The Function of Bed Management in Pandemic Times-A Case Study of Reaction Time and Bed Reconversion.

The last decade was characterized by the reduction in hospital beds throughout Europe. When facing the COVID pandemic, this has been an issue of major importance as hospitals were seriously overloaded with an unexpected growth in demand. The dichotomy formed by the scarcity of beds and the need for acute care was handled by the Bed Management (BM) function. This case study explores how BM was able to help the solidness of the healthcare system, managing hospital beds at best and recruiting others in different settings as intermediate care in a large Local Health Authority (LHA) in central Italy. Administrative data show how the provision of appropriate care was achieved by recruiting approximately 500 beds belonging to private healthcare facilities affiliated with the regional healthcare system and exercising the best BM function. The ability of the system to absorb the extra demand caused by COVID was made possible by using intermediate care beds, which were allowed to stretch the logistic boundaries of the hospitals, and by the promptness of Bed Management in converting beds into COVID beds and reconverting them, and by the timely management of internal patient logistics, thus creating space according to the healthcare demands.

Are Italian nurses ready for patient blood management program? A national social media survey.

BACKGROUND AND AIM: Blood transfusion is one of the five most overused procedures in healthcare. Patient Blood Management (PBM) is a multimodal and multidisciplinary strategy that aims to properly manage the patient blood. In 2015 the Italian National Blood Centre explicitly mentioned the need for the identification of dedicated nursing staff to implement this approach. The purpose of this study is to investigate if Italian nurses are prepared and willing to implement the PBM. METHODS: We conducted a social media survey that registered 235 respondents from the whole Italian territory over a one-month period (15th of May-15th of June 2020). The 23 open and closed-ended questions were intended to investigate the views, the inclinations, and intentions of healthcare professionals towards PBM. RESULTS: PBM can still be considered as a niche topic. Therefore, most respondents declared themselves willing to know more about it, to acquire new skills and grow professionally, to determine benefits for the hospital, to improve the quality of nursing care and act evidence based, and to enhance the nursing role in the multidisciplinary team.   Conclusions: PBM programs are conducted and implemented effectively worldwide, and Italian nurses recognize its importance and are willing to implement it and be a part of it for what then bedside care, the educational, and the managerial role are concerned.    (www.actabiomedica.it)     Key words: Patient blood management, blood transfusion, bloodless nurse, bloodless coordinator, nursing education, nursing management.

Physiotherapy as part of primary health care, Italy.

Objective: To describe the Family and Community Physiotherapist model, which aims to incorporate rehabilitation services within primary health care in Tuscany, Italy. Methods: The Department of Health Professions of the Central Tuscany local health authority designed the model during 2020-2021. We describe the four phases of the organizational case study implementation of the model, namely: (i) analysis of the political and organizational framework, as well as determination of changing health-care needs; (ii) model co-design and training of multiprofessional health-care workers (local general practitioners, physiatrists and geriatricians); (iii) delivery and surveillance of rehabilitation services; and (iv) evaluation. Findings: During the initial roll-out of the project in April-December 2021, general practitioners referred 165 patients with a mean age of 83.7 years (standard deviation: 11.1) to the Family and Community Physiotherapist. Interventions were mainly activated for patients with comorbidities (64/165; 38.8%), followed by those with long-term immobilization issues (36/165; 21.8%). The most commonly provided intervention was counselling, contributing to the achievement of objectives for 127 patients (77.0%). A full rehabilitation path was proposed for only 10 patients (6.1%). No additional costs were incurred by the health authority during the implementation of the model. Conclusion: Our model facilitated the provision of rehabilitative care in the community, preventing the exacerbation of chronic conditions and meeting the population health needs in non-hospital environments. The model overcame the typical lack of integration within health-care services with flexibility, promoting care proximity solutions to cope with health challenges such as an ageing population and the coronavirus disease.

Integrating Key Nursing Measures into a Comprehensive Healthcare Performance Management System: A Tuscan Experience.

This paper addresses the evaluation of nursing quality and safety beyond nursing tasks in specific healthcare settings and sets it in a context that conveys the sense of complexity and multifaceted nature of the contribution that nursing makes to the whole system. The paper describes research conducted in Tuscany during 2019 involving regional managers and heads of nursing departments. This research has led to the development of an integrated evaluation framework through focus groups and consensus process with the latter, which includes Performance Organizational climate data, Patient-Reported Experience Measures (PREMs), and Patient-Reported Outcome Measures (PROMs). This integrated framework aims at both making sense of extant measures as key performance indicators shared among different professionals while recognizing the important role of nursing care by adding specific measures and can be seen as a tool that boosts the sense of "teamness" in healthcare.

Nurses and the acceptance of innovations in technology-intensive contexts: the need for tailored management strategies.

BACKGROUND: Several technological innovations have been introduced in healthcare over the years, and their implementation proved crucial in addressing challenges of modern health. Healthcare workers have frequently been called upon to become familiar with technological innovations that pervade every aspect of their profession, changing their working schedule, habits, and daily actions. PURPOSE: An in-depth analysis of the paths towards the acceptance and use of technology may facilitate the crafting and adoption of specific personnel policies taking into consideration definite levers, which appear to be different in relation to the age of nurses. APPROACH: The strength of this study is the application of UTAUT model to analyse the acceptance of innovations by nurses in technology-intensive healthcare contexts. Multidimensional Item Response Theory is applied to identify the main dimensions characterizing the UTAUT model. Paths are tested through two stage regression models and validated using a SEM covariance analysis. RESULTS: The age is a moderator for the social influence: social influence, or peer opinion, matters more for young nurse. CONCLUSION: The use of MIRT to identify the most important items for each construct of UTAUT model and an in-depth path analysis helps to identify which factors should be considered a leverage to foster nurses' acceptance and intention to use new technologies (o technology-intensive devices). PRACTICAL IMPLICATIONS: Young nurses may benefit from the structuring of shifts with the most passionate colleagues (thus exploiting the social influence), the participation in ad hoc training courses (thus exploiting the facilitating conditions), while other nurses could benefit from policies that rely on the stressing of the perception of their expectations or the downsizing of their expectancy of the effort in using new technologies.

The relationship between healthcare service provision models and patient experience.

PURPOSE: User experience is key for measuring and improving the quality of services, especially in high personal and relation-intensive sectors, such as healthcare. However, evidence on whether and how the organizational model of healthcare service delivery can affect the patient experience is at an early stage. This study investigates the relationship between healthcare service provision models and patient experience by focusing on the nursing care delivery. DESIGN/METHODOLOGY/APPROACH: 65 nurses' coordinators were involved to map the nursing models adopted in the healthcare organizations of in an Italian region, Tuscany. This dataset was merged with patient experience measures reported by 9,393 individuals discharged by the same organizations and collected through a Patient-Reported Experience Measures Observatory. The authors run a series of logistic regression models to test the relationships among variables. FINDINGS: Patients appreciate those characteristics of care delivery related to a specific professional nurse. Having someone who is in charge of the patient, both the reference nurse and the supervisor, makes a real difference. Purely organizational features, for instance those referring to the team working, do not significantly predict an excellent experience with healthcare services. RESEARCH LIMITATIONS/IMPLICATIONS: Different features referring to different nursing models make the difference in producing an excellent user experience with the service. PRACTICAL IMPLICATIONS: These findings can support managers and practitioners in taking decisions on the service delivery models to adopt. Instead of applying monolithic pure models, mixing features of different models into a hybrid one seems more effective in meeting users' expectations. ORIGINALITY/VALUE: This is one of the first studies on the relationship between provision models of high-contact and relational-intensive services (the healthcare services) and users' experience. This research contributes to the literature on healthcare service management suggesting to acknowledge the importance of hybridization of features from different, purely theoretical service delivery models, in order to fit with providers' practice and users' expectations. HIGHLIGHTS: This is one of the first studies on the relationship between provision models of nursing care and patient experience.Healthcare services' users appreciate service delivery characteristics identified with "be cared by," or in other words with having a reference nurse.Nursing models' features that relate to the organizations and that providers tend to judge as professionalizing and evolutive, such as team working, appear not key in relation to patient experience.Pure models of service delivery are theoretically useful, but hybrid models can better meet users' expectations.

Influences over Italian nurses' job satisfaction and willingness to recommend their workplace.

BACKGROUND: Nurses' perception towards job satisfaction and willingness to recommend their workplace are relevant to a number of areas including the quality of nursing care delivery. Hence, an increasing number of scholars seek to understand the factors that influence these two concepts. Yet, inclusiveness and openness to innovation are under-investigated. PURPOSE: The paper focuses on the relative importance that factors like propensity towards innovation, working conditions and inclusion have on nurses' job satisfaction and their willingness to recommend their workplace. METHODS: A large sample of nurses was extracted from the organizational climate survey carried out in all healthcare authorities of nine Italian Regions through the years 2016-2018. Descriptive and multilevel regressions were carried out to investigate the factors that influence nurses' job satisfaction and their willingness to recommend the hospital in which they work in, analysing both overall and in specific age classes. RESULTS: When recommending a workplace, nurses tend to recommend units showing higher propensity to innovate (OR 2.83), while the most important factor related to job satisfaction is the encouragement after a failure (OR 2.23). Inclusiveness is a key factor for both job satisfaction and willingness to recommend, whilst innovation prone organizations appear to be the most attractive for nurses. The levers mix is slightly different among the age classes. Findings identify the levers to be used in order to attract nurse workforce and increase nurses' job satisfaction. These levers are partially different for young and senior nurses.