Nurses' compliance to standard precautions prior to and during COVID-19.

AIMS: To measure nurses' compliance with standard precautions during the COVID-19 pandemic, compare findings with previous assessments and describe the barriers affecting nurses' compliance. BACKGROUND: Healthcare providers' compliance with standard precautions is still limited worldwide. Implementation of infection control policies in hospitals is needed internationally, especially during a pandemic. Surprisingly, studies exploring nurses' compliance with standard precautions are lacking during COVID-19. METHODS: A multicenter cross-sectional study was adopted in two Italian hospitals. Nurses' compliance with standard precautions was measured through The Compliance with Standard Precautions Scale (Italian version). An open-ended question explored the barriers to nurses' compliance with standard precautions. Reporting, followed the STROBE guidelines. RESULTS: A total of 201 nurses were enrolled in 2020. Nurses' compliance with standard precautions was suboptimal. A statistically significant improvement in the compliance rate with standard precautions was observed between pre- and during COVID-19 assessments. High compliance was found in the appropriate use of surgical masks, gloves and sharps disposal. Nurses perceived personal, structural and organizational barriers to standard precautions adherence. CONCLUSION: Nurses' compliance with standard precautions was not 100%, and different factors impeded nurses to work safely. Our findings provide institutional leaders and educators with the basis for implementing policies to optimize nurse safety, well-being and patient care. IMPLICATIONS FOR NURSING AND HEALTH POLICIES: Nurses have the right to work safely, and when the shortage of personal protective equipment and nurses during an emergency threatens healthcare quality worldwide, policymakers are challenged to act by establishing an effective allocation of resources for consistent compliance with standard precautions. Moreover, nurses should actively engage in the implementation of infection control policies to improve safe behaviours among citizens and students accessing hospitals.

The differences between learned and practiced competences among nurses: An international pilot study.

AIM: The primary aim was to describe differences, if any, between learned and practiced competences among a convenience sample of Italian and Slovenian nursing staff; the secondary aim was to validate an instrument capable of measuring internationally such competences. BACKGROUND: The distance between competences learned and those practiced as a source of under- or over-education has not been investigated to date at the international level. DESIGN: A explorative observational investigation was performed in 2019 by involving 426 Italian and Slovenian members of the nursing staff working in medical and surgical departments. The study was conducted according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. METHODS: Members of the nursing staff (health care assistants, general nurses, specialist nurses and advanced nurses) were invited to complete the Nursing Competence Instrument based on the European Federation of Nursing Association's four categories of the nursing care continuum, from health care assistants to advanced practice nurses. RESULTS: The construct validity of the Nursing Competence Instrument indicated the presence of four identifiable dimensions (internal consistency ranging from 0.82 to 0.93). On average, the scores of the competences practiced were interestingly slightly higher than those learned among general care nurses. In contrast, health care assistants, specialist nurses and advanced practice nurses, reported to have learned importantly slightly lower as that practiced. CONCLUSIONS: At the overall levels, nurses tend to apply what they had been thought; additionally, all profiles seem to rate at low ranges both the competences practiced and those learned, suggesting the need to maximise nursing competences, both in the classroom and in the daily practice. Mapping the degree of competences acquired in education, as applied in the clinical practice, might assist clinical nurses, nurse educators and health care managers to identify areas at need of improvement. Moreover, mapping differences (if any) across countries might have research, managerial and educational implications.

Perceived Barriers and Enablers of Nursing Research in the Italian Context: Findings from a Systematic Review.

Introduction: The research capacity of nurses has been reported to be still constrained in several countries, and not fully implemented in its potentiality due to a large number of factors. Despite its relevance both for clinical and public health purposes, no summary has been compiled to date regarding factors influencing the research capacity in the Italian context. Therefore, the primary aim of this review was to identify the barriers and enablers of conducting research as perceived by Italian nurses. Methods: We conducted a systematic review. The following databases have been searched: ILISI ® (Indice della Letteratura Italiana di Scienze Infermieristiche) MEDLINE-via PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Ovid, Open Grey, Google Scopus, and Web of Science. Eight studies met the inclusion criteria. Results: The studies were mainly descriptive, with two quasi-experimental. A total of seven barriers and four facilitators of conducting research among Italian nurses were identified. The constraints were poor English knowledge, technology and library availability and accessibility, understaffing and lack of time, nursing culture characteristics, lack of nursing leadership support, scarce funding availability, and the bureaucratic ethical committee process. The facilitators were nursing journal reading, expert research team support, university and hospital partnerships, and international cooperation. Conclusions: Given the small number and the high heterogeneity of the emerged studies, this systematic review provides an initial framework for the constraints that prevent, and the strategies that promote, Italian nurses' participation/conducting of research projects that could inform policies in this field.

Chief Nurse Executives involuntary turnover in times of health care reforms: Findings from an interpretative phenomenology study.

In recent years, due to several health care system reforms in different countries, an increased involuntary turnover rate of Chief Nurse Executives has been reported around the World. However, no data on their perceived experience of their dismissal have been documented up to now in the European context. Describing the experience of involuntarily dismissed Chief Nurse Executives was the main aim of this interpretative phenomenological study. Data were collected through face-to-face audiotaped interviews performed by involving a purposeful sample of 13 Chief Nurse Executives; data analysis was performed by using the QSR NVIVO 11 software. The Chief Nurse Executives' experience of Being fired is characterized by three main themes: (1) "Health Care Institutions are places influenced by political turbulences"; (2) "My competence and presence in the arena is despised by a range of strategies"; and (3) "Transiting from darkness to light". According to their experience, the reason for dismissal was due to changes in the political climate and the introduction of a new chief executive officer; moreover, Being fired caused a deep pain similar to that experienced during bereavement. In some socio-political contexts, the political climate can influence the role of a Chief Nurse Executive: political membership, whether implicit or explicit, is considered of great value. In other contexts, the Chief Nurse Executives' value is based on professional competences and achieved outcomes. At times of changes in the political climate, the peculiarities of the specific socio-political context should be evaluated as to whether one should anticipate his/her resignation or not.

Management of central venous catheters in pediatric onco-hematology using 0.9% sodium chloride and positive-pressure-valve needleless connector.

PURPOSE: To describe, in a sample of pediatric onco-hematological patients, the rate of occlusions in unused central venous catheters (CVC) flushed once a week with a 0.9% sodium chloride solution through a positive-pressure-valve needleless connector. METHOD: Retrospective cohort study. Subjects aged 0-17 years were identified through a manual search in medical and nursing records and were observed for two years or until the occurrence of one of the following events: start or resume of continuous infusion; CVC removal; death. The primary study outcome was the frequency of CVC occlusion (partial or complete). RESULTS: Fifty-one patients were identified (median age 6 years). The median duration of follow-up was 169 days (IQR 111-305). During the follow up period, 14 patients (27%) had one CVC occlusion, in 2 cases (4%) the occlusion was complete, in 12 (23%) partial. All the occlusions were solved without the need for catheter removal. The lumen diameter ≤ 4.2 vs > 4.2 French showed a statistically significant association with occlusion at multivariate analysis (OR 4.0; 95% CI 1.1-14.7). CONCLUSIONS: Our findings are reassuring with respect to the management of the CVC using the adopted protocol. The study provides useful information for patient care, by verifying the performance of the adopted CVC management protocol and by identifying critical areas for nursing care.

[The firing of nurse managers: literature and experiences]. / La rimozione forzata dei dirigenti infermieri: tra letterature ed esperienze.

INTRODUCTION: The firing of a nursing manager was first documented in the 80' in US. AIM: To describe the involuntary turnover according to the literature and a case-story. METHODS: Literature review and interview to a key informant. RESULTS: The involuntary turnover is preceded by a hard time with indicators of a difficult relationships with the management; it initiates a profound crisis comparable to the loss of a significant person and feelings of failure prevail, self esteem and self confidence decrease. If the manager is fired, external help may be necessary - included psychological counseling - to overcome the traumatic experience. Before effectively facing the future, some time may be needed to deal with the loss effectively. CONCLUSIONS: The firing of a nursing manager is not an exception in Italy but the literature and discussion on the problem is lacking.