Protective and risk factors of workplace violence against nurses: A cross-sectional study.

AIMS: To describe how workplace violence (WPV) is experienced by nurses in hospitals and community services and identify protective and risk factors. METHODS: An online cross-sectional national study was conducted from January to April 2021 in Italy. Hospitals and community services were involved in the study. The survey combined the adapted and validated Italian version of the Violence in Emergency Nursing and Triage (VENT) questionnaire, which explores the episodes of WPV experienced during the previous 12 months, the Practice Environment Scale of the Nursing Work Index (PES-NWI) and some additional questions about staffing levels extracted from a previous RN4CAST study. Nurses working in all clinical settings and community services were invited to participate in the survey. Descriptive and inferential statistics were used for data analysis. We adhered to the STROBE reporting guidelines. RESULTS: A total of 6079 nurses completed the survey, 32.4% (n = 1969) had experienced WPV in the previous 12 months, and 46% (n = 920) reported WPV only in the previous week. The most significant protective factors were nurses' age, patients' use of illegal substances, attitude of individual nurses and considering effective the organization's procedures for preventing and managing episodes of violence. The most significant risk factors included workload, recognizing violence as an inevitable part of the job, patients' cultural aspects and patients' agitated behaviour. The frequency of WPV was significantly higher in certain areas, such as the emergency department and in mental health wards. CONCLUSION: Workplace violence (WPV) against nurses is a very frequent and concerning issue, especially in hospitals and community services. Based on our findings, integrated and multimodal programmes for prevention and management of WPV are recommended. More attention and resources need to be allocated to reduce WPV by improving the quality of nurses' workplace environment and implementing violence-free policies for hospitals. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Impact Workplace verbal and physical violence is a widespread phenomenon, both in hospital and community settings, and even during COVID-19 pandemic. This problem is exacerbated by the lack of effective reporting systems, fear of retaliation and the tendency to consider violence as an inevitable part of the job. The characteristics of professionals, patients, work environment and organizational factors are involved in the spread of workplace violence, determining its multifactorial nature. Integrated and multimodal programmes to prevent and manage of workplace violence are probably the only way to effectively counteract workplace violence against nurses. Healthcare policymakers, managers of hospital and community services need to proactively prevent and effectively manage and monitor episodes of violence. Nurses need to feel protected and safeguarded against any form of verbal or physical violence, to provide high-quality care in a totally safe environment. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

A Multicentric Pilot Study of Student Nurse Attitudes and Beliefs toward Sexual Healthcare.

Nurse educators are tasked with the education of students to become providers of holistic care, and part of that care includes sexuality. Students carry attitudes and beliefs that influence their behavior; therefore, students who carry negative attitudes about sexual healthcare are less likely to provide that care. This is an international, multicenter study of nursing students' attitudes and beliefs about the provision of sexual healthcare. The Sexuality Attitudes and Beliefs Survey, which measures attitudes toward the provision of sexual healthcare and has a range of scores from 12 to 72, was given to 129 students across Spain, Portugal, Italy and the United States and revealed negative attitudes about sexuality, with a mean SABS score of 39.95. Higher scores on the SABS reveal more negative attitudes and reduced likelihood of provision of sexual healthcare. Statistically significant differences were found when comparing queer and heterosexual students (41.69 vs. 38.06), and students in their final year of school held more negative attitudes toward the provision of sexual healthcare (41.4 vs. 39.5 and 39.2). This study shows that nurse educators continue to need to focus on the attitudes student nurses carry about sexuality. There is a critical shortage of education strategies to meet the needs of student nurses so that they will be comfortable and confident in providing sexual healthcare.

Educating to sexuality care: the nurse educator's experience in a multicenter study.

Background: Sexuality is an issue inherent in the lives of all human beings. Education for Sexuality takes place informally, through relationships with the environment, with the family as a model, and formally, as a pedagogical practice in Teaching. Education for sexuality is recognized as an instrument of social transformation that leads to changes in behaviors and norms related to sexuality. Objectives: Knowing the perception of nursing professors about sexuality education in professional training, recognizing attitudes of these professors in relation to sexual education and identifying barriers in education for sexuality. Methods: Exploratory and descriptive study, using qualitative methodology. Data collection was carried out from semi-structured interviews and thematic analysis. Results: The interviewees consider sexuality education to be very important, being taught in the nursing course, addressing different themes. In general, they reported feeling comfortable teaching these topics. The identified barriers to the level of education students are in, students' knowledge and reactions to the topic, religious and cultural issues, and the time available to talk about the topic and professional aspects. Conclusion: Sexuality is a fundamental theme in nursing education and needs to be further explored to overcome the barriers associated with its approach.

Education on Vaccination Competence: an Intensive Course for Skillful Health Science Students.

Background: Vaccination is one of the most successful and cost-effective interventions for public health. Studies have shown that health professionals who have good knowledge and positive attitudes towards vaccination are more likely to provide effective vaccination protection to people, including themselves. Therefore, health science students must acquire evidence-based knowledge during their education to meet the challenges of healthcare. Objective: The aim of this study was to investigate the knowledge, attitudes and feedback of health science students who participated in the Educating Vaccination Competence (EDUVAC) Intensive Course. Methods: A five-day Intensive Course was implemented for health science students, which included a pre-assignment. The EDUVAC Intensive Course used different teaching methods (lectures, workshops, interactive games, discussions), group work, study visits, and cultural programs to encourage students' motivation. For the purpose of the study, students filled out an online questionnaire after giving informed consent. Results: Sample consisted of 31 health science students from five European Higher Institutions. They had very good knowledge on most knowledge questions. In the post measurement it was significantly greater and equal to 81%, p<0.001. Almost all students (93.5%) totally agreed that "It is important for adults to receive all recommended vaccines according to national guidelines". The statement "I have had an active attitude and participation in the Intensive Course" received 80.6% total agreement. Over 90.3% rated the Intensive Course as "excellent" or "above average". Conclusions: After completing the EDUVAC Intensive Course, students felt confident in their vaccination knowledge and skills, which benefited their professional development.

Adaptation and Validation of the Sexuality Attitudes and Beliefs Scale for the Italian Context.

BACKGROUND: Nurses dealing with a patient's sexuality must start from an awareness of their own experience, specific attitudes, and possible limits. What emerges from the literature is a conservative tendency in nurses, which underlines the difficulty in this awareness, but even a difficulty in improving the necessary knowledge/skills. It is, therefore, essential to create tools that can raise awareness of these limits. OBJECTIVE: the present study aims to explore the psychometric properties of the Attitudes and Beliefs about Sexuality Scale, adapted and validated for the Italian context. METHOD: This is an instrumental, cross-sectional piece of research, whose SABS validation process applies the steps of Beaton and Valmi. The convenience sample collected data from 223 participants in the first approach. This was followed by a retest involving 44 students randomly selected from those who responded in the first phase. Ethical principles were respected. RESULTS: The SABS questionnaire demonstrated good test-retest reliability, good internal consistency, and adequate construct validity. CONCLUSIONS: The Italian version of the SABS is valid and reliable for use with nursing students. This is the fourth language in which the SABS is available for research.

Lifestyle changes during the first and second waves of the COVID-19 pandemic in medical college students: are there gender-related differences?

BACKGROUND AND AIMS: The COVID-19 pandemic has seriously affected young people. The present study aims to explore the effects of COVID-19 on lifestyle in 500 undergraduate students both during the acute phase of the pandemic (so-called "first wave") and during the second spread of infections (so-called "second wave"). Gender differences were also explored.  Methods and results. During the first wave we found weight gain in 48.6% of subjects, a switch to an unhealthy diet (43%), and an increase in the amount of food introduced (35%). Interestingly, women showed higher intake of food in order to cope, while men privileged higher wine consumption as a coping mechanism. We observed a sharp reduction in physical activity, increased sedentary behaviours and deterioration in sleep quality. Stress correlates with eating to cope (r=0.86; p<0.001); drinking to cope (r=0.83; p<0.001). Contrary to expectations, the second wave led to a situation similar to the first. We have detected a further deterioration in quality of sleep (67% vs 77%; p<0.01) and also a reduction in sleeping time (68.6% vs 77.7; p<0.01). CONCLUSIONS: The long pandemic has led to unhealthy lifestyle changes in the student population of our municipality in Northern Italy. There are gender differences in lifestyle modifications developed during the pandemic that suggest a different response to stress. Moreover, the persistence of pandemic-related stress due to the "second wave" has severely affected the lifestyle habits of undergraduate student.

Attitudes and Beliefs of Portuguese and American Nursing Students about Patients' Sexuality.

Nursing school graduates must be prepared to interact comfortably and effectively with patients about their sexual health. This study analyses the attitudes and beliefs about patient sexuality held by Portuguese and American nursing students. OBJECTIVE: In Portuguese and American nursing students, (1) we analyzed students' attitudes and beliefs towards sexuality using the Sexuality Attitudes and Beliefs Survey (SABS); (2) we identified nationality, socio-demographic information, and affective-sexual beliefs and attitudes. METHOD: Quantitative, cross-sectional study; convenience sample of 296 students (63.2% Portuguese; 36.8% American); mean age: 21.9 years (SD = 3.12); two-way ANOVA and multiple correspondence analyses were performed. RESULTS: Attitudes and beliefs toward sexuality: Portuguese women are more liberal than men, contrary to American students. Among both nationalities, participants with multiple sexual partners held more conservative attitudes. Sexual orientation: bisexual American students and homosexual Portuguese students are conservative. Multiple correspondence analysis revealed two profiles: (1) Portuguese students: liberal-tolerant in attitudes towards patient sexuality, live with family/roommate, 18 to 21 years old, no or one sexual partner; (2) US students: traditionalist attitudes towards patient sexuality, share house, 22 and 23 years old, multiple partners. CONCLUSION: Human sexuality must be addressed in nursing education curricula.

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.

Cultural Competence and Cultural Sensitivity Education in University Nursing Courses. A Scoping Review.

When assessing the fragility that characterizes the health of an immigrant person, a culturally competent transformation of the nurse-patient teaching-learning process is necessary. Therefore, it is considered essential to incorporate cultural competence and intercultural communication in higher nursing education. OBJECTIVE: To determine the content and knowledge of cultural competence and intercultural communication offered in higher education in nursing courses. DESIGN: The Campinha-Bacote model of cultural competence was used as the primary reference. METHOD: A scoping review was conducted about studies published in the period 2003 and 2020. The research was conducted between May and October 2020. More than a hundred documents (books, chapters, articles, conference proceedings) have been consulted. RESULTS: Undergraduate nursing courses and postgraduate education move toward promoting cultural competence and sensitivity through teaching strategies. CONCLUSIONS: Teaching projects that combine multiple competencies are more effective, including teacher training. A predominant element is a need for continuous and transversal projects. University nursing education must adapt culturally competent curricula.

[Descriptive analytical study on patient mobilization of the Internal Medicine Department of the USL - IRCCS of Reggio Emilia (MOBINT)]. / Studio analitico descrittivo sulla mobilizzazione dei pazienti del Dipartimento Internistico dell'Azienda USL ­ IRCCS di Reggio Emilia (MOBINT).

INTRODUCTION: Hospitalisation represents a significant risk factor for the decline in the general conditions of the elderly. Loss of autonomy in elderly inpatients, together with immobilisation, has been defined as 'Hospital-Acquired Disability' and affects 65% of this class of patients. Less than half of them will regain independent mobilisation. Included among the negative effects are: falls, increased percentage of admission to nursing homes, longer hospital admissions, increased mortality and morbitity. Despite these facts, elderly patients remain in bed for 83-95% of their hospital stay; they rarely walk or are mobilised. Only on an international level has this issue been analysed OBJECTIVES: To analyse active mobilisation in inpatients. METHODS: Prospective analytical and descriptive study performed from December 2018 - May 2019 in the Clinical Medicine department of the AUSL of Reggio Emilia. Descriptive analysis of the data has been performed. RESULTS: A total of 1725 patients were screened for the study. After applying the inclusion criteria, 295 patients were enrolled in the study, 9 of which were then excluded for failure to be mobilised. 66.4% of these patients were mobilized the morning during hygiene-rounds. According to the nurse, they appeared in a stable state, alert and oriented (88.1%) and used a variety of aids (from 1 to 3) (57.3%). The frequency of mobilisations were: 44.4% once a day, 31.2% twice, 24.4% three times or more. DISCUSSION: This study highlighted that mobilisation is strictly correlated to first assistance, frequently relying on health care assistants, and is mostly applied to oriented patients who only need one assistant. Further studies are required to investigate connections between patient's features and mobilisation.

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.

Development and psychometric testing of the care dependence perception questionnaire.

OBJECTIVE: This multicentre study aimed to develop a measure of the perception of care dependence in patients diagnosed with cancer and to test its psychometric properties. METHODS: The questionnaire was developed based on findings emerged from a meta-synthesis and from qualitative studies conducted in three hospitals in Italy. The draft questionnaire was tested for face and content validity and pilot-tested with patients. The questionnaire was completed by care-dependent patients with cancer. Test-retest was conducted to verify stability. Exploratory factor analysis (EFA) was performed using a Maximum Likelihood robust estimator. RESULTS AND CONCLUSION: The Scale-Content Validity Index was 0.92. The final 15-item questionnaire was completed by 208 patients admitted to two hospitals. The EFA yielded a two-factor model including a positive and a negative perception of care dependence. Factor score determinacy coefficients, Cronbach's alpha coefficients, composite reliability coefficients and Intraclass Correlations Coefficients yielded satisfactory results confirming internal consistency and stability. The hedonic balance score is also available as a single indicator of subjective well-being. The study provides initial validation of the Care DEeP Questionnaire that can be used by cancer nurses to assess positive and negative patient experiences with care dependence and to personalise and improve their care.

Sexual Competence in Higher Education: Global Perspective in a Multicentric Project in the Nursing Degree.

Sexuality is an important issue in the university careers of nursing students to ensure that they provide comprehensive care. It is necessary according to the recommendation of the World Health Organization. However, research reveals deficiencies and the need for further development. The aim of the study is to describe the perspective of teachers and students on the content of sexuality in nursing education. The project aims to analyze the attitudes and beliefs of the students about the sexuality of their patients. Furthermore, the experience and sexual lives of the future nurses, as well the teaching of sexuality content in the curriculum, will be analyzed. As for the educators, their level of knowledge about sexuality and vision of sexuality education in undergraduate nursing education will be analyzed. This study is an exploratory and descriptive study with a quantitative-qualitative approach in a multi-center context. The sample is composed of students and professors of nursing courses from five universities (Portugal, Spain, Italy and United States). Questionnaires and semistructured interviews will be used for data collection. The results of the study will allow the inclusion of sexual competence in the curriculum from the beginning in higher education. This article describes the research protocol.

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.

Online Education for Vaccination Competence Among Health Sciences Students.

The EDUVAC project aims to develop and implement a web-based course on educating vaccination competence among health sciences students. In the current study students' feedback and evaluation is assessed which guided the partners' efforts to improve the final course content and learning material that will be available for open access. After completing the web-based course, most of the students (N=103, 75.1%) perceived their vaccination knowledge was up to date and their overall participating experience was "above average or excellent (N=119, 86.9%). While, almost all of the students (N=127, 92.7%) found that the web-based course has benefitted them and their future career. Our findings support that the web-based courses can provide satisfactory learning experience to University students and offer flexibility when needed especially in times that remote education is the only option.

Construct Validity of the Activities Scale for Kids Performance in Children with Cerebral Palsy: Brief Report.

Aims: This study collects evidence of construct convergent validity of the Activity Scale for Kids performance (ASKp), comparing its results with the 66-item Gross Motor Function Measure (GMFM-66) and with the Gross Motor Function Classification System (GMFCS) and testing the ASKp's ability to discriminate between individuals with different functional capabilities. Methods: This cross-sectional study involved 60 children with spastic cerebral palsy (CP) assessed with the GMFM-66 who self-administered the Italian version of the ASKp. Results: Children were 10.9 (±3) years old with GMFCS Level I-III. Moderate correlations were found between GMFM and ASKp scores (r = 0.577; p < .001), and between GMFCS levels and ASKp score (rs = -0.541, p < .001). The ASKp discriminated between children with different functional capabilities, determined by the GMFCS (F = 18.2, p < .001). Conclusions: ASKp is valid to assess physical functioning, a crucial domain in rehabilitation of children with spastic CP. Trial registration: ClinicalTrials.gov Identifier: NCT03325842.

Safety and efficacy of Staged Extubation Set in patients with difficult airway: a prospective multicenter study.

BACKGROUND: A safe extubation is the extension of any airway management strategy. Despite different guidelines, a number of extubation accidents still occurs. Re-intubation failure could be fatal, thus a strategy and safe and efficient devices for this purpose are essential. METHODS: Multicentric prospective observational study on adult patients with endotracheal intubation and known difficult airway. A Staged Extubation Set® (SES) was used for extubation. Demographics, ASA, El Ganzouri, type of surgery, re-intubation success/failure and complications were recorded. The aim of the study was the assessment of the rate of re intubation failure, complications during failures, patients' comfort and evidence of airway injury. RESULTS: Overall, 114 subsequent difficult airway patients were enrolled. Fifteen patients (13%) required re-intubation: ten of 15 (66%) were successfully re-intubated, with a first-pass success rate of 100%. In five patients (33%), re-intubation over SES was unsuccessful, with re-intubation difficulty rate three (easy), three (quite easy) and nine (very difficult) and five cases of desaturation. Complications included one case of esophageal intubation, one case of lip trauma, and two cases of airway edema. Of 114 patients, eight (7%) perceived the procedure as intolerable. CONCLUSIONS: The results from this study show a relatively satisfactory success rate with a relatively high number of re-intubations failure and a low incidence of complications when using a SES in a cohort of difficult airway patients, all failures due to guidewire dislodgement during or after extubation. Further research is needed to improve success rate; at the same time the need for an extubation protocol is strongly advocated.

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.