Evaluating best evidence in occupational therapy for patients with hip replacement: guidelines.

SUMMARY: Object. The following study was carried out in order to evaluate through guidelines the best evidence in occupational therapy for daily activities and quality of life of patients with hip prostheses. Methods. Recommendations were generated following the grading method of the National Program for Guidelines/National System Guidelines (PNLG-SNLG), a system for developing guidelines for recommendations in clinical practice. The Appraisal of Guidelines Research and Evaluation in Europe (AGREE) tool was also applied. Results. A total of seven studies were included in this research: one randomized controlled trial, two systematic reviews, two outcomes research studies, and two observational studies. We found that, for the three clinical questions we proposed, more research on the effectiveness of treatments is required. Conclusions. The evidence resulting from this study is not sufficient to determine whether the rehabilitation techniques under consideration are effective.

Epidemiology of Chronic Pain in the Latium Region, Italy: A Cross-Sectional Study on the Clinical Characteristics of Patients Attending Pain Clinics.

In Italy, chronic pain affects more than a quarter of the population, whereas the average European prevalence is 21%. This high prevalence might be due to the high percentage of Italian people who do not receive treatment, even after the passing of law 38/2010 (the right to access pain management in Italy), which created a regional network for the diagnosis and treatment of noncancer chronic pain. Italian epidemiologic studies on chronic pain are scanty, and this observational, multicenter, cross-sectional study is the first to investigate the clinical characteristics of patients who attended the pain management clinics in the Latium Region, Italy, for the management of their noncancer chronic pain. A total of 1,606 patients (mean age 56.8 years, standard deviation ± 11.4), 67% women, were analyzed. Severe pain was present in 54% of the sample. Women experienced pain and had it in two or more sites more often than men (57% vs. 50%, p = .02; and 55.2% vs. 45.9%, p < .001, respectively). Chronic pain was musculoskeletal (45%), mixed (34%), and neuropathic (21%). In more than 60% of the cases, chronic pain was continuous, and in 20% it had lasted for more than 48 months; long-lasting pain was often neuropathic. Low back (33.4%) and lower limbs (28.2%) were the main locations. Severe intensity of pain was statistically significantly associated with female gender (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.06-1.84); with International Classification of Diseases, Ninth Revision, codes for chronic pain syndrome (OR 2.14; 95% CI 1.55-2.95); and with continuous pain (OR 2.02; 95% CI 1.54-2.66). Neuropathic pain and mixed pain were significantly associated with number of sites, and a trend seemed to be present (OR 2.11 and 3.02 for 2 and 3 + sites; 95% CI 1.59-2.79 and 2.00-4.55, respectively).

Attitude and Knowledge of Pain Management Among Italian Nurses in Hospital Settings.

Pain is multidimensional, and, as such, the chief reason patients seek urgent healthcare services. If inadequately assessed and untreated, pain may negatively impact on the quality of life of the patient. Treating pain is an important step in regaining control over quality of life. The objective of the present study is to examine the level of knowledge and types of approach among Italian nurses who deal with pain assessment and management. The Ferrell and McCaffery's Knowledge and Attitudes Survey Regarding Pain (KASRP) was distributed to 286 nurses employed in one of the biggest specialized hospitals in Rome, Italy. The interviewed staff work at three different settings, according to the healthcare assistance they are required to provide: intensive care unit (ICU), subintensive care unit (SICU), and ordinary ward (OW). Descriptive statistics, including frequencies and means, as well as analysis of chi-square (p < .05), were used to compare differences in scores by demographic characteristics of the participants and different settings. A logistic regression model was performed to evaluate the factors that may influence the attitude to pain and the level of knowledge of care providers. Results have shown that the odds of developing positive attitudes towards pain management were 1.62 times higher (95% CI: .92 to 2.85) in nurses employed in SICUs than in those working in OWs, while the odds of possessing a satisfactory level of knowledge was 1.76 times higher (95% CI: .93 to 3.31) among nurses in ICUs than those in OWs. A "good assessment" was better for SICU (OR = 2.17, p < .05) and ICU (OR = 3.20, p < .05) nurses. Our survey has highlighted an overall limited level of knowledge in the assessment and management of pain among the nursing staff. It is therefore a priority to implement specific training to healthcare providers from different fields, who may respond differently to patients with pain. On the other hand, further investigations are required on a greater sample of Italian nurses to better understand how to overcome the most problematic barriers to achieving good pain assessment and control.

[ICNP- International Classification of Nursing Practice: origin, structure and development]. / ICNP - Classificazione Internazionale per la pratica infermieristica: origini, strutturazione e sviluppo.

ICNP is a standardized nursing terminology included within acknowledged terminologies by WHO, it is a relevant aspect of ICN programs and strategies. This paper aims to describe structure and characteristics of ICNP terminology as well as to highlight how this tool can be useful both in practice and in terms of nursing professional development. This version looks like a pyramid with seven axes describing different areas of nursing and related interventions, enriched by two special axes related to pre-coordinated Diagnosis / Outcomes (DC) and Operations (IC) which facilitate daily use in practice. In order to clarify how this tool can be actually be used in daily nursing practice some examples are provided, clarifying how adopting the current version of ICNP terminology (2015 release) Diagnosis/Outcomes and Interventions can be built. The ICNP Italian Centre is committed to introduce it to Italian nurses as a tool for sharing and disseminating terminology in our Country, having as main final aim to achieve even in Italy, professional visibility objectives promoted in different ways by the International Council of Nurses.

Distraction as a technique to control pain in pediatric patients during venipuncture. A narrative review of literature.

INTRODUCTION: Distraction is a non-pharmacological intervention aimed to reduce procedural pain in children. Venipuncture is one of the most widely used diagnostic and therapeutic procedure in pediatric patients. Analgesia during venipuncture may be efficiently achieved with distracting techniques. OBJECTIVE: To describe active and passive distraction techniques to reduce distress in children undergoing venipuncture. METHOD: Data from CINHAL, PubMed, ILISI and Cochrane's databases were used to review existing literature and primary and secondary studies published between 2003 and 2014 were included. Queries were obtained with keywords such as distraction, complementary therapies, pain, pediatric, the Boolean operators AND and OR were used. RESULT: Twenty eligible articles out of the one hundred and forty-three retrieved (20/143) were selected; among these there were 3 systematic and 5 narrative reviews, 11 experimental and quasi-experimental studies and 1 observational study. Active and passive distraction techniques seemed extremely effective to reduce distress and pain in children undergoing venipuncture. Modest evidence of efficacy and absent side effects support this approach. CONCLUSION: Further RCTs are needed to compare the different types of existing active and passive distraction techniques. The presence of parents and the location where painful procedures are administered should be included in the assessment of this approach.

[The concept of Health Literacy and its importance for nursing]. / Il concetto di Health Literacy e la sua importanza per la professione infermieristica.

INTRODUCTION: Individuals and population's health is influenced by environmental, social economical and cultural aspects which in turn connect individuals to society. In order to decide autonomously, independently and consciously individuals should have several competences. The aim of this study is to identify, analyse and emphasise health literacy concept relevance per se,its relationship with nursing through a narrative revision focused on: Health literacy definition recognition and analysis; evaluation of connection between nursing and health literacy. METHODS: A narrative review was carried out through PUBMED and CINHAL, using 'health literacy' and nursing related terms, in English or Italian between 2010 and 2015. RESULTS: Results show that 'health literacy' is fully appraised, while attention paid by nurses on the topic is poor due both to a lack of awareness of its relevance on individuals' health and of appraisal. Twenty-height definition emerged from the revision; concepts expressed by scholars are mainly focused on very few individuals' abilities and competences applied to the health context (reading, writing, calculation, comprehension, listening and so on). CONCLUSIONS: According to the results it is difficult to define health literacy due to its multidimensional nature. Notwithstanding the above an attempt to develop a unique new definition of health literacy has been carried out although its multidimensional nature and its strong connection to several variables constantly under development. Nevertheless it is imperative that educational modules would be developed and stably integrated in health care education, at the same time a strong effort is due from professional and policy makers to provide population of the necessary tools in order to improve their health.

[Non-urgent access to care and nurses' roles in the Emergency Department: a narrative literature review]. / Accessi non urgenti nel Dipartimento di Emergenza (D.E.) e ruoli dell'infermiere. Una revisione narrativa della letteratura.

PURPOSE: To detect what is written in literature with respect to the access of non-urgent patients in Emergency Department, highlighting associated nursing roles during the period 2003-2013. METHOD: A literature review on international literature was carried out using PubMed database, where 41 significant articles were selected. RESULTS: The articles analyzed are focused on the organization of the E.D., the response patterns (Fast Track-See and Treat etc.) in some countries and the evaluation of the nursing roles and competences. In literature, the model and the roles studied have proved to be effective in reducing waiting times in E.D. and increasing users' satisfaction without reducing the quality of provided care. CONCLUSIONS: The literature shows that the implementation of Fast Track must be developed with a nursing staff with advanced skills on emergency. The introduction of these roles assumes that health systems should address the problem of inter-professional work.

[Alzheimer's disease and caregivers experience in home care]. / L'esperienza dei caregiver primari che assistono a domicilio le persone affette dalla Malattia di Alzheimer.

The aim of this study is to investigate the experience of primary caregivers (men and women) of Alzheimer Disease dementia, in order to tailor program and project to avoid care giving burden. A qualitative phenomenological method was used and the sample was defined by data saturation. Interviews were carried out and recorded in a day care Centre, transcribed verbatim. The analysis was conducted coding common themes and phrases. Six main themes emerged. Our results are similar to those existing in literature, showing care givers as individual in great danger physically and mentally. In the light of the study it is possible to tailor a nursing model in order to improve quality of life and decrease the burden of caregivers, this model should be implemented and analyzed.

[E-learning and university nursing education: an overview of reviews]. / E-learning e formazione infermieristica universitaria: una overview delle revisioni.

INTRODUCTION: The increasing use of digital technologies and e-learning in nursing education and the health professions was also reflected in the time to many studies and reviews. The aim of this overview was to analyze education through e-learning technologies for nursing and health professional students. METHOD: A comprehensive search of literature was conducted using database PubMed/MEDLINE, Ebsco/CINAHL, 2003-2013. RESULT: The search strategy resulted in the inclusion, in first instance, of 9732 items. After the reduction of duplicates, applying limits and other parameters of inclusion/exclusion and, at the end, evaluation of quality through AMSTARD check list, we included in this overview, 22 reviews. The analized reviews were allowed to spread in different topic areas: study population (students and faculty), e-learning methods (blended learning Game/3D/situated learning) and evaluation (information technology, learning satisfaction comparison of e-learning with the traditional teaching methods) CONCLUSION: This overview demonstrates that e-learning in nursing academic education is a valid alternative to traditional learning. If e-learning activities are well structured and modulated, some advantages and economies are clear possible. Regard effects of e-learning on the improvement of ability, data are at the momenti limited when compared to traditional learning. Often e-learning appear as an adjunct respect traditional learning, but is necessary consider e-learning and digital tecnology as priority for the future of education of nursing students.

Anatomy and physiology for nursing students: is problem-based learning effective?

This study investigated whether problem-based learning (PBL) was an effective strategy for nursing students learning anatomy and physiology. Anatomy and physiology are subject areas that have posed long standing difficulty for nursing students. Since anatomy and physiology underpin clinical decision making it is important that nursing students are able to understand and retain this knowledge and apply it to practice. Problem-based learning offers potential advantages for teaching anatomy and physiology as clinical cases can provide the impetus for student problem solving. This project trialled a simple PBL scenario and investigated students' response to the task of problem solving in a laboratory setting adapted to simulate a hospital ward. The study found students learn better, retain the knowledge and merge theory with simulated practice when a PBL teaching mode is used. While PBL was effective, blended, web based and hybrid PBL models warrant investigation.

[Etiology and prevalence of chronic pain in adults: a narrative review]. / La Prevalenza del Dolore Cronico Non Oncologico nell'Adulto e Patologie Associate: una revisione narrativa della letteratura.

The chronic nonmalignant pain is an underestimated epidemiologic health problem. It is a disease in its own right. It is one of the major reasons because patients use health service. The magnitude of chronic pain is in terms of human suffering and costs to society. The aim of this review is to identify the diagnosis and the prevalence of nonmalignant chronic pain in the adults. We have done a review of the literature from 1998 to 2012 using the virtual newspaper libraries starting from data bases (Pub-Med, CINAHL, Cochrane). We have made a narrative review of the articles obtained. Excluding topics of headache, pain for pediatric and geriatric groups, cancer pain and disease-specific items. Studies were classified for year, author sample, methods, age groups and definition of pain. We have obtained 7 articles. These epidemiological studies conducted in different part of the world, reported prevalence rates of chronic pain ranging from 16-53%. They shows a high heterogeneity of results concerning diagnosis and methods. Although limited the number of articles, show the high complexity of the phenomenon.

[The status of the art of scientific articles in Italy between 2003 -2009: an analysis of articles published by nursing Italian journals]. / La produzione scientifica italiana attaverso un'analisi degli articoli pubblicati sulle riviste infermieristiche: 2003-2009.

This study investigates  the number of  articles published by Italian nursing journals by analyzing five Italian journals between 2003 and 2009. This is the third part of a study started  in 1978,  two articles were already published in 2005. The work is aimed at monitoring the number of nursing articles published. The articles were cataloged according to predefined criteria with the main aim to verify the status of the progress of research and theoretical development among Italian nurses. Results show that, although there is an increase in publications which apply research methods, these are still below the international trend and that, at national level, nurses prefer  topics such as care plans, regulations and organization of work rather than research or scientific evidence. On the one hand there is a raise on Italian nurses of interest in wider topic in order to be closer to the international debate, on the other hand there is a lack of adequate tools to improve knowledge and specific investments in research. As result of this there is a strong limitation in the knowledge growth of Italian nurses together with a lack of participation among and for different generations of nurses. In addition to the above it has been enucleated a scarcity within the literature analyzed of development of theoretical models, theories and concepts. Conversely theoretical models, theories and concepts are important pillars of scientific knowledge and they have a strong role in professional development, moreover these are necessary in order to set and improve nursing and nurses image nowadays far from the exclusive applied science.

A comparison of the hand hygiene knowledge, beliefs and practices of Italian nursing and medical students.

AIM: This paper reports a study examining the hand hygiene knowledge, beliefs and practices of Italian nursing and medical students with the aim of informing undergraduate curricula. BACKGROUND: In comparison with registered nurses, physician status is a risk factor for non-compliance with hand hygiene guidelines. Little research has been conducted to determine if differences between the professions in relation to hand hygiene are apparent at the undergraduate level. Cross-disciplinary studies that may provide an insight into this topic are lacking. METHODS: A questionnaire was administered to a convenience sample of 117 nursing and 119 medical students in a large university in Rome, Italy, to determine their hand hygiene knowledge, beliefs and practices. The data were collected in 2007-2008. RESULTS: Nursing students' hand hygiene knowledge (F = 9·03(1,230); P = 0·003), percentage compliance (Z = 6·197; P < 0·001) and self-reported hand hygiene practices (F = 34·54(1,230); P < 0·001) were significantly higher than that of medical students. There were no statistically significant differences between hand hygiene beliefs. Mean scores on the knowledge questions were low for both groups, reflecting primarily a knowledge deficit in relation to the use of alcohol-based hand rubs to decontaminate hands in the healthcare setting. CONCLUSION: Statistically significant disciplinary differences in hand hygiene knowledge and self-reported practices were apparent among undergraduate Italian healthcare students. Further research is needed to determine the causative factors. The overall low scores on the knowledge items indicate that these students require further education on hand hygiene, particularly in relation to the use of alcohol-based hand rubs.

Right to life, right to end of life: some considerations.

Human rights have undergone constant evolution. Recently, however, new generations of rights are developing: from political and civil rights to social and economic rights, so much so that this period may be defined as the age of human rights. Many differences exist between moral rules and judicial law. While moral rights are not necessarily recorded in statutory law, some judicial laws, which are capable of being imposed and/or appealed within a true territorial government, originate from moral rules. Common sense has reservations about whether human rights can be labelled as laws in a rudimentary way; instead, society places human rights in the category of moral rights. These moral rights, in fact, are not the fruit of compromise, but are absolute and essential to the inner self. Throughout this article, the evolution of end of life rights is discussed, with particular regard to how those rights are directly correlated to organ transplantation.

[Post-traumatic stress disorder in the Ares 118 voluntary ambulance staff in the Latina area: preliminary study to validate the PTSS-10]. / Disturbo post traumatico da stress dei volontari dell'ARES 118 area Latina: studio preliminare per validare la scala PTSS-10.

The study investigates and describes post-traumatic stress testing for the Italian validation of the abbreviated form of the Scale for the Symptoms of Post Traumatic Stress Disorder (PTSS-10). It's a scale comprising 10 items and the article takes into consideration the German version, derived from the original Norwegian. The scale is based on the concept of multidirectional stress supported by Lazarus. Its validation and testing was conducted on a group of 60 ARES 118 volunteers of Latina. The study reports the internal reliability of the translated instrument, calculated using Cronbach's alpha and compared to German study. 'Factor Analysis is calculated and the results are discussed. Some remarks, also, are made by relating scores indicating a suspected PTSD with socio-demographic variables. The results demonstrate the reliability of the instrument, but for a generalization, it should be tested on a larger sample and apply the test -retest.

[The experience of coma patients and their relatives]. / L'esperienza delle persone che sono state in coma e dei loro famigliari.

This article describes the experience of patients (8) who have come out of coma , using a method combining qualitative evaluation and semi-structured interview. The experience of the family members who acted as care-givers is also taken into consideration. Given the context, data saturation was not observed, and 8 interviews were obtained. The principle caregivers were also asked to describe their experience. The interviews were transcribed verbatim and read through carefully so that the significant aspects could be divided into groups using a model for the evaluation of outcome which requires further validation.

The use of complementary therapies for chronic pain in Italian hospices.

PURPOSE: Although there has been an increase in the use of CT (Complementary Therapy) in Europe, little is known about CT available in Italian hospices. The present study is aimed at assessing the diffusion and typologies of CT used to treat chronic pain in Italian hospices. METHODS. An online survey was e-mailed to a regional sample of 16 hospices, which included questions on common CT used to treat malignant or nonmalignant chronic pain, and the barriers to their utilization. RESULTS: The response rate was 81%. Only 5 hospices (38%) offered CT with conventional treatment. Massage therapy was the most common type of CT used, followed by naturopathy, nurturing touch, hypnotherapy, guided imagery, and aromatherapy. Barriers to the delivery of CT included insufficient knowledge of CT by staff, limited knowledge, and lack of funding. CONCLUSIONS: Although limited to Lazio hospices, this survey shows a partial use of CT for the treatment of chronic pain, caused by economic and cultural barriers.

[Stress and nursing : study to evaluation the level of satisfaction in nurses]. / Stress e lavoro infermieristico: Indagine conoscitiva sulla soddisfazione di un gruppo di infermieri.

Not unfrequently stress in nurses is related to work organization. The literature shows that the nursing profession has a high risk of psychological stress. Stress is one of the factors that contributes to inefficiency, increasing staff turnover and sick leave, and reduces the quality and quantity of care , affecting health costs and diminishing work satisfaction. This article presents the results of a study performed to evaluate 34 variables, constituting the Nursing Stress Scale (NSS) , and their level in the nursing staff of a Rome specialistic hospital. Of the 80 nurses who received the questionaire , 49 responded, a sufficient number to make the results of the study significant. The authors illustrate the methods used together with some socio-demographic considerations and how some of these can be correlated to the 7 factors adopted for multi-variate analysis. The results obtained were concordant with those described in the literature, confirming that poor organization and conflictual or ambiguous work roles negatively affect well-being and that nursing directors should bear this in mind when aiming to create a harmonious work environment.

Alzheimer's care at home: a focus on caregivers strain.

The aging population is increasing worldwide. According to Italian authors, Italy is one of the leading and increasing aging populations in the world. Placing more numbers on the elderly increases the number of people who will live with dementia in the future and in our case of study, in an increase of people with Alzheimer's disease. Researchers have demonstrated that Alzheimer's disease comes with aging and it eventually affects the person's cognitive, emotional, and physical well being. Those who become diagnosed with Alzheimer's will eventually need assistance in their daily living, especially when it begins to progress to a higher stage. Daily assistance can come from staff at a hospital or from family members at home, but whether it is the patient's spouse or offspring, the person caring for the patient forms a burden of responsibility on themselves over time. The objective of this paper is to discuss and compare the effects of the burden placed on the Alzheimer's caregiver: sleep, anxiety and depression, stress, and use or nonuse of support services. The focus of this literature review is to submit what on the research of caregiver strain at home.

Effectiveness of the telephonic-case-management for treatment of headache. A pilot study.

Chronic or intermittent headache affects the patients' quality of life, and has direct and indirect social costs. Several chronic illnesses are already treated through telephone counseling, however there is poor evidence in literature about headache treatment via telenursing, and it is not clear which role could the nurse play in this specific field. The study was carried out at the headache centre of "G. D'Annunzio" University - Chieti, and involved 62 patients, half of them were assigned to receive specialized telenursing in addiction to the standard care bean. During the 13 weeks of follow up the headache characteristics were regularly assessed (frequency and intensity). Pain assessment was performed using the VAS, and quality of life was assessed at baseline and at the end of the follow up using the SF-12 standard V1 questionnaire. The differences between the two groups are statistically significant during the last 5 week of follow up, (8th -12th; 0.002