The first COVID-19 new graduate nurses generation: findings from an Italian cross-sectional study.

BACKGROUND: Nursing education has been disrupted by the onset of the COronaVIrus Disease 19 (COVID-19) pandemic, potentially impacting learning experiences and perceived competencies at the time of graduation. However, the learning experiences of students since the onset of COVID-19, their perceived competences achieved and the employment status one month after graduation, have not been traced to date. METHODS: A cross sectional online survey measured the individual profile, the learning experience in the last academic year and the perceived competences of the first COVID-19 new nursing graduates in two Italian universities. Details relating to employment status and place of employment (Covid-19 versus non-COVID-19 units) one month after graduation were also collected and the data compared with those reported by a similar cohort of new graduates pre-pandemic in 2018-2019. All those who graduated in November 2020 and attended their third year after the onset of the COVID-19 pandemic were eligible. The online survey included individual, nursing programme and first working experience variables alongside the Nurse Competence Scale (NCS). Descriptive and inferential statistical analyses were performed. RESULTS: A total of 323 new graduates participated. In their last academic year, they experienced a single, long clinical placement in non-COVID-19 units. One month after graduation, 54.5% (n = 176) were working in COVID-19 units, 22.9% (n = 74) in non-COVID-19 units and 22.6 (n = 73) were unemployed. There was no statistical difference among groups regarding individual variables and the competences perceived. Fewer new graduates working in COVID-19 units experienced a transition programme compared to those working in non-COVID-19 units (p = 0.053). At the NCS, the first COVID-19 new graduate generation perceived significantly lower competences than the pre-COVID-19 generation in the 'Helping role' factor and a significant higher in 'Ensuring quality' and 'Therapeutic interventions' factors. CONCLUSIONS: The majority of the first COVID-19 new graduate generation had been employed in COVID-19 units without clinical experience and transition programmes, imposing an ethical debate regarding (a) the role of education in graduating nurses in challenging times with limited clinical placements; and (b) that of nurse managers and directors in ensuring safe transitions for new graduates. Despite the profound clinical placement revision, the first COVID-19 new graduate generation reported competences similar to those of the pre-COVID-19 generation, suggesting that the pandemic may have helped them to optimise the clinical learning process.

The experience of individuals placed in quarantine: A systematic review, meta-summary, and meta-synthesis.

OBJECTIVE: To summarize the experience of individuals placed in quarantine during an outbreak. DESIGN: A meta-summary and a meta-synthesis based upon a systematic review of qualitative studies. SAMPLE: The Cumulative Index of Nursing and Allied Health Literature, MEDLINE, and Scopus databases were all searched up to April 2020. MEASUREMENTS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed; then, the methodological quality of the studies included was assessed with the Critical Appraisal Screening Programme tool for qualitative studies. RESULTS: Five studies have been included documenting the experience of 125 adult individuals. A total of 16 codes emerged: in the meta-summary, the most and least frequent codes were "Thinking about quarantine" (80%) and "Emotional roller coaster," "Being alert for any symptom," "Trusting or not?," "Knowing who brought the infection," and "Living in a surreal world" (20%). The codes which emerged were categorized into three main themes which summarized the whole experience of being placed in quarantine: (a) "Being swamped with a thousand emotions"; (b) "Being restrained"; and (c) "Needing to be considered." CONCLUSIONS: The experience of quarantine for people is a long journey which can feel chaotic due to uncertainty about the consequences on health, work, and the future. The findings of this study can help nurses in caring for quarantined individuals by enabling them to understand people's need for educational and emotional support. Ensuring the supply of consistent information is also important to increase people's compliance.

Missed nursing education: Findings from a qualitative study.

AIM: To understand what nursing education activities are missed in the daily life of nursing programmes, by also identifying antecedents and consequences of missed educational activities. DESIGN: A descriptive qualitative study according to the COnsolidated criteria for REporting Qualitative research guidelines. METHODS: A purposeful sample of 32 participants with different roles (nurse educators, clinical nurses, students, and administrative personnel) and working in different settings (university, administrative, healthcare service levels) were involved in three focus groups and nine face-to-face interviews from 2019-2020. Both focus groups and face-to-face interviews were audio-recorded and transcribed verbatim. The data that emerged were thematically categorized by induction. FINDINGS: Missed Nursing Education reflects those educational activities needed in the process of nursing education that are missed or delayed. Direct educational activities missed include clinical rotations, classroom teaching and students' overall learning experience. Indirect missed educational activities concern continuing professional development of nursing faculty members, nursing discipline development and the organizational processes of the nursing programme. As antecedents, missed nursing education is triggered by factors at the organizational, nursing faculty, and student levels. Consequences have been reported for students, nursing faculty, clinical nurses, and patients. CONCLUSIONS: Missed Nursing Education can be considered a multifaceted, multicausal phenomenon, with multitargeted consequences. IMPACT: To date, missed nursing care has only been investigated in clinical practice. However, care also permeates the relationship between nurse educators and students. Thus, at the point of 'educational care' delivery, aspects can also be omitted. Educational activities at risk of being missed or delayed affect the quality of nursing education and, in the short- and in the long- terms, also the quality of patient care. Some Missed Nursing Education antecedents can be modified by appropriate strategies that should be addressed by policy, health care and academic institutions.

Unveiling Oxygen Vacancy Superstructures in Reduced Anatase Thin Films.

Oxygen vacancies are known to play a crucial role in tuning the physical properties and technological applications of titanium dioxide TiO2. Over the last decades, defects in substoichiometric TiO2 have been commonly associated with the formation of TinO2n-x Magnéli phases, which are extended planar defects originating from crystallographic shear planes. By combining advanced transmission electron microscopy techniques, electron energy-loss spectroscopy and atomistic simulations, we reach new understanding of the oxygen vacancy induced structural modulations in anatase, ruling out the earlier shear-plane model. Structural modulations are instead shown to be due to the formation of oxygen vacancy superstructures that extend periodically inside the films, preserving the crystalline order of anatase. Elucidating the structure of oxygen defects in anatase is a crucial step for improving the functionalities of such material system and to engineer devices with targeted properties.

Depicting clinical nurses' priority perspectives leading to unfinished nursing care: A pilot Q methodology study.

AIMS: To highlight (a) trends common to all nurses on priorities attributed to interventions, and (b) whether there are profiles of nurses working in the same context who prioritize interventions in a similar way. BACKGROUND: The underlying prioritization of interventions leading to unfinished nursing care has been minimally investigated. METHODS: A 2017 pilot Q methodology study. Full-time nurses, with at least 6 months of experience in a surgical unit, were involved. Eleven nurses rated the priority given in daily practice (from -3 as the lowest to +3 as the highest) to 35 Q-sample statements representing nursing care, non-nursing and organisational interventions. RESULTS: Overall, the intervention receiving the lowest priority was 'Providing patient hygiene', while the highest was 'Answering phone calls'. In the by-person factor analysis (total variance = 60.79%), three profiles of nurses emerged, (a) 'Patient safety-oriented' (variance = 31.66%); (b) 'Nursing task-oriented' (=16.32%); and (c) 'Team process-oriented' (=12.81%). CONCLUSIONS: Three profiles of nurses emerged in the same setting with significant differences both in the statistical order of priorities and in their practical implications. IMPLICATIONS FOR NURSING MANAGEMENT: Understanding levels of prioritization, which are not only affected by the unit but also by sub-groups of nurses who rank priorities in a similar way, can support nurse managers in their role.

The experiences of patients electrically shocked by an implantable cardioverter defibrillator: Findings from a descriptive qualitative study.

BACKGROUND: To date, few studies have explored cases of implantable cardioverter defibrillator (ICD) shock delivery with the intent of understanding patients' educational and supportive needs. AIMS AND OBJECTIVES: To explore patient experiences as lived before, during and after one or more shocks. DESIGN: A descriptive qualitative study carried out between 2016 and 2017. METHODS: Semi-structured face-to-face audio-recorded interviews were performed and analysed using a content analysis methodology. RESULTS: A total of 50 patients (average age = 68.3 years; largely male = 49; 98%) were interviewed. Four themes emerged: (a) "Feeling surprised vs. alerted by the changes inside me"; (b) "Living an intense, mono-dimensional vs. living a multidimensional storm experience", (c) "Facing the event vs. being supported"; and (d) "Living a drama vs. being used to it". CONCLUSIONS: Findings suggest that ICD use can trigger negative physical and emotional effects in patients. Moreover, nurses should recognize patients' educational needs according to the stage of adaptation that each patient is experiencing with the aim of tailoring appropriate supportive interventions. RELEVANCE TO CLINICAL PRACTICE: Therefore, it is necessary to consider the psychological needs of patients by integrating these into clinical care at different levels (emergency department, hospital ward, home). Specific structured support aimed at helping patients overcome intense negative experiences is suggested, especially in the first stage of the adaptation process. Nurses should also ensure that appropriate education programmes with adequate follow-up interventions are offered to improve the experience of living with an ICD. In addition, patient-reported outcomes should be routinely collected from patients with an ICD.

Quantitative Analysis of the Oxidation State of Cobalt Oxides by Resonant Photoemission Spectroscopy.

Quantitative assessment of the charge transfer phenomena in cobalt oxides and cobalt complexes is essential for the design of advanced catalytic materials. We propose a method for the evaluation of the oxidation state of cobalt oxides with mixed valence states using resonant photoemission spectroscopy. The method is based on the calculation of the resonant enhancement ratio (RER) from the heights of the resonant features associated with the Co3+ and Co2+ states. The nature of the corresponding states was corroborated by means of density functional calculations. We employed a well-ordered Co3O4(111) film to calibrate the RER with respect to the atomic Co3+/Co2+ ratio. The method was applied to monitor the reduction of a well-ordered Co3O4(111) film to CoO(111) upon annealing under exposure to isopropanol. We demonstrate that this method yields the stoichiometry of cobalt oxides at a level of accuracy that cannot be achieved when fitting the Co 2p core level spectra.

Heterogeneous reactions of SO2 on the hematite(0001) surface.

Heterogeneous reactions at the surfaces of mineral dusts represent a key process in the formation of atmospheric aerosols. To quantify the rate of aerosol formation in climate modeling as well as combat hazardous aerosols, a deep understanding of the mechanisms of these reactions is essential. In the present work, density functional theory calculations, including a Hubbard-like +U correction, were employed to elucidate the reaction between SO2 and the hematite(0001) surface. Three reaction conditions are considered: dry, wet, and aerobic. In the absence of water and oxygen, adsorption energies of SO2 on the clean Fe-O3-Fe-termination were found to be about -0.8 to -1.0 eV and resulted in the formation of an adsorbed SO3-like species. The addition of water leads to surface hydroxylation and has little effect on promoting the SO2 adsorption. Under such circumstances, an HSO3-like species was formed with a smaller adsorption energy of about -0.5 eV. By contrast, the presence of molecular oxygen enhances the SO2 adsorption significantly as the two species combine to form sulfate SO4 2-, with adsorption energies of -1.31 to -1.64 eV. The calculated vibrational frequencies of the adsorbate species provide insight into the surface bonding and a useful spectral fingerprinting for experimental measurements. These results elucidate the atomistic mechanism of the reaction between SO2 and hematite and highlight the important role of atmospheric O2 in the formation of sulfates.

Self-texturizing electronic properties of a 2-dimensional GdAu2 layer on Au(111): the role of out-of-plane atomic displacement.

Here, we show that the electronic properties of a surface-supported 2-dimensional (2D) layer structure can self-texturize at nanoscale. The local electronic properties are determined by structural relaxation processes through variable adsorption stacking configurations. We demonstrate that the spatially modulated layer-buckling, which arises from the lattice mismatch and the layer/substrate coupling at the GdAu2/Au(111) interface, is sufficient to locally open an energy gap of ∼0.5 eV at the Fermi level in an otherwise metallic layer. Additionally, this out-of-plane displacement of the Gd atoms patterns the character of the hybridized Gd-d states and shifts the center of mass of the Gd 4f multiplet proportionally to the lattice distortion. These findings demonstrate the close correlation between the electronic properties of the 2D-layer and its planarity. We demonstrate that the resulting template shows different chemical reactivities which may find important applications.

Catalytic Proton Dynamics at the Water/Solid Interface of Ceria-Supported Pt Clusters.

Wet conditions in heterogeneous catalysis can substantially improve the rate of surface reactions by assisting the diffusion of reaction intermediates between surface reaction sites. The atomistic mechanisms underpinning this accelerated mass transfer are, however, concealed by the complexity of the dynamic water/solid interface. Here we employ ab initio molecular dynamics simulations to disclose the fast diffusion of protons and hydroxide species along the interface between water and ceria, a catalytically important, highly reducible oxide. Up to 20% of the interfacial water molecules are shown to dissociate at room temperature via proton transfer to surface O atoms, leading to partial surface hydroxylation and to a local increase of hydroxide species in the surface solvation layer. A water-mediated Grotthus-like mechanism is shown to activate the fast and long-range proton diffusion at the water/oxide interface. We demonstrate the catalytic importance of this dynamic process for water dissociation at ceria-supported Pt nanoparticles, where the solvent accelerates the spillover of ad-species between oxide and metal sites.

Effects of Thermal Electronic Excitations on the Diffusion of Oxygen Adatoms on Graphene.

We conduct first-principles calculations to study oxygen diffusion on the graphene surface as a function of temperature up to 3000 K. The minimum energy migration path and the corresponding activation energy are determined by the nudged elastic band method with explicit inclusion of thermal electronic excitations. Below 1000 K the activation energy for epoxy oxygen to migrate remains close to its room temperature value (0.72 eV). Above 1000 K the activation energy decreases near linearly with temperature, from 0.70 eV at 1000 K to 0.47 eV at 3000 K. We show that this reduction originates from thermal electronic excitations. In particular, the effect is determined by the large contrasts in the electronic structures of the initial and transition states: the transition state exhibits much larger electronic density of states near the Fermi level and is more susceptible to thermal electronic excitations. The reduction in activation energy leads to appreciable enhancement in the diffusivity of oxygen adatoms. A moderate decrease in the vibrational prefactor, also caused by thermal electronic excitations, does not alter this trend. These findings may facilitate future works to accurately describe the dynamics of O adatoms on graphene at high T, which are critical for determining surface thermodynamic properties such as equilibrium coverage.

Reactivity of atomically dispersed Pt(2+) species towards H2: model Pt-CeO2 fuel cell catalyst.

The reactivity of atomically dispersed Pt(2+) species on the surface of nanostructured CeO2 films and the mechanism of H2 activation on these sites have been investigated by means of synchrotron radiation photoelectron spectroscopy and resonant photoemission spectroscopy in combination with density functional calculations. Isolated Pt(2+) sites are found to be inactive towards H2 dissociation due to high activation energy required for H-H bond scission. Trace amounts of metallic Pt are necessary to initiate H2 dissociation on Pt-CeO2 films. H2 dissociation triggers the reduction of Ce(4+) cations which, in turn, is coupled with the reduction of Pt(2+) species. The mechanism of Pt(2+) reduction involves reverse oxygen spillover and formation of oxygen vacancies on Pt-CeO2 films. Our calculations suggest the existence of a threshold concentration of oxygen vacancies associated with the onset of Pt(2+) reduction.

Creating single-atom Pt-ceria catalysts by surface step decoration.

Single-atom catalysts maximize the utilization of supported precious metals by exposing every single metal atom to reactants. To avoid sintering and deactivation at realistic reaction conditions, single metal atoms are stabilized by specific adsorption sites on catalyst substrates. Here we show by combining photoelectron spectroscopy, scanning tunnelling microscopy and density functional theory calculations that Pt single atoms on ceria are stabilized by the most ubiquitous defects on solid surfaces--monoatomic step edges. Pt segregation at steps leads to stable dispersions of single Pt(2+) ions in planar PtO4 moieties incorporating excess O atoms and contributing to oxygen storage capacity of ceria. We experimentally control the step density on our samples, to maximize the coverage of monodispersed Pt(2+) and demonstrate that step engineering and step decoration represent effective strategies for understanding and design of new single-atom catalysts.

Counting electrons on supported nanoparticles.

Electronic interactions between metal nanoparticles and oxide supports control the functionality of nanomaterials, for example, the stability, the activity and the selectivity of catalysts. Such interactions involve electron transfer across the metal/support interface. In this work we quantify this charge transfer on a well-defined platinum/ceria catalyst at particle sizes relevant for heterogeneous catalysis. Combining synchrotron-radiation photoelectron spectroscopy, scanning tunnelling microscopy and density functional calculations we show that the charge transfer per Pt atom is largest for Pt particles of around 50 atoms. Here, approximately one electron is transferred per ten Pt atoms from the nanoparticle to the support. For larger particles, the charge transfer reaches its intrinsic limit set by the support. For smaller particles, charge transfer is partially suppressed by nucleation at defects. These mechanistic and quantitative insights into charge transfer will help to make better use of particle size effects and electronic metal-support interactions in metal/oxide nanomaterials.

[The natural story of a mega selection for nurses: a case study]. / La storia naturale di un mega-concorso di area vasta per infermieri: studio di un caso.

INTRODUCTION: In the Italian National Health Service, it has been documented recently a new phenomenon called 'mega-selection' where thousands of newly graduates submit their application and compete for the few positions available. However, scarce scientific information is available on mega - selections and their outcomes. OBJECTIVES: To evaluate the nurses candidates profile attending the public selections, the factors affecting their likelihood of success and the duration of the entire selection process. METHODS: Administrative data of the public selection of nurses performed by 4-health trusts in Friuli Venezia Giulia (Italy) has been obtained: the number and characteristics of the candidates admitted, as well as of those who passed the competition. RESULTS: Over 3.901 applications, 3.880 candidates were admitted to the selection; only 1.690 (43.3%) attended the public selection, 417 (10.6%) passed the first examination and 217 (7%) passed the competition (7%). The winners were, on average, 27 years old, graduated from approximately 1.5 years, lived and obtained their nursing degree in the northern Italian regions. CONCLUSIONS: With the hiring freezing documented in recent years in the health sector, a large number of candidates are expected in the public selections; however a limited number succeed in the selection process. Some recommendations are proposed to streamline the public selection process.

Predictive power of individual factors and clinical learning experience on academic success: findings from a longitudinal study.

Academic failure is the inability of a nursing student to graduate or to complete the nursing degree on time. This longitudinal cohort study, involving 2 Italian universities, documents the effects of selected individual variables and the quality of the clinical learning experience as perceived by students on academic success. Factors related to the clinical learning experience were the quality of the supervisory relationship, pedagogical atmosphere, and commitment of the ward related to the level of personalized nursing care delivered and clarity of nursing documentation.

Rigid- and polarizable-ion potentials for modeling Ru-polyoxometalate catalysts for water oxidation.

This work assesses the predictive power and capabilities of classical interatomic potentials for describing the atomistic structure of a fully inorganic water-oxidation catalyst in the gas phase and in solution. We address a Ru-polyoxometalate molecule (Ru-POM) that is presently one of the most promising catalysts for water oxidation due to its efficiency and stability under reaction conditions. The Ru-POM molecule is modeled with two interatomic potentials, the rigid ion model and the shell model potentials, which are used to perform molecular dynamics simulations. The predictions of these two approaches are discussed and compared to the available ab-initio data. These results allow us to establish the suitable level of theory to model complex heterogeneous interfaces between the Ru-POM and electrodes in solution.

Watch the screw. An unusual complication of orbital reconstruction.

Traumatic intraocular foreign bodies are a particular subset of open globe injuries usually caused by metal processing, blasts, or yard work. This case report presents a retained intraocular screw as a complication of mesh positioning during lateral orbit reconstruction after resection of a left spheno-orbital infiltrating meningioma.

Interface structure and reactivity of water-oxidation Ru-polyoxometalate catalysts on functionalized graphene electrodes.

We combine classical empirical potentials and density functional theory (DFT) calculations to characterize the catalyst/electrode interface of a promising device for artificial photosynthesis. This system consists of inorganic Ru-polyoxometalate (Ru-POM) molecules that are supported by a graphitic substrate functionalized with organic dendrimers. The experimental atomic-scale characterization of the active interface under working conditions is hampered by the complexity of its structure, composition, as well as by the presence of the electrolyte or solvent. We provide a detailed atomistic model of the electrode/catalyst interface and show that the catalyst anchoring is remarkably dependent on water solvation. A tight host-guest binding geometry between the surface dendrimers and the Ru-POM catalyst is predicted under vacuum conditions. The solvent destabilizes this geometry, leads to unfolding of the dendrimers and to their flattening on the graphitic surface. The Ru-POM catalyst binds to this organic interlayer through a stable electrostatic link between one POM termination and the charged terminations of the dendrimers. The calculated dynamics and mobility of the Ru-POM catalyst at the electrode surface are in fair agreement with the available high-resolution transmission electron microscopy data. In addition, we demonstrate that the high thermodynamic water-oxidation efficiency of the Ru-POM catalyst is not affected by the binding to the electrode, thus rationalizing the similar electrochemical performances measured for homogeneous and heterogeneous Ru-POM catalysts.