Cardiovascular nurses and organizational well-being: a systematic review.

AIMS: This systematic review assesses the organizational well-being of nurses working in cardiovascular settings and identifies environmental variables influencing it. METHODS AND RESULTS: The Joanna Briggs Institute's methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines have been followed. The search was conducted, from the database inception up to and including 1 December 2022, on Medline (via PubMed), Cumulative Index of Nursing and Allied Health, Cochrane Library, and Scopus. Critical appraisal and data extraction were conducted using standardized tools. Six articles of high quality were included. These mostly concerned cross-sectional studies, conducted in heterogeneous contexts, which highlight the peculiarity of the cardiovascular nursing setting. Three thematic areas were identified: stressors of cardiovascular settings; outcomes of stressors on nurses; and coping strategies used by cardiovascular nurses to deal with such stress factors. Identified stress factors included a lack of autonomy, conflicts between professional and family roles, high workloads, and stressful relationships with patients and caregivers. These organizational variables could generate nurses' burnout, depression, irritability, and/or sleep disorders. In trying to cope with such stressors, cardiovascular nurses used different strategies for compensating, avoiding, escaping, or ignoring the problem, or, in other cases, became somewhat aggressive. CONCLUSION: Considering the limited data, cardiovascular nursing coping strategies should be further investigated, so that effective pathways for preventing or limiting stress factors can be identified and applied by the organizations. Monitoring and intervening on stress factors in this care setting could improve cardiovascular nurses' organizational well-being and accordingly patients' outcomes. REGISTRATION: PROSPERO: CRD42022355669.

Measuring Nurses' Organizational Well-Being: A Systematic Review of Available Instruments.

This systematic review aimed to identify and compare instruments measuring nurses' organizational well-being, summarise the dimensions measured by these instruments, the statistical analysis performed for validity evidence and identify an instrument that comprehensively investigates nurses' organizational well-being. The JBI Manual for Evidence Synthesis and the PRISMA checklist were used as guidelines. The search was conducted on Medline, CINAHL, Cochrane Library and Scopus. Critical appraisal and data extraction were drawn on the COSMIN checklist. Dimensions were conceptually synthesized by the measurement concepts' similarity. Twenty-two articles were retrieved and they included 21 instruments that measured nurses' organizational well-being. The instruments vary by dimension number (range 2-19), items (range 12-118) and concept elicitation. A plurality of methodologies has been used in instrument development and assessments of evidence for validity. Only four instruments reported a concurrent criterion validity or a measurement comparison with an already tested-for-validity instrument. Similar dimensions were leadership and support, relationships and communication, work-family balance, work demands, violence, control and autonomy, satisfaction and motivation, work environment and resources, careers, and organizational policy. This review underlines the core areas of the instruments that measure nursing organizational well-being. It allows administrators and researchers to choose the appropriate instruments for monitoring this multidimensional concept.

Work-related stress, job satisfaction, and quality of work life among cardiovascular nurses in Italy: Structural equation modeling.

AIM: To investigate the simultaneous effects of work-related stress and job satisfaction on cardiovascular nurses' quality of work life. BACKGROUND: Prior research has investigated nurses' work-related stress, job satisfaction, and quality of work life as separate aspects and not in specific nursing settings, such as cardiovascular wards. Cardiovascular care settings can be particularly stressful for nurses, who are often faced with distress, depression and patients and caregivers' physical and psychological exhaustion. METHODS: A multicenter cross-sectional study was conducted among 1126 cardiovascular nurses from 10 hospitals in Italy. Work-related stress, job satisfaction, and quality of work life were measured using valid and reliable questionnaires. Structural equation modeling was performed. RESULTS: Nurses working in critical cardiac care units experienced more stress than their colleagues working in other cardiac units. Nurses working in cardiac outpatient clinics reported lower quality of work life than those working in other cardiac settings. There was a negative relationship between work-related stress and nurses' quality of work life, which was partially mediated by job satisfaction, indicating that stress generated by the work environment negatively affect nurses' quality of work life by reducing their job satisfaction. CONCLUSION: Cardiovascular nurses' quality of work life is negatively affected by work-related stress. The work-related stress is mediated through job satisfaction. Nurse managers should maximize nurses' job satisfaction by providing comfort at work, supporting professional development opportunities, sharing organizational objectives, and actively listening and addressing nurses' concerns. When cardiovascular nurses' quality of work life is elevated, patients' care quality and outcomes are improved.

Specialized Nurse-led Care of Chronic Wounds During Hospitalization and After Discharge: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effectiveness of specialized nurse-led care of patients with chronic wounds, provided both during hospitalization and postdischarge, on wound healing and readmission rates. METHODS: An unblinded randomized controlled trial was conducted. Participants were patients with chronic wounds, randomly assigned to either the experimental group (cared for by wound care nurses both during hospitalization and postdischarge) or to the control group (cared for according to standard practice). Wound healing was identified as the primary outcome. RESULTS: Overall, 1,570 patients were randomized, 1,298 of whom were included in the per-protocol analysis (707 in the experimental group and 591 in the control group). Nurse-led wound care quadrupled the probability of healing and reduced the number of treatment weeks and hospital readmissions. CONCLUSIONS: Chronic wound care that was entrusted to specialized nurses improved outcomes in terms of wound healing, repair and regeneration, length of treatment, and rate of readmission, compared with standard practice. Future studies should evaluate the impact of care provided by specialized wound care nurses on patients' quality of life and healthcare costs. Nurse managers should promote the implementation of chronic wound clinical-care pathways entrusted to specialized nurses to improve patients' clinical outcomes and reduce hospital readmissions.

Effectiveness of transitional care interventions in patients with serious illness and their caregivers: a systematic review protocol.

OBJECTIVE: The objective of this review is to evaluate the effectiveness of transitional care interventions for seriously ill patients and their caregivers. INTRODUCTION: Seriously ill patients and their caregivers may have complex health and social care needs that require services from numerous providers across multiple sectors. Transitional care interventions have been designed to enhance a collaborative approach among providers to facilitate the care transition process. However, the effectiveness of transitional care interventions for seriously ill patients and their caregivers, and the effects of such interventions on their outcomes, remain unclear. INCLUSION CRITERIA: Randomized controlled trials with adult patients (≥18 years old) with serious illness and their caregivers involved in transitional care programs will be considered for inclusion. The patients' outcomes will include mortality and/or survival, symptoms (eg, pain, nausea), and health-related quality of life. The caregivers' outcomes will include caregiver burden, preparedness, and well-being. METHODS: The JBI methodology for systematic reviews of effectiveness will be followed. The search strategy will aim to locate published and unpublished studies. Electronic databases, including PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials, will be systematically searched from 2003 to the present. Studies in English, Italian, Spanish, French, and German will be included. Critical appraisal and data extraction will be conducted using standardized tools. Quantitative data will be pooled in statistical meta-analysis or, if statistical pooling is not possible, the findings will be reported narratively. Certainty of the evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42022319848.

Towards a new conceptual model for nurses' organizational well-being: An integrative review.

AIM: The aim of this study is to summarize conceptual models of nurses' organizational well-being and identify common variables among them. BACKGROUND: To understand how the characteristics of an organizational context affect workers' well-being, numerous conceptual models have been developed. Such models have been conceptualized in various working contexts other than health care and not always considering the particularities of the profession of nursing. EVALUATION: This integrative review was conducted using the resources of PubMed, CINAHL, Scopus and the Cochrane Library, up until March 2022, and by applying a modified version of Cooper's five-stage methodology, in accordance with the PRISMA guideline. KEY ISSUES: Six reference models focused on different organizational variables and used to evaluate nurses' organizational well-being were identified: the Effort-Reward Imbalance (ERI) model; the Job Demands-Resources (JD-R) model; the Utriainen et al. model; the Demands-Resources and Individual-Effects (DRIVE) model; the Well-Being, Health-Promoting Lifestyle and Work Environment Satisfaction (WHS) model and the Nursing Worklife Model (NWM). CONCLUSION: There is no consensus in the nursing literature on an all-encompassing conceptual model of nurses' organizational well-being or on working environment characteristics to be studied or monitored for defining nurses' well-being. IMPLICATIONS FOR NURSING MANAGEMENT: Coming to a consensus on the definition of a nurses' organizational well-being model and its variables would facilitate nursing management in monitoring and intervening on nurses' work-life quality and in improving nursing performance and caring outcomes.

Nursing leadership in clinical practice, its efficacy and repercussion on nursing-sensitive outcomes: A cross-sectional multicentre protocol study.

AIM: The aim of this study to describe a research protocol for evaluating the relationship between nursing leadership, organisational well-being and nurse and patient outcomes. BACKGROUND: The head nurses' leadership style influences the organisational context. When an organisation promotes nurses' well-being, they perform better performances and are more satisfied and engaged with their job. This reduces stress levels, burnout and absenteeism and improves physical and psychological health. METHODS: A multicentre study will be conducted. A self-report questionnaire will be administered to head nurses and nurses they coordinate. Study findings will include nurse-sensitive outcomes (e.g., pressure injuries, infections and mortality). Descriptive and correlational analyses will be conducted, and a structural equation model will be tested. RESULTS: Results might verify that a correctly judged leadership style of the head nurse will enhance the organisational context experienced by nurses and improve nursing sensitive outcomes. CONCLUSION: This study will demonstrate the organisational role of middle managers and the direct repercussions on their staff and patients, understanding the relationship between organisational, process and outcomes variables. IMPLICATIONS FOR NURSING MANAGEMENT: If the results confirmed the hypothesis, health care managers would cultivate and stimulate the head nurses' leadership style, thus increasing nurses' organisational well-being and achieving better patient outcomes. No Patient or Public Contribution.

The Wounded Healer: A Phenomenological Study on Hospital Nurses Who Contracted COVID-19.

Since the pandemic began nurses were at the forefront of the crisis, assisting countless COVID-19 patients, facing unpreparedness, social and family isolation, and lack of protective equipment. Of all health professionals, nurses were those most frequently infected. Research on healthcare professionals' experience of the pandemic and how it may have influenced their life and work is sparse. No study has focused on the experiences of nurses who contracted COVID-19 and afterwards returned to caring for patients with COVID-19. The purpose of this study was therefore to explore the lived personal and professional experiences of such nurses, and to describe the impact it had on their ways of approaching patients, caring for them, and practicing their profession. A phenomenological study was conducted with 54 nurses, through 20 individual interviews and 4 focus groups. The main finding is that the nurses who contracted COVID-19 became "wounded healers": they survived and recovered, but remained "wounded" by the experience, and returned to caring for patients as "healers," with increased compassion and attention to basic needs. Through this life-changing experience they strengthened their ability to build therapeutic relationships with patients and re-discovered fundamental values of nursing. These are some of the ways in which nurses can express most profoundly the ethics of work done well.

Effect of a wound healing protocol on patients with stage III and IV pressure ulcers: a preliminary observational study.

OBJECTIVE: To evaluate the influence of a wound healing protocol for stage III and IV pressure ulcers (PUs), and to determine the predictive power of specific sociodemographic and clinical characteristics on wound healing and infection. METHOD: This longitudinal study included participants with stage III and IV PUs who were recruited from 10 acute care settings of an Italian university hospital, and who were managed with a protocol inspired by the TIMECare model. Data were collected between October 2018 and March 2019. The National Pressure Ulcer Advisory Panel Staging System was used to stage the PUs. Wound healing was assessed with the Pressure Ulcer Scale for Healing (PUSH). Nutritional status was assessed with the Mini Nutritional Assessment Index. Data collection took place at admission and every seven days thereafter-a total of six times before discharge. The outcome and predictors of wound healing were assessed with Student's paired t-tests and multiple linear regressions, respectively. RESULTS: Patients (n=126) were almost equally split between male and female, with a mean age of 78.17 years and who were all retired. Stage III and IV PUs were most prevalent at the sacrum (65.5% and 73.2%, respectively). PUSH wound healing scores improved significantly after six weeks in both stage III and IV PUs (p<0.001). Nutritional status was predictive of wound healing (R2=0.12). CONCLUSION: Our results showed that a good nutritional status and a protocol inspired by the TIMECare model were associated with wound healing improvements in stage III and IV PUs. We recommend this protocol in older patients with stage III and IV PUs.

Nurses' Quality of Life Scale: Validation and Psychometric Properties.

The Nursing Quality of Life Scale (NQOLS) is a 28-item self-report measure evaluating the four dimensions of nurses' quality of life, namely, the physical, emotional, working, and social dimensions. The purpose of this study is to assess the psychometric properties, including validity and reliability, of the NQOLS. The study enrolled 1105 nurses who provided direct assistance to patients. The NQOLS factorial structure was tested using a cross-validation approach via Exploratory Structural Equational Modeling, which confirmed the instrument's four-dimension structure. Reliability was assessed using omega coefficients, proving excellent for all factors. Cluster analysis identified five distinct groups, each composed of participants sharing a substantial similarity with respect to their profile in the NQOLS. These five identifiable clusters presented significant differences not only in the NQOLS but also in the risk of work-related stress, emotional labor, and burnout. The results show that NQOLS is a simple, reliable, lean tool for measuring nurses' overall QoL, whose various parts can additionally be used to answer specific research questions.

A mixed methods study of an organization's approach to the COVID-19 health care crisis.

BACKGROUND: Healthcare emergency can increase work-related stress and reduce nurses' job satisfaction and quality of life. Managerial decisions and proactive interventions implemented to react to the emergency ensure the best patient outcomes. PURPOSE: The purpose of this study was to verify whether a proactive organizational approach can limit nurses' work-related stress and help preserve their job satisfaction and quality of life during a health emergency. METHODS: A longitudinal mixed methods study was conducted. Data were collected before and after the transformation into a SARS-CoV-2 Hospital and the implementation of organizational interventions. Focus groups were conducted to investigate quantitative data. FINDINGS: After the implementation of interventions and as the pandemic progressed, work-related stress decreased and job satisfaction and quality of life increased. DISCUSSION: Through proactive organization, even during an emergency, nurses are prepared for working, and work-related stress due to changes is reduced. Nurses are motivated and satisfied with their organization and management, and quality of life increases.

An integrated system for Peripherally Inserted Central Catheter tip confirmation in oncology and haematology patients.

INTRODUCTION: Although there are many methods to confirm vascular device tip, chest x-ray represents the recommended procedure to verify the correct positioning of a central device, but it exposes patients to x-rays, delays treatment, and permits device length to be checked post-procedure. AIM: To evaluate the efficacy of Peripherally Inserted Central Catheter positioning through an Integrated System (ultrasound-guided and electrocardiogram confirmation). METHODS: A case-control study was conducted on a randomized sample of 165 patients, requiring Peripherally Inserted Central Catheter placement for chemotherapy treatment. The case group was composed of patients with vascular device placed through the Integrated System and the control group devices' length was anthropometrically estimated. Chest radiography was performed on both groups to verify tip location. RESULTS: No cases of primary malposition related to the Integrated System were registered. The vascular devices positioned with the Integrated System were all correctly placed and in 91.8% (n=101) the intra-procedural tip location was comparable to the one identified in the x-ray. CONCLUSION: The Integrated System represented a simple and efficient method to correctly place vascular device, allowing intra-procedural tip confirmation and avoiding primary malposition. It would eliminate the need for performing chest radiography, reduce costs and time for healthcare professionals and patients.

The role of occupational stress in the association between emotional labor and burnout in nurses: A cross-sectional study.

Aim To test a model to evaluate the influence of emotional labor on burnout and the mediating role of work-related stress reported by nurses. BACKGROUND: Nurses are particularly exposed to work-related stress caused by their relationships with their patients. Even though their emotional involvement can cause work-related stress for professionals, nurses recognize this as a fundamental part of the caring relationship, and it has been proved to be therapeutic for patients. The effects of emotional labor contribute to stress, and prolonged exposure to it contributes to burnout syndrome, with repercussions on nurses' health and quality of life, and patients' quality of care. METHODS: A multicentre correlational study was conducted on a sample of 207 nurses from different clinical areas in three hospitals in Italy. A self-report questionnaire was used to measure levels of emotional labor, burnout and work-related stress. RESULTS: High levels of emotional labor and work-related stress increase burnout syndrome in nurses. Work-related stress mediates the relationship between emotional labor and burnout. The Oncology ward is identified as the major clinical area exposing nurses to emotional labor. CONCLUSIONS: The results of this study highlight the mediating role of work-related stress in the relationship between emotional labor and burnout, offering a new field for intervention to interrupt this process.

Risk factors for a difficult intravenous access: A multicentre study comparing nurses' beliefs to evidence.

AIMS AND OBJECTIVES: To summarise the evidence about patient-related risk factors for difficult intravenous access in adults, and at identifying nurses' beliefs and their consistency with evidence. BACKGROUND: Peripheral intravenous cannulation is a common procedure for nurses, but rates of failure at first attempt of peripheral intravenous cannulation range 10%-40%. Nurses' beliefs about difficult intravenous access factors might influence their clinical practice more than current evidence. DESIGN: The study included a literature review of the evidence on patient-related risk factors for difficult intravenous access, the development of an instrument to investigate nurses' beliefs about this topic and a cross-sectional multicentre survey on clinical nurses. METHODS: The quality of the studies included was evaluated through the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A synthesis of evidence for each risk factor was produced. A survey instrument was developed including 26 risk factors, which were then rated by nurses as perceived predictors of difficult intravenous access. The STROBE guidelines for study reporting were followed. RESULTS: Four hundred and fifty clinical nurses working in four hospitals in Italy were surveyed. Nurses' beliefs were in line with evidence in considering body mass index, drug abuse, lymphadenectomy and chemotherapy as difficult intravenous access factors. Beliefs about difficult intravenous access factors were influenced by nurses' work experience and frequency of peripheral intravenous cannulation. Nurses also identified as risk factors for difficult intravenous access oedema, thrombophlebitis, hypovolaemia, skin lesions and irritant therapies, which have been minimally investigated by research. CONCLUSIONS: An overall congruence between nurses' beliefs and evidence about risk factors for difficult intravenous access was found. With their expertise, nurses may fill the knowledge gap of clinical evidence and open new paths for clinically meaningful research. RELEVANCE TO CLINICAL PRACTICE: Nurses' beliefs about difficult intravenous access factors can be influenced by their work experience and clinical setting. Integrating nurses' beliefs with scientific evidence can increase the quality of care.

Vessel health and preservation: An integrative review.

AIMS AND OBJECTIVES: To describe and synthesise current knowledge on the maintenance and preservation of vessels in patients who need the placement of a vascular access device. INTRODUCTION: To administer drugs, blood or intravenous fluids, nurses or doctors insert a peripheral vascular access device on the arm using the traditional approach. This approach implies that devices are blindly inserted until flow is satisfactory and all possible sites have been exhausted. A proactive approach would ensure at the outset that the best device is used for each patient, eliminating repeated attempts at cannulation. DESIGN: An integrative review was conducted using data recorded until July 2017. Searches were conducted in PubMed, Cochrane Library, CINAHL and Scopus. REVIEW METHOD: A modified version of Cooper's five-stage method and the PRISMA guidelines were used to perform the integrative review. RESULTS: Nine papers were included in this review. The patients were active participants in a proactive approach to vessel health and preservation. The involvement of each healthcare professional in vessel health and preservation improves outcomes and expands the use of a proactive approach to vascular device management. Because nurses are directly involved in the use of such devices and support patients during the decision-making process, they should take the lead in the use of the proactive approach. CONCLUSION: Despite the many documented advantages of the proactive approach to preserving vessels in many settings and healthcare systems, it has not been widely tested. Future research is needed to guarantee high-quality vessel health and preservation care, thus contributing to the development and dissemination of the proactive approach. RELEVANCE TO CLINICAL PRACTICE: The proactive approach preserves vessels for future needs, improves the delivery of the treatment plan and reduces length of stay, costs, risk of infection, complications and pain perceived by patients. This approach also ensures better use of nurses' time and vascular access device material.

[Integrated Procurement Model: A new approach to Tissue and Organ Procurement]. / Un modello integrato per l'identificazione dei potenziali donatori: un nuovo approccio nei trapianti di organi e tessuti.

INTRODUCTION: Literature has shown that the process of procurement of organs and tissues is fundamental in determining the number of donations. Starting from these assumptions, an integrated procurement model of organs and tissues has been designed and tested, where nurse specialists in organ donation coordinate the team and the entire process. AIM: To evaluate the effectiveness of the Integrated Procurement Models in terms of identifying potential donors and the number of donations. METHODS: A retrospective observational study was conducted before and after the introduction of the new procurement model in a large University Hospital in Rome. The data of potential donors identified, the number of donations made and the efficiency indicators of the donation process were compared. RESULTS: 692 potential donors were identified. The introduction of the integrated model increased the number of actual donors (from 31 to 51), brain death assessments (from 69 to 99), and the efficiency indicators of the donation process (from 0.25 to 0.29). From the comparison between the activities before and after the introduction of the integrated procurement model, statistically significant differences emerged regarding the number of donors and the amount of corneal tissue extracted. CONCLUSIONS: The adoption of the standardized Integrated Procurement Model would increase the number of potential donors and actual donations, thanks also to the key role assumed by the nurse specializing in organ donation as team and process coordinator.

[Wound Care Management: impact on outcomes of nursing care]. / Documentare la gestione del wound-care: quali ripercussioni sugli outcome assistenziali.

AIM: To evaluate wound care management in Rome's Hospital. METHOD: Observational study, divided into phases, through the analysis of 301 nursing records of patients either admitted to the hospital with ulcer pressure at the admission or grown later. Among the nursing records, 151 have been analyzed directly in the wards and 150 are referred to the triennium 2010-2012 and have been traced in a computerized version. RESULTS: The nursing records concerning the ulcer pressure is completed in 4% average. The Push Tool and Braden scale are respectively present in 6% and 86% of the nursing records analyzed. The treatment are correct in the 80% of the cases. The clinic outcome is stable in 68% of the cases and in the 13% is registered an enhancement. CONCLUSIONS: The study underlined an increase of the nursing documentation, although not completed caused by the absence of the Push Tool scale. It has been registered an enhancement of the clinic outcome in the five years and a better pertinence in the treatment of the ulcers pressure. However is evident the necessity of increasing education courses on the ulcers pressure.