Nursing - a core element of rehabilitation.

AIM: 2020 was been acknowledged by the World Health Organization as the International Year of the Nurse and the Midwife. On this occasion, the Global Rehabilitation Alliance and the International Council of Nurse would like to conceptually reflect the role of nurses in rehabilitation. BACKGROUND: Rehabilitation and nursing are strictly ingrained. Rehabilitation aims at improving, reaching and maintaining optimal functioning of persons with disability and persons with health conditions experiencing disability. Nursing is defined as use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life. Nursing has a crucial role in all phases of rehabilitation care (acute, post-acute and long-term rehabilitation). Nurses deliver rehabilitation in many settings, in nursing homes and community-based rehabilitation. The main principle is not to deliver care for the patient but deliver care with the patient. This includes explaining, demonstrating and practising with the goal to help the patient to (re-)gain independence. DISCUSSION: Nurses play an important role in delivering rehabilitation and are involved in all aspects of the multidimensional rehabilitation process. One of the important points is that in most settings, nurses are the professionals with a prolonged relationship with patients and families, and may have the best insight into the patients' personal and contextual factors with regard to the rehabilitation process. CONCLUSION AND IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY: Strengthening nursing in rehabilitation is a vital factor to deliver high-quality rehabilitation and to achieve optimum outcomes. For this reason, we urge all relevant stakeholders at governmental and rehabilitation service provider levels to work towards these goals.

Comparison across 12 countries on knowledge, attitude, and behavior scores about medication errors in Intensive Care Units: an international study.

OBJECTIVE: The aim of the study was to explore the degree of agreement of intensive care unit nurses working on a set of medication error preventive strategies and to examine possible predictors of nurses' knowledge, attitude and behavior. MATERIALS AND METHODS: Observational, international, and cross-sectional study. Iran, Malta, Spain, Pakistan, Nepal, Qatar, Ecuador, Australia, Finland, Italy, Egypt, and Jordan were the countries included in this survey. To collect data, the Knowledge, Attitude and Behavior in Medication Errors questionnaire was used. A descriptive statistical analysis was performed for the socio-demographic characteristics of the sample and three multiple logistic regressions were performed. RESULTS: The international sample consists of 1383 nurses, of whom 478 (34.6%) were men and 900 (65.1%) were women and their mean age was 35.61 years with a range of 19-61. Descriptive statistics conducted on the international sample show a medium to high degree of agreement among participants concerning some preventive strategies of medication error. In addition, the results of the present study show a strong relationship between positive nurses' attitudes and correct behaviors and/or adequate knowledge, as well as between adequate knowledge and correct behaviors (p< 0.01). CONCLUSIONS: Further studies are needed to explore the issue of medication error concerning nurses' cultural backgrounds, as well as to assess similarities and disparities among international nurses.

The state of the evidence about the Synergy Model for patient care.

AIM: To systematically and critically summarize the state of the evidence about the Synergy Model and its utilization in nursing practice. BACKGROUND: The Synergy Model emphasizes the importance of alignment between patient needs and nurse competencies in achieving adequate patient- and nurse-related outcomes. It is a relatively new patient-centred care model developed at the end of the 1990s. INTRODUCTION: Despite the Synergy Model's potential to support patient-centred care, its practical application is still mainly limited. Thus far, literature about the Synergy Model has not yet been synthesized, undermining its broader utilization globally. METHODS: A systematic search was performed on the following databases: PubMed, CINAHL and Scopus. The authors used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement and checklist to guide the systematic search; 26 papers were included in this study. A critical interpretative synthesis was adopted to summarize the data extracted from the included papers. RESULTS: Five interpretative themes emerged: conceptualization, experiences from the field, nursing education, patient-related outcomes and system-related outcomes. Synergy Model shows a precise theoretical definition, and it was implemented in multiple clinical settings, mainly in critical care contexts. It seems to have a positive influence on patient-related, nurse-related and system-related outcomes. DISCUSSION: Synergy Model seems to be positively associated with specific susceptible outcomes, such as patient satisfaction, reduction of patient's complications, staff satisfaction, empowerment, and engagement of patients and healthcare providers. However, the level of evidence is still limited. CONCLUSION: Future international research should demonstrate the feasibility of implementing the Synergy Model at an international level. More empirical research is needed to demonstrate the effectiveness of the model on susceptible outcomes. IMPLICATIONS FOR NURSING AND HEALTH POLICY: This systematic review could support further development of international programmes based on the Synergy Model. The Synergy Model's implementation has the potential to optimize nursing competencies, patient- and nurse-related outcomes.

Socio-demographic analysis of free-lance nurses in a non-institutional employment regimen.

INTRODUCTION: The free-lance nurse, not bound to rigid organizational systems, can offer personalized assistance always respecting the rights of the person and of the profession. More recent graduates have decided to undertake the nursing profession by moving towards the free-lance nursing, considering it both as a career opening and as a professional opportunity, although this option never got much attention from the researchers in the Italian nursing scene. Free-lance nursing is now considered a valuable opportunity to develop a nursing career. This market is destined to grow for different reasons, such as an increasing chronicity of health conditions of more and more ageing population and the deficits of the National Health Service (Servizio Sanitario Nazionale - SSN) in community and home care. AIM: The aim of the study was to evaluate the correlation between the development of the free-lance nursing and the Italian socio-economic context. METHODS: The design of the study was descriptive - observational. Data collection and observation was carried out from January 2018 until April 2108. For the analysis a linear regression model was adopted to quantify a cause-effect relationship between one or more independent variables and the dependent variable which interprets the phenomenon investigated. The regression carried out was descriptive to analytically express the observed reality and represent it in a plausible way. The specification model was represented as: Free-lance nurses per capita = per capita income + Out of Pocket expense per capita + waiting lists in days + number of beds per inhabitants + NHS nurses per inhabitants. RESULTS: The estimate carried out had an R of 0.813, R-square equal to 0.6612, adjusted R-square 0.540 and standard error of the estimate 1.277, highlighting a correlation between the variables adopted in the model and a p = 0.005. From the analysis of the variables used, the average per capita income (p = 0.045) and the nurses working in the National Health Service /1,000 beds (p = 0.017) were statistically significant. CONCLUSIONS: It can be stated that the free-lance nursing profession is costly for patients and therefore develops more revenue where the average per capita income grows, but the research also seems to show that, where the National Health Service has too few nurses, the private demand increases in order to satisfy healthcare needs.

Shaping nursing profession regulation through history - a systematic review.

AIM: The aim of this systematic review was to provide a critical synthesis of the factors that historically shaped the advancements of nursing regulators worldwide. BACKGROUND: An in-depth examination of the different factors that moulded regulatory changes over time is pivotal to comprehend current issues in nursing. INTRODUCTION: In the light of global health scenarios, the researchers explored the factors that historically influenced the socio-contextual circumstances upon which governments made regulatory changes. METHODS: A systematic search was performed on the following databases: PubMed, CINAHL, Scopus, OpenGrey and ScienceDirect. The review included papers from January 2000 to October 2016 published in English. The authors used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and an inductive thematic approach for synthesis. RESULTS: Two main themes were identified: factors underpinning current challenges and historical and contextual triggers of regulation. The first theme was composed of three aspects: education, migration and internationalization, and policy and regulation; the second theme consisted of four attributes: demographics, economics, history of registration and wars, and historical changes in nursing practice. DISCUSSION: Factors that shaped nursing regulation were linked to changing demographics and economics, education, history of nursing registration, shifting patterns of migration and internationalization, nursing practice, policy and regulation and significant societal turns often prompted by wars. CONCLUSION: A deeper understanding of the developments of the nursing regulatory institutions provides the foundation for portable standards that can be applied across an array of jurisdictions to guarantee a better public safety. IMPLICATION FOR NURSING AND HEALTH POLICY: Understanding factors that socially, legislatively and politically have influenced the development of regulatory bodies over time helps to mould local, national and international policies that have a stronger impact on health worldwide. To achieve this, there must be effective cooperation among systems of nursing regulations globally.

Evaluation of the perception of clinical competencies by nursing students in the different clinical settings: an observational study.

INTRODUCTION: The university educational sphere has many dilemmas. The question of sufficient knowledge and skills for students to acquire abilities to provide care in different clinical setting is one important dilemma. AIM: To measure the level of competencies by nursing students and its application in different clinical environments. METHODS: Nursing students of two Italian universities participated in the research. Data collection took place April to July 2015 using the Nurse Competence Scale. The Strengthening Reporting of Observational Studies in Epidemiology Guidelines was used to describe the study. Pearson's chi-square test, Student's t test, and regression tests were used for statistical analysis. RESULTS: The questionnaire response rate was 87.27% (n = 698). Most of the nursing students assessed their level of competency as 'good' and evaluated themselves as more competent than their actual nursing role. Students also appraised themselves as competent either via their clinical practices accomplished or in the therapeutic interventions. CONCLUSION: This study shows that the self-evaluation of the competencies acquired by nursing students in clinical settings in Latium and Abruzzo is of a good standard. This study also affirms that NCS is a valuable and reliable tool to measure clinical competencies in different clinical settings.

Nurse Competence Scale: psychometric assessment in the Italian context.

INTRODUCTION: The Nurse Competence Scale is a tool for evaluating nursing clinical competence. This tool has been used and psychometrically validated previously in different countries but never in Italy. Assessing the validity and reliability of the Nurse Competence Scale in the Italian context has been a strong necessity for many years. AIM: To test the psychometric properties and evaluate the internal construct validity of the Italian version of the Nurse Competence Scale. METHODS: This study is a secondary analysis on a database of 698 bachelor nursing students who were trained in different clinical settings at two Italian universities. Internal consistency was examined with Cronbach's alpha coefficients and inter-item analysis, and construct validity was evaluated by Exploratory Factor Analysis with Oblimin rotation with Kaiser normalization, and eventually Confirmatory Factor Analysis. RESULTS: The results highlighted the necessity for refinements of the Nurse Competence Scale in the Italian Context. The original model of the Nurse Competence Scale (73 items) was not confirmed. The confirmatory factor analysis presented significant values of Chi-squared test = 10942.766, with degrees of freedom being 2.534 and a ratio of χ²/df = 4.318. The Comparative Fit Index value was significant 0.809 and the Normed Fit Index 0.765 was noteworthy too. The value of Root Mean Square Error of Approximation was significant 0.069. The Cronbach's α coefficient for the new scale was excellent (0.922). The exploratory factor analysis resulted in the Italian Nurse Competence Scale composed of 58 items divided into seven dimensions: using the research, professional awareness, ethical values, tutorial functions, professional leadership, educational interventions, and management of care processes. CONCLUSIONS: The Italian version of the Nurse Competence Scale with 7 dimension and 58 items is an appropriate tool for describing and comparing self-assessed competencies by nurses. Such evaluations could constitute an important contribution to have better educational environments. Self-assessment of competencies can also raise a stronger awareness of individual educational needs.

Stakeholders in nursing education: their role and involvement.

INTRODUCTION: In literature, there is evidence that all stakeholders need to be involved in the curricula building process to make sure that health professionals are "educated" to meet the stakeholders' "demands". In Italy, the involvement of stakeholders in the definition of university curricula is ratified by various regulations. AIMS: To describe the major experiences of stakeholder involvement in nursing education, identify the main stakeholders for nursing education, and the processes in which they are involved. METHODS: The search strategy included an electronic exploration of the relevant databases. The search terms were: Stakeholders, Curriculum, Nursing Education combined with Boolean operators. The references of the retrieved articles were hand searched for additional related studies. RESULTS: Most of the studies identified were from the United Kingdom, Australia, and the USA. In Italy, no relevant studies were found. The most frequently identified stakeholders were: students, clinicians, educators, nurse managers. They were mainly involved during profound changes in the curricula and the implementation of new educational approaches. DISCUSSION AND CONCLUSIONS: Stakeholders are mostly involved in countries with a private funding system for universities. Such funding systems have probably developed in the academia a greater propensity to involve stakeholders, to provide recognition of success when starting new programs, and are perceived more as marketing research. This seems contrary to the spirit of the Italian and European regulatory interventions, which instead, provide a structured commitment to consolidating and expanding the collaboration among universities, users, and the world of labor. This latter collaboration should facilitate internship activities, lifelong learning, and employability of the newly-graduated professionals.

The licensure exam in nursing degree courses: a survey in the four universities of the Lazio Region.

BACKGROUND: In recent years, the nursing licensure exam is at the centre of a national and international wide debate. This debate regards the planning of the nursing licensure exam in many Universities and the competences that this exam must certify to ensure quality, effectiveness, and ethics of nursing care from newly-graduated nurses to general public. The aim of this study was to describe the practical tests used for the licensure exam in the four Universities of the Lazio Region. The researchers analyzed the type of practical tests used and the field of competences assessed according to the degrees of performance defined by the Dublin Descriptors. METHODS: The data were collected through semi-structured interviews to Presidents, Directors and Lecturers of nursing degree courses and through direct retrieval of the written texts of the licensure exam. Two researchers analyzed the practical tests. A special lecture-grid divided into three different sections to interpret the data was created. Statistical analysis was carried out by means of Epi-info 3.5.1/2008. RESULTS: Analysis of data showed that the most used tests were Discussion of theoretical and practical aspects in context (33.6%), followed by the Test with open and/or closed questions (23,9%). Psychomotor and relational skills tests were little used. The most valued field of competence was the cognitive one (85,5%) that assessed, above all, the storage of the concept. The ability to interpret data and solve problems was less valued. CONCLUSIONS: The study showed the high discrepancy in the types of tests used in the four Universities of the Lazio Region. Universities found it difficult to assess psychomotor and relational skills of the students. Most of the cognitive tests utilized omitted the evaluation of mastery of complex competences. Therefore, there is the necessity of a new planning of the nursing licensure exam to overcome these critical issues.

Cultural adaptation and linguistic validation of the Family Decision Making Self Efficacy Scale (FDMSES).

INTRODUCTION: Nurses, following their ethical mandate, collaborate with other health and social professionals or people involved in caring activities. Caregivers in this context are becoming more and more significant for the family or the cared person, who for their stable presence and emotional proximity play a pivotal caring role. To maximize the contribution of caregivers, objective tools that emphasize their skill sets are necessary. The cross-cultural adaptation and validation of the Family Decision Making Self-Efficacy Scale is part of a larger project aimed at understanding the resilience of caregivers in the field of palliative care. Self-efficacy is one of the aspects of personality most closely associated with resilience. Self-efficacy is shown in a specific context, therefore, its study and evaluation of its level, require capabilities that enable individuals perceive themselves as effective in a particular circumstance. The Family Decision Making Self- Efficacy Scale assesses the behavior of caregivers of patients at the end of their life. METHODS: The Family Decision Making Self-Efficacy Scale was translated (forward and back translation) and was adapted to the Italian clinical cultural setting by a research team that included experts in palliative care, native translators with experience in nursing and experts in nursing. A consensus on the wording of each item in relation to semantic, idiomatic, experiential and conceptual equivalence was sought. The clarity of the wording and the pertinence of the items of the scenario with the conscious patient and with the unconscious patient were evaluated by a group of caregivers who tested the instrument. RESULTS: The Italian version of the instrument included 12 items for the scenario with the conscious patient and 12 for the scenario with the unconscious patient. The working group expressed consensus on the pretesting version of the instrument. The pre-testing version of the scale was tested on 60 caregivers, 47 taking care of conscious patients and 13 taking care of unconscious patients. In both cases the content of the items was judged relevant and understandable. CONCLUSIONS: The results for the cross-cultural validation were satisfactory and allowed the application of the instrument in the Italian context.

[Group educational intervention in diabetic foot: the objectives, pedagogical strategies, level of knowledge and results]. / Intervento educativo di gruppo sul piede diabetico: obiettivi, strategie pedagogiche, contenuti di conoscenza, risultati.

Detailed contents and aims of an educational intervention for diabetic foot are presented, together with evaluation tools and results at 3, 6 and 12 month interval after the course. Knowledge level and "health" of the foot were assessed at 12 month interval on 2/3 of the 100 diabetic patients originally exposed to the educational intervention. After 12 months 80% of patients showed a good retention of knowledge on practical issues related to foot care, while 77% of patients with persistent foot problems were not independent (because of hypo-mobility or sight problems) in foot care.

[The methodology and planning of an educational intervention in diabetic foot]. / Metodologia e programmazione di un intervento educativo sul piede diabetico.

Diabetic foot is considered one of the most threatening and disabling complications for a diabetic patient: lesions of the extremities can become so severe that the person may risk the amputation of the toe, foot or leg. Methodology of planning and implementation of an educational intervention for the prevention of the diabetic foot is presented in its various steps: from the identification of priorities and contents to the problems and difficulties encountered in the implementation of the program.

[A proposed check on the educational role of the professional nurse with the diabetic patient]. / Proposta di verifica del ruolo educativo dell'infermiere professionale con il paziente diabetico.

The nursing personnel of a day hospital for diabetic patients selected at random two 30 patients groups out of the cohort of those who had followed an educational course in the same day hospital, and out of the cohort of first contacts with the hospital. A formal evaluation has been made on two topics: the correctness of the technical execution of various procedures, the patient's perception of the factors which could play a role in determining the quality of communication between nurses and patients. Patients who were exposed to the original course appear to perform better. Along the same line, patients of the day hospital seem to share a status of conscious acceptance of the disease and of its direct personal implications.