Psychometric testing of the caregiver contribution to self-care of coronary heart disease inventory.

BACKGROUND: Caregivers are important contributors to the self-care of patients with coronary heart disease (CHD). AIMS: The aims of this study are to describe the development and psychometric properties of the caregiver contribution to self-care of coronary heart disease inventory (CC-SC-CHDI). METHODS: The CC-SC-CHDI was developed from the patient version of the scale, the Self-care of Coronary Heart Disease Inventory (SC-CHDI) and translated into Italian using forward and backward translation. Baseline data from the HEARTS-IN-DYADS study were used. Confirmatory factor analysis (CFA) was conducted to assess factorial validity; Cronbach's alpha and the model-based internal consistency index were used to test internal consistency reliability, and Pearson's correlation coefficient was used to test convergent validity, by investigating the association between the CC-SC-CHDI and the SC-CHDI scores. RESULTS: We included 131 caregivers (mean age 55 years, 81.2% females, 74% married) of patients affected by CHD (mean age 66 years, 80.2% males, 74% married). The CFA confirmed two factors in the caregiver contribution to self-care maintenance scale ("consulting behaviors" and "autonomous behaviors"), one factor for the CC to self-care monitoring scale, and two factors in the CC to self-care management scale ("consulting behaviors and problem-solving behaviors"). Reliability estimates were adequate for each scale (Cronbach's alpha and model-based internal consistency indexes ranging from 0.73 to 0.90). Significant and positive correlations were observed between CC-SC-CHDI and SC-CHDI scales. CONCLUSION: The CC-SC-CHDI has satisfactory validity and reliability and can be used confidently in clinical settings and research to assess caregiver contributions to CHD self-care.

The role of nurse-patient mutuality on self-care behaviours in patients with chronic illness.

AIM: To examine the role of nurse-patient mutuality on three self-care behaviours in chronic illness patients. DESIGN: A cross-sectional multi-centre study was conducted. METHODS: Mutuality was measured with the Nurse-Patient Mutuality in Chronic Illness scale which has the dimensions of developing and going beyond, being a point of reference and deciding and sharing care, and self-care was measured with the Self-care of Chronic Illness Inventory (SC-CII). Multivariable linear regression analyses were used to assess the contribution of three dimensions of mutuality on self-care maintenance, monitoring and management behaviours controlling for patient gender, age, education, number of medications, and presence of a family caregiver. RESULTS: The sample included 465 inpatients and outpatients with at least one chronic illness. The three dimensions of mutuality had different roles in their influence on the three dimensions of self-care. Developing and going beyond was significantly associated with self-care maintenance and self-care monitoring behaviours. Point of reference was significantly associated with self-care maintenance behaviour. Deciding and sharing care was significantly associated with self-care monitoring and self-care management behaviours. CONCLUSION: The mutuality between nurse and patient may be a novel area of research to support and improve patient self-care behaviours with implications for clinical practice and education. IMPLICATION FOR PROFESSION AND PATIENT CARE: Mutuality between nurse and patient increases patient engagement, symptom recognition, decision-making process and patient-centred approach favouring the development of self-care behaviours. IMPACT: Mutuality between nurse and patient is a new concept and its association with the patient outcomes could bring relevance to the nursing profession. Self-care behaviours are important in the management of chronic diseases, but are difficult to perform. Mutuality between nurse and patient influences the three different behaviours of self-care in chronic illness, for this reason it is important to increase the level of mutuality in this dyad. REPORTING METHOD: STROBE checklist for cross-sectional studies was followed in this study. PATIENT OR PUBLIC CONTRIBUTION: Patients were involved in the sample of the study.

Mutuality between nurses and patients with chronic illnesses: A cross-sectional descriptive study.

BACKGROUND AND AIM: Mutuality is a process in which the patient participates and is involved in decision-making and care interventions. The aim of this study was to measure mutuality in the relationship between nurses and chronic illness patients. METHODS: This study had a cross-sectional design; the sample included 249 patients and 249 nurses. Mutuality was measured with the Nurse-Patient Mutuality in Chronic Illness scale. RESULTS: Patients had higher scores in almost all items (p < 0.001). Patients demonstrate high reciprocity towards nurses and the ability to express and share their emotions. Patients consider nurses their point of reference and share with them their health goals. Nurses show more difficulty in being mutual with the patient, especially in the aspects related to the sharing of emotions, objectives, and planning. The egalitarian relationship score was low in both patients and nurses. CONCLUSION: These findings are important to consider at clinical, educational, organisational, and policy levels. Nurse education and organisation must push towards respect for the wishes of patients, the possibility of expressing their choices, and their involvement in the care plan. PRACTICE IMPLICATIONS: In clinical practice, it is necessary to put the patients more at the centre, involving them in the identification of objectives and in making decisions.

Perceived knowledge on the ICNP© in undergraduate nursing students: the development of a scale.

OBJECTIVES: To develop and validate an instrument to assess nursing students' perceived knowledge on the International Classification for Nursing Practice. METHODS: The study design is an initial development of a scale by a longitudinal, prospective, monocentric study. An instrument, including a final pool of 6 items, was developed and through a Content Validity approved by experts. Cronbach's alpha coefficient, Exploratory Factor Analysis and Confirmatory Factor Analysis were calculated in a sample of nursing students. RESULTS: The instrument demonstrated a CVI of 1.0. Cronbach's alpha coefficient was 0.879. Exploratory Factor Analysis indicated one component, with a saturation of items in the range between 0.594 and 0.856. Confirmatory Factor Analysis confirmed the structure. CONCLUSIONS: Although further studies are needed, the preliminary analyses of the instrument suggest satisfaction in terms of content validity, factorial structure, and reliability. This instrument may rise interest in international nursing educational context.

Nursing Home Organization Mealtimes and Staff Attitude Toward Nutritional Care: A Multicenter Observational Study.

OBJECTIVES: The aims of this study were to investigate the practices of registered nurses and nurse aides at mealtimes in nursing homes (NHs) and to evaluate the attitudes of health care staff toward the nutritional care of older people. DESIGN: This is a multicenter cross-sectional study. SETTING AND PARTICIPANTS: The study involved a convenience sample of NH health care staff: physicians, registered nurses, and nurse aides. METHODS: Data were collected on characteristics of the dining environment, organizational and nutritional care practices, staff-resident ratio, and staff activities during meals, using 2 questionnaires and staff attitudes were assessed with Staff Attitudes to Nutritional Nursing Care Geriatric Scale (SANN-G). Total score ranges from 18 to 90 points, with the following cutoffs: ≥72, positive attitude; ≤54, negative; and 55-71 points, neutral attitude. RESULTS: A total of 1267 workers from 29 NHs in northern Italy participated in the study. The most common nutritional assessment tool used by nurses was the Malnutrition Universal Screening Tool. A median of 4.0 and 4.2 people (family caregivers, volunteers and staff) were present for feeding support, respectively, at lunch and dinner. A median of 2.5 and 2.0 staff members at lunch and at dinner, respectively, fed residents. Overall, 1024 health care workers responded to SANN-G of which 21.9% showed a negative attitude, 57.2% neutral, and 20.9% a positive attitude. Nurse aides (190/714) showed worse attitudes compared with registered nurses (20/204) and physicians (2/36); differences were statistically significant. Overall, the best attitudes were toward "habits," "interventions," and "individualization" of nutritional care. Staff who had received nutritional training (29.2%) had best attitudes. CONCLUSIONS AND IMPLICATIONS: The results suggest that NHs should ensure adequate staff-resident ratio during meals, involving trained volunteers and relatives. Moreover, health professionals' knowledge and attitude toward nutritional care should be improved through continuous training.

A qualitative phenomenological study of nurses' experiences in caring for infants and children with life-limiting and life-threatening conditions.

PURPOSE: To understand the experience of nurses caring for infants and children with life limiting and life-threatening conditions. DESIGN AND METHODS: A qualitative phenomenological study was conducted, collecting data through deep interviews. Sample included twenty-seven nurses working in paediatric and neonatal intensive care units. RESULTS: Four themes emerged: suffering, being there, protect yourself and support. The experience of caring for children with limiting and life-threatening conditions affects nurses positively, with personal and professional gratification, but also negatively, as it leads to the development of compartmentalization, avoidance, and high levels of stress. CONCLUSIONS: The organization should make resources available to help nurses build resilience, improve emotional intelligence, and process experiences and emotions, thereby bringing benefits and improvements in infant and childcare. PRACTICE IMPLICATIONS: Comparison between colleagues is one of the most effective tools for supporting each other. Dedicated times and spaces to be able to carry out the debriefings managed by the nurses themselves, guided and mediated by an expert figure, such as a psychologist or a trainer, would be recommended.

Psychometric properties and measurement invariance of the 7-item General Anxiety Disorder scale (GAD-7) in an Italian coronary heart disease population.

BACKGROUND: Generalized Anxiety Disorder is predominant in coronary heart disease (CHD) patients. 7-item Generalized Anxiety Disorder (GAD-7) scale psychometric properties have never been tested in CHD populations. This study aims to verify the GAD-7 psychometric properties and measurement invariance in an Italian CHD sample. METHOD: A baseline data secondary analysis from HEARTS-IN-DYADS study. Several healthcare facilities enrolled an adult inpatient sample. Anxiety and depression data were collected using GAD-7 and Patient Health Questionnaire 9 (PHQ-9). Factorial validity was assessed with confirmatory factor analysis; construct validity was tested by correlating GAD-7 scores with PHQ-9 scores and other sociodemographic characteristics; internal consistency reliability was assessed using Cronbach's alpha and the composite reliability index, while confirmatory multigroup factor analysis was employed to investigate measurement invariance across gender and age (65 vs. 65). RESULTS: We enrolled 398 patients (mean age 64.7 years; 78.9 % male; 66.8 % married). Factor structure was confirmed as unidimensional. Construct validity was confirmed with significant associations between GAD-7 and PHQ-9 scores, female gender, having a caregiver, and being employed. Cronbach's alpha and composite reliability index were 0.89 and 0.90, respectively. Measurement invariance across gender and age was confirmed at the scalar level. LIMITATIONS: A convenience sample in one European country, a small female sample, validity testing against a single criterion. CONCLUSION: Study results demonstrate adequate validity and reliability of the GAD-7 in an Italian CHD sample. It showed satisfactory invariance properties; GAD-7 is suitable for measuring anxiety in CHD while making significant comparisons of scores among stratified gender and age groups.

Development and validation of two versions of the Nurse-Patient Mutuality in Chronic Illness scale.

AIMS: The aim of the study was to develop and psychometrically test the Nurse-Patient Mutuality in Chronic Illness (NPM-CI) scale in two versions, one for nurses and one for patients. METHOD: A multiphase methodological study was conducted. In the first phase, a qualitative investigation was conducted through interviews and an analysis of the content; inductively, the items of two instruments were generated, one for nurses and one for patients. In the second phase, the content and face validity were assessed through the expert consensus method. In the third phase, exploratory factor analysis (EFA), Cronbach's alpha test, intraclass correlation and Pearson correlation coefficients were conducted to estimate construct, criterion validity and instrument reliability. For each phase, the sample included nurses and patients recruited from a large hospital in Northern Italy. Data collection was conducted between June and September 2021. RESULTS: Nurse and patient versions of the NPM-CI scale were developed. Two rounds of consensus reduced the items from 39 to 20; content validity index ranged between 0.78 and 1, content validity ratio was 0.94. Face validity indicated clarity and comprehensibility of the items. EFA identified three latent factors for both the scales. Internal consistency was satisfactory, with Cronbach's alphas ranging between .80 and .90. Test-retest stability was suggested, with an intraclass correlation coefficient of .96 (nurse scale) and .97 (patient scale). Predictive validity was established, with a Pearson correlation coefficient of .43 (nurse scale) and 0.55 (patient scale) between the mutuality scales and satisfaction in providing and receiving care. CONCLUSION: The results suggest that the NPM-CI scales are sufficiently valid and reliable for the clinical practice among chronic illness patients and the nurses caring for them. A more in-depth exploration of this construct in the context of nursing and patient outcomes is warranted. PATIENT OR PUBLIC CONTRIBUTION: Patients were involved in all study phases. IMPACT: Mutuality is fundamental in the relationship between nurse and patient, based on trust, equality, reciprocity, and mutual respect. The NPM-CI scale was developed and psychometric estimated through a multiphase study in both nurse and patient versions. The NPM-CI scale measures the factors of 'developing and going beyond', 'being the point of reference' and 'deciding and sharing care'. The NPM-CI scale allows us to measure mutuality in clinical practice and research. Expected outcomes and influencing factors for patients and nurses could be associated.

Risk of skin tears associated with nursing interventions: A systematic review.

BACKGROUND: Skin tears are a significant problem for patients and healthcare professionals. They can cause pain, impact quality of life, and become chronic and infected. The risk of skin tears is associated with dependence in daily life activities and with nursing interventions. OBJECTIVES: To examine which nursing interventions increase the risk of skin tears. DESIGN: Systematic review. DATA SOURCES: The MEDLINE, CINAHL, Scopus, and Cochrane Library databases were searched in March 2022. PUBLICATION YEARS: Publications included were from 2012 to 2022. RESULTS: Seventeen articles were included in the final analysis reporting nursing interventions associated with the risk of skin tears. Hygiene with cold water and soap, not applying leave-on products to moisten/protect dehydrated skin, and wearing short sleeves were found to be associated with skin tears. Transferring patients into and out of bed in a rough manner and wearing jewelry or long nails can increase the risk of skin tears. Removal of adhesive dressings or bandages can also cause skin tears. CONCLUSION: Nursing staff need to know which interventions put their patients at risk of skin tears and which interventions are recommended to prevent skin tears. Nursing care can affect the health of the patient's skin.

The process of learning and professional development according to nursing students' experience during Covid-19: A constructivist grounded theory study.

AIM: This study explored the experiences of nursing students with respect to learning processes and professional development during internships with COVID-19 patients to build a novel theoretical model. BACKGROUND: The COVID-19 outbreak had a profound impact on the worldwide learning system and it interrupted the internship experiences of nursing students. After the second wave of COVID-19, to balance academic activities with COVID-19 containment, some Italian universities allowed nursing students' internships in COVID-19 units. This new experience may have influenced nursing students' learning processes and professional development, but this is yet to be investigated. DESIGN: A qualitative study using a constructivist grounded theory (CGT) approach. METHODS: Nursing students were recruited from two hospitals in northern Italy between January and April 2021. Data are gathered from interviews and a simultaneous comparative analysis were conducted to identify categories and codes, according to Charmaz's (2006) theory. RESULTS: The sample consisted of 28 students. The results suggested the core category, that is the 'Students' sense of belonging to the nursing profession' and four main categories: (1) From knowledge to know-how, (2) A new relationship modality, (3) Sharing and socialisation and (4) Responsibilization. Finally, a premise and a corollary, respectively (5) Motivation and the (6) Circularity of the process, were identified. CONCLUSION: Our study proposed a new theory of nursing students' learning processes in clinical contexts during internships with COVID-19 patients. Despite significant difficulties, the nursing students developed a unique learning process characterised by motivation. Therefore, our study provided insight into the learning process during a pandemic and investigated the support needed for nursing students to continue their internships.

Psychometric Testing of the Self-Care of Coronary Heart Disease Inventory Version 3.0.

BACKGROUND: In this updated Self-Care of Coronary Heart Disease Inventory (SC-CHDI) v3.0, items were added to better reflect the theory of self-care of chronic illness and revised based on recent research. The expanded SC-CHDI now reflects the theoretical concepts of self-care maintenance, monitoring, and management. OBJECTIVE: The aim of this study was to evaluate the psychometric properties of the SC-CHDI v3.0. METHODS: In a sample of adults with coronary heart disease, we tested the SC-CHDI v3.0 validity with confirmatory factor analysis. Reliability was calculated using Cronbach α, factor score determinacy coefficient, and global reliability index for multidimensional scales, with values > 0.70 considered adequate. RESULTS: The sample (n = 205) was predominantly male (79%) with a mean age of 65.3 ± 11.1 years. The self-care maintenance scale encompassed 2 distinct behaviors, namely, "illness related behaviors" and "health promoting behaviors," which reflect consulting and autonomous dimensions, respectively. The goodness-of-fit indices were adequate: χ2(25, N = 205) =31.86, P = .16, comparative fit index = 0.97, Tucker-Lewis Index = 0.95, root mean square error of approximation = 0.04 (90% confidence interval, 0.00-0.07), P = .705, and standardized root mean square residual = 0.045. Analysis of the new self-care monitoring scale yielded a single factor; goodness-of-fit indices were excellent: χ2(12, N = 205) =11.56, P = .48, comparative fit index = 1.00, Tucker-Lewis Index = 1.00, root mean square error of approximation < 0.001 (90% confidence interval, 0.000-0.07), P = .86, and standardized root mean square residual = 0.02. The self-care management scale had 2 dimensions of autonomous and consulting behavior with strong goodness-of-fit indices: χ2(7, N = 205) =6.57, P = .47, comparative fit index = 1.00, Tucker-Lewis Index = 1.00, root mean square error of approximation ≤ 0.001 (90% confidence interval, 0.00-0.08), P = .76, and standardized root mean square residual = 0.02. Reliability estimates were ≥0.80 for all scales. CONCLUSIONS: Our testing suggests that the SC-CHDI v3.0 is a sound measure of the essential elements of self-care for adults with coronary heart disease.

Nurse's bedside screening of dysphagia: an umbrella review.

INTRODUCTION: Dysphagia often results in serious, poor health outcomes. Nurses have an important role in assessing dysphagia. Therefore, they need reliable and effective screening tools to detect dysphagia. The purpose of this umbrella review is to locate the most valid, reliable, and usable bedside screening tools that allow nurses to identify dysphagia in institutionalized patients. METHODS: Umbrella Review as suggested by the Joanna Briggs Institute. Inclusion criteria were: systematic reviews of randomized controlled trials or cross-sectional studies. We excluded: pediatric and psychiatric patients. We searched on PubMed, CINAHL, Scopus, Cochrane Library, the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, and the Joanna Briggs Institute Evidence-Based Practice Database. RESULTS: Six reviews were included. Four tools were reported in all the reviews: 3 oz swallowing water test, Mann Assessment of Swallowing Ability, Toronto Bedside Swallowing Screening Test, Gugging Swallowing Screen. They have shown fair to good sensitivity and specificity. The reviews analysed did not allow for a comparative analysis between instruments, which may be hindering the selection of the optimal instrument for clinical practice. CONCLUSIONS: Almost all reviews have considered stroke patients. The next steps will be to determine if there is a tool applicable in multiple settings with different patients and if this intervention is cost-effective.

The characteristics of self-care in children with spinal muscular atrophy: an integrative review.

INTRODUCTION: Spinal muscular atrophy (SMA) is one of the most common genetic causes of death in children. Recently, European Commission (EU) has approved a new gene therapy based on onasemnogene abeparvovec (Zolgensma) for the treatment of patients with SMA. It is essential that children suffering from SMA also apply self-care methods to maintain their health, monitor their weight and food intake, and use appropriate remedies. Indeed, self-care is a crucial element in the health care system because it is able to improve survival and prevent hospitalizations. The purpose of this review is to systematically explore the characteristics of self- care in children with SMA and the relationship with their parents and the collaboration of health- care professionals. EVIDENCE ACQUISITION: An integrative review of the literature has been conducted. The electronic databases CINAHL, Embase, PubMed, and SCOPUS were searched. EVIDENCE SYNTHESIS: Thirteen articles met the inclusion criteria and were reviewed using Whittemore and Knalf's integrative review methodology. The analysis of the 13 articles selected for the review show that previous literature has focused on six prevalent themes: problem solving and care behavior, decision making, optimizing living with an illness, high quality, child-focused homecare, healthcare professionals, and monitoring behaviors. CONCLUSIONS: This paper highlights how self-management behaviors depend on four basic aspects: the person (individual, cognitive, and social perceptions), the patient's family (level of knowledge of the pathology, involvement in the management and quality of relationship with the patient), the community (relationships with external social contexts, such as school and other organizations), and the healthcare system (availability of resources and the degree of evolution of healthcare).

Mutuality in nursing: A conceptual framework on the relationship between patient and nurse.

AIMS: To describe and develop a conceptual framework for the process of mutuality between nurse and patient. DESIGN: This was a qualitative study with a grounded theory (GT) design following the constructivist approach of Charmaz (SAGE handbook of research, 2014). METHODS: A sample of 33 patients with one or more chronic diseases and 35 nurses were interviewed between July and October 2020. Comparative and simultaneous data analyses were conducted. Theoretical sampling and saturation of categories were used to define the sample size. RESULTS: A conceptual framework for mutuality between nurse (mean age 42 SD ±7 years, 89% female) and patient (mean age 63 SD ±8 years, 42% female) was developed, including the mutuality process, potential influencing factors for both nurses and patients, and outcomes. The mutuality process was characterised by three dimensions: developing and going beyond, being a reference, and deciding and sharing care. Influencing factors for nurses were personal characteristics and professional organisation, while for patients these were age and past experiences. Nurse outcomes were satisfaction and quality of life; patient outcomes were improved self-care and reduction of hospitalisation and emergency admissions. CONCLUSION: This study described a new conceptual framework for mutuality between nurse and patient, which could improve our understanding of the relationship between nurses and patients, thus enhancing both nurse and patient outcomes.

Mutuality in Motor Neuron Disease: A Mixed-Method Study.

ABSTRACT: BACKGROUND: Mutuality, a positive relationship between caregiver and care receiver that affects patient's health and caregiver's burden, stress, and well-being, has never been investigated in motor neuron disease. METHOD: We conducted a mixed-method study with convergent parallel design. Quantitative data were collected with the Mutuality Scale, and qualitative data were collected using deep interviews. The sample was composed of 30 people with motor neuron diseases and 24 family caregivers. RESULTS: Deductive, qualitative content analysis of the interviews confirmed the presence of mutuality and its 4 dimensions. The average score of patients' Mutuality Scale was 3.07 (SD, 0.79; range, 1.3-4), and that of the caregivers was 3.16 (SD, 0.53; range, 2.2-3.9). The dimensions "love" and "shared values" had the highest scores, whereas the dimension "shared pleasurable activities" had the lowest score. Patients' and caregivers' answers correlated. CONCLUSION: Mutuality concept and its 4 dimensions had content validity in motor neuron disease people. Nurses should consider the level of mutuality and adopt strategies to increase and preserve it.

[The use of International Classification for Nursing Practice (ICNP) in pediatric and neonatal settings: literature review]. / L'utilizzo della Classificazione Internazionale per la Pratica Infermieristica (ICNP) in ambito pediatrico e neonatale: revisione della letteratura.

INTRODUCTION: Literature reports that the use of Standardized Nursing Terminology contributes to a better implementation of nursing care and patients' safety and to do research. ICNP is an international and combinatorial standard terminology proposal by ICN, adaptable to different settings, among which paediatric and neonatal. METHODS: A literature review on different databases (Medline/Pubmed, CINAHL, Embase, Web of Science and Scopus) was conducted to investigate the use of ICNP in professional practice in paediatric and neonatal settings. RESULTS: 44 papers were included in the review; 33 of which focused on the paediatric setting while 11 on the neonatal setting. It is evident ICNP is usable in both settings, permitting to describe nursing care to different age groups, in-hospital, out-of-hospital and in specific clinical situations. DISCUSSION: ICNP is up to the task of describing nursing care, implementing nursing care plans, analysing types of nursing care for management aims, studying concepts or specific pediatric or neonatal situations. ICNP is adaptable to different nursing frameworks and models. Few studies analyses ICNP implementation or effectiveness in clinical settings. Additional research is needed to verify ICNP effectiveness in paediatric and neonatal settings and to implement contextual catalogues.

Going inside the relationship between caregiver and care-receiver with Amyotrophic Lateral Sclerosis in Italy, a Grounded Theory study.

People with amyotrophic lateral sclerosis become dependent on caregivers for daily activities and to perform self-care activities at home. The family caregiver has an important role in the care. The patient decides and controls care but depends on the caregiver to implement self-care behaviours. The quality of caregiver-patient relationships could influence clinical outcomes, as it occurs in other illnesses, so the aim of this study was to investigate the relationship between the Amyotrophic Lateral Sclerosis patients and their family caregiver and how it impacts care, and patient and caregiver outcomes. We interviewed 22 patients/caregivers in a Neuromuscular Clinical Center in the South of Europe, between July and October 2018. A Grounded Theory approach was used, comprising line by line 'initial coding', memos writing, 'focused coding', advanced memos and categories definition. From the interviews three main categories emerged: 'reciprocity', 'loving to care' and 'changing to care' and four secondary categories: 'having support', 'sharing suffering', 'protecting each other' and 'thinking positive'. A stable and calm relationship between patient and caregiver, characterised by reciprocity, mutual help and affection affected patient self-care provided at home and the caregiver burden. The concept of mutuality seems to describe this relationship, despite the patient's dependence on the caregiver. The relationship with health professionals and educational interventions could influence the quality of the relationship. Further studies are needed to describe the quality of the relationship in this dyad, to investigate the presence of mutuality and how it affects patient and caregiver outcomes.

[Effectiveness and safety of non-pharmacological interventions for the prevention of venous thromboembolism in stroke patients: an overview of systematic reviews]. / Efficacia e sicurezza degli interventi non farmacologici per la prevenzione del tromboembolismo venoso nei pazienti con stroke: una overview di revisioni sistematiche.

INTRODUCTION: Half of the deaths recorded in non-surgical patients attributable to venous thromboembolism (VTE) affect those with stroke. The uncertain benefit of anticoagulant therapy has increased interest in non-pharmacological intervention to prevent VTE. AIM: To evaluate the efficacy and safety of non-pharmacological interventions to prevent VTE in stroke patients. METHODS: Overview of systematic reviews with retrieval of documents in compliance with the PICOS Framework and through a research strategy implemented on 4 April 2019 in six biomedical databases and in the PROSPERO registry. The tools used to assess the methodological quality and the risk of bias were the AMSTAR checklist and the ROBIS tool, respectively. The results have been synthesized with narrative modality. RESULTS: Seven systematic reviews of different methodological quality and risk of bias met the inclusion criteria. The non-pharmacological interventions of prophylaxis used are graduated compression stockings (GCS) and intermittent pneumatic compression devices (IPCD). The first has no effect on VTE and has important side effects, the second is promising in reducing mortality from all causes and decreases the incidence of deep vein thrombosis. DISCUSSION: The use of IPCD, despite the efficacy observed, should be reserved, after a risk assessment of VTE and a subgroup analysis, for patients who can derive the maximum benefit from the intervention. CONCLUSIONS: In stroke patients the use of GCS to prevent VTE is not recommended because it is not superior to standard care and can cause damage. IPCD as a intervention of prophylaxis appears to be effective but further confirmation is needed from future studies.

Stress Reduction Techniques for Health Care Providers Dealing With Severe Coronavirus Infections (SARS, MERS, and COVID-19): A Rapid Review.

OBJECTIVE: A rapid review was conducted to identify the most effective stress reduction techniques for health care providers dealing with patients infected with severe coronavirus (SARS, MERS, and COVID-19). METHODS: PubMed, PsychInfo, Embase, and CINAHL databases were searched to identify relevant studies. Searches were restricted by date (2000 until present). All empirical quantitative and qualitative studies in which relaxation techniques of various types implemented on health care providers caring for patients during severe coronavirus pandemics and articles that consider the implementation of mental health care services considered to be pertinent, such as commentaries, were included. RESULTS: Fourteen studies met the selection criteria, most of which were recommendations. Only one study described a digital intervention, and user satisfaction was measured. In the recommendations, both organizational and individual self-care interventions were suggested. CONCLUSIONS: Further research is necessary to establish tailor-made effective stress reduction interventions for this population, during these challenging and particular times.

Nurses' knowledge about malnutrition in older people: A multicenter cross-sectional study.

OBJECTIVES: Malnutrition, among older people, has a prevalence of 22% in hospitals, 17.5% in nursing homes, and 8.7% in home care. Adequate knowledge among health care staff is necessary for risk identification and adequate intervention. The aim of this study was to translate and validate the Knowledge of Malnutrition-Geriatric (KoM-G) questionnaire in Italian and to investigate the malnutrition knowledge of registered nurses working in hospitals, nursing homes, home care, and palliative care in Italy. METHOD: The KoM-G questionnaire was translated and validated in terms of content validity, internal consistency, and interrater reliability. Subsequently, a multicenter cross-sectional study in different settings was performed. RESULTS: The KoM-G ITA questionnaire showed excellent content validity, internal consistency, and good intrarater reliability. There were 511 nurses who completed the questionnaire. On average, 61.9% of the respondents answered the questions correctly. CONCLUSION: The level of knowledge about malnutrition in nurses is adequate. Training courses and management protocols should be implemented to improve nursing care for malnourished older people.