A Cell-Phone Medication Error eHealth App for Managing Safety in Chronically Ill Young Patients at Home: A Prospective Study.

Introduction: Whereas ample information describes medication errors (MEs) in children or in mixed pediatric and adult populations discharged with acute or chronic diseases from hospital to community settings, little is known about MEs in children and adolescents with chronic diseases discharged home, a major concern. To promote home medication safety, we trained parents of children discharged with chronic diseases to record ME with a tailored cell-phone eHealth app. Methods: In a 1-year prospective study, we used the app to monitor ME in patients with chronic diseases discharged home from a tertiary hospital in Rome, Italy. Univariate and multivariate analyses detected the ME incidence rate ratio (IRR). Results: Of the 310 parents enrolled, 194 used the app. The 41 MEs involved all drug management phases. The ME IRR was 0.46 errors per child. Children <1 year had the highest ME risk (1.69 vs. 0.35, p = 0.002). Children discharged from the cardiology unit had a statistically higher ME IRR than others (3.66, 95% confidence interval: 1.01-13.23%). Conclusions: The highest ME risk at home involves children with chronic diseases <1 year old. A significant ME IRR at home concerns children with heart diseases of any age. Parents find a tailored eHealth app for monitoring and reporting ME at home easy to use. At discharge, clinical teams need to identify age-related and disease-residual risks to target additional actions for monitoring ME, thus increasing medication safety at home.

Work-related stress, job satisfaction, and quality of work life among cardiovascular nurses in Italy: Structural equation modeling.

AIM: To investigate the simultaneous effects of work-related stress and job satisfaction on cardiovascular nurses' quality of work life. BACKGROUND: Prior research has investigated nurses' work-related stress, job satisfaction, and quality of work life as separate aspects and not in specific nursing settings, such as cardiovascular wards. Cardiovascular care settings can be particularly stressful for nurses, who are often faced with distress, depression and patients and caregivers' physical and psychological exhaustion. METHODS: A multicenter cross-sectional study was conducted among 1126 cardiovascular nurses from 10 hospitals in Italy. Work-related stress, job satisfaction, and quality of work life were measured using valid and reliable questionnaires. Structural equation modeling was performed. RESULTS: Nurses working in critical cardiac care units experienced more stress than their colleagues working in other cardiac units. Nurses working in cardiac outpatient clinics reported lower quality of work life than those working in other cardiac settings. There was a negative relationship between work-related stress and nurses' quality of work life, which was partially mediated by job satisfaction, indicating that stress generated by the work environment negatively affect nurses' quality of work life by reducing their job satisfaction. CONCLUSION: Cardiovascular nurses' quality of work life is negatively affected by work-related stress. The work-related stress is mediated through job satisfaction. Nurse managers should maximize nurses' job satisfaction by providing comfort at work, supporting professional development opportunities, sharing organizational objectives, and actively listening and addressing nurses' concerns. When cardiovascular nurses' quality of work life is elevated, patients' care quality and outcomes are improved.

Self-care behaviors in patients with cancer treated with oral anticancer agents: a systematic review.

PURPOSE OF REVIEW: Continuous progress in cancer care has led to its increased use in oral anticancer agents that are easily managed by patients at home with fewer costs and hospitalizations. However, correct self-care behaviors are needed for the safe use of these medications. This review aimed to synthesize studies on self-care behaviors in patients treated with oral anticancer agents. METHODS: This systematic review used a convergent qualitative synthesis design for mixed studies. Studies on adult patients with cancer using any kind of oral anticancer agent and describing self-care maintenance, self-care monitoring, and/or self-care management behaviors were searched on PubMed, EMBASE, and CINAHL. After data extraction, the findings were retained for qualitative synthesis. FINDINGS: Of 3419 records, 19 studies were included in this review. From the qualitative synthesis, all the retrieved behaviors were synthesized in the three self-care dimensions. Five themes and 18 subthemes were identified. Self-care maintenance included "adherence to the medications" and "prevention." Self-care monitoring consisted of "health surveillance and recognition of illness changes." Self-care management included "seeking help" and "autonomous management of side effects." Overall, most of the behaviors described focused only on adherence. CONCLUSION: The findings of this systematic review could guide future studies on self-care and drive future interventions aimed at improving self-care in this vulnerable population. Nurses and other healthcare professionals should provide self-care support to patients taking oral anticancer agents. In particular, they should promote behaviors aimed at improving well-being, preserving health, or managing side effects.

Attitudes and practices towards vital signs monitoring on paediatric wards: Cross-validation of the Ped-V scale.

PURPOSE: To develop and psychometrically test an instrument measuring the attitudes and practices towards vital signs (VS) monitoring in nurses caring for children on paediatric wards (Ped-V scale). DESIGN AND METHODS: This is a multicentre cross-validation study with a cross-sectional design. The Ped-V scale was developed by adapting the V-scale to the paediatric context and administered to a convenience sample of clinical nurses working in paediatric wards from January to May 2020. The content validity of the Ped-V scale was evaluated by a group of 10 experts. The psychometric properties of the scale were tested through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). RESULTS: Overall, 10 Italian hospitals participated in the study, and 640 questionnaires were completed (87% female). At EFA a 30-item version of the scale and four factors emerged. This solution was confirmed at CFA: F1) 'Inaccuracy of VS monitoring and workload'; F2) 'Clinical competence and communication'; F3) 'Standardization and protocol adherence'; F4) 'Misconceptions about key indicators'. Cronbach's alpha ranged between 0.63 and 0.85. CONCLUSIONS: The Ped-V scale is valid and reliable for use in the paediatric context to identify barriers concerning nurses' self-efficacy, competences, and knowledge of clinical indicators of paediatric critical deterioration, attitudes towards accuracy, standardization, communication to senior team members and the appropriate use of technology in paediatric VS monitoring. PRACTICE IMPLICATIONS: The Ped-V scale may assist in identifying gaps in nurses' attitudes and devising strategies to change nurses' beliefs, knowledge, skills and decreasing individual, local cultural or organizational barriers towards VS monitoring.

Participation of nurses and allied health professionals in research activities: a survey in an academic tertiary pediatric hospital.

BACKGROUND: Involvement in research activities is complex in pediatric nursing and allied health professionals (AHPs). It is important to understand which individual factors are associated with it to inform policy makers in promoting research. METHODS: A cross-sectional observational study was conducted to describe the level of participation in research activities over the last ten years of nurses and AHPs working in a tertiary pediatric hospital. A large sample of nurses and AHPs working in an Italian academic tertiary pediatric hospital completed an online self-report questionnaire between June and December 2018. Three multivariate logistic regression analyses were performed to predict participation in research projects, speaking at conferences, and writing scientific articles. RESULTS: Overall, data from 921 health professionals were analyzed (response rate = 66%), of which about 21% (n = 196) reported participating in a research project, while 33% (n = 297) had attended a scientific conference as a speaker, and 11% (n = 94) had written at least one scientific paper. Having a Master or a Regional Advanced Course, working as an AHP or a ward manager, as well as regularly reading scientific journals and participation in an internal hospital research group or attendance in a specific course about research in the hospital, significantly predicted participation in research projects, speaking at conferences and writing scientific papers. It is important to foster research interest and competencies among health professionals to improve participation in research projects, speaking at conferences, and writing scientific papers. CONCLUSIONS: Overall, we found a good level of attendance at conferences as speakers (33%), a moderate level of participation in research (21%), and low levels for writing scientific papers (11%). Our study highlighted the need to support participation in research activities among nurses and AHPs. Policymakers should identify strategies to promote research among nurses and AHPs, such as protected rewarded time for research, specific education, strengthened collaboration with academics, and financial support. Moreover, hospital managers should promote the development of research culture among health professionals, to improve their research competencies and evidence-based practice.

Living with cancer in the COVID-19 pandemic: An Italian survey on self-isolation at home.

OBJECTIVE: To investigate the perception of self-isolation at home in patients with cancer during the lockdown period resulting from the COVID-19 outbreak in Italy. METHODS: A cross-sectional descriptive study was conducted through an online survey of patients with cancer who were sheltering at home from 29th March to 3rd May 2020. Perception of self-isolation was assessed using the ISOLA scale, after evaluation of its psychometric properties. Content analysis was used to analyse two open-ended questions. RESULTS: The participants were 195 adult patients with cancer (female = 76%; mean age = 50.3 ± 11.2; haematological malignancy = 51.3%). They reported moderate isolation-related suffering (M = 2.64 ± 0.81), problems in their relationships with others (M = 3.31 ± 1.13) and difficulties in their relationships with themselves (M = 3.14 ± 1.06). Patients who experienced significantly more social problems were older, had less education and were living without minor children. Overall, four main categories emerged from the qualitative content analysis: (1) lack of freedom and social life, (2) uncertainty and worries, (3) feeling supported and (4) dealing with isolation. CONCLUSION: Living with cancer in the COVID-19 pandemic was often perceived as an isolating experience, primarily in terms of detachment from loved ones.

Development and psychometric testing of the care dependence perception questionnaire.

OBJECTIVE: This multicentre study aimed to develop a measure of the perception of care dependence in patients diagnosed with cancer and to test its psychometric properties. METHODS: The questionnaire was developed based on findings emerged from a meta-synthesis and from qualitative studies conducted in three hospitals in Italy. The draft questionnaire was tested for face and content validity and pilot-tested with patients. The questionnaire was completed by care-dependent patients with cancer. Test-retest was conducted to verify stability. Exploratory factor analysis (EFA) was performed using a Maximum Likelihood robust estimator. RESULTS AND CONCLUSION: The Scale-Content Validity Index was 0.92. The final 15-item questionnaire was completed by 208 patients admitted to two hospitals. The EFA yielded a two-factor model including a positive and a negative perception of care dependence. Factor score determinacy coefficients, Cronbach's alpha coefficients, composite reliability coefficients and Intraclass Correlations Coefficients yielded satisfactory results confirming internal consistency and stability. The hedonic balance score is also available as a single indicator of subjective well-being. The study provides initial validation of the Care DEeP Questionnaire that can be used by cancer nurses to assess positive and negative patient experiences with care dependence and to personalise and improve their care.

Pediatric nurses in pediatricians' offices: a survey for primary care pediatricians.

BACKGROUND: The role played by nurses in caring for children in pediatricians' officies in the community is crucial to ensure integrated care. In Italy, pediatricians are responsible for the health of children aged 0-14 years living in the community. This study aimed to describe Italian primary care pediatricians' opinions about the usefulness of several nursing activities that pediatric nurses could perform in pediatricians' offices. METHODS: An online survey with pediatricians working in primary care in Italy was conducted between April-December 2018. A 40-item questionnaire was used to assess four types of nursing activities: clinical care, healthcare education, disease prevention, and organizational activities. The answers ranged from 1 (not useful at all) to 6 (very useful). Moreover, three open-ended questions completed the questionnaire. RESULTS: Overall, 707 pediatricians completed the online survey. Participants were mainly female (63%), with a mean age of 57.74 (SD = 6.42). The presence of a pediatric nurse within the pediatrician's office was considered very useful, especially for healthcare education (Mean 4.90; SD 1.12) and disease prevention (Mean 4.82; SD 1.11). Multivariate analysis confirmed that pediatricians 'with less working experience', 'having their office in a small town', and 'collaborating with a secretary and other workers in the office' rated the nurse's activities significantly more useful. CONCLUSIONS: A pediatric nurse in the pediatrician's office can significantly contribute to many activities for children and their families in the community. These activities include clinical care, healthcare education, disease prevention, and the organizational processes of the office. Synergic professional activity between pediatricians and pediatric nurses could ensure higher health care standards in the primary care setting.

Nursing students' academic self-efficacy: A longitudinal analysis of academic self-efficacy changes and predictive variables over time.

AIM: To analyse any changes seen in the academic self-efficacy of nursing students during the three years of their academic education as well as the associated predictive factors. DESIGN: A longitudinal study design was applied. METHODS: The sample included 220 students who attended a large university in central Italy. The students' academic self-efficacy was measured using the Academic Nurses' Self-Efficacy Scale. Data were collected annually from 2014/2015 to 2017/2018 at the beginning of the first year (T0), at the end of the first year (T1), at the end of the second year (T2) and at the end of the third year (T3). A repeated measure univariate analysis of variance (ANOVA) was conducted to detect any possible changes in the students' academic self-efficacy scores over the four measurement points. To identify the factors that are predictive of academic self-efficacy, a linear regression model was used. RESULTS: Overall, the students' academic self-efficacy did not change significantly over the three-year period of their education. Both sex (female) and age (24-50 years) during T0-T2 significantly predicted changes in the students' academic self-efficacy over time. Moreover female students started with lower academic self-efficacy scores than male students, although their academic self-efficacy increased over time, while the male students' academic self-efficacy actually decreased over time. In addition, students with a scientific background reported higher academic self-efficacy than other students. CONCLUSIONS: Although the students' academic self-efficacy did not change over time, from a theoretical perspective, academic self-efficacy can be developed using a number of strategies such as a well-organised tutorial during the clinical learning phase and feedback or encouragement. IMPACT: Academic staff should monitor nursing students' academic self-efficacy over time, particularly in the case of male and younger students, students with a partner and students with a humanities background during the first 2 years of the course.

Development and psychometric evaluation of the motivation for nursing student scale (MNSS): a cross sectional validation study.

OBJECTIVES: To develop a self-report scale to measure academic motivation among nursing students and to test its psychometric properties. METHODS: a cross-sectional validation study with a convenience sample of nursing students (n=1,635) was performed. The Motivation Nursing Students Scale was developed; content, face, construct validity, hypothesis testing and reliability were evaluated. RESULTS: The validity structure revealed a four-factor solution and the model reached a satisfactory fit (χ2=622.835 df=160, p<0.01, CFI=0.90, TLT=0.83, RMSEA=0.060 (90% [CI] 0.055-0.064, p=0.001, SRMR=0.067). The hypothesis testing was confirmed with a positive correlation of the academic self-efficacy with Introjected, Intrinsic motivation and a negative correlation with Amotivation. CONCLUSIONS: We verified a link between academic self-efficacy and motivation. Both motivation and self-efficacy may increase academic achievement and the possibility for HEIs to degrees a number of students in line with demands.

The Influence of Caregiver Preparedness on Caregiver Contributions to Self-care in Heart Failure and the Mediating Role of Caregiver Confidence.

BACKGROUND: Caregiver contributions (CC) to heart failure (HF) self-care maintenance (ie, CC to maintaining HF stability) and management (ie, CC to dealing with HF signs and symptoms) improve patient outcomes, but it is unknown whether caregiver preparedness influences CC to self-care and whether caregiver confidence mediates this process. OBJECTIVES: We evaluated the influence of caregiver preparedness on CC to HF self-care maintenance and management and the mediating role of caregiver confidence. METHODS: This is a secondary analysis of the MOTIVATE-HF study. Patients were 18 years or older, with a diagnosis of HF in New York Heart Association classes II to IV, who had insufficient self-care and did not have severe cognitive impairment. Patients' informal caregivers were those people inside or outside the family who gave most of the informal care to the patients. We used the Caregiver Preparedness Scale and the Caregiver Contribution to Self-Care of HF Index. We tested a path analysis model and the indirect effects. RESULTS: Caregivers (n = 323) were 55 (SD, 15) years old on average and predominantly female (77%). The path analysis showed that higher scores in caregiver preparedness were associated with higher scores in caregiver confidence. In turn, higher caregiver confidence was associated with higher CC to self-care maintenance and management. Caregiver confidence mediated the association between caregiver preparedness and CC to self-care maintenance and management. CONCLUSIONS: Caregiver confidence may play a role in CC to self-care. Interventions to improve CC to HF self-care should not only be focused on improving caregiver preparedness but also should consider the role of caregiver confidence.

The role of occupational stress in the association between emotional labor and burnout in nurses: A cross-sectional study.

Aim To test a model to evaluate the influence of emotional labor on burnout and the mediating role of work-related stress reported by nurses. BACKGROUND: Nurses are particularly exposed to work-related stress caused by their relationships with their patients. Even though their emotional involvement can cause work-related stress for professionals, nurses recognize this as a fundamental part of the caring relationship, and it has been proved to be therapeutic for patients. The effects of emotional labor contribute to stress, and prolonged exposure to it contributes to burnout syndrome, with repercussions on nurses' health and quality of life, and patients' quality of care. METHODS: A multicentre correlational study was conducted on a sample of 207 nurses from different clinical areas in three hospitals in Italy. A self-report questionnaire was used to measure levels of emotional labor, burnout and work-related stress. RESULTS: High levels of emotional labor and work-related stress increase burnout syndrome in nurses. Work-related stress mediates the relationship between emotional labor and burnout. The Oncology ward is identified as the major clinical area exposing nurses to emotional labor. CONCLUSIONS: The results of this study highlight the mediating role of work-related stress in the relationship between emotional labor and burnout, offering a new field for intervention to interrupt this process.

A Longitudinal Study about Substance Abuse among Italian Nursing Students: Can We Define a Socio-demographic Profile?

BACKGROUND: University time is considered to be a period of vulnerability among nursing students for substance abuse, which can create an unsafe clinical practice. The aim of this study was to investigate the substance abuse of nursing students in the form of alcohol, drugs and tobacco use during the course of studies. In addition, another study aim was to describe a typical socio-demographic profile for substance-abusing students. METHODS: A longitudinal study design based on a sample of 254 nursing students was used. Data from the same cohort of students at the baseline level (T0), at the end of the first year (T1), at the end of the second year (T2) and at the end of the third year (T3) were analysed. RESULTS: A decrease in the number of nursing students who smoke regularly, an increase in the number of those who use drugs to lose control and of those who drink weekly were found. CONCLUSION: The early recognition of substance-abusing students can be fundamental to their health, academic background and safe clinical practice.

Development and initial validation of a questionnaire to assess patients' perception of protective isolation following haematopoietic stem cell transplantation.

The aim of this study was to develop and psychometrically test a questionnaire assessing patients' perception of protective isolation following haematopoietic stem cell transplantation (HSCT). The conceptual framework for developing the questionnaire was a three-dimensional model that emerged from a metasynthesis: isolation-related suffering, relationship with oneself and relationship with others. Item selection was performed through a focus group, comparison with the findings of two phenomenological studies, and content validity with 22 experts. Cognitive interviews with five patients were used to verify face validity. A validation study was conducted in 10 Italian centres, all members of the Italian Group of stem cell transplant (GITMO). Patients completed the questionnaires between 7 and 9 days post-transplant. Dimensionality was tested through exploratory factor analysis (EFA). A total of 17 items yielded a content validity index (CVI) of 0.88. Participants included 186 adult patients receiving autologous (48%) or allogeneic (52%) HSCT in protective isolation. The EFA yielded a three-factor solution, explaining 55% of the variance. The scale showed adequate psychometric properties, with the exception of three items, which were eliminated. Future studies should test the psychometric properties of the questionnaire through confirmatory factor analysis and verify its transcultural validity.

Factors influencing the perception of protective isolation in patients undergoing haematopoietic stem cell transplantation: A multicentre prospective study.

OBJECTIVES: To identify which factors can influence the patients' perception of protective isolation following Haematopoietic Stem Cell Transplantation (HSCT). METHODS: This is a prospective study conducted in 10 Italian centres, members of the Italian Group of stem cell transplant (GITMO). Patients' perception of protective isolation was assessed using the ISOLA scale between 7 and 9 days post-transplant. Statistical linear regression analysis was performed. RESULTS: The participants were 182 adult patients receiving autologous (48%) or allogeneic (52%) HSCT in protective isolation. Male sex (ß = .152), education level (ß = -.245), double room (ß = .186), satisfaction with visiting hours (ß = -.174) and emotional support from nurses (ß = -.169) were independently associated with isolation-related suffering. Significant predictors of the relationship with oneself included body temperature (ß = -.179), fatigue (ß = -.192) and emotional support from nurses (ß = -.292). Factors independently associated with the relationship with others were education (ß = -.230), chemotherapy cycles (ß = -.218), pain (ß = .150) and satisfaction with visiting hours (ß = -.162). CONCLUSION: Healthcare providers should pay greater attention in caring for those patients who are at risk for a negative isolation experience. Nurses should provide emotional support.

Psychometric testing of the Caring Behaviors Inventory for nursing students.

AIM AND OBJECTIVE: To test the psychometric properties of the nursing students' version of the 24-item Caring Behaviours Inventory. BACKGROUND: Caring is at the heart of nursing and should also be a core value in nursing education. Caring can be manifested through measurable behaviours. The Caring Behaviors Inventory is a valid and reliable measure of nurses' caring behaviours in clinical settings. It has already been used among nursing students, but it needs more psychometric testing. DESIGN: Cross-sectional validation study. METHOD: The questionnaire was filled in by 300 undergraduate nursing students at two Italian universities in May 2016. Exploratory factor analysis was conducted using Mplus maximum likelihood with GEOMIN oblique rotation. A multifaceted approach was used to evaluate the model fit. The STROBE checklist for cross-sectional studies was followed. RESULTS: Four dimensions were identified: "being with," "doing with competence," "responding to individual needs" and "providing effective care." Adequate fit indices and high reliability of the factors were found. Correlations between factors were positive and significant. CONCLUSION: This study makes it possible to use the same tool to compare the caring practices perceived by students, nurses and patients. Further studies with bigger samples could be stratified to investigate the associations between caring levels and student characteristics. The Caring Behaviors Inventory can be used to call attention to caring in nursing education, helping to make this concept less elusive. RELEVANCE TO CLINICAL PRACTICE: The effective self-assessment of nursing students' caring behaviours offers opportunities for reflection on their caring practice. This could improve the caring level of their behaviours in clinical practice and help them to become caring nurses in the future.

Risk factors for a difficult intravenous access: A multicentre study comparing nurses' beliefs to evidence.

AIMS AND OBJECTIVES: To summarise the evidence about patient-related risk factors for difficult intravenous access in adults, and at identifying nurses' beliefs and their consistency with evidence. BACKGROUND: Peripheral intravenous cannulation is a common procedure for nurses, but rates of failure at first attempt of peripheral intravenous cannulation range 10%-40%. Nurses' beliefs about difficult intravenous access factors might influence their clinical practice more than current evidence. DESIGN: The study included a literature review of the evidence on patient-related risk factors for difficult intravenous access, the development of an instrument to investigate nurses' beliefs about this topic and a cross-sectional multicentre survey on clinical nurses. METHODS: The quality of the studies included was evaluated through the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A synthesis of evidence for each risk factor was produced. A survey instrument was developed including 26 risk factors, which were then rated by nurses as perceived predictors of difficult intravenous access. The STROBE guidelines for study reporting were followed. RESULTS: Four hundred and fifty clinical nurses working in four hospitals in Italy were surveyed. Nurses' beliefs were in line with evidence in considering body mass index, drug abuse, lymphadenectomy and chemotherapy as difficult intravenous access factors. Beliefs about difficult intravenous access factors were influenced by nurses' work experience and frequency of peripheral intravenous cannulation. Nurses also identified as risk factors for difficult intravenous access oedema, thrombophlebitis, hypovolaemia, skin lesions and irritant therapies, which have been minimally investigated by research. CONCLUSIONS: An overall congruence between nurses' beliefs and evidence about risk factors for difficult intravenous access was found. With their expertise, nurses may fill the knowledge gap of clinical evidence and open new paths for clinically meaningful research. RELEVANCE TO CLINICAL PRACTICE: Nurses' beliefs about difficult intravenous access factors can be influenced by their work experience and clinical setting. Integrating nurses' beliefs with scientific evidence can increase the quality of care.

Experiences of compliance with standard precautions during emergencies: A qualitative study of nurses working in intensive care units.

Aim To explore factors that influence intensive care nurses' experiences of being compliant with standard precautions (SP) during emergencies. BACKGROUND: Intensive care nurses can be exposed to a greater risk of biohazardous exposure during an emergency. The primary strategy to address the complex variety of biological hazards in clinical practice is represented by the implementation of SP guidelines. Previous research has indicated that nurses' compliance rates with SPs are suboptimal, but no study has focused on the factors influencing compliance during an emergency. DESIGN: A descriptive qualitative study was conducted in an Italian university hospital with 19 intensive care nurses who had at least two years of work experience in critical care. The nurses were interviewed in four focus groups and were asked about their experiences of being compliant with SPs during an emergency. Data were analyzed using conventional content analysis. RESULTS: Three themes emerged: conflict, competencies, and context. Conflict was reported regarding the need to save the patient and the need for self-protection through the use of SPs. In particular, nurses had to manage the pressure of limited time. Competencies were identified by nurses' knowledge, attitude, skills, training, and experience. Context was related to the work and organizational conditions during the emergency, including overcrowding. CONCLUSION: To support intensive care nurses' compliance with SPs during emergencies, conflict, competencies, and context should be audited regularly in clinical practice. The findings of this study could inform infection control programs and training that targets intensive care nurses.

Validity and reliability of the Palliative Care Transition Measure for Caregivers (PCTM-C).

OBJECTIVE: Patients suffering from advanced disease face different care transitions. The transition from acute to palliative care is challenging and may lead to the discontinuity of care. Family caregivers become important sources of information, as patients begin to experience difficulties in coping with emotional transition events. The Care Transition Measure was developed to evaluate care transitions as experienced by the elderly. It has never been used in palliative care. The aim of this study was to test the validity and reliability of a modified version of the Palliative Care Transition Measure, specifically the Palliative Care Transition Measure for Caregivers (PCTM-C). METHOD: The study included two main phases. Phase I focused on the construction of a modified version of the Palliative Care Transition Measure through two focus groups and by computing the content validity index. Phase II focused on testing the psychometric properties of the PCTM-C on 272 family caregivers through confirmatory factor analysis. RESULT: The content validity index for each of the items was higher than 0.80, whereas that for the scale was 0.95. The model tested with confirmatory factor analysis fitted the data well and confirmed that the transition measures referred to communication, integrated care and a trusting-relationship, and therefore the core dimensions of continuity according to existing conceptual models. The internal consistency was high (Cronbach's alpha = 0.94). SIGNIFICANCE OF RESULTS: The PCTM-C proved to be a suitable measure of the quality of such transitions. It may be used in clinical practice as a continuity quality indicator and has the potential to guide interventions to enhance family caregivers' experience of care continuity.

Five Years of Journal Clubs With Pediatric Nurses and Allied Health Professionals: A Retrospective Study and Satisfaction Survey.

PURPOSE: Journal Clubs (JCs) for nurses and allied health professionals have been held in an Italian pediatric hospital since April 2008. This study aimed to: examine what type of articles have been used during JCs across 5years; investigate the potential implications for clinical and organizational practice; assess the participants' satisfaction about JCs and their contribution to professional development. DESIGN AND METHODS: Using a retrospective design, all articles proposed in the JCs were examined. Specific criteria were used to evaluate the implications for practice within the hospital, which were classified as direct or indirect. Using a cross-sectional design, 63 JCs participants were asked to express their opinion and satisfaction about the JC sessions attended. RESULTS: Overall, 132 articles were analyzed: most of them focused on pediatric care (64.4%) and nursing (96.2%). Almost half of the articles (n=60, 45.6%) were appraised as having brought implications for clinical practice, both direct (58.3%) and indirect (41.7%). Forty-one participants (12 attendees; 29 active participants) completed a questionnaire about their opinion about JCs. Most of participants (80.5%) reported that the topics selected for the JCs were interesting and relevant to their everyday practice. CONCLUSIONS: Multidisciplinary JCs were considered useful for clinical practice, improvement of the quality of care, and professional development. However, lack of pragmatism and the difficulty to bridge the gap between research and practice were reported as weaknesses. PRACTICE IMPLICATIONS: JCs can represent a quality improvement strategy for promoting research utilization among health professionals and thereby improving the quality of care.