Nurses' intention to leave, nurse workload and in-hospital patient mortality in Italy: A descriptive and regression study.

Higher nurse-to-patient ratios are associated with poor patient care and adverse nurse outcomes, including emotional exhaustion and intention to leave. We examined the effect of nurses' intention to leave and nurse-patient workload on in-hospital patient mortality in Italy. A multicentered descriptive and regression study using clinical data of patients aged 50 years or older with a hospital stay of at least two days admitted to surgical wards linked with nurse variables including workload and education levels, work environment, job satisfaction, intention to leave, nurses' perception of quality and safety of care, and emotional exhaustion. The final dataset included 15 hospitals, 1046 nurses, and 37,494 patients. A 10 % increase in intention to leave and an increase of one unit in nurse-patient workload increased likelihood of inpatient hospital mortality by 14 % (odds ratio 1.14; 1.02-1.27 95 % CI) and 3.4 % (odds ratio 1.03; 1.00-1.06 95 % CI), respectively. No other studies have reported a significant association between intention to leave and patient mortality. To improve patient outcomes, the healthcare system in Italy needs to implement policies on safe human resources policy stewardship, leadership, and governance to ensure nurse wellbeing, higher levels of safety, and quality nursing care.

Fundamental care: An evolutionary concept analysis.

AIM: To report an analysis of the concept of fundamental care in the literature. DESIGN: An evolutionary concept analysis. DATA SOURCES: PubMed and CINAHL Complete databases were consulted using the key terms: fundamental care, fundamentals of care, essential care, basic nursing care and basic care revised. Articles published from 2008 to 2022, in English and Italian, in scholarly/peer-reviewed nursing journals were included. METHODS: Rodgers's Evolutionary Method of concept analysis was used. Our thematic analysis yielded common themes related to the concept, antecedents, attributes and consequences of fundamental care. RESULTS: A total of 50 articles were analysed. Thirty-eight attributes were identified, such as integration of care, patient and family centred care and trusting relationship; eight antecedents including nursing care, nursing practice and care context; and 17 consequences including the safety, quality and consistency of care. CONCLUSION: This review of literature reveals that there is no consistent definition of the concept of 'fundamental care'. Findings from this exploration of the literature emphasized the importance of communication, the contextual environment, leadership influence and nurse-patient relationship in providing effective and high-quality fundamental care. Our definition of this concept may help nurse leaders in practice, research, education, management and policy to promote and enhance the application of fundamental care. IMPACT: What problem did the study address? While numerous studies examine fundamental nursing care, various terms are used with no consensus on definitions emerging. Given the relevance of this topic, reaching a clear and agreed definition of fundamental care is essential. What were the main findings? Fundamental care encompasses the importance of communication, the contextual environment, leadership influence and nurse-patient relationship in providing effective and high-quality care. Where and on whom will the research have an impact? This definition of fundamental care will assist nurse leaders and researchers to promote and enhance the examination and application of fundamental care in clinical practice to ensure better care outcomes across all healthcare settings.

Nursing management of emergency department violence-Can we do more?

BACKGROUND: Emergency departments are the services with the highest risk of violence for nurses. Reports of violence in health care have increased exponentially in the last decade. Front line hospital services are more at risk, and worldwide there are attempts to quantify, manage and prevent episodes of violence, but no consistent solutions have yet been identified. AIMS: To stimulate reflection on causal factors of violence against nurses in emergency departments and discuss potential solutions and strategies for aspects that largely remain unresolved. DESIGN: A position paper underpinned by experiences and evidence reported in the literature. METHODS: A search of Scopus and CINAHL using the term 'violence' provided information concerning the prevalence of the term 'violence' in contemporary literature and enabled to capture a general overview of contributing factors of violence and current approaches to its management and prevention. CONCLUSIONS: However, while risk factors have been identified, there is a tendency to over accentuate the extent of their contribution. The main risk factors present conditions related to or accompanied by mental illness and the impact of overcrowding and long waiting times. RELEVANCE TO CLINICAL PRACTICE: More is needed in terms of implementation of more far-reaching, holistic, practical and effective management solutions to promote nurses' safety and adequately support vulnerable patients.

The structure of the Italian version of the Practice Environment Scale of the Nursing Work Index.

AIM: To investigate the factor structure of an Italian translation of the Practice Environment Scale of the Nursing Work Index (PES-NWI). BACKGROUND: Italy suffers from high turnover rates, yet validated tools in Italian to study and manage the problem are lacking. The PES-NWI measures aspects of nurses' working environment. This study reports on the translation and investigation of the structure of the translated PES-NWI scale. METHODS: A survey was conducted with 3667 nurses from 182 hospitals across 13 Italian regions using the PES-NWI. The structure of this scale was investigated using principal components analysis and other properties, including internal consistency (Cronbach's alpha). Construct validity was investigated using logistic regression. RESULTS: The Italian translation of the PES-NWI showed a five-factor structure, and Cronbach's alpha of the factors ranged between 0.80 and 0.92. Logistic regression showed that the PES-NWI was positively related to job satisfaction (odds ratio = 10.3; CI 8.62-12.35) and negatively related to intention to leave (odds ratio = 0.14; CI 0.12-0.16). CONCLUSIONS: The original five-factor structure of the PES-NWI was evident in the present study, albeit with some different factor loadings. IMPLICATIONS FOR NURSING MANAGEMENT: The Italian version of the PES-NWI can be used by nurse managers to tackle the workforce issues related to nurses' work environments in a major European country.

Advancing nursing in Italy through the development and evaluation of an innovative postgraduate programme in Family and Community Nursing - A pilot study.

Introduction: Due to the impact on the public health systems of the ageing and the increasing frailty of the population, the European Union and the World Health Organisation have emphasised how family and community nurses (FCNs) could play an important role in supporting the ageing process through prevention, promotion, and protection in the territory. Methods: This study describes the first experience in Italy of a one-year postgraduate blended-learning master course divided into 5 modules for FCNs piloted as part of the EuropeaN curriculum for fAmily aNd Community nursE (ENhANCE) 2018-2020 project, funded by the European Commission. The 5 modules focused on: Epidemiology and Prevention (14 ECTS); Fundamentals of care (19 ECTS); Organisational Models and Priority Health Problems (12 ECTS); Communication Models and Continuity of Care (5 ECTS); and Nursing Research (10 ECTS). Participants included a total of 45 students and 23 lecturers and a team of clinical tutors. Results: The Italian pilot course for the FCNs proved to be a successful example of innovative teaching methods using blended didactic methods, which enabled participants to achieve high-standard learning outcomes and competencies in the field of family and community nursing. Conclusions: The pilot course is well suited to preparing competent family and community nurses to meet the growing healthcare needs of the population. Therefore, we have planned to replicate this course to increase the workforce of family and community nurses, who through their healthcare services aimed at prevention, promotion and protection, will ensure high quality services to the public and consequently relieve the burden on acute hospitals.

Nursing competence in continuous renal replacement therapy: development and validation of a measurement tool.

BACKGROUND: Acute Renal Failure is an essential condition frequently encountered in intensive care units and requires targeted treatment. The critical care nursing team must be adequately trained to manage patients undergoing Continuous Renal Replacement Therapy. OBJECTIVES: To develop and validate the Continuous Renal Replacement Therapy - Measurement Competency Tool, aimed at measuring nursing competence in managing patients undergoing renal replacement techniques. METHODS: A cross-sectional tool validation study with a test-retest.A total of 30 critical care nurses participated in this study. The study examined content and face validity. Test-retest reliability with Pearson's r correlation and internal consistency reliability was assessed using Cronbach's α. Current guidelines for Continuous Renal Replacement Therapy techniques were used to develop an instrument to measure nursing competence through an online survey. A pool of 10 experts evaluated this tool. RESULTS: The Continuous Renal Replacement Therapy - Measurement Competency Tool achieved good content and face validity (S-CVI= 0.97; I-CVI=87%-100%), and good internal consistency reliability (Cronbach's α= 0.799). Pilot testing and test-retesting was conducted with 30 critical care nurses. The intraclass correlation for the test-retest analysis indicates excellent test-retest reliability, confirming the stability of the tool. ConclUSION: The tool assesses nursing competence concerning Continuous Renal Replacement Therapy techniques in the intensive care unit, which proved to be valid and reliable. This new tool will make it possible to measure the competence of nurses with respect to Continuous Renal Replacement Therapy techniques.

Nursing competence in CRRT: creation and validation of a measurement tool.

BACKGROUND: Acute Renal Failure is an essential condition frequently encountered in intensive care units and requires targeted treatment. The nursing team must be adequately trained in the management of the patient undergoing CRRT. AIM: To build and validate the CRRT-MCT (Continuous Renal Replacement Therapy -Measurement Competency Tool), which aims to measure nursing competence in managing patients undergoing renal replacement techniques. METHODS: The most current guidelines for CRRT techniques were used to create an instrument to measure nursing competence. A pool of 10 experts evaluated this instrument. The pilot study examined content and face validity. Test-retest reliability with r-Person correlation and internal consistency reliability with Crombach's was assessed. RESULTS: The CRRT-MCT achieved good content and face validity (S-CVI= 0.96; I-CVI=70%-100%), good internal consistency reliability (Crombach's = 0.83). Two hundred and forty nurses employed in intensive care units did pilot testing and test-retesting. The t-test showed no significant difference between test and retest results, confirming the stability of the tool (Pearson's r = 0.984) CONCLUSIONS: The instrument assesses nursing competence concerning CRRT techniques in the ICU and is valid, reliable and understandable. NURSING IMPLICATION: The creation and validation of this tool enables nurses to understand their level of competence for the care of patients undergoing CRRT with the ultimate aim of becoming aware of their gaps and undertaking training to fill them to provide the best possible nursing care.