Defining a balance by compromising with fear: A grounded theory study on returning to eating after a total gastrectomy.

OBJECTIVES: Gastric cancer patients undergoing total gastrectomy face nutrition-related complications and worsening quality of life after surgery. In this context, gastrectomized cancer patients are required to cope with new conditions. Little is known about their accommodating feeding to the new life condition as a negotiated process among stakeholders in real contexts. This study aimed to investigate the shaping of this process as influenced by the perspectives of patients, health-care professionals (HPs), and caregivers (CGs). METHODS: A constructivist grounded theory study, through semi-structured interviews and interpretative coding, was designed to answer the following research question: "what is the process of returning to eating and feeding after a gastrectomy?" RESULTS: The final sample included 18 participants. "Defining a balance by compromising with fear" is the core category explaining returning to eating as a process negotiated by all actors involved, with patients trying to find a feeding balance through a multi-layer compromise: with the information received by HPs, the proprioception drastically altered by gastric resection, new dietary habits to accept, and complex and often minimized conviviality. This process involves 4 main conceptual phases: relying on the doctors' advice, perceptive realignment, rearranging food intake, and food-regulated social interaction. Those categories are also shaped by the fear of being unwell from eating and the constant fear of tumor relapse. SIGNIFICANCE OF RESULTS: Multiple actors can meet patients' and their CGs' nutritional, care, and psychosocial needs. A multidisciplinary approach involving nutritionists, psychologists, occupational therapists, social workers, and anthropologists can be key to effectively managing these patients' survivorship care. We suggest training all the professionals on the first level of nutritional counseling.

Assessment of COVID-19 Fear in Five European Countries before Mass Vaccination and Key Predictors among Nurses and Nursing Students.

BACKGROUND: Levels of fear have increased since the COVID-19 pandemic outbreak. The absence of a safe and effective vaccine for mass-vaccination deteriorates this situation, which has a significant impact on mental health. This study aimed to assess the feelings of fear among nurses and nursing students in five European countries. METHODS: A multicenter cross-sectional study was conducted in five European countries (Greece, Albania, Cyprus, Spain, and Kosovo) before the start of mass vaccination in Europe. Data collection was conducted in December 2020-January 2021 using an online questionnaire for nursing students and professional nurses. Fear of COVID-19 Scale (FCV-19S) was used for measuring levels of fear. IBM SPSS version 21.0 was used for statistical analysis. RESULTS: The study population included 1135 nurses and 1920 nursing students from Kosovo (n = 1085), Spain (n = 663), Greece (n = 534), Albania (n = 529), and Cyprus (n = 244). According to multivariable analysis, females (OR = 2.53, 95% CI = 1.89-3.15), married (OR = 0.86, 95% CI = 0.24-1.48), nurses (OR = 0.87, 95% CI = 0.28-1.45) and those with a chronic disease (OR = 0.86, 95% CI = 0.11-1.62) were more fearful of COVID-19. CONCLUSIONS: It is important to decrease fear in the population of nurses who are at the frontlines of the pandemic. The provision of appropriate education and training activities for nurses and students to manage their stress levels is of high importance. Future studies should focus on levels of fear after the administration of several safe and effective vaccines worldwide.

"Challenging Professional Boundaries": A Grounded Theory Study of Health Professionals' First Experiences of End-of-Life Care in Hospital.

Little is known about health professionals first experiences of End-of-Life care in hospital. This study aims to understand the psycho-social process that occurs when hospital-based health professionals engage in caring for a dying patient for the first time. We conducted a Grounded Theory study, with 19 health professionals. Challenging professional boundaries is the core category which explains the overall process. The theoretical model we conceptualized evidenced three phases: 1) building a relationship between patient/family and professionals, 2) the disrupting impact and 3) the reaction phase. Our analysis highlighted the initial strong impact of this experience, which brought professionals to perceive emotional suffering and feelings of inadequacy. The new aspect our grounded theory revealed is that all the categories are pertinent to all the professionals involved, therefore they explain important aspects of interprofessional collaboration in End-of-Life care.

Factors influencing nursing students' intention to accept COVID-19 vaccination: A pooled analysis of seven European countries.

BACKGROUND: Experiencing the third wave of COVID-19 pandemic, high vaccination coverage by a safe and effective vaccine globally would be a great achievement. Acceptance of vaccination by nursing students is an important issue as they play a decisive role as future professionals in educating patients, counselling, and guiding them to the right clinical decision. OBJECTIVES: To explore the intention of nursing students to get vaccinated for SARS-CoV-2 infection and the factors acting either as motivators or as barriers towards vaccination. DESIGN: A multicenter cross-sectional design. PARTICIPANTS: In total 2249 undergraduate nursing students participated. METHODS: The study was conducted in 7 universities in participating countries (Greece, Albania, Cyprus, Spain, Italy, Czech Republic, and Kosovo) through a web survey. Data was collected during December 2020-January 2021 in all countries. RESULTS: Forty three point 8% of students agreed to accept a safe and effective COVID-19 vaccine, while the acceptance was higher among Italian students. The factors for intention to get vaccinated were male gender (p = 0.008), no working experience in healthcare facilities during the pandemic (p = 0.001), vaccination for influenza in 2019 and 2020 (p < 0.001), trust in doctors (p < 0.001), governments and experts (p = 0.012), high level of knowledge (p < 0.001) and fear of COVID-19 (p < 0.001). CONCLUSIONS: Understanding of factors that influence students' decision to accept COVID-19 vaccination could increase the acceptance rate contributing to a management of the pandemic.

Core Evidence-Based Practice Competencies and Learning Outcomes for European Nurses: Consensus Statements.

BACKGROUND: Consensus on evidence-based practice (EBP) competencies and associated learning outcomes for registered nurses has not yet been achieved in the European context. AIMS: To establish a set of core EBP competencies for nurses and the most important EBP learning outcomes encompassing attitudes, knowledge, and skills dimensions for implementation into nursing education in European countries. METHODS: A multi-phase modified Delphi survey was conducted: Phase 1, a literature review; Phase 2, a two-round consensus of experts; and Phase 3, a Delphi survey. Experts from six European countries participated. RESULTS: In Phase 1, 88 records were selected and 835 statements extracted, which were grouped according to the seven steps of EBP. After removing 157 duplicates, the remaining competencies (n = 678) were evaluated in Phase 2. Then, a two-round expert consensus was reached, with 24 competencies and 120 learning outcomes identified and divided into affective, cognitive, and skills domains. In Phase 3, based on a Delphi survey expert consensus, all evaluated statements were included in a final set of competencies and learning outcomes. Only two learning outcomes were recommended for allocation to a different domain, and four were reformulated as suggested, with no further changes to the others. LINKING EVIDENCE TO ACTION: The set of EBP competencies and learning outcomes can guide nurse educators, managers, and EBP stakeholders in the development of content that incorporates EBP knowledge, skills, and attitudes into educational programs. Prioritizing the EBP competencies and learning outcomes that are most necessary and adapting them to every context will provide healthcare organizations with guidelines for enhancing the continuing education of nurses. These results could facilitate the development of effective tools for assessing nursing students' and nurses' perception of competencies required for EBP processes.

[Italian Validation of Evidence Based Practice Evaluation Competence Questionnaire (EBP-COQ)]. / Validazione per il contesto italiano dell'Evidence Based Practice Evaluation Competence Questionnaire (EBP-COQ).

INTRODUCTION: due to the nature of Evidence-Based Practice and its relevance to nursing, the skills that it requires should be integrated in the healthcare degree programs. Therefore, the Evidence-Based Practice process should be introduced in the nursing education program to strengthen the students' independence and self-learning skills. The evaluation of the effectiveness of the academic teaching and the assessment of the competence degree achieved by students are hindered by the lack of validated assessment instruments. In the Italian context, today there is no instrument to assess the knowledge, skills and attitudes to Evidence-Based Practice. OBJECTIVE: the authors aimed at validating, for the Italian context, the Evidence-Based Practice Evaluation Competence Questionnaire (EBP-COQ). METHODS: this study was an Italian linguistic and cultural adaptation of a research instrument. To this end, the Beaton and Sousa Model were used. These models require six phases and aim at producing a pre-final version of the instrument to be submitted to a sample of nursing students. RESULTS: Each item has reached a content validity index (I-CVI) value equal to or greater than 0.9 and a scale validity index (S-CVI) value of 0.992 for the whole questionnaire. The study has confirmed the reliability of the instrument's internal consistency with a Cronbach's alpha value of 0.892. The reliability of the test-retest confirms the stability of the questionnaire over time (Pearson's r = 0.976). The factorial analysis confirmed the construct validity. CONCLUSION: the instrument has been validated in its psychometric characteristics and is ready to be administered to Italian nursing students.

Educational Interventions for Teaching Evidence-Based Practice to Undergraduate Nursing Students: A Scoping Review.

Background: Evidence-based practice (EBP) is the appropriate approach to guide healthcare personnel in their clinical practice. Despite the importance of EBP, undergraduate nursing students are not very much engaged and have a lack of knowledge and skills. Aim: The aim of this study was to gather, assess and synthesize evidence on educational interventions promoting evidence-based practice competencies in traditional undergraduate nursing students. Methods: This is a scoping review on sixteen English and non-English databases. A data extraction form was established including authors, year of publication, country, types of participant, specific objectives, study design, educational intervention, comparison if existed, and outcomes of significance. Results: The search strategy retrieved 8901 records in total. After screening for duplicates and eligibility, 20 articles were included in the qualitative synthesis. Improvement in EBP domains such as knowledge, skills, attitudes/behaviours, EBP beliefs, use, practice, level of evidence, critical thinking and future use of EBP were mentioned and assessed in different studies. Conclusions: EBP training can improve nursing students' capacity in healthcare provision. Teaching EBP competencies along undergraduate nursing curricula should be a high priority at nursing programmes. The use of innovative approaches seems to be more effective than traditional ways. Education of EBP increases its future use and critical thinking and EBP programs improve self-efficacy and the level of evidence utilization.

Teaching evidence-based practice (EBP) in nursing curricula in six European countries-A descriptive study.

BACKGROUND: Teaching evidence-based practice (EBP) in nursing education varies among nurse educators and universities. Lack of nurses' knowledge and skills are among the barriers commonly associated with the limited use of EBP in practice. OBJECTIVES: To describe the presence, characteristics and content of courses of EBP in nursing bachelor's, master's, and PhD programs in six European countries. DESIGN: A descriptive study design was employed. SETTINGS: The study was implemented as part of the EBP e-Toolkit Project as a strategic partnership of six European higher education institutions from six countries in the framework of the Erasmus+ Programme. PARTICIPANTS: Census sampling (N = 225) was used. A total of 162 (72%) faculties responded from the following countries: Spain (79), Italy (44), the Czech Republic (15), Poland (12), Greece (7), and Slovenia (5). METHODS: Three structured instruments were developed by using the consensus development panel. The research was conducted from December 2018 to March 2019. For names of subjects, a manual narrative Template Analysis was used with open descriptive coding. RESULTS: Subjects in "EBP in Nursing or Health Care" are included in 45 (29.2%) bachelor's programs, mostly worth 180 European Credit Transfer System (ECTS) credits, 30 (28%) master's, and 6 (40%) PhD programs. In bachelor's programs, an average of 134 h are spent teaching EBP steps, followed by 127 h in master's programs and 52 h in PhD programs. EBP subjects have different focuses: clear topics in EBP, development of research knowledge, awareness of the need for evidence-based clinical work, and understanding the needs of the profession. CONCLUSIONS: Teaching EBP is not yet sufficiently integrated into nursing curricula. For more efficient integration, guidelines on the standardization of teaching approaches and content have to be developed in all three cycles of higher education. Further research is needed on the implementation of teaching at master's and PhD levels of nursing curricula.

Linguistic-cultural validation of the oral health assessment tool (OHAT) for the Italian context.

BACKGROUND: The increase in the ageing population and the consequent establishment of a network of adequate structures to respond effectively to the welfare needs of institutionalized elderly people have stimulated the discussion by healthcare professionals on the subject of oral hygiene.Literature data show that the same attention has not been paid to oral health care compared to other health needs. Many studies have demonstrated that oral health has a significant impact on the quality of life, especially for older people. Poor oral health also has a considerable role on the physical condition of the elderly because it affects their ability to eat, feed themselves, forcing them to have unbalanced diets. The consequence of this condition is dehydration, malnutrition and impairment of communication skills. The essential nursing activity for oral care is the assessment of the state of oral health, an activity that should be conducted by means of valid tools. To date there are no tools for assessing the health of the oral cavity validated for the Italian linguistic-cultural context. The aim of this study is to conduct a linguistic-cultural validation for the Italian context, of the original Australian version of the Oral Health Assessment Tool (OHAT) scale. METHODS: Study design: Linguistic-cultural validation and adaptation of a tool for the assessment of oral health. The Beaton and Sousa & Rojjanasrirat (2011) models were used to conduct the linguistic-cultural validation and adaptation process. This validation involved 368 inmates/patients aged over 65 years with cognitive deficit. RESULTS: The face validity was confirmed by a score for each item related to clarity equal to or greater than 80%. The content validity was confirmed by an content validity index for items (I-CVI) score equal to or greater than 0.8 for each item and an content validity index for scales (S-CVI) of 0.93 for the entire tool. For the reliability of the internal consistency the Cronbach alpha was calculated, which was found to be 0.82. The test-retest was calculated by means of the Pearson coefficient correlation which turned out to be 0.5. CONCLUSIONS: The Italian version of the OHAT is a tool that can help to consider oral health at the same level as other health needs aimed at increasing the quality of nursing care provided. This tool can be used by nurses to assess the health of the oral cavity in elderly subjects also with cognitive deficit.

[The linguistic and cultural validation of a tool to evaluate the cultural competence in nurses]. / La validazione linguistica e culturale di uno strumento di valutazione della competenza culturale infermieristica.

INTRODUCTION: Cultural competence is described as a complex process of elements useful to work in an intercultural context. It could be evaluated with several different tools. In literature different English scales are available, and all of them start from the operator's perception. The Physician's Cultural Competence for Patient Satisfaction (PCCPS), by Ahmed and Bates (2012), is the only scale that consider the perception of the person. OBJECTIVE: validation and linguistic-cultural adaptation of the PCCPS at the nursing Italian context. METHOD: the study used Beaton e Valmi's models, that expect five phases to elaborate a pre-final version of the tool, this has to be dispensed to a sample of experts and to target population. RESULTS: at the third administration to the expert group, the tool got the face's validity (clearness 70%), the content's validity (I-CVI), and the index of content's validity (S-CVI). The reliability of internal's consistency has been confirmed by an alpha di Cronbach's value of 0.8-0.9. The fidelity of the reliability confirms the tool's stability in the time (correlation inter item 0.8; Sperman- Brown's coefficient 0.9; Guttman's index 0.9). DISCUSSION: the validation path resulted really complex: major problems were related to the adaptation to the nursing context and to the sample population, who has a limited knowledge of the Italian language. These elements have been requested the necessity to reformulate the tool several times, but even working to get clearness, it has been looked to maintain the semantic and conceptual equivalence to the original version.

The Italian validation of the Salford-Scott Nursing Values Questionnaire.

BACKGROUND: To properly direct nursing training and to improve the professional practice to become more effective, it is important to understand students' values. Literature review has shown that there have been changes in students' values in the last 20 years. In contemporary students, a general decrease in altruism has been observed, but also a larger appreciation for honesty toward patients has been declared. The analyzed literature did not find validated tools available in Italian that explore personal and professional values of nursing students. DESIGN OF THE STUDY: This study was an Italian linguistic and cultural adaptation of a research tool. PURPOSE: The authors aimed to validate, for the Italian context, the Salford-Scott Nursing Values Questionnaire, enhanced by Johnson to explore the nursing profession's values. METHODS: The Beaton Model was used as well as Valmi's. These models require five phases, with the goal of producing a pre-final version of the instrument for it to then be administered to a sample of the target and expert population. ETHICAL CONSIDERATIONS: The study was approved by the Council of the Nursing Degree University course of the Modena and Reggio Emilia University, Reggio Emilia site, and the identity of the subjects was protected at every moment of the testing. RESULTS: Face validation was achieved since the clarity percentile for each item was 100%. Content validity was also reached, measured from the content validity index and the scale validity index. The study has confirmed the reliability of the instrument's internal consistence with a value of Cronbach's alpha on 0.95 of total of items. The reliability of the test-retest confirms the stability of the instrument in time (r = 0.908; p = 0.01). CONCLUSION: The study concludes that the instrument is ready to be administered to the target population, a sample group of nursing students.

[Assessment and choice of the device for vascular access]. / Accertamento e scelta dei dispositivi ad accesso venoso.

The accurate vascular monitoring by nurses both at the beginning and during infusion treatment, in addition to the selection of the best device for each patient, can increase patient satisfaction, reduce complications, preserve peripheral veins, reduce or eliminate time used to find unlikely vein access, reduce hospital stay length and reduce the costs associated with infusion treatment. Aims of study are to ascertain the presence of a procedure for choosing the most suitable venous device for each patient, to identify nurses' criteria to make a vascular assessment, and to describe when nurses make a vascular assessment. A descriptive study with convenience sample of 290 nurses. The data collection instrument is an anonymous questionnaire. The questionnaires administered, returned, and considered valid were 227. 14% of the sample states that within their ward there is a a procedure to evaluate the most suitable device, while 70% states the opposite and 16% of the sample states that "they do not know". The results show fairly clearly that in the wards considered there is no procedure currently in use in order to choose the most suitable device for each patient, that nurses do not have clear criteria to make a vascular assessment, that they carry out vascular assessment at different times of the infusion's process.

[Nursing competences and basic education: descriptive study on new-graduate nurses]. / Competenze infermieristiche e formazione di base: studio descrittivo sui neolaureati infermieri.

UNLABELLED: The pressing need by the health organizations of new-graduate nurses immediately able to take full charge of the ward, together with the radical changes of nursing education, led the professional community to discuss the education of new-graduate nurses. AIM: To describe if new-graduate nurses at the Nursing Degree Course in Reggio Emilia, have the competences adequate to the demands of the health care organizations. METHODS: Fifty ward Nursing Manager of a National health Service, where new-graduate nurses of the 2009-2010 academic year were emploied by at least one month were interviewed by phone. A list of 34 competences were identified and grouped into six skill areas (taking care, technical, managerial, communication, professional ethics, education and professional updating); for each, respondents had to rank the level of compentence on a Likert scale from 1 not able to 5 fully able. RESULTS: According to Nursing Managers new-graduate nurses are able to identify the patient care problems (mean score 4.1+0.8), to perform nursing techniques (mean score 4.4+0.7) and to meet the deadlines of the organizations (mean score 4.2+0.8). All Nursing Managers agree that new-graduate nurses have required skills and knowledge to work in their units. DISCUSSION: The level of expertise of by new-graduates in the areas investigated appears adequate to fulfill the role of nurse in health care organizations after a short period of coaching by a senior nurse.

Teaching evidence-based practice: developing a curriculum model to foster evidence-based practice in undergraduate student nurses.

UNLABELLED: For the nature of the Evidence-Based Practice (EBP) and its relevance to nursing, the skills that it requires should be a component in the basic Nursing degree courses. For this reason, the EBP process should be introduced early on in nursing education to develop students' independence and ability to self-learning. AIM: the aim of this study is to describe the perception that newly graduated nurses have relative to the benefits of the skills learned during the laboratory's three-year EBP in consideration of the construction of the thesis, the research of evidence and usefulness of the EBP process for the development of their professional career. METHODS: A descriptive study with a sample of 300 newly graduated nurses from the Degree Course in Nursing of the University of Modena and Reggio Emilia, venue of Reggio Emilia. The data collection instrument was an anonymous questionnaire. It was possible to answer through a 10 Likert scale. RESULTS: The sample considers effective the research of evidence carried out (mean 6, SD 2), related to the problems of patients (mean 7, SD 2); the sample considered the skills acquired during the laboratory's three-year EBP to be useful for career development (mean 7, SD 2). CONCLUSIONS: the decision to include the laboratory's three-year EBP in the curriculum of the Nursing degree promotes the development of skills relating to the use of the EBP process, competence that in the literature is indicated as one of the core competencies that all health professionals should develop and maintain throughout their professional career.

[Evidence-based practice in nursing curricula: the experience of nursing degree course of Reggio Emilia. A pilot study]. / Valutazione percepita degli studenti infermieri sui tutor clinici.

Given the lack of evidence in literature concerning the presence of Evidence-Based Practice (EBP) in nursing curricula, but considering its importance in order to educate future nurses to use critical thinking and to base their practice on scientific evidence, tutors and nursing teachers of the Nursing Degree Course of Reggio Emilia (Università degli Studi di Modena e Reggio Emilia), have decided to introduce a three-year laboratory of EBP. The purposes of this project are: to describe the three-year EBP laboratory of Nursing Degree, its objectives, its structure, its integration with practical training and nursing subjects and its students evaluation strategies; to get students verify the perception of the usefulness of the three-year EBP laboratory regarding the elaboration of the graduation thesis, the search for appropriatem answers for patients met during clinical trainings and the usefulness of the EBP process in view of the development of their professional career. The design of research of this pilot study is correlation-descriptive. It has been selected a sample of convenience consisting of 56 nurses graduated in the autumn session of the academic year 2007-2008. For data collection we have used an electronic questionnaire (Microsoft Word with closed fields) structured for the purpose. The laboratory has been effective in learning to use the database to search for evidences and to use the database to search for evidences related to nursing problems met in training placements. Finally, graduated nurses consider the EBP process an essential element of professional nursing luggage. Although the sample is restricted the results indicates the good educational choice made by our Nursing Degree Course of integrating the EBP Laboratory in the curriculum.

[Nurse's competence indicators: linguistic and cultural validation of the Nurse Competence Scale]. / Gli indicatori della competenza infermieristica: validazione linguistica e culturale della Nurse Competence Scale.

UNLABELLED: For some years, the clinical performance of new-graduate nurses, has been a leading topic in international scientific literature. In Italy there are many criticisms to basic education; ever since the basic education moved from the regional schools to the university, the main question that the teachers, the clinical nurses and the nursing managers are asking is whether the level of competence of new-graduates is appropriate to the demands of the world of work. Many criticisms have been addressed to the gap between theory and practice and between education and clinic. In Italy this has stimulated a debate towards a shared definition of competence and especially towards defining indicators that can assess/measure this phenomenon. The purposes of this study are: translating the indicators of Nurse Competence Scale (NCS) in the Italian language and test its validity and reliability; provide a tool for evaluating competence in Italian in order to use it in the context of our country. MATERIALS AND METHODS: after a research on the Medline and Cinhal electronic data base, the NCS was identified and submitted to a process of linguistic translation (English-Italian-English) and to a process of validation using the test-retest methodology (test of Wilcoxon), the Intraclass Correlation Coefficient (ICC) and Cronbach's alpha. RESULTS: the evaluation given by nurses in the first administration does not differ significantly with those of the second one. For all sections of the NCS the ICC reports values greater than 0.85. CONCLUSIONS: the Nurse Competence Scale appears valid in its Italian version and it might be used to measure the competences of Italian nurses.

[The relative's need of participation in the care plan in a general medicine ward]. / Il bisogno di partecipazione al progetto di care dei familiari di un paziente ricoverato in un reparto di medicina generale.

All the scientific literature agrees on the fact that the shelter in hospital is a delicate moment for the patient. Also for relatives the shelter in hospital of their dear one is not of easy management, often they are excluded, insecure, alone and with a frankly uncertain role. The purpose of this study is to explore the role and the needs perceived from the relatives of an in-patient in a general medicine unit and to explore which role and which needs of the relatives are perceived from the nurses of a same ward. The sample of the study consisted of 49 relatives of in-patients in the ward of Medicina III dell'Azienda Ospedaliera di Reggio Emilia and of 18 nurses of the same ward. It was found that information is the most important need expressed by the relatives and that for the nurses is hard to satisfy it. Moreover, the nurses haven't a clear idea of the relative's role and they are inclined to exclude them from the care project.

[Nursing interventions for the prevention of the delirium in intensive care unit (ICU): a randomized study]. / Interventi infermieristici nella prevenzione del delirium in Unità Coronarica: uno studio randomizzato.

UNLABELLED: The delirium is a common and problematic condition that involves between 10% and 50% of the in-patients. The in-patients in intensive care unit (ICU) are more at risk (about 38%). These data are not realistic because delirium is a condition that can be either unrecognized or misdiagnosed; between 66% and 84% of delirium in elderly hospitalized patients is unrecognized by clinicians. The aim of this study is to verify if nurses activities directed to the patient and environment, for maintaining time-space orientation and cognitive functions, can diminish or slow down the increase of delirium. The sample of this study is made up of 48 patients; using randomize technique 31 patients were assigned to the control group and 17 to the experimental group. RESULTS: In the control group 6 patients were assessed with delirium, while 3 were assessed in the experimental group; the relative risk is 0.9 and the Odds ratio 0.9. CONCLUSION: The results of this study demonstrate that the nurses' activities can have an important role in order to assess, diminish and slow down the increase of delirium.

[A randomized study to manage the peripheral intravenous catheter with saline washing]. / Lavaggio con fisiologica vs otturatore per la gestione del catetere venoso periferico: uno studio randomizzato.

The scope of this study is to compare the washing of the CVP using normal saline solution before each closure and every 6 hours, with closing the CVP using an obturator after the suspension of the infused therapy, in function of the maintenance of the perviousness and the appearance of complications. The study population included 83 patients; using the randomised trail technique, 40 patients had been assigned to the group of washing and 43 to the group of the obturator. The results of this study demonstrate that, in order to maintain the perviousness of the CVP and the reduction of the appearance of complications, there is no significant difference between the washing of the CVP with normal saline solution before each closure with a stopper and every 6 hours, and the closure of the CVP with an obturator without washing at the suspension of the infused therapy.

[Criteria used by nurses in choosing the site for intramuscular injections: custom or scientific evidence?]. / Quali criteri utilizzano gli infermieri nella scelta delie sedi delle iniezioni intramuscolari: consuetudine o evidenza scientifica?

The nursing literature of the last 20 years recommends the ventrogluteal site how the best site for intramuscular injections Beecroft, Redick, 1990, but, the few studies done with the aim to discover which is the most frequently used site report that the dorsogluteal site is the one preferred from nurses Farley, Joyce, Long et al., 1996. The propose of this descriptive study is to understand which are the criteria used by nurses when they have to decide which site choose for administering an intramuscular injection. 167 Italian nurses, from the province of Reggio Emilia, that answered at an anonymous questionnaire, compose the sample of this study. The study's outcomes demonstrate that the most frequently site used from the nurses is the dorsogluteal. The most frequently principles that support this choice are the easier access, the large muscle's bulk, the lower sensibility at the pain and the request of the patient. These reasons suggest that the nurses are guided, in choose the site for administering an intramuscular injection, much more by the customs than the evidence.