[The involvement of patients in the assessment of nursing students during their practical training: a scoping review]. / Il coinvolgimento dei pazienti nel processo di valutazione dello studente di Infermieristica in tirocinio: una scoping review.

. The involvement of patients in the assessment of nursing students during their practical training: a scoping review. INTRODUCTION: In health care education, several experiences of patient involvement in students' assessment are documented internationally: this represents a challenge for nursing education. OBJECTIVE: To analyze user involvement experiences in nursing student assessment in order to identify: a) potential benefits and challenges, b) assessment methods and tools, c) assessed skills. METHODS: A scoping review was conducted according to the methodology proposed by the Joanna Briggs Institute. Methods and findings have been reported according to the PRISMA-ScR (Systematic reviews and Meta-Analyses extension for Scoping Reviews) statement. RESULTS: The results of the 22 included studies, published between 1995 and 2021, mainly in the United Kingdom and Europe, indicate that user' engagement is an experience that can be useful and meaningful. However, it is not without challenges such as the difficulty of providing critical feedback, student anxiety, and the investment of time and resources required. Assessments can be collected through scales, questionnaires, or interviews, focusing on interpersonal skills such as listening and respect, allowing tutors to gather surprising details about students' performance. CONCLUSIONS: Patients can provide original insights into nursing student's caring behaviors and can be a source of learning based on valuing the point of view of care receivers. Implementing patient participation in this process requires clarity, commited adherence and rigorous planning.

[The use of standardized nursing languages in electronic medical records: an exploratory study on opportunities, limitations, and strategies]. / L'uso del linguaggio standardizzato infermieristico nelle cartelle cliniche elettroniche: studio esplorativo su opportunità, limiti e strategie.

. The use of standardized nursing languages in electronic medical records: an exploratory study on opportunities, limitations, and strategies. INTRODUCTION: Standardized nursing languages (SNLs) have found increasing application in electronic medical records in recent years. In Italy their use is still uneven and accompanied by a silent debate between positions 'against' and 'for' their use. AIM: To render visible the debate regarding SNLs in Italy, and the strategies to consider when digitized records are based on a SNL. METHOD: Data has been collected through audio-recorded semi-structured interviews, selecting three Italian nursing professors, four managers representing Italian healthcare settings that used a SNT and a representative of the Central committee of the National federation of orders of nursing professions. The thematic approach was used to analyze the data. RESULTS: Participants reported having introduced digitized records based on nursing diagnoses, integrated with the Nursing Interventions Classification System and Nursing Outcome Classification, Clinical Care Classification System, Nursing Sensitive Outcomes or mixed models. Divergent aspects emerge regarding: (1) using nursing languages vs a common language to other healthcare professions; (2) planning care vs enhancing clinical reasoning; (3) measuring nursing care vs accepting the variability of the practice, and (4) making documentation efficient vs dedicating more time. Some convergences have emerged and a set of indications for introducing electronic records when based on standardized languages. CONCLUSIONS: The introduction of electronic documentation requires the use of homogeneous languages. The debate on the potential and limits of SNL is still open and requires reflection among researchers, trainers, clinicians, and coordinators/managers of nursing care regarding the choices to be made which may have long-term effects on many nurses.

The relevance of the contribution of psychoneuroendocrinoimmunology and psychology of reasoning and decision making to nursing science: A discursive paper.

AIM: Patients' death or adverse events appear to be associated with poor healthcare decision-making. This might be due to an inability to have an adequate representation of the problem or of the connections among problem-related elements. Changing how a problem is formulated can reduce biases in clinical reasoning. The purpose of this article is to explore the possible contributions of psychoneuroendocrinoimmunology (PNEI) and psychology of reasoning and decision-making (PRDM) to support a new nursing theoretical frame. DESIGN: Discursive paper. METHOD: This article discusses the main assumptions about nursing and nurses' ability to face patient's problems, suggesting a new approach that integrates knowledge from PNEI and PRDM. While PNEI explains the complexity of systems, highlighting the importance of systems connections in affecting health, PRDM underlines the importance of the informative context in creating a mental representation of the problem. Furthermore, PRDM suggests the need to pay attention to information that is not immediately explicit and its connections. CONCLUSION: Nursing recognizes the patient-nurse relationship as the axiom that governs care. The integration of PNEI and PRDM in nursing theoretics allows the expansion of the axiom by providing essential elements to read a new type of relationship: the relationship among information. PNEI explains the relationships between biological systems and the psyche and between the whole individual and the environment; PRDM provides tools for the nurse's analytical thinking system to correctly process information and its connections. IMPACT ON NURSING PRACTICE: A theoretical renewal is mandatory to improve nursing reasoning and nursing priority identification. Integrating PNEI and PRDM into nursing theoretics will modify the way professionals approach patients, reducing cognitive biases and medical errors. NO PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public involvement in the design or writing of this discursive article.

A Nurse-Led Model of Care with Telemonitoring to Manage Patients with Heart Failure in Primary Health Care: A Mixed-Method Feasibility Study.

Purpose: To determine whether a nurse-led care model with telemonitoring in primary care for patients with stable heart failure and their caregivers is feasible and acceptable. Patients and Methods: A mixed-methods feasibility study was conducted. Patients with stable heart failure and their caregivers were consecutively enrolled from March 2021 to April 2022. Participants were managed by nurses in a community health center through education and monitoring with a mobile app. The outcomes were feasibility outcomes, self-care outcomes, and qualitative acceptability and satisfaction. Quantitative and qualitative outcomes were linked to understanding how the model of care might benefit patients. Results: Twenty-six patients and nine of their caregivers were enrolled. Ten participants used the mobile app. Nineteen patients and eight caregivers were interviewed. Participants who improved their self-care appreciated the help in finding coping strategies, being close to the clinic, and feeling cared for. Participants with fewer improvements in self-care perceived the model of care as useless and were far from the centre. Participants decided to use the app mainly for usefulness prevision, and most of them were satisfied. Conclusion: The model of care was not successful in recruiting patients, and adjustments are needed to improve the recruitment strategy and to engage people who perceive the model of care as not useful or unable to use the app.

The Self-Perceived E-Learning Environment Scale: Development and Psychometric Properties in a Nursing Students Samples.

AIM: E-learning is increasingly used in education, creating a learning environment that needs to be studied thoroughly for developing new learning opportunities. BACKGROUND: Drawing from the community of inquiry framework, the present work provides the theoretical foundation and measurement validation of the Self-Perceived E-Learning Environment Scale (SEES). The SEES measures core aspects of the e-learning context: autonomous strategic planning, social interaction, and teacher feedback. METHOD: Through two studies carried out in sample of nursing students, an exploratory (n = 302) and confirmatory (n = 245) factor analysis revealed a three-factor structure. RESULT: The results provide empirical evidence of appropriate psychometric properties (i.e., reliability, validity). CONCLUSION: The SEES can be used in a higher education context, particularly in nursing education programs. Theoretical, methodological, and practical implications for exploring the e-learning environment in nursing educational settings are discussed.

Moving forward the Italian nursing education into the post-pandemic era: findings from a national qualitative research study.

BACKGROUND: During the CoronaVIrus-19 (COVID-19) pandemic, nursing education has been dramatically transformed and shaped according to the restrictions imposed by national rules. Restoring educational activities as delivered in the pre-pandemic era without making a critical evaluation of the transformations implemented, may sacrifice the extraordinary learning opportunity that this event has offered. The aim of this study was to identify a set of recommendations that can guide the Italian nursing education to move forward in the post-pandemic era. METHODS: A qualitative descriptive design was undertaken in 2022-2023 and reported here according to the COnsolidated criteria for REporting Qualitative research guidelines. A network was established of nine Italian universities offering a bachelor's degree in nursing for a total of 6135 students. A purposeful sample of 37 Faculty Members, 28 Clinical Nurse Educators and 65 Students/new graduates were involved. A data collection was conducted with a form including open-ended questions concerning which transformations in nursing education had been implemented during the pandemic, which of these should be maintained and valued, and what recommendations should address the transition of nursing education in the post-pandemic era. RESULTS: Nine main recommendations embodying 18 specific recommendations have emerged, all transversally influenced by the role of the digital transformation, as a complementary and strengthening strategy for face-to-face teaching. The findings also suggest the need to rethink clinical rotations and their supervision models, to refocus the clinical learning aims, to pay attention towards the student community and its social needs, and to define a pandemic educational plan to be ready for unexpected, but possible, future events. CONCLUSIONS: A multidimensional set of recommendations emerged, shaping a strategic map of action, where the main message is the need to rethink the whole nursing education, where digitalization is embodied. Preparing and moving nursing education forward by following the emerged recommendations may promote common standards of education and create the basis on for how to deal with future pandemic/catastrophic events by making ready and prepared the educational systems.

[Transitioning Italian nursing education in the post-pandemic period: priorities in the light of lessons learnt]. / Transitare la formazione infermieristica italiana nel periodo post pandemico: le priorità alla luce delle lezioni apprese.

. Transitioning Italian nursing education in the post-pandemic period: priorities in the light of lessons learnt. INTRODUCTION: Once back to normalcy, many nursing education activities have been restored without an in-depth analysis of which transformations enacted in the pandemic period should be maintained and valued. AIM: To identify priorities to effectively transitioning nursing education in the post-pandemic period. METHOD: Descriptive qualitative design. A network of nine universities involved 37 faculty members, 28 clinical nurse educators and 65 students/new graduates. Data were collected through semi-structured interviews; the main priorities reported in each university were combined to gain a global view. RESULTS: Nine priorities emerged, including the need to: 1. reflect on distance learning to promote its complementary role to face-to-face teaching; 2. rethinking the rotations of clinical practical training by refocusing their aims, duration, and preferred settings; 3. understanding how to integrate the virtual and the in-presence learning spaces into the educational pathway; 4. continuing with inclusive and sustainable strategies. Considering that nursing education is essential, it is a priority to develop a pandemic education plan capable of guaranteeing its continuity in all circumstances. CONCLUSIONS: Nine priorities have emerged all considering the importance of digitalization; the lessons learnt, however, indicate the need to enact an intermediate phase capable of guiding towards the complete transition of the education in the post-pandemic era.

[Identifying population needs: methods of analysis and stratification]. / Identificare i bisogni della popolazione: metodi di analisi e di stratificazione.

. Identifying population needs: methods of analysis and stratification. In this article, examples of population stratification models used at the national level to identify different levels of needs and interventions are reported. Most models are based primarily on health data, diseases, clinical complexity, use of health services, hospitalizations, emergency room access, pharmaceutical prescriptions, and exemption codes. The limitations of these models relate to the availability and integration of data, as well as generalizability in different contexts. Moreover, to address the difficulty of implementing effective local interventions, the co-production or integration of social and health services is strongly suggested. Some survey techniques are presented to detect the needs, expectations, and resources of specific communities or populations.

Delirium prevalence, risk factors and outcomes among patients with acute stroke: A multi-centre observational study.

BACKGROUND: Delirium is a frequent and serious acute neuropsychiatric syndrome leading to worse prognosis including mortality. Patients with ischaemic and/or haemorrhagic stroke are vulnerable to delirium. However, predisposing and precipitating factors have not been fully discovered to date, leaving this area of practice under-represented in available guidelines. AIMS: To describe the prevalence, associated factors and main in-hospital outcomes of post-stroke delirium. METHODS: A multi-centre observational study was conducted from 2019 to 2020 and reported according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Data were collected in stroke units located in two large hospitals in the North-East region of Italy. Consecutive adult patients with ischaemic and/or haemorrhagic stroke with a Glasgow Coma Scale > 5, who were willing to participate, were included. Data at admission, during the in-hospital stay and at discharge were collected by trained nurses, not involved in the care of patients, with (a) validated tools, (b) direct observation, and (c) access of patients' records. RESULTS: A total of 78 patients were enrolled (mean 73.1 years; 59% male), and 70.5% of them had suffered an ischaemic stroke. The mean National Institutes of Health Stroke Scale (NIHSS) at admission was 8.2 ± 7.0. A total of 34.6% of patients developed post-stroke delirium; the onset was mainly on the first day of admission (70.4%) and the condition lasted for an average of 3.7 days (SD 2.6). In the multivariate logistic regression, 64.1% of the delirium variance was explained by the NIHSS scores (RR 1.259, 95%CI 1.035-1.533; p = 0.022). Patients with post-stroke delirium reported higher functional dependence at discharge and the need for more delaying of hospital care to be admitted in rehabilitation units. CONCLUSIONS: At admission, higher scores in the NIHSS evaluation might suggest which patients are at an increased risk of delirium. Avoiding interventions that could potentially increase this risk, together with continuous surveillance, become imperative for nurses who are constantly and closely present by their patients' side, in order to prevent this serious complication.

[The TeMP_cardio Model for the district management of heart failure patients: a feasibility study for the implementation of the family nurse]. / Il modello TeMP_Cardio per la gestione del paziente con scompenso cardiaco sul territorio: uno studio di fattibilità con l'introduzione dell'infermiere di famiglia e comunità.

. The TeMP_cardio Model for the district management of heart failure patients: a feasibility study for the implementation of the family nurse. INTRODUCTION: The need to enhance primary health nursing care and chronic disease management requires the development of complex and feasible models in local contexts. AIM: To test the feasibility of a complex care model, based on the introduction of the family and community nurse for patients with stable heart failure and their caregivers. METHODS: A pre-post six-month feasibility study was conducted in 2021-2022 in the Autonomous Province of Trento. Patients with stable heart failure able to access services were taken in charge with a multidisciplinary model, with the nurse as care manager, and technological and telemonitoring support. RESULTS: 26 patients out of 137 were included and nine of their caregivers. Ten participants accepted to use the mobile app. Twenty-three patients and seven caregivers completed the study, and the app was used regularly by five participants. Self-care skills improved in patients, mostly in self-monitoring, less in caregivers. One access to the emergency department for heart failure exacerbation was detected. CONCLUSIONS: The model was evaluated feasible to retain patients, with the need to build effective strategies for the recruitment, and the regular use of telemonitoring tools.

[Education in rare diseases. Where are we now?] / La formazione nelle malattie rare. A che punto siamo?

Rare diseases represent a numerous (more than 30 million patients throughout Europe), diverse (more than 6000 disease ascertained), and complex group of genetic, metabolic, neurologic, congenital and other type of disorders presenting both in pediatric and adult age. Research, education and care are the mainstay of the national rare disease plans of the member states, including Italy. Early diagnosis and multidisciplinary care, particularly in severe or progressive disorder, are mandatory to treat disorders (when a specific treatment is available) and/or avoid life-threatening complications. According to the catchphrase "you can only diagnose what you know", it is intuitive how important is education and the "culture of suspect" in rare disease. In the last decade, a pre- and post-graduate academic planning on rare disease have been set up in Italy, with the aim to be comprehensive and up-to-date with the literature, traversal to both general physicians and all the specialties, longitudinal during all the study courses.

[Nurse decision making in triage cose assignment: a qualitative descriptive study]. / Il processo decisionale dell'infermiere nell'attribuzione del codice di triage: uno studio qualitativa descrittivo.

. Nurses' decision making in triage code assignment: a qualitative descriptive study. INTRODUCTION: Given the importance of improving Emergency Department (ED) quality of care and patient satisfaction and safety, analyzing how nurses make decisions in the triage process may help healthcare organizations in developing effective and safe EDs and in supporting healthcare staff. The present study was therefore conducted to explore factors that contribute to nurses' decision-making in the triage process. METHODS: Two Focus groups with 20 nurses have been conducted and content data analyses performed following a descriptive qualitative approach. RESULTS: Three main aspects tend to affect nurses' decision making in the triage process and therefore influence priority code assignment: the patient's condition (signs and symptoms, risk of adverse clinical evolution, presence of frailty conditions), the organizational setting (patients flow, relationship with medical staff, stressful environment, support from the organization) and the nurse's experience (experience with similar situations, intuition, burden of responsibility). Nurses tend to balance adherence to protocols with appropriate responsiveness of the ED department and tend to seek peer feedback regarding to the priority code assigned. CONCLUSIONS: Triage is a complex process, consisting of many factors, resulting from contingent situations that vary continuously. These elements intersect in a process that continuously tends to affect the decision.

Why do nursing students leave bachelor program? Findings from a qualitative descriptive study.

BACKGROUND: Over the past few years, the phenomenon of "nursing student attrition" has been unevenly studied. Investigators often focused on independent predictors as age, family obligations, final grade of high school, demanding physical and mental workload and others. Specifically, just a few studies applied qualitative methods to better comprehend the very needs of first year students enrolled in a bachelor's degree in nursing sciences (BSN), to sustain their learning process and define effective strategies to reduce student drop-out. METHODS: We conducted a qualitative descriptive study. Thirty-one nursing students at Verona University were interviewed using a semi-structured guide. Data analysis was performed according to a descriptive approach by Sandelowski & Barroso (2000). RESULTS: A total number of 31 students were interviewed. The most recurrent themes regarding the reasons behind BSN drop-out were: understanding that they were not suited to be nurses, perception of missing/lack of psychological, physical and practical resources needed to successfully cope with both nursing school and the nursing profession, inconsistencies between the image of the profession and the reality of the job, feelings of disappointment for the experiences of internship, perceived lack of support from the clinical teacher while going through difficult experiences. CONCLUSIONS: We can consider a part of these drop-out decisions normal, even physiological when students come to realise that they are not suited for the nursing profession. However, it's important to guide nursing students with adequate counselling in order to give them the essential tools to cope with the training and the future as health professionals.

Occurrence and reasons for unfinished nursing care between COVID-19 and non-COVID-19 patients.

AIM: To compare the occurrence and the reasons for unfinished care among coronavirus disease (COVID-19) and non-COVID-19 patients as perceived by nurses. BACKGROUND: The recent pandemic has imposed tremendous changes in hospitals in all countries. INTRODUCTION: Investigating the occurrence of and the reasons for unfinished care as perceived by nurses working in COVID-19 and non-COVID-19 units might help to gain insights and to address future pandemics. METHODS: A comparative cross-sectional study based on the STROBE guideline has been conducted during November 2020-January 2021. The Unfinished Nursing Care Survey, comprising part A (elements) and part B (reasons), was administered online to all 479 nurses working in medical and surgical units converted progressively into COVID-19 and non-COVID-19 units. A total of 90 and 200 nurses participated, respectively. RESULTS: No differences in the unfinished care occurrence have emerged at the overall level between nurses caring for COVID (2.10 out of 5; 95% confidence interval [CI], 1.94-2.27) and non-COVID-19 patients (2.16; 95% CI, 2.06-2.26). Reasons for unfinished care reported significant higher averages among nurses caring for COVID (2.21; 95% CI, 2.10-2.31) as compared with those caring for non-COVID-19 patients (2.07; 95% CI, 2.01-2.14; p = 0.030). DISCUSSION: The overall occurrence of unfinished care was slightly higher compared with pre-pandemic data in all patients. CONCLUSIONS: Reasons triggering unfinished care were slightly different and were due to priority setting and human resources issues, which were perceived at higher significance among nurses working in COVID-19 compared with non-COVID-19 units. IMPLICATION FOR NURSING AND HEALTH POLICIES: A clear map of action has emerged that might be valid in the post-COVID-19 era as well as in the case of future pandemics.

The emotional side of the e-learning among nursing students: The role of the affective correlates on e-learning satisfaction.

Emotions are a core component of the learning process, which impact not only academic performance, but also the way we perceive our training, including the full remote training. The present studyaims to investigate the mediating role played by positive and negative emotions in the relationship between the cognitive and the social presence of the e-learning environment and the satisfaction with e-learning. Based on the Community of Inquiry (CoI) framework and on a cross-sectional study, our theoretical model was assessed (by using structural equation modelling) in a sample of 353 undergraduate nursing students at an Italian university. The results showed that the students' e-learning experience is related to both positive and negative emotions in different ways, which in turn impacts the satisfaction with the e-learning. Thus, findings highlight the complex interplay between e-learning perceptions, affective correlates and satisfaction with remote training. Theoretical and practical implications related to the development of educational interventions are further discussed.

Organisational models in primary health care to manage chronic conditions: A scoping review.

Chronic diseases are increasing incessantly, and more efforts are needed in order to develop effective organisational models in primary health care, which may address the challenges posed by the consequent multimorbidity. The aim of this study was to assess and map methods, interventions and outcomes investigated over the last decade regarding the effectiveness of chronic care organisational models in primary care settings. We conducted a scoping review including systematic reviews, clinical trials, and observational studies, published from 2010 to 2020, that evaluated the effectiveness of organisational models for chronic conditions in primary care settings, including home care, community, and general practice. We included 67 international studies out of the 6,540 retrieved studies. The prevalent study design was the observational design (25 studies, 37.3%), and 62 studies (92.5%) were conducted on the adult population. Four main models emerged, called complex integrated care models. These included models grounded on the Chronic Care Model framework and similar, case or care management, and models centred on involvement of pharmacists or community health workers. Across the organisational models, self-management support and multidisciplinary teams were the most common components. Clinical outcomes have been investigated the most, while caregiver outcomes have been detected in the minority of cases. Almost one-third of the included studies reported only significant effects in the outcomes. No sufficient data were available to determine the most effective models of care. However, more complex models seem to lead to better outcomes. In conclusion, in the development of more comprehensive organisational models to manage chronic conditions in primary health care, more efforts are needed on the paediatric population, on the inclusion of caregiver outcomes in the effectiveness evaluation of organisational models and on the involvement of social community resources. As regarding the studies investigating organisational models, more detailed descriptions should be provided with regard to interventions, and the training, roles and responsibilities of health and lay figures in delivering care.

[The implementation of a District Clinic to overcome the shortage of general practitioners in the Basso Vicentino area]. / Attivazione del Presidio Territoriale di Assistenza Primaria per affrontare la carenza di medici di medicina generale nel territorio del Basso Vicentino.

. The implementation of a District Clinic to overcome the shortage of general practitioners in the Basso Vicentino area. INTRODUCTION: The demographic and epidemiological changes of Western societies lead to the implementation of new organizational models based on prevention and health promotion interventions mainly oriented to chronic patients. This approach promotes people's living places as the privileged place of care. AIM: To guarantee, in a rural area, the care of patients without a general practitioner, through the activation of the Primary Care District Clinic. METHODS: After having mapped the main chronic health problems of the catchment area, an outpatient care service based on an integrated medical-nursing approach was implemented. The Family and Community Nurse was responsible for the stratification of subgroups of patient according to their health problem, ensuring an integrated care of patients with chronic diseases or frail conditions, by education and symptoms monitoring. A convenience sample of 100 patients was selected, to analyze the degree of satisfaction with the care offered, by administering a questionnaire. RESULTS: Six months after its implementation, 4,000 patients accessed to the District Clinic. Those who answered the questionnaire declared high levels of satisfaction for the care received. The main needs were requests for repeated prescriptions and prescriptions for specialist examinations or visits for acute symptoms. CONCLUSIONS: The implemented model is promising, the patients were satisfied with the care received but would prefer to have contacts with the same nurse over time.

[The complexity of research in primary care: notes of method]. / La complessità della ricerca infermieristica nelle cure primarie: appunti di metodo.

. The complexity of the nursing research in the primary health care: methodological challenges and suggestions. INTRODUCTION: Research in primary care nursing has grown in the last decades addressing the national and international call aimed at increasing the primary health care services. METHOD: A of the main possible challenges that researchers might encounter in primary care research is proposed, as well as suggestions aimed at implementing strong research methodologies. RESULTS: The study designs feasible in this setting such as that observational, randomized cluster and/or pragmatic trials, stepped wedge designs, and mixed-method studies are discussed; as well as strategies to involve the population, e.g., with participatory research; how to describe the interventions and the possible outcomes sensitive to the family/community nurses care to consider. CONCLUSIONS: National and international guidelines promote the implementation of the family/community nurses. Many Italian regions are implementing the model tailored to the context: these initiatives should be accompanied studies capable to document their outcomes.