Challenges and best practices of dispatcher-assisted cardiopulmonary resuscitation: A scoping review protocol.

Introduction: Improved survival from out-of-hospital cardiac arrest with good neurological outcome was observed in association with dispatcher-assisted cardiopulmonary resuscitation, increasing the number of bystander-initiated resuscitations and minimizing the no-flow time in the first minutes of cardiac arrest. Objective: The objective of this scoping review is to map and summarise the existing literature on dispatcher-assisted cardiopulmonary resuscitation, focusing on reported experiences, challenges, and best practices, highlighting strategies that could improve the provision of cardiopulmonary resuscitation instructions to bystanders during out-of-hospital cardiac arrest. Inclusion criteria: Studies related to dispatcher-assisted cardiopulmonary resuscitation, involving human subjects, with an English abstract. The concept of interest is focused on the methods of provision of dispatcher-assisted cardiopulmonary resuscitation analysing specific experiences of implementation, challenges, and best practices, and can be generalized to any country; cultural factors, geographic features, and specific racial or gender-based differences will be analysed and discussed. Methods: Four databases (PubMed, Embase, Cumulative Index to Nursing & Allied Health Literature, and the Cochrane Library) will be searched for studies published from 2018 to 2023. All study designs, including experimental and observational studies, will be assessed for inclusion. Titles and abstracts of identified citations will be screened for inclusion; subsequently, full texts of potentially relevant sources will be assessed for inclusion by two reviewers. Any disagreements between the reviewers will be resolved through discussion. Relevant grey literature (conference proceedings, government documents, and theses) will be analysed and included. Data will be extracted in a standardized form, following Joanna Briggs Institute recommendations. Results will be synthesized and reported using a narrative approach, categorising findings into themes related to the effectiveness of dispatcher-assisted cardiopulmonary resuscitation, challenges, and best practices.

How Teaching and Internship Influence the Evidence-Based Practice Approach of Nursing Students: A Longitudinal Study.

AIM: The study aimed to analyze students' approach to evidence-based practice and evaluate the effect of teaching (based on lessons in statistics, epidemiology, evidence-based nursing, bioengineering, English language) and internship experiences on the attitude of nursing students to evidence-based practice. METHOD: In 2019,one hundred nineteen second-year nursing students from an Italian university were involved in a pre-post longitudinal study. The Italian version of the Student-Evidence Based Practice Questionnaire was administered to nursing student in four moments of one academic year. RESULTS: The Student-Evidence Based Practice Questionnaire showed different mean scores based on the four moments of the survey with a significant increase after the experience of planning clinical cases with an online simulation system. In particular, the aptitude subscale does not have significant improvements in the various phases of the study. Conversely, the support of the clinical tutor affects student performance. The didactic module on evidence-based nursing develops the ability to assess the quality of the information found and its sharing. Basic English proficiency is not significantly correlated. CONCLUSION: To develop evidence-based practice knowledge, aptitude, and skills in nursing students, it is necessary to strengthen the learning opportunities both in classroom lessons and in simulation and internship experiences.

Exploring the terminological validity of 'chronic pain' nursing diagnosis: A retrospective descriptive study using nursing diaries.

AIM: The aim of this study is to generate empirical evidence, drawing from clinical records, with the goal of elevating the level of evidence supporting the nursing diagnosis (ND) of 'chronic pain'. BACKGROUND: Chronic pain is a prevalent condition that affects all age groups. Patients often feel disbelieved about their pain perception, leading to adverse psychological effects, difficulty accessing healthcare and poor rehabilitation outcomes. DESIGN: Retrospective descriptive study. Standards for Reporting Diagnostic Accuracy Studies guidelines were followed in this study. METHODS: Data were extracted from Electronic Health Records (EHR) of patients admitted to the University Hospital of Perugia, Italy, between March 2016 and December 2022. The study sample comprised individuals without a specific medical diagnosis or high-risk population. Out of 1,048,565 EHR, 43,341 clinical-nursing diaries with the keyword 'pain' were identified, from which 283 clinical-nursing notes were selected based on a keyword-based retrieval technique and diagnostic definition for further analysis. RESULTS: Our study findings support the diagnostic descriptors of the 'chronic pain' ND in clinical-nursing diaries. We observed the presence of 9 out of 11 defining characteristics, 7 out of 10 related factors, 4 out of 8 at-risk populations and 11 out of 17 associated conditions. CONCLUSIONS: The study validated diagnostic criteria for chronic pain and proposed 'haematological pathology' as a new associated condition. The findings were presented to the Diagnosis Development Committee of NANDA-International for further review. However, limitations of the study prompted the need for further analysis using natural language processing and artificial neural network techniques. As a result, a new research direction using artificial intelligence (AI) tools was initiated. RELEVANCE TO CLINICAL PRACTICE: The study validates diagnostic descriptors for chronic pain and proposes future directions in semantic analysis and AI tools, aiming to enhance clinical practice and decision-making in nursing care. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Quality of life, Stress, and Burnout of Italian nurses during the outbreak of COVID-19: a cross-sectional study / La qualità della vita, stress e burnout negli infermieri durante il periodo della Pandemia da Covid-19 in Italia: uno studio trasversale.

INTRODUCTION: The COVID-19 pandemic was a whispered problem for nurses, causing feelings of anxiety, stress, and burnout. Many studies investigated the pandemic's negative effects on nurses, but the relationship between burnout and the quality of life (QoL) in Italian nurses was lacking. AIM: To describe Italian nurses quality of life and stress during the Covid-19 outbreak. METHODS: METHODS: We conducted a cross-sectional study between March 25, 2020, to May 15, 2020. The MBI scale was used to detect burnout, while the SVQI was for nurses' quality of life (QoL). We used descriptive and correlational statistical tests between the scales and risk factors. The significance level was set at P. 0.05. RESULTS: A total of 384 nurses were assessed, 58.1% (223) were female, 41.9% (161) were male. Depersonalization appeared in 85% of cases, emotional exhaustion in 52.3%, and personal accomplishment in 17.4%. Overall, nurses report a dissatisfaction with the physical, emotional and social QoL. The factors that contribute to onset of the syndrome was: gender (p = 0.003), ward (p = 0.03), care to COVID-19 patients (p = 0.02). Women are dissatisfied with physical (p = 0.001), emotional (p = 0.001) and social (p =0.002) QoL. Statistically significant differences by department (p = 0.01) and geographical area of Northern Italy (p = 0.02). CONCLUSION: During the COVID-19 outbreak, some factors studied are associated with high-stress levels and low physical and social QoL. Women were the gender most affected by the effects of the pandemic.

Teaching strategies of clinical reasoning in advanced nursing clinical practice: A scoping review.

AIM/OBJECTIVE: To report and synthesize the main strategies for teaching clinical reasoning described in the literature in the context of advanced clinical practice and promote new areas of research to improve the pedagogical approach to clinical reasoning in Advanced Practice Nursing. BACKGROUND: Clinical reasoning and clinical thinking are essential elements in the advanced nursing clinical practice decision-making process. The quality improvement of care is related to the development of those skills. Therefore, it is crucial to optimize teaching strategies that can enhance the role of clinical reasoning in advanced clinical practice. DESIGN: A scoping review was conducted using the framework developed by Arksey and O'Malley as a research strategy. Consistent with the nature of scoping reviews, a study protocol has been established. METHODS: The studies included and analyzed in this scoping review cover from January 2016 to June 2022. Primary studies and secondary revision studies, published in biomedical databases, were selected, including qualitative ones. Electronic databases used were: CINAHL, PubMed, Cochrane Library, Scopus, and OVID. Three authors independently evaluated the articles for titles, abstracts, and full text. RESULTS: 1433 articles were examined, applying the eligibility and exclusion criteria 73 studies were assessed for eligibility, and 27 were included in the scoping review. The results that emerged from the review were interpreted and grouped into three macro strategies (simulations-based education, art and visual thinking, and other learning approaches) and nineteen educational interventions. CONCLUSIONS: Among the different strategies, the simulations are the most used. Despite this, our scoping review reveals that is necessary to use different teaching strategies to stimulate critical thinking, improve diagnostic reasoning, refine clinical judgment, and strengthen decision-making. However, it is not possible to demonstrate which methodology is more effective in obtaining the learning outcomes necessary to acquire an adequate level of judgment and critical thinking. Therefore, it will be necessary to relate teaching methodologies with the skills developed.

Nursing students and COVID-19 vaccination. ESitA Study An Observational Study.

BACKGROUND AND AIM: Vaccine hesitancy is an important problem in terms of health policy. This historical moment leads us to wonder if vaccine hesitancy is also present among nursing students who should be particularly sensitive to the subject Methods: Between February 10 to February 17 2021, 1080 students enrolled in the Bachelor of Science in Nursing in the Department of Medicine and Surgery of the University of Perugia, were invited to reply to an online questionnaire sent to their university email accounts. RESULTS AND CONCLUSIONS: A certain amount of vaccination hesitancy was detected among the students in our study. It can be assumed that the issues surrounding the AstraZeneca vaccine, which occurred at the start of the vaccination campaign, may have led to an increase in people's hesitancy. Boosting vaccination campaigns, including appropriate use of social media, may lead to greater acceptance. Also, it would be useful to assess the cultural basis of the recent anti-Vax controversy, particularly for students of nursing or other health professions, who should be able to evaluate, source and recognize the most validated data.

Patients who leave the Emergency Department without being seen. Has COVID-19 affected this phenomenon?

BACKGROUND AND AIM: Patients who present to an Emergency Department (ED) and leave without being seen by a physician represent a safety concern because they may become severely ill and experience adverse events as a result of lacking or delayed ED treatment. Prior to the COVID-19 outbreak, the increasing number of patients accessing care through the ED in Italy and throughout the world has had implications for health policies. METHODS: A retrospective cohort study that included all ED visits from 1st January 2013 to 31st December 2018 in the Perugia University Hospital has been carried out. RESULTS: During the 5 years investigated 26,344 out of 300,372 (8.77%) patients who attended the ED left the triage area before being seen with an average of 439 patients per month. The same phenomenon has been analysed from February to October 2020. During these 9 months there were a total of 1,824 out of 30,990 (5.88%) patients who left the ED without being seen with an average of 202 per month. The latter value is one third lower than the one related to the period investigated prior to the COVID-19 outbreak. CONCLUSIONS: Such investigation could help to differentiate actual essential demand from non-essential demand within the ED, which could inform quality-improvement policies. Several strategies could be implemented to lower the proportion of patients who leave the department without being seen. Reorganising the activities in the ED with different paths should be implemented with the aim of reducing waiting times and in turn patients' satisfaction.

Aggressions on Social Networks: What Are the Implications for Healthcare Providers? An Exploratory Research.

Incidents of violence by healthcare users against staff have been considered as sentinel events. New forms of aggression, i.e., cyberbullying, have emerged with the advent of social networks. Medical literature includes some reports about workplace cyberbullying on nurses and young doctors by colleagues/supervisors, but not by users. To investigate cyberbullying on healthcare providers via social networks, we carried out an exploratory quali-quantitative study, researching and analyzing posts and comments relating to a local Health Trust (ASL5) in Italy, published from 2013 until May 2020 on healthcare worker aggressions on social networks on every local community's Facebook page. We developed a thematic matrix through an analysis of the most recurring meaning categories (framework method). We collected 217 texts (25 posts and 192 comments): 26% positive and 74% negative. Positive posts were shared about ten times more than negative ones. Negative comments received about double the "Likes" than the positive ones. Analysis highlighted three main meaning categories: 1. lack of adequate and functional structures; 2. negative point of view (POV) towards some departments; 3. positive POV towards others. No significant differences were observed between the various categories of healthcare workers (HCW). Geriatric, medical wards and emergency department were the most frequent targets of negative comments. All the texts referred to first-line operators except for one. Online violence against HCW is a real, largely unknown, problem that needs immediate and concrete attention for its potentially disastrous consequences. Compared to traditional face-to-face bullying, it can be more dangerous as it is contagious and diffusive, without spatial, temporal or personal boundaries.

User-friendly system (a smartphone app) for reporting violent incidents in the Emergency Department: an Italian multicenter study.

BACKGROUND: Nurses, particularly emergency nurses, are among the health workers most exposed to workplace violence. Although reporting systems are increasingly used, under-reporting remains high. Recent studies suggest that the use of easy registration systems could facilitate violence reporting. OBJECTIVES: To verify if a friendly reporting system based on a Mobile-app can facilitate the reporting of violent episodes and reduce under-reporting. METHODS: Twenty emergency departments of five North and Central Italian regions participated in an interventional, multicentric, pre-post study to verify if a user-friendly reporting system based on a mobile app can facilitate the reporting of violent episodes and reduce under-reporting. RESULTS: Three hundred and eighty-four out of 754 potentially eligible nurses answered the short questionnaire at time T0, and 318 registered for the use of the app. One hundred and eighty-nine answered the questionnaire at time T1. The t-Test for Paired Samples, although with a low mean difference, shows a significant difference in the change in the frequency of the reporting of violent episodes. The correlational tests showed no significant differences in the subgroups divided by demographic and professional characteristics. The usability of the app was considered very high. CONCLUSIONS: The simplification of the reporting system and the preliminary acquisition of data on the characteristics of the ED and each nurse, can save time and facilitate the reporting, but technology alone is not enough to solve the under-reporting.

Evidence-Based Practice (EBP) implementation among nursing students: Italian validation of S-EBPQ.

BACKGROUND AND AIM: The use of Evidence-Based Practices in nursing has become essential for providing effective, safe, and personalized care. Nurses must learn the skill to use Evidence-Based Practice in universities, which represents the core of nursing education. Therefore, it appears necessary to evaluate students' learning after the training period and to identify the strengths and obstacles to the implementation of Evidence-Based Practice put to use. This study aims to validate the Italian version of the Student Evidence Based Practice Questionnaire. METHODS: The questionnaire was translated into Italian according to the World Health Organization guidelines. Content validation was carried out. A study was conducted on a sample of 119 students. The questionnaire was administered at four different times during the training period. The data were evaluated using the ANOVA test for repeated measures, Cronbach's Alpha, and Pearson's Correlation Coefficient. RESULTS: The Content Validity Index demonstrated values greater than 0.8 in all items and overall. Cronbach's Alpha showed values above 0.90 in the entire questionnaire. There was no correlation between the sex or age of the students and the score in the questionnaire. The mean scores gradually increased over the four administrations. CONCLUSIONS: The Student Evidence-Based Practice Questionnaire in the Italian version has proven to be a valid tool for assessing students' approach to Evidence-Based Practice.

Can a user-friendly system improve reporting of workplace violence towards emergency nurses? Findings of a multicenter study.

BACKGROUND: Nurses, particularly emergency nurses, are among the health workers most exposed to workplace violence (WPV). Despite WPV recording systems are becoming more common, the under-reporting is still widespread. Studies suggest that the use of simple and easy registration systems could facilitate the reporting of violent events. AIM: To verify if a friendly reporting system based on a Mobile-app can facilitate the WPV reporting. METHODS: The University of Florence has developed an application for Android and iOs to report incidents of violence towards emergency nurses. Started from 5 February 2018 and ended on 17 March 2019 in 20 Italian emergency departments, our 6-month study involved the participation of 386 nurses enabled to use this mobile app. RESULTS: 189 participants answered the questionnaire at the beginning (time T0) and at the end (time T1) of the trial period. The questionnaire item about the frequency of reporting of violent events in the last 6 months was scored: 1 for "Yes, all", 2 for "Yes, some", 3 for "No, only informally", and 4 for "No, not at all". The answers obtained the following arithmetic mean values (M), standard deviation (SD) at time T0 and T1, respectively M = 2.65, SD = 0.972, and M = 2.26, SD = 0.864. The result of the Paired Samples t-Test returned a t=3.614, df= 99 CONCLUSIONS: This result indicates a statistically significant difference in the change in the propensity to report, even if for small values. NURSING IMPLICATIONS: The technology cannot solve the problem of underreporting alone. To solve this problem it is necessary to act on several front.

[Maternal Satisfaction and Birth: a web-based survey]. / Soddisfazione materna ed evento nascita: una web-based survey.

INTRODUCTION: Maternal satisfaction regarding care during delivery is an indicator of maternity service's quality. METHODS: We conducted an observational study between May and August 2018, using an online questionnaire for women who have delivered in the last 3 years. Data was processed using descriptive and bivariate analysis, considering satisfaction as outcome. RESULTS: Sample includes 1229 women. About 73% had a spontaneous vaginal delivery, of which 29.3% received a Kristeller manoeuvre and 34,4% episiotomy. Three women out of 10 complaint about lack of involving in the decision-making process, 13.9% of women believe that their delivery's experience can negatively influence their decision to have another child, and 19.8% would like not to give birth again in the same hospital. Four women out of 10 are only partially satisfied with the care received and 6.4% is not satisfied at all. Satisfaction is significantly associated to the following variables: age more than 25 years old, positive environment during labour, gentle attitude of healthcare provider, respect of needs, respect of dignity, woman's inclusion in the decision making process, presence of a trustworthy person during the labour/delivery, vaginal delivery, positive delivery's experience, episiotomy, Kristeller manoeuvre, skin-to-skin contact, support during breastfeeding and postpartum period, choice to come back in the hospital for another delivery. CONCLUSION: We should implement strategies to promote the mother-partner-child triad as a central focus during delivery and allocate human resources in more efficient ways.

[Emergency nurses and workplace violence: a cross-sectional study in Campania, South Italy]. / Gli infermieri di pronto soccorso e la violenza sul luogo di lavoro: un'indagine trasversale nel contesto campano.

AIM: To determine the characteristics of workplace violence towards emergency nurses in Campania, South Italy. INTRODUCTION: In Italy, workplace violence is a severe and widespread problem. A national survey describes that, working in South Italy significantly increases the probability of being exposed. However, available data in Campania workplace violence towards nurse emergency department (ED) is lacking. METHOD: We used a cross-sectional design, in two emergency department. Between April and May 2019, we distributed a questionnaire (QIN16VIPs). Three types of violence have been investigated: verbal/physical violence, verbal violence and physical violence. The data were analyzed using procedures of descriptive statistics. RESULTS: A total of 83 questionnaires (response rate 92.3%), 48.2% of emergency nurses experienced verbal violence, 21.7% both verbal and physical violence and only 28.9% denied having experienced either. Nurses feeling at risk in emergency setting were more exposed to workplace violence (p=0.001). Anxiety (p=0.023) and anger (p=0.001) were perceived feeling with significant repercussions on the degree of evidence working in ED (p=0.043) and on trust in management (p=0.001). CONCLUSIONS: Workplace violence turns out to be a serious and widespread problem that generates negative feelings in the attacked subject that affect the personal and work dimension. The promotion of simple and anonymous reporting systems would help nurses to be more aware of the importance of reporting the event, which is still in deficit today, thus preventing a true and proper estimate of the phenomenon. Future research should be focused for preventive measures could be drawn up to reduce the problem.

Workplace violence in emergency departments: The health professionals and security personnel alliance.

Violence in the health sector is a widespread worldwide phenomenon. Emergency nurses and emergency physicians are among the most exposed. In violent incidents, security personnel also play an important role. Wand and colleagues on Emergency Medicine Australasia have tried to give voice to the opinions and experiences of security personnel in responding to aggression and behavioural problems. Sharing some data from our 2016 Italian National Survey on Violence towards Emergency Nurses, further elements are provided on this issue. The different perspectives of healthcare professionals and security personnel can converge in an alliance to counteract violence in the ED.

Violence towards Emergency Nurses: The 2016 Italian National Survey-A cross-sectional study.

AIM: To analyse the dimensions and characteristics of violence towards Emergency nurses in a national context (Italy). BACKGROUND: Nurses are the most exposed to workplace violence, especially in Emergency Department contexts. METHODS: A cross-sectional study was conducted in all Italian regions. Descriptive analyses were used to examine violence from patients and relatives (Type II violence) concerning personal characteristics of the Emergency nurses and perpetrators, environmental and organisational factors. Multinomial logistic regression analysis was used to investigate risk factors. RESULTS: About 76.0% of Emergency nurses experienced verbal violence, 15.5% both verbal and physical violence and only 8.5% denied having experienced either. Older age and more experience in Emergency settings are protective factors. Working in the South of Italy significantly increases the probability of being exposed. DISCUSSION: There are many factors explaining violence, but some correlations are not clear. CONCLUSION: Factors that have a positive effect on this problem include: specific training for younger nurses, a strong alliance between users and health personnel to restore a relationship of trust between parties, physical barriers and appropriate architectural measures. IMPLICATIONS FOR NURSING MANAGEMENT: Comprehensive approaches can represent an effective strategy to counteract workplace violence.

The influence of age on the psychological profile of patients with cardiac implantable electronic devices: results from the Italian population in a multicenter study conducted by the European Heart Rhythm Association.

BACKGROUND: Cardiac implantable electronic devices (CIEDs) are widely used to treat bradyarrhythmias or improve the prognosis of patients with heart failure (HF). AIMS: To evaluate age-related (≤ 75 vs. > 75 years) attitudes, worries, psychological effects and needs in an Italian CIEDs population. METHODS: Patients attending their periodical ambulatory evaluation received a questionnaire conceived by the European Heart Rhythm Association Scientific Initiatives Committee as part of a multicenter, multinational snapshot survey. Seven countries participated in the study, and 1646 replies were collected. Of these, 437 (27%) were from Italy. Present results refer to the Italian population only. CIEDs were stratified into devices to treat bradycardia or HF. RESULTS: The use of CIEDs was more common in advanced age. Older patients needed less information about CIEDs than younger ones (p = 0.044), who would prefer to be better informed about CIEDs-related consequences on psychologic profile (p = 0.045), physical (p < 0.001) and sexual (p < 0.001) activities, and driving limitations (p = 0.003). When compared to older subjects, younger individuals experienced more difficulties (p = 0.035), especially in their professional (p < 0.001) and private life (p = 0.033), feeling their existence was limited by the device (p < 0.001). Conversely, quality of life (HRQL) more often improved in the elderly (p = 0.001). Information about what to do with CIEDs at the end of life is scant independently of age. CONCLUSIONS: HRQL after CIEDs implantation improves more frequently in older patients, while the psychological burden of CIEDs is usually higher in younger patients. End of life issues are seldom discussed.