Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 12 de 12
Filtrar
Más filtros










Base de datos
Intervalo de año de publicación
1.
Ig Sanita Pubbl ; 73(2): 107-119, 2017 Mar-Apr.
Artículo en Italiano | MEDLINE | ID: mdl-28617775

RESUMEN

The national expenditure limits set by the spending review has required reorganization and streamlining measures. The present study was conducted in 2015, among 2,020 nurses and 861 doctors in the autonomous province of Trento (Italy), to describe their perceptions of the containment measures introduced in healthcare spending, following the spending review. Results show that nurses and doctors were most affected by the measures regarding staff management (staff turnover rate, reducing overtime and changes in training). These measures, however, cannot be adopted for a long period of time without leading to negative effects on organization and quality of care.


Asunto(s)
Actitud del Personal de Salud , Gastos en Salud , Enfermeras y Enfermeros , Médicos , Italia
2.
Scand J Caring Sci ; 31(4): 768-778, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28509365

RESUMEN

BACKGROUND: Patient satisfaction with nursing care (NC) is an important predictor of overall satisfaction with the hospital experience. However, the concept of patient satisfaction has been criticised both at the theoretical and at the methodological levels, and more attention on patient dissatisfaction has been called for with the aim of identifying strategies to improve the quality of care. AIMS: To describe dissatisfaction with NC as perceived by acute medical patients and identify predictors. DESIGN AND METHODS: A secondary analysis of longitudinal data involving 12 Italian medical units was performed. A consecutive sample of 1016 patients ≥65 years (2012-2013) was included, and their satisfaction with NC was assessed, administering the Italian version of the Patient Satisfaction Scale (PSS) at the day of discharge. The scale was based on 11 items evaluated on a four-point Likert scale (score ranging from 11 - very dissatisfied to 44 - very satisfied). Patients were defined as 'satisfied with NC' when the score was ≥33, whereas they were considered as 'dissatisfied with NC' when the score was <33. A logistic regression analysis was performed to identify the predictors of patient dissatisfaction with NC. RESULTS: There were 788 (77.6%) patients satisfied (≥33 at the PSS) and 228 (22.4%) dissatisfied with NC (<33). The risk of dissatisfaction was likely to be higher in female patients (RR 1.883, 95% CI 1.359-2.609), in those who developed pressure sores during the in-hospital stay (RR 1.555, 95% CI 1.021-2.368), who received NC with high skill mix (RR 1.072, 95% CI 1.034-1.111) and those who were admitted to a large hospital (RR 1.001, 95% CI 1.001-1.002). In contrast, increased age (RR 0.987, 95% CI 0.975-0.998), increased amount of care offered by Registered Nurses (RR 0.984, 95% CI 0.974-0.994), a higher proportion of baccalaureate nurses on staff (RR 0.975, 95% CI 0.958-0.993) and being admitted to a teaching hospital (RR 0.497, 95% CI 0.130-0.910) all decreased the likelihood of being dissatisfied with NC. CONCLUSIONS: Dissatisfaction with NC was affected by individual, NC and hospital variables, such as the amount of staff resources, nurses education and skill mix. The findings emerged may inform clinicians, managers and policymakers regarding strategies that should be designed and implemented to prevent patient dissatisfaction.


Asunto(s)
Hospitalización , Atención de Enfermería/normas , Satisfacción del Paciente , Anciano , Femenino , Humanos , Estudios Longitudinales , Masculino , Calidad de la Atención de Salud
3.
J Tissue Viability ; 26(2): 85-88, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28365206

RESUMEN

To describe the prevalence and incidence density of hospital-acquired unavoidable pressure sores among patients aged ≥65 years admitted to acute medical units. A secondary analysis of longitudinal study data collected in 2012 and 2013 from 12 acute medical units located in 12 Italian hospitals was performed. Unavoidable pressure ulcers were defined as those that occurred in haemodynamically unstable patients, suffering from cachexia and/or terminally ill and were acquired after hospital admission. Data at patient and at pressure ulcer levels were collected on a daily basis at the bedside by trained researchers. A total of 1464 patients out of 2080 eligible (70.4%) were included. Among these, 96 patients (6.5%) hospital-acquired a pressure ulcer and, among 19 (19.7%) were judged as unavoidable. The incidence of unavoidable pressure ulcer was 8.5/100 in hospital-patient days. No statistically significant differences at patient and pressure ulcers levels have emerged between those patients that acquired unavoidable and avoidable pressure sores. Although limited, evidence on unavoidable pressure ulcer is increasing. More research in the field is recommended to support clinicians, managers and policymakers in the several implications of unavoidable pressure ulcers both at the patient and at the system levels.


Asunto(s)
Unidades de Cuidados Intensivos/estadística & datos numéricos , Úlcera por Presión/epidemiología , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Humanos , Incidencia , Estudios Longitudinales , Masculino , Úlcera por Presión/clasificación , Úlcera por Presión/prevención & control , Prevalencia , Factores de Riesgo
4.
Aging Clin Exp Res ; 29(3): 517-527, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-27155980

RESUMEN

BACKGROUND: Given the progressive demographic ageing of the population and the National Health System reforms affecting care at the bedside, a periodic re-evaluation of in-hospital mortality rates and associated factors is recommended. AIMS: To describe the occurrence of in-hospital mortality among patients admitted to acute medical units and associated factors. Two hypotheses (H) were set as the basis of the study: patients have an increased likelihood to die H1: at the weekend when less nursing care is offered; H2: when they receive nursing care with a skill-mix in favour of Nursing Aides instead of Registered Nurses. METHODS: Secondary analysis of a prospective study of patients >65 years consecutively admitted in 12 Italian medical units. Data on individual and nursing care variables were collected and its association with in-hospital mortality was analysed by stepwise logistic regression analysis. RESULTS: In-hospital mortality occurrence was 6.8 %, and 37 % of the patients died during the weekend. The logistic regression model explained 34.3 % (R 2) of the variance of in-hospital mortality: patients were six times (95 % CI = 3.632-10.794) more likely at risk of dying at weekends; those with one or more AEDs admissions in the last 3 months were also at increased risk of dying (RR 1.360, 95 % CI = 1.024-1.806) as well as those receiving more care from family carers (RR = 1.017, 95 % CI = 1.009-1.025). At the nursing care level, those patient receiving less care by RNs at weekends were at increased risk of dying (RR = 2.236, 95 % CI = 1.270-3.937) while those receiving a higher skill-mix, thus indicating that more nursing care was offered by RNs instead of NAs were at less risk of dying (RR = 0.940, 95 % CI = 0.912-0.969). CONCLUSIONS: Within the limitations of this secondary analysis, in addition to the role of some clinical factors, findings suggest redesigning acute care at weekends ensuring consistent care both at the hospital and at the nursing care levels.


Asunto(s)
Enfermedad Crítica/mortalidad , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Atención Posterior/estadística & datos numéricos , Anciano , Causas de Muerte , Comorbilidad , Enfermedad Crítica/enfermería , Femenino , Humanos , Italia , Modelos Logísticos , Estudios Longitudinales , Masculino , Personal de Enfermería en Hospital/provisión & distribución , Estudios Prospectivos
5.
Scand J Caring Sci ; 31(1): 85-95, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-27163738

RESUMEN

BACKGROUND: Informal caregiving offered by family members has been widely studied in the community setting, but little attention to date has been dedicated to that offered at the hospital level. AIMS: To describe the proportion of patients admitted to acute medical units receiving care from informal caregivers as decided by the family and to identify the factors affecting the numbers of care shifts performed by informal caregivers. DESIGN AND METHODS: A longitudinal study was performed involving 12 acute medical units located in 12 northern Italian hospitals. RESULTS: All patients (N = 1464) admitted to medical units were included, and 77.1% of them received at least one shift of informal care during their in-hospital stay, especially during the mornings and afternoons. At the patient level, those at higher risk of prolonged hospitalisation and difficult discharge at admission, and those reporting higher occurrence of adverse events, such as pressure sores, confusion events and use of physical restraints during hospitalisation, were more likely receiving informal care. At the nursing care level, a higher amount of missed nursing care was associated with an increased number of care shifts offered by informal caregivers during patient hospitalisation, whereas the amount of care offered by staff was a protective factor. CONCLUSIONS: Families play a care role in the care of older patients admitted to acute medical units. They contribute substantially to the care of patients, especially during morning and afternoon shifts.


Asunto(s)
Cuidadores/psicología , Enfermería de Cuidados Críticos/organización & administración , Familia/psicología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Italia , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
6.
J Eval Clin Pract ; 22(5): 771-80, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27144880

RESUMEN

RATIONALE: There is growing interest in validating tools aimed at supporting the clinical decision-making process and research. However, an increased bureaucratization of clinical practice and redundancies in the measures collected have been reported by clinicians. Redundancies in clinical assessments affect negatively both patients and nurses. METHODS: To validate a meta-tool measuring the risks/problems currently estimated by multiple tools used in daily practice. A secondary analysis of a database was performed, using a cross-validation and a longitudinal study designs. In total, 1464 patients admitted to 12 medical units in 2012 were assessed at admission with the Brass, Barthel, Conley and Braden tools. Pertinent outcomes such as the occurrence of post-discharge need for resources and functional decline at discharge, as well as falls and pressure sores, were measured. Explorative factor analysis of each tool, inter-tool correlations and a conceptual evaluation of the redundant/similar items across tools were performed. Therefore, the validation of the meta-tool was performed through explorative factor analysis, confirmatory factor analysis and the structural equation model to establish the ability of the meta-tool to predict the outcomes estimated by the original tools. RESULTS: High correlations between the tools have emerged (from r 0.428 to 0.867) with a common variance from 18.3% to 75.1%. Through a conceptual evaluation and explorative factor analysis, the items were reduced from 42 to 20, and the three factors that emerged were confirmed by confirmatory factor analysis. According to the structural equation model results, two out of three emerged factors predicted the outcomes. CONCLUSIONS: From the initial 42 items, the meta-tool is composed of 20 items capable of predicting the outcomes as with the original tools.


Asunto(s)
Eficiencia Organizacional , Evaluación en Enfermería/organización & administración , Habitaciones de Pacientes , Anciano , Bases de Datos Factuales , Análisis Factorial , Femenino , Hospitalización , Humanos , Entrevistas como Asunto , Italia , Masculino , Observación , Investigación Cualitativa
7.
Geriatr Nurs ; 37(3): 192-9, 2016 May-Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26895646

RESUMEN

Describing the trajectories of hospital-associated functional decline in older patients admitted to acute medical units and identifying predictors at the individual, nursing, and hospital levels, were the aims of the study. A longitudinal survey among 12 acute medical units in which 1464 patients were consecutively enrolled and evaluated using the Barthel Index (BI), was performed. Functional decline was defined as a decrease in the BI of at least 5 points from admission to discharge. In all, 17.1% participants (n = 251) demonstrated functional decline. In accordance with multiple logistic regression analysis, 28.8% (R(2)) of the variance in the functional decline was explained by: confusion/disorientation (RR = 4.684; 95% CI = 3.144-6.978), admission from nursing homes (RR = 2.464; 95% CI = 1.642-3.697), daily care expressed in minutes offered by nursing aides (RR = 1.535; 95% CI = 1.275-1.849), higher workforce skill-mix (RR = 2.221; 95% CI = 1.763-2.797), bladder catheter insertion (RR = 1.599; 95% CI = 1.128-2.268), and higher BI score at admission (RR = 1.019; 95% CI = 1.014-1.024). Increasing the amount of care delivered by competent nurses-having a bachelors degree-providing and supervising direct-care activities, may reduce the occurrence of functional decline in older patients admitted to medical units.


Asunto(s)
Actividades Cotidianas , Evaluación Geriátrica , Hospitalización , Anciano , Confusión , Hospitales , Humanos , Estudios Longitudinales , Factores de Riesgo , Cateterismo Urinario
8.
Aging Clin Exp Res ; 28(1): 139-46, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26025462

RESUMEN

BACKGROUND: The Conley Scale is one of the most widespread fall-risk screening tools in medical unit settings, despite the lack of data regarding its validity in patients currently admitted to these units. AIMS: Establishing the validity of the Conley Scale in identifying patients at risk of falling in an acute medical setting. METHODS: A 6-months longitudinal study in 12 acute medical units from September 2012 to March 2013, a total of 1464 patients with ≥65 years of age were consecutively enrolled and evaluated with the Conley Scale within 24 h of admission. A construct validity, internal consistency, and a priori and a posteriori predictive validity study was performed. RESULTS: The explorative factor analysis showed a two-factor structure explaining a total variance of 48.3 %: previous history (30.41 %), and physical and cognitive impairment (17.9 %). The scale reported a poor internal consistency (Cronbach's α = 0.465) and the capability to correctly identify 18/649 patients as being at risk of falling, whereas the negative predictive value was 98.5 %. The sensitivity and specificity values were 60.0 and 55.9 %, respectively. No difference emerged between patients scored as at risk and those scored as not at risk in the time elapsed from admission to the first fall (HR = 0.600, 95 % CI 0.289-2.247 p = .166). DISCUSSION: The Conley Scale is not able to predict falls in elderly acute medical patients, and has reported poor internal consistency and accuracy. CONCLUSIONS: More studies are needed to develop appropriate tools to predict the risk of falling in elderly individuals admitted to an acute medical setting.


Asunto(s)
Accidentes por Caídas , Disparidades en el Estado de Salud , Competencia Mental , Medición de Riesgo/métodos , Accidentes por Caídas/prevención & control , Accidentes por Caídas/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Femenino , Evaluación Geriátrica/métodos , Hospitalización/estadística & datos numéricos , Humanos , Estudios Longitudinales , Masculino , Valor Predictivo de las Pruebas , Recurrencia , Reproducibilidad de los Resultados , Factores de Riesgo
9.
Intern Emerg Med ; 10(6): 693-702, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-25840678

RESUMEN

Missed nursing care (MNC), such as nursing care omitted or delayed, has not been measured in the Italian context where several cost containment interventions affect the care offered in medical units. The aim of the study is to identify the amount, type, and reasons for MNC in the Italian medical care setting and to explore the factors that affect the occurrence of MNC. A 3-month longitudinal survey was carried out followed by a cross-sectional study design in 12 north eastern acute medical units. A total of 314 nursing staff members were involved. Multivariate logistic regression was performed to identify the predictors of MNC. Patient ambulation (91.4 %), turning the patient every 2 h (74.2 %), and right timing in administering medications (64.6 %) were the most perceived MNC. Among the most frequent reasons were the unexpected rise in patient volume or critical conditions (95.2 %), inadequate numbers of staff (94.9 %), and large numbers of admissions/discharges (93.3 %). The R (2) 33.2 % of the variance in MNC were explained by a full-time position (OR 4.743, 95 % CI 1.146-19.629), communication tensions between Registered Nurses and Nurses' Aides (OR 1.601, 95 % CI 1.020-2.515), the amount of experience in medical unit (OR 1.564, 95 % CI 1.021-2.397), and the amount of daily care offered by Nurses' Aides (1.039, 95 % CI 1.011-1.067). A substantial amount of basic and clinically relevant nursing interventions was perceived to be missed, and this may lead to an increase in negative outcomes for patients admitted to a medical unit. Appropriate standards of nursing care should be adopted urgently in medical units aiming to protect frail patients.


Asunto(s)
Atención de Enfermería/normas , Carga de Trabajo/normas , Adulto , Estudios Transversales , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Análisis Multivariante , Enfermeras y Enfermeros , Atención de Enfermería/tendencias , Habitaciones de Pacientes/normas , Recursos Humanos
10.
Aging Clin Exp Res ; 25(6): 707-10, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24142847

RESUMEN

BACKGROUND: According to available evidence, when the nurse-to-patient ratio is insufficient the occurrence of accidental falls, pressure sores, malnutrition, hospital-acquired dependency in activities of daily living, infections associated with nursing practice and errors in administration of medication as well as mortality all increase. However, while several countries have established a body of evidence and policies concerning the minimum nurse-to-patient ratio, the amount of nursing care offered in Italian medical units remains under-studied. METHODS: Evaluating variability in the nurse-to-patient ratio and in the skill-mix offered, 12 medical units willing to participate were evaluated with a face-to-face interview performed by a researcher to the nurse manager of the unit. The role of the unit at the hospital level, the nurse-to-patient ratio available on a daily basis, the skill-mix and the strategies enacted in the case of patient overcrowding or understaffing were collected. RESULTS: The mission of the medical units is devoted mainly towards elderly people. The bed occupancy is high and the strategies adopted in case of patient overcrowding determine unstable environments both for medical units (extra beds) and other units (patients temporarily hosted). In the medical units, nurses attend to 5-13 patients in the morning, 7.6-14.6 in the afternoon, and 12.3-30.5 during the night. The skill-mix ranges from 43.5 % (more nursing aides than nurses are available on the ward) to 81.2 % (more nurses than nursing aides are available). CONCLUSIONS: This assessment exercise indicates that nursing care in medical units faces high workloads. Establishing national minimum standards of nursing care to be delivered towards older people admitted in Italian medical units is recommended.


Asunto(s)
Atención de Enfermería , Personal de Enfermería en Hospital , Atención al Paciente , Factores de Edad , Anciano , Unidades Hospitalarias , Humanos , Italia , Carga de Trabajo
12.
Ig Sanita Pubbl ; 67(6): 777-92, 2011 Nov-Dec.
Artículo en Italiano | MEDLINE | ID: mdl-22508648

RESUMEN

Nurse staffing levels have always been an issue and the optimal level and mix of nurses required to deliver quality care as cost-effectively as possible continues to be discussed at both national and international levels. In Italy, a network of experts rom ten local health and hospital authorities was set up in June 2010. The, main objectives of the network were to define, validate and approve a panel of relevant indicators, identify minimum standards of safety and develop recommendations to guide decision-making regarding hospital nurse staffing levels. The indicators and recommendations developed by the network are presented in this paper.


Asunto(s)
Personal de Enfermería en Hospital/normas , Admisión y Programación de Personal , Calidad de la Atención de Salud/normas , Administración de la Seguridad/normas , Humanos , Italia , Personal de Enfermería en Hospital/provisión & distribución , Evaluación de Resultado (Atención de Salud)/normas , Carga de Trabajo
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA