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1.
BMC Neurol ; 19(1): 310, 2019 Dec 02.
Artículo en Inglés | MEDLINE | ID: mdl-31791260

RESUMEN

BACKGROUND: Patients with acute stroke are particularly vulnerable to delirium episodes. Although delirium detection is important, no evidence-based recommendations have been established to date on how these patients should be routinely screened for delirium or which tool should be used for this purpose in this population. Therefore, the aim of this study was to identify delirium screening tools for patients with acute stroke and to summarise their accuracy. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of Medline, CINAHL and Scopus databases was performed to include: (a) diagnostic test accuracy studies; (b) evaluating tools detecting delirium among patients with acute stroke; (c) written in English; (d) published up to September 2018. The included studies were assessed in their quality by using the Quality Assessment of Diagnostic Accuracy Studies-2. RESULTS: A total of four studies have been performed to date in the field with a variable quality for the methodology used and documentation of the accuracy of mainly two tools, as (1) the 4-Assessment Test for delirium (4AT), reporting a range of sensitivity from 90.2 to 100% and a specificity from 64.5 to 86%; and (2) the Confusion Assessment Method-Intensive Care Unit (CAM-ICU) showing a sensitivity of 76% (95% Confidence of Interval [CI] 55-91) and a specificity of 98% (95%CI 93-100). Other tools have been studied as: The Abbreviated Mental Test-10, the Abbreviated Mental Test short form, the Clock Drawing Test, the Cognitive Examination derived from the National Institutes of Health Stroke Scale and the Glasgow Coma Scale. Moreover, the use of a single question-namely, 'Does this patient have cognitive issues?' as answered by the multidisciplinary team-has been subjected to a validation process. CONCLUSIONS: To date a few primary studies have been published to test the accuracy of tools in their ability to detect post-stroke delirium; among those available, the 4AT and the CAM-ICU tools have been mostly studied. Research has just started to add evidence to the challenge of detecting and usefully assessing newly-acquired delirium among stroke patients: therefore, more studies are needed to improve the knowledge and allow a robust selection of the most useful tool to use in this population.

2.
Aging Clin Exp Res ; 2019 Aug 05.
Artículo en Inglés | MEDLINE | ID: mdl-31378845

RESUMEN

BACKGROUND: The management of delirium among older in-hospital patients is a challenge, leading to worse outcomes, including death. Specifically, psychomotor agitation, one of the main characteristics of hyperactive delirium, requires a significant amount of medical and nursing surveillance. However, despite its relevance, to date incidence and/or prevalence of psychomotor agitation, its predictors and outcomes have not been studied among Italian older patients admitted in medical units. AIMS: To describe the incidence and the prevalence of psychomotor agitation among patients aged > 65 years admitted to medical units and identify predictors at the individual, nursing care and hospital levels. METHODS: A longitudinal multicentre study was conducted involving 12 medical units in 12 northern Italian hospitals. Descriptive, bivariate and multivariate logistic regression analyses were performed. RESULTS: Among the 1464 patients included in the study, two hundred (13.6%) have manifested episode(s), with an average of 3.46/patient (95% confidence of interval [CI] 2.73-4.18). In 108 (54.0%) patients, episode(s) were present also in the week prior to hospitalisation: therefore, in-hospital-acquired psychomotor agitation was reported in 92 patients (46%). The multivariate logistic regression analysis explained the 25.4% of the variance and identified the following variables as psychomotor agitation predictors: the risk of falls (relative risk [RR] 1.314, 95% CI 1.218-1.417), the amount of missed nursing care (RR 1.078, 95% CI 1.037-1.12) and the patient's age (RR 1.018, 95% CI 1.002-1.034). Factors preventing the occurrence of episode(s) were: the amount of care received from graduated nurses (RR 0.978; 95% CI 0.965-0.992) and the lower functional dependence at admission (RR 0.987, 95% CI 0.977-0.997). CONCLUSIONS: A considerable number of elderly patients admitted in medical units develop psychomotor agitation; its predictors need to be identified early to inform decisions regarding the personal care needed to prevent its occurrence, especially by acting on modifiable factors, such as the risk of falls, missed nursing care and functional dependence.

3.
Int J Older People Nurs ; 14(3): e12245, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31148416

RESUMEN

BACKGROUND: Nursing students report care of the older people as an undesirable career pathway. Positive clinical placement experiences influence students' attitudes and career intentions with respect to nursing home (NH) setting. The clinical environment's quality depends on meaningful learning opportunities, the relationship with the preceptors, and the pedagogical atmosphere as influenced by the staff-student interactions. AIM: The aim of this study was to explore nursing students' perceptions on their clinical learning experience and competence learned in the NH setting as compared to other clinical areas. METHODS: A secondary analysis was performed of an Italian national cross-sectional study involving 9,607 nursing students attending 95 different three-year bachelor laureate nursing programmes in 27 universities. A questionnaire exploring individual and nursing programme variables was devised. Moreover, students self-reported the perceived quality of the clinical learning experience using the Clinical Learning Quality Evaluation Index tool and the degree of competence learned using a four-point Likert-type scale. RESULTS: Students in the NH setting scored the overall quality of the learning environment significantly higher (p = 0.046) compared to those experiencing other clinical settings, and they scored higher learning occasions (p = 0.002) and self-directed learning opportunities (p = 0.018). No difference emerged in the perceived mean degree of competences learned at the end of the clinical rotation (p = 0.271). CONCLUSION: Nursing students perceive the NH setting to be a good quality learning environment with valuable learning opportunities and self-directed learning opportunities compared to other settings. The nursing home setting provides opportunities to acquire clinical competences comparable to the ones in other clinical settings such as hospital units. IMPLICATIONS FOR PRACTICE: Nursing home settings should be considered by all nursing programmes as a learning environment particularly worthy for students at different levels of their education.

4.
Eur J Cardiovasc Nurs ; 18(6): 435-448, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31027426

RESUMEN

BACKGROUND: Delirium is a complex syndrome characterised by disturbances in attention and awareness, associated with alterations in cognitive functions, which can emerge in a time frame of hours or days and tend to fluctuate in severity over time. Delirium is a clinical manifestation of the brain's vulnerability and diminished resilience to insult. Stroke patients are particularly vulnerable to delirium episodes. AIMS: The aim of this study was to map: (a) studies focused on ischaemic or haemorrhagic post-stroke delirium; (b) factors that have been investigated as being possibly associated with post-stroke delirium; and (c) outcomes that have been studied to date. METHODS: A scoping review was performed. Medline, CINAHL, Cochrane Database of Systematic Reviews, PsycINFO and Scopus databases were searched. Eligible studies were those: (a) exploring any variable regarding delirium in patients with stroke; (b) involving adults; (c) as primary studies; (d) written in English; and (e) published before April 2017. RESULTS: To date 25 studies have been published, mainly prospective or cohort studies. The most commonly studied predisposing factors have been the older age, gender, aetiology of the stroke and its location, and the presence of previous cognitive decline/dementia. The most studied precipitating factors to date have been pneumonia, urinary tract infections and symptoms of neglect. Functional dependence, length of inhospital stays, post-stroke cognitive impairments or dementia, short and long-term mortality have been the most studied post-stroke delirium outcomes. CONCLUSIONS: Studies across different clinical settings, also at the international level, including more female patients and a wider range of ages should be designed in order to improve the evidence available to develop specific clinical guidelines. Standardised frameworks of research addressing the great variability of methods and measures used in the field should be established at the international level by clinicians and researchers' experts in the field.

5.
BMJ Open ; 9(3): e025575, 2019 03 20.
Artículo en Inglés | MEDLINE | ID: mdl-30898820

RESUMEN

OBJECTIVE: To explore nursing students' interprofessional educational (IPE) experiences during their most recent clinical rotation and to explore the factors supporting IPE experiences. DESIGN: National cross-sectional study on data collected in 2016. SETTING: 95 Bachelor of Nursing Sciences programmes; 27 Italian Universities. PARTICIPANTS: Students who (a) were attending or just completed their clinical rotations lasting at least 2 weeks in the same unit, and (b) willing to participate in the study. PRIMARY AND SECONDARY OUTCOMES: First to measure the occurrence of IPE experiences in the most recent clinical rotation; the secondary outcome was to discover factors associated with IPE occurrence. MEASURES: The primary outcome was measured using questions based on a 4-point Likert scale (from 0='never' to 3='always'). Explanatory variables were collected at both individual and regional levels with items included in the same questionnaire. RESULTS: 9607 out of 10 480 students took part in the study. Overall, 666 (6.9%) perceived not having had any IPE experience, while 3248 (33.8%), 3653 (38%) and 2040 (21.3%) reported having experienced IPE opportunities 'only a little', to 'some extent' or 'always', respectively. From the multilevel analysis performed using the generalised linear mixed model, factors promoting the occurrence of IPE experiences were mainly set at (a) the clinical learning environment level (high: learning environment quality, self-directed learning encouragement, learning opportunities, quality of safety and nursing care and quality of tutorial strategies); and (b) the regional level, where significant differences emerged across regions. In contrast, male gender was negatively associated with the perception of having had IPE experiences. CONCLUSIONS: A large number of nursing students experienced either 'never' or 'only a little' IPE opportunities, thus suggesting that nursing education tends to remain within the nursing profession. Limiting students' interprofessional exposure during education can prevent future collaborative approaches that have been shown to be essential in providing best patient care. In order to increase IPE exposure, it is necessary to develop strategies designed both at the singular unit and regional levels.

6.
Nurse Educ Today ; 75: 13-21, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30669021

RESUMEN

BACKGROUND: Effective performance of clinical handovers should be one of the priorities of nursing education to promote efficient communication skills and ensure patient safety. However, to date, no studies have explored to what extent nursing students are involved in handovers. OBJECTIVE: To explore nursing students' handover involvement during their clinical rotations and associated factors. METHOD: This was a secondary analysis of a large national cross-sectional study that involved 9607 undergraduate nursing students in 27 universities across 95 three-year Italian baccalaureate nursing programs. The involvement in the clinical handovers was the end point (from 0, never, to 3, always). A path analysis was performed to identify variables directly and indirectly affecting students' handover involvement. RESULTS: Handover involvement was reported as 'only a little', 'to some extent', and 'always' by 1739 (18.1%), 2939 (30.6%), and 4180 (43.5%) students, respectively; only 749 (7.8%) of students reported never being involved. At the path analysis explaining the 19.1% of variance of nursing students' involvement, some variables emerged that directly increased the likelihood of being involved in handovers. These were being female (ß = 0.115, p < 0.001); having children (ß = 0.107, p = 0.011); being a 3rd-year student (ß = 0.142, p < 0.001) and being a 2nd-year student as compared to a 1st-year student (ß = 0.050, p = 0.036); and having a longer clinical rotation (ß = 0.015, p < 0.001) in units with high 'quality of the learning environment' (ß = 0.279, p < 0.001). Moreover, students who were supervised by the nurse teacher (ß = -0.279, p < 0.001), or by a nurse on a daily basis (ß = -0.253, p = 0.004), or by the staff (ß = -0.190, p < 0.001) reported being less involved in handovers as compared to those students supervised by a clinical nurse. Variables with indirect effects also emerged (model of student's supervision adopted at the unit level, and number of previous clinical rotations attended by students). Moreover, handover involvement explained 11.5% of students self-reported degree of competences learned during the clinical experience. CONCLUSIONS: Limiting students' opportunity to be involved in handover can prevent the development of communication skills and the professional socialization processes. Strategies at different levels are needed to promote handover among undergraduate nursing students.


Asunto(s)
Pase de Guardia/estadística & datos numéricos , Preceptoría/métodos , Estudiantes de Enfermería/estadística & datos numéricos , Estudios Transversales , Bachillerato en Enfermería/métodos , Bachillerato en Enfermería/estadística & datos numéricos , Femenino , Humanos , Masculino , Preceptoría/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven
7.
Worldviews Evid Based Nurs ; 15(6): 480-490, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30328676

RESUMEN

BACKGROUND: Easy-to-access tools have been demonstrated to improve evidence-based practice (EBP) competences among nursing students. However, students' perception of access to EBP tools (e.g., clinical practice guidelines [CPGs], protocols) is unknown. AIMS: To explore: (1) nursing students' opportunity to access EBP tools during their education, and (2) associated factors. METHODS: A national cross-sectional study including all Italian nursing programs. Nursing students were deemed eligible according to the following inclusion criteria: Those who (1) were attending or just ended their practical rotation lasting at least 2 weeks at the time of the survey, and (2) expressed through written informed consent their willingness to take part in the study. Participants were asked about their perceived opportunity to access EBP tools during their most recent clinical learning experience (from 0 - not at all to 3 - always). A set of explanatory variables was collected at the individual, nursing program, and regional levels by using a questionnaire. RESULTS: Nine thousand six hundred and seven (91.6%) out of 10,480 nursing students took part in the study. Overall, 4,376 (45.6%) students perceived not at all or only a small opportunity to access EBP tools during their most recent clinical rotation. In the multilevel analysis, factors promoting access were mainly set at the clinical learning environment level (high safety and nursing care quality, high self-directed learning opportunities, high quality of the learning environment, and being supervised by a clinical nurse). In contrast, male gender and lower academic class were associated with a lower perception of accessibility to EBP tools. A consistent variability in the perceived opportunity to access EBP tools emerged across regions. LINKING EVIDENCE TO ACTION: Evidence-based decision-making is increasingly expected from nurses. Therefore, nursing faculties should safeguard and continuously improve students' competence regarding EBP, by implementing strategies mainly at the nursing program and regional levels.

8.
Med Educ ; 52(11): 1156-1166, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30345687

RESUMEN

CONTEXT: Error reporting is considered one of the most important mediating factors for patient safety (PS). However, reporting errors can be challenging for health care students. OBJECTIVES: The aims of the study were: (i) to describe nursing students' opportunity to report errors, near misses or PS issues that emerged during their clinical learning experience; and (ii) to explore associated factors of the process of reporting itself. METHODS: A national survey was conducted on 9607 (91.7%) undergraduate nursing students. The endpoint was to have reported PS issues in the last clinical learning experience (from 0 'never' to 3 'always'). Explanatory variables were set individual, nursing programme and regional levels. RESULTS: A total of 4004 (41.7%) nursing students reported PS issues from 'never/rarely' to 'sometimes'. In the multi-level analysis, factors increasing the likelihood of reporting events affecting PS have been mainly at the nursing programme level: specifically, higher learning opportunities (odds ratio [OR] = 3.040; 95% confidence interval [CI], 2.667-3.466), self-directed learning opportunities (OR = 1.491; 95% CI, 1.364-1.630), safety and nursing care quality (OR = 1.411; 95% CI, 1.250-1.594) and quality of tutorial strategies OR = 1.251; 95% CI, 1.113-1.406). By contrast, being supervised by a nurse teacher (OR = 0.523; 95% CI, 0.359-0.761) prevented the disclosure of PS issues compared with being supervised by a clinical nurse. Students attending their nursing programmes in some Italian regions showed a higher likelihood (OR from 1.346 to 2.938) of reporting PS issues compared with those undertaking their education in other regions. CONCLUSIONS: Nursing students continue to be reticent to report PS issues. Given that they represent the largest generation of future health care workers, their education regarding PS should be continuously monitored and improved; moreover, strategies aimed at developing a non-blaming culture should be designed and implemented both at the clinical learning setting and regional levels.

9.
Nurs Ethics ; : 969733018774617, 2018 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-29783904

RESUMEN

BACKGROUND: Undergraduate nursing students have been documented to experience ethical distress during their clinical training and felt poorly supported in discussing the ethical issues they encountered. Research aims: This study was aimed at exploring nursing students' perceived opportunity to discuss ethical issues that emerged during their clinical learning experience and associated factors. RESEARCH DESIGN: An Italian national cross-sectional study design was performed in 2015-2016. Participants were invited to answer a questionnaire composed of four sections regarding: (1) socio-demographic data, (2) previous clinical learning experiences, (3) current clinical learning experience quality and outcomes, and (4) the opportunity to discuss ethical issues with nurses in the last clinical learning experience (from 0 - 'never' to 3 - 'very much'). Participants and research context: Participants were 9607 undergraduate nursing students who were attending 95 different three-year Italian baccalaureate nursing programmes, located at 27 universities in 15 Italian regions. Ethical considerations: This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines after the research protocol was approved by an ethics committee. FINDINGS: Overall, 4707 (49%) perceived to have discussed ethical issues 'much' or 'very much'; among the remaining, 3683 (38.3%) and 1217 (12.7%) students reported the perception of having discussed, respectively, 'enough' or 'never' ethical issues emerged in the clinical practice. At the multivariate logistic regression analysis explaining 38.1% of the overall variance, the factors promoting ethical discussion were mainly set at the clinical learning environment levels (i.e. increased learning opportunities, self-directed learning, safety and nursing care quality, quality of the tutorial strategies, competences learned and supervision by a clinical nurse). In contrast, being male was associated with a perception of less opportunity to discuss ethical issues. CONCLUSION: Nursing faculties should assess the clinical environment prerequisites of the settings as a context of student experience before deciding on their accreditation. Moreover, the nursing faculty and nurse managers should also enhance competence with regard to discussing ethical issues with students among clinical nurses by identifying factors that hinder this learning opportunity in daily practice.

10.
Assist Inferm Ric ; 36(1): 41-50, 2017 Jan-Mar.
Artículo en Italiano | MEDLINE | ID: mdl-28398391

RESUMEN

. The Clinical Learning Quality Evaluation Index for nursing students. INTRODUCTION: The Italian nursing programs, the need to introduce tools evaluating the quality of the clinical learning as perceived by nursing students. Several tools already exist, however, several limitations suggesting the need to develop a new tool. AIM: A national project aimed at developing and validating a new instrument capable of measuring the clinical learning quality as experience by nursing students. METHODS: A validation study design was undertaken from 2015 to 2016. All nursing national programs (n=43) were invited to participate by including all nursing students attending regularly their clinical learning. The tool developed based upon a) literature, b) validated tools already established among other healthcare professionals, and c) consensus expressed by experts and nursing students, was administered to the eligible students. RESULTS: 9606 nursing in 27 universities (62.8%) participated. The psychometric properties of the new instrument ranged from good to excellent. According to the findings, the tool consists in 22 items and five factors: a) quality of the tutorial strategies, b) learning opportunities; c) safety and nursing care quality; d) self-direct learning; e) quality of the learning environment. CONCLUSIONS: The tool is already used. Its systematic adoption may support comparison among settings and across different programs; moreover, the tool may also support in accrediting new settings as well as in measuring the effects of strategies aimed at improving the quality of the clinical learning.


Asunto(s)
Competencia Clínica/normas , Educación en Enfermería/normas , Aprendizaje , Estudiantes de Enfermería , Encuestas y Cuestionarios/normas , Adulto , Femenino , Humanos , Italia , Masculino , Psicometría/normas , Reproducibilidad de los Resultados , Estudios Retrospectivos
11.
Nurse Educ Today ; 52: 15-21, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28214665

RESUMEN

BACKGROUND: Some nursing programmes offer night shifts for students while others do not, mainly due to the lack of evidence regarding their effectiveness on clinical learning. OBJECTIVES: The principal aims of the study were to describe nursing students' perceptions and to explore conditions influencing effectiveness on learning processes during night shifts. DESIGN: An explanatory mixed-method study design composed of a cross-sectional study (primary method, first phase) followed by a descriptive phenomenological study design (secondary method, second phase) in 2015. SETTING: Two bachelor of nursing degree programmes located in Northern Italy, three years in length and requiring night shifts for students starting in the second semester of the 1st year, were involved. PARTICIPANTS: First phase: all nursing students ending their last clinical placement of the academic year attended were eligible; 352 out the 370 participated. Second phase: a purposeful sample of nine students among those included in the first phase and who attended the highest amount of night shifts were interviewed. METHODS: First phase: a questionnaire composed of closed and open-ended questions was adopted; data was analyzed through descriptive statistical methods. Second phase: an open-ended face-to-face audio-recorded interview was adopted and data was analyzed through content analysis. RESULTS: Findings from the quantitative phase, showed that students who attended night shifts reported satisfaction (44.7%) less frequently than those who attended only day shifts (55.9%). They also reported boredom (23.5%) significantly more often compared to day shift students (p=0001). Understanding of the nursing role and learning competence was significantly inferior among night shift students as compared to day shift students, while the perception of wasting time was significantly higher among night shift students compared to their counterparts. Night shift students performed nursing rounds (288; 98.2%), non-nursing tasks (247; 84.3%) and/or less often managed clinical problems (insomnia 37; 12.6% and disorientation/confusion 32; 10.9%). Findings from the qualitative phase showed night shifts are experienced by students as a "time potentially capable of generating clinical learning": learning is maximized when students play an active role, encounter patients' clinical problems and develop relationships with patients, caregivers and staff. CONCLUSIONS: Night shifts remains ambiguous from the students' perspective and their introduction in nursing education should be approached with care, considering the learning aims expected by students in their clinical placements and the education of clinical mentors education who should be capable of effectively involving students in the process of night care by avoiding non-nursing tasks.


Asunto(s)
Aprendizaje , Estudiantes de Enfermería/psicología , Tolerancia al Trabajo Programado/psicología , Estudios Transversales , Bachillerato en Enfermería , Femenino , Humanos , Italia , Masculino , Mentores , Investigación Cualitativa , Encuestas y Cuestionarios , Adulto Joven
12.
Int J Nurs Stud ; 68: 60-72, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28088008

RESUMEN

BACKGROUND: The clinical learning environment is fundamental to nursing education paths, capable of affecting learning processes and outcomes. Several instruments have been developed in nursing education, aimed at evaluating the quality of the clinical learning environments; however, no systematic review of the psychometric properties and methodological quality of these studies has been performed to date. OBJECTIVES: The aims of the study were: 1) to identify validated instruments evaluating the clinical learning environments in nursing education; 2) to evaluate critically the methodological quality of the psychometric property estimation used; and 3) to compare psychometric properties across the instruments available. DESIGN: A systematic review of the literature (using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines) and an evaluation of the methodological quality of psychometric properties (using the COnsensus-based Standards for the selection of health Measurement INstruments guidelines). DATA SOURCES: The Medline and CINAHL databases were searched. Eligible studies were those that satisfied the following criteria: a) validation studies of instruments evaluating the quality of clinical learning environments; b) in nursing education; c) published in English or Italian; d) before April 2016. REVIEW METHODS: The included studies were evaluated for the methodological quality of the psychometric properties measured and then compared in terms of both the psychometric properties and the methodological quality of the processes used. RESULTS: The search strategy yielded a total of 26 studies and eight clinical learning environment evaluation instruments. A variety of psychometric properties have been estimated for each instrument, with differing qualities in the methodology used. Concept and construct validity were poorly assessed in terms of their significance and rarely judged by the target population (nursing students). Some properties were rarely considered (e.g., reliability, measurement error, criterion validity), whereas others were frequently estimated, but using different coefficients and statistical analyses (e.g., internal consistency, structural validity), thus rendering comparison across instruments difficult. Moreover, the methodological quality adopted in the property assessments was poor or fair in most studies, compromising the goodness of the psychometric values estimated. CONCLUSIONS: Clinical learning placements represent the key strategies in educating the future nursing workforce: instruments evaluating the quality of the settings, as well as their capacity to promote significant learning, are strongly recommended. Studies estimating psychometric properties, using an increased quality of research methodologies are needed in order to support nursing educators in the process of clinical placements accreditation and quality improvement.


Asunto(s)
Educación en Enfermería/normas , Psicometría , Humanos
13.
Assist Inferm Ric ; 35(1): 29-35, 2016 Jan-Mar.
Artículo en Italiano | MEDLINE | ID: mdl-27183424

RESUMEN

UNLABELLED: . Validation of the Italian Clinical Learning Environment Instrument (SVIAT): study protocol. INTRODUCTION: Nursing students obtain most of their university credits in internship environments whose quality can affect their clinical learning. Several tools are available to measure the quality of the clinical learning environment (CLE) as perceived by students: these instruments developed in other countries, were validated in Italian but do not discriminate those CLEs capable (or not) to promote significant clinical learning. AIM: To validate an instrument to measure the capability of the CLE to generate clinical learning; the secondary aim is to describe the learning environments as perceived by nursing students according to individual course site and tutorial models adopted. METHODS: The study will be developed in three phases: a) instrument development and pilot phase, b) validation of the psychometric properties of the instrument and c) description of the CLEs as perceived by the students including factors/item confirmed in the validation process. Expected outcomes. A large validation, with more than 8,000 participating students is expected; the construct under lying will be confirmed through exploratory and confirmatory factor analysis and will report high internal consistency; the instrument will report also a high test-retest and inter-rater reliability; in addition, the instrument will demonstrate predictive ability by discriminating those units able (or not) to activate effective learning processes.


Asunto(s)
Educación en Enfermería/normas , Estudios de Evaluación como Asunto , Italia , Aprendizaje , Psicometría , Autoinforme
14.
J Emerg Nurs ; 42(5): 420-6, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27181194

RESUMEN

UNLABELLED: For clinical nurses, especially those working in emergency departments, it is crucial to measure blood glucose (BG) in an accurate, timely, and safe manner. Many differences in practice exist with regard to use of the first or second drop of blood for testing, and no consistent guidelines are available for capillary BG testing at home or in ED settings. The purpose of this study is to evaluate the BG differences between the first and second drop of capillary blood collected from the same site in patients with type 1 diabetes. METHODS: A consecutive sample of 195 persons with type 1 diabetes who had washed their hands and were not suspected of having hypoglycemia were included in the study. Descriptive and inferential statistical analysis for non-normal distributed variables was performed. RESULTS: A strong correlation emerged between the BG reported in the first and the second drops (Spearman's rho test [rs] 0.979, P < .001; Pearson r 0.978, P < .001). The average BG values obtained from the first and second drops were 184.30 mg/dL (median, 166) and 187.6 mg/dL (median, 172), respectively, and thus the second drop showed higher glucose values compared with the first drop. However, BG values of the second drop were not higher in all occasions: whereas some evaluations reported higher BG values in the second drop capillary sample (n = 123), others reported higher values in the first drop (n = 65), and still others reported identical measurements in the first and second drops (n = 7). Five outliers were present with a BG difference from -39 to -53 mg/dL in the first drop compared with the second drop, and 3 outliers were present with a BG difference from +46 to +57 mg/dL in the first drop compared with the second drop. However, the differences that emerged were not affected by glucose concentration (P = .221). DISCUSSION: Using the first drop of blood in a patient with clean hands allows emergency nurses to perform the test more quickly, resulting in immediate information. Findings indicate that the first drop of blood is adequate for clinical decision making, but the clinician should use judgment if using protocols in which small values (eg, 6 mg/dL) are important, because the first drop is more likely to have a slightly lower value.


Asunto(s)
Análisis Químico de la Sangre/métodos , Glucemia/análisis , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/diagnóstico , Enfermería de Urgencia/métodos , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados
15.
Assist Inferm Ric ; 34(3): 134-41, 2015 Jul-Sep.
Artículo en Italiano | MEDLINE | ID: mdl-26488929

RESUMEN

AIM: To identify nurses' doubts and questions (about lumbar puncture, related nursing interventions and post-dural puncture headache - PDPH) and to find answers in the available literature. METHODS: 26 nurses were asked to identify open questions and a literature review was conducted searching on Medline, Cochrane database of Systematic Reviews and Cinahl. RESULTS: Atraumatic needles, small gauge, cranial bevel oriented insertion and stylet reinsertion are variables that reduce the risk of PDPH. Bed rest has no efficacy in reducing this complication. On the contrary, it may increase the risk of PDPH. There are not enough evidences about the efficacy of additional fluid intake after the procedure. It's not clear if the risk of PDPH could be affected by the position during lumbar puncture and the volume of cerebrospinal fluid withdrawn. CONCLUSIONS: This literature review clarifies some aspects of lumbar puncture and PDPH: the use of traumatic or atraumatic needles, the bevel orientation and stylet reinsertion, bed rest. More research is needed to study the efficacy of other interventions, still uncertain (patient position during the procedure, volume of cerebrospinal fluid withdrawn, hydration and analgesic drugs' efficacy).


Asunto(s)
Reposo en Cama/enfermería , Ambulación Precoz/enfermería , Fluidoterapia/enfermería , Posicionamiento del Paciente/enfermería , Cefalea Pospunción de la Duramadre/enfermería , Punción Espinal/enfermería , Enfermería Basada en la Evidencia , Humanos , Agujas/efectos adversos , Postura , Factores de Riesgo , Punción Espinal/efectos adversos
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