources included other healthcare workers (50%, 47/94), the Internet (48.9%, 46/94), workshops and seminars (29.8%, 28/94), and formal nursing education (17.0%, 16/94). Only 5.3% (5/94) reported that professional journals were a source of knowledge. During their professional activities, 71.6% (111/155) of the nurses encountered patients using complementary and alternative therapies, while 47.1% (73/155) treated patients asking for information about these techniques. CONCLUSION: The fact that nurses are responding to demands for these therapies without a solid knowledge base makes it imperative that the nursing curriculum be expanded to include these topics.

[Problem solving abilities of nursing students: the experience of the bachelor degree course in nursing at the University of Udine]. / L'abilità di problem solving dello studente infermiere: l'esperienza del corso di Laurea in Infermieristica dell'Università di Udine.

The process nurses adopt to solve the patients' problems is known as "Problem Solving" in the literature. Problem Solving Abilities include Diagnostic Reasoning, Prognostic Judgment and Decision Making. Nursing students apply the Problem Solving to the Nursing Process that is the mental and operative approach that nurses use to plan the nursing care. The purpose of the present study is to examine if there is a positive relationship between the number of Educational Tutorial Strategies (Briefing, Debriefing and Discussion according to the Objective Structured Clinical Examination Methodology) used for nursing students and their learning of Problem Solving Abilities (Diagnostic Reasoning, Prognostic Judgment and Decision Making). The study design was retrospective, descriptive and comparative. The Problem Solving Instrument, specifically developed for this study and proved for its reliability and validity, was used to collect the data from a sample of 106 nursing care plans elaborated by the second-year students of the Bachelor Degree in Nursing of the University of Udine. Nursing care plans were elaborated during three times consecutively, after students had participated in different Educational Tutorial Strategies. Results showed that the more the students took part in a higher number of Educational Tutorial Strategies the more they significantly increased their Problem Solving Abilities. The results demonstrate that it is important to use Educational Tutorial Strategies in the nursing education to teach skills.