Generalized music therapy to reduce neuroactive drug needs in critically ill patients. Study protocol for a randomized trial.

BACKGROUND: Critically ill patients are exposed to several physical and emotional stressors, needing analgesic and sedative drugs to tolerate invasive procedures and the harsh intensive care unit (ICU) environment. However, this pharmacological therapy presents several side effects: guidelines suggest using a light sedation target, keeping critically ill patients calm, conscious, and cooperative. Personalized music therapy (MT) can reduce stress and anxiety, decreasing the need for drugs. The aim of the current investigation is to compare different approaches for MT in the ICU: a personalized approach, with music selected by patients/families and listened through headphones, or a generalized approach, with ambient music chosen by a music therapist and transmitted through speakers. PRIMARY OUTCOME: number of days "free from neuroactive drugs" in the first 28 days after ICU admission. SECONDARY OUTCOMES: total amount of neuroactive drugs (midazolam, propofol, morphine, fentanyl, haloperidol), stress during ICU stay (sleep at night, anxiety and agitation, use of physical restraints, stressors evaluated at discharge), the feasibility of generalized MT (interruptions requested by staff members and patients/families). METHODS: Randomized, controlled trial with three groups of critically ill adults: a control group, without MT; a personalized MT group, with music for at least 2 h per day; a generalized MT group, with music for 12.5 h/day, subdivided into fifteen 50-min periods. DISCUSSION: One hundred fifty-three patients are expected to be enrolled. This publication presents the rationale and the study methods, particularly the strategies used to build the generalized MT playlist. From a preliminary analysis, generalized MT seems feasible in the ICU and is positively received by staff members, critically ill patients, and families. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03280329. September 12, 2017.

Perceived usefulness of the nurse-patient therapeutic relationship in the rehabilitation journey of people with urinary incontinence: A mixed-method study.

INTRODUCTION: Despite various studies on the impact of incontinence on patients' lives, the existing literature has not investigated the contribution of nursing care during rehabilitation in terms of quality of life. Fewer data, therefore, exist on the characteristics and perceived impact of the therapeutic relationship as part of the rehabilitation program. AIMS: To investigate the characteristics of the nurse-patient therapeutic relationship and its impact throughout the rehabilitation program; to describe the levels of patient burden on everyday activities. MATERIALS AND METHODS: A monocentric, retrospective, multimethod descriptive study was conducted in the nurse-led continence clinic of a major teaching hospital in Northern Italy. A phenomenological approach with semistructured interviews was adopted after 6 weeks of rehabilitation, following the method of phenomenological enquiry by Giorgi. The short form 12 questionnaire was administered upon admission of patients to the clinic, after 6 weeks, and during the last consultation to investigate the impact of urinary incontinence (UI) on daily activities and physical and psychological quality of life. RESULTS: Ninety-one adult patients of both genders presenting for nonneurogenic nonpostpartum UI were consecutively enrolled. Physical scores (PCS-12) and MCS-12 scores significantly increased over time. Psychological scores showed great variability upon admission, which was reduced halfway through the rehabilitation program. The thematic analysis highlighted four categories based on data saturation: the impact of UI on daily activities, strategies to face the problem, feelings, and the role of nurses. CONCLUSIONS: This mixed-method investigation suggests the importance of therapeutic nursing relationships, clinical expertise, and rehabilitative skills. Quality of life is arguably related to the positive results of the rehabilitation program but also to the environment, patients perceive in terms of support, honesty, and trust.

Early identification of risk for eating disorders in Italian secondary school students: a cross-sectional study.

AIM: Eating disorders are major illnesses that primarily affect adolescents and young adults and seriously threaten public health. Early identification of at-risk individuals and timely initiation of treatment is crucial to improve outcomes. The Inside Out Institute Screener (IOI-S) is a rapid self-administration screening tool for high-risk and early-stage eating disorders. This study aimed to investigate the risk of having an eating disorder in a sample of Italian students by testing the Italian version of the IOI-S. METHODS: A multicentre cross-sectional study was conducted in a population of students aged 12-19 years; validity and reliability of the IOI-Sita were investigated. RESULTS: Four-hundred and ninety-one (81.97%) students were enrolled, 24.85% of whom were found to be at "very high risk" of an eating disorder, according to IOI-Sita. Younger (p<0.001) and female (p<0.001) students had higher risk scores. The EFA confirmed the original monodimensional structure of the tool, S-CVI=0.95%. The Content Validity Index of the scale (S-CVI) was 0.95, ω coefficient was 0.927. DISCUSSION AND CONCLUSIONS: This research confirms the need to screen for eating disorders in Italian youth adequately; the psychometric properties of the IOI-Sita confirm it as a valid and reliable tool for screening high-risk and early-stage eating disorders.

A virtual reality eyes disease experience for undergraduate nursing students: A phenomenological study protocol.

Amongst those responsible for the prevention of ocular diseases, registered nurses certainly play an essential role; however, the literature reports that the awareness/consideration of this type of disease by nurses and nursing students can be improved. It is, therefore, appropriate to carry out educational interventions aimed at increasing consideration/awareness of eye diseases consequences through virtual simulation; moreover, the students' experience during this type of activity still needs to be investigated. Therefore, this study aims to explore the experience of glaucoma and cataract sight virtual simulation among Italian nursing students with a qualitative, multi-centric phenomenological research. Bachelor nursing students from different universities in Italy will explore what it means to live with eye diseases through a virtual reality APP. Colaizzi's approach will be used to assess student experiences, investigated through an interview, a pre-experience questionnaire and side notes on student behavior during the experience and the interviews.

MITEx: A Portable Hand Exoskeleton for Assessment and Treatment in Neurological Rehabilitation.

This work describes the design and preliminary characterization of a novel portable hand exoskeleton for poststroke rehabilitation. The platform actively mobilizes the index-metacarpophalangeal (I-MCP) joint, and it additionally offers individual rigid support to distal degrees of freedom (DoFs) of the index and thumb. The test-bench characterization proves the capability of the device to render torques at the I-MCP level with high fidelity within frequencies of interest for the application (up to 3 Hz). The introduction of a feed-forward friction compensation at the actuator level lowers the output mechanical stiffness by 32%, contributing to a highly transparent behavior; moreover, the functionality of the platform in rendering different interaction strategies (patient/robot-in-charge) is tested with three healthy subjects, showing the potential of the device to provide assistance as needed.

Abdominal massage and laxative use for constipation: a pilot study.

BACKGROUND: Constipation is a very frequent condition. Pharmacological treatment leads to the onset of complications in the long term. AIM: To study the effects of abdominal massage and bowel training combined with polyethene glycol compared with laxative alone. Researchers studied the frequency of evacuations, use of laxatives, appetite, and food intake of older persons. In addition, feasibility in the daily routine of nursing care was studied. METHODS: A pilot, randomised controlled trial was conducted. Older people living in a facility for self-sufficient residents were enrolled and randomised to the intervention or control group. The massage was administered for 4 weeks. The stool type according to the Bristol Stool Form Scale and secondary outcomes were collected at baseline, before any massage session and at the end of the intervention. FINDINGS: 32 participants were enrolled. Significant improvements were found in the number of evacuations, need for enemas, Bristol scores, appetite and food intake. CONCLUSION: Significant improvements were found in all major outcomes.

Alarm Fatigue in Nursing Students Undertaking Clinical Training in Intensive Care Units: A Multicenter Study.

BACKGROUND: The frequency of alarms from monitors and other electro-medical devices is of great utility but can increase the professional's workload and expose nurses in the intensive care unit to Alarm Fatigue. A recent study suggested that students in training can also experience the problem during their first clinical experiences in intensive care. Unfortunately, no data are available about the Italian panorama. To explore Alarm Fatigue among Bachelor of Science in Nursing students at the end of their internship experience in intensive care settings. METHODS: Multicenter cross-sectional design. A convenience sample of nurses from 3 Italian university hospitals was recruited. The students completed the revised version of the "Alarm Fatigue questionnaire-ita" at the end of the clinical internship in intensive care settings. RESULTS: 130 nursing students were enrolled (response rate 59.36%). The overall level of Alarm Fatigue was Me= 24.5 IQR [17.5, 30.5]. In addition, 9.23% of the sample reported errors or near misses related to Alarm Fatigue during the internship experience. The alarm fatigue level was higher in students who committed "errors/almost errors" (p=0.038) and in "student workers" (p=0.005). DISCUSSION: The extent of alarm fatigue experienced by nursing students requires developing a preventive strategy.

Transcutaneous electrical nerve stimulation for pelvic pain: A scoping review of treatment protocols, practical indications, and caveats.

BACKGROUND: Neuromodulation (NM) is a family of therapies based on electrical stimulation to target specific nerves that control LUTS (Lower Urinary Tract Symptoms) and pain. The aim is to modulate what is happening within the nervous system to achieve therapeutic effects. A particular type of neuromodulation, called TENS (Transcutaneous Electrical Nerve Stimulation), has proven effective for treating pelvic pain. The available evidence provides indications regarding the many aspects of TENS that influence therapeutic effects, but a comprehensive review has yet to be conducted. METHODS: Scoping review on Pubmed, CINAHL, Embase, Scopus, and Web of Science, including clinical trials, reviews, case studies or series, and other descriptive studies, according to the Joanna Briggs and PRISMA methodology. RESULTS: The 31 papers retrieved allowed the formulation of precise indications about the DOs and DON'Ts of electrode placement, waveform, pulse duration, pulse frequency, amplitude, session duration, and frequency of sessions. This paper also discusses the biochemical and neuro urological mechanisms of TENS. CONCLUSION: TENS effectiveness is influenced by many factors, some self-evident, others subtle, which this paper elucidates. Pelvic pain requires a multimodal approach, of which TENS is just a part. TENS should therefore be viewed as one of the components of the rehabilitation program in the frame of thorough and continuous patient assessment.

Validation of the Italian version of the spirituality and spiritual care rating scale (SSCRS-ita).

PURPOSE: To translate and validate the Italian version of the Spirituality and Spiritual Care Rating Scale (SSCRS-ita). METHODS: A single-center cross-sectional study was performed from October 15 to November 15, 2019 in a public hospital in Milan, Italy. The scale was drafted using the back-translation method. Prior to administration, the Italian version of the scale was assessed for content validity and retest stability by calculating the content validity index. Internal consistency was investigated by calculating Cronbach's alpha coefficient, test-retest stability by Spearman's rho coefficient. FINDINGS: A total n = 337 nurses participated in the survey by correctly completing the scale. The Kaiser-Meyer-Olkin test (0.81) and Bartlett's test of sphericity (p < 0.001) confirmed the adequacy of the sample to conduct exploratory factor analysis (EFA). The factorial model of EFA without rotation and then with nonorthogonal Promax rotation confirmed the presence of the four constructs identified by the original author. CONCLUSIONS: SSCRS-ita showed promising psychometric properties in terms of validity and reliability. The results of this study, together with the lack of in-depth studies in the Italian health and educational panorama, suggest the need to develop an educational pathway which, starting from the curricula of basic training and continuing with the updating of nursing staff, is dedicated to the detection of the spiritual needs of the patient. IMPLICATIONS FOR NURSING PRACTICE: The SSCRS-ita is the first validated Italian tool concerning the consideration of the needs of spirituality and spiritual care in healthcare contexts; the possibility to use this tool is the first step towards a better integration of the mentioned dimensions of care in a nursing care qualitative perspective in Italy.

Nurses' role in the management of persons with chronic urogenital pelvic pain syndromes: A scoping review.

BACKGROUND: Pelvic pain has cognitive, behavioral, sexual, and emotional consequences. Nurses involved in pelvic floor rehabilitation clinics have contacts with patients reporting chronic pain and should know the most appropriate service for patient referral, to submit the problem to professionals capable of correctly assessing and managing the condition. Furthermore, in some countries nurses can use conservative methods to treat the painful symptoms inside a multidisciplinary team such as breathing retraining, biofeedback, and noninvasive neuromodulation. This paper aims to provide an overview of the literature regarding the role of rehabilitation nurses in dealing with patients suffering from chronic urogenital pelvic pain or urogenital painful syndromes, inside a multidisciplinary team. METHODS: Scoping review on Pubmed, CINAHL, Embase, Scopus, Web of Science including trials, reviews, case studies or series, and other descriptive studies regarding the role of nurses inside the multidisciplinary team in the management of males and females presenting chronic pelvic pain (CPP) or chronic pelvic pain syndrome (CPPS). RESULTS: The 36 papers included in this review allowed answering research questions in four areas of nursing: collecting basic information, referring the person to appropriate services, evidence-based nursing interventions for CPP and CPPS, and proper documentation. Clinical history and assessment of breathing pattern, Muscular assessment and research of trigger points are the main points of data collection. Techniques for muscular relaxation and breathing retraining are important aspects of treatment, as well as biofeedback and noninvasive neuromodulation where the law allows nurses to practice such techniques. The McGill pain questionnaire and the pain inventory of the International Pain Society allow systematic data collection and handover. CONCLUSION: Rehabilitation nurses work inside multidisciplinary teams when dealing with persons suffering from pelvic pain; further research is needed as our comprehension of the underlying pathophysiological mechanisms of CPP and CPPS evolve.

A low-power ankle-foot prosthesis for push-off enhancement.

Passive ankle-foot prostheses are light-weighted and reliable, but they cannot generate net positive power, which is essential in restoring the natural gait pattern of amputees. Recent robotic prostheses addressed the problem by actively controlling the storage and release of energy generated during the stance phase through the mechanical deformation of elastic elements housed in the device. This study proposes an innovative low-power active prosthetic module that fits on off-the-shelf passive ankle-foot energy-storage-and-release (ESAR) prostheses. The module is placed parallel to the ESAR foot, actively augmenting the energy stored in the foot and controlling the energy return for an enhanced push-off. The parallel elastic actuation takes advantage of the amputee's natural loading action on the foot's elastic structure, retaining its deformation. The actuation unit is designed to additionally deform the foot and command the return of the total stored energy. The control strategy of the prosthesis adapts to changes in the user's cadence and loading conditions to return the energy at a desired stride phase. An early verification on two transtibial amputees during treadmill walking showed that the proposed mechanism could increase the subjects' dorsiflexion peak of 15.2% and 41.6% for subjects 1 and 2, respectively, and the cadence of about 2%. Moreover, an increase of 26% and 45% was observed in the energy return for subjects 1 and 2, respectively.

A nurse-led educational intervention for relieving idiopathic constipation: a retrospective study.

BACKGROUND: Constipation is a common condition. Although numerous articles emphasise the importance of conservative interventions, none have set out a complete educational programme. AIMS: To describe the results of an evidence-based, nurse-led educational intervention for functional constipation in adults. METHODS: A retrospective study of patient records with an analysis of Wexner constipation scores and Bristol stool charts was carried out before and after a nurse-led educational programme on nutrition and bowel habits. FINDINGS: Twenty-nine patients were enrolled (19 women and 10 men), with a median age of 61 (53-71) years, a mean BMI of 24.4±3.88 kg/m2 and comparable baseline Wexner and Bristol scores. A statistically significant improvement in Wexner scores (P<0.001) and a clinically relevant but not statistically significant (P=0.682) improvement in Bristol scores were observed. CONCLUSION: The results suggest this investigation should be repeated on a larger scale. An educational intervention could be included in all consultations on any issue that could affect bowel activity.

Transcultural Adaptation of and Theoretical Validation Models for the Spanish Version of the Nurses' Global Assessment of Suicide Risk Scale: Protocol for a Multicenter Cross-sectional Study.

BACKGROUND: The use of validated instruments means providing health professionals with reliable and valid tools. The Nurses' Global Assessment of Suicide Risk (NGASR) scale has proven to be valid and reliable in supporting the nursing evaluation of suicide risk in different languages and cultural environments. OBJECTIVE: The aims of our study are to translate and adapt the NGASR scale for the Spanish population and evaluate its psychometric properties in patients with suicide risk factors. METHODS: The translation, adaptation, and modeling of the tool will be performed. The sample will include 165 participants. The psychometric analysis will include reliability and validity tests of the tool's internal structure. The tool's reliability will be assessed by exploring internal consistency and calculating the Cronbach α coefficient; significance values of .70 or higher will be accepted as indicators of good internal consistency. The underlying factor structure of the Spanish version of the NGASR scale will be assessed by performing an exploratory factor analysis. The Kaiser-Meyer-Olkin measure of sample adequacy and the Bartlett sphericity statistic will be calculated beforehand. For the latter, if P is <.05 for the null hypothesis of sphericity, the null hypothesis will be rejected. RESULTS: Participants will be recruited between April 2022 and December 2022. Our study is expected to conclude in the first quarter of 2023. CONCLUSIONS: We hope to find the same firmness that colleagues have found in other countries in order to consolidate and promote the use of the NGASR tool in the Spanish population. The prevention and treatment of suicidal behavior require holistic, multidisciplinary, and comprehensive management. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/39482.

Violence and unsafety in Italian hospitals: Experience and perceptions of nursing students.

BACKGROUND: Assessment of workplace violence towards healthcare workers represents a challenge for healthcare organizations worldwide. Workers' experience and perceived risk of violence may have a serious impact on job satisfaction and retention of workers. To date, no studies have been conducted on nursing students. OBJECTIVES: To assess the prevalence of physical and non-physical violence among nursing students during their clinical experiences and to analyze the perceived risk of violence. METHODS: Multicentre, cross-sectional survey. We enrolled a convenience sample of nursing students of the bachelor's degree in Nursing of the University of Milan (Italy). The students completed a structured questionnaire prepared in accordance with the available literature on violence in healthcare settings. RESULTS: Out of 1185 questionnaires sent, 603 were collected (50.89%). 35.1% had experience of verbal violence during the clinical internship training period, while 8.1% were victims of physical violence. 202 students (33.5%) reported unsafety, which was related to experience of physical or psychological violence, witnessed episodes of violence, gender, hospital structure and efficacy of the safety policies. CONCLUSIONS: Our findings highlight that nursing students are exposed to the risk of violence which influences their perception of risk.

Alarm fatigue in nurses working in intensive care units: A multicenter study.

BACKGROUND: Technological progress improves health care efficiency, quality, safety, and cost, supporting clinical activity in various scenarios, such as Intensive Care Unit (ICU). A timely response to alarms from monitors and other ICU electromedical devices is therefore crucial. The number of false alarms tend to desensitize care providers increasing the risk of experiencing alarm fatigue and, at times, lead to severe consequences for patients. OBJECTIVES: To assess the psychometric properties of the Italian version of the Alarm Fatigue Questionnaire and to explore the phenomenon of alarm fatigue among nurses working in intensive care settings. METHODS: The CVI-I was calculated to evaluate the validity of the content of the tool. Construct validity was investigated through exploratory factor analysis. Cronbach's alpha coefficient (α) was used to examine the internal consistency of the scale and Spearman's rho coefficient to test for stability.We designed a multicentre cross-sectional survey. A convenience sample of nurses from 4 Major Italian hospitals was recruited. The nurses completed the Italian version of the Alarm Fatigue Questionnaire. RESULTS: The content validity index CVI-S of the scale (CVI-S) was 91.11%; Cronbach's alpha coefficient was 0.71. The Italian version of the tool explained 67.18%of the overall variance. 396 nurses were enrolled (79.84%). The overall level of alarm fatigue was Me = 29 [22;30]. 42.17%of the sample reported prior experience with alarm fatigue incidents. CONCLUSIONS: The extension of alarm fatigue requires the adoption of a preventive intervention plan. The Italian version of the Alarm Fatigue Questionnaire shows promising psychometric properties.

Adaptation and validation of the Caregiver Burden Inventory in eating disorders.

BACKGROUND: Living with people diagnosed with a mental disorder is known to increase the risk of developing high levels of so-called "caregiver burden" in informal caregivers. In-depth analysis of this phenomenon and specific assessment tools for caregivers of patients diagnosed with Eating Disorders (EDs) are lacking. In this study, we aimed to evaluate the psychometric properties of the Caregiver Burden Inventory in EDs and employ this adapted tool in this category of caregivers. METHODS: A cross-sectional study was conducted in the Eating Disorders outpatient unit of an Italian University hospital. Face and content validity were investigated by calculating standard Content Validity Indices (CVI-I and CVI-S) after administering the Inventory to 6 expert nurses with at least 5 years of experience in mental health services assisting people diagnosed with Eating Disorders. Internal consistency was evaluated with Cronbach's α coefficient for the overall scale and subscales. An exploratory factor analysis (EFA) was performed to explore latent constructs. The adapted CBI was then administered to 62 informal caregivers of ED patients. RESULTS: The EFA yielded a 5-factor structure. The CVI-S was 97.2%; the Cronbach α coefficient was 0,90 (> 0.74 in each subscale). The median burden level in the experimental population was 40.0 [range = 21 to 54], in a theoretical range from 0 (no burden) to 96 (highest level of burden). CONCLUSION: The Caregiver Burden Inventory appears to be a valid and reliable instrument to assess caregiver burden in individuals diagnosed with Eating Disorders. Further research is needed to evaluate this tool's efficiency in improving individually tailored interventions on families.

Eating disorders (EDs) are characterized by the development of abnormal eating habits, dysregulation of body weight and/or body image distortion. The pervasiveness of EDs may significantly affect the life of patients' caregivers in terms of emotional load, termed Caregiver Burden (CB). This may impact the quality of life of the entire family and promote conflicts which may in turn exacerbate ED behaviours. Among several international assessment tools to measure CB, the Caregiver Burden Inventory (CBI) is perhaps the most widely employed. However, this tool has never been specifically tested in caregivers of ED patients. Here we show that CBI can adequately quantify burden in this category of caregivers. Systematic use of this instrument can support healthcare workers who aim to address the carer's discomfort and promote a focused monitoring of subjects with increased risk, in order to adequately plan targeted intervention programs.

Nursing students' attitudes towards suicide and suicidal patients: A multicentre cross-sectional survey.

BACKGROUND: Education of nursing students can be a valuable resource in contributing to suicide prevention in mental health service users. The evaluation of students' attitudes towards a complex clinical issue is an important aspect of education that can expand traditional paths to acquisition of competence. Thus far, very few studies investigated attitudes towards suicidal risk among nursing students, and no data are available on Italian settings. OBJECTIVES: The aim of this study was to explore nursing students' attitudes towards suicidal risk across the Nursing schools in three Italian universities. DESIGN: Multicentre cross-sectional survey incorporating a before-after design. SETTING AND PARTICIPANTS: A non-randomized sample of nursing students of the bachelor's degree in Nursing in three University hospitals was recruited. METHODS: Nursing students completed "Suicide Behaviour Attitude questionnaire-Italian version" (SBAQ-ita scale); second-year nursing students of the University of Milan completed the scale before (T0) and 2 months after (T1) a specific lecture on suicide and suicidal risk. RESULTS: Three hundred and fourteen students were enrolled (response rate 76.77%). The overall score of sample attitudes had a Median (Me) of 3.5[2.5;4] for the domain "Feeling towards the patient", 3[2;4] for the domains "Professional ability", 5[3;7] for the domain "Right to suicide", 5[4;6] for the domain "Knowledge". Improved median score regarding the domain "Professional ability" (0.015), and decreased median score on the "Knowledge" (0.021) domain were observed at T1. CONCLUSIONS: The study highlights the impact of an educational intervention on nursing students' attitudes, supporting its implementation to improve academic education programmes.

The attitude towards organ donation: Differences between students of medicine and nursing. A preliminary study at Unizkm - Catholic University "Our Lady of Good Counsel" of Tirana.

BACKGROUND: A favourable attitude towards organ donation and transplantation is fundamental among health professionals to promote consent, especially in a young healthcare system like Albania. OBJECTIVE: To analyse the differences in the attitude towards organ donation and transplantation and the influencing factors among medical doctors- and nurses-to-be. METHODS AND DESIGN: The article is based on an observational, descriptive, cross-sectional study. The population includes medical and nursing students of the Catholic University of Good Counsel - Unizkm of Tirana, Albania. RESULTS: 389 out of 401 students took part in the investigation, of whom 324 enrolled in the Medicine undergraduate program and 65 in the Nursing undergraduate program. Medical doctors-to-be showed higher awareness about the issue of donation than their colleagues from Nursing, and they were more engaged in discussion with other parties. CONCLUSION: The preliminary results of our pilot study highlight the need to organise more training on the topic of organ donation and transplantation among clinical students, especially those studying Nursing.