[The conceptualization of nursing in the Italian literature: an integrative analysis to inform theory development]. / La concettualizzazione dell'assistenza infermieristica nella letteratura italiana: un'analisi integrativa a supporto dello sviluppo di una teoria.

INTRODUCTION: Nursing theories are essential for orienting nursing practice. To date, three models for nursing practice have been developed in Italy. In addition, significant epistemological reflections have been published, sparking a rich professional debate regarding the theoretical foundations of nursing in Italy. However, conceptual models from other countries are often still used, despite many difficulties associated with applying them in practice. In order to investigate and redress this 'theoretical gap' and related implications for intervention, three scoping reviews of the Italian nursing literature were conducted to examine three categories of nursing knowledge: (a) nursing practice in Italy; (b) the basic nursing concepts of person, health, environment and nursing; and (c) regulatory/normative statements regarding what nursing practice should be in Italy. AIM: The purpose of this investigation was to identify how nursing is conceptualized in the Italian literature through an integrative narrative analysis of three scoping reviews. METHODS: The Scoping Review according to the recommendations published by Arksey and O'Malley and subsequently implemented by Levac et al. has been selected as the optimal methodology for mapping nursing knowledge. At the end of the reviews carried out to answer the three research questions, the researchers integrated the results by conducting a coding of the results. RESULTS: The narrative synthesis highlighted a systemic conception of persons in their social context, 'incorporated' within relational systems. Persons are imagined as active agents with self-determination toward promoting their own health. Health, derived from levels of equilibrium between multiple systemic components and based on the person's holistic view, is a fundamental right and a collective social interest. Maintaining or promoting a person's health requires careful consideration of all these constitutive and integral elements. The nursing process is implemented through technical acts as well as relational and caring skills. Professional autonomy, influenced by clinical and organizational contexts, is expressed in collaboration with other professionals who contribute to the healthcare process. The results of this integrative narrative analysis suggest the need for a holistic vision of persons, with an active role in their health management, indissociable from the system of relationships in which this is contextualized, within which nurses are embedded. CONCLUSION: In light of the results of our investigation, the promotion of a conceptualization of nursing based on the centrality of the person-social relational system and on the active role of persons that nurses work with, this could guide approaches used in nursing education and administration. This could help enhance care provided by nurses and persons' participation in decisions regarding their own health.

Dermatological diseases, sexuality and intimate relationships: A qualitative meta-synthesis.

AIMS AND OBJECTIVES: To conduct a systematic review and meta-synthesis of findings from qualitative research about sexuality and intimate relationship among patients with dermatological diseases. BACKGROUND: Over the last few decades, there has been an increase in clinical research investigating aspects related to sex and sexuality in patients living with dermatological diseases. In fact, studies recognise a negative impact on various aspects of intimacy, such as sexual function, self-esteem and romantic relationships. The body of qualitative literature about sexuality in the context of dermatological diseases is emerging but consists mainly of small studies that would benefit from aggregation, synthesis and interpretation to highlight and summarise the overarching dimensions to this clinical issue. DESIGN: A systematic review and meta-synthesis of qualitative studies. METHODS: BioMed Central, Cochrane Library, MEDLINE, CINAHL, PsycINFO, PsycARTICLES, ERIC, Scopus, and Web of Science were searched between June-November 2017 with no publication date limits. Screening and selection of studies was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). After retrieval, the qualitative data were subject to meta-synthesis to identify overarching themes. RESULTS: Ten qualitative studies were found. We identified four themes: (a) Embarrassment and shame; (b) Impaired sense of attractiveness and sexual avoidance; (c) Relationship issues; and (d) Lack of professional support. The patients in these studies adopted negative coping styles, such as avoidance and hiding their bodies. CONCLUSION: When assessing and evaluating patient care in dermatology, it is important that sexuality and the impact the disease could have on relationships is included. RELEVANCE TO CLINICAL PRACTICE: An important part of nursing care is ensuring that patients are helped to develop positive coping strategies rather than negative ones. Patients with dermatological conditions also need advice and treatment to address any physically related sexual problems. Nurses need to be the initiators of these sensitive conversations to put patients at ease and work together to implement positive measures to reduce the sexuality-related issues patients face.

Experiences of participating in intergenerational interventions in older people's care settings: A systematic review and meta-synthesis of qualitative literature.

AIMS: To synthesize the findings of qualitative research exploring the experiences of being involved in intergenerational interventions in older people's care settings. DESIGN: A meta-synthesis of the qualitative literature, employing Sandelowski and Barroso's method, was conducted. DATA SOURCES: Eight databases were searched in March 2017. REVIEW METHODS: The PRISMA statement was used for reporting the different phases of the literature search and the Critical Appraisal Skills Programme (CASP) qualitative research checklist was used as an appraisal framework. Data synthesis was conducted using Sandelowski and Barroso's method. RESULTS: Four qualitative studies were included in the meta-synthesis. Thematic analysis revealed four themes: 'Recreating the family'; 'Building intergenerational empathy and respect'; 'Uplifting and energizing'; and 'Engagement risks and challenges'. CONCLUSION: The meta-synthesis strengthens the evidence that intergenerational interventions can be positive. However, it also shows that there may also be some negative aspects if not planned or managed carefully. IMPACT: This review contributes to the body of evidence by synthesizing the experiences of older people and children involved in intergenerational interventions. Although qualitative literature supports the quantitative evidence that intergenerational interventions can have a positive effect, intergenerational interventions could also have negative effects on some participants. Older people may feel tired, or experience feelings of infantilization. Practitioners need to be more aware of the potential negative effects of intergenerational interventions and include risk assessment, possibly by requiring ethical scrutiny.

Orthostatic hypotension among elderly patients in Italian internal medicine wards: an observational study.

Orthostatic hypotension (OH) is a multifactorial disorder, often asymptomatic. The prevalence of OH increases with age, ranging from 5 to 11% among middle-aged patients to 55% in the frail elderly depending on age and associated comorbidities. OH is often unrecognized or misdiagnosed and little is known about its prevalence in hospitalized elderly patients. Our aims were: (1) to determine the prevalence of OH in a cohort of elderly patients hospitalized in two internal medicine wards in Italy; (2) and to describe their characteristics and symptoms. During the 5 months from March 1, 2017 to July 31, 2017, the first 85 consecutive patients (65 years or older) admitted in two internal medicine wards were enrolled. Patients were included in the study if they were able to get out of bed alone or with minor assistance, and able to stand up for at least 3 min. The study population comprised 85 patients with a mean age of 79.6 ( ± 7.2) years. OH was found in 64 (75.3%), occasional OH in 41 (48.2%), persistent OH in 23 (27.1%), and 21 (24.7%) patients had no OH. All patients had diastolic OH and 37 (57.8%) also systolic. Patients with persistent OH were oldest, with a higher percentage of renal failure. Twenty-six patients (40.6%) with OH reported symptoms. Dizziness was the most common symptom, especially after breakfast. No association was found between type of medications and risk of OH. Mortality risk was not statistically different between patients with or without OH 3 (p = 0.10) and 6 months after discharge (p = 0.18), but a trend was observed. We found that OH is very common in the patients admitted in the internal medicine wards, particularly diastolic OH. Close attention should be paid to OH and its symptoms, especially dizziness, in the oldest-old patients, and in patients with renal failure.

Research awareness among children's nurses: An integrative review.

BACKGROUND: Developing nursing research skills, awareness and research utilisation are important for improving healthcare outcomes and are key to ensuring the full understanding and knowledge base necessary for optimal delivery of care. Nevertheless, little is known about research awareness in children's nurses. AIMS AND OBJECTIVES: To address this issue, an integrative literature review was conducted for studies published between January 2007 and January 2017 to obtain up-to-date evidence about the extent of research awareness and utilisation among children's nurses. METHODS: Using PubMed, Cochrane Library, ILISI and CINAHL databases, 21 studies related to children's nurses' research awareness were included in the final review, which was later developed and structured in keeping with PRISMA checklist and guidelines. CONCLUSIONS: The studies isolated show that nurses' knowledge about and utilisation of research vary and that there are many existent barriers to and facilitators of evidence-based practice in the paediatric setting. Some studies report that introducing a cultural and/or change in clinical practice change to improve research utilisation can have positive impacts on healthcare outcomes and the quality of nursing care of children. It is recommended that structured approaches to improving research utilisation be considered and additional research is needed to explore the benefits of these approaches. RELEVANCE TO CLINICAL PRACTICE: Despite more than three decades of the evidence-based practice movement within nursing, barriers still exist among children's nurses in the use of research in practice. If the use of research to improve the delivery of children's nursing care is to become a reality, then nurses' research awareness needs to improve to underpin care delivery with optimal evidence in a cohesive informed manner.

[The development of nursing research ten years after the establishment of PhD Schools of Nursing in Italy]. / Lo sviluppo della ricerca infermieristica in Italia a dieci anni dall'istituzione delle scuole dottorali.

INTRODUCTION: In Italy, the nursing doctoral programs were established in 2006, and after ten years we though it would be important to understand how nursing research in Italy has developed thanks to its four doctoral schools of nursing. Our research question was: How have the Italian doctoral schools of nursing contributed to the development of nursing research in the last ten years? METHODS: A national descriptive observational was conducted to collect all the publications made by the four nursing doctoral schools in Florence, Genoa, L'Aquila, and Rome between 2006 and 2015. For the enrolment of the participants, an online survey was sent to the e-mail address of each student provided by the reference University. The publications collected through the CVs of the current and former doctoral students were then checked against Web Science. The publication trends were analysed considering the type of journal, the Impact Factor (IF), and the topics. RESULTS: A total of 478 papers published between 2006-2015 were retrieved, of which 226 (47.59%) were published in Italian journals and 250 (52,41%) on international journals. The great majority of the papers (59,21%) were published in 30 journals, of which 15 had an Impact Factor (range 0.236 - 3.755). The main topics were clinical care, research methods, education, management, ethics, and policies. CONCLUSIONS: Between 2006 and 2015, Italy has produced nursing knowledge and scientific data that can be used to improve the quality of care and facilitate discussions with health policy decision-makers in order to better address the incumbent heath challenges of the near future.

The contribution of nursing doctoral schools to the development of evidence 10 years after their establishment in Italy: An exploratory descriptive survey of former and current doctoral students' publications.

AIM: To analyse through an exploratory descriptive survey how former and current doctoral students' publications have contributed to the development of evidence between the establishment of the doctoral schools of nursing in 2006-2015. DESIGN: An exploratory descriptive survey. METHODS: We analysed the papers published in peer-reviewed journals by the four Italian PhD Schools of Nursing between 2006-2015. Additional missing information was retrieved from Web of Science. RESULTS: We identified 478 scientific papers. The papers increased from 12 in 2006-110 in 2015. Most are published in 29 journals, of which 15 had an impact factor ranging between 0.236-3.755. These results show the increasingly significant contribution of nursing doctoral programmes to the production of evidence, which can be used to improve the quality of nursing and inform health policies. Nursing doctoral schools deserve a greater recognition, especially by Italian funding agencies and political institutions.

A review of the role of nurse leadership in promoting and sustaining evidence-based practice.

AIM: This integrative review aims to explore how nursing leadership influences evidence-based practice in contemporary health care settings. BACKGROUND: Although managers and environmental ward culture have long been identified as being among the main barriers to evidence-based practice, there is little overall conceptualization and understanding of the specific role of nurse leaders in directly influencing and supporting this. EVALUATION: The team carried out an integrative literature review (n = 28) utilizing PubMed, CINAHL and the Cochrane Library (2006-2016). KEY ISSUES: The key role of leadership, the methodology used, and understanding and addressing barriers to or facilitators of the implementation of evidence-based practice emerged as key issues. CONCLUSION: Nurse managers have a particular influential role on the implementation of evidence-based practice in terms of providing a supportive culture and environment. For this they need to have an underlying knowledge but also to be aware of and address barriers to implementation, and understand the key role of nurse managers in creating and supporting the optimum environment. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers need to facilitate and enhance nurses' use of evidence-based practice. Both managers and nurses need to have the necessary academic preparation, support and resources required for practising using an evidence base.

Mixed-methods research in nursing - a critical review.

AIMS AND OBJECTIVES: To review the use of mixed-methods research in nursing with a particular focus on the extent to which current practice informs nurse researchers. It also aimed to highlight gaps in current knowledge, understanding and reporting of this type of research. BACKGROUND: Mixed-methods research is becoming increasingly popular among nurses and healthcare professionals. Emergent findings from this type of research are very useful for nurses in practice. The combination of both quantitative and qualitative methods provides a scientific base for practice but also richness from the qualitative enquiry. However, at the same time mixed-methods research is underdeveloped. METHODS: This study identified mixed-methods research papers and critically evaluated their usefulness for research practice. To support the analysis, we performed a two-stage search using CINAHL to find papers with titles that included the key term 'mixed method'. CONCLUSION: An analysis of studies that used mixed-methods research revealed some inconsistencies in application and reporting. Attempts to use two distinct research methods in these studies often meant that one or both aspects had limitations. Overall methods were applied in a less rigorous way. This has implications for providing somewhat limited direction for novice researchers. There is also potential for application of evidence in healthcare practice that limited validity. RELEVANCE TO CLINICAL PRACTICE: This study highlights current gaps in knowledge, understanding and reporting of mixed-methods research. While these methods are useful to gain insight into clinical problems nurses lack guidance with this type of research. This study revealed that the guidance provided by current mixed-methods research is inconsistent and incomplete and this compounds the lack of available direction. There is an urgent need to develop robust guidelines for using mixed-methods research so that findings may be critically implemented in practice.