Validation of the Italian version of the Discomfort Scale - Dementia of Alzheimer Type.

AIM: This paper is a report of a study to validate the Discomfort Scale - Dementia of Alzheimer Type in Italian. BACKGROUND: Dementia is a long and highly debilitating illness with a slow course and a steadily rising prevalence. Improving the quality of life of patients with dementia requires instruments to measure their problems and symptoms, because they are unable to communicate and interact with others. In Italy, there are no validated scales to assess discomfort for this population. The Discomfort Scale - Dementia of Alzheimer Type was developed in the USA and has been further tested there as well as in Germany. METHODS: The data were collected by 21 nurses during 2006 in five nursing homes with 71 patients with severe dementia. Face and content validity were evaluated in a focus group. Discriminant validity was assessed with the opposite-group approach and internal consistency and inter-rater reliability were measured. RESULTS: The discriminant validity of the Italian Discomfort Scale - Dementia of Alzheimer Type showed its ability to detect patients with high and low levels of discomfort. Reliability testing gave positive results: the internal consistency level was satisfactory (0.814) and comparisons of overall discomfort scores across nurses show good reliability. CONCLUSION: These findings support the use of Discomfort Scale - Dementia of Alzheimer Type in a clinical setting for people with severe dementia for both research and practice. Its ease of use and comprehensibility, and the limited time required to observe patients renders the Discomfort Scale - Dementia of Alzheimer Type a practical instrument for assessment and choosing care interventions.

[Aging of nursing workforce: survey in three hospital of in Piedmont region]. / Invecchiamento della popolazione infermieristica: analisi in tre ospedali piemontesi.

AIMS: Aging of registered nurses workforce is already a worrying issue in many countries and therefore attempts to estimate its alarming dimension are on course. Some worrying signals are already evident in Italy but, to date, no data are available on the size and possible evolution of the problem. METHODS: This study aims to describe the trend of the aging of nurses workforce in three hospitals of Turin in the next 25 years and to explore retention strategies. RESULTS: The percentage of nurses > 45 years ranges from 19 to 21% but it is bound to steadily increase, ranging from 59 to 71%. CONCLUSIONS: The creation of an healthy work place, tailored to the needs of ageing of the workforce and the implementation of retention strategies and incentives centered on this age-group will be one of the immediate future challenges, to govern an highly predictable emergency.

[Nursing care priorities and problems: the nurses point of view]. / Priorità e problemi per l'assistenza: il punto di vista degli infermieri.

AIM: An experience of a tentative contribution of the nurses to the health policy planning is described. METHODS: Fifty one focus groups were organized, with nurses from different contexts (hospital, district, free lance nurses; caring for paediatric, geriatric surgical and medical patients) and nurses were asked to identify problems encountered in patients care, select one, discuss contributing causes assign a weight (from 1 to 100) and define the nurses' contribution to the resolution/improvement of each cause. The problems were discussed in groups and possible solutions identified, with specific attention to the potential implications of regional health policies. RESULTS: The main difficulties identified were the lack of continuity in patients care (for geriatric and paediatrics patients), 12 groups, and the management of chronic patients (7 groups); the lack of information to patients, 6 groups; the appropriateness of care, from hospital admissions to waiting lists, 5 groups; the management of surgical patients, 5 groups; the lack of nursing personnel, 5 groups; the safety of patients and health personnel, 4 groups; and other problems reported by less than 3 groups. CONCLUSIONS: This experience allowed nurses to reflect on health care problems throughout the trajectory from the specific problem to its general implications, also for the health care policies. The solutions identified in fact, encompass a dimension relevant for health policy planning. It is also an experience of opportunity (and feasibility) of involvement of the "general nurses" and not only nurse managers, to reflect on practice and propose a specific and original contribution to the development of regional and local policies.