Perceived usefulness of the nurse-patient therapeutic relationship in the rehabilitation journey of people with urinary incontinence: A mixed-method study.

INTRODUCTION: Despite various studies on the impact of incontinence on patients' lives, the existing literature has not investigated the contribution of nursing care during rehabilitation in terms of quality of life. Fewer data, therefore, exist on the characteristics and perceived impact of the therapeutic relationship as part of the rehabilitation program. AIMS: To investigate the characteristics of the nurse-patient therapeutic relationship and its impact throughout the rehabilitation program; to describe the levels of patient burden on everyday activities. MATERIALS AND METHODS: A monocentric, retrospective, multimethod descriptive study was conducted in the nurse-led continence clinic of a major teaching hospital in Northern Italy. A phenomenological approach with semistructured interviews was adopted after 6 weeks of rehabilitation, following the method of phenomenological enquiry by Giorgi. The short form 12 questionnaire was administered upon admission of patients to the clinic, after 6 weeks, and during the last consultation to investigate the impact of urinary incontinence (UI) on daily activities and physical and psychological quality of life. RESULTS: Ninety-one adult patients of both genders presenting for nonneurogenic nonpostpartum UI were consecutively enrolled. Physical scores (PCS-12) and MCS-12 scores significantly increased over time. Psychological scores showed great variability upon admission, which was reduced halfway through the rehabilitation program. The thematic analysis highlighted four categories based on data saturation: the impact of UI on daily activities, strategies to face the problem, feelings, and the role of nurses. CONCLUSIONS: This mixed-method investigation suggests the importance of therapeutic nursing relationships, clinical expertise, and rehabilitative skills. Quality of life is arguably related to the positive results of the rehabilitation program but also to the environment, patients perceive in terms of support, honesty, and trust.

Abdominal massage and laxative use for constipation: a pilot study.

BACKGROUND: Constipation is a very frequent condition. Pharmacological treatment leads to the onset of complications in the long term. AIM: To study the effects of abdominal massage and bowel training combined with polyethene glycol compared with laxative alone. Researchers studied the frequency of evacuations, use of laxatives, appetite, and food intake of older persons. In addition, feasibility in the daily routine of nursing care was studied. METHODS: A pilot, randomised controlled trial was conducted. Older people living in a facility for self-sufficient residents were enrolled and randomised to the intervention or control group. The massage was administered for 4 weeks. The stool type according to the Bristol Stool Form Scale and secondary outcomes were collected at baseline, before any massage session and at the end of the intervention. FINDINGS: 32 participants were enrolled. Significant improvements were found in the number of evacuations, need for enemas, Bristol scores, appetite and food intake. CONCLUSION: Significant improvements were found in all major outcomes.

A qualitative phenomenological study of nurses' experiences in caring for infants and children with life-limiting and life-threatening conditions.

PURPOSE: To understand the experience of nurses caring for infants and children with life limiting and life-threatening conditions. DESIGN AND METHODS: A qualitative phenomenological study was conducted, collecting data through deep interviews. Sample included twenty-seven nurses working in paediatric and neonatal intensive care units. RESULTS: Four themes emerged: suffering, being there, protect yourself and support. The experience of caring for children with limiting and life-threatening conditions affects nurses positively, with personal and professional gratification, but also negatively, as it leads to the development of compartmentalization, avoidance, and high levels of stress. CONCLUSIONS: The organization should make resources available to help nurses build resilience, improve emotional intelligence, and process experiences and emotions, thereby bringing benefits and improvements in infant and childcare. PRACTICE IMPLICATIONS: Comparison between colleagues is one of the most effective tools for supporting each other. Dedicated times and spaces to be able to carry out the debriefings managed by the nurses themselves, guided and mediated by an expert figure, such as a psychologist or a trainer, would be recommended.

Alarm Fatigue in Nursing Students Undertaking Clinical Training in Intensive Care Units: A Multicenter Study.

BACKGROUND: The frequency of alarms from monitors and other electro-medical devices is of great utility but can increase the professional's workload and expose nurses in the intensive care unit to Alarm Fatigue. A recent study suggested that students in training can also experience the problem during their first clinical experiences in intensive care. Unfortunately, no data are available about the Italian panorama. To explore Alarm Fatigue among Bachelor of Science in Nursing students at the end of their internship experience in intensive care settings. METHODS: Multicenter cross-sectional design. A convenience sample of nurses from 3 Italian university hospitals was recruited. The students completed the revised version of the "Alarm Fatigue questionnaire-ita" at the end of the clinical internship in intensive care settings. RESULTS: 130 nursing students were enrolled (response rate 59.36%). The overall level of Alarm Fatigue was Me= 24.5 IQR [17.5, 30.5]. In addition, 9.23% of the sample reported errors or near misses related to Alarm Fatigue during the internship experience. The alarm fatigue level was higher in students who committed "errors/almost errors" (p=0.038) and in "student workers" (p=0.005). DISCUSSION: The extent of alarm fatigue experienced by nursing students requires developing a preventive strategy.

Approach to fever in children among final-year nursing students: a multicenter survey.

BACKGROUND: Unfounded concerns regarding fever are increasingly observed among nurses worldwide. However, no study has so far explored the preferred approach towards pediatric fever among nursing students. Therefore, we aimed to investigate the attitude towards pediatric fever among final-year nursing students. METHODS: Between February and June 2022, final-year nursing students of 5 Italian university hospitals were asked to answer an online survey on their approach to fever in children. Both quantitative and qualitative methods were utilized. Multiple regression models were employed to explore the existence of moderators on fever conceptions. RESULTS: The survey was filled in by 121 nursing students (response rate 50%). Although most students (98%) do not consider discomfort to treat fever in children, only a minority would administer a second dose of the same antipyretic in nonresponsive cases (5.8%) or would alternate antipyretic drugs (13%). Most students would use physical methods to decrease fever (84%) and do not think that fever has mainly beneficial effects in children (72%). The own know-how adequacy on fever was inversely associated (OR 0.33, 95% CI 0.13-0.81) with the beliefs that high fever might lead to brain damage. No further predictive variable was significantly associated with the concern that fever might be associated with brain damage, the advice of physical methods use, and the assumption that fever has mostly positive effects. DISCUSSION: This study shows for the first time that misconceptions and inappropriate attitudes towards fever in children are common among final-year nursing students. Nursing students could potentially be ideal candidates for improving fever management within clinical practice and amongst caregivers.

The Effects of Early Mobilization on Acquired Weakness in Intensive Care Units: A Literature Review.

BACKGROUND: Intensive care unit (ICU)-acquired weakness (ICUAW) is defined as a clinical syndrome of neuromuscular weakness, and a consequence of critical illness, unrelated to any other etiology. It is associated with difficult weaning from the ventilator, prolonged ICU stay, increased mortality, and other important long-term outcomes. Early mobilization is defined as any active exercise in which patients use their muscle strength actively or passively within the first 2 to 5 days of critical illness. Early mobilization can be safely initiated from the first day of admission to the ICU during mechanical ventilation. OBJECTIVES: The purpose of this review is to describe the effects of early mobilization on complications from ICUAW. METHOD: This was a literature review. Inclusion criteria were as follows: observational studies and randomized controlled trials conducted with adult patients (aged ≥18 years) admitted to the ICU were included. Studies selected were published in the last 11 years (2010-2021). RESULTS: Ten articles were included. Early mobilization reduces muscle atrophy, ventilation, length of hospital stay, and ventilator-associated pneumonia and improves patients' responses to inflammation and hyperglycemia. DISCUSSION: Early mobilization appears to have a significant impact on the prevention of ICUAW and appears to be safe and feasible. The results of this review could be useful for improving the provision of efficient and effective tailored care for ICU patients.

Transcutaneous electrical nerve stimulation for pelvic pain: A scoping review of treatment protocols, practical indications, and caveats.

BACKGROUND: Neuromodulation (NM) is a family of therapies based on electrical stimulation to target specific nerves that control LUTS (Lower Urinary Tract Symptoms) and pain. The aim is to modulate what is happening within the nervous system to achieve therapeutic effects. A particular type of neuromodulation, called TENS (Transcutaneous Electrical Nerve Stimulation), has proven effective for treating pelvic pain. The available evidence provides indications regarding the many aspects of TENS that influence therapeutic effects, but a comprehensive review has yet to be conducted. METHODS: Scoping review on Pubmed, CINAHL, Embase, Scopus, and Web of Science, including clinical trials, reviews, case studies or series, and other descriptive studies, according to the Joanna Briggs and PRISMA methodology. RESULTS: The 31 papers retrieved allowed the formulation of precise indications about the DOs and DON'Ts of electrode placement, waveform, pulse duration, pulse frequency, amplitude, session duration, and frequency of sessions. This paper also discusses the biochemical and neuro urological mechanisms of TENS. CONCLUSION: TENS effectiveness is influenced by many factors, some self-evident, others subtle, which this paper elucidates. Pelvic pain requires a multimodal approach, of which TENS is just a part. TENS should therefore be viewed as one of the components of the rehabilitation program in the frame of thorough and continuous patient assessment.

Efficacy, effectiveness, usability and acceptability of devices for female urinary incontinence: A scoping review.

AIMS AND OBJECTIVES: Investigate evidence available on the efficacy, safety and acceptability of devices for the management of female urinary incontinence, in which clinical settings and specific female populations they have been tested. Learn more about healthcare professionals' perspectives and experiences regarding female urinary incontinence devices. BACKGROUND: Urinary incontinence is defined as the involuntary leakage of urine, estimated to affect 25%-45% of women. Urinary incontinence predisposes the skin to urinary incontinence dermatitis, it is one of the most common documented causes of inappropriate urinary catheterisation, favouring catheter-associated infection. Several products for managing female urinary incontinence are available, no accurate and systematic data on usability, effectiveness and associated outcomes of these products are available. DESIGN AND METHODS: A scoping review was conducted, using a methodological framework including the following five steps: identification of the research question; identification of relevant documents; selection of documents included in the review; tracking of information and data; synthesis and reporting of results. Twenty-one articles were selected. PRISMA-ScR Checklist was followed. RESULTS: The devices explored in the studies were as follows: female external urinary catheter; disposable sanitary pads, diapers or sanitary pads used to manage urinary incontinence in women; mechanical devices; a new prototype of underwear that tracks where pads lose; reusable underwear for light incontinence; a new intelligent system pad. CONCLUSIONS: New smart pads, urine suction systems and female external catheters appear to be effective in preventing and reducing urinary incontinence dermatitis. The female external catheter reduces the days of indwelling catheterisation and could reduce the incidence of catheter associated urinary tract infection; therefore, it should be recommended.

Validation of the Italian version of the spirituality and spiritual care rating scale (SSCRS-ita).

PURPOSE: To translate and validate the Italian version of the Spirituality and Spiritual Care Rating Scale (SSCRS-ita). METHODS: A single-center cross-sectional study was performed from October 15 to November 15, 2019 in a public hospital in Milan, Italy. The scale was drafted using the back-translation method. Prior to administration, the Italian version of the scale was assessed for content validity and retest stability by calculating the content validity index. Internal consistency was investigated by calculating Cronbach's alpha coefficient, test-retest stability by Spearman's rho coefficient. FINDINGS: A total n = 337 nurses participated in the survey by correctly completing the scale. The Kaiser-Meyer-Olkin test (0.81) and Bartlett's test of sphericity (p < 0.001) confirmed the adequacy of the sample to conduct exploratory factor analysis (EFA). The factorial model of EFA without rotation and then with nonorthogonal Promax rotation confirmed the presence of the four constructs identified by the original author. CONCLUSIONS: SSCRS-ita showed promising psychometric properties in terms of validity and reliability. The results of this study, together with the lack of in-depth studies in the Italian health and educational panorama, suggest the need to develop an educational pathway which, starting from the curricula of basic training and continuing with the updating of nursing staff, is dedicated to the detection of the spiritual needs of the patient. IMPLICATIONS FOR NURSING PRACTICE: The SSCRS-ita is the first validated Italian tool concerning the consideration of the needs of spirituality and spiritual care in healthcare contexts; the possibility to use this tool is the first step towards a better integration of the mentioned dimensions of care in a nursing care qualitative perspective in Italy.

Nurses' role in the management of persons with chronic urogenital pelvic pain syndromes: A scoping review.

BACKGROUND: Pelvic pain has cognitive, behavioral, sexual, and emotional consequences. Nurses involved in pelvic floor rehabilitation clinics have contacts with patients reporting chronic pain and should know the most appropriate service for patient referral, to submit the problem to professionals capable of correctly assessing and managing the condition. Furthermore, in some countries nurses can use conservative methods to treat the painful symptoms inside a multidisciplinary team such as breathing retraining, biofeedback, and noninvasive neuromodulation. This paper aims to provide an overview of the literature regarding the role of rehabilitation nurses in dealing with patients suffering from chronic urogenital pelvic pain or urogenital painful syndromes, inside a multidisciplinary team. METHODS: Scoping review on Pubmed, CINAHL, Embase, Scopus, Web of Science including trials, reviews, case studies or series, and other descriptive studies regarding the role of nurses inside the multidisciplinary team in the management of males and females presenting chronic pelvic pain (CPP) or chronic pelvic pain syndrome (CPPS). RESULTS: The 36 papers included in this review allowed answering research questions in four areas of nursing: collecting basic information, referring the person to appropriate services, evidence-based nursing interventions for CPP and CPPS, and proper documentation. Clinical history and assessment of breathing pattern, Muscular assessment and research of trigger points are the main points of data collection. Techniques for muscular relaxation and breathing retraining are important aspects of treatment, as well as biofeedback and noninvasive neuromodulation where the law allows nurses to practice such techniques. The McGill pain questionnaire and the pain inventory of the International Pain Society allow systematic data collection and handover. CONCLUSION: Rehabilitation nurses work inside multidisciplinary teams when dealing with persons suffering from pelvic pain; further research is needed as our comprehension of the underlying pathophysiological mechanisms of CPP and CPPS evolve.

A nurse-led educational intervention for relieving idiopathic constipation: a retrospective study.

BACKGROUND: Constipation is a common condition. Although numerous articles emphasise the importance of conservative interventions, none have set out a complete educational programme. AIMS: To describe the results of an evidence-based, nurse-led educational intervention for functional constipation in adults. METHODS: A retrospective study of patient records with an analysis of Wexner constipation scores and Bristol stool charts was carried out before and after a nurse-led educational programme on nutrition and bowel habits. FINDINGS: Twenty-nine patients were enrolled (19 women and 10 men), with a median age of 61 (53-71) years, a mean BMI of 24.4±3.88 kg/m2 and comparable baseline Wexner and Bristol scores. A statistically significant improvement in Wexner scores (P<0.001) and a clinically relevant but not statistically significant (P=0.682) improvement in Bristol scores were observed. CONCLUSION: The results suggest this investigation should be repeated on a larger scale. An educational intervention could be included in all consultations on any issue that could affect bowel activity.

Violence and unsafety in Italian hospitals: Experience and perceptions of nursing students.

BACKGROUND: Assessment of workplace violence towards healthcare workers represents a challenge for healthcare organizations worldwide. Workers' experience and perceived risk of violence may have a serious impact on job satisfaction and retention of workers. To date, no studies have been conducted on nursing students. OBJECTIVES: To assess the prevalence of physical and non-physical violence among nursing students during their clinical experiences and to analyze the perceived risk of violence. METHODS: Multicentre, cross-sectional survey. We enrolled a convenience sample of nursing students of the bachelor's degree in Nursing of the University of Milan (Italy). The students completed a structured questionnaire prepared in accordance with the available literature on violence in healthcare settings. RESULTS: Out of 1185 questionnaires sent, 603 were collected (50.89%). 35.1% had experience of verbal violence during the clinical internship training period, while 8.1% were victims of physical violence. 202 students (33.5%) reported unsafety, which was related to experience of physical or psychological violence, witnessed episodes of violence, gender, hospital structure and efficacy of the safety policies. CONCLUSIONS: Our findings highlight that nursing students are exposed to the risk of violence which influences their perception of risk.

[The need for preventive nursing care from a gender perspective at Bollate prison. An example: breast cancer.] / Il bisogno di assistenza infermieristica di natura preventiva in ottica di genere presso il Carcere di Bollate . Un esempio: il cancro della mammella.

Breast cancer is prevalent in females, accounting for 25% of the world's cancers. Prevention is strategic, and the nurse is an active part in educational and preventive programs, highlighting how the need for preventive nature is combined with gender medicine. The objective was to investigate the knowledge of breast cancer prevention among inmates of Bollate prison (Milan). 51% (52) adhered; women had an average age of 44 years (SD: 9.8), and 39% (20) were inmates from 1 to 3 years. 93% (48) knew about breast cancer prevention, 43% (26) had undergone specific preventive checkups outside of the prison, and 62% (31) had performed self-palpation. All women felt it was important to implement prevention in the prison environment. A high percentage of female inmates with an educational qualification was observed to be aware of breast cancer prevention and to have undergone screening programs in their lifetime. Emerges the strong willingness of women prisoners to be involved and the educational role of the nurse in the prison setting also from a gender perspective.

Assessing non-technical skills in undergraduate nursing students: a validation study.

OBJECTIVES: Non-technical skills (NTS) are fundamental to the nursing profession to ensure safe, quality care. Purpose: The aim of this study was to develop a new instrument to assess NTS among nursing students: the Non-Technical Skills Student Evaluation (NTS-SE) tool. METHODS: A cross-sectional study was conducted to test the psychometric properties of the tool. A number of 1,087 nursing students were enrolled from five Bachelor Schools of Nursing. RESULTS: Exploratory and confirmatory factor analysis suggested the suitability of a two-factor model. The final version of the NTS-SE consisted of 23 items distributed in two domains: cognitive skills and interpersonal skills. For each domain, Cronbach's alpha coefficients were above 0.94. There were significant differences in scores between second- and third-year students (p<0.001) and among the different nursing schools (p<0.001). CONCLUSIONS: The NTS-SE can be useful when assessing the effect of educational strategies and/or clinical traineeship experiences on the acquisition of NTS.

Alarm fatigue in nurses working in intensive care units: A multicenter study.

BACKGROUND: Technological progress improves health care efficiency, quality, safety, and cost, supporting clinical activity in various scenarios, such as Intensive Care Unit (ICU). A timely response to alarms from monitors and other ICU electromedical devices is therefore crucial. The number of false alarms tend to desensitize care providers increasing the risk of experiencing alarm fatigue and, at times, lead to severe consequences for patients. OBJECTIVES: To assess the psychometric properties of the Italian version of the Alarm Fatigue Questionnaire and to explore the phenomenon of alarm fatigue among nurses working in intensive care settings. METHODS: The CVI-I was calculated to evaluate the validity of the content of the tool. Construct validity was investigated through exploratory factor analysis. Cronbach's alpha coefficient (α) was used to examine the internal consistency of the scale and Spearman's rho coefficient to test for stability.We designed a multicentre cross-sectional survey. A convenience sample of nurses from 4 Major Italian hospitals was recruited. The nurses completed the Italian version of the Alarm Fatigue Questionnaire. RESULTS: The content validity index CVI-S of the scale (CVI-S) was 91.11%; Cronbach's alpha coefficient was 0.71. The Italian version of the tool explained 67.18%of the overall variance. 396 nurses were enrolled (79.84%). The overall level of alarm fatigue was Me = 29 [22;30]. 42.17%of the sample reported prior experience with alarm fatigue incidents. CONCLUSIONS: The extension of alarm fatigue requires the adoption of a preventive intervention plan. The Italian version of the Alarm Fatigue Questionnaire shows promising psychometric properties.

Experience of relatives in the first three months after a non-COVID-19 Intensive Care Unit discharge: a qualitative study.

BACKGROUND: The novel coronavirus brought Intensive Care Units (ICUs) back to their past when they were closed to family members. The difficulties of family caregivers encountered after the ICU discharge might have been increased during the coronavirus disease 2019 (COVID-19) pandemic. However, no traces of their experience have been documented to date. The objective of this study is to explore the everyday life experience of relatives in the first three months after a non-COVID-19 ICU discharge. METHODS: A descriptive qualitative study was conducted in 2020-2021. Two Italian general non-COVID-19 ICUs were approached. Follow-up telephone interviews were conducted three months after the ICU discharge. The study has been conducted according to the COnsolidated criteria for REporting Qualitative research principles. RESULTS: A total of 14 family members were interviewed. Participants were mostly females (n = 11; 78.6%), with an average age of 53.9 years. After three months of care of their beloved at home, relatives' experience is summarised in three themes: "Being shaken following the ICU discharge", as experiencing negative and positive feelings; "Returning to our life that is no longer the same", as realising that nothing can be as before; and "Feeling powerless due to the COVID-19 pandemic", given the missed care from community services and the restrictions imposed. CONCLUSIONS: Relatives seem to have experienced a bilateral restriction of opportunities - at the hospital without any engagement in care activities and their limited possibility to visit the ICU, and at home in terms of formal and informal care.

[Severe marginality in the Como area. Homelessness phenomenon and nursing care.] / La grave marginalità nel territorio del Comasco.Il fenomeno degli homeless e la presa in carico infermieristica.

Homelessness is a growing problem. These people face huge inequalities and frequent hospitalizations, often lacking social support. The condition is one of extreme poverty and affects public health care costs. The risk of mortality and morbidity is high. Together with the synergy between health care institutions and targeted policies, Third Sector Associations are fundamental. The nurse is crucial in responding to the needs of the most fragile individuals by ensuring an integrated approach to care. The Como Services for Serious Marginalization are concerned with taking charge of and satisfying the needs of homeless people through the services provided also in the current pandemic. The main exigencies that emerge are hospitality, active listening and the need for primary services. Both Italian and immigrant populations are represented. The realities involved rely on the figure of the nurse both directly and indirectly. The health inequity faced by the homeless requires special attention. The homelessness needs require an integrated service model with reorganization needed due to the ongoing pandemic. The Nurse can become central to the territorial management of frailty and social vulnerabilities.

Adaptation and validation of the Caregiver Burden Inventory in eating disorders.

BACKGROUND: Living with people diagnosed with a mental disorder is known to increase the risk of developing high levels of so-called "caregiver burden" in informal caregivers. In-depth analysis of this phenomenon and specific assessment tools for caregivers of patients diagnosed with Eating Disorders (EDs) are lacking. In this study, we aimed to evaluate the psychometric properties of the Caregiver Burden Inventory in EDs and employ this adapted tool in this category of caregivers. METHODS: A cross-sectional study was conducted in the Eating Disorders outpatient unit of an Italian University hospital. Face and content validity were investigated by calculating standard Content Validity Indices (CVI-I and CVI-S) after administering the Inventory to 6 expert nurses with at least 5 years of experience in mental health services assisting people diagnosed with Eating Disorders. Internal consistency was evaluated with Cronbach's α coefficient for the overall scale and subscales. An exploratory factor analysis (EFA) was performed to explore latent constructs. The adapted CBI was then administered to 62 informal caregivers of ED patients. RESULTS: The EFA yielded a 5-factor structure. The CVI-S was 97.2%; the Cronbach α coefficient was 0,90 (> 0.74 in each subscale). The median burden level in the experimental population was 40.0 [range = 21 to 54], in a theoretical range from 0 (no burden) to 96 (highest level of burden). CONCLUSION: The Caregiver Burden Inventory appears to be a valid and reliable instrument to assess caregiver burden in individuals diagnosed with Eating Disorders. Further research is needed to evaluate this tool's efficiency in improving individually tailored interventions on families.

Eating disorders (EDs) are characterized by the development of abnormal eating habits, dysregulation of body weight and/or body image distortion. The pervasiveness of EDs may significantly affect the life of patients' caregivers in terms of emotional load, termed Caregiver Burden (CB). This may impact the quality of life of the entire family and promote conflicts which may in turn exacerbate ED behaviours. Among several international assessment tools to measure CB, the Caregiver Burden Inventory (CBI) is perhaps the most widely employed. However, this tool has never been specifically tested in caregivers of ED patients. Here we show that CBI can adequately quantify burden in this category of caregivers. Systematic use of this instrument can support healthcare workers who aim to address the carer's discomfort and promote a focused monitoring of subjects with increased risk, in order to adequately plan targeted intervention programs.