Self-care styles of patients with chronic obstructive pulmonary disease: A mixed methods case study.

BACKGROUND: In people affected by chronic obstructive pulmonary disease (COPD), self-care is crucial for improving quality of life, decreasing symptom burden, and reducing health care-related costs. Unlike other chronic conditions, little is known about the factors that influence different self-care styles in COPD patients. OBJECTIVES: To explore the factors that could influence the self-care styles of patients with COPD. METHODS: A mixed methods case study design was used. Quantitative and qualitative data were collected at the same stage in a purposive sample of patients with COPD through questionnaires, interviews, and focus groups. Data were analyzed separately and then integrated to compare the cases. RESULTS: Thirty-seven patients with COPD were recruited from an outpatient clinic, pulmonary rehabilitation unit and online in a patient support group. On average, participants scored below the level of adequacy in all self-care dimensions. Self-care maintenance was influenced by patient age, education level, and economic status. Most participants reported performing self-care behaviors, while some did not because they found it difficult or because they did not recognize their importance. When the quantitative and qualitative data of patients with higher and lower levels of self-care were integrated, four different styles of self-care were identified according to COPD severity, psychological distress and level of self-efficacy: proactive, inactive, reactive, and hypoactive. CONCLUSIONS: Personal, clinical, psychological, and social factors not only influence the level of self-care performed by COPD patients but also contribute to the understanding of different self-care styles. This knowledge could support health care professionals in tailoring educational interventions.

[Are falls a nursing sensitive outcome?] / La caduta è un esito sensibile all'assistenza infermieristica?

. Are falls a nursing sensitive outcome? Falls have historically been regarded as nursing-sensitive outcomes, i.e., problems that nurses can intervene in, to prevent their occurrence. However, falls are not a uniform phenomenon, as they can vary significantly and occur despite good nursing care. Furthermore, their predictability and preventability in the care of patients should be carefully considered. Since patient care involves multiple professionals, it is important to reflect on whether and to what extent a fall can be considered a sensitive outcome of nursing care or care in general. This contribution proposes some reflections on falls as a sensitive outcome and indicator of quality of care.

[The management of diabetic foot: the new guidelines of the International Working Group on Diabetic Foot]. / La gestione del piede diabetico: le nuove linee guida dell'International Working Group on Diabetic Foot.

. The management of diabetic foot: the new guidelines of the International Working Group on Diabetic Foot. The publication of the new guidelines on the diabetic foot are an opportunity for a fine-tuning of the (few) new developments, but of the soundness of the evidence and knowledge known so far. Compared to the previous 2019 guidelines, the 2023 update included the analysis of randomised clinical trials only, a more accurate application of the GRADE method, a leaner and more current bibliography, and an update of the strength of some recommendations from low to conditional. The real big news in the 2023 update is the publication of a specific guideline for the diagnosis and treatment of Charcot neuro-osteoarthropathy in people with diabetes, neuropathy and in the absence of skin lesions.

Factors Associated with Falls in Community-Dwelling Older Adults: A Subgroup Analysis from a Telemergency Service.

According to the number of falls, fallers can be single (only one fall) or recurrent (two or more falls), with different risk profiles for loss of independence and frailty. The presence of risk factors in community-dwelling single- and recurrent fallers using a wearable fall-detection device, such as the Personal Emergency Response System (PERS), as part of a telemergency service, is still unknown. This article evaluates how using a PERS, within a telemergency service, helps identify risk profiles and assessment of any differences between non-fallers and fallers in community-dwelling older adults. A sub-group analysis was performed, dividing users into non-fallers (n = 226) and fallers (≥1 fall; n = 89); single-fallers (n = 66) and recurrent fallers (n = 23). Median age was higher in fallers (87.7 years vs. 86), whereas recurrent fallers were less independent, had fewer comorbidities, and had more low-extremity disabilities. The use of the PERS for medical problems (Adjusted OR = 0.31), excluding falls, support calls (Adjusted OR = 0.26), and service demands (Adjusted OR = 0.30), was significantly associated with a fall risk reduction. The findings suggest that the integration within a telemergency service may impact on fall-risk factors.

Supporting health and social care professionals in serious illness conversations: Development, validation, and preliminary evaluation of an educational booklet.

Serious illness conversations aim to align the care process with the goals and preferences of adult patients suffering from any advanced disease. They represent a challenge for healthcare professionals and require specific skills. Conversation guides consistent with task-centered instructional strategies may be particularly helpful to improve the quality of communication. This study aims to develop, validate, and preliminarily evaluate an educational booklet to support Italian social and healthcare professionals in serious illness conversations. A three-step approach, including development, validation, and evaluation, was followed. A co-creation process with meaningful stakeholders led to the development of the booklet, validated by 15 experts on clarity, completeness, coherence, and relevance. It underwent testing on readability (Gulpease index, 0 = lowest-100 = maximum) and design (Baker Able Leaflet Design criteria, 0 = worst to 32 = best). Twenty-two professionals with different scope of practice and care settings evaluated acceptability (acceptable if score ≥30), usefulness, feasibility to use (1 = not at all to 10 = extremely), and perceived acquired knowledge (1 = not at all to 5 = extremely). After four rounds of adjustments, the booklet scored 97% for relevance, 60 for readability, and 25/32 for design. In all, 18 (81.8%), 19 (86.4%) and 17 (77.3%) professionals deemed the booklet acceptable, moderate to highly useful, and feasible to use, respectively; 18/22 perceived gain in knowledge and all would recommend it to colleagues. The booklet has good readability, excellent design, high content validity, and a high degree of perceived usefulness and acquired knowledge. The booklet is tailored to users' priorities, mirrors their most frequent daily practice challenges, and offers 1-minute, 2-minute and 5-minute solutions for each scenario. The co-creation process ensured the development of an educational resource that could be useful regardless of the scope of practice and the care setting to support professionals in serious illness conversations.

Stakeholders' Perspective on the Key Features of Printed Educational Resources to Improve the Quality of Clinical Communication.

Social and healthcare professionals often feel ill equipped to effectively engage in difficult conversations with patients, and poor proficiency negatively affects the quality of patient care. Printed educational resources (PERs) that provide guidance on sustaining complex clinical communication may be a source of support if thoughtfully designed. This study aimed to describe the key features of PERs in order to improve the quality of clinical communication according to the perspective of meaningful stakeholders. This was a descriptive secondary analysis of data collected by three remote focus group discussions that involved 15 stakeholders in the context of developing an educational booklet to support professionals in complex communication scenarios. Focus groups were audio-recorded and transcribed verbatim, and an inductive thematic analysis was performed. Three key features of PERs that aim toward quality improvement in clinical communication were identified: (1) having the potential to provide benefits in clinical practice; (2) facilitating, encouraging, and enticing reading; and (3) meeting the need of professionals to improve or update their knowledge. These findings suggest that PERs relevant to professionals' clinical priorities and learning needs may make their efforts to apply learning in practice more likely and consequently result in improved healthcare quality.

[Patient and public involvement in research]. / Il coinvolgimento della popolazione e dei pazienti nella ricerca.

. Patient and public involvement in research. Patient and public involvement (PPI) entails research being carried out 'with' members of the public, rather than 'to', 'about' or 'for' them. The word public can refer to patients, potential patients, carers and people who use health and social care services, people from organisations that represent people who use services as well as members of the public. People with lived experience of a particular service or health condition may add value to the research and even influence the research question. The involvement may occurr in any stage of the research process, but preferably since the very start, when the study is designed. To obtain a real involvement and participation some practical tips are suggested. In this paper advantages but also difficulties related to PPI are presented, based both on the literature but also from the authors' experience.

[The consequences of visiting restrictions in long term care facilities: a narrative review of the literature]. / Le conseguenze delle restrizioni delle visite nelle strutture sanitarie residenziali: una revisione narrativa della letteratura.

. The consequences of visiting restrictions in long term care facilities: a narrative review of the literature. INTRODUCTION: To prevent the spread of Covid-19, residential health care facilities banned access to informal caregivers. AIM: To describe the consequences of visiting restrictions in residential facilities during the pandemic and to identify the strategies adopted to lessen their effects. METHODS: A narrative review of the literature was carried out by searching PubMed and CINAHL database between October 2022 and March 2023. The research included primary, qualitative and quantitative studies written in English/Italian language, and in which data collection was performed after 2020. RESULTS: Twenty-eight studies were included: 14 qualitative, 7 mixed-method and 7 quantitative. Residents and family members experienced anxiety, sadness, loneliness, apathy, anger and frustration. Technology tried to ensure contact, but with limitations due to residents' cognitive-sensory impairments, technological expertise, and staff's available time. Attempts to allow visitors again were welcomed with gratitude, but access was not always granted, causing discontent. Health care professionals experienced the restrictions with ambivalence, torn between the need to prevent contagion and concerns for residents' quali-ty of life. CONCLUSIONS: Visiting restrictions had negative consequences for residents, family members and health care professionals. The sense of abandonment experienced pointed out the lack of strategies able to balance safety and quality of life.

[Nursing associations and the war in Ukraine]. / Associazioni infermieristiche e guerra in Ucraina.

. Nurses' associations and war in Ukraine. The tragic irruption of war with all its scenarios of horror and destruction in the heart of Europe has documented the depth of the absence of a culture of peace in the international community of States, which have not be willing nor capable to propose a credible platform leading to a diplomatic solution of a conflict where all big powers are complice. While the strictly health related impacts represent a direct and specific interest and challenge for the nursing profession, it is clear that we are facing a future where a new awareness of being citizen of a world which requires a different culture and commitment must become part of our training and strategies of presence in the society. A survey of the positions assumed by the nursing organisation at international level, together with few model reflections on the broader implications of what we are living, is proposed as a first expression of a long term commitment and interest.