The perception of dignity in the hospitalized patient: Findings from a meta-synthesis.

Dignity is a value inherent to all human beings, guaranteed to every individual from birth, and influenced by culture and society. It is protected by various laws and declarations, and represents one of the fundamental human rights. Preserving human dignity is an essential aspect of nursing practice and a central element of care. Dignity is a highly subjective and personal concept; there may be variations in the way that patients perceive it and in the ways that nurses can guarantee it. A systematic review of the qualitative literature was conducted to obtain a comprehensive understanding of adult patients' perceptions of dignity in a hospital setting. This review adhered to the PRISMA Statement for reporting systematic reviews, and the results were reported in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. Major databases (PubMed, CINAHL, Scopus, and PsycINFO) were consulted and resulted in the inclusion of 21 studies. Methodological quality was assessed using the Critical Appraisal Skills Program (CASP) Checklist for Qualitative Studies. Six main themes emerged from the data analysis: (1) The concept of dignity and its various dimensions; (2) The significance of maintaining one's own privacy and confidentiality; (3) The hospital environment's influence on patients' dignity; (4) Healthcare professionals' characteristics and behaviours that affect dignity; (5) The role of communication and the relationship with healthcare providers; and (6) The patient's ability to make choices and be involved actively in their care. These findings underscore the importance of understanding caregivers' perspectives on dignity to ensure that they provide respectful and dignified care and treatment that prioritizes the patient's mental and physical needs.

Surviving cancer following total laryngectomy: a phenomenological study.

PURPOSE: Total laryngectomy followed by radiotherapy is a life-preserving treatment for patients with locally advanced laryngeal cancer. This study explored how persons who had undergone total laryngectomy perceived themselves as cancer survivors in the follow-up phase. METHODS: A descriptive phenomenological approach was adopted. We employed a purposive sampling strategy to collect data through interviews at the otorhinolaryngology outpatient clinics of two research hospitals in northern Italy. The interviews were transcribed verbatim and analysed, following the seven analytical steps of Colaizzi's descriptive analysis. RESULTS: The final sample included 19 patients. The following main themes were identified: (i) accepting a life with the "without" to survive; (ii) feeling unpleasant emotions; (iii) getting the hang of communication again; and (iv) reclaiming one's role. Together, they highlight the lived experiences of laryngectomised patients during the follow-up phase and how they perceived themselves as cancer survivors. CONCLUSION: Laryngectomised patients are a uniquely vulnerable population. This study provides insights into how surgical procedures change and affect their lives over time to improve care models, patient education, and support systems. Survivors must be adequately prepared to transition from treatment and return to the community. This preparation should begin before treatment is started. Functional education, accurate information, and psychological support must be arranged and provided before surgery. Regarding the post-treatment phase, it is essential to support voice rehabilitation and peer support, and improve the family network, to ensure these patients' reintegration into society and social recognition.

Job satisfaction and generational nursing characteristics among registered nurses in the United States, Italy and Finland: Results of a survey study.

AIMS: The aim of this study is to describe job satisfaction and multigenerational nursing characteristics between nurses in the United States, Italy and Finland. BACKGROUND: Job satisfaction and work characteristics may be viewed differently among nurses of different generations and countries. METHODS: Data were collected on the Kuopio University Hospital Job Satisfaction Scale and Multidimensional Nursing Generations Questionnaire. A total of 1,433 usable surveys were returned and analysed using multivariate analysis of variance. RESULTS: Nurses in the United States were most satisfied in all subareas of job satisfaction. Across all generations and countries, Leadership scores were most consistent. Results did not show any generational similarities on job satisfaction or generational work characteristics that held constant across all countries. Scores on dimensions indicating intergenerational conflict were highest in the United States and lowest in Finland. Measures indicating good intergenerational relationships and teamwork were highest in Finland and lowest in the United States. CONCLUSIONS: Country impacted job satisfaction and multigenerational characteristics more than generational cohort. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers and leaders leading multigenerational teams occupy a pivotal role in multigenerational teamwork and attitudes toward change.

Providing care to a family member affected by head and neck cancer: a phenomenological study.

BACKGROUND: Cancer is recognized as a family illness as many head and neck cancer (HNC) patients after treatment require assistance from a family caregiver throughout the rest of their life. The purpose of this study was to explore the lived experience of primary family caregivers of HNC patients dealing with laryngectomy regarding their complex supportive role. METHODS: Phenomenological study based on individual interviews of twelve primary caregivers of HNC patients, recruited by purposeful sampling. Interview contents were analyzed in depth, in accordance with Colaizzi's descriptive analysis framework, to explore and identify significant themes and subthemes. RESULTS: Analysis evidenced three main topics and subthemes embracing various aspects of the caregiver's lived experiences: (1) experiencing disease and the pathway of care, (2) handling changes to everyday life, and (3) support received by others. CONCLUSION: Given the essential role the caregiver has in the patient's post-treatment recovery, future planning of HNC patient care must consider the caregivers' needs. In order to guarantee an appropriate and effective health professional care, it is important to consider caregivers' issues and needs as part of HNC patient care planning from the diagnosis to the follow-up.

Correction to: providing care to a family member affected by head and neck cancer: a phenomenological study.

The name of Luca Ghirotto was incorrectly captured in the original manuscript.

Listening to the voice of patients with head and neck cancer: A systematic review and meta-synthesis.

The aim was to conduct a systematic review and a meta-synthesis of primary qualitative studies exploring experiences of head and neck cancer patients (HNC) undergoing radio and/or chemotherapy, in order to provide a better understanding of this phenomenon and supply new directions for care and clinical practice. Six databases were systematically searched, and 13 studies were included. The meta-synthesis methodology was adopted to conceptualise the way in which patients lived their cancer journey and the impact of treatments on their daily life. Four themes embracing various aspects of HNC patients' experiences were identified: (a) self-body image and perceived quality of life; (b) experiences and treatment of symptoms; (c) cancer journey; and (d) the relationship with health professionals. The finding demonstrates the importance of acknowledging that treatment sequelae and patients' daily issues do not appear, develop and affect people's lives in isolation and should be considered and analysed as a whole within the social and cultural context of patients' lives. Further research is needed to explore the treatment experience of HNC patients throughout their cancer journey with a more holistic approach that involves health professionals, caregivers and other family members and peers in the community.

Psychometric validation of the Multidimensional Nursing Generations Questionnaire (MNGQ).

AIMS: To perform a psychometric test of the factor structure of the Multidimensional Nursing Generation Questionnaire, an instrument developed to measure nursing generational characteristics in the workplace and investigate the relations among its factors and background variables. BACKGROUND: Nurses today include members of the Baby Boomer and X and Y generations, whose characteristics in the work environment have not been studied thoroughly. DESIGN: Instrument and construct cross-sectional study for psychometric testing/validation. METHODS: Questionnaire components and constructs were tested using confirmatory factor analysis (CFA), structural equation modelling and Cronbach's alpha. For this purpose, a survey was conducted in November 2016 on a sample of Finnish and Italian nurses working in public hospitals (N = 3,218). RESULTS: Eight hundred twenty-two nurses completed the questionnaire, where CFA identified 48 items and six factors with acceptable internal consistency (Cronbach's alpha range: 0.73-0.88): (a) Conflicts between generations; (b) Patient safety view; (c) Relationships issues between generations; (d) Working as a multigenerational team; (e) Orientation to change; and (f) Work propensity and availability. Various relations were identified among the background variables and factors that related largely to generational belonging, educational level and country. CONCLUSION: The final version of the questionnaire demonstrates a more robust factor structure than did the preliminary. Further tests should be conducted on nurses in different countries/cultures and work environments. IMPACT: The complete validation of the Multidimensional Nursing Generation Questionnaire will provide research evidence useful to create an inclusive work environment for each generation.

Patients experiences of bedside handover: findings from a meta-synthesis.

BACKGROUND: Bedside shift reports have been recently recommended to ensure handovers. However, no evidence summarising studies designed to determine the qualitative approaches capable of better understanding patient experience have been published to date. AIM: The aim of this study was to acquire a deeper understanding of the experiences of patients regarding bedside shift reports. DATA SOURCES AND REVIEW METHODS: A systematic review of qualitative studies followed by a meta-synthesis method based upon Sandelowski's and Barroso's guidelines was performed. Four databases were systematically explored (PubMed, CINAHL, Scopus and PsycINFO) without any limitation in time and up to the 31 August 2018. A total of 10 studies were included and evaluated in their methodological quality; then, a thematic synthesis was developed to synthetize the findings. RESULTS: Three major themes reflect patients' experience regarding the bedside shift reports: (i) 'Being involved'; (ii) 'Being the centre of nursing care processes'; and (iii) 'Experiencing critical issues'. Patients are supportive of bedside shift reports as a right, as an opportunity to be involved, and of being in the centre of the nursing care process. By designing and implementing bedside shift reports, nurses also have an opportunity to increase patient safety and to provide concrete proof of the advancements achieved by the nursing profession in recent years. CONCLUSIONS: The bedside shift reports experience has been little studied to date from the perspective of patients. According to the findings, implementation of the bedside shift reports should include providing education to nurses with regard to the preferences and expectations of patients, as well as the critical issues that they can experience during the bedside shift reports. Presenting the bedside shift reports method, asking patient consent, discussing potential critical issues and the degree of involvement preferred at hospital admission, is strongly recommended.

Bedside shift handover implementation quantitative evidence: Findings from a scoping review.

AIM: To map the research methods, frameworks, structures, processes and outcomes investigated to date when implementing nursing bedside shift reports (BSRs). BACKGROUND: BSRs have become an area of increased interest among nurse managers (NMs) with several projects aiming at implementing bedside reports also as a strategy to increase nursing surveillance and reduce adverse events. However, to date, no summary of the available evidence has been provided with regard to research methods, theoretical frameworks underpinning BSR implementation and outcomes aiming at supporting NM decision-making in this field. EVALUATION: A scoping review including quantitative studies written in English and retrieved from five databases was performed in 2018. KEY ISSUES: Twenty-two studies originating from USA, Australia, Finland and Sweden, largely monocentric in nature and involving mainly medical/surgery units, have been performed to date. BSR implementation has been conducted mainly under organisational change theories, patient safety and nursing conceptual models. The BSR outcomes have been measured at the patient, nurse and organisational levels and reported positive trends. CONCLUSION: Professional reports-describing success transitions from traditional methods of handover to BSRs, and scientific studies aimed at improving evidence in the field, have been conducted to date, in order to document BSR implementation processes and outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: BSRs should be designed and conducted under a theory of organisational change; moreover, clinical nurses should be trained and supported in the transition from the traditional shift report to the BSR; while implementing this transition, outcomes should be set at the patient, nurses and organisational levels with the aim of tracing the comprehensive effects of the change.

[National survey to verify the implementation of State-Regions agreements introducing the professional profile of health social care worker and instituting a complementary training program for nursing assistants, Italy]. / Indagine nazionale sull'applicazione degli Accordi Stato-Regioni del 22 febbraio 2001 e 16 gennaio 2003 istitutivi del profilo professionale dell'operatore socio sanitario e della formazione complementare in assistenza sanitaria.

The professional profile of health social care worker (OSS) was introduced in Italy in 2001 and has become a fundamental figure in the Italian healthcare and social-health services system. However, changes have occurred in Italian health, clinical care and social realities since the OSS profile was defined. This article reports the results of a national-level study to investigate the state of application of the State-Regions Agreement of 22 February 2001, establishing the professional profile of OSS and regulating its characteristics and competencies, as that of the agreement of 16 January 2003, regulating the complementary healthcare training for nursing assistants.

Workplace-related generational characteristics of nurses: A mixed-method systematic review.

AIMS: The aim of this study was to describe and summarize workplace characteristics of three nursing generations: Baby Boomers, Generations X and Y. BACKGROUND: Generational differences affect occupational well-being, nurses' performance, patient outcomes and safety; therefore, nurse managers, administrators and educators are interested increasingly in making evidence-based decisions about the multigenerational nursing workforce. DESIGN: Mixed-method systematic review. DATA SOURCES: Medline, CINAHL, PsycINFO and Scopus (January 1991-January 2017). REVIEW METHODS: (1) The Joanna Briggs Institute's method for conducting mixed-method systematic reviews; (2) the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and (3) the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines. The studies' methodological quality was assessed with the Mixed-Methods Appraisal Tool. Quantitative and mixed-method studies were transformed into qualitative methods using a convergent qualitative synthesis and qualitative findings were combined with a narrative synthesis. RESULTS: Thirty-three studies were included with three main themes and 11 subthemes: (1) Job attitudes (work engagement; turnover intentions, reasons for leaving; reasons, incentives/disincentives to continue nursing); (2) Emotion-related job aspects (stress/resilience; well-being/job satisfaction; affective commitment; unit climate; work ethic) and (3) Practice and leadership-related aspects (autonomy; perceived competence; leadership relationships and perceptions). Baby Boomers reported lower levels of stress and burnout than did Generations X and Y, different work engagement, factors affecting workplace well-being and retention and greater intention to leave compared with Generation Y, which was less resilient, but more cohesive. CONCLUSION: Although several studies reported methodological limitations and conflicting findings, generational differences in nurses' job attitudes, emotional, practice and leadership factors should be considered to enhance workplace quality.

Perioperative Pressure Injuries: A Systematic Literature Review.

OBJECTIVE: To conduct a systematic review to investigate risk factors, incidence, and preventive strategies for perioperative pressure injuries (PIs). METHODS: The authors reviewed four databases for literature published from January 2001 to December 2017. Selected articles included primary quantitative studies with prospective, descriptive, and longitudinal design or randomized controlled trials that evaluated risk factors, incidence, and preventive strategies for perioperative PIs. The studies included were evaluated for methodological quality using the Edwards Method Score. The authors used a standardized extraction form to extract inclusion and exclusion criteria, participant demographics, methodology, PI risk instrument and classification systems, type of surgery and anesthesia, PI risk factors, incidence, preventive strategies, and outcomes evaluation. MAIN RESULTS: Of the 115 publications identified, 11 met the inclusion criteria. The risk assessment and PI classification instruments used differed in every study. Incidence of PI varied throughout the studies and was reduced by warming therapy and by a skin care intervention program. CONCLUSIONS: Further studies are necessary to develop a standard risk assessment instrument and preventive strategies and to clarify some contradictions evident in the literature.

Adverse events witnessed by nursing students during clinical learning experiences: Findings from a longitudinal study.

No evidence from any longitudinal study design has been reported to date with regard to patient safety (PS) incidents witnessed by nursing students during their training. Therefore, with the aim of closing this gap in available knowledge, a longitudinal study was performed from 2012 to 2015 by involving all nursing students (n = 145) enrolled in two Italian nursing programs. At the end of each academic year, students were invited to report in writing all PS incidents witnessed during their clinical learning experience; the number of days each student spent in their clinical setting was also collected from administrative records. Ninety students were included and 94 incidents were reported: 17 (18.1%) by first year students, 27 (28.7%) by second year students, and 50 (53.2%) by third year students. One third of students did not report any PS incident at the end of each academic year, while only a few reported more than one. The incidence density was 3.8/1000 days of clinical training without statistical differences across academic years. Supporting nursing students by encouraging them to share, discuss, and reflect on their clinical learning experience might increase their confidence in reporting safety incidents.

[The process of defining the competence profile of the healthcare professions manager in the Veneto Region]. / Il processo di definizione del profilo di competenza del coordinatore delle professioni sanitarie nella Regione del Veneto.

Presented here is the approach used by a multidisciplinary working group fo the drafting of the "core" competence profile of the healthcare professions manager in the Veneto Region. Defining a competence profile allows for specifying a standard for measuring the skills acquired by a professional and the gap level from what is expected by the organization, as well as orienting the preparatory education to carry out the related role.

[Measuring nursing sensitive outcomes in publicly funded hospitals in the Veneto Region, Italy: the development of a regional policy]. / Misurare gli esiti dell'assistenza infermieristica nelle Aziende Ospedaliere e Socio Sanitarie Locali della Regione del Veneto: sintesi dell'esperienza di sviluppo di una policy regionale.

INTRODUCTION: The indicators used in the Italian National Outcome Strategy does not include measurement of nursing care outcomes so these have not yet been assessed systematically in our country but only in the context of specific research projects. Positive and negative outcomes of nursing care have been documented in the literature, the latter associated with missed nursing care, a phenomenon that occurs when conditions are such that nurses are unable to deliver planned care to patients. OBJECTIVES: To describe the rationale, methodology and main results achieved to date in the development of a regional policy aimed at establishing a panel of indicators for monitoring nursing care-sensitive outcomes hospitals in publicly funded hospitals in the Veneto Region (northern Italy). METHODS: A plurennial, multi-method project based on [1] identification of selection criteria for a Minimum Data Set of indicators; [2] a rapid review of the literature and of the policies established internationally to measure nursing care-sensitive outcomes; [3] the establishment of an initial panel of indicators and evaluation of any critical issues with the chosen indicators, and [4] identification of the most appropriate tool for measuring missed nursing care. RESULTS: The medical and surgical units were considered to be the most suitable settings for the pilot study. Following the literature review, indicators that were already being monitored in the current regional information system were chosen, with the intent to prevent an additional administrative burden to nurses. By using a progressive consensus process, five outcome indicators (functional status, falls, pressure sores, urinary tract infections, aspiration pneumonia) and one process indicator (missed nursing care) were selected., and the tools for measuring the above-mentioned indicators and their related risks, were identified. A regional policy was then established to measure these indicators in a pilot phase, with the intent of implementing them as stable indicators to be measured in the new computerized hospital information system. CONCLUSIONS: An initial panel of nursing-sensitive outcome indicators has been defined to be used in Internal Medicine and General Surgery units of hospitals in Italy's Veneto Region. Despite its limitations, the project represents the first effort to create a regional policy to measure the contribution of nursing care to the health outcomes of patients and that will also the identification of potential relations with other variables such as personnel staffing and/or skill mix.

The Multidimensional Nursing Generations Questionnaire: development, reliability, and validity assessments.

PURPOSE: To develop and perform reliability and validity assessments of the international Multidimensional Nursing Generations Questionnaire. BACKGROUND: There are three generations of nurses in the European workforce. There is little research on the characteristics of these generations and the ways in which to manage them professionally, and no instrument has yet been developed to measure these aspects specifically. METHODS: With results from previous studies, 69 nursing generations-oriented items were created in English, translated into Italian and Finnish, and pretested to form the basis of an instrument that was tested between September and October 2014 on a sample of Finnish and Italian nurses (n = 1302) using principal component analysis and Cronbach's alpha. RESULTS: Fifty-four items and eight components (Cronbach's α range: 0.61-0.81) were identified in the instrument: (1) conflicts between generations; (2) patient safety view; (3) relationships between generations; (4) working as a multigenerational team; (5) orientation to change; (6) presenteeism and job propensity; (7) intention to leave, and (8) flexibility and availability. CONCLUSIONS: The instrument showed acceptable preliminary psychometric properties and satisfactory internal consistency. IMPLICATIONS FOR NURSING MANAGEMENT: The Multidimensional Nursing Generations Questionnaire is a useful tool to measure the characteristics of different generations of nurses and to develop management strategies tailored to those generations.

[Generations of Italian nurses compared: an exploratory study]. / Generazioni infermieristiche italiane a confronto: uno studio esplorativo.

AIM: The influence that generations have on complex nursing work environment have not been investigated yet in Italy. The majority of studies realized on this topic up to now has a small sample size and is monocentric. None Italian study has directly investigated nursing multigenerational workforce. The study aimed to investigate the existence of generational differences in Italian nurses professional within the italian context and describe their characteristics. METHODS: A 33 items questionnaire devised for the purpose was administred to a sample of 317 nurses of two major Italian North-East hospital. Five dimensions were analyzed: professional space, professional role, professional culture, orientation to care, relationships among generations. RESULTS: Data showed statistically significant differences among nurses generations in 9 items. The dimensions with the greatest number of significant items were found to be relationship among generations (6 items), followed by orientation to care, professional space and professional role (1 item each). CONCLUSIONS: Results highlighted the existence of generational differences and give some information on perceptions and relationships between italian nurses generations. Being the first exploratory study on Italian nurses, it is currently impossible to compare these results with those of previous studies. Further investigation is needed to make more comparisons with international literature.

Nursing Students' Knowledge of Patient Safety and Development of Competences Over their Academic Years: Findings from a Longitudinal Study.

INTRODUCTION: Future nurses should possess the knowledge and competences necessary to ensure patient safety. However, little evidence is available on the way in which students learn patient safety-related principles over time. This study explored the progress of a cohort of Italian undergraduate nursing students as they acquired patient safety knowledge and competences from time of enrolment to graduation. METHODS: A longitudinal study carried out between 2015 and 2018 enrolled a cohort of 90 nursing students from two Italian Bachelor of Nursing Science Degree Courses at the Udine University, Italy. The students were followed-up on an annual basis and data collection was performed three times: at the end of the 1st, 2nd and 3rd years. The validated Italian version of the Professional Education in Patient Safety Survey tool was used to collect data. RESULTS: At the end of the 1st year, students reported an average 4.19 out of 5 patient safety knowledge acquired in classrooms (CI 95%, 4.11-4.28), which was stable at the end of the 2nd (4.16; CI 95%, 4.06-4.26) and 3rd years (4.26; CI 95%, 4.16-4.32) and no statistical differences emerged over the years. With regard to the competences acquired in clinical settings, at the end of the 1st year the students reported an average 4.28 out of 5 (CI 95%, 4.20-4.37), which decreased significantly at the end of the 2nd year (4.15; CI 95%, 4.07-4.23; p=0.02) and increased at the end of the 3rd year (4.37; CI 95%, 4.27-4.47; p<0.01). CONCLUSIONS: Nursing students' competences in patient safety issues increases over time, while their knowledge remains stable. Students are more vulnerable at the end of the 1st year, when they seem to be overconfident about patient-safety issues.

Rehabilitation strategies for low anterior resection syndrome. A systematic review.

OBJECTIVE: To summarize the evidence in the literature about rehabilitative treatments that reduce low anterior resection syndrome (LARS) symptoms in patients who underwent surgery for colorectal cancer. METHODS: We have search in PubMed, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health and Scopus databases. Studies selected were limited to those including only patient undergone low rectal resection with sphincter preservation and with pre-post assessment with a LARS score. Five articles fit the criteria. RESULTS: The percutaneous tibial nerve stimulation demonstrated moderate results and sacral nerve stimulation was found to be the best treatment with greater symptom improvement. Only one study considered sexual and urinary problems in the outcomes assessment. CONCLUSIONS: In clinical practice patients should evaluate with the LARS and other score for evaluation of urinary and sexual problems. Future research must be implemented with higher quality studies to identify the least invasive and most effective treatment/s.