Elements Characterising Multicomponent Interventions Used to Improve Disease Management Models and Clinical Pathways in Acute and Chronic Heart Failure: A Scoping Review.

This study aimed to summarise different interventions used to improve clinical models and pathways in the management of chronic and acute heart failure (HF). A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. MEDLINE (via PubMed), Embase, The Cochrane Library, and CINAHL were searched for systematic reviews (SR) published in the period from 2014 to 2019 in the English language. Primary articles cited in SR that fulfil inclusion and exclusion criteria were extracted and examined using narrative synthesis. Interventions were classified based on five chosen elements of the Chronic Care Model (CCM) framework (self-management support, decision support, community resources and policies, delivery system, and clinical information system). Out of 155 SRs retrieved, 7 were considered for the extraction of 166 primary articles. The prevailing setting was the patient's home. Only 46 studies specified the severity of HF by reporting the level of left ventricular ejection fraction (LVEF) impairment in a heterogeneous manner. However, most studies targeted the populations with LVEF ≤ 45% and LVEF < 40%. Self-management and delivery systems were the most evaluated CCM elements. Interventions related to community resources and policy and advising/reminding systems for providers were rarely evaluated. No studies addressed the implementation of a disease registry. A multidisciplinary team was available with similarly low frequency in each setting. Although HF care should be a multi-component model, most studies did not analyse the role of some important components, such as the decision support tools to disseminate guidelines and program planning that includes measurable targets.

Teaching strategies of clinical reasoning in advanced nursing clinical practice: A scoping review.

AIM/OBJECTIVE: To report and synthesize the main strategies for teaching clinical reasoning described in the literature in the context of advanced clinical practice and promote new areas of research to improve the pedagogical approach to clinical reasoning in Advanced Practice Nursing. BACKGROUND: Clinical reasoning and clinical thinking are essential elements in the advanced nursing clinical practice decision-making process. The quality improvement of care is related to the development of those skills. Therefore, it is crucial to optimize teaching strategies that can enhance the role of clinical reasoning in advanced clinical practice. DESIGN: A scoping review was conducted using the framework developed by Arksey and O'Malley as a research strategy. Consistent with the nature of scoping reviews, a study protocol has been established. METHODS: The studies included and analyzed in this scoping review cover from January 2016 to June 2022. Primary studies and secondary revision studies, published in biomedical databases, were selected, including qualitative ones. Electronic databases used were: CINAHL, PubMed, Cochrane Library, Scopus, and OVID. Three authors independently evaluated the articles for titles, abstracts, and full text. RESULTS: 1433 articles were examined, applying the eligibility and exclusion criteria 73 studies were assessed for eligibility, and 27 were included in the scoping review. The results that emerged from the review were interpreted and grouped into three macro strategies (simulations-based education, art and visual thinking, and other learning approaches) and nineteen educational interventions. CONCLUSIONS: Among the different strategies, the simulations are the most used. Despite this, our scoping review reveals that is necessary to use different teaching strategies to stimulate critical thinking, improve diagnostic reasoning, refine clinical judgment, and strengthen decision-making. However, it is not possible to demonstrate which methodology is more effective in obtaining the learning outcomes necessary to acquire an adequate level of judgment and critical thinking. Therefore, it will be necessary to relate teaching methodologies with the skills developed.

[What are the needs of caregivers caring for people living in chronic conditions? Qualitative research]. / Quali sono i bisogni dei caregiver di persone che vivono una condizione di cronicità: ricerca qualitativa.

BACKGROUND: The population ageing generates new challenges related to the treatment of chronic diseases. The course of the disease makes patients and caregivers (CGs) vulnerable and their ability to self-care is threatened. CGs can be supported by the Advanced Practice Nurse (APN). OBJECTIVE: The aim is to deepen the CGs' needs of people with chronic conditions in Insubrica region. METHOS: It's a qualitative descriptive survey, conducted between September 2019 and February 2020. The CGs' convenience sample of people with chronic illness was differentiated by age, gender, profession, chronic diseases and included 20 participants. Data were collected through short motivational interviews and the compilation of a socio-family genogram. The thematic analysis of the interviews' Verbatim transcription was carried out by 4 researchers. RESULTS: The thematic analysis has shown 26 themes collected in 6 macrothemes and in addition highlighted that the chronic condition and vulnerability are linked together; therapeutic adherence and self-care depend on disease awareness, and CGs make little use of the social support network; CONCLUSION: Based on the results, it can be said that the APN can meet the GCs' needs through the skills gained in training (CanMEDS and Hamric model); encourage inter-professional and integrated care, and promote the formal and informal network.

[How do Advanced Practice Nurses participate in building health policy projects?] / Come gli infermieri di pratica avanzata partecipano alla costruzione di progetti di politica sanitaria?

INTRODUCTION: Patients' needs and the change of health professionals' roles have led researchers to reflect about the involvement of nurses in care processes development, as well as health policies. Studies confirm how advanced nursing training promotes quality of care and reduces the costs of healthcare. The introduction of the Advanced Practice Nurses (APNs) could potentially be an added value also in the Swiss healthcare context, where this figure is positioning. The study aims to investigate how APNs can participate in building health policy projects. METHOD: This is a qualitative study. Four focus groups were conducted on nurses with managerial and clinical roles. A content analysis approach with three review phases was applied. RESULTS: The identified macro-themes are: APN: Advanced training provides the skills needed to exercise the role. However, it emerges that the recognition of nurses in the field of health policies originates from a cultural change. Interprofessional collaboration: Multidisciplinary work allows overall patient care. However, requests for advice from the APN is still marginal. Health policy: The emerged needs are: defining a target population, educating the population and encouraging organizations to obtain quality certifications. Proposals for improvement: adequate training and the involvement of specialized figures are required for suitable care. CONCLUSIONS: APNs have potential impact upon health policy discussions. The authors recommend investing on education and cultural change, in order to maximize the active involvement in discussions supporting progress in nursing practice.

Experience of middle management nurses during the COVID-19 pandemic in Switzerland: A qualitative study.

AIMS: To explore the experiences of middle management nurses during the COVID-19 pandemic in Switzerland. BACKGROUND: The outbreak of COVID-19 has placed extraordinary demands on health care systems worldwide, which were found mostly unprepared. In this situation, middle management nurses played a strategic role because they acted as a link between organizational directives and the clinical practice. METHODS: This is a qualitative study that used a face-to-face interview with semi-structured questions to learn about the experiences of middle management nurses during the COVID-19 pandemic. After recruiting participants through purposeful sampling, data were analysed by means of thematic analysis using Nvivo 12. RESULTS: In total, 12 middle managers were interviewed. Data analysis identified four macro-themes-Changes; Conflicting emotions; Relation; Role-and 20 sub-themes. CONCLUSION: The sudden challenges posed by the pandemic required middle managers to shift their focus from advanced planning to negotiation for meeting the rapidly evolving needs of nursing staff and top management, in order to guarantee the nursing team's well-being and organizational efficiency. IMPLICATIONS FOR NURSING MANAGEMENT: Lessons learned from the pandemic suggest the need for fine-tuning organizational models and the importance that nurse middle managers affirm and uphold the core values for nursing and engage patient and staff advocacy.

[Bullying in Ticino's healthcare contexts: Impact on employee's well being and organization]. / Il bullismo nel sistema sanitario ticinese: L'impatto sul benessere dei collaboratori e sull'organizzazione.

INTRODUCTION: Bullying in health care setting has a globally prevalence between 1% and 87% and it's in constant increase described by "WHO" as: "Bullying is a major public health problem". It is defined as a repeated ill-treatment, harmful for the health of one or more individuals by one or more people. There are different types of behaviours and they vary from verbal abuse, offensive conduct, humiliating and intimidating attitudes. Those attitudes won't help you doing your job. Different are the outcomes that those actions have on victims: anxiety, sleep disturbances, generalized pain and reduced attention. The objective of the study was to investigate the presence of the phenomenon within the Ticino (Swiss Canton) on healthcare contexts and to explain its experiences. METHODS: A qualitative study was conducted on a sample of healthcare professionals who are active in the Ticino (Switzerland) healthcare context through 18 semi-structured interviews and their thematic analysis. RESULTS: The results that emerged shows how the problem is also relevant in Ticino`s healthcare contexts, sometimes with different modalities and outcomes, moreover, experiencing these situations during one's working career leads to re-proposing such behaviours, as it is considered a rite of passage. What emerges in a predominant way is the lack of programs or structures aimed to prevent and support the victim and the perpetrator.

[Description and analysis of disease representation in chronic patients through the Illness Perception Questionnaire (IPQ-r): implications for clinical practice]. / Descrizione e analisi delle rappresentazioni di malattia nei pazienti cronici attraverso l'Illness Perception Questionnaire (IPQ-r): implicazioni per la pratica clinica.

INTRODUCTION: According to the theory of Self-Regulation, the individual develops self-regulation processes that guide the course of pathology through mental representations of disease. These should be an essential part of nursing in developing the patient's motivation and self-efficacy, and the Illness Perception Questionnaire allows us to understand the construction processes. AIM: The aim is to analyze the mental representations of illness of a group of chronically ill patients, to evaluate the implications in therapeutic adherence and clinical practice. METHODS: Pilot study conducted on a sample of 89 chronically ill patients through the Illness Perception Questionnaire. RESULTS: By correlating the illness dimensions of the Self-Regulation, the significant relationship between emotional representations and the other dimensions emerges. Negative emotions lead the individual to perceive more the cyclical duration of the disease, the severity of its consequences, have a lower perception of coherence and understanding of the disease. A greater opinion of personal control corresponds to a lower perception of serious consequences and a greater perception of control of treatment. The prevalence of negative emotions and a lower disease consistency score are highlighted in patients with low educational level. CONCLUSION: The study demonstrated the adequacy of IPQ-r in detecting disease representations, which can affect outcomes in treatment. Above all, the importance of the emotional dimension related to the perception of the disease. The application of IPQ-r can be a valid tool for nurses in detecting the perception of illness of their patients resulting in a useful strategy to promote the educational process and promote adequate therapeutic adherence.

[25 February - 28 March 2020 my experience at the time of Covid-19: narratives of a group of nurses who worked in the Canton of Ticino]. / 25 febbraio ­ 28 marzo 2020 il mio vissuto al tempo del Covid-19: narrazioni di un gruppo di infermieri che lavorano in Canton Ticino.

INTRODUCTION: In February 2020 the first case of COVID-19 arrived in Canton Ticino. Since then, many things have changed at great speed, especially in health organizations, and these changes have had a strong impact on the nursing profession. The objective of this research was: to investigate the experiences of nurses at different organizational levels who were confronted with the COVID pandemic in the first month in which it occurred. METHODS: Narrative Research. The data collection was carried out involving a group of 20 nurses working in different contexts and roles in Canton Ticino. The collected narrations were analyzed through a thematic analysis of their content using Nvivo 12®. RESULTS: The thematic analysis of the narrations made it possible to define 26 themes and 6 macro-themes: Pandemic, What changes, Communication, Emotions/experiences, Role and image, Interprofessional collaboration. The results of this research make it possible to understand how a heterogeneous group of nurses experienced the particular period of pandemic in Canton Ticino and which reflections were derived from it. Some of the aspects highlighted can be compared with what is present in the international literature on the subject in order to find common ways of action for the nursing leadership, in the different Countries, facing the need to organize, manage and support nursing professionals in this and future pandemic situations. CONCLUSIONS: The results of this research can be used both at an organisational and educational level and can be the starting point for future research.

The Role of Professional Competency in Influencing Job Satisfaction and Organizational Citizenship Behavior Among Palliative Care Nurses.

It is crucial that palliative care nurses feel competent to practice their profession in accordance with ethical principles, to personalize care, to remain sensitive, to ensure respect, and to communicate effectively. The aim of this study was to verify that higher levels of perceived professional competency predict better individual and organizational outcomes, such as job satisfaction and organizational citizenship behavior. An online cross-sectional survey was conducted with 107 Italian palliative care nurses. Structural equation modeling technique was used for data analysis. The model fitted the data well. Professional competency was positively associated with both job satisfaction (ß = 0.39) and organizational citizenship behavior (ß = 0.53). The more confidence palliative care nurses have in their professional competency, the more they are satisfied with their job and engage in organizational citizenship behavior. Fostering professional competency in palliative nursing can help not only patients and their families but also the nurses themselves, the organization, and their coworkers.

Prosocial behaviour in palliative nurses: psychometric evaluation of the prosociality scale.

AIM: The aim of this study was to examine the psychometric properties of a prosociality scale within the palliative nursing context, and then examine the impact of prosocial behaviour in relation to job and educational satisfaction among palliative nurses. METHODS: An online cross-sectional survey was conducted in 25 Italian palliative care centres, with a total of 107 nurses completing the prosociality scale by Caprara et al (2005) . Exploratory and confirmatory factor analyses were examined to evaluate a multidimensional model of prosociality. RESULTS: A three-factor solution with a second order factor fitted the data well. The three dimensions extracted were labelled as helping, empathy, and sharing. Participants reported high levels of prosociality. In addition, prosociality was positively associated with job and educational satisfaction. CONCLUSIONS: The prosociality scale was valid and reliable when tested with palliative nurses. Although prosociality may be embedded in nurses' personalities, this quality should be actively promoted to expand and improve the culture and the ethics of nursing.

[Nurses and Organizational Citizenship Behavior: contribution to the Italian validation of the Podsakoff et al. scale]. / Gli infermieri e il "Comportamento di Cittadinanza Organizzatva": contributo alla validazione italiana della scala di Podsakoff et al.

BACKGROUND: Workers engaging in Organizational Citizenship Behaviour (OCB) can benefit colleagues, organization and stakeholders. Such behavior is vital to the efficacy of health care organizations as they can have a positive effect on the quality of care and users' satisfaction. Therefore, it is important to assess such behaviour with a valid and reliable instrument. OBJECTIVES: The purpose of this study was to test, from a confirmatory perspective, the dimensionality of the Italian version of the Podsakoff et al. OCB scale in a large sample of nurses, and at the same time to evaluate the differences in nurses' OCB considering socio-demographic and job characteristics. METHODS: The study included 886 nurses from different health organizations in Italy. The psychometric characteristics of the Italian OCB scale were tested through confirmatory factor analysis (CFA). The differences in nurses' OCB, according to several socio-demographic and job characteristics, were evaluated through a series of correlations and analysis of variance. RESULTS: The CFA of the Italian OCB scale confirmed the hypothesized factor structure, consisting of three dimensions: altruism, civic virtue and conscientiousness. Nurses' gender and professional training were positively correlated with OCB, while the amount of extra work was negatively correlated. In regard to clinical work settings, palliative care nurses engaged in OCB more than nurses working in other areas. CONCLUSIONS: The Italian OCB scale is a valid and reliable instrument. Its use can support all individuals involved in the promotion of workers' organizational well-being in implementing processes aimed at fostering nurses' OCB.

Barriers in the management of cancer-related pain and strategies to overcome them: findings of a qualitative research involving physicians and nurses in Italy.

INTRODUCTION AND AIMS: There are many barriers and obstacles that even today lead to an inadequate treatment of cancer-related pain. The aim is to describe the experiences of a group of Italian physicians and nurses as far as the nature of these barriers is concerned and the possible tools to be used to overcome them. MATERIAL AND METHOD: We run 5 focus groups with 42 healthcare professionals (11 physicians, 31 nurses) working in 5 hospitals in Italy. The findings of the focus groups were analysed according to the "Content Analysis" method. RESULTS: Five main items emerged: the importance of communication, the need for education regarding pain therapy, the ethnic/cultural/religious differences, the mutual trust and support within the working group, the daily challenges. CONCLUSION: In harmony with the most recent literature, physicians and nurses voice above all their need for an education more directly aimed at overcoming the prevailing barriers rooted in ignorance, prejudice and fears.

The effectiveness of the quality program Pac-IficO to improve pain management in hospitalized cancer patients: a before-after cluster phase II trial.

BACKGROUND: Cancer-related pain continues to be a major healthcare issue worldwide. Despite the availability of effective analgesic drugs, published guidelines and educational programs for Health Care Professionals (HCPs) the symptom is still under-diagnosed and its treatment is not appropriate in many patients. The objective of the study is to evaluate the efficacy of the Pac-IFicO programme in improving the quality of pain management in hospitalised cancer patients. METHODS/DESIGN: This is a before-after cluster phase II study. After the before assessment, the experimental intervention - the Pac-IFicO programme - will be implemented in ten medicine, oncology and respiratory disease hospital wards. The same assessment will be repeated after the completion of the intervention. The Pac-IFicO programme is a complex intervention with multiple components. It includes focus group with ward professionals for identifying possible local obstacles to optimal pain control, informative material for the patients, an educational program performed through guides from the wards, and an organisational intervention to the ward. The primary end-point of the study is the proportion of cancer patients with severe pain. Secondary end-points include opioids administered in the wards, knowledge in pain management, and quality of pain management. We plan to recruit about 500 cancer patients. This sample size should be sufficient, after appropriate statistical adjustments for clustering, to detect an absolute decrease in the primary end-point from 20% to 9%. DISCUSSION: This trial is aimed at exploring with an experimental approach the efficacy of a new quality improvement educational intervention. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02035098.

Therapeutic education to cancer patients: experiences of Italian nurses.

INTRODUCTION: Therapeutic patient' education is a complex process requiring a proper level of communication between the patient and the healthcare professional. Nurses play a key role in providing the patients and their families with educational activities. OBJECTIVE: This paper is the report of a study which investigates the experiences of some Italian nurses with regards to their role in therapeutic education to cancer patients. METHODS: Qualitative research. Semi-structured interviews were carried out with 52 nurses working in different Local Health Service Units of two northern Italy regions: Piedmont and Valle d'Aosta. To identify categories and items arising from the data, the researchers used a qualitative content analysis. RESULTS: The interview format was classified into six main categories: a) Patient education as daily care activity; b) Relevance of communication and dialogue for educational purposes; c) Relative usefulness of written information; d) Therapeutic education recording; e) Patients' feedbacks as a tool for assessing therapeutic education; and f) Difficult communication. CONCLUSIONS: The experience of nurses in terms of their professional role in therapeutic education for cancer patients shows the steady presence of educational activities carried out in a non-planned way. This research confirms the need to launch educational interventions for nurses. IMPLICATIONS FOR PRACTICE: It is essential to implement an action plan to promote opportunities of professional training in the field since among the most frequent reasons for project failure in therapeutic education is the lack of expert human resources.

[Project "Hospital without pain": analysis of the Italian situation before the law 38]. / Progetti "ospedale senza dolore": analisi della realtà italiana prima della legge 38.

Project "Hospital without pain": analysis of the Italian situation before the law 38. Background. Some years ago, the project "Pain free Hospital" started in Italy to improve standards of pain management. Recently, Italian government passed a new law, which sets patient's right to receive palliative care and pain therapy. Aim. To evaluate pain prevalence in Italian hospitals before the new Italian law, analyzing the articles published within the project "Pain free Hospital". Methods. We did a Medline research using the following key words: pain; "Pain free Hospital"; cancer patients; Italian; Italy, from 1995 to 2010, and contacted all Italian centers of pain therapy. Results. Six articles met inclusion criteria. Pain prevalence was unexpectedly high in all the studies examined, albeit with wide differences among hospitals (37,7%-91%). Discussion. Our research shows that pain is not adequately controlled in Italian hospitals, probably for many reasons (wards organization, difficulty in prescribing opioids, etc.) but, above all, due to "opiophobia". The new Italian law should guarantee better analgesic treatments for all patients with persistent pain, both oncological and non oncological.