Unfolding of a Temperature-Sensitive Domain Controls Voltage-Gated Channel Activation.

Voltage-gated ion channels (VGICs) are outfitted with diverse cytoplasmic domains that impact function. To examine how such elements may affect VGIC behavior, we addressed how the bacterial voltage-gated sodium channel (BacNa(V)) C-terminal cytoplasmic domain (CTD) affects function. Our studies show that the BacNa(V) CTD exerts a profound influence on gating through a temperature-dependent unfolding transition in a discrete cytoplasmic domain, the neck domain, proximal to the pore. Structural and functional studies establish that the BacNa(V) CTD comprises a bi-partite four-helix bundle that bears an unusual hydrophilic core whose integrity is central to the unfolding mechanism and that couples directly to the channel activation gate. Together, our findings define a general principle for how the widespread four-helix bundle cytoplasmic domain architecture can control VGIC responses, uncover a mechanism underlying the diverse BacNa(V) voltage dependencies, and demonstrate that a discrete domain can encode the temperature-dependent response of a channel.

Self-care behaviors and their individual-level determinants in Italian adults with Marfan syndrome: A single-center cross-sectional study.

AIM: This study aimed to describe the levels of self-care behaviors and self-care self-efficacy in patients with Marfan syndrome and to identify the individual-level determinants of self-care behaviors. BACKGROUND: The behaviors aimed at maintaining health stability (self-care maintenance), monitoring signs and symptoms (self-care monitoring), and taking action when signs and symptoms occur (self-care management) are key aspects of the care for addressing the complexity of care of patients with Marfan syndrome. However, the description of self-care behaviors and their determinants in patients with Marfan syndrome are highly under-described. METHODS: The adopted design was descriptive observational with a cross-sectional data collection on 111 patients with MFS in a single Italian specialized and reference center for this disease between 2020 and 2021. RESULTS: Performing healthy activities and managing illness, therapies, and follow-ups to maintain health over time (self-care maintenance) was almost adequate (mean score = 67.87 ± 13.17), as well as the ability to recognize signs and symptoms promptly (self-care monitoring, mean score = 67.95 ± 26.70). The ability to respond to symptoms when they occur (self-care management, mean score = 54.17 ± 19.94) was sub-optimal. The stronger positive predictor of each self-care behavior was self-care self-efficacy. CONCLUSIONS: This study suggested prioritizing educational activities focused on enhancing self-care management in patients with Marfan syndrome and strengthening their self-care self-efficacy. Researchers should develop and validate evidence-based educational approaches to enhance self-care in patients with Marfan syndrome, and clinical nurses should strengthen their focused educational activities to improve the self-care management of these patients.

K2P2.1 (TREK-1)-activator complexes reveal a cryptic selectivity filter binding site.

Polymodal thermo- and mechanosensitive two-pore domain potassium (K2P) channels of the TREK subfamily generate 'leak' currents that regulate neuronal excitability, respond to lipids, temperature and mechanical stretch, and influence pain, temperature perception and anaesthetic responses. These dimeric voltage-gated ion channel (VGIC) superfamily members have a unique topology comprising two pore-forming regions per subunit. In contrast to other potassium channels, K2P channels use a selectivity filter 'C-type' gate as the principal gating site. Despite recent advances, poor pharmacological profiles of K2P channels limit mechanistic and biological studies. Here we describe a class of small-molecule TREK activators that directly stimulate the C-type gate by acting as molecular wedges that restrict interdomain interface movement behind the selectivity filter. Structures of K2P2.1 (also known as TREK-1) alone and with two selective K2P2.1 (TREK-1) and K2P10.1 (TREK-2) activators-an N-aryl-sulfonamide, ML335, and a thiophene-carboxamide, ML402-define a cryptic binding pocket unlike other ion channel small-molecule binding sites and, together with functional studies, identify a cation-π interaction that controls selectivity. Together, our data reveal a druggable K2P site that stabilizes the C-type gate 'leak mode' and provide direct evidence for K2P selectivity filter gating.

Remote motivational interviewing to improve patient self-care and caregiver contribution to self-care in heart failure (REMOTIVATE-HF): Rationale, design, and methodology for a multicentre randomized controlled trial.

In patients with heart failure (HF), self-care, and caregiver contribution to self-care (i.e., the daily management of the disease by patients and caregivers) are essential for improving patient outcomes. However, patients and caregivers are often inadequate in their self-care and contribution to self-care, respectively, and struggle to perform related tasks. Face-to-face motivational interviewing (MI) effectively improves self-care and caregiver contribution to self-care, but the evidence on remote MI is scarce and inconclusive. The aims of this randomized controlled trial will be to evaluate whether remote MI performed via video call in patients with HF: (1) is effective at improving self-care maintenance in patients (primary outcome); (2) is effective for the following secondary outcomes: (a) for patients: self-care management, self-care monitoring, and self-efficacy; HF symptoms; generic and disease-specific quality of life; anxiety and depression; use of healthcare services; and mortality; and (b) for caregivers: contribution to self-care, self-efficacy, and preparedness. We will conduct a two-arm randomized controlled trial. We will enroll and randomize 432 dyads (patients and their informal caregivers) in Arm 1, in which patients and caregivers will receive MI or, in Arm 2, standard care. MI will be delivered seven times over 12 months. Outcomes will be assessed at baseline and 3 (primary outcome), 6, 9, and 12 months from enrollment. This trial will demonstrate whether an inexpensive and easily deliverable intervention can improve important HF outcomes. With the restrictions on in-person healthcare professional interventions imposed by the COVID-19 pandemic, it is essential to evaluate whether MI is also effective remotely.

Development and validation of the parents' healthcare needs scale for adolescents with congenital heart disease.

PURPOSE: The healthcare needs of parents of adolescents with congenital heart disease (CHD) have been under-investigated as no valid and reliable tools have been developed for assessing their needs. Therefore, this study aims to develop and validate the Parents' Healthcare Needs Scale for adolescents with CHD (PHNS-CHD). DESIGN AND METHODS: A multi-method approach and multi-phase design were employed. Phase one referred to generating scale items based on emerging themes in the literature, and phase two showed the validation process, divided into three steps. Step one tested the content and face validity of the first version of the PHNS-CHD. After that, step two described the initial psychometric validation process of scale using an exploratory factorial analysis (EFA). Then, step three confirmed the PHNS-CHD factorial structure and assessed its internal consistency. RESULTS: The PHNS-CHD showed evidence of face and content validity, adequate construct, and internal consistency and stability. Specifically, it had 22 items grouped into five domains, labeled as follows: Healthcare education to the child; to be supported as a parent, clinical support to the child, the continuum of care to the child; emotional support to the child. CONCLUSIONS: The PHNS-CHD is a psychometrically robust measure for assessing the healthcare needs of parents of adolescents with CHD. PRACTICE IMPLICATIONS: The PHNS-CHD might help clinicians, especially pediatric nurses, assess the healthcare needs of parents of adolescents with CHD and design adequate care plans for the whole family.

Barriers to self-monitoring implementation in the oral anticoagulated population: A qualitative study.

AIM: This study aimed to explore and understand the barriers perceived by Italian nurses to adopting self-monitoring for managing oral anticoagulation in real-life settings. BACKGROUND: Barriers to self-monitoring implementation for managing oral anticoagulation have been poorly described. DESIGN: The study had a qualitative descriptive and exploratory design with a hybrid approach. METHODS: A literature review was conducted to identify a priori barriers (deductive approach), while a small and semi-structured focus group discussion was performed to explore the contextual barriers experienced by Italian nurses (inductive approach). A classic content analysis technique was adopted. Data were collected in 2019. FINDINGS: Two main categories were identified. Organizational barriers referred to the lack of inter-professional collaboration and health-care system strategies to provide clinical pathways for self-monitoring. Individual barriers encompassed professional characteristics (e.g. university background, professional knowledge, continuum education and accountability/responsibility) and patient characteristics (e.g. patient health literacy and knowledge, engagement/empowerment and educational programmes). Finally, unwarranted clinical variation in oral anticoagulation management arose as a barrier determined by organizational and individual elements. CONCLUSIONS: The results of this study pointed out an urgent public health issue in addressing barriers influencing self-monitoring practice and in sustaining care models that might enhance the quality improvement of self-monitoring for managing oral anticoagulation.

Efficacy of motivational interviewing on enhancing self-care behaviors among patients with chronic heart failure: a systematic review and meta-analysis of randomized controlled trials.

Although motivational interviewing (MI) seems to be promising for enhancing self-care behaviors (i.e., daily disease management and responses to symptoms) in patients with heart failure (HF), no quantitative pooling of effect sizes has been described to summarize and test its efficacy on self-care. Given that self-care behaviors of patients with HF are essential to enhance pharmacological adherence and disease management and optimize clinical outcomes, we sought to perform a systematic review of randomized control trials (RCTs) regarding MI's efficacy on enhancing self-care behaviors among patients with HF, synthesizing MI effects on self-care through meta-analyses. Nine randomized controlled trials were included. MI showed moderate effects on enhancing self-care confidence (Hedge's g = 0.768; 95%CI = 0.326-1.210; P = 0.001) and self-care management (i.e., responses to symptoms) (Hedge's g = 0.744; 95%CI = 0.256-1.232; P = 0.003) and large effects on improving self-care maintenance (i.e., adherence to treatment and symptom monitoring) (Hedge's g = 0.873; 95%CI  = 0.430-1.317; P < 0.001). No significant effects were found for enhancing the self-reported physical functioning (Hedge's g = -0.385; 95%CI = -1.063-0.294; P = 0.267) or the directly assessed physical functioning using the 6-min walking test (Hedge's g = -0.131; 95%CI = -0.981-0.720; P = 0.072). Although future research is still required to identify situation-specific indications regarding how MI should be implemented in relation to specific clinical conditions, this study showed that MI is an effective strategy to improve self-care in patients with HF.

Predictors of Adjustment to Living with an Ostomy: Results of a Cross-sectional Study.

OBJECTIVE: To describe predictors of adjustment to living with an ostomy among Italian adults with an enterostomy or a colostomy. METHODS: A multicenter, cross-sectional design was performed, sampling 403 patients with an ostomy in three different outpatient clinics of northern Italy between April 2018 and December 2020. Data were collected by stoma therapists in ambulatory settings using the Italian version of the Ostomy Adjustment Inventory-23 and patient medical records. RESULTS: Acceptance was lower among women, patients who underwent emergency surgery, those with a urostomy, and those with a body mass index of less than or equal to 25 kg/m2. Negative feelings were associated with higher body mass index, colostomies, shorter length of time of living with an ostomy, and emergency ostomy creation. CONCLUSIONS: Being young and having a high level of education are protective against psychosocial problems and help promote acceptance and social engagement. The findings of this study help identify patients who are likely to be more vulnerable and need greater support through specific educational and motivational interventions.

Mapping the literature on Digital and Technological Solutions in nursing: a scoping review protocol. / Mappatura della letteratura sulle soluzioni digitali e tecnologiche nell'assistenza infermieristica: un protocollo di scoping review.

INTRODUCTION: Digital and technological solutions (DTS) might have an impact on people's personal and professional lives. These types of solutions, according to studies, have the potential to revolutionize and improve the quality and long-term sustainability of healthcare activities, with nurses playing a significant role. Although DTS appears to be intimately linked to the future of nursing, technology must be utilized as an active rather than passive tool. Nonetheless, understanding DTS appears to be difficult, and a scoping study can provide a thorough overview of such a complicated topic. As a result, the scoping study on this topic will map all of the important aspects of DTS and synthesize studies on the nursing workforce, as well as analyze and clarify knowledge gaps and aid future research and development. This article presents the study protocol. METHODS: The Joanna Briggs Institute (JBI) scoping review methodology will be used for the proposed scoping review. It will include both quantitative and qualitative scientific research as well as grey literature on DTS in nursing. Only English-language works will be considered for inclusion. Two independent reviewers will take part in an iterative process of evaluating literature, choosing papers, and extracting data. Disagreements among reviewers will be resolved through debate until a consensus is reached or through consultation with the study team if necessary. Results will be presented using descriptive statistics, diagrammatic or tabular displayed information, and narrative summaries, as specified in the JBI guidelines. DISCUSSION: This scoping review protocol explained why it is important to describe the literature on embracing DTS in the nursing field, how to approach the research process, and what the study's key implications will be. The protocol itself may be helpful to increase transparency in the research process, attract interested researchers to work with the group that developed the protocol and offer a practical methodological benchmark for researchers interested in performing scoping reviews by serving as an example of a scoping review protocol.

Effects from physical exercise on reduced cancer-related fatigue: a systematic review of systematic reviews and meta-analysis.

BACKGROUND: Cancer-related fatigue is one of the most prevalent and distressing symptoms among cancer patients, resulting in a great cancer research challenge. Numerous systematic reviews of physical training interventions have been conducted to find the most effective approach. However, evidence remains fragmented, and in which cancer population physical training is more effective than other populations is still unclear. Thus, this study critically appraised systematic reviews and meta-analyses on physical training to reduce adults' cancer-related fatigue. METHODS: A systematic review of systematic reviews and meta-analysis (PROSPERO: CRD42020189049), assessing the efficacy of exercise training for reducing cancer-related fatigue in adults, was conducted in PubMed, CINAHL, Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects, and Pedro. The selected studies (standardized mean difference, SMD; 95%CI), was quantitatively pooled using a random-effects model. Heterogeneity was tested using chi-squared (Q) and I-square statistics (I2). RESULTS: Of 1438 identified articles, 11 met the inclusion criteria, and ten were meta-analyzed. The results yielded a positive effect of physical training on fatigue in all cancer populations, SMD = -0.33 (-0.43, -0.23). Subgroup analysis based on tumor localization showed a slightly higher physical training effect on fatigue in adults with breast cancer, SMD = -0.36 (-0.57, -0.15), and prostate cancer SMD = -0.34 (-0.45, -.0.22). CONCLUSIONS: Our analysis demonstrated some potential improvement in cancer-related fatigue in adult patients undergoing physical training during and after cancer treatments, particularly in patients with breast or prostate cancer.

Nursing self-efficacy for oral anticoagulant therapy management: Development and initial validation of a theory-grounded scale.

AIM: This study aimed to develop and validate a nursing self-efficacy scale for OAC management (SE-OAM). BACKGROUND: Oral anticoagulant therapy (OAC) requires specific nursing competencies. Given that self-efficacy acts as a proxy assessment of nursing competence, its measurement is pivotal for addressing educational programs to enhance nursing competence in managing OAC. Thus far, the measurement of self-efficacy in OAC is undermined by the unavailability of valid and reliable tools. METHODS: A multi-method and multi-phase design was adopted: Phase one was a methodological study encompassing developmental tasks for generating items. Phase two comprised the validation process for determining the content validity, construct and concurrent validity, and internal consistency through two cross-sectional data collections. RESULTS: In total, 190 nurses were enrolled for determining the psychometric structure of the SE-OAM through an exploratory approach, and 345 nurses were subsequently enrolled to corroborate its most plausible factor structure derived from the exploratory analysis. The SE-OAM showed evidence of face and content validity, adequate construct, concurrent validity, good internal consistency, and stability. The final version of the scale encompassed 21 items kept by five domains: clinical management, care management, education, clinical monitoring, and care monitoring. CONCLUSIONS: The SE-OAM showed evidence of initial validity and reliability, fulfilling a current gap in the availability of tools for measuring nursing self-efficacy in managing OAC. SE-OAM could be strategic for performing research to improve the quality of OAC management by enhancing nursing self-efficacy.

Burnout syndrome and its determinants among healthcare workers during the first wave of the Covid-19 outbreak in Italy: a cross-sectional study to identify sex-related differences.

INTRODUCTION: Several studies described burnout levels of healthcare workers (HCWs) during the COVID-19 pandemic; however, sex-related differences remain poorly investigated. OBJECTIVE: To describe sex-related differences in burnout and its determinants among HCWs during the first pandemic wave of the COVID-19 in Italy. METHODS: A cross-sectional study was performed between April and May 2020. The framework given by the Job Demands Resources (JD-R) model was used to assess burnout determinants (risk and protective factors). RESULTS: Male HCWs (n=133) had higher levels of depersonalization than female HCWs (P=0,017) and female HCWs (n=399) reported greater emotional exhaustion rates (P=0,005). Female nurses were the most exposed to burnout (OR=2,47; 95%CI=1,33-4,60; P=0,004), emotional exhaustion (OR=1,89; 95% CI=1,03-3,48; P=0,041), and depersonalization (OR=1,91; 95% CI=1,03-3,53; P=0,039). Determinants of burnout differed between sexes, and some paradoxical associations were detected: the score of job demands was a protective factor in females for burnout, emotional exhaustion, and depersonalization, resilience was a risk factor for males. CONCLUSIONS: This study reveals that the stressors in male and female HCWs tended to be associated with burnout differently. Both sexes showed alarming burnout levels, even if the weights of emotional exhaustion and depersonalization acted in different ways between the sexes. The revealed paradoxical effects in this study could reflect the study's cross-sectional nature, highlighting that more resilient and empathic individuals were more consciously overwhelmed by the challenges related to the COVID-19 pandemic, thus reporting higher scores of emotional exhaustion and burnout. Future in-depth and longitudinal analyses are recommended to further explore sex-related differences in burnout among HCWs.

Determinants of health-related quality of life: a cross-sectional investigation in physician-managed anticoagulated patients using vitamin K antagonists.

BACKGROUND: Literature has paid little attention in describing the specific contribution of each modifiable and non-modifiable characteristics on health-related quality of life (HRQoL) in physician-managed anticoagulated patients using vitamin K antagonists (VKAs). To describe how patients' treatment-specific knowledge, health literacy, treatment beliefs, clinical, and socio-demographic characteristics influence HRQoL in Italian physician-managed anticoagulated patients using VKAs. METHODS: Cross-sectional multicentre study with a consecutive sampling strategy, enrolling 164 long-term anticoagulated patients. Clinical and socio-demographic characteristics were collected from electronic medical records. Valid and reliable questionnaires were used to collect patients' treatment-specific knowledge, health literacy, beliefs about VKAs, physical and health perceptions. RESULTS: Obtaining and understanding health information (i.e., communicative health literacy) positively predicts both adequate mental (ORadjusted = 10.9; 95%CI = 1.99-19.10) and physical (ORadjusted = 11.54; 95%CI = 1.99-34.45) health perceptions. Conversely, the ability to perform proper health decision making (i.e., critical health literacy) was associated with lower rates of adequate mental health perception (ORadjusted = 0.13; 95%CI = 0.03-0.63). Further, age negatively predicted physical health perception (ORadjusted = 0.87; 95%CI = 0.81-0.93). CONCLUSIONS: Health literacy plays an interesting role in predicting HRQoL. The relationship between critical health literacy and mental health perception could be influenced by some psychological variables, such as distress and frustration, which could be present in patients with higher levels of critical health literacy, as they could be more inclined for self-monitoring. For this reason, future research are needed to identify the most suitable patients' profile for each OAC-management model, by longitudinally describing the predictive performance of each modifiable and non-modifiable determinant of HRQoL.

A multi-phase study for the development of a self-efficacy measuring scale for ostomy care nursing management.

AIM: To develop and psychometrically test a self-efficacy scale for ostomy care nursing management. DESIGN: This study adopted a multi-method and multi-phase design. METHOD: Phase 1 of the study was comprised of the developmental tasks, where items were generated based on the emergent themes from literature. The items were then discussed with a panel of experts. Phase 2 focused on the validation process of the scale, where its content validity, construct and concurrent validity, and its internal consistency were assessed. The validation process was conducted between January 2018 - January 2019. RESULTS: The final version of the self-efficacy scale in ostomy care nursing management encompasses 24 items in three domains, namely the clinical assessment domain, the education and relationship domain, and the teamwork domain. The scale showed the evidence of face and content validity, adequate construct and concurrent validity, and adequate internal consistency. CONCLUSION: The developed scale can be used in clinical and educational research. IMPACT: This study presents the development and validation of the first valid and reliable self-reporting measurement for nurses' self-efficacy in ostomy care nursing management. Self-efficacy ostomy care nursing management encompasses 24 items and three domains, which are clinical assessment, education and relationship, and teamwork. This research will have an impact on nursing education, as it addresses the need for a specific self-efficacy assessment of ostomy care nursing management. Self-efficacy ostomy care nursing management will have an impact on nurses and patients, as it can be used to improve nurses' self-efficacy and clinical outcomes for patients in ostomy care.

The Byzantine Role of Big Data Application in Nursing Science: A Systematic Review.

Big data have the potential to determine enhanced decision-making process and to personalize the approach of delivering care when applied in nursing science. So far, the literature on this topic is still not synthesized for the period between 2014 and 2018. Thus, this systematic review aimed to identify and synthesize the most recent evidence on big data application in nursing research. The systematic search was undertaken for the evidence published from January 2014 to May 2018, and the outputs were formatted using the PRISMA Flow Diagram, whereas the quality appraisal was addressed by recommendations consistent with the Critical Appraisal Skills Program. Twelve studies on big data in nursing were included and divided into two themes: the majority of the studies aimed to determine prediction assessment, while only four studies were related to the impact of big data applications to support clinical practice. This review tracks the recent state of knowledge on big data applications in nursing science, revealing the potential for nursing engagement in big data science, even if currently limited to some fields. Big data applications in nursing might have a tremendous potential impact, but are currently underused in research and clinical practice.

Effects of Implementing Standardized Organizational Interventions on Drug Therapy Management (DTM): A Quasi-Experimental Study.

SUMMARY: Background. Interruptions occurring during the drug preparation and administration have a documented effect on patients' safety. However, literature has paid little attention to show how the introduction of a set of standardized organizational interventions, based on the combination of the current evidence, could reduce the number of interruptions occurring during drug therapy management. For this reason, this study used the most recent evidence to combine a set of standardized organizational interventions, and it was aimed to assess the effect of those interventions on the number of interruptions occurring during drug therapy management (Hypothesis a) and the overall duration of the therapy administration (Hypothesis b). Methods. A quasi-experimental study was performed, using pre- and a post- organizational implementation data collections in a single Italian center. The data collections were related to the interruptions and 40 shifts were randomly selected for both pre- and post-phase, respectively on December 2016 and February 2017. The standardized organizational interventions were implemented using the current evidence on this topic. Results. The standardized organizational interventions decreased the interruptions in the post-implementation phase, but those had not an effect on the duration of the therapy administration. Conclusions. This study represented an updated evidence, which describes the effect of a standardized and evidence-based set of organisational interventions' implementation on drug therapy management. Our results suggest a number of hints for managers and future researches. Managers should keep into account the usefulness of those interventions, while future researches with experimental designs are needed to provide harder evidence on this topic.

Development and validation of the pressure ulcer management self-efficacy scale for nurses.

BACKGROUND: Pressure ulcers (PUs) represent a current issue for healthcare delivery. Nurse self-efficacy in managing PUs could predict patients' outcome, being a proxy assessment of their overall competency to managing PUs. However, a valid and reliable scale of this task-specific self-efficacy has not yet been developed. OBJECTIVES: To develop a valid and reliable scale to assess nurses' self-efficacy in managing PUs, that is, the pressure ulcer management self-efficacy scale for nurses (PUM-SES). METHODS: This study had a multi-method and multi-phase design, where study reporting was supported by the STROBE checklist (File S1). Phase 1 referred to the scale development, consisting in the items' generation, mainly based on themes emerged from the literature and discussed within a panel of experts. Phase 2 focused on a three-step validation process: the first step aimed to assess face and content validity of the pool of items previously generated (initial version of the PUM-SES); the second aimed to assess psychometrics properties through exploratory factorial analysis; the third step assessed construct validity through confirmative factorial analysis, while concurrent validity was evaluated describing the relationships between PUM-SES and an established general self-efficacy measurement. Reliability was assessed through the evaluation of stability and internal consistency. RESULTS: PUM-SES showed evidence of face and content validity, adequate construct and concurrent validity, internal consistency and stability. Specifically, PUM-SES had four domains, labelled as follows: assessment, planning, supervision and decision-making. These domains were predicted by the same second-order factor, labelled as PU management self-efficacy. CONCLUSION: PUM-SES is a 10-item scale to measure nurses' self-efficacy in PU management. A standardised 0-100 scoring is suggested for computing each domain and the overall scale. PUM-SES might be used in clinical and educational research. RELEVANCE TO CLINICAL PRACTICE: Optimising nurses' self-efficacy in PU management might enhance clinical assessment, determining better outcomes in patients with PUs.

Individual-level determinants of interprofessional team collaboration in healthcare.

Interprofessional team collaboration (ITC) is pivotal for the safety and the quality of healthcare settings, being associated with higher staff and patient satisfaction. However, individual-level determinants (i.e. socio-demographic and working satisfaction) remain currently largely unexplored. This study aimed to describe the overall ITC (i.e. partnership, cooperation, coordination), identifying the individual-level determinants of each ITC domain. This study had a multicentre approach, using cross-sectional data collection. ITC was assessed using the Interprofessional Team Collaboration Scale II, Italian version (I-AITCS II). The determinants of ITC were investigated through multivariable linear regression models. The study results showed significant associations between the same ITC domains, as well as the important role of work satisfaction in determining cooperation and coordination. Physicians reported more inadequate partnership levels than other healthcare professionals. This study provides insights for future research and gives a useful description of the determinants of ITC for multi-stakeholder healthcare organizations.

International Nursing: GSD International Nursing Academy: An Italian Case of Practical Disruption Highlighting the Worth of Nursing Within Health Care Organizations.

It is strategic to describe and disseminate available examples of how nurses find the modus operandi to being fully integrated in their organizations, including the nurse role in determining improvements in clinical practice, management, education, and/or research. This article describes the recent experiences of Gruppo San Donato International Nursing Academy. The disruptive case shared here underlines the worth of nursing within health care organizations. The Gruppo San Donato International Nursing Academy aims to be a striking model to innovate health care delivery through the optimal utilization of the nursing workforce, uniting the areas of nursing management, nursing education, and research into a unique organizational platform.

Bedside nursing handover and organisational will to achieve personalisation within an Italian Cardiac SurgeryUnit: the nurses' viewpoint through a qualitative study.

INTRODUCTION: Bedside nursing handover may be an efficient way to achieve quality nursing outcomes, supporting the personalization of care. Recent literature attests to how bedside nursing handover is perceived by cardiac patents, but the experience of nurses participating in these handovers is largely unknown. The aim of this study is to explore nurses' experiences after the implementation of bedside nursing handover in an Italian cardiac surgical ward. METHOD: A qualitative descriptive research approach was used to respond to the study aim, and the data was collected using two focus groups. RESULTS: The main themes that were identified revolved around improving nursing care, greater professionalism, effective relationships, consequences for the patient, and obstacles to change. Moreover, we found that nurses perceive bedside nursing handover to be effective in promoting patient-centred care. The nurses in our study also felt that any difficulties with the implementation of a bedside nursing handover protocol (e.g. confidentiality) should be addressed through continued nursing education. CONCLUSIONS: This study provides a valuable insight into nurses' perceptions of bedside nursing handover in a single cardiac surgery setting in Italy and is the first qualitative investigation from this perspective. Further research may help to elucidate the impact of bedside nursing handover on clinical and organisational outcomes.