Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 89
Filtrar
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.
J Transcult Nurs ; : 1043659619889118, 2019 Nov 21.
Artículo en Inglés | MEDLINE | ID: mdl-31752617

RESUMEN

Introduction: In recent decades, Italy has been exposed to significant migrant flows resulting from political and economic instability in neighbouring countries. As a result, there has been an increased amount of cultural and linguistic diversity (CALD) among nursing students. The aim of this study was to explore the experience of CALD nursing students as lived in the Italian nursing programmes. Method: A descriptive phenomenological method was used in 2017 with the involvement of a purposeful sample of 21 CALD nursing students in five Italian Bachelor of Nursing Science campuses. Data were collected using semistructured interviews; the subsequent content analysis was conducted by two independent researchers. Results: CALD nursing students reported having lived a transformative experience based on seven themes, from "living in the middle, between belonging and detachment" to "acquiring cultural awareness and cultural sensitivity." Discussion: Dealing with linguistic and cultural differences can affected CALD students' academic success, but also encourages them to develop awareness and cultural sensitivity by influencing their peers and the environment of the nursing programme. Therefore, having CALD students is a great value for nursing programmes. Nursing programmes should embody the values of cultural sensitivity and acceptance, including them as a nursing care value and as a concrete strategy to support CALD students. They should also develop strategies to promote the knowledge and responsibilities of nurses among CALD students and increase cultural sensitivity among faculty members at different levels.

3.
Assist Inferm Ric ; 38(2): 66-76, 2019.
Artículo en Italiano | MEDLINE | ID: mdl-31241052

RESUMEN

. The team-based care models in primary care: General Practitioners' perspectives on nurses' role. INTRODUCTION: In the last decade in Italy, different team-based primary care models have been developed that involve the collaboration of General Practitioners (GPs) with other professionals, such as nurses. AIMS: To investigate the GPs attitude towards the role and levels of autonomy of nurses in the primary care settings. METHODS: A two-phase exploratory study was performed: 1) a focus group with a purposeful sample of 12 GPs was conducted to identify the potential patients-clients/problems and activities that might be assigned to nurses; 2) a questionnaire was developed to analyze the levels of autonomy GPs assigned to nurses for different patients-clients/problems and activities. The questionnaire was administered to a convenience sample of 45 GPs, who were also interviewed to explain their choices. RESULTS: GPs recognized autonomy to nurses in the assessment, monitoring and education on lifestyles, prevention of falls, malnutrition and compliance with treatments; in performing technical and organizational activities. They believed necessary supervision or providing indications to nurses in the management of chronic patients, especially in the assessment of signs and symptoms of deterioration, in monitoring and follow-up and partly on the contents of health education. Finally, GPs felt responsible of the management of pluri-pathological and unstable patients, such as heart failure patients, due to their highly unpredictable and rapid deterioration. CONCLUSIONS: GPs expressed a positive attitude towards the role of nurses in the primary care setting, which varied depending on patients' instability and clinical complexity.

4.
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.

5.
J Nurs Manag ; 27(6): 1148-1158, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31066948

RESUMEN

AIM: To elucidate how workgroup commitment and motivation jointly influence nurses' proactive behaviour. BACKGROUND: The need to offer effective patient care has encouraged health care organisations to promote proactive behaviours among nurses. Longitudinal relationships among motivation, commitment and nurses' proactivity remain unexplored. METHODS: A self-reported questionnaire was administered to nurses of an Italian hospital. A cross-lagged panel analysis was carried out. RESULTS: A total of 221 questionnaires were returned at Time 2 (T2). T1 affective workgroup commitment was positively related to T2 autonomous motivation and negatively related to T2 controlled motivation. T1 continuance workgroup commitment was positively related to T2 controlled motivation but unrelated to T2 autonomous motivation. T1 autonomous motivation was positively related to T2 proactive behaviour, while T1 controlled motivation was unrelated to it. Finally, no direct association between T1 commitment variables and T2 proactive behaviour was observed, suggesting that autonomous motivation fully mediated the affective commitment-proactive behaviour relationship. CONCLUSION: This study highlights the importance of workgroup affective commitment and autonomous motivation to foster nurses' proactive work behaviour. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers may foster affective workgroup commitment and ultimately promote nurse proactivity by creating a shared climate that supports occupational needs and values and encourages a positive affective state towards nursing practice.

6.
Assist Inferm Ric ; 38(1): 6-14, 2019.
Artículo en Italiano | MEDLINE | ID: mdl-30933185

RESUMEN

. The nurses' tasks performed by aids in hospital settings: a mixed-methods study. INTRODUCTION: The role of Nurses' aides (NAs) in the clinical practice has been widely debated to date. AIMS: To describe the activities/tasks performed by NAs and the dedicated time; to identify the activities/tasks shifted from nurses to NAs and to investigate the motivations. METHODS: A multi-center mixed-methods study was conducted. Fifty-six NAs working in 17 hospitals in the North-Italy were observed during daily practice and then interviewed about the motivations associated with task shifting. RESULTS: NAs mainly performed direct care tasks (67.7% of the observed time), such as helping with personal hygiene, feeding and mobilization. Larger hospitals (p = 0.034), surgical units (p = 0.001), a skill mix> 40% (p = 0.044) and a reduced nurse to patient ratio (p = 0.041), were significantly associated with a higher amount of indirect care activities/tasks performed by NAs. The tasks shifted most frequently from nurses to NAs were: mobilization (22; 39.3%) and personal hygiene (21; 37.5%) of unstable patients, feeding patients with dysphagia (19; 34%), intra-venous set replacement (16; 28.6%) and pressure ulcers' dressing (11; 19.6%). NAs reported that they chose to act autonomously because of their experience and the trust-based relationship with nurses, in order to promptly respond to patients needs and to reduce nurse workload. CONCLUSIONS: It is necessary to further assess the development of the NAs role in the hospital setting to understand their inclusion in the nursing care.


Asunto(s)
Rol de la Enfermera , Asistentes de Enfermería/organización & administración , Personal de Enfermería en Hospital/organización & administración , Carga de Trabajo , Adulto , Femenino , Hospitales/estadística & datos numéricos , Humanos , Italia , Masculino , Persona de Mediana Edad
7.
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.

8.
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.

9.
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
10.
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.

11.
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.

12.
Assist Inferm Ric ; 37(3): 128-135, 2018 Jul-Sep.
Artículo en Italiano | MEDLINE | ID: mdl-30303193

RESUMEN

. Extent and type of implicit rationing of nursing care in seven South Tyrolean hospitals: a descriptive study. INTRODUCTION: Implicit rationing of nursing care is an international phenomenon, defined as withholding of or failure to carry out necessary nursing interventions due to a lack of nursing resources. AIMS: To describe the extent and type of nursing care implicitly rationed in South Tyrolean hospitals, and to explore differences across clinical areas and between registered nurses (RNs) and support staff. METHODS: The Basel Extent of Rationing of Nursing Care (BERNCA) questionnaire was completed between September and November 2015, by 934 RNs and support staff of the seven hospitals, involved in direct adult patient care (24 medical, 13 surgical, 5 rehabilitation, 4 intensive care units). Descriptive and explorative analyses were performed. RESULTS: The most rationed activities concerned "nursing care planning" (37.3%), "surveillance of confused patient" (30.7%), "providing emotional support" (30.1%) and "talking with patients and family" (28.4%). Of the ten most rationed activities, seven were common to RN and support staff, and across clinical areas, although with different frequencies. Significant differences between clinical areas were observed for: "nursing care planning", "rehabilitation care", and "comfort/talking with patients and family". DISCUSSION: Implicit rationing of nursing care occurs in South Tyrolean hospitals, mainly related to care planning and documentation. Higher priority is given to activities related to direct patient care. Further investigations on priority setting to increase the awareness among frontline nurses of what is rationed, and to guarantee the safety and quality of care is warranted.

14.
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.

15.
Ig Sanita Pubbl ; 74(1): 49-57, 2018 Jan-Feb.
Artículo en Italiano | MEDLINE | ID: mdl-29734322

RESUMEN

Presented here is the approach used by a multidisciplinary working group fo the drafting of the "core" competence profile of the healthcare professions manager in the Veneto Region. Defining a competence profile allows for specifying a standard for measuring the skills acquired by a professional and the gap level from what is expected by the organization, as well as orienting the preparatory education to carry out the related role.

16.
Ig Sanita Pubbl ; 74(6): 547-564, 2018.
Artículo en Italiano | MEDLINE | ID: mdl-31030213

RESUMEN

INTRODUCTION: The indicators used in the Italian National Outcome Strategy does not include measurement of nursing care outcomes so these have not yet been assessed systematically in our country but only in the context of specific research projects. Positive and negative outcomes of nursing care have been documented in the literature, the latter associated with missed nursing care, a phenomenon that occurs when conditions are such that nurses are unable to deliver planned care to patients. OBJECTIVES: To describe the rationale, methodology and main results achieved to date in the development of a regional policy aimed at establishing a panel of indicators for monitoring nursing care-sensitive outcomes hospitals in publicly funded hospitals in the Veneto Region (northern Italy). METHODS: A plurennial, multi-method project based on [1] identification of selection criteria for a Minimum Data Set of indicators; [2] a rapid review of the literature and of the policies established internationally to measure nursing care-sensitive outcomes; [3] the establishment of an initial panel of indicators and evaluation of any critical issues with the chosen indicators, and [4] identification of the most appropriate tool for measuring missed nursing care. RESULTS: The medical and surgical units were considered to be the most suitable settings for the pilot study. Following the literature review, indicators that were already being monitored in the current regional information system were chosen, with the intent to prevent an additional administrative burden to nurses. By using a progressive consensus process, five outcome indicators (functional status, falls, pressure sores, urinary tract infections, aspiration pneumonia) and one process indicator (missed nursing care) were selected., and the tools for measuring the above-mentioned indicators and their related risks, were identified. A regional policy was then established to measure these indicators in a pilot phase, with the intent of implementing them as stable indicators to be measured in the new computerized hospital information system. CONCLUSIONS: An initial panel of nursing-sensitive outcome indicators has been defined to be used in Internal Medicine and General Surgery units of hospitals in Italy's Veneto Region. Despite its limitations, the project represents the first effort to create a regional policy to measure the contribution of nursing care to the health outcomes of patients and that will also the identification of potential relations with other variables such as personnel staffing and/or skill mix.


Asunto(s)
Política de Salud , Hospitales Públicos/normas , Atención de Enfermería/normas , Evaluación de Resultado (Atención de Salud)/organización & administración , Indicadores de Calidad de la Atención de Salud , Accidentes por Caídas/estadística & datos numéricos , Áreas de Influencia (Salud) , Unidades Hospitalarias , Humanos , Italia , Personal de Enfermería en Hospital , Evaluación de Resultado (Atención de Salud)/métodos , Evaluación de Resultado (Atención de Salud)/normas , Gravedad del Paciente , Admisión y Programación de Personal , Proyectos Piloto , Neumonía por Aspiración/epidemiología , Neumonía por Aspiración/enfermería , Úlcera por Presión/epidemiología , Úlcera por Presión/enfermería , Infecciones Urinarias/epidemiología , Infecciones Urinarias/enfermería
17.
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
18.
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
19.
Assist Inferm Ric ; 36(1): 7-13, 2017 Jan-Mar.
Artículo en Italiano | MEDLINE | ID: mdl-28398387

RESUMEN

. An overview of education models for nursing students clinical practice: a literature review. INTRODUCTION: In the past decade the nursing education research developed and tested a number of clinical educational models. AIM: To describe the most used clinical educational models and to analyze their strengths and weaknesses in fostering the learning processes of nursing students. METHODS: A literature review of studies on clinical education models for undergraduate nursing student, published in English, was performed. Electronic database Pubmed and Cinhal were searched until November 2016. RESULTS: Nineteen studies were included in the review and five clinical education model identified: 1) the university tutor supervises a group of students and selects learning opportunities; 2) a clinical expert/tutor nurse works side by side with one student; 3) the student is responsible of his/her learning process with the supervision of the ward staff; 4) a clinical tutor of the ward is dedicated to the students' supervision; 5) the student is not assigned to a ward but clinical learning opportunities matched with his/her needs are selected by the university. CONCLUSIONS: All the clinical education models shared the focus on students' learning needs. Their specific characteristics better suit them for different stages of students' education and to different clinical settings.


Asunto(s)
Competencia Clínica , Modelos Educacionales , Estudiantes de Enfermería , Actitud del Personal de Salud , Humanos , Aprendizaje , Investigación en Educación de Enfermería
20.
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
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA