Nurses' experiences of being recruited and transferred to a new sub-intensive care unit devoted to COVID-19 patients.

AIM: To describe the experiences of Italian nurses who have been urgently and compulsorily allocated to a newly established COVID-19 sub-intensive care unit. BACKGROUND: In the context of the COVID-19 pandemic, no studies have documented the experience of nurses urgently reallocated to a newly created unit. METHOD: A qualitative descriptive study. Twenty-four nurses working in a sub-intensive care unit created for COVID-19 patients participated in four focus groups. Audio-recorded interviews were verbatim-transcribed; then, a thematic analysis was performed. RESULTS: The experience of nurses was summarized along three lines: (a) 'becoming a frontline nurse', (b) 'living a double-faced professional experience' and (c) 'advancing in nursing practice'. CONCLUSIONS: Nurses who experienced being mandatorily recruited and urgently reallocated to a COVID-19 unit lived through a mix of negative feelings in the early stages, a double-faced situation during the episode and, at the end, the perception of global growth as a person, as a team and as a professional. IMPLICATION FOR NURSING MANAGEMENT: Nurse managers could play a key role in identifying and preparing nurses in advance to mitigate their concerns and their sense of unpreparedness. The value attributed to nursing care should be promoted both during and after the current COVID-19 pandemic.

Missed nursing care in a long-term rehabilitation setting: findings from a cross-sectional study.

Background: There is a growing amount of literature that links missed nursing care (MNC) to negative patient outcomes, reduced patient safety and poor quality of care. However, only few studies have investigated this phenomenon in long-term rehabilitation settings.Aim: To explore MNC occurrence, type, reasons and predictors in three rehabilitation units.Design: A cross-sectional study was performed between August and September 2017.Method: 95 registered nurses and nursing assistants completed section A (interventions missed) and section B (perceived reasons for MNC) of the MISSCARE Survey tool. Descriptive, bivariate and linear regression analyses were performed.Findings: The top missed elements were patient ambulation (score 2.4 out of 5, Standard Deviation [SD] 0.8), mouth care (2.3, SD 0.8) and participation to multidisciplinary meetings (2.3, SD 1.1). Lack of personnel was the most frequent reason reported for MNC with a score of 2.9 out of 4 (SD 0.9). At the linear regression analysis, advanced nursing education (ß = 3.58, CI 95% 1.32-5.84) and inadequate handovers (ß = 3.64, CI 95% 0.37-6.91) both increased the perception of MNC occurrence.Conclusion: MNC occurrence in rehabilitation settings appears to be lower than in other contexts; however, the most commonly missed elements are similar to those reported in other settings. As good strategies to detect the difference between expected nursing care and the one delivered to patients, advanced education and good quality handovers seem beneficial. Further research is needed to establish more evidence on predictors by developing longitudinal study designs.

[Effective interventions enacted by Nurse Managers in daily practice to prevent and/or minimize the missed nursing care: ?ndings from an Italian qualitative study]. / Interventi attuati da infermieri con ruoli manageriali nella pratica quotidiana per prevenire e minimizzare le Missed Nursing Care: risultati di uno studio qualitativo italiano.

INTRODUCTION: Missed Nursing Care is widely recognized as affecting patient safety and healthcare outcomes. Theoretical frameworks, antecedents and consequences have been extensively studied while interventions aimed at preventing the Missed Nursing Care remain little investigated to date. Nurse Managers and Nurse Directors play a main role in promoting interventions at the unit, hospital and at the policy levels. However, few evidences are available to date, thus limiting an evidence-based approach. The aim of this study was to emerge interventions used on a daily basis by Nurse Managers and Directors to prevent and/or minimize Missed Nursing Care. METHODS: A qualitative descriptive study design based upon a positive deviance approach was adopted. Twelve Nurse Managers and Nurse Directors were purposefully selected, working at Hospital, Healthcare Trust or Nursing Home levels, in Italy. Participants were interviewed in two focus group sessions. A thematic analysis of the audio-recorded interviews was performed by two researchers. RESULTS: The following interventions have been reported as effective in preventing and/or minimizing the Missed Nursing Care: (a) Expanding the nursing care capacity; (b) Ensuring the standard of care and an early detection of failures; (c) Monitoring the processes of care; (d) Promoting a shared decision-making; (e) Redesigning the layout of the hospital systems; (f) Promoting a culture towards the Missed Nursing Care prevention, and (g) Realigning the nurse management to the care of patients. DISCUSSION: Several interventions based mainly on process dimension and with preventive intents are daily enacted by Nurse Managers and Directors to prevent and/or minimize Missed Nursing Care. Measuring the effect of these interventions through rigorous studies could help in expanding the evidence available to contrast a phenomenon that threatens patient safety.

Developing policies and actions in response to missed nursing care: A consensus process.

AIM: To support the development of appropriate policies and actions in the field of missed nursing care (MNC). BACKGROUND: There has been an ever-growing international debate on MNC, interventions that nurses have identified as necessary for their patients, but which for various reasons they are unable to provide or are forced to delay. Despite MNC's relevance, its translation into policies and actions has not been documented to date. METHOD: A consensus development method was employed involving (a) a nominal group composed of experts in the field, policymakers and the President of the Regional Nursing Professional Boards, and (b) 218 nurses appointed primarily at the managerial levels. RESULTS: A total of eight consensus statements were approved and organized in a series of sub-statements designed to (1) render the concept of MNC culturally acceptable in the Italian context, with the agreement that compromised nursing care (CNC) is the best term to be used in this field, as a synonym for MNC; (2) measure CNC as a strategy to increase patient safety; (3) select an appropriate CNC measurement tool; (4) optimize CNC measurement; (5) conduct effective CNC data analysis; (6) design and implement interventions to prevent and/or minimize CNC; (7) assess and disseminate findings on interventions' effectiveness; and (8) provide final remarks on the way to move forward. CONCLUSIONS: We developed a process to introduce the phenomenon of MNC in the Italian culture and agreed firstly on the term compromised nursing care, which better reflects MNC's meaning according to the context and facilitates an open discussion on the phenomenon both within and outside the profession. The following consensus statements emerged represent a systematic approach, starting from the measurement and finishing with the re-measurement of the occurrence of MNC after having implemented concrete actions. IMPLICATIONS FOR NURSING MANAGEMENT: The approved consensus statements can guide decision-makers to develop concrete policies and actions that promote the improvement of quality of care and patients' safety by minimizing and/or preventing MNC's occurrence.

[Missed nursing care and italian nursing practice: preliminary finding of a consensus conference]. / Missed nursing care e pratica infermieristica italiana:risultati preliminari di una consensus conference.

. Missed nursing care and italian nursing practice: preliminary findings of a consensus conference. In recent years in Italy there has been renewed interest in missed nursing care due to various factors, such as participation in the RANCARE project, with 28 European and non-EU countries, the opportunity to develop international exchanges, specific projects and field based research. We explored a range of ideas and processes, culminating in a conference designed to address specific issues relating to missed nursing care, in the Italian nursing practice. After a preliminary review of the literature on the psychometric properties of the available tools, with the intent of further deepening our understanding of the concept of missed nursing care, its implications for practice, management, education and research. After two days of presentations and discussions, the more than participating nurses agreed on a set of preliminary recommendations regarding missed nursing care and Italian nursing practice. This paper reports on the preliminary consensus findings from the conference.

Nursing effectiveness in Italy: findings from a grounded theory study.

AIM: The aim of the present study was to conceptualize the basic social process by which nursing intervention affects patient outcomes in Italian daily practice. BACKGROUND: Different frameworks explain the relationship between nursing care and patient outcomes. However, several authors have suggested the need to develop further theory in order to understand this relationship. METHOD: A qualitative study based on a grounded theory approach was undertaken to generate a conceptual description of nursing care in Italy and its relationship to patient outcomes. Data collection and analysis processes were conducted simultaneously in an Italian Teaching Hospital from 2007 to 2009. FINDINGS: Nursing effectiveness (the core variable) expresses the positive effects of the nursing system on patient outcomes, on patient safety and on the multi-disciplinary outcomes. The two interdependent social processes that assure nursing effectiveness are: creating a supportive environment for potentially effective nursing (causative factors); and performing organizational, clinical and collaborative intervention (nursing strategies and consequences). CONCLUSIONS: The factors determining a potentially supportive environment for nursing effectiveness are similar to those documented in the literature but the need for clinical nurses to compensate systematically when this support is not available seems to be unique. IMPLICATIONS FOR NURSING MANAGEMENT: Understanding the basic processes involved in the determination of nursing effectiveness in one country has implications for nursing leaders' decision-making, on National Health Service policy recommendations and on professional development both at national and international levels.

[Criteria for delegating the safe hospital administration of drug therapy via natural route to nurses aids in hospital]. / I criteri per affidare in sicurezza la somministrazione della terapia per via naturale agli operatori sanitari con formazione complementare in ospedale.

AIM: To assess if and how many patients admitted to hospital could receive the drug therapy via natural route by specialized nurses aids (OSSc). METHODS: Focus group to identify the items of an assessment instrument to select patients eligible to receive drug therapy from OSSc, validation (face validity, test retest, interrater reliability and factorial analysis) and implementation on 227 patients admitted to medical and surgical wards. RESULTS: During admission 106/227 patients (46.5%) could receive the therapy from OSSc for at least one day: 21 (9.2%) at admission, 73 (32.1%) after 4 days and 12 (11.3%) in the following days, but 29/106 (27.3%) formerly eligible patients change their condition and therapy should be administered by nurses. On average in medical wards 7.7 patients/day would be eligible while only 2.6 in surgery. CONCLUSIONS: The delegation of drug therapy in acute hospitals to OSSc seems unlikely for patients complexity and the need of daily assessments and adjustments. Nurses should each time select eligible patients guaranteeing the necessary supervision. This extra workload is not affordable.

Process and factors influencing Italian nurse graduates' first choice of employment: a descriptive study.

Describing factors influencing the first choice of employment and comparing between countries are the first step to (a) creating a global perspective, (b) encouraging reflection and awareness among staff education and developing professionals strategies, (c) reflecting on nonattractive wards or hospitals, and (d) considering the relevance of different factors emerging during international recruitment. The aim of this work is to develop the first exploratory research into which factors influence this choice for newly graduated Italian nurses, comparing with evidence from international literature. To find out which factors influence most the choice of newly graduated nurses, a questionnaire was given to new graduates who had completed the bachelor of nursing science degree course in Udine. A total of 45 nurses, with an average age of 24 years and who graduated in 2004 and had worked for 2 months, responded. To choose which hospital they would start working in, the new graduates were presented with 101 questions and had 77 interviews overall; the choice of hospital depends not only on the initial interview with the nursing directors but also on the availability of places in the requested ward. The major factors influencing the choice of the first ward are the type of patients to be nursed, the possibility to use the knowledge gained during the degree course, and the desire for professional advancement. The factors that have less influence, however, are the types of shift work and the leadership qualities of the medical director or the charge nurse. Within the limits, this first exploratory research discovers some Italian new graduates' traits in their first work experience. Taking notice of the factors involved in the choice of the first clinical placement will help the hospitals and the nursing profession to better understand the needs and expectations of the new graduates.

Competence of Romanian nurses after their first six months in Italy: a descriptive study.

AIMS AND OBJECTIVES: Aims of this study were to describe (a) the Romanian nurses' reasons for emigration and the difficulties experienced in the first six months of integration, (b) their perception of the level of professional independence and competence gained in the first six months of working and (c) the strategies that either facilitated or impeded their development of professional independence at a teaching hospital. BACKGROUND: The international recruitment of nursing staff is a strategy adopted by the Italian State to confront nursing shortages. Although the critical aspects and the opportunities available have been reported for many years, little has been written about the professional autonomy perceived by these nurses six months after their placement in the host country. DESIGN: A descriptive study involving Romanian nurses working at the Udine University Training Hospital (Italy) was used. METHODS: The participants were interviewed using anonymous questionnaires, which contained eight open and 20 closed questions. With their consent, the interview was done in the ward and took on average 45 minutes (from 30-60 minutes). Given a choice of language to use by the bilingual researcher, half the participants chose Romanian. RESULTS: The small, homogenous group of Romanian nurses used as the sample and employed at the University Training Hospital, felt satisfied (in the areas of culture/placement/integration) and recorded similar facilitating factors and obstacles as those documented by other authors. By the sixth month following placement they felt they had a sufficient level of autonomy, but this was not the case in many skills, which are an essential part of Italian nursing. CONCLUSIONS: The expectations of the hospitals involved in international recruitment are higher than the Romanian nurses can guarantee, especially in the first six months. Integration obviously needs substantial investment, less 'red-tape' and a longer period of time for adjustment. RELEVANCE TO CLINICAL PRACTICE: It is necessary to help and support the placement of these nurses into the Italian workforce with programmes where their practical work is supervised by permanent trained staff, allowing them to develop autonomy and ensuring an optimal standard of nursing care for the patients. It would be necessary to continue these programmes for more than six months.

[LARS Research Project. Nursing Research Laboratory of the Health Regional Agency of the Friuli Venezia Giulia Region. Observational study on the outcomes of organizative models of medical wards on nurses, patients and organization]. / Progetto di Ricerca LARS (Laboratorio di Ricerca Infermieristica Agenzia Regionale alla Sanità, Friuli Venezia Giulia). Studio osservazionale sugli esiti dei modelli organizzativi assistenziali delle medicine, su infermieri, su pazienti ed organizzazione.

UNLABELLED: No large scale studies have been conducted in Italy to assess factors that influence hospital nurses' satisfaction. AIMS: To explore the relationship between participative organizative models and outcomes on nurses (work satisfaction, burnout, intention to stay), patients (satisfaction with quality of care) and organization (nurses turnover). MATERIALS AND METHODS: This multicentre regional study involves 20 acute medical wards and more than 500 nurses. Data on the organizative model adopted in the ward will be collected with an ad hoc questionnaire with scores from 7 (scarce-limited involvement of nurses in decision making) to 35 (nurses take decisions on the management of the ward). Nurses satisfaction with their work is measured with the Nursing Work Index Revised; burnout with the Maslack Burnout Inventory; patients satisfaction with the Experiences of Nursing Care Scale Newcastle Satisfaction with Nursing Scale. The outcomes considered for the organization will be turnover, absences from work, injuries. RESULTS: The study is ongoing. The association of each outcome to the organizzative model will be explored. Multivariate regression model will be adjusted for casemix index of the previuos year. T test and chi square tests will be used and a p value of 0.05 will be considered significant.

[Management of the patient's pain in a highly specialized health center]. / Modalità di gestione del dolore percepito dal paziente in un ospedale ad alta specializzazione.

The management of pain sensations is useful to enhance technical quality within hospitals: this study provides an overview of pain management in a highly specialized health center. In 69.6% of cases the patients answers matched with those of health staff: the most interesting factor is the health staff's willingness to attend training courses aimed at treating the patients pain.