Profiling vaccine hesitancy in nursing to tailor public healthcare policies: A cross-sectional international study.

INTRODUCTION: Vaccine hesitancy is a complex issue of global concern. As nurses play a vital role in delivering patient care and shaping public opinions on vaccines, interventions to address vaccine hesitancy in nursing are imperative. As such, identifying profiles of characteristics and attitudes contributing to hesitancy may help identify specific areas of focus to target tailored global vaccination uptake campaigns. The purpose of this study was to profile the characteristics and attitudes contributing to hesitancy toward COVID-19 and Influenza vaccines in the nursing community. DESIGN: This multisite, cross-sectional study recruited 1967 registered nurses and 1230 nursing students from the United Kingdom, Finland, and Italy between March and September 2023. METHODS: Data collection involved an online survey adopting the Vaccination Attitudes Examination (VAX) Scale, the Bergen Social Media Addiction Scale, and questions pertaining to sociodemographic and occupational characteristics. A k-means cluster analysis was used to identify various clusters of hesitancy based on the VAX Scale. One-way ANOVA and chi-square tests were used to identify significant differences in sociodemographic characteristics, occupational factors, vaccination attitudes, and social media usage between the clusters. RESULTS: Three distinct clusters were identified. Profile A showed high vaccine confidence, profile B displayed slight hesitancy, and profile C reported high levels of hesitancy. In profile C, higher levels of vaccine hesitancy were identified in younger, less experienced nurses with lower educational attainment. While older nurses with higher educational attainment, who were in senior roles, were more vaccine-confident and had a consistent history of accepting the Influenza and COVID-19 vaccinations (profile A). The study found Italian nurses highly hesitant (profile C), British nurses highly confident (profile A), and Finnish nurses evenly distributed between confident, slightly hesitant, and highly hesitant (profiles A, B, and C, respectively). In addition, more frequent usage of Instagram and TikTok was associated with vaccine hesitancy (profiles B and C), and LinkedIn and X were more common among vaccine-confident individuals (profile A). CONCLUSIONS: This study has identified specific sociodemographic and occupational factors that are related to vaccine hesitancy in an international sample of nurses. Additionally, attitudes contributing to hesitancy were identified, with worries about unforeseen future effects of the vaccine being identified as a critical attitude that may undermine confidence and increase hesitancy in nursing. This study also sheds light on the influence that social media platforms have on vaccine hesitancy and, as such, indicates which platforms are effective to disseminate vaccination campaigns to global nursing communities. CLINICAL RELEVANCE: Global vaccination campaigns should focus on specific profiles and clusters to promote vaccination in the international nursing community. Empowering nurses early in their careers will help to instill positive vaccination behaviors, ensuring a sustained uptake of vaccinations throughout the individual's career and beyond, with an impact on promoting vaccination at the public health level as well.

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

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

Workload of home care nurses: Italian adaptation, validity, and reliability of the National Aeronautics and Space Administration Task Load Index questionnaire.

The aim of this study was to adapt the National Aeronautics and Space Administration Task Load Index (NASA-TLX) to the home care setting and translate and validate it in Italian. An online questionnaire containing the Italian version of the NASA-TLX adapted to the home care setting was administered to home care nurses to measure workload. Content Validity Index, Exploratory, and Confirmatory Factor Analyses were used to measure the psychometric characteristics of the modified NASA-TLX. The modified Italian version of NASA-TLX_HC-IT showed good psychometric characteristics in measuring the workload of home care nurses, with excellent fit indices. The reliability, calculated with Cronbach's alpha, was 0.73, indicating adequate reliability. A negative correlation between workload and job satisfaction among home care nurses, as well as a positive association between high workload and intention to leave the workplace, was verified. The modified Italian version of the NASA-TLX_HC-IT was confirmed to be a valid and reliable instrument to measure workload in home care nursing. Furthermore, the correlation between workload and the intention to leave the workplace among home care nurses was an important result that community nursing managers should consider preventing the shortage of home care nurses.

Working conditions, missed care and patient experience in home care nursing in Italy: An observational study.

INTRODUCTION: The aging of the population requires an appropriate knowledge of the type of care that needs to be provided to inform healthcare policies. In Italy, neither home care nursing, nor the patient experiences have ever been described. OBJECTIVES: To describe the characteristics of nurses and care recipients involved in home care. METHODS: A descriptive cross-sectional study conducted in 18 Italian Regions. Between April and October 2023, data from nurses and patients involved in home care were collected through two surveys. Psychosocial conditions in workplaces, missed care, and care experiences were assessed using validated tools. Descriptive statistics and Pearson's correlations were performed. RESULTS: A total of 46 local healthcare units were included in this study, with a total of 2549 nurses and 4709 care recipients. Nurses (mean age 46.60; 79.48% female; 44.68% regional nursing diploma as the highest qualification) reported good working conditions (42.37; SD = 12.25; range = 0-100) and a high mean number of missed care activities (5.11; SD = 3.19; range 0-9). Most nurses (83.41%) reported high levels of job satisfaction, while 20.28% intended to leave their job. Patients (mean age 75.18; 57.57% female; 36.95% primary school), on the other hand, rated positively the care they had received (8.23; range = 0-10). CONCLUSIONS: Despite the perception of critical issues at work and some missed care, satisfaction in nurses and patients was high. These data constitute a preliminary snapshot of the studied phenomena, which will be investigated through more in-depth analyses.

Identifying patterns and profiles of vaccination hesitancy among nurses for tailoring healthcare policies in the UK: A cross-sectional study.

AIMS: To profile the characteristics of nurses with varying levels of vaccine hesitancy toward the COVID-19 and influenza vaccines. BACKGROUND: In many countries across the world, healthcare workers, and nurses in particular, display significant reluctance toward COVID-19 and influenza vaccines due to concerns about safety, distrust in healthcare policies, and media influences. To address this, a proposed approach involves profiling nurses to tailor vaccination campaigns and to improve acceptance rates and public health outcomes. METHODS: This cross-sectional study adopted the Vaccination Attitudes Examination scale to assess hesitancy toward COVID-19 and influenza vaccines among 294 registered nurses in the UK between March and July 2023. A K-means cluster analysis was performed. The Strengthening the Reporting of Observational Studies in Epidemiology guidelines were adopted. RESULTS: Three profiles were identified. Profile A showed low vaccination hesitancy, profile B showed average hesitancy, and profile C showed high hesitancy toward vaccines. The highest concern for all profiles was related to unforeseen future effects of vaccination. Profile C had more nurses in early career roles, whereas nurses in profiles A and B were in more senior roles. Profile A showed higher educational attainment. Nurses in profile C used Snapchat more, whereas nurses in profile A used Twitter more frequently. CONCLUSION: This study identified specific characteristics associated with higher levels of vaccination hesitancy in nursing. Unforeseen future effects of vaccination are a core aspect to consider in promoting vaccination. IMPLICATIONS FOR NURSING AND NURSING POLICY: Policies and vaccination campaigns should be targeted on early career nurses and should deliver tailored messages to dispel misinformation about unforeseen future effects of vaccination through specific social media platforms. Senior nurses should be involved as role models in promoting vaccination. These results are key for enhancing an evidence-based approach to implementing global health policies in healthcare.

Community health services in European literature: A systematic review of their features, outcomes, and nursing contribution to care.

BACKGROUND: To meet the population's needs, community care should be customized and continuous, adequately equipped, and monitored. INTRODUCTION: Considering their fragmented and heterogeneous nature, a summary of community healthcare services described in European literature is needed. The aim of this study was to summarize their organizational models, outcomes, nursing contribution to care, and nursing-related determinants of outcomes. METHODS: A systematic review was performed by searching PubMed, CINAHL, Scopus, and Embase in October 2022 and October 2023 (for updated results). Quantitative studies investigating the effects of community care, including nursing contribution, on patient outcomes were included and summarized. Reporting followed the PRISMA checklist. The review protocol was registered on PROSPERO (CRD42022383856). RESULTS: Twenty-three studies describing six types of community care services were included, which are heterogeneous in terms of target population, country, interventions, organizational characteristics, and investigated outcomes. Heterogeneous services' effects were observed for access to emergency services, satisfaction, and compliance with treatment. Services revealed a potential to reduce rehospitalizations of people with long-term conditions, frail or older persons, children, and heart failure patients. Models are mainly multidisciplinary and, although staffing and workload may also have an impact on provided care, this was not enough investigated. DISCUSSION: Community health services described in European literature in the last decade are in line with population needs and suggest different suitable models and settings according to different care needs. Community care should be strengthened in health systems, although the influence of staffing, workload, and work environment on nursing care should be investigated by developing new management models. CONCLUSIONS AND IMPLICATIONS FOR HEALTH POLICY: Community care models are heterogeneous across Europe, and the optimum organizational structure is not clear yet. Future policies should consider the impact of community care on both health and economic outcomes and enhance nursing contributions to care.

A large cross-sectional survey of COVID-19 vaccination willingness amongst healthcare students and professionals: Reveals generational patterns.

AIMS: To determine coronavirus disease 2019 (COVID-19) vaccination hesitancy in healthcare professionals and healthcare students in Italy across four generations (baby boomers, generations X, Y and Z). DESIGN: A cross-sectional descriptive study was performed through an online survey conducted from May to June 2021. The STROBE guidelines were adopted for reporting. METHODS: Data were collected by initially sending a survey link to a convenience sample of healthcare professionals and students, which was followed by snowball sampling. The VAX scale was validated and adopted. An ANOVA was performed to detect differences in vaccine-hesitancy beliefs between the four generational groups. RESULTS: The survey was completed by 1226 healthcare professionals and students. Worries about unforeseen future effects accounted for the higher vaccination hesitancy factor across generations. More positive attitudes towards COVID-19 vaccination were expressed by members of generation Z than by members of generation Y and baby boomers. Members of generation X had the highest vaccination hesitancy scores in the overall scale. CONCLUSION: The results suggest that public health campaigns should take into account the generational differences in COVID-19 vaccination hesitancy to achieve higher levels of vaccine acceptance, including amongst healthcare professionals and students. IMPACT: Vaccination is the most effective strategy to tackle the COVID-19 pandemic. The advice of health professionals strongly influences vaccination willingness in the general population. A consideration of the generational patterns in the COVID-19 vaccination hesitancy of healthcare workers and students may increase vaccination uptake in these populations, which in turn may lead to greater public acceptance of the vaccine.

Lived experiences of frontline nurses and physicians infected by COVID-19 during their activities: A phenomenological study.

We analyzed the lived experiences of frontline nurses and physicians who were affected by COVID-19 through a phenomenological approach, using Cohen's methodology with interview data. The participants were enrolled in the study in May 2020 during the COVID-19 pandemic in Italy. The inclusion criteria were (i) being a nurse or physician employed full time caring for COVID-19 patients before falling ill; (ii) contracting SARS-CoV-2 between February 2020 to May 2020; (iii) having recovered before enrollment; and (iv) providing informed consent to participate. Sixteen participants (60% nurses) with an average age of 45 years were included. The following main themes were extrapolated from our data analysis: "fear of diagnosis," "loneliness (as isolation)," "touch of nurses," and "feeling guilty of abandonment." Several aspects emerging from our study highlight the strong emotional impact of COVID on nurses and physicians infected during their activities, such as feelings of fear and loneliness on the one hand, and of impotence and guilt for not being able to help on the other.

Effectiveness of a family nurse-led programme on accuracy of blood pressure self-measurement: A randomised controlled trial.

AIMS AND OBJECTIVES: To evaluate the effectiveness of a Family Nurse Practitioner (FNP)-led programme on the degree of adherence of current recommendations on home blood pressure self-measurement (HBPM) as compared to routine care and management. BACKGROUND: HBPM plays an important role for monitoring hypertensive patients; however, patients' adherence to current guidelines is unsatisfactory. A nurse-led training programme in the community setting could be an effective strategy to achieve high level of patients' adherence to recommendations. DESIGN: A multicentre randomised controlled trial was carried out from September 2016 to September 2017. METHODS: In total, 170 patients were randomly allocated into the intervention group (n = 83) and the usual care (n = 87). All participants received usual care (written and verbal information on HBPM recommendations); subjects in the intervention group also received 1-hour training session on how to correctly self-measure BP. Clinical trial registration was done (ClinicalTrials.gov.: NCT04681703). The CONSORT checklist for randomised controlled trials was used in this study. RESULTS: At baseline, the level of adherence to the recommendation was similar in the two groups (p < .05). After 1 month, the adherence significantly increased in the intervention group, where patients were more likely to measure BP at the same hour and from the same arm, in a quiet environment, with the back and uncovered arm supported and the legs uncrossed; recording BP more than once in each measurement session; keeping a diary of blood pressure measurements; use of the appropriate cuff and proper placement of the cuff; and resting for >5 min before performing the measurement (all p < .05). CONCLUSIONS: The FNP-led programme is effective in improving patients' adherence to guidelines on the correct technique to self-measure BP at home. RELEVANCE TO CLINICAL PRACTICE: This programme may be added to the existing interventions in the community setting or considered into specifically nurse-led hypertension management models.

Anxiety, sleep disorders and self-efficacy among nurses during COVID-19 pandemic: A large cross-sectional study.

AIM AND OBJECTIVES: To assess the prevalence of anxiety, sleep disorders and self-efficacy and their predicting factors among nurses facing COVID-19. BACKGROUND: The spread of COVID-19 throughout the world determined a series of modifications of several National Health Service organisations, with a potential series of psychological consequences among nurses, who were particularly afflicted by this situation of changes and precariousness. DESIGN: A cross-sectional study was carried out from February-April 2020. METHODS: A total of 1,005 nurses employed in different Italian hospital wards, during the COVID-19 pandemic, were recruited. Analyses were based on descriptive statistics and multivariate logistic regression. The STROBE checklist for cross-sectional studies was used in this study. RESULTS: The prevalence of sleep disturbances, moderate anxiety and low self-efficacy was 71.4%, 33.23% and 50.65%, respectively. We found a positive correlation between anxiety and sleep quality (0.408; p < .0001) and negative correlations between self-efficacy and anxiety (-0.217; p < .0001) and sleep quality and self-efficacy (-0.134; p < .0001). The factor independently associated with all variables was gender. Females were more prone to sleep disturbances, anxiety and low levels of self-efficacy than males (p < .05). CONCLUSIONS: The prevalence of anxiety, sleep disorders and low self-efficacy among Italian nurses during the COVID-19 pandemic was high. Healthcare managers should recognise and consider these results to reduce the risk of the onset of major mental problems that could result in post-traumatic stress disorder. RELEVANCE TO CLINICAL PRACTICE: Nurses facing major incidents as COVID-19 pandemic are among healthcare personnel exposed to a high risk to develop psychological disturbance that should be assessed and recognised, in order to find helpful coping strategies to inform support services and avoid to hesitate in post-traumatic stress disorders.

Trust in Nurses Scale: validation of the core elements.

BACKGROUND: The Trust in Nurses Scale (TNS) was developed and psychometrically assessed so that patients' trust could be accurately and reliably measured. The TNS has been translated, assessed and administered to patients in Europe, Asia and North America. AIM: This descriptive, cross-sectional, correlational study aimed to assess the psychometric characteristics of the Italian version of the Trust in Nurses Scale. METHODS: An Italian version of the TNS was developed. We used a forward-backward translation methodology to establish semantic and conceptual equivalence within the Italian context. The scale was then administered to a convenience sample of 200 hospitalised patients in medical, surgical or oncology units. Internal consistency and construct validity were assessed performing Cronbach's alpha and confirmatory factor analysis (CFA). Both a 4-item and a 5-item TNS were assessed. RESULTS: The 4-item TNS demonstrated better construct validity than the 5-item version. Similarly, the internal consistency reliability was better with 4 items than 5 (0.83 and 0.79, respectively). CONCLUSION: The Italian version of the scale has acceptable reliability and validity and may be used to assess this aspect of the nurse-patient relationship. Being tested in different settings, it may be used with all patients admitted to hospital. Trust in nurses is critically important to patient outcomes; however, it is rarely measured quantitatively on a wide scale. The use of the Italian validated scale could be useful to increase evidences on this important topic, as it represents a core component of nursing care.

Morality traits for an ideal nurse manager: A multicentre cross-sectional study.

AIMS: To investigate which morality traits are more important for nurses to determine positive opinions of their nurse manager. BACKGROUND: People selected morality more often than sociability and competence when forming a positive opinion towards an ideal or a newcomer manager. METHODS: A multicentre, cross-sectional study was carried out by administering two questionnaires to 775 nurses on the influence of morality, sociability and competence traits on their impression formation processes. RESULTS: Regarding nurses' perceptions about the morality, sociability and competence traits of an ideal nurse manager, the total score for morality was 20.0; for sociability, it was 14.2; and for competence, it was 19.6. For nurses' opinions about a new nurse manager, the total score of the morality section was 16.2, which was very similar to the total score of the competence section (mean = 16.1). CONCLUSION: Morality positively influences nurses' initial impression of an ideal manager, and though it seems to be a necessary condition, it is not sufficient by itself to support the nursing staff's perception towards a new manager. IMPLICATIONS FOR NURSING MANAGEMENT: Our findings could be useful in better understanding the role of morality in social perceptions and behavioural consequences of staff nurses towards their nurse manager.

Nursing during the COVID-19 outbreak: A phenomenological study.

AIM: The aim of this study was to explore the experience of Italian nurses engaged in caring for patients with COVID-19. BACKGROUND: COVID-19 found the health care world unprepared to face an emergency of such magnitude. Italy was one of the most affected European countries, with more than 250,000 cases. Understanding the impact of events of this magnitude on nurses provides a framework of knowledge on which educational training could be based to face similar situations in the future to prevent further breakdown. METHODS: The hermeneutic approach by Cohen was used. Semi-structured interviews were conducted using a voice-over Internet protocol. Interviews were transcribed, read in depth and analysed. RESULTS: Twenty nurses were interviewed. Four themes were extracted: uncertainty and fear, alteration of perceptions of time and space, change in the meaning of 'to care' and changes in roles and relationships. CONCLUSIONS: Psychological support in association with emergency training prevents stress and helps tackle compassion fatigue. IMPLICATIONS FOR NURSING MANAGEMENT: Policies to improve nursing science should be developed to ensure better quality of care, a higher number of professionals and, consequently, an increase in the safety of patients.

Presenteeism levels among Italian nurses. A multicentric survey.

BACKGROUND: Presenteeism represents the need to "get to work although we feel sick"; thus, affecting the quality of work, leading to errors or omissions, reducing productivity and increasing costs. Nurses are among the job categories with the highest degree of Presenteeism, which may negatively affect work quality. AIMS AND OBJECTIVES: To assess the prevalence of Presenteeism among Italian nurses. METHODS: A cross-sectional, multicentric study was carried out from January to December 2015 in a sample of Italian nurses. A total of 652 nurses completed the questionnaire. The mean Stanford Presenteeism Scale (SPS-6) total score was 21.6 (±4.0). Nurses showed high Presenteeism levels when considering the "Avoiding distractions" and "Completing work" sections of the Scale. RESULTS: Male nurses showed a lower degree of Presenteeism than women, which also tended to be less severe with increasing age. The presence of ≥1 self-reported health problem was associated with an increase in the score. CONCLUSIONS: In line with previous studies performed outside Italy, Presenteeism appear to be a widespread condition also among Italian nurses, requiring appropriate treatment and recognition by healthcare providers. The results of this survey might be used as a minimum, most likely underestimated basis for targeted public health policies.

Italian Nurses' Attitudes Towards Neonatal Palliative Care: A Cross-Sectional Survey.

PURPOSE: Neonatal palliative care becomes an option for critically ill neonates when death is inevitable. Assessing nurses' attitudes towards, barriers to, and facilitators of neonatal palliative care is essential to delivering effective nursing care. METHODS: This study was conducted from January to September 2015 and involved Italian nurses employed in Level III neonatal intensive care units in 14 hospitals in northern, central, and southern Italy. A modified version of the Neonatal Palliative Care Attitudes Scale (NiPCAS) was adopted to assess nurses' attitudes. FINDINGS: A total of 347 neonatal nurses filled out the questionnaire. The majority were female (87.6%), with a mean age of 40.38 (±8.3) years. The mean score in the "organization" factor was 2.71 (±0.96). The "resources" factor had a mean score of 2.44 (±1.00), while the "clinician" factor had a mean score of 3.36 (±0.90), indicating the main barriers to and facilitators of implementing palliative nursing care. CONCLUSIONS: Italian neonatal nurses may face different obstacles to delivering neonatal palliative care and to improve their attitudes in this field. In the Italian context, no facilitators of, only barriers to, palliative care delivery were identified. CLINICAL RELEVANCE: Nurses' attitudes towards neonatal palliative care are essential to supporting nurses, who are constantly exposed to the emotional and moral distress connected with this field of end-of-life nursing care.

Nursing Education: challenges and perspectives in a COVID-19 age.

The COVID-19 outbreak deeply changed our lives on different levels. Social restrictions and distancing shaped in a different way our view of social relationships and behaviours. Like many aspects of daily life, also education has undergone radical changes. Nursing care was strongly affected by the outbreak, not only due to the risks in everyday practice, the heavy workload or the impact on nurses' daily lives outside the healthcare settings, but also because nursing is caring profession and it embeds in its roots the close relationship with the patient, the touch, the patients' body proximity as a way to communicate and to deliver an effective nursing care. All these issues, when brought in nursing education are also a learning opportunity for students and a way to develop their professional identity and to focusing on the nursing role. The COVID-19 outbreak heavily hit the clinical learning environments, as they are healthcare settings. The situation affected students' learning opportunities, since clinical placements were suspended, Universities closed and in-person courses moved into online teaching. While lessons and courses rapidly switched into online teaching, in order to safeguard students' education and faculty's activity, it was not possible to manage the pre-clinical activities, such as simulations and labs, in order to support technical and relational competences. Most of all, it was not possible to arrange the clinical placements due to the uncertainty of the healthcare settings and the social and organizational restrictions to limiting unnecessary accesses to the services, as recommended by the American Association of Colleges of Nursing in 2020.Recently, many authors have explored the issues related to the future of nursing education. In detail, an emerging issue is how it will be possible to educating nurses in a society facing isolation and social distance measures, but at the same time, in a society that needs more and more prepared clinical nurses.

Nursing students' knowledge and attitudes of blood donation: A multicentre study.

AIMS AND OBJECTIVES: To investigate factors involved in the blood donation (BD) in a population of Italian nursing students (NSs). BACKGROUND: Young people are still numerically limited among potential blood donors. Recent research on this topic has underlined the need to promote recruitment programmes and focused advertising campaigns to specific targeted population. DESIGN: Cross-sectional study. The STROBE checklist was used to grant adequate and complete reporting of research. METHODS: The study was carried out in five Italian Universities, and a structured, 22-item questionnaire was distributed to 532 NSs (mean age = 24.64, SD = 7.41, min = 19; max = 55; population, female = 80.8% of total) to explore propensity, obstacles, knowledge of BD and to assess associations between variables. Descriptive (frequency, mean and SD) and inferential (χ2 ) statistics were conducted. RESULTS: The overall level of knowledge among NSs donors is high, when compared with non-donors (p < 0.05); the propensity for donation is acceptable (34.8% of the total are donors; mean = 3.17 donation). The obstacles perceived by participants are "practical" (20% and 22.8% think they do not have enough time to donate or are unsuitable because of lifestyle reasons; respectively). A relevant aspect regards the NSs' perceived role as future healthcare professionals to be responsible to educate and influence potential donors (81.5%). CONCLUSIONS: Specifically tailored BD campaigning should be implemented to sensitise University students. NSs could become effective motivators among students of different Universities or faculties. Thanks to their role and capability to put themselves in the peer group. NSs could contribute to the promotion of this selfless practice and to the development of a mature, responsible civic attitude. RELEVANCE TO CLINICAL PRACTICE: Nursing educators should play a pivotal role in developing teaching methods to promote BD among NSs.

Attitudes Towards and Knowledge About Lesbian, Gay, Bisexual, and Transgender Patients Among Italian Nurses: An Observational Study.

PURPOSE: To assess Italian nurses' knowledge and attitudes towards gay and lesbian sexual orientation and lesbian, gay, bisexual, and transgender (LGBT) patients, as there is currently no literature exploring the attitudes of nurses in Italy. METHODS: A multicenter, cross-sectional study was conducted between May 2015 to January 2016, using a data collection tool composed of three validated questionnaires and a sociodemographic form. FINDINGS: Eight hundred twenty-four nurses filled out the questionnaire. Despite their awareness of homosexuality as a "natural expression of one's sexuality," Italian nurses showed only moderately positive attitudes towards lesbian and gay patients. A more positive attitude was displayed by women when compared with men (p < .001). Greater knowledge of homosexuality was associated with female gender (p = .042), moderate-wing political affiliation (p = .014), and more affirmative behaviors (p = .008). Men were found to have greater awareness of being prepared to care for LGBT people (p = .022). CONCLUSIONS: Although Italian nurses displayed moderately positive attitudes and affirmative behaviors, there is the need to increase their cultural competencies regarding sexual minorities. CLINICAL RELEVANCE: LGBT patients feel some discomfort in approaching physicians or nurses. It is important to know nurses' attitudes in caring for LGBT patients in order to modify inappropriate and discriminatory behaviors.

Children's Perceptions About the Quality of Pediatric Nursing Care: A Large Multicenter Cross-Sectional Study.

INTRODUCTION: This study explored children's perceptions about the quality of nursing care and the determinants of their evaluations according to different categories of children's ages. DESIGN: Multicenter cross-sectional study carried out on 692 pediatric patients in eight large Italian regional hospitals. METHODS: We used a validated questionnaire, translated and adapted to the Italian context, consisting of 49 items (5-point Likert scale) exploring nurse characteristics, nursing activities, and nursing environment. FINDINGS: The mean score of children's perceptions of their overall experience of hospitalization was 3.96; the nurse characteristics factor obtained the highest score (mean = 3.79), and it was in positive correlation with the satisfaction level across different age categories: 4 to 6 years, ß = .37; 7 to 11 years, ß = .31; and 12 to 14 years, ß = .32. CONCLUSIONS: Nurse characteristics is the only significant factor contributing to children's satisfaction across the three different age categories. CLINICAL RELEVANCE: In pediatric nursing care, it is important to emphasize that nurses' personal characteristics and the ability to connect with children are essential compared to the ability to perform tasks.

Health literacy among caregivers of patients with heart failure: A multicentre cross-sectional survey.

AIMS AND OBJECTIVES: To assess the levels of health literacy of Italian caregivers of patients with heart failure. BACKGROUND: Health literacy is related to patients' health outcomes. Low health literacy has been found in older people with heart failure, and less is known on the health literacy of caregivers whose patients are suffering from heart failure. DESIGN: Observational, multicentre, cross-sectional study. METHODS: From July 2015-May 2016, caregivers were recruited in five hospitals from Central and Southern Italy. To assess health literacy, the Italian version of the Short Test of Functional Health Literacy tool was used. RESULTS: A total of 173 caregivers participated in the research, the majority being females (60.1%), aged between 46-60 years (52.6%) and 96 (55.5%) were from Central Italy. 33.5% of caregivers were patients' children, and 16.2% were paid caregivers of foreign origins. The average level of health literacy was adequate; however, lower levels were found among patients' spouses and those of older age. CONCLUSION: Our results, in contrast with previous studies, showed adequate health literacy levels of caregivers. However, caregivers older in age and with a low education level showed the lowest health literacy, emphasising the need for healthcare workers, to check caregivers' health literacy, before entrusting them with the care of patients. RELEVANCE TO CLINICAL PRACTICE: As this research gives, for the first time, an overview on Italian caregivers' levels of health literacy, its results may be used to improve Italian healthcare professionals' knowledge of caregivers' health literacy, before entrusting them with the care of patients.