What are the nursing competencies related to antimicrobial stewardship and how they have been assessed? Results from an integrative rapid review.

BACKGROUND: Antimicrobial resistance issues, and the consequent demand for antimicrobial stewardship (AMS) programs, need to be investigated urgently and clearly. Considering the large amount of time nurses spend at patients' bedside, the aim of the present study was to examine recent literature on nursing competency in AMS. METHODS: Drawing from Tricco and colleagues' seven-stage process, a rapid review was performed. MEDLINE, CINAHL and EMBASE databased were searched from December 1st, 2019 until December 31st, 2021. Article screening and study selection were conducted independently by three reviewers. Data were analyzed narratively and categorized adopting an inductive thematic coding. RESULTS: Sixteen studies met the inclusion criteria and were included. Publications were mainly authored in USA (n = 4), Australia and New Zealand (n = 4) and Asia (n = 4), followed by Europe (n = 2) and Africa (n = 2). Ten studies were quantitative in design, followed by qualitative (n = 4) and mixed-methods studies (n = 2). Nursing competency in AMS seems to be influenced by a two-dimensional model: on the one hand, internal factors which consisted in knowledge, attitudes and practices and, on the other hand, external aspects which are at environmental level in terms of structures and processes. CONCLUSION: This study provided a map of dimensions for researchers and practitioners to consider when planning clinical governance, educational activities, and research programs. Significant opportunities exist for nurses to contribute to practice, education, research, and policy efforts aimed at reducing antimicrobial resistance.

Organizational citizenship behaviour as a protective factor against the occurrence of adverse nursing-sensitive outcomes: A multilevel investigation.

AIMS: This study aimed to investigate the association between organizational citizenship behaviour enacted by nurses and the occurrence of adverse nursing-sensitive patient outcomes. BACKGROUND: Managing psychosocial factors (i.e., aspects concerning the work environment) is key to ensure patient safety, to prevent exacerbation of case complexity and to cope with critical shortages in human and financial resources. METHODS: Self-report measures of nurses' organizational citizenship behaviour were combined with objective data on the incidence of adverse nursing-sensitive outcomes (i.e., pressure ulcers and restraint use) collected through patients' medical records. Participants were 11,345 patients and 1346 nurses across 52 teams working in 14 Italian hospitals. Data were analysed using multilevel binary logistic regression models. RESULTS: A negative relationship between nurses' organizational citizenship behaviour and restraint use was identified, with an odds ratio of 0.11. Thus, for a one-unit higher organizational citizenship behaviour score, the odds of using restraints shrink to about one eighth of the previous level. CONCLUSIONS: Intervention strategies to foster the implementation of organizational citizenship behaviour among nurses may inhibit the occurrence of critical outcomes affecting patients' health and well-being (i.e., using restraint devices). IMPLICATIONS FOR NURSING MANAGEMENT: In health care organizations, shaping a psychosocial environment encouraging organizational citizenship behaviour can mitigate the occurrence of adverse nursing-sensitive outcomes such as restraint use on patients.

Long-Term Patient-Centred Follow-up in a Prospective Cohort of Patients with COVID-19.

INTRODUCTION: To better define COVID-19 long-term impact we prospectively analysed patient-centred outcomes, including general health and symptom duration. METHODS: Barthel index (BI), St. George's Respiratory Questionnaire adapted to patients with COVID-19 (aSGRQ) and WHO Clinical Progression Scale (CPS) were measured at enrolment and at 6 weeks from the onset of symptoms. Persistence of most frequently reported symptoms was assessed at 6 weeks and, among symptomatic patients, at 12 weeks from the onset of symptoms. Predictors of impaired general health over time were identified using an ordinal multilevel multivariate model. RESULTS: A total of 448 patients (55% men, median age 56 years) were enrolled. WHO-CPS showed mild, moderate and severe disease in 48%, 42% and 10% of patients at admission and mild disease in all patients at follow-up, respectively. BI and aSGRQ were normal in 96% and 93% patients before COVID-19 but only in 47% and 16% at COVID-19 diagnosis and in 87% and 65% at 6-week follow-up. Male gender was identified by all three assessments as a predictor of impaired general health (BI, OR 2.14, p < 0.0001; aSGRQ, OR 0.53, p = 0.003; WHO-CPS, OR 1.56, p = 0.01). Other predictors included age, ICU admission and comorbidities (e.g. cardiovascular disease and cancer) for BI, hospital admission for aSGRQ, age and presence of comorbidities for WHO-CPS. At 6- and 12-week follow-up, 39% and 20% of patients, respectively, were still reporting symptoms. Fatigue and breathlessness were the most frequently reported symptoms. CONCLUSIONS: Long-term follow-up facilitates the monitoring of health impairment and symptom persistence and can contribute to plan tailored interventions.

[Nursing sensitive outcomes: the results of a multicentre study]. / Gli esiti sensibili alle cure infermieristiche:i risultati di uno studio multicentrico.

. Nursing sensitive outcomes: the results of a multicentre study. INTRODUCTION: The relationship between staffing characteristics and nursing sensitive outcomes has been explored in several studies. AIMS: To assess the effect of staffing characteristics, nurses' wellbeing at work and hours of care on pressure sores, falls and physical restrains occurrence. METHODS: Longitudinal study including from February 2014 to June 2015 a total of 24110 consecutive patients and 2606 nurses of 134 units (geriatrics and medicine (GM), orthopedic-traumatology (OT) and rehabilitation and long-term care (LR) of 12 Italian regions. Data was collected up to 15 days for each included patient, and regarding the staff of each shift by ad hoc trained personnel. RESULTS: There is a large variability in both patients and nurses' characteristics across wards, as well as of outcomes, even in the same area (e.g., GM). Patients in GM received a mean of 144±35 minutes of care/day; 186±146 in OT and 140±40 in LR. The incidence of pressure sores was 5.3%±4.8% in GM; 5.1%±5.6% in OT and 8.6%±10.1% in LR. The incidence of falls was 1.9%±2.1% in GM, 0.8%±1% in OT and 2.9%±3.8% in LR. Restraints were used in 41.4%±30.3% of patients in GM, among 24.8%±23.4% in OT and 54.7%±29.7% in LR. The multilevel analyses confirmed the importance of clinical factors but also the positive effects of staff characteristics such as the number of expert nurses and the negative effects of a negative work environment, although with wide variations across settings have emerged. CONCLUSIONS: Staff characteristics related to work environment affect patient outcomes but the large variability across wards would require further stratification of the data to better understand and interpret the findings.

[Nursing sensitive outcomes and staffing: a review on healthcare associated infection]. / Esiti sensibili alle cure infermieristiche e staffing:le infezioni correlate all'assistenza.Revisione della letteratura.

. Nursing sensitive outcomes and staffing: a review on healthcare associated infection. INTRODUCTION: Healthcare associated infections (HAI) continue to be an unresolved problem in hospital settings. AIM: To assess the relationship between nurse staffing and healthcare associated infections in different settings. METHODS: From April to May 2015 a review of literature was conducted consulting PubMed, CINAHL and Cochrane Library. RESULTS: An increased amount of Registered Nurse Hours Per Patient Day (RNHPPD) and nurse-to-patient ratio was associated to a decreased occurrence of HAI. In particular an increase of RNHPPD was associated to a reduction of postoperative (OR 0.83, IC95% 0.0.70-0.99), and ventilator-associated pneumonia (OR 0.21, IC95% 0.08-0.53). Even the number of urinary tract infections (-34%) and sepsis (OR 0.54, IC95%: 0.31-0.92) decreased significantly. The most significant results associated to an increase of HPPD were obtained in intensive care units. CONCLUSIONS: The review showed the correlations between nurse staffing and the most frequent HAIs. Nursing managers should be aware of the adequate nurse-to-patient ratios and skill-mix in order to inform decision making and improve the quality and safety of patients care.

Sociodemographic, clinical and organisational factors associated with delayed hospital discharges: a cross-sectional study.

BACKGROUND: Evidence from studies conducted in Western countries indicates that a significant proportion of hospital beds are occupied by patients who experience a delayed hospital discharge (DHD). However, evidence about this topic is lacking in Italy, and little is known on the patients' and organisational characteristics that influence DHDs. Therefore, we carried out a survey in all the hospitals of a Northern Italian region to analyse the prevalence and the determinants of DHD. METHODS: A cross-sectional study was carried out during an index period of 15 days in 256 operative units in Emilia-Romagna, a Northern Italian region with 4.4 million inhabitants, to identify patients medically fit for discharge but still hospitalised. The characteristics of these patients (n = 510) were compared with all the other patients (n = 5,815) hospitalised in the same operative units during the index period using multilevel logistic regression models. RESULTS: The one-day prevalence of DHD was 8.1%. More than half of DHD patients (52.7%) waited to access long-term/rehabilitation units or residential care homes, 16.7% experienced a delay for family-related reasons, and 14.5% were waiting to be admitted to other rehabilitation services. Among DHD patients hospitalised in long-term/rehabilitation units, 45.3% were waiting to be transferred to residential care homes. Patients' characteristics associated with a higher likelihood of DHD in multilevel logistic regression were older age, provision of intensive care, a diagnosis of dementia, tumours or femoral/shoulder fractures, and a number of comorbidities. Patients hospitalised in long-term/rehabilitation units, as well as in orthopaedics/traumatology units, were significantly more likely to have a DHD compared with patients hospitalised in general surgery units. Moreover, compared with Local Health Authority Hospitals, being hospitalised in Hospital Trusts was associated with a higher likelihood of DHD. CONCLUSIONS: Although the prevalence of DHD in the present study is markedly lower than that reported in the literature, we submit that the DHD problem should be addressed with major organisational innovations, with a special focus on the ageing of the population and epidemiological trends. Organisational changes imply new ways of managing emerging clusters of patients whose needs are not efficiently or effectively met by traditional organisation models and services.

Healthcare-related infections outside the hospital: a new frontier for infection control.

In all industrialized countries, an increasing number of persons are cared for outside the acute hospitals: thus, infection control programs should be adapted to the new scenario. This paper briefly reviews the epidemiological features of infections acquired outside the acute care hospital, focusing on residential homes for the elderly. An intervention study aimed at reducing the healthcare associated infections in 22 residential facilities in Emilia-Romagna region is described.

Rates of surgical-site infection: an international comparison.

OBJECTIVES: To quantify the occurrence of surgical-site infections (SSIs) in an Italian region and to estimate the proportion of potentially avoidable infections through benchmarking comparison. DESIGN: Prospective study during 1 month based on a convenience sample of surgical patients admitted to 31 public hospitals. All of the patients undergoing an intervention included among the 44 operative procedures of the National Nosocomial Infections Surveillance (NNIS) System were enrolled. Ninety-five percent of the patients were actively observed after discharge for up to 30 days for all of the operations and for up to 1 year for operations involving implantation. RESULTS: Among the 6,167 operative procedures studied, 290 infections were recorded (4.7 per 100 procedures), 206 (71%) of which were SSIs (3.3 per 100 procedures; 95% confidence interval, 2.9-3.9). One hundred thirty-five SSIs (65.5%) were superficial infections, 53 (25.7%) were deep infections, and 12 (5.8%) were organ-space infections; in 6 cases (2.9%), the type of SSI was not recorded. The frequency of SSIs observed in this study was significantly higher for several procedures than that expected when the NNIS System rates (standardized infection ratio [SIR] ranging from 1.77 to 6.42) or the Hungarian rates (SIR ranging from 1.28 to 3.04) were applied to the study population. CONCLUSIONS: The high intensity of postdischarge surveillance can in part explain the differences observed. To allow for meaningful benchmarking comparison, in addition to intrinsic patient risk, data on the intensity of postdischarge surveillance should be included in published reports.

[Prevalence and prevention and treatment modalities for pressure sores. Study of the Emilia-Romagna region]. / Prevalenza e modalità di prevenzione e trattamento delle lesioni da decubito. Uno studio della Regione Emilia-Romagna.

This audit initiative aimed at assessing the prevalence of pressure sores in the public hospitals of Emilia-Romagna, and at monitoring the rate of use of specific modalities of prevention and cure. The design was cross-sectional, with information collected on three index days during 2000 by trained personnel. Overall, the prevalence of pressure sores at the regional level was 7.1%, with remarkable variation across hospitals (from 2.9% to 9.7%), also after adjustment for case mix. As for patterns of prevention and cure, 74% of patients at risk (according to the Braden scale) of developing a pressure sores received only standard low technology devices, and 50% of those in need were included in a systematic programme of postural change. Adequate (according to the available evidence) medications were used in 45% of patients with a pressure sore. The overall prevalence of pressure sore is close (or even inferior) to that observed in similar studies. However, variation between hospitals indicates that the current health services ability to deal with pressure sore is variable and often suboptimal. This evaluation is also supported by the limited adoption of adequate preventive and curative modalities.