[Haemopoietic stem cells transplantation: a narrative review]. / Il trapianto di cellule staminali emopoietiche: una revisione narrativa.

. Haemopoietic stem cells transpantation: a narrative review. Haematopoietic stem cell transplantation (HSCT) is an effective treatment for many haematological malignancies and its employment is growing thanks to the increased possibility of finding suitable donors and the discovery of therapies to treat major complications. The fourth contribution on emergencies in the oncology setting proposes a narrative literature review to describe the transplant pathway, the types of HSCT, the conditioning regimen, the stem cells reinfusion, the aplasia phase, the major complications and the follow-up. The review included secondary studies published from 2020 to 2022, on adult transplanted patients and written in English; 30 studies were included. In addition, 28 primary studies describing key issues and 11 textbooks were added. Both autologous and allogeneic HSCT expose patients to infectious or drug therapy-related complications, such as mucositis and bleedings. The allogeneic HSCT is at higher risk of major complications such as the graft-versus-host disease and the venous-occlusive disease. The update proposed is accompanied by two cases with multiple choice questions, in patients who underwent autologous stem cells hematopoietic transplantation: case 1 (published in this issue of the AIR journal) on septic shock and case 2 (which will be published in the next issue of the AIR journal) on a massive hemothorax.

Nurses' engagement levels in an Italian public healthcare trust: findings from a cross-sectional study.

SUMMARY: Introduction. Assessing nursing engagement and designing strategies to improve engagement according to the specific needs of the staff have been considered essential to avoid losing nurses, mitigate future shortages and improve patients' outcomes. Objectives. To explore engagement levels of staff nurses working in an Italian public health-care trust comprising a general hospital, a rehabilitation hospital, district centers and mental health services, and their association with demographic and professional variables. Methods. The Health Care Advisory Board's Nurse Engagement Survey (NES) was used to measure 547 nurses' engagement levels. Results. Out of 499 nurses, 8% were engaged, 40% were content, 39% were ambivalent and 13% were disengaged. According to the multiple linear regression analysis which has showed R 27.3% (R2 7.5%) of the variance in the total score of NES, being older than 45 years was associated with an increased likelihood of being work-engaged (ß 0.121, [Confidence of Interval] CI 95% 0.066 to 0.457); differently, having the intention to leave the unit in the next three months (ß -0.168, CI 95% -0.552 to -0.179), and working at the hospital levels as compared to other settings (e.g., Mental Health Service, ß -0.150, CI 95% -0.140 to -0.038) were negatively associated with the WE. Conclusions. Nursing leaders should prioritize strategies to increase Registered Nurses' engagement. Specific initiatives devoted to younger nurses and to those intending to leave the unit, as well as to those working at the hospital level, are needed given these groups have a higher likelihood to be not or poorly engaged.

A randomised controlled trial examining the effectiveness of cartoons as a distraction technique.

AIM: Distress and pain associated with immunisation are significant problems for children, carers and healthcare professionals. This study was designed to determine whether distraction by watching cartoons during immunisation could reduce the distress and pain perceived by the children. METHODS: A sample of 35 six year olds was randomly assigned to one of two groups: the first was distracted by standard techniques during immunisation, the second by watching cartoons. Levels of distress were measured with the amended observation scale of behavioural distress, and of pain by the Wong-Baker FACES pain rating scale. RESULTS: The levels of distress were significantly lower in the group distracted by cartoons compared with children who received traditional distraction techniques during immunisation. CONCLUSION: By using an easy, cheap intervention, children's first introduction to health services can be made a positive experience which will decrease the number developing pre-procedural anxiety or a fear of needles.

Unexpected deaths in medical wards during night shifts: a narrative analysis of nursing experiences.

AIMS AND OBJECTIVES: To explore nurses' narratives of unexpected patient deaths during nightshifts. BACKGROUND: Despite the importance of patient care and safety during the night, little attention has been paid to this issue in scientific literature. Very few studies have investigated the outcome of night-time nursing care in patients, and there is a distinct paucity of knowledge regarding the experiences of nurses who discover a patient who has died unexpectedly during a night shift. DESIGN: A qualitative study design using semi-structured interviews, interpreted by a narrative inquiry methodology, was adopted. METHODS: A purposeful sample of 15 nurses working in Italian medical wards who had found a patient who had died unexpectedly during a night shift, and who had given their informed consent were interviewed in the period from 2009-2011. An inductive content analysis of the narrated experiences was performed. FINDINGS: A patient's unexpected death during a night shift is something that nurses fear, and when it occurs, the experience is remembered as a nightmare. From the narratives of the participant nurses, five categories described what happened at night when a patient who had died unexpectedly was discovered: (1) the night started by nurses selecting patients needing intensive surveillance; (2) patients were reprioritised for intensive surveillance; (3) nurses were deceived by apparently normal findings; (4) nurses realised the failure of their protective role; and (5) as a consequence, more intrusive surveillance measures were adopted after the event. CONCLUSIONS: From the narratives, a number of failures in cumulative and individual surveillance occurred during the night when a patient died unexpectedly. The deaths were recognised late, causing intense pain in nurses; this experience affected the following night shifts, when the nurses' surveillance was more intensive, insistent and intrusive towards patients, even if this was unnecessary. RELEVANCE TO CLINICAL PRACTICE: The continuing belief that the night shift is a time when fewer nurses are needed means that the number of registered nurses is reduced and reliance is placed on nursing aides instead, placing patients at risk by compromising the effectiveness of surveillance and the consequent clinical decisions made by nurses and physicians.

Strain and health implications of nurses' shift work.

OBJECTIVES: The study investigated whether nurses' different working schedules are associated with different levels of job-related strain, health symptoms and behavior. No reports have been accessible in the relevant literature on the possible association between shift work and job-related strain in nurses. MATERIALS AND METHODS: This was a cross-sectional study conducted at a large university hospital in North-East Italy, involving 806 nurses working in selected departments. A multilevel logistic regression was applied to assess the association between work shift conditions and selected outcomes. RESULTS: Night shifts were associated not only with higher odds of having a high Job Demand, but also with lower odds of having a high Decision Authority and consequently with a stronger likelihood of having higher levels of Job Strain (high Job Demand score ≥ 38 and Low Decision Authority). The night shift was associated with various symptoms, particularly exhaustion (p = 0.039) and gastric pain (p = 0.020). Nurses' working schedules did not affect their job satisfaction scores. CONCLUSIONS: It has been confirmed that night shifts are a risk factor for nurses' health perception and working night shifts carries a considerable degree of strain. This is a condition that hospital nursing managements need to consider carefully to avoid burnout in nursing personnel and prevent an excessive turnover in this profession, which is a recurring problem for health care organizations.