Perceptions of nursing staff and students regarding attrition: a qualitative study.

OBJECTIVES: This research aims to explore the perceptions of nursing students and directors of bachelor of nursing degree courses regarding reasons for attrition amongst nursing students. METHODS: A qualitative descriptive study was conducted using inductive thematic analysis. The study included a purposeful sample of 12 students and 4 directors of bachelor of nursing degree courses. RESULTS: As reasons for attrition, the directors highlighted a lack of preparation for nursing studies and students' limited awareness of possibilities for support and learning. The students emphasized insufficient support from academic staff and poor course organization. Economic and family issues and a misunderstanding of the professional role of a nurse were cited as reasons by both directors and students. CONCLUSIONS: The findings provide important insight into attrition in the nursing programme. Further research is warranted, particularly in other contexts. Addressing student attrition requires a comprehensive approach that includes the provision of adequate support systems, mentorship, and resources for students.

Self-efficacy, burnout and academic success in nursing students: A counterfactual mediation analysis.

AIM: To test the mediating role of burnout in the relationship between self-efficacy and academic success in nursing students. DESIGN: This was a cross-sectional secondary analysis of longitudinal research aimed at exploring the academic success of nursing students. METHODS: We enrolled a convenience sample of nursing students attending 21 Italian baccalaureate nursing degree programmes. Data were collected from 2014 to the 2018-2019 academic year. We analysed the wave of data collected during the third year of the programme. The measurements were the Academic Nurse Self-Efficacy scale (ANSEs) and the Scale of Work Burnout (SWEBO). A mediation analysis with a counterfactual approach was performed. RESULTS: The participants (n = 556) had a median age of 20 years (IQR 19-22) and the majority was female [70.5% (392/556)]. Academic success was reached by 51.97% (289/556) of the students. The findings reveal a significant direct effect of self-efficacy on academic success and also a significant indirect effect of this relationship via burnout. CONCLUSION: The mechanism by which self-efficacy influences academic performance in nursing students is more complex than a simple direct relationship. Universities should consider screening students for variables affecting academic success to decrease academic costs and increase ranking systems classification. IMPACT: Nurses' professors should be engaged in strategies to promote self-efficacy. The area of intervention should be structured both during classes and internships, in tandem with the mentor and the clinical nurse.

Moral distress in nursing students: Cultural adaptation and validation study.

BACKGROUND: Moral distress, defined as moral suffering or a psychological imbalance, can affect nursing students. However, many new instruments or adaptations of other scales that are typically used to measure moral distress have not been used for nursing students. AIM: This study aimed to translate, culturally adapt and evaluate the psychometric properties of an Italian version of the Moral Distress Scale for Nursing Students (It-ESMEE) for use with delayed nursing students (students who could not graduate on time or failed the exams necessary to progress to the next level). RESEARCH DESIGN: The study used a cross-sectional research design. PARTICIPANTS AND RESEARCH CONTEXT: Incidental sampling resulted in a sample of 282 delayed nursing students (mean age = 26.73 ± 4.43 years, 73% female) enrolled between May and August 2020 in a University of central Italy. ETHICAL CONSIDERATIONS: The research protocol was approved by the internal review board of the university, and all participants provided their written informed consent. RESULTS: The study confirmed a multidimensional second-order factorial structure for the It-ESMEE with five dimensions: improper institutional conditions to teach user care, authoritarian teaching practices, disrespect for the ethical dimension of vocational training, lack of competence of the teacher and commitment of ethical dimension of user care. The internal consistency was high (0.753-0.990 across the factors), and the standard error of measurement and smallest detectable change were adequate. DISCUSSION: The It-ESMEE is able to assess moral distress in delayed nursing students with good validity and reliability. It can be used in research and to determine moral distress levels, helping teachers to monitor the condition in nursing students. CONCLUSION: This instrument can help in comprehending moral distress, enabling students to develop coping and intervention strategies to maintain their well-being, and to ensure the quality of nurse education.

Measuring academic satisfaction in nursing students: a systematic review of the instruments.

Student academic satisfaction is one of the most important factors affecting the success and quality of a higher education institute and is an indicator about teaching and learning. This study aims to summarize and critically evaluate the instruments assessing academic satisfaction in nursing education. A systematic review was undertaken, PRISMA were used for the screening of studies. MEDLINE, Cochrane, Scopus and CINAHL were searched using MeSH terms; seven eligible articles were identified referring to five assessment tools. COSMIN was used for evaluation of the methodological of the instruments. The systematic review identified five satisfaction measurement tools used in nursing education. The analysis of the instruments rarely considered a confirmative validity structure, measurement error or criterion validity. The best available instrument was the Nursing Students Satisfaction Scale (NSSS) for validation methodology; however, it needs further validation studies that consider CFA, reliability, criteria validity, hypothesis testing and measurement error.

Nursing students' academic self-efficacy: A longitudinal analysis of academic self-efficacy changes and predictive variables over time.

AIM: To analyse any changes seen in the academic self-efficacy of nursing students during the three years of their academic education as well as the associated predictive factors. DESIGN: A longitudinal study design was applied. METHODS: The sample included 220 students who attended a large university in central Italy. The students' academic self-efficacy was measured using the Academic Nurses' Self-Efficacy Scale. Data were collected annually from 2014/2015 to 2017/2018 at the beginning of the first year (T0), at the end of the first year (T1), at the end of the second year (T2) and at the end of the third year (T3). A repeated measure univariate analysis of variance (ANOVA) was conducted to detect any possible changes in the students' academic self-efficacy scores over the four measurement points. To identify the factors that are predictive of academic self-efficacy, a linear regression model was used. RESULTS: Overall, the students' academic self-efficacy did not change significantly over the three-year period of their education. Both sex (female) and age (24-50 years) during T0-T2 significantly predicted changes in the students' academic self-efficacy over time. Moreover female students started with lower academic self-efficacy scores than male students, although their academic self-efficacy increased over time, while the male students' academic self-efficacy actually decreased over time. In addition, students with a scientific background reported higher academic self-efficacy than other students. CONCLUSIONS: Although the students' academic self-efficacy did not change over time, from a theoretical perspective, academic self-efficacy can be developed using a number of strategies such as a well-organised tutorial during the clinical learning phase and feedback or encouragement. IMPACT: Academic staff should monitor nursing students' academic self-efficacy over time, particularly in the case of male and younger students, students with a partner and students with a humanities background during the first 2 years of the course.

Academic failure and its predictors in Baccalaureate nursing students: A longitudinal study.

AIMS AND OBJECTIVES: To describe the sociodemographic and academic characteristics of nursing students who report academic failure and to identify the determinants of academic failure (no degree on time) in a population of nursing students. BACKGROUND: Although prior studies have shown that academic failure is influenced by multiple factors, the studies mentioned have mostly focused on specific single variables associated with academic failure, and they have reported inconsistent results. DESIGN: A prospective follow-up study design was used in an Italian Baccalaureate Nursing Degree program. A total sample of 2,040 at baseline and a random subsample of 753 students were considered for academic failure determinants. The study followed the recommendations of STROBE (Strengthening the Reporting of Observational studies in Epidemiology). METHODS: We included in the model academic background, self-efficacy, sociodemographic variables and self-efficacy in psychomotor skills and motivation. We used the Academic Nurse Self-Efficacy Scale (ANSEs), the Nursing Self-Efficacy in Psychomotor Skill Scale (NSE-PS) and the Motivation Nursing Students' Scale (MNSS) which have been validated on nursing students. For the assessment of predictors of academic failure, a two-stage hierarchical logistic regression analysis was performed. RESULTS: Students who had academic failure were 69.4% of the sample. Predictors of academic failure were the secondary school certification grade, the university pre-admission test score; the academic self-efficacy, self-efficacy in psychomotor skills and clinical training examination grades were additional predictors. CONCLUSIONS: The secondary school certification grade, the University pre-admission test score, low academic self-efficacy, low self-efficacy in psychomotor skills and low clinical training examination grades were predictors of academic failure in nursing students. RELEVANCE TO CLINICAL PRACTICE: Our findings suggest that the universities could consider a cut-off in the pre-admission test score as a critical value for identifying students who are likely to fail. In addition, nursing faculty staff should consider strategies for developing self-efficacy and motivation.

Development and psychometric evaluation of the motivation for nursing student scale (MNSS): a cross sectional validation study.

OBJECTIVES: To develop a self-report scale to measure academic motivation among nursing students and to test its psychometric properties. METHODS: a cross-sectional validation study with a convenience sample of nursing students (n=1,635) was performed. The Motivation Nursing Students Scale was developed; content, face, construct validity, hypothesis testing and reliability were evaluated. RESULTS: The validity structure revealed a four-factor solution and the model reached a satisfactory fit (χ2=622.835 df=160, p<0.01, CFI=0.90, TLT=0.83, RMSEA=0.060 (90% [CI] 0.055-0.064, p=0.001, SRMR=0.067). The hypothesis testing was confirmed with a positive correlation of the academic self-efficacy with Introjected, Intrinsic motivation and a negative correlation with Amotivation. CONCLUSIONS: We verified a link between academic self-efficacy and motivation. Both motivation and self-efficacy may increase academic achievement and the possibility for HEIs to degrees a number of students in line with demands.

Providing care to a family member affected by head and neck cancer: a phenomenological study.

BACKGROUND: Cancer is recognized as a family illness as many head and neck cancer (HNC) patients after treatment require assistance from a family caregiver throughout the rest of their life. The purpose of this study was to explore the lived experience of primary family caregivers of HNC patients dealing with laryngectomy regarding their complex supportive role. METHODS: Phenomenological study based on individual interviews of twelve primary caregivers of HNC patients, recruited by purposeful sampling. Interview contents were analyzed in depth, in accordance with Colaizzi's descriptive analysis framework, to explore and identify significant themes and subthemes. RESULTS: Analysis evidenced three main topics and subthemes embracing various aspects of the caregiver's lived experiences: (1) experiencing disease and the pathway of care, (2) handling changes to everyday life, and (3) support received by others. CONCLUSION: Given the essential role the caregiver has in the patient's post-treatment recovery, future planning of HNC patient care must consider the caregivers' needs. In order to guarantee an appropriate and effective health professional care, it is important to consider caregivers' issues and needs as part of HNC patient care planning from the diagnosis to the follow-up.

Correction to: providing care to a family member affected by head and neck cancer: a phenomenological study.

The name of Luca Ghirotto was incorrectly captured in the original manuscript.

Academic self-efficacy in Bachelor-level nursing students: Development and validation of a new instrument.

AIMS: An available strategy to counteract academic failure is the development and implementation of student academic self-efficacy; however, to date, there are no instruments measuring it. The aim of this study was to develop and psychometrically test an academic nurse self-efficacy scale. DESIGN: A longitudinal study design was used in accordance with Consensus-based Standards for the Selection of health status Measurement Instruments guidelines. METHODS: A convenience sample of 1,129 nursing students attending the first year of the course were involved. The data collection began in 2014 and went on for 3 years. Data were collected at the beginning of the first (T0), at the end of the first (T1), at the end of the second (T2), and at the end of the third (T3) year. The academic nurse self-efficacy scale was evaluated for content and face validity, for construct validity with explorative, confirmative factor analysis and hypothesis testing and for reliability. The standard error and the smallest detectable difference were also evaluated. RESULTS: Scree plot analysis suggested a four-factor solution and confirmative factor analysis model reached a good fit. We verified the first hypothesis, partially the second and not the third. The dimensions show a Cronbach's α 0.72-0.83. The smallest detectable difference was 26%. CONCLUSIONS: The academic nurse self-efficacy scale had good validity and reliability and should be considered for nursing students. IMPACT: These findings may have an impact on universities, mainly in nursing degree programmes because nurse educators can identify nursing students with low academic self-efficacy and help them in their academic duties. Indirectly, academic self-efficacy monitoring can be used for evaluating the effect of different teaching strategies or mentorship support over time.

Health habits of nursing students: A longitudinal study of health perceptions and health habits.

AIMS AND OBJECTIVES: To examine nursing students' health habits. More specifically, the objectives were to determine whether there were any changes in their health habits during their course of study, and to understand whether the students' perceptions about good health conditions cohered with their health-related behaviour. BACKGROUND: The transition from high school to university has an undesirable effect on students' health habits, and nursing students' unhealthy behaviours may prevent them from helping patients improve their poor health habits. DESIGN: A longitudinal design was used. The study followed the recommendations of STROBE (Strengthening the Reporting of Observational studies in Epidemiology). METHODS: All students were recruited from a nursing science degree course in an Italian university. The sample consisted of 351 nursing students. Data were collected at the baseline during their entrance into the university (T0) and at the end of their third year of coursework (T3). We developed the Nursing Student Health Habits Scale, which was administered by a trained researcher. The McNemar test and the Wilcoxon signed-rank test to evaluate the differences in health habits between T0 and T3, and a logistics model to assess the factors influencing students' good health perceptions were used. RESULTS: From T0 to T3, there were decreases in the number of students who requested physician consultations (p = .01) and increases in those who exercised daily (p = .003). There was also a change in the nutrition model (p = .018). In the multivariate model, physician consultations for medical problems and performing physical exercise were factors influencing good health perceptions. CONCLUSIONS: Future research is needed to illuminate other aspects of students' health habits. RELEVANCE TO CLINICAL PRACTICE: Universities are advised to address these problems by reflecting on undergraduate and postgraduate curriculum content concerning health management and disease prevention.

Development and initial validation of a theory of planned behaviour questionnaire to assess the nursing students' Intention to be self-employed.

BACKGROUND: Self-employment represents a new work opportunity for new nursing graduates; however, little is known about nursing students' Intention to meet this new demand from the labour market. AIMS: To develop a theory-driven questionnaire to assess students' Intentions for self-employment and psychometrically test this scale. METHOD: A cross-sectional study was conducted investigating 344 nursing students in their final year in an Italian university. The content, face, construct, convergent and discriminant validity, and reliability were evaluated. We also tested the theory of planned behaviour. RESULTS: The Planned Self-Employment Scale demonstrated satisfactory validity and good reliability. A moderate Intention to be self-employed emerged among nurses (3.6 ± 1.5 out of 7). This level of Intention was predicted by the Attitudes and Perceived Behaviour Control dimensions. CONCLUSION: The Planned Self-Employment Scale exhibited good validity and reliability and can thus be used with nursing students. IMPLICATIONS FOR NURSING MANAGEMENT: Educators need to design a curriculum to improve students' decision-making and autonomy. At the central level, there is a need to produce guidelines that offer guidance to both nurses and patients, as well as the system as a whole with regard to this new form of nursing service.

A Longitudinal Study about Substance Abuse among Italian Nursing Students: Can We Define a Socio-demographic Profile?

BACKGROUND: University time is considered to be a period of vulnerability among nursing students for substance abuse, which can create an unsafe clinical practice. The aim of this study was to investigate the substance abuse of nursing students in the form of alcohol, drugs and tobacco use during the course of studies. In addition, another study aim was to describe a typical socio-demographic profile for substance-abusing students. METHODS: A longitudinal study design based on a sample of 254 nursing students was used. Data from the same cohort of students at the baseline level (T0), at the end of the first year (T1), at the end of the second year (T2) and at the end of the third year (T3) were analysed. RESULTS: A decrease in the number of nursing students who smoke regularly, an increase in the number of those who use drugs to lose control and of those who drink weekly were found. CONCLUSION: The early recognition of substance-abusing students can be fundamental to their health, academic background and safe clinical practice.

Listening to the voice of patients with head and neck cancer: A systematic review and meta-synthesis.

The aim was to conduct a systematic review and a meta-synthesis of primary qualitative studies exploring experiences of head and neck cancer patients (HNC) undergoing radio and/or chemotherapy, in order to provide a better understanding of this phenomenon and supply new directions for care and clinical practice. Six databases were systematically searched, and 13 studies were included. The meta-synthesis methodology was adopted to conceptualise the way in which patients lived their cancer journey and the impact of treatments on their daily life. Four themes embracing various aspects of HNC patients' experiences were identified: (a) self-body image and perceived quality of life; (b) experiences and treatment of symptoms; (c) cancer journey; and (d) the relationship with health professionals. The finding demonstrates the importance of acknowledging that treatment sequelae and patients' daily issues do not appear, develop and affect people's lives in isolation and should be considered and analysed as a whole within the social and cultural context of patients' lives. Further research is needed to explore the treatment experience of HNC patients throughout their cancer journey with a more holistic approach that involves health professionals, caregivers and other family members and peers in the community.

Bedside shift handover implementation quantitative evidence: Findings from a scoping review.

AIM: To map the research methods, frameworks, structures, processes and outcomes investigated to date when implementing nursing bedside shift reports (BSRs). BACKGROUND: BSRs have become an area of increased interest among nurse managers (NMs) with several projects aiming at implementing bedside reports also as a strategy to increase nursing surveillance and reduce adverse events. However, to date, no summary of the available evidence has been provided with regard to research methods, theoretical frameworks underpinning BSR implementation and outcomes aiming at supporting NM decision-making in this field. EVALUATION: A scoping review including quantitative studies written in English and retrieved from five databases was performed in 2018. KEY ISSUES: Twenty-two studies originating from USA, Australia, Finland and Sweden, largely monocentric in nature and involving mainly medical/surgery units, have been performed to date. BSR implementation has been conducted mainly under organisational change theories, patient safety and nursing conceptual models. The BSR outcomes have been measured at the patient, nurse and organisational levels and reported positive trends. CONCLUSION: Professional reports-describing success transitions from traditional methods of handover to BSRs, and scientific studies aimed at improving evidence in the field, have been conducted to date, in order to document BSR implementation processes and outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: BSRs should be designed and conducted under a theory of organisational change; moreover, clinical nurses should be trained and supported in the transition from the traditional shift report to the BSR; while implementing this transition, outcomes should be set at the patient, nurses and organisational levels with the aim of tracing the comprehensive effects of the change.

Perioperative Pressure Injuries: A Systematic Literature Review.

OBJECTIVE: To conduct a systematic review to investigate risk factors, incidence, and preventive strategies for perioperative pressure injuries (PIs). METHODS: The authors reviewed four databases for literature published from January 2001 to December 2017. Selected articles included primary quantitative studies with prospective, descriptive, and longitudinal design or randomized controlled trials that evaluated risk factors, incidence, and preventive strategies for perioperative PIs. The studies included were evaluated for methodological quality using the Edwards Method Score. The authors used a standardized extraction form to extract inclusion and exclusion criteria, participant demographics, methodology, PI risk instrument and classification systems, type of surgery and anesthesia, PI risk factors, incidence, preventive strategies, and outcomes evaluation. MAIN RESULTS: Of the 115 publications identified, 11 met the inclusion criteria. The risk assessment and PI classification instruments used differed in every study. Incidence of PI varied throughout the studies and was reduced by warming therapy and by a skin care intervention program. CONCLUSIONS: Further studies are necessary to develop a standard risk assessment instrument and preventive strategies and to clarify some contradictions evident in the literature.

Adverse events witnessed by nursing students during clinical learning experiences: Findings from a longitudinal study.

No evidence from any longitudinal study design has been reported to date with regard to patient safety (PS) incidents witnessed by nursing students during their training. Therefore, with the aim of closing this gap in available knowledge, a longitudinal study was performed from 2012 to 2015 by involving all nursing students (n = 145) enrolled in two Italian nursing programs. At the end of each academic year, students were invited to report in writing all PS incidents witnessed during their clinical learning experience; the number of days each student spent in their clinical setting was also collected from administrative records. Ninety students were included and 94 incidents were reported: 17 (18.1%) by first year students, 27 (28.7%) by second year students, and 50 (53.2%) by third year students. One third of students did not report any PS incident at the end of each academic year, while only a few reported more than one. The incidence density was 3.8/1000 days of clinical training without statistical differences across academic years. Supporting nursing students by encouraging them to share, discuss, and reflect on their clinical learning experience might increase their confidence in reporting safety incidents.

Human rights conflicts experienced by nurses migrating between developed countries.

BACKGROUND: Some developed countries have recently changed their role in the context of international recruitment, becoming donors due to socio-economical and political factors such as recessions. This is also the case in Italy, where there has been a flow of immigrant nurses out of the country that has been documented over the past several years. In a short time, it has become a donor country to other developed European countries, such as the United Kingdom. AIMS: To advance knowledge in the context of human rights conflicts and ethical implications of the decision-making process of nurses who migrate between developed countries, such as from Italy to the United Kingdom, during times of recession. RESEARCH DESIGN: A case study based on the descriptive phenomenological approach was undertaken in 2014. Participants and research context: A total of 26 Italian newly graduated nurses finding a job in the United Kingdom were interviewed via Skype and telephone. Ethical considerations: The Internal Review Board of the University approved the project. FINDINGS: In accordance with the descriptive phenomenological approach undertaken, three main themes emerged: (1) escaping from the feeling of being refused/rejected in order to be desired, (2) perceiving themselves respected, as a person and as a nurse, in a growth project and (3) returning if the country changes its strategy regarding nurses. DISCUSSION: Ethical implications in the context of human rights, such as autonomy of the decision, social justice and reciprocal obligation, non-maleficence and double effect, have been discussed. CONCLUSION: The call for investing in nurses and nurses' care in developed countries facing recession is urgent. Investing in nurses means respecting individuals and citizens who are at risk of developing health problems during the recession.

[Surgical site infections in breast surgery: a descriptive study]. / Infezioni della ferita chirurgica e glicemia nelle pazienti sottoposte a chirurgia della mammella: studio descrittivo.

BACKGROUND: The incidence of postoperative surgical site infections (SSIs) in breast surgery is 3.1%. The risk to develop SSIs seems correlated to the level of glycemia. MATERIALS AND METHODS: The aim is to test a correlation between glycemic values and SSIs in breast surgery with a longitudinal perspective study. The data were collected in a Surgical Department of a University Hospital of north-east Italy; the study is in the context of the Regional Surveillance Program of Health Agency. RESULTS: We have observed 100 patients. The incidence of the SSIs has been 5.7%. The patients that have developed the SSIs were in ordinary recovery, with a glycemic value taller then the patients without SSIs both in preoperative (92.6 vses 88.5) that in postoperative period (104 vses 91.8 and 108.3 vses 94). CONCLUSIONS:  We cannot test a correlation between SSIs and glycemic value nevertheless for the clinical practice we have important guideline.

[Perioperative blood glucose levels and surgical site infections in patients undergoing colorectal cancer surgery: a feasibility study]. / Glicemia e infezioni della ferita chirurgica nei pazienti sottoposti a chirurgia colon rettale: studio di fattibilità

This study was carried out in the framework of a regional surveillance program of surgical site infections, to assess the feasibility of performing a longitudinal study to evaluate possible correlations between perioperative blood glucose levels and surgical site infections in patients undergoing colorectal cancer surgery. A convenience sample of patients aged 18 years and above, admitted to the University Hospital of Udine (Friuli Venezia Giulia region, Italy) from 1 January to 31 March 2011, were invited to participate in the study. Patients admitted for recanalization surgery for obstructing carcinomas were excluded. Twenty-five patients participated in the study, 20% (n=5) of whom had a surgical site infection. No correlation was found between blood glucose levels and surgical site infections. The costs of performing a study of this kind would be mainly related to the number of persons involved in data collection and the estimated time required is 12 to 18 months. For the future conduct of the study, it is hoped that simpler operational methods may be agreed upon within the healthcare facility.