The Family and Community Nurses Cultural Model in the Times of the COVID Outbreak: A Focused Ethnographic Study.

The ageing population, increasingly frail and chronically ill, and COVID-19 pandemic challenges have highlighted national health systems' vulnerability and, more strongly/to a greater extent, the pivotal role of the family and community nurse (FCN). However, the recent introduction of FCNs in primary care settings has yet to be explored in Italy. This study aimed to identify the FCNs' cultural model and its implementation during the COVID-19 outbreak. A focused ethnographic study was performed in a primary care community service in northern Italy. Participants were FCNs (N = 5), patients and caregivers (N = 12). Qualitative data were collected through semi-structured interviews, field notes, observation of FCNs' activities and access to documents. Qualitative analysis identified themes concerned with crucial aspects of FCNs' activities, role implementation, and their relationship with patients and families. This study illuminated how the FCN strategically takes care of and identifies patients' and community needs. Although the COVID-19 outbreak hindered effective FCN project implementation, this study highlighted that the pandemic provided a chance to better identify cultural, organisational and educational weaknesses that need to be addressed to support the full accomplishment of FCNs' scope of practice.

[Census of experiences implemented during the Covid period in the Novara, vercelli, Vallemaggia and Locarno areas]. / Censimento delle esperienze attuate in epoca Covid nei territori di Novara, Vercelli, Vallemaggia e Locarno.

. Experiences implemented during the Covid period in the Novara, Vercelli, Vallemaggia and Locarno areas. INTRODUCTION: The Covid-19 pandemic promoted the organization of several initiatives for the elderly. AIM: To map the local district initiatives for citizens >65 years active during the Covid pandemic in 3 districts of Piedmont and Ticino Canton. METHODS: The data were collected through interviews, contacting local Institutions, volunteer organisations and associations and through free research on the web and on institutional websites. RESULTS: The 26 interviews were conducted between August and September 2022: 16 in the Novara area, 4 in Vercelli and 6 in Canton Ticino. Forty-six initiatives were collected, mainly addressing social-healthcare needs, of which seven were already active in the pre-covid period; overall eight are still ongoing. The initiatives consisted of listening windows, home support (meals, shopping, face-masks, delivery of clean clothes to hospitalized patients). 31 were activated by public services with the collaboration of voluntary services. CONCLUSIONS: The mapping of the initiatives showed their heterogeneity and the fundamental role of volunteering in guaranteeing the continuity of supporting services. These experiences should be consolidated over time by institutions and the public health service, enhancing the contribution of volunteers.

Nursing students' clinical placement experiences during the Covid-19 pandemic: A phenomenological study.

AIM: This study explored the clinical placement experiences of nursing students during the Covid-19 pandemic. BACKGROUND: The health emergency caused by Covid-19 required a rapid reorganisation of care settings. This reorganisation entailed revisiting the clinical placements settings and learning programs of Italian nursing faculties. Some Italian universities wanted to seize the health emergency as a learning opportunity enabling the nursing student to acquire additional knowledge and skills. DESIGN: We conducted a descriptive qualitative study employing a phenomenological approach. The study population was second and third-year nursing students. The students did their clinical placement in 5 Northern Italy hospitals, mainly in infectious diseases wards, intensive care and sub-intensive care units, emergency department, short-stay surgical units and internal medicine wards. In these departments, the inpatient wards were entirely converted into Covid-19 units. Ethical approval was obtained from the local ethics committee. METHODS: Semi-structured, open-ended interviews were conducted in March-April 2021 and analysed following a phenomenological approach. RESULTS: Twenty-one nursing students in their 2nd and 3rd academic year participated. Their average age was 24 years. 81% were female and 19% were male. Three main themes were generated: (i) Learning which surpasses technicalities; (ii) Confronting dignity issues; (iii) Feeling treated as an equal in the workspace. Students had to learn how to lower their fear and self-manage the emotional burden to be a caring presence for the patients who were intensely suffering from the disease and isolation. Attending a clinical practice placement in Covid-19 wards led them to focus on human dignity issues: participants realised how dignity was questioned and how they could become patients' advocates. Students also described that they felt part of the team, with their student role almost fading. CONCLUSIONS: This study describes that the most unpredictable public health emergency, such as Covid-19, can provide learning opportunities in the practice environment for nursing students. Students described feeling useful and capitalising on new competencies. Designing educational activities for nursing students concerning pandemic emergencies may be strategic for dealing with similar situations in the future.

[Sleep disorders and frailty status in older people: a narrative review]. / Disturbi del sonno e stato di fragilità nell'anziano: una revisione narrativa.

AIM: The aim of this study is to review the impact of sleep-related disorders on the level of elder frailty, and, conversely, the possible correlation between the level of fragility detected and eventually related poor sleep. METHOD: A narrative review have been conducted. Comprehensive database searches of MEDLINE, Cochrane, EMBASE, Cinahl were undertaken. Both prospective, cross selectional and retrospective observational cohort studies, published from 2000 to 2015, have been included. Appraisal and analysis using the STROBE statement have been undertaken. RESULTS: 8 studies are included. Increasing evidence supports possible bidirectional correlation between elder frailty and poor sleep, excessive daytime sleepiness and decreased sleep efficiency. Potential outcomes relevant to these sleep disorders in old age include mortality, depression and altered functional autonomy. CONCLUSION: Interventions on the circadian rhythm could have significant clinical implications in the frail elderly. The nursing interest should be geared to the use of validated tools, in order to detect the first signs of any sleeping disorder, in order to postpone or overcome the outcomes derived. The planning of stimulating activities, to facilitate moments of aggregation, would only increase the desire of belonging, as continuous cognitive stimulation.

Screening tools for identification of elder abuse: a systematic review.

AIMS AND OBJECTIVES: To review the efficacy and accuracy of tools administered to older people, intended to detect and measure elder abuse. BACKGROUND: The mistreatment of older people represents a widespread problem, with exponential growth risk, especially considering the progressive ageing of the world population. It could have serious consequences for the victim's health if not recognised early, denounced and stopped. Abuse is often undetected by service providers because there is a lack of awareness surrounding the magnitude of the problem. Education and formal training in the signs of abuse are also generally poorly developed, as are reporting procedures which would lead to further investigation. DESIGN: Systematic review. METHODS: Comprehensive database searches of MEDLINE, Cochrane, EMBASE and Scopus were undertaken. Screening of 695 articles resulted in 11 included. Appraisal and analysis using PRISMA Statement and STROBE checklist were undertaken. RESULTS: Eleven screening tools have been presented: H-S/EAST, VASS, EASI, CASE, BASE, E-IOA, EAI, EPAS, CPEABS, OAPAM and OAFEM, all aimed at healthcare professional or, in some cases, expected to be specifically used by nurses. CONCLUSIONS: The fundamental function of any assessment instrument is to guide through a standardised screening process and to ensure that signs of abuse are not missed. Several tools have been tested; some have demonstrated a moderate to good internal consistency and some have been validated to allow an early identification. None have been evaluated against measurable violence or health outcomes. RELEVANCE TO CLINICAL PRACTICE: Nurses and all healthcare providers should screen patients routinely. However, we are not able to recommend a single tool as the selection and implementation has to be appropriate to the setting. Furthermore, the study population and the possibility of using multiple tools in combination should be taken into consideration, to assess all the aspects of violence.

[The certification of nurses' competence in positioning and managing a vascular hemostasis system]. / Certificazione degli infermieri per il posizionamento e la gestione di un sistema di emostasi vascolare.

AIM: The application of a vascular hemostasis system is a specialistic competence that could be charged to a cardiology nurse upon formal recognition of the acquired skill. METHOD: Haemostasis systems are routinely implemented by cardiology nurses. To officially recognize this skill a course was organized with two lectures, practical training and supervised practice. RESULTS: 8 nurses attended the course and after the accreditation each introduced 150 Angio-Seals without relevant complications. Each minor problem is routinely discussed to exclude any malpractice. CONCLUSIONS: Certification of new skills is feasible and nurses' skills can be formally recognized with specific courses.