Peripheral intravenous catheter failure, nurse staffing levels and care complexity individual factors: A retrospective multicentre cohort study.

INTRODUCTION: Short peripheral intravenous catheter (PIVC) failure is a common complication that is generally underdiagnosed. Some studies have evaluated the factors associated with these complications, but the impact of care complexity individual factors and nurse staffing levels on PIVC failure is still to be assessed. The aim of this study was to determine the incidence and risk factors of PIVC failure in the public hospital system of the Southern Barcelona Metropolitan Area. METHODS: A retrospective multicentre observational cohort study of hospitalised adult patients was conducted in two public hospitals in Barcelona from 1st January 2016 to 31st December 2017. All adult patients admitted to the hospitalisation ward were included until the day of discharge. Patients were classified according to presence or absence of PIVC failure. The main outcomes were nurse staffing coverage (ATIC patient classification system) and 27-care complexity individual factors. Data were obtained from electronic health records in 2022. RESULTS: Of the 44,661 patients with a PIVC, catheter failure was recorded in 2,624 (5.9%) patients (2,577 [5.8%] phlebitis and 55 [0.1%] extravasation). PIVC failure was more frequent in female patients (42%), admitted to medical wards, unscheduled admissions, longer catheter dwell time (median 7.3 vs 2.2 days) and those with lower levels of nurse staffing coverage (mean 60.2 vs 71.5). Multivariate logistic regression analysis revealed that the female gender, medical ward admission, catheter dwell time, haemodynamic instability, uncontrolled pain, communication disorders, a high risk of haemorrhage, mental impairments, and a lack of caregiver support were independent factors associated with PIVC failure. Moreover, higher nurse staffing were a protective factor against PIVC failure (AUC, 0.73; 95% confidence interval [CI]: 0.72-0.74). CONCLUSION: About 6% of patients presented PIVC failure during hospitalisation. Several complexity factors were associated with PIVC failure and lower nurse staffing levels were identified in patients with PIVC failure. Institutions should consider that prior identification of care complexity individual factors and nurse staffing coverage could be associated with a reduced risk of PIVC failure.

The relationship between psychological capital, burnout and perceived stress in junior nurses: a latent profile analysis.

Background: Psychological capital, an intrinsic personal asset, enhances junior nurses' ability to navigate transition and sustain superior job performance. This study aimed to classify junior nurses into distinct psychological capital profiles and examine their associations with burnout and perceived stress levels. Methods: A cross-sectional study involving 480 junior nurses from three hospitals in Beijing assessed psychological capital, stress, and burnout using e-questionnaires, from July 2021 to August 2022. We employed exploratory latent profile analysis for psychological capital profiling and logistic regression with the best subset method to identify the influential factors. Results: The results of the latent profile analysis supported the models of two latent profiles, which were defined as low psychological capital (224, 46.5%) and high psychological capital (256, 53.5%). Logistic regression revealed that introverted nurses and those experiencing moderate to high levels of burnout and stress were more likely to exhibit low psychological capital. Conclusion: Nursing management should proactively identify and support junior nurses with low psychological capital, with a focus on introverted individuals, to mitigate the impact of stress and burnout.

Investigating the Risk of Patient Manual Handling Using the Movement and Assistance of Hospital Patients Method among Hospital Nurses in Botswana.

BACKGROUND: Evidence on the prevalence of lower back pain (LBP) among nurses is widespread in the literature, with several risk factors being reported. These include manual handling of patients, repetitive bending and twisting movements, and long working hours. It is reported that LBP has negative health outcomes and causes poor work performance among healthcare workers (HCWs). The magnitude of ergonomic risks associated with these healthcare activities has not been adequately investigated in Botswana. Thus, this study aimed to investigate the ergonomic risk levels associated with the manual handling of patients and its association with the prevalence of LBP among nurses in Botswana. METHODS: This was an observational cross-sectional hospital-based study conducted in a Botswana public tertiary hospital from March to April 2023. The Movement and Assistance of Hospital Patients (MAPO) tool was used to collect data on ergonomic risk levels. Data on the demographic characteristics of participants were collected using a tool adapted from the Nordic Musculoskeletal Questionnaire (NMQ). Odds ratios and 95% confidence intervals were estimated to determine the association between ergonomic risk levels and the prevalence of LBP. RESULTS: A total of 256 nurses participated and completed the study. The self-reported prevalence of LBP in this study was 76.6%. The risk of acquiring LBP was high (90.5%) based on the MAPO index. Although the frequencies of self-reported LBP were high among nurses, these did not show any significant association with the MAPO index data. This could be partly due to the small sample size. CONCLUSIONS: There was a high prevalence of LBP in this study, which was corroborated by the MAPO index data. This has demonstrated the value of the MAPO index in forecasting the risk of patient manual handling. The findings might help Botswana formulate policies intended to address ergonomic preventive measures, directed towards reducing the MAPO index score by addressing the single risk determinants.

Association of quality of nursing care with violence load, burnout, and listening climate.

BACKGROUND: Violence against nurses is common. Previous research has recommended further development of the measurement of violence against nurses and integration of the individual and ward-related factors that contribute to violence against hospital nurses. This study was designed to address these issues by investigating the associations between violence, the listening climate of hospital wards, professional burnout, and perceived quality of care. For this purpose, we used a new operationalization of the violence concept. METHODS: We sought nurses to participate in the study through social media which yielded 765 nurses working in various healthcare systems across Israel who volunteered to complete a self-administered online questionnaire. 80% of the sample were hospital nurses, and 84.7% were female. The questionnaire included validated measures of burnout, listening climate, and quality of care. Instead of using the traditional binary measure of exposure to violence to capture the occurrence and comprehensive impact of violence, this study measured the incremental load of violence to which nurses are subjected. RESULTS: There were significant correlations between violence load and perceived quality of care and between constructive and destructive listening climates and quality of care. Violence load contributed 14% to the variance of burnout and 13% to the variance of perceived quality of care. The ward listening climate moderated the relationship between burnout and quality of care. CONCLUSIONS: The results of this study highlight the impact of violence load among nurses and the ward listening climate on the development of burnout and on providing quality care. The findings call upon policymakers to monitor violence load and allocate resources to foster supportive work environments to enhance nurse well-being and improve patient care outcomes.

Individual Attributes and Environmental Conditions of Registered Nurses Working in Freestanding Emergency Departments in the United States: A Descriptive Exploratory Study.

INTRODUCTION: Freestanding emergency departments (FSEDs) are emergency facilities not connected to inpatient services. The percentage of FSEDs of all EDs grew from 1% in 2001 to 12% in 2017, making FSEDs a substantial subset of US emergency care. The purpose of this study was to describe the individual attributes and environmental conditions of registered nurses working in FSEDs in the US. METHODS: A quantitative descriptive exploratory design with cross-sectional survey methodology. RESULTS: A total of 364 emergency nurses responded to the survey. Most reported their FSED was open 24 hours/day (99.5%), with board-certified emergency physicians onsite (91.5%) and a mean of 3.6 RNs working per shift. Resources immediately available in more than 50% of FSEDs included laboratory and imaging services, and in fewer than 30% of FSEDs included behavioral health care, MRI, obstetric care, orthopedic care, neurologic care, and surgical consult care. Respiratory therapy was reported by 39.6% of respondents as being immediately available. A significant minority of respondents expressed concerns about adequacy of resources and training and the effect on patient care in both survey (30% of respondents) and open-ended questions (42.5% of respondents). DISCUSSION: The practice environment of emergency nurses in FSEDs was reported as having positive elements; however, a substantial subpopulation reported serious concerns. FSEDs adhere to some of the standards put forward by the American College of Emergency Physicians, with notable exceptions in the areas of staffing RNs, staffing ancillary staff, and availability of some resources.

Analysis of factors associated with needlestick injuries of clinical nurses by applying a human factor analysis and classification system: A nationwide cross-sectional survey.

AIMS: This study aims to investigate the current situation of needlestick injuries (NSIs) of clinical nurses and identify associated factors by using the theoretical framework of the human factors analysis and classification system (HFACS). DESIGN: A nationwide cross-sectional survey was conducted. METHODS: Multi-stage sampling was used to investigate 3336 nurses in 14 Chinese hospitals. Descriptive statistics and univariate and multivariate logistic regression were employed to reveal the rate of NSIs and their associated factors. RESULTS: A total of 970 nurses (29.1%) reported having experienced at least one NSI in the past year. The multivariate logistic regression analysis showed that good hospital safety climate and clinical nurses in intensive care unit (ICU) and emergency department had protective effects against NSIs compared with nurses in internal medicine department. The nurse, senior nurse, and nurse in charge have significantly increased the risk for NSIs compared with the associate chief nurse or above. Patients with poor vision but wearing glasses and poor vision but not wearing glasses were more prone to have NSIs. Working in the operating room compared with internal medicine, average weekly working time of >45 h compared with ≤40 h and poor general health led to increased risk of NSIs. CONCLUSION: The rate of NSIs in clinical nurses was high in China. Individual factors including professional title, department, visual acuity and general mental health and organisational factors including weekly working hours and hospital safety atmosphere were significantly correlated with the occurrence of NSIs. RELEVANCE TO CLINICAL PRACTICE: Nursing managers should focused on physical and psychological conditions of clinical nurses, and organisational support is required to enhance the hospital safety atmosphere. NO PATIENT OR PUBLIC CONTRIBUTION: Contributions from patients or the public are irrelevant because this study aims to explore current situation and factors associated with NSIs in clinical nurses.

Mediating Role of Rumination in Second Victim Experience to Turnover Intention in Psychiatric Nurses.

BACKGROUND: Psychiatric nurses often face patient safety incidents that can cause physical and emotional harm, even leading to s econd victim syndrome and staff shortages. Rumination-a common response after nurses suffer a patient safety event-may play a specific role between the second victim experience and turnover intention. Understanding these mechanisms is crucial for supporting psychiatric nurses and retaining psychiatric nursing resources. OBJECTIVES: The study aimed to explore the associations among second victim experience, rumination, and turnover intention in psychiatric nurses and confirm how second victim experience influences turnover intention through rumination and its subtypes. METHODS: A descriptive, cross-sectional study was adapted to survey 252 psychiatric nurses who experienced a patient safety incident at three hospitals in China between March and April 2023. We used the Sociodemographic and Patient Safety Incident Characteristics Questionnaire (the Chinese version of the Second Victim Experience and Support Tool), the Event-Related Rumination Inventory, and the Turnover Intention Scale. Path analysis with bootstrapping was employed to accurately analyze and estimate relationships among the study variables. RESULTS: There was a positive association between second victim experience and turnover intention. In addition, both invasive and deliberate rumination showed significant associations with second victim experience and turnover intention. Notably, our results revealed that invasive and deliberate rumination played partial mediating roles in the relationship between second victim experience and turnover intention in psychiatric nurses. DISCUSSION: The negative experience and turnover intention of the psychiatric nurse second victims are at a high level. Our results showed that invasive rumination positively mediated the relationship between second victim experience and turnover intention, and deliberate rumination could weaken this effect. This study expands the knowledge of the mechanisms underlying the effect of the second victim experience on turnover intention. Organizations must attach importance to the professional dilemmas of the psychiatric nurses' second victims. Nurse managers can reduce nurses' turnover intention by taking measures to reduce invasive rumination and fostering deliberate meditation to help second victims recover from negative experiences.

A New Perspective on Missed Nursing Care in the Emergency Department: A Descriptive Cross-Sectional Study.

INTRODUCTION: This descriptive cross-sectional study describes missed nursing care, quality of care, and patient safety rated by nursing staff in emergency departments. Required patient care that is omitted or delayed (missed nursing care) is associated with poorer quality of care and increased risk for adverse events, but studies are scarce in the emergency setting. METHODS: Emergency registered nurses and nursing assistants (N=126) at 2 Swedish emergency departments participated in the study. The MISSCARE survey-Swedish version was used for data collection. RESULTS: Emergency nursing staff assessed that nursing care is frequently missed in the emergency department. More than half of the 24 nursing care items were reported as missed by over 50% of the participants, and registered nurses rated most items significantly higher compared to nursing assistants. Half of the nursing staff perceived quality of care to be good, but nearly the same proportion perceived patient safety as poor. Registered nurses viewed both quality and safety worse than nursing assistants. DISCUSSION: The present study found very high levels of missed nursing care in most nursing items. Results indicate that nursing staff in emergency departments need to prioritize between the tasks and that some tasks may not be relevant in the context. The emergency setting focuses primarily on identifying signs of urgency, assessing patients, performing interventions, and diagnostics. However, even items that seemed to be prioritized, such as reassessment of vital signs, had a surprisingly high level of missed nursing care in comparison to in-hospital wards.

Nurses' safety climate, quality of care, and standard precautions adherence and compliance: A cross-sectional study.

INTRODUCTION: Investigations about the interrelationships of nurses' safety climate, quality of care, and standard precautions (SP) adherence and compliance remain particularly scarce in the literature. Thus, we tested a model of the associations between nurses' safety climate, quality of care, and the factors influencing adherence and compliance with SPs utilizing the structural equation modeling (SEM) approach. DESIGN: Cross-sectional design complying with STROBE guidelines. METHODS: Using convenience sampling, nurses (n = 730) from the Philippines were recruited. Data were collected between April and September 2022 using four validated self-report measures. Spearman Rho, mediation and path analyses, and SEM were employed for data analysis. RESULTS: Acceptable model fit indices were shown by the emerging model. The safety climate is positively associated with quality of care and factors influencing adherence to and compliance with SPs. Quality of care directly affected factors influencing adherence to SPs. The factors influencing adherence to SPs directly affected SP compliance. Quality of care mediated between safety climate and the factors influencing adherence to SPs. Factors influencing adherence to SPs mediated between safety climate, quality of care, and SP compliance. CONCLUSIONS: The study's variables are not distinct but overlapping nursing concepts that must be examined collectively. Nurse administrators can utilize the emerging model to formulate strategies and regulations for evaluating and enhancing nurses' safety climate, quality of care, and SP adherence and compliance. CLINICAL RELEVANCE: Our findings may impact policymaking, organizational, and individual levels to improve nurses' clinical practice. PATIENT OR PUBLIC CONTRIBUTION: This study had no patient contribution or public funding.

Relationships Among Individual and Hospital Characteristics and Self-Efficacy in Labor Support Among Intrapartum Nurses in Texas.

OBJECTIVE: To explore the relationships among individual and workplace characteristics and self-efficacy in labor support among intrapartum nurses. DESIGN: Cross-sectional survey. SETTING: Online distribution from April to August 2020. PARTICIPANTS: Members of the Texas section of the Association for Women's Health, Obstetric, and Neonatal Nurses (N = 106). METHODS: I conducted descriptive analysis on individual and workplace characteristics, including scores on the Self-Efficacy Labor Support Scale. I conducted backward stepwise multivariate linear regression to assess the factors associated with self-efficacy in providing labor support. RESULTS: Years as an intrapartum nurse had a positive association with self-efficacy in labor support. Experience with open-glottis pushing, the overall cesarean birth rate, and the use of upright positioning during labor and birth were also positively associated with self-efficacy in labor support. Conversely, lack of recognition by providers was negatively associated with self-efficacy in labor support. CONCLUSION: Findings suggest that modifiable factors at the individual and hospital levels are associated with nurses' self-efficacy in labor support. Hospitals must work to engage in obstetric practices that are congruent with providing labor support, including the use of experienced nurses to mentor new nurses and the creation of a unit culture to reinforce the intent of individual nurses to provide labor support.

Missed nursing care: A cross-sectional and multi-centric study from Turkey.

AIM: The aim of this study is to explore the extent of missed nursing care in Turkey and identify its predictors. DESIGN: This was a descriptive, cross-sectional, multicentre study. METHODS: A total of 477 nurses working in seven public hospitals participated in this study from March to July 2019. The survey included two components: a personal and professional characteristics data form and the MISSCARE survey. RESULTS: The study revealed that emotional support, patient bathing and ambulation were the most frequently missed nursing care activities. An inadequate number of assistive personnel and staff, along with an unexpected increase in patient volume, were identified as the primary reasons for missed nursing care. Of the 21 missed nursing care activities, nine predictive models showed statistical significance (p < 0.05). Factors such as the type of unit, years of work experience, working hours, number of patients cared for in a shift and intention to leave the unit were found to be significant predictors of seven missed nursing care activities (p < 0.05). CONCLUSION: This study found that numerous variables influence each care activity, which suggests the need to devise more targeted and specific strategies to minimize missed nursing care. Thorough investigation into the impact of these strategies on each care activity is essential.

Study on the influence of patient safety culture on the pain and turnover intention of Chinese nurses in adverse nursing events.

AIM: Exploring the influence of patient safety culture on nurses' pain and turnover intention the job as a second victim. DESIGN: The study employed a cross-sectional design. METHODS: From July 2020 to August 2020, a convenience sampling method was used to select 1525 clinical nurses from hospitals of different levels in Shandong Province as the research subjects, and the general data survey method, patient safety culture scale and the assessment entries on pain in the second victim experience and support scale, using a convenience sampling method. RESULTS: Patient safety culture is an influencing factor that affects the second-victim pain and turnover intention. Among them, the non-punitive response to errors, open communication, cooperation between different departments, organizational learning and promotion has a statistically significant influence on the second-victim pain and turnover intention.

Evidence-Based Design in the Hospital Environment: A Staff's Burnout Study in the COVID-19 Era.

OBJECTIVE: This study aimed to evaluate the evidence-based design of the hospital physical space effect on the burnout of nurses and physicians during COVID-19. The research question was to identify the connection between daylight, nature-view windows, and hospital staff burnout during Covid-19. BACKGROUND: The evidence-based design in the hospital environment affects the health of the medical staff. The promotion of the hospital environment has a significant effect on healthcare system improvement. METHODS: This cross-sectional study was performed on 406 nurses and physician's burnout in Guilan province in 2020. Three questionnaires were used: demographic, physical space of the hospital, daylight, nature-view windows, and Maslach Burnout Inventory. Logistic regression (LR) analysis was used to determine the association between burnout and the hospital environment. The significance level was considered with p < .05. RESULTS: The results showed statistically significant correlations between patient units and the environmental characteristics of the hospitals with staff's burnout (p < .001). Of note, 62.9% of physicians and 71.9% of nurses had moderate work-related burnout. The highest burnout score was seen among staffs of emergency departments adjusted multivariate LR model revealed that 27.1% of work-related burnout in nurses and physicians was predictable with age, light, marital status, and hospitals. Our results showed that accessing more daylight could reduce burnout (p = .018, odds ratio [OR] = 0.910). CONCLUSION: Based on the result, the daylight impact on burnout reduction is more significant than other factors. It is suggested that adequate lighting, proper environmental design, and nature-view windows could create appropriate space for enhancing medical staff satisfaction and reducing burnout.

Assessing the Impact of Community Factors on Acute Care Nurses' Job Satisfaction and Turnover Intention.

BACKGROUND: Community factors may affect nurses' job behavior and decision making. There is a gap in the literature regarding the impact of community satisfaction, family ties, and community preferences on acute care nurses' turnover intention and job satisfaction. Furthermore, no studies have examined the differences in community satisfaction, community preferences, and family ties among nurses working in rural and urban settings. PURPOSE: To identify the impact of family ties, community satisfaction, and community preferences on turnover intention and job satisfaction among acute care nurses working in Ontario's urban and rural areas. METHODS: Descriptive correlational survey design was used in this study. A targeted stratified sampling technique was used to recruit acute care nurses working in Ontario's urban and rural areas (N = 349) between May 2019 and July 2019. Dillman's approach was used to guide data collection. Parametric and non-parametric tests were used for data analysis. RESULTS: A significant association was found between working settings and community preferences. A statistically significant positive relationship between community satisfaction and nurses' job satisfaction was identified. Furthermore, community satisfaction had a negative impact on turnover intention. Neither community preference nor family ties were significantly associated with turnover intention or job satisfaction. CONCLUSION: The study suggests that community satisfaction can influence important nurse work-related outcomes. Future studies should replicate and validate these results in different contexts and cultures. Retaining nurses may be difficult if they are not satisfied with their communities.

Application of PDCA Process Management in Day Operation Ward and the Influence of Nursing Quality and Safety.

Objective: To survey the application of PDCA (plan, do, check, and action) process management in day operation ward and the influence of nursing quality and safety. Methods: The routine nursing management was carried out in our hospital from March 2019 to March 2020, which was set as the control group (N = 20), and the PDCA process management was implemented from March 2020 to March 2021 as the research group (N = 20). Twenty nurses and patients were selected as subjects in two periods of time. The nursing quality, the score of individual quality control examination in clinical department, the nursing quality of operating room, the incidence of adverse events and nursing errors, the number of problems existing in the quality management of nursing documents, and the score of nursing satisfaction were accessed. Results: In the comparison of nursing quality, the nursing safety, specialty quality, and nursing norms of the study group were higher compared to the control (P < 0.05). In terms of the scores of individual quality control examination in clinical departments, the scores of ward management, rescue, therapeutic articles, drug management, first-level nursing, nursing documents, and head nurses in the study group were greater compared to the control (P < 0.05). In terms of the operating room nursing quality score, the instrument management, instrument preparation, nurses' cooperation skills, disinfection and isolation quality, and the total score of the study group were above the control (P < 0.05). In terms of the incidence of operative adverse events and nursing errors, the incidence of nosocomial infection, iatrogenic injury, information check error, equipment failure, violation of operation regulations, ECG monitoring error, infusion operation error, and medication error in the study group was lower compared to the control (P < 0.05). According to the comparison of the number of problems existing in the quality management of nursing documents, the number of problems in temperature sheet, medical order, evaluation sheet, nursing record, and other nursing documents in the study group was lower than the control (P < 0.05). The scores of nursing communication, professional technology, nursing service attitude, nursing environment, and knowledge education in the study group were higher in contrast to the control (P < 0.05). Conclusion: The application of PDCA management can effectively enhance the nursing quality and safety of the day operation ward, further facilitate the quality of hospital nursing work, and improve patient satisfaction, which exert great potential, and application value in the management of day ward in the future.

Nursing Infection Control Practice Adherence, Related Barriers, and Methods of Intervention.

OBJECTIVE: This study aims to evaluate the level of infection control (IC) practice adherence and related barriers among nursing staff at a US academic medical center. Furthermore, it surveys staff to identify interventions to improve adherence with IC practices. BACKGROUND: Infectious disease emergencies have exposed healthcare workers to increased infection risk. This study aims to explore IC practice adherence in the tertiary hospital setting and further investigate the personal protective equipment (PPE) champion role as a method to boost adherence. METHODS: This descriptive quality improvement study includes 2 parts: 1) A PPE champion role was piloted to support healthcare worker adherence to IC practices; and 2) a survey was disseminated to nursing staff to identify the perceptions of their own and coworkers' adherence to IC practices as well as suggestions for improvement. RESULTS: Twenty-six percent of PPE champion observations found nursing staff nonadherent with IC practices and policies. Barriers included knowledge deficit (38%), lack of motivation (38%), time constraints (21%), and lack of supplies (3%). Two hundred sixty-four RNs and nurse technicians responded to the IC survey. Nursing staff rated their IC adherence higher than observed by their peers. Perceived barriers to adherence included the lack of supplies (53%), knowledge of proper technique (41%), time constraints (35%), and motivation (5%). Staff recommended using PPE champions (52%) and mandating supervised practice of essential skills (48%) to increase adherence. CONCLUSIONS: Nursing staff reported barriers related to their knowledge of proper technique and suggested interventions including supervised practice of critical skills. It seems that the PPE champion role is a popular method to boost IC practice adherence that can be implemented during pandemic and nonpandemic environments at minimal cost.

Relationship between shift-work and life-style behaviors among emergency department nurses in Jordan.

Shift-work can alter the nurses' lifestyle behaviors, which negatively influence health. This study is purposed to assess the relationship between shift-work and selected lifestyle behaviors including, dietary habits, physical activity, and nicotine dependence among Jordanian nurses who work at the emergency department. A cross-sectional, descriptive correlational design was used. A total of 275 Jordanian nurses from the emergency department of Jordanian hospitals participated in the questionnaire. The results showed that 50.2% of the nurses suffered from poor dietary habits, 81.8% of them were physically inactive, and 65.1% had nicotine dependence. There was a positive correlation between shift-work, dietary habits, physical activity, and nicotine dependence. Therefore, the effects of shift-work should be considered when planning and developing interventional programs to enhance nurses' health and promote healthy behaviors among nurses workforce during shift-work.

For the flaring up of the flu: The nurses of the Maggiore Hospital in Milan hit by the Spanish fever.

In the last year of the Great War, Italy was also hit by the Spanish flu. The Civic Hospitals faced a deadly disaster with insufficient resources. All the heavy workload fell on the female nursing staff, who were the only ones able ensure the continuity of the hospital services. This study aimed to explore the impact of the influenza on the health of the nurses at the Maggiore Hospital in Milan during the second and third epidemic waves. Historical research was conducted between February and May 2020. Primary sources were retrieved from the historical archives of the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and the daily newspaper Corriere della Sera. In the autumn of 1918, the Maggiore Hospital in Milan changed its organization to hospitalise patients affected by the influenza pandemic. Although the hospital managers wanted to protect their healthcare staff from the risks of contagion by means of prophylaxis rules, 388 lay nurses and 80 religious sister nurses were affected by this insidious disease. The second and third waves of the pandemic claimed 25 victims of duty. Remembered for their altruism and spirit of abnegation, the hospital community honoured their sacrifice, and the citizens expressed their gratitude.

Assessment of patients' understanding of inflammatory bowel diseases: Development and validation of a questionnaire.

BACKGROUND: Educating patients regarding thier inflammatory bowel disease (IBD) is important for their empowerment and disease management. We aimed to develop a questionnaire to evaluate patient understanding and knowledge of IBD. METHODS: We have developed the Understanding IBD Questionnaires (U-IBDQ), consisting of multiple-choice questions in two versions [for Crohn's disease (CD) and ulcerative colitis (UC)]. The questionnaires were tested for content and face validity, readability, responsiveness and reliability. Convergent validity was assessed by correlating the U-IBDQ score with physician's subjective assessment scores. Discriminant validity was assessed by comparison to healthy controls (HC), patients with chronic gastrointestinal (GI) conditions other than IBD, and to GI nurses. Multivariate analysis was performed to determine factors associated with a high level of disease understanding. RESULTS: The study population consisted of IBD patients (n = 106), HC (n = 35), chronic GI disease patients (n = 38) and GI nurses (n = 19). Mean U-IBDQ score among IBD patients was 56.5 ± 21.9, similar for CD and UC patients (P = 0.941), but significantly higher than that of HC and chronic GI disease patients and lower than that of GI nurses (P < 0.001), supporting its discriminant validity. The U-IBDQ score correlated with physician's subjective score (r = 0.747, P < 0.001) and was found to be reliable (intra-class correlation coefficient = 0.867 P < 0.001). Independent factors associated with high U-IBDQ scores included academic education (OR = 1.21, 95% CI 1.10-1.33, P < 0.001), biologic therapy experience (OR = 1.24, 95% CI 1.01-1.53, P = 0.046), and IBD diagnosis at <21 years of age (OR = 2.97, 95% CI 1.05-8.87, P = 0.050). CONCLUSIONS: The U-IBDQ is a validated, reliable and short, self-reported questionnaire that can be used for assessing understanding of disease pathophysiology and treatment by IBD patients.

Work Stress, Coping Strategies, and Health-Related Quality of Life among Nurses at an International Specialized Cancer Center.

OBJECTIVE: The main objective of this study is to identify work stress, coping strategies, and health-related quality of life and the relationship between them among oncology nurses. METHODS: A cross-sectional design was conducted at King Hussein Cancer Center. A convenience sampling technique was used to select 446 nurses. A self-administered questionnaire was utilized using three scales: the Work Stressor Inventory for Nurses in Oncology, Revised Ways of Coping Checklist, and Research and Development 36-Item for Health Survey. RESULTS: The results showed that the levels of work stress (2.61/5), using coping strategy scale (1.59/4), and health-related quality of life scale (50.54/100) were moderate. The total mean value of the work stress scale had a significant positive correlation with the total mean value of the coping strategy scale (r=0.322*, p < 0.05) and a significant negative correlation with health-related quality of life. Moreover, there is no significant correlation between the total mean value of the coping strategy scale and the health-related quality of life scale (r=0121, p >0.05). Age and years of experience were negatively correlated with health-related quality of life (r=0.217 and 0.182 respectively, p < 0.05). CONCLUSION: Oncology nurses had a moderate level of work stress, coping strategy scale, health-related quality of life scale. Work stress has a significant correlation with using coping strategies and health-related quality of life among oncology nurses. Proper training regarding effective coping strategies is required. More studies are recommended to examine work stress, coping strategy, and health quality of life among oncology nurses.