Impact of telemedicine on health outcomes in children with medical complexity: an integrative review.

Children with medical complexity (CMC) are a high priority population with chronic illnesses dependent on the use of health services, on technological systems to support their vital functions and characterized by multiple health needs. One of the main challenges linked to chronic conditions is finding solutions to monitor CMC at home, avoiding re-hospitalization and the onset of complications. Telemedicine enables to remotely follow up patients and families. An integrative review was performed to assess whether telemedicine improves health outcomes for CMC. Medline/PubMed, CINAHL, Cochrane Library, Web of Science, and Scopus were searched to identify studies describing the effect of using telemedicine systems on health outcomes for CMC. The PRISMA guidelines were used to select the papers. The methodological quality of the studies was evaluated through the Johanna Briggs Institute critical appraisal tools and the Cochrane Collaboration ROB 2.0. A total of 17 papers met the quality criteria and were included. Specialized telemedicine systems (tele-visits), telehealth, and tele-monitoring have been reported to reduce unplanned hospitalizations and visits, decrease total costs for healthcare services and families, and increase satisfaction for family members. No effect was found on the quality of life in children and their families.Conclusion: Available evidence supporting the use of telemedicine in CMC is favorable but limited. High-quality methodological studies including other unexplored health outcomes such as mental health, hospital readmissions, mortality, caregiver competences, and self-efficacy are needed to confirm the effectiveness of telemedicine systems in improving health outcomes for CMC. What is Known: • CMC are an extremely fragile patient population with frequent access to healthcare services compared with other chronic conditions. • There is conflicting evidence of the effectiveness of telemedicine clinical outcomes, healthcare utilization, and costs in pediatrics. What is New: • There is some evidence that for CMC, telemedicine reduces unplanned hospitalizations, healthcare service costs, and financial burden for families, while increasing caregivers' satisfaction with care. • Further research is needed to confirm the effectiveness of telemedicine systems in improving health for CMC.

Diabetic education in nursing: A Rodgers' evolutionary concept analysis.

AIM: This concept analysis aims to clarify the concept of diabetic education in nursing to provide guidance for the further conceptualization and clarification of diabetic education in nursing. BACKGROUND: Patient education is a fundamental component of diabetes care. Nurses have taken up a major role in educating people with diabetes to manage their conditions. However, the exact meaning of diabetic education in nursing remains challenging. DESIGN: Rodgers' evolutionary method of concept analysis was performed to explore the concept of diabetic education in nursing. DATA SOURCE: We conducted a literature search on Cumulative Index to Nursing and Allied Health Literature (CINAHL), MedLine, and PsycInfo for works published until October 2020 using "patient education," "diabetes," and "nursing" as key terms. RESULTS: The concept analysis revealed that key attributes of diabetic education in nursing include patient-centered and interactive approaches, planning, and problem solving. Antecedents related to individuals with diabetes are their backgrounds, needs, and motivations, while the antecedents related to nurses are experience and attitude. Finally, three different consequences of the concept emerged: an increase in knowledge and skills, a behavioral change, and the improvement of clinical outcomes.

Professional quality of life, self-compassion, resilience, and empathy in healthcare professionals during COVID-19 crisis in Spain.

The coronavirus pandemic has exposed healthcare professionals to suffering and stressful working conditions. The aim of this study was to analyze professional quality of life among healthcare professionals and its relationship with empathy, resilience, and self-compassion during the COVID-19 crisis in Spain. A cross-sectional study was conducted with 506 healthcare professionals, who participated by completing an online questionnaire. A descriptive correlational analysis was performed. A multivariate regression analysis and a decision tree were used to identify the variables associated with professional quality of life. Empathy, resilience, and mindfulness were the main predictors of compassion fatigue, compassion satisfaction, and burnout, respectively.

Understanding the concept of compassion from the perspectives of nurses.

BACKGROUND: The high level of satisfaction of users of a health service is largely due to the fact that they receive excellent care from healthcare professionals. Compassionate care is an essential component of excellent care. But what do nurses understand compassion to be? RESEARCH OBJECTIVES: To analyse the concept of compassion from the perspective of nurses in the Andalusian Public Health System, Spain. RESEARCH DESIGN: This is a qualitative study following the grounded theory model. Four focus groups and 25 in-depth interviews were conducted. PARTICIPANTS AND RESEARCH CONTEXT: A total of 68 nursing professionals working in the Andalusian Public Health System (Spain) participated. Theoretical sampling was used, with participants being recruited using the snowball technique. ETHICAL CONSIDERATIONS: This research was approved by the Research Ethics Committee of the Centro-Almería Health District (CEICA 27/9/17). FINDINGS: From the analysis of the data, four themes emerged that helped to understand the concept of compassion according to nurses: 'Negative perception of the term compassion', 'Compassion and empathy as synonyms', 'Beyond empathy', and 'Effects of having a compassionate attitude'. DISCUSSION: Nurses perceive the concept of compassion differently to each other and even contradictorily. This concept is imbued with cultural elements, which adds confusion to understanding it, and is even perceived as something negative similar to pity. CONCLUSION: Nurses confuse the concepts of empathy and compassion as if they were synonymous. Before considering training in compassion for healthcare professionals, it is essential to clarify the concept of compassion through educational interventions.

Diagnostic features of SARS-COVID-2-positive patients: A rapid review and meta-analysis.

AIMS: To identify the main diagnostic features of SARS-CoV-2-positive patients at the time of hospitalisation and their prevalence. BACKGROUND: Since the COVID-19 outbreak in China in December of 2019, several studies attempted to identify the epidemiological, viral and clinical characteristics of SARS-CoV-2. Given the rapid widespread transmission of the COVID-19 disease worldwide, a more comprehensive and up-to-date understanding of its features is needed to better inform nurses, clinicians and public health policy makers. METHODS: A rapid review and meta-analysis were carried out to identify the main diagnostic features of SARS-CoV-2-positive patients at the time of hospitalisation. All case series, cross-sectional, case-control and cohort studies published from 01/01/2020 till 30/06/2020 in English and Chinese that stated all or at least two of the outcomes of interest (clinical features, laboratory and radiological findings) were included. We performed a random-effects model meta-analysis to calculate pooled prevalence and 95% confidence intervals. Conduction of the review adheres to the PRISMA checklist. RESULTS: 21 studies involving 8837 patients were included in the quantitative synthesis. Fever, cough and fatigue were the most common clinical features, while the most relevant laboratory abnormalities at the time of hospitalisation were lymphopenia, elevated C-reactive protein and lactate dehydrogenase. CT images showed a bilateral lung involvement, with ground glass infiltrates and patchy shadows on most patients. CONCLUSION: This review provides an up-to-date synthesis of main diagnostic features of SARS-CoV-2-positive patients at the time of hospitalisation. RELEVANCE TO CLINICAL PRACTICE: Our findings could provide guidance for nurses and clinicians to early identification of positive patients at the time of the hospitalisation through a complete definition of main clinical features, laboratory and CT findings.

Meta-Synthesis of the Needs of Women Cared for by Midwives During Childbirth in Hospitals.

OBJECTIVE: To identify and meta-synthesize results of qualitative studies on the needs of women cared for by midwives during childbirth in hospitals. DATA SOURCES: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and the Cochrane Library. STUDY SELECTION: We restricted the bibliographic search to articles published in English to July 31, 2020. The initial search yielded 6,407 articles, and after 2,504 duplicates were removed, we screened the titles and abstracts of 3,903 articles. We conducted a full-text review of 89 articles and included 13 qualitative studies about the needs of women who were hospitalized during childbirth and had midwives as their primary maternity care providers. DATA EXTRACTION: We extracted data (e.g., authors, publication date, type of study, sample size, results, and quotes) from the full text of each article into a standardized table. Two authors reviewed all articles using the Critical Appraisal Skills Programme tool to assess study quality and to independently score each study. DATA SYNTHESIS: We analyzed the findings of each study and synthesized them to develop themes. We found 14 major themes that reflected the needs of women during hospitalization for childbirth: Nutrition, Hygiene, Privacy, Information, Bodily Respect, Respect for Social Role, Family Intimacy, Shelter, Pain Management, Partnership, Movement, Reassurance, Support, and Empowerment. We categorized these themes in Maslow's hierarchy of needs to better understand the phenomenon. CONCLUSION: We identified 14 needs that midwives and nurses can meet when they care for women in hospitals during childbirth. Standardized methods to assess these needs and to link them to specific interventions can be used by midwives and nurses, which will likely affect women's satisfaction with their experience and overall quality of care.

Compassion fatigue, burnout, compassion satisfaction and perceived stress in healthcare professionals during the COVID-19 health crisis in Spain.

AIMS AND OBJECTIVES: To evaluate compassion fatigue (CF), burnout (BO), compassion satisfaction (CS) and perceived stress in healthcare professionals during the coronavirus disease 2019 (COVID-19) health crisis in Spain. BACKGROUND: Spain has been one of the countries hardest hit by the health crisis caused by the COVID-19 pandemic. Healthcare professionals have had to deal with traumatic and complex situations in the work context. In these particularly stressful situations, many professionals may develop CF or BO, which puts them at risk for mental health problems. DESIGN: Cross-sectional online survey. METHODS: A total of 506 healthcare professionals (physicians and nurses) who were working in healthcare centres during the COVID-19 pandemic participated. CF, CS and BO were assessed with the Professional Quality of Life Questionnaire, and perceived stress was measured with the Perceived Stress Scale-14. Socio-demographic and occupational variables were also analysed. Data were collected during the period of the highest incidence of cases and highest mortality rates due to COVID-19 in Spain. This article adheres to the STROBE guidelines for the reporting of observational studies. RESULTS: Physicians had higher CF and BO scores, while nurses had higher CS scores. Perceived stress scores were similar in both occupations. Professionals working in specific COVID-19 units and in emergency departments had higher CF and BO scores, while levels of CS and perceived stress were similar regardless of the workplace. RELEVANCE TO CLINICAL PRACTICE: Despite the health crisis situation and its implications for healthcare professionals, the levels of CF and BO have remained moderate/high. However, CS seems to be increasing, especially among nurses, possibly due to their motivation to relieve suffering and due to their perceived social recognition. It is necessary to implement interventions that help improve CS and prevent BO and CF among professionals in the long term.

The Nurse Led of stroke patient after discharge from hospital. A Systematic Review and GRADE.

AIM: Stroke is the second cause of death worldwide and the third cause of death in industrialized countries. To investigate the effectiveness of the nurse's role the management for people affected by stroke after discharge from hospital to home. METHOD: A systematic review was performed. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was carried out. MEDLINE, CINAHL, Web of Science and Scopus were searched for studies on the effectiveness of the nurse's role in managing the stroke rehabilitation process after discharge from the home hospital from 2000 to June 2018 in English. The methodological quality was assessed by the Cochrane Collaboration's tool for assessing Risk of Bias (RoB). The GRADE system was used for evaluating evidence quality of each outcome. RESULTS: 7,025 studies were identified, 12 met the inclusion criteria. The outcomes in the literature are quality of life related to the degree of independence and depression, to the perception and health management and to the adaptation and stress tolerance. No primary outcome is reported in the literature with a high degree of confidence. DISCUSSION: The nurse's role the management for people affected by stroke after discharge from hospital to home represent an effective strategy for an improvement in the functional outcome, quality of life and reduction of costs.

Spiritual Dimension at the End of Life: A Phenomenological Study from the Caregiver's Perspective.

The lives of healthy and sick people are structured according to a variety of conceptual matrices. One of these matrixes consists of philosophical, spiritual, and religious convictions, being this especially relevant in the process of the end of life. The objective of the study is to understand the meaning that individuals at the end of life and the relatives of such individuals award spiritual and/or religious beliefs through an examination of caregiver narratives. Multicentric study was developed that used a qualitative design and a phenomenological approach. The study was conducted in the autonomous community of Andalusia, specifically in the provinces of Almeria, Malaga, Seville, Granada, and Huelva. The selection method was purposive sampling. Caregivers who had lost a relative in a period between 2 months and 2 years previously and who were not in a process of pathological grieving were selected for inclusion in the study. The method involved five discussion groups and 41 in-depth interviews, with a total of 87 participants. A change of paradigms is necessary in which, among other elements, the focus of palliative care is centered on the ability to address these spiritual needs, and healthcare professionals are trained to assist in the provision of such care. Another important consideration is the inequality of spiritual supported provided by clergy from various religions. At least in the cultural context of the research, Catholic chaplains were the only institutional figures whose presence was assumed necessary by health organizations. However, the cultural and/or religious diversity in the autonomous community in which the study was conducted is increasingly broad and complex. It appears necessary to incorporate a variety of clergies in health units so that all patients may find support, whether in terms of companionship or celebration.

[Vaccination, attitudes and perception of parents. Study in the ASL of Salerno]. / Vaccinazioni, attitudini e percezione dei genitori. Indagine nella ASL di Salerno.

OBJECTIVE: Despite the many advances obtained thanks to vaccination, in recent years it has been a marked drop in vaccination coverage. In fact, data show the failure in reaching the 95% of coverage, equal to the safety threshold for almost all vaccinations. This is due to the phenomenon of vaccine hesitancy. Aim of this study is to describe knowledge, attitudes and perceptions respect to childhood vaccinations in a sample of parents of patients of a Free Choice Pediatrician (PLS) in the territory of Salerno Local Healthcare Service, (ASL) to assess what might be the educational needs of parents to decrease the hesitation. METHODS: A quantitative observational descriptive and phenomenological study was conducted, recruiting parents belonging to a PLS in ASL Salerno, through a questionnaire constructed ad hoc. RESULTS: Parents are not always favorable to vaccination and for some vaccine they fear a bond with a pharmaceutical business. All have vaccinated their children but not for all available vaccinations. DISCUSSION AND CONCLUSIONS . Through the educational means of the PLS doubts about vaccinations are minor and the sample of children is vaccinated, although parents appear not totally supportive and considers vaccinations as a warranty by the ASL. The sample has shown a discrepancy between the health workers about the need to vaccinate or not. Hence the need to train the health care professional before and make him responsible and then inform, through a dedicated path, who should receive the vaccine.

The Experiences of Family Caregivers at the End of Life: Suffering, Compassion Satisfaction and Support of Health Care Professionals: Experiences of Caregivers at the End of Life.

A death with dignity is influenced by the quality of care offered to patients. The objective of this study was to identify, through the firsthand experiences and insights of family caregivers, the key elements related to the care offered to patients with a terminal illness at the end of life. This multicenter qualitative study was based on the paradigm of hermeneutic phenomenology. Participants were relatives of patients with terminal illness who had been identified as primary caregivers. Five discussion groups and 41 in-depth interviews were organized with a total of 81 participants. The content of the interviews was analyzed based on the methods developed by Giorgi (J Phenom Psychol 1997;28(2):235-260). The results indicate the existence of 3 dimensions: the caregiver's suffering, compassion satisfaction with the care provided, and the support of health care professionals. Understanding the experiences of family members providing end-of-life care allows improved care and provides dignity in death. Health and social systems must provide comprehensive assistance covering the different aspects of needed care. Health professionals occupy a privileged position in the care of these patients and their families.

Competence and Compassion: Key Elements of Professional Care at the End of Life From Caregiver's Perspective.

In the act of caring for and helping people in the end-of-life process, the professional who provides care and assistance must know how to maintain a relationship of closeness, empathy, and compassion for the pain and suffering of the person who is going to die. The objective was to understand, elaborate on, and characterize the key elements of end-of-life care of patients from a caregiver's perspective through a qualitative phenomenological multicenter study. Participants were caregivers who had lost a family member at least 2 months but less than 2 years in the past. The techniques used were 5 discussion groups and 41 in-depth interviews, which included a total of 81 participants. To analyze the information, a protocol developed by Giorgi was followed. Two dimensions or units of meaning, with subdimensions, emerged: (1) Technical competence, with the subdimensions "Control of symptoms" and "Continuity of care," and (2) Compassion, with the subdimensions "Effective/affective communication," "Attitudes of kindness and closeness toward the patient and the family," and "Generosity and personalized flexibility of care." Assistance at the end of life requires the proper preparation of professionals who care for these patients, in addition to a compassionate attitude on the part of professionals and the people accompanying the dying person, that fosters a more humanized and dignified treatment in the dying process.

[The Adherence's indicators of cancer patients to oral chemotherapy. A sistematic literature review]. / Gli indicatori di aderenza dei pazienti oncologici alla chemioterapia orale. Evidenze empiriche da una revisione sistematica della letteratura.

INTRODUCTION: Adherence has a key role in treating patients as influences the effectiveness of therapeutic treatment for improving overall survival, life expectancy, quality of life and reducing healthcare costs. There are gaps in identifying indicators to be used to evaluate adherence and ways in which these indicators should be adopted. The aim of this paper is to identify adherence's indicators in literature. METHODS: Systematic review was carried out in, Cinhal-EBSCO, Medline-PUBMED and Scopus including studies of measure patient's adherence in English and published from 2010 to 2016. Inclusion and exclusion criteria were used. The quality of the articles was assessed with the NewCastle Ottawa Scale for observational studies and the Cochrane Collaboration Risk of Bias for experimental studies. RESULTS: Of the 7,368 papers initially retrieved, 15 met the inclusion criteria (11 observational studies, 4 RCTs), for a total of 1,396 patients. The indicators found are: self-report tools, pill counts, drug recharge rate, continuous measures, metabolic dosage. A patient is considered adherent to the treatment if he or she assumes a percentage of drugs ≥ 80% of the prescribed medications. DISCUSSION: A better adherence rating is obtained by using multiple instruments at the same time. The objective indicators derive from the direct measurement methods of adherence, the subjective ones from the indirect.

The meaning of empowerment within Italian nursing care settings.

AIM: To examine the current state of empowerment of nurses in Italy. BACKGROUND: Empowerment is a broad concept that is also relevant to the field of nursing practice. Its comprehension and use are important because empowerment allows nurses to take control of their own practice. A clear understanding of empowerment is necessary for nurses to take advantage of this important tool. DESIGN: Focus groups were conducted. METHODS: A literature review was performed, and two focus groups were selected between January and February 2014. RESULTS: Sixteen nurses participated in the research. Empowerment is seen as being strongly connected to autonomy and is not associated with power, as the word itself suggests. Italian nurses define empowerment as the creation of conditions that help to establish the possibility for people to develop and express their value and potential. CONCLUSIONS: Empowerment is defined as a condition in which the individual nurse takes control of his/her own practice and thereby provides awareness and confidence to a group. IMPLICATIONS FOR NURSING MANAGEMENT: Italian nurses need to feel appreciated and supported by their own organisations. If warranted, empowerment would allow them to contribute to enhance care, which is the core of the nursing profession.

Philosophical and theoretical content of the nursing discipline in academic education: A critical interpretive synthesis.

BACKGROUND: Nursing as clinical practice, management and research are based on nursing philosophy and theory. Thus, the philosophical and theoretical content is required to be incorporated in academic education in order to enable nurses' skills for reflection, analysis, and thinking about the profession. OBJECTIVE: The aim of this review was to describe what is known of the philosophical and theoretical content of the nursing discipline within academic education. DESIGN: A critical interpretive synthesis (CIS). METHODS: Electronic searches were performed across four databases, CINAHL, Scopus, Medline, and Web of Science, for papers published in English from 1980 to 2016. The selection of original articles was based on stages, and inclusion and exclusion criteria were used. Quality of the selected papers were evaluated by method sensitive appraisal criteria. The five phases of CIS were used to combine the selected data. RESULTS: The searches resulted 9148 titles, whereas 13 were selected. Nurses need philosophical and theoretical education in order to be aware of human health and explain the complexity of the human experience of illness. The philosophy of science, the philosophy of care, and theory development were highlighted as the key contents in nursing academic education as these subjects are central to the discipline that ensures that nurses acquire advanced skills. A model was developed that linked disciplinary issues the progression nursing science through the influence of advanced skills. CONCLUSIONS: Based on the findings in this study the philosophical and theoretical content of nursing discipline crates a basis for the academic education and enables a professional and exclusive vision for nurses. It provides an overall understanding of people's lives and support nurses to achieve deeper awareness of the meaning of illness and health in a person lifespan what is needed on the evidence-based decision making.

Are community-based nurse-led self-management support interventions effective in chronic patients? Results of a systematic review and meta-analysis.

The expansion of primary care and community-based service delivery systems is intended to meet emerging needs, reduce the costs of hospital-based ambulatory care and prevent avoidable hospital use by the provision of more appropriate care. Great emphasis has been placed on the role of self-management in the complex process of care of patient with long-term conditions. Several studies have determined that nurses, among the health professionals, are more recommended to promote health and deliver preventive programs within the primary care context. The aim of this systematic review and meta-analysis is to assess the efficacy of the nurse-led self-management support versus usual care evaluating patient outcomes in chronic care community programs. Systematic review was carried out in MEDLINE, CINAHL, Scopus and Web of Science including RCTs of nurse-led self-management support interventions performed to improve observer reported outcomes (OROs) and patients reported outcomes (PROs), with any method of communication exchange or education in a community setting on patients >18 years of age with a diagnosis of chronic diseases or multi-morbidity. Of the 7,279 papers initially retrieved, 29 met the inclusion criteria. Meta-analyses on systolic (SBP) and diastolic (DBP) blood pressure reduction (10 studies-3,881 patients) and HbA1c reduction (7 studies-2,669 patients) were carried-out. The pooled MD were: SBP -3.04 (95% CI -5.01--1.06), DBP -1.42 (95% CI -1.42--0.49) and HbA1c -0.15 (95% CI -0.32-0.01) in favor of the experimental groups. Meta-analyses of subgroups showed, among others, a statistically significant effect if the interventions were delivered to patients with diabetes (SBP) or CVD (DBP), if the nurses were specifically trained, if the studies had a sample size higher than 200 patients and if the allocation concealment was not clearly defined. Effects on other OROs and PROs as well as quality of life remain inconclusive.

[Compassionate nursing care: the experience of italian nurses]. / Cure infermieristiche compassionevoli: l'esperienza degli infermieri italiani.

AIM: In international nursing literature compassion and compassionate care has acquired a considerable importance and it's considered to be a growing phenomenon. The approach to the application of compassionate care to patients is clearly not well-defined in Italian nursing. The aim of this study is to define what compassionate care is through the analysis of Italian nurses' experiences. METHOD: The research is based on a qualitative method. Content analysis was used to analyze the transcript data. The research has been carried out by creating three focus groups, for a total of 15 nurses. RESULTS: All the participants expressed their opinions freely. The outcomes of the analysis can be grouped in four areas: definition of compassion and compassionate care; categorisation of patients; provision of care; and formation and training in compassionate care. The survey has shown contrasting opinions, negative opinions such as feelings of rejections and positive opinions such as love, charity, empathy and support. The last one (support) in particular has highlighted the importance of involving the patient's relatives in providing compassionate care. CONCLUSIONS: It is difficult to define exactly the meaning of compassion and compassionate care.This study has contributed to extend and deep the current knowledge in regard of the concept of compas-sionate care applied to assistance entities. Further research is needed in the field of compassionate care to strength the effectiveness of assistance provided by nurses.

Bacterial Epidemiology and Antimicrobial Resistance in the Surgery Wards of a Large Teaching Hospital in Southern Italy.

OBJECTIVES: Surgical infections represent an increasingly important problem for the National Health System. In this study we retrospectively evaluated the bacterial epidemiology and antimicrobial susceptibility of the microorganisms concerned as well as the utilization of antibiotics in the General and Emergency Surgery wards of a large teaching hospital in southern Italy in the period 2011-2013. METHODS: Data concerning non-duplicate bacterial isolates and antimicrobial susceptibility were retrieved from the Vitek 2 database. The pharmacy provided data about the consumption of antibiotics in the above reported wards. Chi-square or Fisher's exact test were used. RESULTS: In all, 94 Gram-negative were isolated in 2011, 77 in 2012, and 125 in 2013, Escherichia coli, Acinetobacter baumannii and Pseudomonas aeruginosa always being the most frequently isolated microorganisms. A. baumannii showed high rates of resistance to carbapenems (with values of 100% in 2011 and 2012) and low rates of resistance to tigecycline, colistin and amikacin. In the same years, there were respectively 105, 93, and 165 Gram-positive isolated. The rate of MRSA isolates ranged from 66% to 75% during the study period. CONCLUSIONS: Our results show no significant increase in antimicrobial resistance over the period in question, and a higher rate of both MRSA isolates and resistance to carbapenems in A. baumannii compared with other European data.

[Structural empowerment and job satisfaction among nurses coordinators: a pilot study]. / Empowerment strutturale e soddisfazione sul lavoro tra gli infermieri coordinatori: uno studio pilota.

INTRODUCTION: In literature, the structural empowerment and the job satisfaction have been studied in many different work settings but more need to be done in the setting of Head Nurses. OBJECTIVE: The goal of the study is to evaluate the structural empowerment level of head nurses and if it impacts on the job satisfaction. METHODS: A cross sectional design study was used. We enrolled 125 head nurses from three different hospitals of Rome. To collect the data we used a questionnaire that included both a part of the collection of sociopersonal data and the two scales (job satisfaction and structural empowerment). We used the SPSS19.0 statistical Software for data analysis to detect significant results. RESULTS: Head Nurse declared to be not enough satisfied at work (mean=3.43) and their structural empowerment level resulted moderate (mean=3.16). The structural empowerment of head nurses impacts their job satisfaction especially concerning opportunities for social and professional interactions, praises, awards, audit and responsibilities. CONCLUSIONS: Results underline structural empowerment relevance in head nurses job satisfaction. Healthcare organizations need to address job satisfaction to improve quality of care and more specifically that of head nurses since they directly impact on nurses job satisfaction.

Epidemiology and antibiotic resistance in a large Italian teaching hospital.

We focused our attention on susceptibility profile of Acinetobacter spp., Pseudomonas spp., and Klebsiella spp. isolated from biological specimens at the University Hospital of Salerno between June 2011 and October 2012. Acinetobacter, with a prevalence of Acinetobacter baumannii (97%) presented a high range of resistance to the antimicrobials considered, excluding colistin (COL). Klebsiella spp. isolates, with a prevalence of Klebsiella pneumoniae (90%), presented a variable pattern of resistance [from 9·8% for COL to 50% for levofloxacin (LEV)]. Extended-spectrum beta-lactamases production was detected in 15% of isolates. Most Pseudomonas isolates were P. aeruginosa with a high rate of resistance (95% to amoxicillin/clavulanate and trimethoprim/sulfamethoxazole, and <50% to the other antibiotics). Colistin remained the most effective drug tested. This study provided useful information of the local bacterial epidemiology hopefully permitting to establish a more effective empirical therapy, preventing the inappropriate use of antibacterial agents and possibly limiting the diffusion of antibacterial resistance.