Pediatric nursing-sensitive outcomes in lower and medium complexity care units: A Delphi study.

BACKGROUND: The effectiveness of pediatric care is made more challenging to analyze by the need for specialist nursing and by the specific characteristics of pediatric patients, as opposed to adult patients, such as ongoing rapid growth and development, and different physical, cognitive, and emotional demands. Previous research has identified "Pediatric Nursing-Sensitive Outcomes" (PNSOs) in intensive care unit settings, though pediatric intensive care beds only represent a very limited percentage of hospital beds. To improve care quality and safety for a larger population of patients, this study aims to identify PNSOs in lower and medium-complexity care units (LMCCUs). METHODS: This study uses the Delphi method to gather expert opinion on priority PNSOs in LMCCUs, with a 75 % consensus pass threshold. A preliminary list of PNSOs was identified from a literature review and used as inputs for two Delphi rounds conducted between January and March 2023. RESULTS: 27 panelists were recruited and passed 17 PNSOs: pressure injury; failure to rescue; patient/family experiences; central line-associated bloodstream infections; surgical site infections; healthcare-associated infections; medication errors; hospitalization breastfeeding continuity; peripheral intravenous infiltrate or extravasation; pediatric falls; pain assessment and management; vital sign monitoring; nutrition; discharge planning; family-centered care practice; healthcare environment; nurse voluntary turnover. CONCLUSION: This study contributes to research on PNSOs and builds consensus on priorities for LMCCUs. Future research should clinically evaluate these PNSOs and their association with organizational and professional variables often investigated in an adult but not a pediatric setting.

Nursing leadership style and error management culture: a scoping review.

PURPOSE: This paper aims to assess the influence of nursing leadership style on error management culture (EMC). DESIGN/METHODOLOGY/APPROACH: This scoping review was conducted following the integrative review methodology of the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, CINAHL, Scopus, Web of Science, Embase and EBSCO databases were systematically searched to identify studies on nursing leadership, error management and measurement, and error management culture. The studies' methodological quality was then assessed using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. FINDINGS: Thirteen manuscripts were included for review. The analysis confirmed that nursing leadership plays an important role in EMC and nurses' intention to report errors. Three emerging themes were identified: 1) leadership and EMC; 2) leadership and the intention to report errors; and 3) leadership and error rate. RESEARCH LIMITATIONS/IMPLICATIONS: A major limitation of the studies is that errors are often analyzed in a transversal way and associated with patient safety, and not as a single concept. PRACTICAL IMPLICATIONS: Healthcare managers should promote training dedicated to head nurses and their leadership style, for creating a good work environment in which nurses feel free and empowered to report errors, learn from them and prevent their reoccurrence in the future. ORIGINALITY/VALUE: There is a positive relationship between nursing leadership and error management in terms of reduced errors and increased benefits. Positive nursing leadership leads to improvements in the caring quality.

Head Nurse Leadership: Facilitators and Barriers to Adherence to Infection Prevention and Control Programs-A Qualitative Study Protocol.

BACKGROUND: The effective management of Healthcare-Associated Infections (HAIs) relies on the implementation of good practice across the entire multidisciplinary team. The organizational context and the role of head nurses influence the team's performance and behavior. Understanding how decision-making processes influence healthcare professionals' behavior in the management of HAIs could help identify alternative interventions for reducing the risk of infection in healthcare organizations. This study aims to explore how the behaviors promoted and actions implemented by the head nurse can influence healthcare professionals' adherence to Infection Prevention and Control (IPC) programs. METHODS: A multi-center qualitative study will be conducted using a Grounded Theory approach. Observations will be conducted, followed by individual interviews and/or focus groups. A constructive and representative sample of healthcare professionals who care directly for patients will be enrolled in the study. The COnsolidated criteria for REporting Qualitative research (COREQ) checklist will be followed to ensure the quality of this study protocol. A multistep inductive process will be used to analyze the data. CONCLUSIONS: The study results will provide an understanding of how nurses perceive the influence of leadership and how they modify their behaviors and activities toward patients according to IPC programs. The study will identify barriers and facilitators to IPC compliance and suggest strategies to minimize negative patient outcomes, such as the development of an HAI.

Telehealth vs in-person education for enhancing self-care of ostomy patients (Self-Stoma): Protocol for a noninferiority, randomized, open-label, controlled trial.

INTRODUCTION: Postoperative patients with ostomies experience significant changes in their lives as a result of the device implantation. Self-care is important to improve their health outcomes. Telehealth provides an opportunity to expand access to self-care education. AIM: This is a multicenter, non-inferiority randomized, open-label, controlled trial to evaluate the non-inferiority of a telehealth intervention to the standard in-person approach in improving self-care behaviors. METHODS AND ANALYSIS: Three hundred and eighty-four patients aged ≥ 18 years, with a recently placed ostomy, no stomal/peristomal complications, and documented cognitive integrity will be randomly assigned (1:1) to receive either a telehealth intervention (four remote educational sessions) or a standard educational approach (four in-person sessions) delivered in outpatient settings. Every session (remote and in-person) will occur on Days 25, 32, 40, and 60 after discharge. Follow-ups will occur 1, 3, and 6 months after the last intervention session. Primary outcome is self-care maintenance measured using the Ostomy Self-care Index (OSCI). Secondary outcomes include self-care monitoring, self-care management, self-efficacy (OSCI), quality of life (Stoma specific quality of Life), depression (Patient Health Questionnaire-9), adjustment (Ostomy Adjustment Inventory-23), stomal and peristomal complication rates, healthcare services utilization, mobility, and number of working days lost. Analyses will be performed per intention-to-treat and per protocol. ETHICS AND DISSEMINATION: This study has been approved by the Institutional Review Board of the main center (registration number: 119/22). Following completion of the trial, dissemination meetings will be held to share the results of the study with the participants and the health-care team. Adoption of telehealth technologies for ostomy patients can improve service organization by ensuring better integration and continuity of care. If the remote intervention produces comparable effects to the in-person intervention, it would be wise to make telehealth education an alternative treatment for addressing the educational needs of uncomplicated postoperative ostomy patients. TRIAL REGISTRATION: ClinicalTrials.gov (identifier number: NCT05796544).

Cardiovascular nurses and organizational well-being: a systematic review.

AIMS: This systematic review assesses the organizational well-being of nurses working in cardiovascular settings and identifies environmental variables influencing it. METHODS AND RESULTS: The Joanna Briggs Institute's methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines have been followed. The search was conducted, from the database inception up to and including 1 December 2022, on Medline (via PubMed), Cumulative Index of Nursing and Allied Health, Cochrane Library, and Scopus. Critical appraisal and data extraction were conducted using standardized tools. Six articles of high quality were included. These mostly concerned cross-sectional studies, conducted in heterogeneous contexts, which highlight the peculiarity of the cardiovascular nursing setting. Three thematic areas were identified: stressors of cardiovascular settings; outcomes of stressors on nurses; and coping strategies used by cardiovascular nurses to deal with such stress factors. Identified stress factors included a lack of autonomy, conflicts between professional and family roles, high workloads, and stressful relationships with patients and caregivers. These organizational variables could generate nurses' burnout, depression, irritability, and/or sleep disorders. In trying to cope with such stressors, cardiovascular nurses used different strategies for compensating, avoiding, escaping, or ignoring the problem, or, in other cases, became somewhat aggressive. CONCLUSION: Considering the limited data, cardiovascular nursing coping strategies should be further investigated, so that effective pathways for preventing or limiting stress factors can be identified and applied by the organizations. Monitoring and intervening on stress factors in this care setting could improve cardiovascular nurses' organizational well-being and accordingly patients' outcomes. REGISTRATION: PROSPERO: CRD42022355669.

Measuring Nurses' Organizational Well-Being: A Systematic Review of Available Instruments.

This systematic review aimed to identify and compare instruments measuring nurses' organizational well-being, summarise the dimensions measured by these instruments, the statistical analysis performed for validity evidence and identify an instrument that comprehensively investigates nurses' organizational well-being. The JBI Manual for Evidence Synthesis and the PRISMA checklist were used as guidelines. The search was conducted on Medline, CINAHL, Cochrane Library and Scopus. Critical appraisal and data extraction were drawn on the COSMIN checklist. Dimensions were conceptually synthesized by the measurement concepts' similarity. Twenty-two articles were retrieved and they included 21 instruments that measured nurses' organizational well-being. The instruments vary by dimension number (range 2-19), items (range 12-118) and concept elicitation. A plurality of methodologies has been used in instrument development and assessments of evidence for validity. Only four instruments reported a concurrent criterion validity or a measurement comparison with an already tested-for-validity instrument. Similar dimensions were leadership and support, relationships and communication, work-family balance, work demands, violence, control and autonomy, satisfaction and motivation, work environment and resources, careers, and organizational policy. This review underlines the core areas of the instruments that measure nursing organizational well-being. It allows administrators and researchers to choose the appropriate instruments for monitoring this multidimensional concept.

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.

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.

Specialized Nurse-led Care of Chronic Wounds During Hospitalization and After Discharge: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effectiveness of specialized nurse-led care of patients with chronic wounds, provided both during hospitalization and postdischarge, on wound healing and readmission rates. METHODS: An unblinded randomized controlled trial was conducted. Participants were patients with chronic wounds, randomly assigned to either the experimental group (cared for by wound care nurses both during hospitalization and postdischarge) or to the control group (cared for according to standard practice). Wound healing was identified as the primary outcome. RESULTS: Overall, 1,570 patients were randomized, 1,298 of whom were included in the per-protocol analysis (707 in the experimental group and 591 in the control group). Nurse-led wound care quadrupled the probability of healing and reduced the number of treatment weeks and hospital readmissions. CONCLUSIONS: Chronic wound care that was entrusted to specialized nurses improved outcomes in terms of wound healing, repair and regeneration, length of treatment, and rate of readmission, compared with standard practice. Future studies should evaluate the impact of care provided by specialized wound care nurses on patients' quality of life and healthcare costs. Nurse managers should promote the implementation of chronic wound clinical-care pathways entrusted to specialized nurses to improve patients' clinical outcomes and reduce hospital readmissions.

Measuring academic satisfaction in nursing students: a systematic review of the instruments.

Student academic satisfaction is one of the most important factors affecting the success and quality of a higher education institute and is an indicator about teaching and learning. This study aims to summarize and critically evaluate the instruments assessing academic satisfaction in nursing education. A systematic review was undertaken, PRISMA were used for the screening of studies. MEDLINE, Cochrane, Scopus and CINAHL were searched using MeSH terms; seven eligible articles were identified referring to five assessment tools. COSMIN was used for evaluation of the methodological of the instruments. The systematic review identified five satisfaction measurement tools used in nursing education. The analysis of the instruments rarely considered a confirmative validity structure, measurement error or criterion validity. The best available instrument was the Nursing Students Satisfaction Scale (NSSS) for validation methodology; however, it needs further validation studies that consider CFA, reliability, criteria validity, hypothesis testing and measurement error.

Towards a new conceptual model for nurses' organizational well-being: An integrative review.

AIM: The aim of this study is to summarize conceptual models of nurses' organizational well-being and identify common variables among them. BACKGROUND: To understand how the characteristics of an organizational context affect workers' well-being, numerous conceptual models have been developed. Such models have been conceptualized in various working contexts other than health care and not always considering the particularities of the profession of nursing. EVALUATION: This integrative review was conducted using the resources of PubMed, CINAHL, Scopus and the Cochrane Library, up until March 2022, and by applying a modified version of Cooper's five-stage methodology, in accordance with the PRISMA guideline. KEY ISSUES: Six reference models focused on different organizational variables and used to evaluate nurses' organizational well-being were identified: the Effort-Reward Imbalance (ERI) model; the Job Demands-Resources (JD-R) model; the Utriainen et al. model; the Demands-Resources and Individual-Effects (DRIVE) model; the Well-Being, Health-Promoting Lifestyle and Work Environment Satisfaction (WHS) model and the Nursing Worklife Model (NWM). CONCLUSION: There is no consensus in the nursing literature on an all-encompassing conceptual model of nurses' organizational well-being or on working environment characteristics to be studied or monitored for defining nurses' well-being. IMPLICATIONS FOR NURSING MANAGEMENT: Coming to a consensus on the definition of a nurses' organizational well-being model and its variables would facilitate nursing management in monitoring and intervening on nurses' work-life quality and in improving nursing performance and caring outcomes.

The Wounded Healer: A Phenomenological Study on Hospital Nurses Who Contracted COVID-19.

Since the pandemic began nurses were at the forefront of the crisis, assisting countless COVID-19 patients, facing unpreparedness, social and family isolation, and lack of protective equipment. Of all health professionals, nurses were those most frequently infected. Research on healthcare professionals' experience of the pandemic and how it may have influenced their life and work is sparse. No study has focused on the experiences of nurses who contracted COVID-19 and afterwards returned to caring for patients with COVID-19. The purpose of this study was therefore to explore the lived personal and professional experiences of such nurses, and to describe the impact it had on their ways of approaching patients, caring for them, and practicing their profession. A phenomenological study was conducted with 54 nurses, through 20 individual interviews and 4 focus groups. The main finding is that the nurses who contracted COVID-19 became "wounded healers": they survived and recovered, but remained "wounded" by the experience, and returned to caring for patients as "healers," with increased compassion and attention to basic needs. Through this life-changing experience they strengthened their ability to build therapeutic relationships with patients and re-discovered fundamental values of nursing. These are some of the ways in which nurses can express most profoundly the ethics of work done well.

Nursing leadership in clinical practice, its efficacy and repercussion on nursing-sensitive outcomes: A cross-sectional multicentre protocol study.

AIM: The aim of this study to describe a research protocol for evaluating the relationship between nursing leadership, organisational well-being and nurse and patient outcomes. BACKGROUND: The head nurses' leadership style influences the organisational context. When an organisation promotes nurses' well-being, they perform better performances and are more satisfied and engaged with their job. This reduces stress levels, burnout and absenteeism and improves physical and psychological health. METHODS: A multicentre study will be conducted. A self-report questionnaire will be administered to head nurses and nurses they coordinate. Study findings will include nurse-sensitive outcomes (e.g., pressure injuries, infections and mortality). Descriptive and correlational analyses will be conducted, and a structural equation model will be tested. RESULTS: Results might verify that a correctly judged leadership style of the head nurse will enhance the organisational context experienced by nurses and improve nursing sensitive outcomes. CONCLUSION: This study will demonstrate the organisational role of middle managers and the direct repercussions on their staff and patients, understanding the relationship between organisational, process and outcomes variables. IMPLICATIONS FOR NURSING MANAGEMENT: If the results confirmed the hypothesis, health care managers would cultivate and stimulate the head nurses' leadership style, thus increasing nurses' organisational well-being and achieving better patient outcomes. No Patient or Public Contribution.

Effect of a wound healing protocol on patients with stage III and IV pressure ulcers: a preliminary observational study.

OBJECTIVE: To evaluate the influence of a wound healing protocol for stage III and IV pressure ulcers (PUs), and to determine the predictive power of specific sociodemographic and clinical characteristics on wound healing and infection. METHOD: This longitudinal study included participants with stage III and IV PUs who were recruited from 10 acute care settings of an Italian university hospital, and who were managed with a protocol inspired by the TIMECare model. Data were collected between October 2018 and March 2019. The National Pressure Ulcer Advisory Panel Staging System was used to stage the PUs. Wound healing was assessed with the Pressure Ulcer Scale for Healing (PUSH). Nutritional status was assessed with the Mini Nutritional Assessment Index. Data collection took place at admission and every seven days thereafter-a total of six times before discharge. The outcome and predictors of wound healing were assessed with Student's paired t-tests and multiple linear regressions, respectively. RESULTS: Patients (n=126) were almost equally split between male and female, with a mean age of 78.17 years and who were all retired. Stage III and IV PUs were most prevalent at the sacrum (65.5% and 73.2%, respectively). PUSH wound healing scores improved significantly after six weeks in both stage III and IV PUs (p<0.001). Nutritional status was predictive of wound healing (R2=0.12). CONCLUSION: Our results showed that a good nutritional status and a protocol inspired by the TIMECare model were associated with wound healing improvements in stage III and IV PUs. We recommend this protocol in older patients with stage III and IV PUs.

Self-efficacy, burnout and academic success in nursing students: A counterfactual mediation analysis.

AIM: To test the mediating role of burnout in the relationship between self-efficacy and academic success in nursing students. DESIGN: This was a cross-sectional secondary analysis of longitudinal research aimed at exploring the academic success of nursing students. METHODS: We enrolled a convenience sample of nursing students attending 21 Italian baccalaureate nursing degree programmes. Data were collected from 2014 to the 2018-2019 academic year. We analysed the wave of data collected during the third year of the programme. The measurements were the Academic Nurse Self-Efficacy scale (ANSEs) and the Scale of Work Burnout (SWEBO). A mediation analysis with a counterfactual approach was performed. RESULTS: The participants (n = 556) had a median age of 20 years (IQR 19-22) and the majority was female [70.5% (392/556)]. Academic success was reached by 51.97% (289/556) of the students. The findings reveal a significant direct effect of self-efficacy on academic success and also a significant indirect effect of this relationship via burnout. CONCLUSION: The mechanism by which self-efficacy influences academic performance in nursing students is more complex than a simple direct relationship. Universities should consider screening students for variables affecting academic success to decrease academic costs and increase ranking systems classification. IMPACT: Nurses' professors should be engaged in strategies to promote self-efficacy. The area of intervention should be structured both during classes and internships, in tandem with the mentor and the clinical nurse.

Nurses' Quality of Life Scale: Validation and Psychometric Properties.

The Nursing Quality of Life Scale (NQOLS) is a 28-item self-report measure evaluating the four dimensions of nurses' quality of life, namely, the physical, emotional, working, and social dimensions. The purpose of this study is to assess the psychometric properties, including validity and reliability, of the NQOLS. The study enrolled 1105 nurses who provided direct assistance to patients. The NQOLS factorial structure was tested using a cross-validation approach via Exploratory Structural Equational Modeling, which confirmed the instrument's four-dimension structure. Reliability was assessed using omega coefficients, proving excellent for all factors. Cluster analysis identified five distinct groups, each composed of participants sharing a substantial similarity with respect to their profile in the NQOLS. These five identifiable clusters presented significant differences not only in the NQOLS but also in the risk of work-related stress, emotional labor, and burnout. The results show that NQOLS is a simple, reliable, lean tool for measuring nurses' overall QoL, whose various parts can additionally be used to answer specific research questions.

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.

Psychometric Evaluation of the Oldenburg Burnout Inventory for Nursing Students.

BACKGROUND: Higher education students, especially nursing students, have drawn more attention as a group that is vulnerable to the risk of developing burnout syndrome. PURPOSE: To test the psychometric properties of the Oldenburg Burnout Inventory in Nursing (OLBI-N). METHODS: The OLBI-N validity and reliability was tested in a sample of 476 nursing students. The validity was assessed with explorative and confirmative factor analyses. For hypothesis testing, we evaluated the correlation between burnout and academic self-efficacy. RESULTS: Two factors (exhaustion and disengagement) were identified, and the confirmative factor analysis of the OLBI-N yielded a good fit. The OLBI-N was significantly correlated with academic self-efficacy (r = .29, -.37, p < .01). CONCLUSIONS: The OLBI-N is a valid, reliable questionnaire for measuring burnout among nursing students.

A mixed methods study of an organization's approach to the COVID-19 health care crisis.

BACKGROUND: Healthcare emergency can increase work-related stress and reduce nurses' job satisfaction and quality of life. Managerial decisions and proactive interventions implemented to react to the emergency ensure the best patient outcomes. PURPOSE: The purpose of this study was to verify whether a proactive organizational approach can limit nurses' work-related stress and help preserve their job satisfaction and quality of life during a health emergency. METHODS: A longitudinal mixed methods study was conducted. Data were collected before and after the transformation into a SARS-CoV-2 Hospital and the implementation of organizational interventions. Focus groups were conducted to investigate quantitative data. FINDINGS: After the implementation of interventions and as the pandemic progressed, work-related stress decreased and job satisfaction and quality of life increased. DISCUSSION: Through proactive organization, even during an emergency, nurses are prepared for working, and work-related stress due to changes is reduced. Nurses are motivated and satisfied with their organization and management, and quality of life increases.