A two-year retrospective study of the neonatal emergency transport service in Northeast Italy.

BACKGROUND: Some newborns require acute transport to a Neonatal Intensive Care Unit (NICU) due to unpredicted or unpredictable reasons. OBJECTIVE: To describe the activity of the Neonatal Emergency Transport Service (NETS) in Northeast Italy. METHODS: An observational retrospective study was performed between 1 January 2018, and 31 December , 2019. RESULTS: A total of 133 transports were collected, with a neonatal transport index of 1.4%. Infants ≤2500 grams were more frequently transferred by NETS than those in the normal group (n = 34/563, 6.0% vs. n = 99/8,437, 1.2%; p < .001). The incidence of preterm birth among transferred newborns was 42/133 (31.6%). For the newborns with >2500 grams, there was a low incidence of a cesarean birth compared to vaginal delivery (23.2% versus 63.5%; p = .001), while the percentages were reversed in the group of infants ≤2500 grams (67.7% versus 20.6%) (p = .001). Infant stabilization time was higher in the underweight group compared to those weighed >2500 grams (31.5 versus 23.0 min; p < .001), as well as the median length of stay in NICU (18.0 versus 8.0 days, respectively, p < .001). The group of infants ≤2500 grams received more intravenous therapy (47.1% vs. 26.2%) and invasive ventilation (26.5% vs. 8.1%), compared to the group of infants who weighed >2500 grams. CONCLUSIONS: This study described a local reality by showing the characteristics of the neonatal transports that took place in a metropolitan area in Northeast Italy. Wider database is necessary to achieve a better knowledge in the field of perinatal outcomes.

Individuals with hearing impairment/deafness during the COVID-19 pandemic: A rapid review on communication challenges and strategies.

AIMS AND OBJECTIVES: This study aimed (a) to identify the communication issues and problems faced by individuals with hearing impairment (HI)/deafness during the COVID-19 pandemic and (b) to describe strategies to overcome the issues/problems and/or prevent their negative impact. BACKGROUND: Individuals with mild or severe HI face everyday communication problems, which have been worsened during the COVID-19 pandemic. However, no studies have summarised the available evidence to better understand the communication challenges faced by them and strategies allowing better interactions. The long duration of the outbreak-more than 2 years, with policies that have just been lifted in some countries-and the possible return of restrictions in the next Winter suggest the need to summarise evidence in the field. DESIGN AND METHODS: A rapid review is reported here in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Medline, CINAHL and Scopus databases were searched, including (a) primary or secondary studies published from January 2020 to 12 January 2022, (b) involving individuals with HI/deafness, (c) during the COVID-19 pandemic and (d) written in English. Data were extracted and summarised by using a content analysis approach. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. RESULTS: Fourteen studies were included as follows: three non-systematic reviews, seven cross-sectional, three quasi- experimental and one qualitative study, performed mainly in the US and the UK. Face mask covering use; physical and social distancing; and information, education, rehabilitation, and healthcare accessibility have emerged as the main challenges triggering consequences such as social isolation, loneliness, poor knowledge regarding the prevention and mental health issues. Strategies mitigating these challenges are as follows: (a) adopting transparent face masks, (b) using basic skills while interacting (e.g. maintaining eye contact), (c) improving the availability of sign language interpreters, (d) allowing the presence of family members and (e) teaching basics of sign language to healthcare professionals. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE: Individuals with HI/deafness live with several challenges, suggesting that their vulnerability has increased tremendously during the COVID-19 pandemic. The effectiveness of strategies to overcome these difficulties should be scrutinised by conducting more research. Moreover, there should be increased awareness among all citizens by equipping them with simple strategies to communicate effectively with individuals with HI, an approach that may increase inclusiveness and prevent further negative consequences and burden.

Family Visiting Restrictions and Postoperative Clinical Outcomes: A Retrospective Analysis.

In the last two years, all hospitals have adopted restricted visitation policies due to the coronavirus disease 2019. The objective of this study was to assess the consequences of hospital visitation restrictions on the most common outcome measures on adult patients who underwent surgery. A retrospective study design was conducted according to the STrengthening the Reporting of OBservational studies in Epidemiology statements in 2021. Forty patients exposed to a no-visitors policy and forty unexposed patients (1:1) were enrolled. Patients who were not allowed to receive family visits were more likely to report disorientation/agitation episodes (n = 25, 62.5% vs. n = 12, 30.0%; p < 0.01), spend more sleepless nights (n = 10, 25.0% vs. n = 1, 2.5%; p < 0.01), be restrained (n = 8, 20.0% vs. n = 1, 2.5%; p = 0.02), incur device-removal incidents (n = 14, 35.0% vs. n = 5, 12.5%; p = 0.01) compared to unexposed patients. Conversely, pain episodes were significantly more frequent in the unexposed group (n = 7.1, SD = 7.9 vs. n = 2.4, SD = 2.8; p < 0.01), and there was lower clinical deterioration risk (NEWS of 0−4 average 19.5, SD = 12.2 evaluations vs. 12.3, SD = 8.6; p < 0.01) compared to exposed patients. According to the results, family visiting restrictions should be measured against their possible advantages in order to prevent negative outcomes for surgical patients and to improve the quality of care.

The first COVID-19 new graduate nurses generation: findings from an Italian cross-sectional study.

BACKGROUND: Nursing education has been disrupted by the onset of the COronaVIrus Disease 19 (COVID-19) pandemic, potentially impacting learning experiences and perceived competencies at the time of graduation. However, the learning experiences of students since the onset of COVID-19, their perceived competences achieved and the employment status one month after graduation, have not been traced to date. METHODS: A cross sectional online survey measured the individual profile, the learning experience in the last academic year and the perceived competences of the first COVID-19 new nursing graduates in two Italian universities. Details relating to employment status and place of employment (Covid-19 versus non-COVID-19 units) one month after graduation were also collected and the data compared with those reported by a similar cohort of new graduates pre-pandemic in 2018-2019. All those who graduated in November 2020 and attended their third year after the onset of the COVID-19 pandemic were eligible. The online survey included individual, nursing programme and first working experience variables alongside the Nurse Competence Scale (NCS). Descriptive and inferential statistical analyses were performed. RESULTS: A total of 323 new graduates participated. In their last academic year, they experienced a single, long clinical placement in non-COVID-19 units. One month after graduation, 54.5% (n = 176) were working in COVID-19 units, 22.9% (n = 74) in non-COVID-19 units and 22.6 (n = 73) were unemployed. There was no statistical difference among groups regarding individual variables and the competences perceived. Fewer new graduates working in COVID-19 units experienced a transition programme compared to those working in non-COVID-19 units (p = 0.053). At the NCS, the first COVID-19 new graduate generation perceived significantly lower competences than the pre-COVID-19 generation in the 'Helping role' factor and a significant higher in 'Ensuring quality' and 'Therapeutic interventions' factors. CONCLUSIONS: The majority of the first COVID-19 new graduate generation had been employed in COVID-19 units without clinical experience and transition programmes, imposing an ethical debate regarding (a) the role of education in graduating nurses in challenging times with limited clinical placements; and (b) that of nurse managers and directors in ensuring safe transitions for new graduates. Despite the profound clinical placement revision, the first COVID-19 new graduate generation reported competences similar to those of the pre-COVID-19 generation, suggesting that the pandemic may have helped them to optimise the clinical learning process.

The experience of individuals placed in quarantine: A systematic review, meta-summary, and meta-synthesis.

OBJECTIVE: To summarize the experience of individuals placed in quarantine during an outbreak. DESIGN: A meta-summary and a meta-synthesis based upon a systematic review of qualitative studies. SAMPLE: The Cumulative Index of Nursing and Allied Health Literature, MEDLINE, and Scopus databases were all searched up to April 2020. MEASUREMENTS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed; then, the methodological quality of the studies included was assessed with the Critical Appraisal Screening Programme tool for qualitative studies. RESULTS: Five studies have been included documenting the experience of 125 adult individuals. A total of 16 codes emerged: in the meta-summary, the most and least frequent codes were "Thinking about quarantine" (80%) and "Emotional roller coaster," "Being alert for any symptom," "Trusting or not?," "Knowing who brought the infection," and "Living in a surreal world" (20%). The codes which emerged were categorized into three main themes which summarized the whole experience of being placed in quarantine: (a) "Being swamped with a thousand emotions"; (b) "Being restrained"; and (c) "Needing to be considered." CONCLUSIONS: The experience of quarantine for people is a long journey which can feel chaotic due to uncertainty about the consequences on health, work, and the future. The findings of this study can help nurses in caring for quarantined individuals by enabling them to understand people's need for educational and emotional support. Ensuring the supply of consistent information is also important to increase people's compliance.

Missed nursing education: Findings from a qualitative study.

AIM: To understand what nursing education activities are missed in the daily life of nursing programmes, by also identifying antecedents and consequences of missed educational activities. DESIGN: A descriptive qualitative study according to the COnsolidated criteria for REporting Qualitative research guidelines. METHODS: A purposeful sample of 32 participants with different roles (nurse educators, clinical nurses, students, and administrative personnel) and working in different settings (university, administrative, healthcare service levels) were involved in three focus groups and nine face-to-face interviews from 2019-2020. Both focus groups and face-to-face interviews were audio-recorded and transcribed verbatim. The data that emerged were thematically categorized by induction. FINDINGS: Missed Nursing Education reflects those educational activities needed in the process of nursing education that are missed or delayed. Direct educational activities missed include clinical rotations, classroom teaching and students' overall learning experience. Indirect missed educational activities concern continuing professional development of nursing faculty members, nursing discipline development and the organizational processes of the nursing programme. As antecedents, missed nursing education is triggered by factors at the organizational, nursing faculty, and student levels. Consequences have been reported for students, nursing faculty, clinical nurses, and patients. CONCLUSIONS: Missed Nursing Education can be considered a multifaceted, multicausal phenomenon, with multitargeted consequences. IMPACT: To date, missed nursing care has only been investigated in clinical practice. However, care also permeates the relationship between nurse educators and students. Thus, at the point of 'educational care' delivery, aspects can also be omitted. Educational activities at risk of being missed or delayed affect the quality of nursing education and, in the short- and in the long- terms, also the quality of patient care. Some Missed Nursing Education antecedents can be modified by appropriate strategies that should be addressed by policy, health care and academic institutions.

Night shifts as a learning experience among nursing students across Europe: Findings from a cross-sectional survey.

BACKGROUND: Organising clinical placements during nights has been reported as an additional opportunity to introduce students to the whole picture of their future responsibilities. However, studies in this field are still lacking. OBJECTIVES: To describe and compare (a) the night shift experience of nursing students across Europe, (b) the patient-related problems that they face during night shifts, (c) the night care activities nursing students are called to perform, and (d) the perceived effects of night shift work on learning outcomes. DESIGN: A cross-sectional study, 2016. SETTINGS: Five European countries: Czech Republic, Italy, Poland, Portugal, and Slovakia. PARTICIPANTS: Nursing students from nine Bachelor of Nursing Science degree programmes attending night shifts during their study period and who were willing to participate were included. A total of 907 out of 1347 (67.3%) eligible students participated. METHODS: Questionnaire based on the available literature, translated into five languages. RESULTS: The duration of the night shift was from an average of 9.8 (CI 95% 9.6-10.0) in Italy to 11.9 (CI 95% 11.7-12.0) in the Czech Republic. Students faced mainly patients' pain without statistical differences across countries (at the overall level, 717 out of 907; 79%; p = .318). However, significant differences in the tasks performed during nights emerged: Polish students reported being more involved in performing basic nursing care (72; 93.5%) as compared to other countries (e.g., Portuguese students 337; 84.9%), (p = .02). Overall, an average of 28.9% of the night shift time was reported to be free of commitments, with higher values among Polish (38%, CI 95% 33.6-42.3) and Slovakian students (33.4%, CI 95% 30.6-36.3) and lower values among Czech Republic students (20.4%, CI 95% 17.6-23.2) (p .001). Boredom and satisfaction were reported as the main feelings during night shifts, with significant differences (p .001) across countries. Students reported significant different effects (p .001) of night shifts on their understanding of a nurse's role (from 5.2 out of 10 in Poland to 6.5 in the Czech Republic), on the understanding of the continuity of nursing care (from 5.2 in Poland to 6.7 in Italy), and on having a relationship with the clinical mentors (from 2.7 and 4.2 in Poland and the Czech Republic, respectively, to 6.9 in Italy). CONCLUSIONS: Night shifts can be both a valuable and a non-valuable learning experience, suggesting the need to carefully plan and assess their effectiveness at the unit level.

What nursing home environment can maximise eating independence among residents with cognitive impairment? Findings from a secondary analysis.

To explore the influence of the Nursing Home (NH) environment on eating independence while taking into account individual and nursing care factors, was the aim of the study. A secondary analysis was performed based on data collected in a multicentre prospective observational study involving 13 NHs. Residents aged >65 were included (n = 1,027). Dependence in eating was measured using the Edinburgh Feeding Evaluation in Dementia scale (EdFED, range 0-20). In addition to individual and nursing care variables, the NHs environments were assessed with the Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH, range 0-149). The mean EdFED score was 2.48 (95% Confidence Interval [CI]=2.22-2.73) and the TESS-NH score was 122.19 (95% CI=115.89-128.49). A linear regression analysis explained 30.8% of the total variance in eating dependence. Alongside individual and nursing care factors, in poor NH unit environments, residents with severe cognitive impairment showed increased eating dependence; in contrast, in better environments, similar residents showed maximal eating performance.

Self-feeding dependence incidence and predictors among nursing home residents: Findings from a 5 year retrospective regional study.

The aim of this regionally-based, retrospective study was to describe the incidence of self-feeding dependence and predictors among elderly patients admitted from 2008 to 2013 to 105 Italian nursing homes. Data reported in a regional database collected at the time of nursing home admission and every 6 months up to the resident's death were accessed. The self-feeding degree of dependence was the dependent variable; at the individual and nursing home levels, explanatory variables were those collected at nursing home admission and every 6 months. The structural equation model and the ordinal polynomial logit regression analysis were performed. A total of 13 175 records of residents when admitted to the nursing home and their following 69 341 records, were included. At the time of nursing home admission, 6496 residents (49.3%) reported a certain degree of dependence in self-feeding and showed slight worsening in their dependence every 6 months. At the individual level, the increased functional dependence raised the proportional odds ratios of approximately 4.36 times of an increased dependence in self-feeding; the degree of cognitive impairment, the lack of social interactions, the occurrence of pressure sores, comorbidities, as well as the clinical instability and time all raised the risk of self-feeding dependence progression. At the nursing home level, an increased number of beds emerged as a factor also increasing the proportional odds of dependence in self-feeding. Factors affecting self-feeding dependence are multi-faceted at the individual and at the nursing home levels.

When are night shifts effective for nursing student clinical learning? Findings from a mixed-method study design.

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.

Students' and families' expenditures to attend a nursing programme in 2011-2012: a comparison of five southern European countries.

AIM: To compare students' and families' nursing education expenditures across Europe. BACKGROUND: Nursing education costs are affected by investments in public education. The remaining costs fall on the shoulders of students and their families. While remaining somewhat understudied, public and student expenditure for nursing education is becoming critical in the current crisis context. Comparative studies on education costs are inevitably affected by a currency bias. Therefore, a standard measure named the Purchasing Power Standard, which has received no attention in nursing research, has been introduced. DESIGN: A mixed-method study incorporating qualitative and quantitative study designs was undertaken in 2011-2012. METHODS: Five nursing faculties located in the Czech Republic, Greece, Italy, Slovakia and Slovenia were included in the study. A questionnaire evaluating students' expenditures was developed in five languages and validated. Six hundred and twenty-five full-time students were recruited. RESULTS: A Slovakian student wishing to pursue a nursing career is required to commit an amount of money per year that corresponds to 15% of the average annual income of a Slovakian citizen. Lower percentages were required by students in Greece (10%), Italy (11%) and Slovenia (12%), while Czech students bore the lowest costs (5%). CONCLUSION: None of the countries involved was supporting nursing students through either direct or indirect financial incentives. Students in some countries were also required to buy and maintain uniforms. There is a need to develop supportive policies, especially in those countries where nursing programmes are expensive and may not be accessible to all talented and motivated students due to limited public support in education and the current economic context.