Time spent on activities that can be delegated and reasons for not delegating among acute care nurses: A mixed-methods study.

AIM: To describe the activities nurses perceived to be delegable to other staff (delegable activities) in order to estimate the time nurses spend on delegable activities and explore nurses' reasons for not delegating these activities. DESIGN: Mixed-methods explanatory sequential. METHODS: In total, 236 nurses from 27 medical and surgical wards of five hospitals in northern Italy completed a web-based survey during a single shift between June and July 2022. Minutes spent on delegable activities, staff member to whom participants could have delegated and reason(s) for not delegating were reported. Chief nurses provided specific wards' characteristics using a paper-and-pencil questionnaire. Twenty semi-structured interviews were conducted to explore delegable activities and reasons for not delegating. Quantitative and qualitative results were merged using joint displays. RESULTS: Participants spent approximately one-quarter of their time performing delegable activities, mainly delegable to nurse aides or nurse clerks, and performed due to a lack/shortage of staff or their concurrent participation in other activities. Participants recognized that activities requiring clinical assessment and decision-making skills cannot be delegated, whereas technical activities and indirect care should be delegated. Organizational, structural and cultural factors, as well as patient characteristics, available staff and experience affected delegation, leading nurses to perform delegable activities to ensure patient care. CONCLUSION: Nurses spend a considerable part of their time on delegable activities due to a lack of staff or support services and suboptimal organization, which could be addressed by optimal staff management, but also to the complexity of the contexts, including individual and cultural factors that should be addressed through policy interventions. IMPACT: This study estimates the time nurses spend on delegable activities in acute care settings. Our findings highlighted the reasons that sustain the decision not to delegate that policymakers, healthcare managers, and nurse educators should consider to promote nurses' delegation skills. REPORTING METHODS: MMR checklist. PATIENT/PUBLIC CONTRIBUTION: None.

Factors Associated with Falls in Community-Dwelling Older Adults: A Subgroup Analysis from a Telemergency Service.

According to the number of falls, fallers can be single (only one fall) or recurrent (two or more falls), with different risk profiles for loss of independence and frailty. The presence of risk factors in community-dwelling single- and recurrent fallers using a wearable fall-detection device, such as the Personal Emergency Response System (PERS), as part of a telemergency service, is still unknown. This article evaluates how using a PERS, within a telemergency service, helps identify risk profiles and assessment of any differences between non-fallers and fallers in community-dwelling older adults. A sub-group analysis was performed, dividing users into non-fallers (n = 226) and fallers (≥1 fall; n = 89); single-fallers (n = 66) and recurrent fallers (n = 23). Median age was higher in fallers (87.7 years vs. 86), whereas recurrent fallers were less independent, had fewer comorbidities, and had more low-extremity disabilities. The use of the PERS for medical problems (Adjusted OR = 0.31), excluding falls, support calls (Adjusted OR = 0.26), and service demands (Adjusted OR = 0.30), was significantly associated with a fall risk reduction. The findings suggest that the integration within a telemergency service may impact on fall-risk factors.

Supporting health and social care professionals in serious illness conversations: Development, validation, and preliminary evaluation of an educational booklet.

Serious illness conversations aim to align the care process with the goals and preferences of adult patients suffering from any advanced disease. They represent a challenge for healthcare professionals and require specific skills. Conversation guides consistent with task-centered instructional strategies may be particularly helpful to improve the quality of communication. This study aims to develop, validate, and preliminarily evaluate an educational booklet to support Italian social and healthcare professionals in serious illness conversations. A three-step approach, including development, validation, and evaluation, was followed. A co-creation process with meaningful stakeholders led to the development of the booklet, validated by 15 experts on clarity, completeness, coherence, and relevance. It underwent testing on readability (Gulpease index, 0 = lowest-100 = maximum) and design (Baker Able Leaflet Design criteria, 0 = worst to 32 = best). Twenty-two professionals with different scope of practice and care settings evaluated acceptability (acceptable if score ≥30), usefulness, feasibility to use (1 = not at all to 10 = extremely), and perceived acquired knowledge (1 = not at all to 5 = extremely). After four rounds of adjustments, the booklet scored 97% for relevance, 60 for readability, and 25/32 for design. In all, 18 (81.8%), 19 (86.4%) and 17 (77.3%) professionals deemed the booklet acceptable, moderate to highly useful, and feasible to use, respectively; 18/22 perceived gain in knowledge and all would recommend it to colleagues. The booklet has good readability, excellent design, high content validity, and a high degree of perceived usefulness and acquired knowledge. The booklet is tailored to users' priorities, mirrors their most frequent daily practice challenges, and offers 1-minute, 2-minute and 5-minute solutions for each scenario. The co-creation process ensured the development of an educational resource that could be useful regardless of the scope of practice and the care setting to support professionals in serious illness conversations.

Serosusceptibility and hesitancy for booster HBV vaccination among health care workers in Italy: A cross-sectional study.

BACKGROUND: Health care workers (HCWs) are at increased risk of exposure to hepatitis B virus (HBV). The most effective prevention measure is vaccination, with a serum hepatitis B surface antibody (HBsAb) titre > 10 mIU/ml considered protective. To date, the sociodemographic and occupational characteristics related to HBV serosusceptibility and factors associated with booster hesitancy remain unclear. Therefore, this study aimed to identify factors associated with maintaining a protective HBsAb titre in a large sample of HCWs and to evaluate factors potentially associated with hesitancy towards vaccine boosters. METHODS: A cross-sectional study was conducted among HCWs who underwent a health surveillance visit between 2017 and 2022. If the serum HBsAb titre was < 10 MIU/ml, a vaccine booster dose was offered. Based on their willingness to be vaccinated, employees were classified into three groups: acceptance, hesitation, and refusal. Uni- and multivariable analyses were performed to assess the association of demographic and occupational characteristics with serosusceptibility and attitudes towards vaccination. RESULTS: A total of 1632 (27%) employees were shown to be nonimmune. A lower median age and being a physician were significantly associated with a protective HBsAb titre. A total of 706 nonimmune employees (43.3%) accepted the vaccination, 865 (53%) hesitated, and 61 (3.7%) refused. The median age of those who refused vaccination was significantly higher than that of those who hesitated and those who were vaccinated. Acceptance of vaccination was significantly higher among nurses, while nurse aides hesitated more; among nonmedical graduate staff both hesitation and refusal were higher than expected. In the multivariable analysis, higher age, female sex, and employment as an allied health care professional were shown to be significantly associated with hesitation/refusal, while being born abroad turned out to be protective. CONCLUSIONS: Our study showed that approximately a quarter of HCWs were not immune to HBV infection, and of these, more than half were hesitant towards or refused the booster dose. The risk of hesitation/refusal was higher with age in women and among allied health care staff. Based on these findings, further studies are needed to prospectively evaluate HBV seroprevalence, vaccination adherence, factors associated with hesitancy, and the effectiveness of health surveillance strategies in a high-risk population susceptible to infection.

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.

[Investing in healthcare professionals. The motivation for enrollment in bachelor nursing courses: results from a pilot study]. / Investire sul personale sanitario: motivi di iscrizione al corso di laurea in Infermieristica. Risultati dello studio pilota.

. Investing in healthcare professionals. The motivation for enrollment in bachelor nursing courses: results from a pilot study. INTRODUCTION: Understanding the reasons for enrolling in a Bachelor of Science in Nursing (BSc Nursing) is crucial for devising strategies to stimulate enrollment and counteract the current decline in applications. A multi-center longitudinal study was initiated to explore motivations for enrollment and dropout rates. The results of the pilot study focusing on enrollment motives are presented. OBJECTIVE: To identify the reasons for enrolling in BSc Nursing programs at five Italian universities. METHODS: First-year BSc Nursing students enrolled in the academic year 2022-2023 completed an online questionnaire exploring socio-demographic and personal information, priority criteria for their choice, information sources, and the following reasons for enrolling (Likert scale 1-5): altruistic motivations, personal interests, preferences, past experiences, job security, advice, fallback options, and the social image of nursing. RESULTS: 759 questionnaires were analyzed (78% of those involved). 64.7% of the students indicated nursing as their first choice, while one-third enrolled as a fallback option, by chance, or because they were uncertain. Altruism was the primary motivation for enrollment (91.8%), but 74.2% of students enrolled to secure a good job or to pursue a career (52.3%), or due to curriculum counseling sessions (13.7%). Some differences were observed between geographical areas. CONCLUSIONS: Students primarily enroll in BSc Nursing programs due to altruism, personal experience, and job prospect. These findings may be valuable for guiding and tailoring information campaigns, and for enhancing the appeal of nursing courses.

Effectiveness of interventions to increase healthcare workers' adherence to vaccination against vaccine-preventable diseases: a systematic review and meta-analysis, 1993 to 2022.

BackgroundVaccination adherence among healthcare workers (HCWs) is fundamental for the prevention of vaccine-preventable diseases (VPDs) in healthcare. This safeguards HCWs' well-being, prevents transmission of infections to vulnerable patients and contributes to public health.AimThis systematic review and meta-analysis aimed to describe interventions meant to increase HCWs' adherence to vaccination and estimate the effectiveness of these interventions.MethodsWe searched literature in eight databases and performed manual searches in relevant journals and the reference lists of retrieved articles. The study population included any HCW with potential occupational exposure to VPDs. We included experimental and quasi-experimental studies presenting interventions aimed at increasing HCWs' adherence to vaccination against VPDs. The post-intervention vaccination adherence rate was set as the main outcome. We included the effect of interventions in the random-effects and subgroup meta-analyses.ResultsThe systematic review considered 48 studies on influenza and Tdap vaccination from database and manual searches, and 43 were meta-analysed. A statistically significant, positive effect was seen in multi-component interventions in randomised controlled trials (relative risk (RR) = 1.37; 95% CI: 1.13-1.66) and in observational studies (RR = 1.43; 95% CI: 1.29-1.58). Vaccination adherence rate was higher in community care facilities (RR = 1.58; 95% CI: 1.49-1.68) than in hospitals (RR = 1.24; 95% CI: 0.76-2.05).ConclusionInterventions aimed at increasing HCWs' adherence to vaccination against VPDs are effective, especially multi-component ones. Future research should determine the most effective framework of interventions for each setting, using appropriate study design for their evaluation, and should compare intervention components to understand their contribution to the effectiveness.

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.

Emergency department visits by nursing home residents. A retrospective Italian study of administrative databases from 2015 to 2019.

BACKGROUND: Visits to Emergency Departments (ED) can be traumatic for Nursing Home (NH) residents. In Italy, the rate of ED visits by NH residents was recently calculated as 3.3%. The reduction of inappropriate ED visits represents a priority for National Healthcare Systems worldwide. Nevertheless, research on factors associated with ED visits is still under-studied in the Italian setting. This study has two main aims: (i) to describe the baseline characteristics of NH residents visiting ED at regional level; (ii) to assess the characteristics, trends, and factors associated with these visits. METHODS: A retrospective study of administrative data for five years was performed in the Piedmont Region. Data from 24,208 NH residents were analysed. Data were obtained by merging two ministerial databases of residential care and ED use. Sociodemographic and clinical characteristics of the residents, trends, and rates of ED visits were collected. A Generalized Linear Model (GLM) regression was used to evaluate the factors associated with ED visits. RESULTS: In 5 years, 12,672 residents made 24,609 ED visits. Aspecific symptoms (45%), dyspnea (17%) and trauma (16%) were the most frequent problems reported at ED. 51% of these visits were coded as non-critical, and 58% were discharged to the NH. The regression analysis showed an increased risk of ED visits for men (OR = 1.61, 95% CI 1.51-1.70) and for residents with a stay in NH longer than 400 days (OR = 2.19, 95% CI 2.08-2.31). CONCLUSIONS: Our study indicates that more than half of NH residents' ED visits could potentially be prevented by treating residents in NH. Investments in the creation of a structured and effective network within primary care services, promoting the use of health technology and palliative care approaches, could reduce ED visits and help clinicians manage residents on-site and remotely.

Stakeholders' Perspective on the Key Features of Printed Educational Resources to Improve the Quality of Clinical Communication.

Social and healthcare professionals often feel ill equipped to effectively engage in difficult conversations with patients, and poor proficiency negatively affects the quality of patient care. Printed educational resources (PERs) that provide guidance on sustaining complex clinical communication may be a source of support if thoughtfully designed. This study aimed to describe the key features of PERs in order to improve the quality of clinical communication according to the perspective of meaningful stakeholders. This was a descriptive secondary analysis of data collected by three remote focus group discussions that involved 15 stakeholders in the context of developing an educational booklet to support professionals in complex communication scenarios. Focus groups were audio-recorded and transcribed verbatim, and an inductive thematic analysis was performed. Three key features of PERs that aim toward quality improvement in clinical communication were identified: (1) having the potential to provide benefits in clinical practice; (2) facilitating, encouraging, and enticing reading; and (3) meeting the need of professionals to improve or update their knowledge. These findings suggest that PERs relevant to professionals' clinical priorities and learning needs may make their efforts to apply learning in practice more likely and consequently result in improved healthcare quality.

Association between exposure to wind turbines and sleep disorders: A systematic review and meta-analysis.

To date, there is scarce evidence on the association between sleep disorders and noise generated by wind turbines. We searched six relevant electronic databases from the inception to May 2023 for relevant articles. The methodological quality of the included articles was evaluated using the US National Institutes of Health tool. Fifteen articles met the inclusion criteria. The overall prevalence of sleep disorders among residents close to wind turbines was 34% (95% Confidence Interval, 0.22-0.47). Univariate meta-regressions for distance and sound power level showed that at higher distance the prevalence of sleep disorders decreases (p = 0.010) and with a higher sound power level the prevalence increases (p = 0.037). Furthermore, this systematic review and meta-analysis highlighted that the overall quality of current research on this topic is poor, and the methods to measure the results are often based on subjective assessments and not validated questionnaires. In conclusion, our preliminary findings suggest that there may be a possible relation between exposure to wind turbines and sleep disorders, although no conclusions can be drawn in terms of causality due to the nature of the retrieved data and the poor quality of current evidence. Future studies should adopt a longitudinal design and focus on objective measurements, supported by validated subjective methods such as questionnaires.

Moving forward the Italian nursing education into the post-pandemic era: findings from a national qualitative research study.

BACKGROUND: During the CoronaVIrus-19 (COVID-19) pandemic, nursing education has been dramatically transformed and shaped according to the restrictions imposed by national rules. Restoring educational activities as delivered in the pre-pandemic era without making a critical evaluation of the transformations implemented, may sacrifice the extraordinary learning opportunity that this event has offered. The aim of this study was to identify a set of recommendations that can guide the Italian nursing education to move forward in the post-pandemic era. METHODS: A qualitative descriptive design was undertaken in 2022-2023 and reported here according to the COnsolidated criteria for REporting Qualitative research guidelines. A network was established of nine Italian universities offering a bachelor's degree in nursing for a total of 6135 students. A purposeful sample of 37 Faculty Members, 28 Clinical Nurse Educators and 65 Students/new graduates were involved. A data collection was conducted with a form including open-ended questions concerning which transformations in nursing education had been implemented during the pandemic, which of these should be maintained and valued, and what recommendations should address the transition of nursing education in the post-pandemic era. RESULTS: Nine main recommendations embodying 18 specific recommendations have emerged, all transversally influenced by the role of the digital transformation, as a complementary and strengthening strategy for face-to-face teaching. The findings also suggest the need to rethink clinical rotations and their supervision models, to refocus the clinical learning aims, to pay attention towards the student community and its social needs, and to define a pandemic educational plan to be ready for unexpected, but possible, future events. CONCLUSIONS: A multidimensional set of recommendations emerged, shaping a strategic map of action, where the main message is the need to rethink the whole nursing education, where digitalization is embodied. Preparing and moving nursing education forward by following the emerged recommendations may promote common standards of education and create the basis on for how to deal with future pandemic/catastrophic events by making ready and prepared the educational systems.

[Transitioning Italian nursing education in the post-pandemic period: priorities in the light of lessons learnt]. / Transitare la formazione infermieristica italiana nel periodo post pandemico: le priorità alla luce delle lezioni apprese.

. Transitioning Italian nursing education in the post-pandemic period: priorities in the light of lessons learnt. INTRODUCTION: Once back to normalcy, many nursing education activities have been restored without an in-depth analysis of which transformations enacted in the pandemic period should be maintained and valued. AIM: To identify priorities to effectively transitioning nursing education in the post-pandemic period. METHOD: Descriptive qualitative design. A network of nine universities involved 37 faculty members, 28 clinical nurse educators and 65 students/new graduates. Data were collected through semi-structured interviews; the main priorities reported in each university were combined to gain a global view. RESULTS: Nine priorities emerged, including the need to: 1. reflect on distance learning to promote its complementary role to face-to-face teaching; 2. rethinking the rotations of clinical practical training by refocusing their aims, duration, and preferred settings; 3. understanding how to integrate the virtual and the in-presence learning spaces into the educational pathway; 4. continuing with inclusive and sustainable strategies. Considering that nursing education is essential, it is a priority to develop a pandemic education plan capable of guaranteeing its continuity in all circumstances. CONCLUSIONS: Nine priorities have emerged all considering the importance of digitalization; the lessons learnt, however, indicate the need to enact an intermediate phase capable of guiding towards the complete transition of the education in the post-pandemic era.

Use of Motivational Interviewing in Older Patients with Multiple Chronic Conditions and Their Informal Caregivers: A Scoping Review.

The use of motivational interviewing is relatively new in multiple chronic conditions (MCCs). A scoping review was conducted according to JBI methodology to identify, map and synthesize existing evidence on the use of motivational interviewing to support self-care behavior changes in older patients with MCCs and to support their informal caregivers in promoting patient self-care changes. Seven databases were searched, from database inception to July 2022, for studies that used motivational interviewing in interventions for older patients with MCCs and their informal caregivers. We identified 12 studies, reported in 15 articles, using qualitative, quantitative, or mixed-method designs, conducted between 2012 and 2022, describing the use of motivational interviewing for patients with MCCs. We could not locate any study regarding its application for informal caregivers. The scoping review showed that the use of motivational interviewing is still limited in MCCs. It was used mainly to improve patient medication adherence. The studies provided scant information about how the method was applied. Future studies should provide more information about the application of motivational interviewing and should address self-care behavior changes relevant to patients and healthcare providers. Informal caregivers should also be targeted in motivational interviewing interventions, as they are essential for the care of older patients with MCCs.

Interventions to Promote End-of-Life Conversations: A Systematic Review and Meta-Analysis.

CONTEXT: Although several interventions aimed to promote end-of-life conversations are available, it is unclear whether and how these affect delivery of end-of-life conversations. Measuring the processes associated with high-quality end-of-life care may trigger improvement. OBJECTIVES: To estimate the effect of interventions aimed to promote end-of-life conversations in clinical encounters with patients with advanced chronic or terminal illness or their family, on process indicators of end-of-life conversations. METHODS: Systematic review with meta-analysis (PROSPERO no. CRD42021289471). Four databases (PubMed, CINAHL, PsycINFO, and Scopus) were searched up to September 30, 2021. The primary outcomes were any process indicators of end-of-life conversations. Results of pairwise meta-analyses were presented as Risk Ratio (RR) for occurrence, standardized mean difference (SMD) for quality and ratio of means (ROM) for duration. Meta-analysis was not performed when fewer than four studies were available. RESULTS: A total of 4,663 articles were scanned. Eighteen studies were included in the systematic review and 16 entered at least one meta-analysis: documented occurrence (n = 8), patient-reported occurrence (n = 4), patient-reported-quality (n = 4), duration (n = 4). There was significant variability in settings, patients' clinical conditions, and professionals. No significant effect of interventions on documented occurrence (RR 1.54, 95% CI 0.84-2.84; I2 91%), patient-reported occurrence (RR 1.52, 95% CI 0.80-2.91; I2 95%), patient-reported quality (SMD 0.83, 95% CI -1.06 to 2.71; I2 99%), or duration (ROM 1.20, 95% CI 0.95-1.51; I2 65%) of end-of-life conversations was found. Data on frequency were conflicting. Interventions targeting multiple stakeholders promoted earlier and more comprehensive conversations. CONCLUSION: Heterogeneity was considerable, but findings suggest no significant effect of interventions on occurrence, patient-reported quality and duration of end-of-life conversations. Nevertheless, we found indications for interventions targeting multiple stakeholders to promote earlier and more comprehensive conversations.

Leaders' Role in Shaping Followers' Well-Being: Crossover in a Sample of Nurses.

The link between well-being at work and leadership has received considerable attention. Leaders have the power to influence followers not only due to formal position, but also their positive behaviors could reinforce the followers' positive working experience. Following the crossover model (Westman, 2001), this study investigates whether leaders' work-related positive psychological states (i.e., work engagement) cross over to those of the followers (i.e., work engagement and job satisfaction) through the mediation of the latter's perception of transformational leadership. We used MPlus 8 to test two multilevel mediations in a sample of 1505 nurses nested in 143 groups led by as many leaders (87.19% of nurses and 56.50% of head nurses of the entire population). Results show that while there is not a crossover of leader work engagement to nurse work engagement, manager work engagement can cross over to nurse job satisfaction, enhancing their well-being through transformational leadership behaviors. This study adds further insights both on crossover theory and on the importance of leaders in expanding and transferring resources to followers at work. Fostering work engagement at a managerial level in the healthcare sector could be the driver to facilitate the well-being of nurses at work, address negative outcomes, and promote positive ones.

Family caregivers' experience of communication with nursing home staff from admission to end of life during the COVID-19 pandemic: A qualitative study employing a transitional perspective.

OBJECTIVES: Family caregivers' (FCs) caregiving in nursing home (NH) moves across 3 main phases: transitioning relatives to long-term care, worsening of a relative's conditions, and end of life; each phase brings specific challenges that FCs must confront. Moreover, during the COVID-19 pandemic, strict mandatory visitor restrictions affected communication modalities. This study explored FCs' experience of communication with NH staff during the COVID-19 pandemic from admission to end of life. METHODS: A descriptive qualitative study with inductive content analysis was performed in 7 Italian NHs from May to June 2021. NH managers purposively identified 25 FCs at different phases of their caregiving trajectory: transitional (i.e., admission in the previous 8 weeks, n = 8), deterioration-in-condition (i.e., acknowledged changes in care needs of their relative after trigger events, n = 10), and end-of-life phase (i.e., death expected in the next weeks or a few months, n = 7), who were interviewed. RESULTS: Regardless the phase of caregiving trajectory, what mattered most to FCs was the opportunity to have regular and sensitive discussions with health-care professionals. The need of in-person communication increased nearing death. The COVID-19 pandemic enhanced FCs' need to interact with health-care professionals they trusted. Knowledge of residents' preferences mitigated FCs' turbulent emotions throughout the overall caregiving trajectory. SIGNIFICANCE OF RESULTS: Findings suggest that in-person contacts should be prioritized and facilitated when possible, particularly at the end of life; nonetheless, meaningful communication can occur also through remote modalities. Investments in training health-care professionals about effective long-distance communication and supportive skills can help trusting relationships to be established. Open discussions about residents' care preferences should be encouraged.

A Situation-Specific Theory of End-of-Life Communication in Nursing Homes.

High-quality end-of-life communication between healthcare professionals (HCPs), patients and/or their family caregivers (FCs) improves quality of life and reduces non-beneficial care at the end of life. Nursing homes (NHs) are among the contexts at the forefront of these conversations. Having a solid theoretical basis for the role of end-of-life communication in NHs in transitioning to palliative-oriented care can offer indications for research, practice, education, and policy related to geropalliative care. This study aimed to develop a situation-specific theory of end-of-life communication in NHs by refining an existing theory. A four-step integrative approach was employed that included: (1) checking the assumptions for theorization; (2) exploring the phenomenon through multiple sources; (3) theorizing; and (4) reporting. All elements of the existing end-of-life communication theory in NHs were confirmed: end-of-life communication improved the understanding of FCs about their relatives' health conditions, shared decision-making, and reflections on the desired preferences of residents/FCs for care at the end of life. Furthermore, the family environment affected the burden of FCs in the decision-making process. Finally, time and resource constraints, regulations, visitation restrictions due to the COVID-19 pandemic, and social and cultural values influenced the quality and timing of communication. The study findings confirmed the impact of the political, historical, social, and cultural context on end-of-life communication, thus providing the basis for a situation-specific theory.