Unfinished nursing care in healthcare settings during the COVID-19 pandemic: a systematic review.

BACKGROUND: Unfinished nursing care is becoming increasingly more of a concern in worldwide healthcare settings. Given their negative outcomes, it is crucial to continuously assess those nursing interventions that are commonly postponed or missed, as well as the underlying reasons and consequences. The worldwide COVID-19 pandemic has made it difficult for health facilities to maintain their sustainability and continuity of care, which has also influenced the unfinished nursing care phenomenon. However, no summary of the studies conducted during the COVID-19 pandemic was produced up to now. The main aim of this study was to systematically review the occurrence of, reasons for, and consequences of unfinished nursing care among patients in healthcare settings during the COVID-19 pandemic. METHODS: Systematic review registered in PROSPERO (CRD42023422871). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guideline and the Joanna Briggs Institute Critical Appraisal tool for cross-sectional studies were used. MEDLINE-PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Scopus were searched from March 2020 up to May 2023, using keywords established in the field as missed care, unfinished nursing care, or implicit rationing. RESULTS: Twenty-five studies conducted mainly in European and Asiatic countries were included and assessed as possessing good methodological quality. The following tools were used: the MISSCARE Survey (= 14); the Basel Extent of Rationing of Nursing Care (= 1), also in its revised form (= 2) and regarding nursing homes (= 2); the Perceived Implicit Rationing of Nursing Care (= 4); the Intensive Care Unit-Omitted Nursing Care (= 1); and the Unfinished Nursing Care Survey (= 1). The order of unfinished nursing care interventions that emerged across studies for some countries is substantially in line with pre-pandemic data (e.g., oral care, ambulation). However, some interesting variations emerged at the country and inter-country levels. Conversely, labour resources and reasons close to the emotional state and well-being of nurses were mentioned homogeneously as most affecting unfinished nursing care during the pandemic. None of the studies investigated the consequences of unfinished nursing care. CONCLUSIONS: Two continents led the research in this field during the pandemic: Europe, where this research was already well established, and Asia, where this research is substantially new. While unfinished care occurrence seems to be based on pre-established patterns across Europe (e.g., regarding fundamentals needs), new patterns emerged across Asiatic countries. Among the reasons, homogeneity in the findings emerged all in line with those documented in the pre-pandemic era.

Comparative accuracy of ChatGPT-4, Microsoft Copilot and Google Gemini in the Italian entrance test for healthcare sciences degrees: a cross-sectional study.

BACKGROUND: Artificial intelligence (AI) chatbots are emerging educational tools for students in healthcare science. However, assessing their accuracy is essential prior to adoption in educational settings. This study aimed to assess the accuracy of predicting the correct answers from three AI chatbots (ChatGPT-4, Microsoft Copilot and Google Gemini) in the Italian entrance standardized examination test of healthcare science degrees (CINECA test). Secondarily, we assessed the narrative coherence of the AI chatbots' responses (i.e., text output) based on three qualitative metrics: the logical rationale behind the chosen answer, the presence of information internal to the question, and presence of information external to the question. METHODS: An observational cross-sectional design was performed in September of 2023. Accuracy of the three chatbots was evaluated for the CINECA test, where questions were formatted using a multiple-choice structure with a single best answer. The outcome is binary (correct or incorrect). Chi-squared test and a post hoc analysis with Bonferroni correction assessed differences among chatbots performance in accuracy. A p-value of < 0.05 was considered statistically significant. A sensitivity analysis was performed, excluding answers that were not applicable (e.g., images). Narrative coherence was analyzed by absolute and relative frequencies of correct answers and errors. RESULTS: Overall, of the 820 CINECA multiple-choice questions inputted into all chatbots, 20 questions were not imported in ChatGPT-4 (n = 808) and Google Gemini (n = 808) due to technical limitations. We found statistically significant differences in the ChatGPT-4 vs Google Gemini and Microsoft Copilot vs Google Gemini comparisons (p-value < 0.001). The narrative coherence of AI chatbots revealed "Logical reasoning" as the prevalent correct answer (n = 622, 81.5%) and "Logical error" as the prevalent incorrect answer (n = 40, 88.9%). CONCLUSIONS: Our main findings reveal that: (A) AI chatbots performed well; (B) ChatGPT-4 and Microsoft Copilot performed better than Google Gemini; and (C) their narrative coherence is primarily logical. Although AI chatbots showed promising accuracy in predicting the correct answer in the Italian entrance university standardized examination test, we encourage candidates to cautiously incorporate this new technology to supplement their learning rather than a primary resource. TRIAL REGISTRATION: Not required.

Between mandatory and aspirational ethics in nursing codes: a case study of the Italian nursing code of conduct.

BACKGROUND: Over the years, national and international nurses' organisations have drawn up Codes of Conduct and Codes of Ethics. A new differentiation has emerged over time between mandatory and aspirational approaches underlying how nurses can be supported by documents with rules to be respected (mandatory ethics) or by incentives (aspirational ethics). However, to date, no research has applied these approaches to analyse available Codes and to identify which approach are predominantly used. METHODS: In this case study, the Italian Nursing Code of Conduct (NCC), published in 2019, composed of 53 articles distributed in eight chapters, was first translated, and then analysed using a developed matrix to identify the articles that refer to mandatory or aspirational ethics. A nominal group technique was used to minimise subjectivity in the evaluation process. RESULTS: A total of 49 articles addressing the actions of the individual nurse were considered out of 53 composing the NNC. Articles were broken down into 97 units (from one to four for each article): 89 units (91.8%) were attributed to a unique category, while eight (8.2%) to two categories according to their meaning. A total of 38 units (39.2%) were categorised under the mandatory ethics and 58 (59.8%) under the aspirational ethics; however, one (1.0%) reflected both mandatory and aspirational ethics. CONCLUSIONS: According to the findings, the Italian Professional Body (FNOPI) has issued a modern code for nursing professionals in which an aspirational perspective is dominant offering a good example for other nursing organisations in the process of updating their codes when aimed at embodying an aspirational ethics.

Virtual Reality for Cardiopulmonary Resuscitation Healthcare Professionals Training: A Systematic Review.

INTRODUCTION: Virtual reality (VR) is becoming increasingly popular to train health-care professionals (HCPs) to acquire and/or maintain cardiopulmonary resuscitation (CPR) basic or advanced skills. AIM: To understand whether VR in CPR training or retraining courses can have benefits for patients (neonatal, pediatric, and adult), HCPs and health-care organizations as compared to traditional CPR training. METHODS: A systematic review (PROSPERO: CRD42023431768) following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. In June 2023, the PubMed, Cochrane Library, Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched and included studies evaluated in their methodological quality with Joanna Briggs Institute checklists. Data were narratively summarized. RESULTS: Fifteen studies published between 2013 and 2023 with overall fair quality were included. No studies investigated patients' outcomes. At the HCP level, the virtual learning environment was perceived to be engaging, realistic and facilitated the memorization of the procedures; however, limited decision-making, team building, psychological pressure and frenetic environment were underlined as disadvantages. Moreover, a general improvement in performance was reported in the use of the defibrillator and carrying out the chest compressions. At the organizational level, one study performed a cost/benefit evaluation in favor of VR as compared to traditional CPR training. CONCLUSIONS: The use of VR for CPR training and retraining is in an early stage of development. Some benefits at the HCP level are promising. However, more research is needed with standardized approaches to ensure a progressive accumulation of the evidence and inform decisions regarding the best training methodology in this field.

Nurses prioritization processes to prevent delirium in patients at risk: Findings from a Q-Methodology study.

BACKGROUND: This study aimed at (a) exploring how nurses prioritise interventions to prevent delirium among patients identified at risk and (b) describing the underlying prioritisation patterns according to nurses' individual characteristics. METHODS: There was used the Q-methodology a research process following specific steps: (a) identifying the concourse, (b) the Q-sample, and (c) the population (P-set); (d) collecting data using the Q-sort table; (e) entering the data and performing the factor analysis; and (f) interpreting the factors identified. RESULTS: There were involved 56 nurses working in medical, geriatric and log-term facilities (46; 82.2 %). The preventive intervention receiving the highest priority was 'Monitoring the vital parameters (heart rate, blood pressure, oxygen saturation)' (2.96 out of 4 as the highest priority; CI 95 %: 2.57, 3.36). Two priority patterns emerged among nurses (explained variance 44.78 %), one 'Clinical-oriented' (36.19 %) and one 'Family/caregiver-oriented' (8.60 %) representing 53 nurses out 56. CONCLUSION: Alongside the overall tendency to prioritise some preventive interventions instead of others, the priorities are polarised in two main patterns expressing two main individual characteristics of nurses. Knowing the existence of individual patterns and their aggregation informs how to shape educational interventions.

Ethics in undergraduate nursing degrees: An international comparative education study.

BACKGROUND: Ensuring morally competent nurses depends on many factors, such as environmental, social, political, and cultural. However, several inadequacies in nursing education have been documented, and no common framework has been established for how nursing ethics should be taught in undergraduate education. RESEARCH QUESTIONS: What are the different approaches across nursing programmes established in teaching ethics? What are the main similarities and differences across programmes facilitating a common understanding in developing a curriculum capable of preparing a morally competent nurse? RESEARCH DESIGN: International comparative education study in five steps: (1) formulating the initial question; (2) defining the units of comparison; (3) determining the variables of comparison; (4) describing the findings; (5) interpreting the findings. The comparative variables were identified, extracted, and populated in a piloted grid. PARTICIPANTS: Six universities were purposefully selected by the Promoting a Morally Competent Nurse project partners for their nursing education curricula as delivered in 2022-2023. ETHICAL CONSIDERATIONS: No ethical approval was required, given no human participants and public data regarding nursing curricula. FINDINGS: Variability emerged in the terminologies used in naming the courses, the numbers of credits and hours devoted to teaching ethics, when the courses are delivered (since the initial semesters of nursing education or concentrated in the final years), and their main modes of delivery (a single or separate module or integrated across the curriculum). Contents have some similarities, whereas the teaching methods varied and included (or not) explicit connections with clinical practice. Attendance is mandatory in all courses. The assessment methods used varied from knowledge-based to more competence-based approaches involving multidimensional strategies. CONCLUSIONS: This comparative study explored similarities and differences across nursing programmes in six different European countries. The reviewed ethics curricula lack significant clarity, and they offer important areas to consider for future development. Issues emerged regarding terminologies, learning workloads, when to deliver, how to deliver, the main contents, and the teaching and assessment methods that merit further discussion.

Factors contributing to the promotion of moral competence in nursing.

Ethics is a foundational competency in healthcare inherent in everyday nursing practice. Therefore, the promotion of qualified nurses' and nursing students' moral competence is essential to ensure ethically high-quality and sustainable healthcare. The aim of this integrative literature review is to identify the factors contributing to the promotion of qualified nurses' and nursing students' moral competence. The review has been registered in PROSPERO (CRD42023386947) and reported according to the PRISMA guideline. Focusing on qualified nurses' and nursing students' moral competence, a literature search was undertaken in January 2023 in six scientific databases: CINAHL, Cochrane Library, PsycINFO, PubMed Medline, Scopus and Web of Science. Empirical studies written in English without time limitation were eligible for inclusion. A total of 29 full texts were retrieved and included out of 5233 citations. Quality appraisal was employed using Joanna Briggs Institute checklists and the Mixed Method Appraisal Tool. Data were analysed using inductive content analysis. Research about the factors contributing to the promotion of qualified nurses' and nursing students' moral competence is limited and mainly explored using descriptive research designs. The contributing factors were identified as comprising two main categories: (1) human factors, consisting of four categories: individual, social, managerial and professional factors, and ten sub-categories; and (2) structural factors, consisting of four categories: educational, environmental, organisational and societal factors, and eight sub-categories. This review provides knowledge about the factors contributing to the promotion of qualified nurses' and nursing students' moral competence for the use of researchers, nurse educators, managers, organisations and policymakers. More research about the contributing factors is needed using complex intervention, implementation and multiple methods designs to ensure ethically sustainable healthcare.

What are the reasons for unfinished nursing care as perceived by hospitalized patients? Findings from a qualitative study.

INTRODUCTION: Unfinished nursing care (UNC), as the care required by patients that delayed or not delivered, has been investigated mainly from the perspective of nurses, while little is still known from the side of patients. Some studies have involved patients to measure which elements of care are mostly unfinished (e.g., mouth care), whereas a few studies have investigated the reasons for UNC as perceived by them. Their involvement in understanding the reasons for UNC is crucial to advance the knowledge and co-develop possible strategies to prevent or minimize UNC. METHODS: This is a descriptive qualitative study performed according to COnsolidated criteria for REporting Qualitative research guidelines in 2022. A purposeful sample of Italian hospitalized patients in two medical and two surgical units was involved. A face-to-face semistructured interview was used to merge reasons for UNC. Qualitative content analysis was conducted to merge subthemes and themes as factors leading to UNC according to the experience of patients. RESULTS: A total of 23 patients (12 surgical and 11 medical) were involved (12/23 male) with an age average of 66.2 years, educated mainly at secondary school, and with previous hospitalizations (20/23), and dependent on nursing care in daily activities (14/23). Reasons for UNC have been identified at four levels: (1) 'New health-care system priorities' and 'Pre-existing frailty of health-care facilities' were reasons identified at the health-care system level; (2) 'Lack of resources attributed to wards', 'Ineffective ward organization' and 'Leadership' were identified at the unit level; (3) 'Nurses' attitudes and behaviour' were reported at the nurses' level and (4) 'Increased nursing care expectations' were pinpointed at the patient level. CONCLUSION: Patients can be involved in identifying UNC, but also in recognizing the underlying reasons. Engaging them in such investigations might broaden our understanding of the phenomenon and the possibility of identifying strategies to minimize and prevent UNC. PATIENT OR PUBLIC CONTRIBUTION: Patients from four hospital units (two medical and two surgical) were involved in face-to-face interviews to merge the reasons perceived by them as triggering UNC. All factors (as themes and subthemes) have derived from their words, thus enhancing the evidence available from the side of the patients.

Facilitating pain assessment and communication in people with deafness: a systematic review.

BACKGROUND: Pain is a common reason for seeking out healthcare professionals and support services. However, certain populations, such as people with deafness, may encounter difficulties in effectively communicating their pain; on the other side, health care professionals may also encounter challenges to assess pain in this specific population. AIMS: To describe (a) the state of the research in the field of pain assessment in individuals with deafness; (b) instruments validated; and (b) strategies facilitating the pain communication or assessment in this population. METHODS: A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were performed, searching Medline, CINAHL, Scopus, Embase and PsycInfo databases, from their initiation to July 2023. Primary and secondary studies, involving adults with deafness and investigating pain assessment and communication difficulties, facilitators, or barriers, were eligible. The included studies were assessed in their methodological quality with the Quality Assessment for Diverse Studies tool; data extraction and the narrative synthesis was provided by two researchers. RESULTS: Five studies were included. Two were validation studies, while the remaining were a case report, a case study and a qualitative study. The interRAI Community Health Assessment and the Deafblind Supplement scale have been validated among people with deafness by reporting few psychometric properties; in contrast, instruments well established in the general population (e.g. Visual Analogue Scale) have been assessed in their usability and understandability among individuals with deafness, suggesting their limitations. Some strategies have been documented as facilitating pain communication and assessment: (a) ensuring inclusiveness (the presence of family members as mediators); (b) ensuring the preparedness of healthcare professionals (e.g. in sign language); and (c) making the environment friendly to this population (e.g. removing masks). CONCLUSIONS: The research regarding pain in this population is in its infancy, resulting in limited evidence. In recommending more research capable of establishing the best pain assessment instrument, some strategies emerged for assessing pain in which the minimum standards of care required to offer to this vulnerable population should be considered.

Lessons learnt while designing and conducting a longitudinal study from the first Italian COVID-19 pandemic wave up to 3 years.

BACKGROUND: Several scientific contributions have summarized the "lessons learnt" during the coronavirus disease 2019 (COVID-19) pandemic, but only a few authors have discussed what we have learnt on how to design and conduct research during a pandemic. The main intent of this study was to summarize the lessons learnt by an Italian multidisciplinary research group that developed and conducted a longitudinal study on COVID-19 patients infected during the first wave in March 2020 and followed-up for 3 years. METHODS: A qualitative research approach embedded into the primary CORonavirus MOnitoRing study (CORMOR) study was developed, according to the the consolidated criteria for reporting qualitative research. Multiple data collection strategies were performed: each member was invited to report the main lessons learnt according to his/her perspective and experience from the study design throughout its conduction. The narratives collected were summarized and discussed in face-to-face rounds. The narratives were then thematically analysed according to their main topic in a list that was resent to all members to check the content and their organization. The list of the final "lessons learnt" has been agreed by all members, as described in a detailed fashion. RESULTS: Several lessons were learnt while designing and conducting a longitudinal study during the COVID-19 pandemic and summarised into ten main themes: some are methodological, while others concern how to conduct research in pandemics/epidemics/infectious disease emergencies. CONCLUSIONS: The multidisciplinary approach, which also included patients' perspective, helped us to protect the consistency and quality of the research provided in pandemic times. The lesson learnt suggest that our research approach may benefit from changes in education, clinical practice and policies.

Untangling a complex skein on ward round terminologies, purposes, and main features through a rapid review.

AIM(S): To increase conceptual clarity in the field of nursing regarding terms, purposes, and main features of rounding as investigated to date. DESIGN: A Rapid Review according to the Cochrane Rapid Reviews Protocol. REVIEW METHODS: These were: (a) set the research question; (b) establish the study eligibility criteria; (c) search the databases; (d) select the studies; (e) extract the data; (f) assess the risk of bias; and (g) provide a synthesis using three methodologies, namely a qualitative content analysis, a thematic and a framework synthesis. DATA SOURCES: MEDLINE (PubMed), Cumulative Index of Nursing and Allied Health databases and grey literature from 2014 to 2022. RESULTS: A total of 72 studies were included; 88 different terminologies are used to describe the rounding from one up to five words. "Preparing the care by ensuring an effective care plan, team and environment", "Delivering tailored and timely nursing care" and "Promoting the quality of care" are the three main purposes of the rounding, including several specific aims. Regarding the main features, these emerged from highly structured/prescriptive to low structured/prescriptive approaches to rounding intervention. CONCLUSION: The word "round" alone seems to be not sufficient to communicate and describe the intervention, suggesting that this field of research is entering within the complex intervention framework. The different aims of the rounding have been conceptually categorized into three main purposes whereas the intervention features may range from simple to very complex, where several options regarding who to involve, how and when to deliver are expressed. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This rapid review followed by three data analysis methodologies have resulted in three main frameworks that may be useful to address the research, the clinical practice and the education regarding the terminologies, the different purposes and the main features of the rounding. No Patient or Public Contribution. NO PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution in the conduct of this study.

Exploring unfinished nursing care among nursing students: a discussion paper.

BACKGROUND: In line with the impetus traceable among the nursing staff, studies regarding the perception of Unfinished Care among students have increased in recent years as also recommended by some policy documents in the consideration that, as future members of the staff, they are expected to raise concerns about failures in the standards of care. However, no discussion of their methodological requirements has been provided to date. The aim of this study is to debate Unfinished Care explorations among nursing students and developing recommendations. METHODS: A Rapid Review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, followed by a scientific discussion based on empirical evidence that emerged from the review combined with expert knowledge. Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases were searched up to May 2022. RESULTS: In the last five years, seven studies have been conducted by researchers affiliated at the university level, involving from 18 to 737 undergraduate students across Europe. By critically analysing their key aspects, there are derived some recommendations in conducting investigations in this field as, (a) the hidden meaning of Unfinished Care investigations among students by also deciding which concept is mostly appropriate to investigate; (b) the need of establishing alliances with the clinical settings in order to involve them in such explorations; (c) more complex research methods capable of exploring this issue among students by promoting learning outcomes and not only a simple data collection; and (e) the influences of these explorations on students' wellbeing, as well as on ethical implications and that regarding the relationship between the healthcare services and the universities. CONCLUSION: Policymakers consider students to be key informants of the quality of nursing care issues witnessed during their clinical placements. The related emerging line of research is intriguing because of the underlying methodological, ethical and system complexities that need to be addressed according to some considerations.

Were the unfinished nursing care occurrence, reasons, and consequences different between COVID-19 and non-COVID-19 patients? A systematic review.

BACKGROUND: Unfinished Nursing Care (UNC) has been documented also during the Coronavirus (COVID-19) pandemic; however, while several secondary studies were conducted before this period to summarise occurrences, reasons, and consequences of UNC and provide a global picture of the phenomenon, no synthesis of the evidence produced during the pandemic has been documented to date. Therefore, the aim of this review is to identify differences, if any, in the UNC occurrence, reasons, and consequences perceived by nurses caring for COVID-19 and non-COVID-19 patients. METHODS: This study is a systematic review (PROSPERO CRD42023410602). According to the Population, Exposure, Comparator, and Outcomes framework, primary comparative cross-sectional, longitudinal, and cohort studies, randomised/non-randomised controlled trials were included from Medline, CINAHL, and Scopus, collecting perceptions of nurses with tools measuring UNC between COVID-19 and non-COVID-19 patients and published in English, Italian, or Turkish. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and Johanna Briggs Quality Appraisal Tool were used, and findings were summarised narratively. RESULTS: Five hospital-based cross-sectional studies using the self-administered MISSCARE and UNC Survey comparing data collected (a) before the pandemic vs. in the first wave; (b) before, in the second and in the third wave; and (c) simultaneously among COVID-19 and non-COVID-19 patients in the second wave. Three main patterns emerged suggesting a higher UNC occurrence among COVID-19 patients in the first wave, less occurrence among them compared to non-COVID-19 patients in the second wave, and contrasting findings with some in favour and others in contrast to COVID-19 patients. Similar patterns emerged regarding UNC reasons while no studies investigated the UNC consequences. CONCLUSIONS: In the first wave, COVID-19 patients were likely to be at increased risk of UNC, while in later waves non-COVID-19 patients were at increased risk of UNC. Reasons also were different across waves. Findings documented during the COVID-19 pandemic may help to prevent UNC in future disasters.

Antecedents of unfinished nursing care: a systematic review of the literature.

BACKGROUND: Unfinished Nursing Care (UNC) concept, that express the condition when nurses are forced to delay or omit required nursing care, has been largely investigated as tasks left undone, missed care, and implicit rationing of nursing care. However, no summary of the available evidence regarding UNC antecedents has been published. The aim of this study is to identify and summarise antecedents of UNC as documented in primary studies to date. METHODS: A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. MEDLINE, CINAHL, SCOPUS, and PROSPERO databases were searched for quantitative studies reporting the relationships between antecedents and UNC published after 2004 up to 21 January 2020. The reference lists of secondary studies have been scrutinised to identify additional studies. Two reviewers independently identified studies and evaluated them for their eligibility and disagreements were resolved by the research team. The quality appraisal was based on the Joanna Briggs Institute Critical Appraisal tools, according to the study designs. A data extraction grid was piloted and then used to extract data. The antecedents that emerged were thematically categorised with an inductive approach. RESULTS: Fifty-eight studies were included; among them, 54 were cross-sectional, three were cohort studies, and one was a quasi-experimental study. They were conducted mainly in the United States and in hospital settings. The UNC antecedents have been investigated to date at the (a) unit (e.g., workloads, non-nursing tasks), (b) nurse (e.g., age, gender), and (c) patient levels (clinical instability). CONCLUSIONS: At the unit level, it is highly recommended to provide an adequate staff level, strategies to deal with unpredictable workloads, and to promote good practice environments to reduce or minimise UNC. By contrast, at the nurse and patient levels, there were no clear trends regarding modifiable factors that could decrease the occurrence of UNC. The map of antecedents that emerged can be used to design interventional studies aimed at changing research from merely descriptive to that which evaluates the effectiveness of interventions.

Unfinished nursing care reasons as perceived by nurses at different levels of nursing services: Findings of a qualitative study.

AIM: This study aimed to investigate reasons for unfinished nursing care across the whole levels of the nursing service as perceived by clinical nurses, ward managers and executive nurses. BACKGROUND: Even though unfinished nursing care has been considered an issue affected by the system, no studies to date have attempted to investigate reasons across the whole levels of the nursing service by involving clinical nurses, ward managers and executive nurses. METHOD: A descriptive qualitative approach was performed in 2021 according to the COnsolidated criteria for REporting Qualitative research guidelines. A large public health care trust was approached, and a purposeful sample of clinical nurses, ward managers and executive nurses was invited to attend face-to-face or online interviews. Twenty-nine interviews were performed (19 clinical nurses, 7 ward managers and 3 executive nurses) and transcribed verbatim. Then, a content analysis was conducted by considering all narratives together followed by an analytic process to identify themes and subthemes at the clinical, ward manager and executive levels. RESULTS: Reasons for unfinished nursing care have emerged at five levels: system (e.g., poor support towards nursing care), unit (e.g., ineffective models of nursing care delivery), nurse managers (e.g., inadequate nurse manager leadership), nurses (e.g., weaknesses in education) and patients (e.g., increased demand for patients' care). CONCLUSION: The evidence available should be expanded to include also unfinished nursing care reasons identified at the system and at the ward manager levels, that both can complete the perceptions of the clinical nurses. IMPLICATIONS FOR NURSING MANAGEMENT: The actors composing the nursing service perceive different reasons and therefore should be involved in detecting and contrasting the unfinished nursing care. The reasons applied or established at the upper level influence the bedside levels: Therefore, strategies to prevent or minimize the unfinished nursing care should be designed at multi-levels in a system-inclusive approach.

Exploring the nexus between the standardized nursing terminologies and the unfinished nursing care phenomenon: An empty systematic review.

PURPOSE: To identify and synthesize evidence regarding the documented relationship between the standardized nursing terminologies and the unfinished nursing care phenomenon. DATA SOURCES: A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature Complete databases were last consulted on November 27, 2023. The review included primary quantitative studies that reported an association between recognized standardized nursing terminologies and unfinished nursing care. Two researchers completedtitle and abstract and full-text screening. DATA SYNTHESIS: Our search identified 149 citations. A full-text review of one paper was undertaken. No studies met our inclusion criteria. We report an empty review. CONCLUSIONS: Standardized nursing terminologies and Unfinished Care are two sides of the same coin: despite their potential commonalities, no studies have documented their potential links. Digital systems, such as electronic health records and decision support systems, could foster this linkage. IMPLICATIONS FOR NURSING PRACTICE: This review suggests that linking the conceptual frameworks can promote the diffusion of standardized nursing terminologies in clinical practice and increase accuracy in the measurement of Unfinished Care. This synergy could promote the contribution of nursing knowledge to patient care, nursing visibility, and be beneficial to clinical nurses, managers, and healthcare systems to international level.

[The use of standardized nursing languages in electronic medical records: an exploratory study on opportunities, limitations, and strategies]. / L'uso del linguaggio standardizzato infermieristico nelle cartelle cliniche elettroniche: studio esplorativo su opportunità, limiti e strategie.

. The use of standardized nursing languages in electronic medical records: an exploratory study on opportunities, limitations, and strategies. INTRODUCTION: Standardized nursing languages (SNLs) have found increasing application in electronic medical records in recent years. In Italy their use is still uneven and accompanied by a silent debate between positions 'against' and 'for' their use. AIM: To render visible the debate regarding SNLs in Italy, and the strategies to consider when digitized records are based on a SNL. METHOD: Data has been collected through audio-recorded semi-structured interviews, selecting three Italian nursing professors, four managers representing Italian healthcare settings that used a SNT and a representative of the Central committee of the National federation of orders of nursing professions. The thematic approach was used to analyze the data. RESULTS: Participants reported having introduced digitized records based on nursing diagnoses, integrated with the Nursing Interventions Classification System and Nursing Outcome Classification, Clinical Care Classification System, Nursing Sensitive Outcomes or mixed models. Divergent aspects emerge regarding: (1) using nursing languages vs a common language to other healthcare professions; (2) planning care vs enhancing clinical reasoning; (3) measuring nursing care vs accepting the variability of the practice, and (4) making documentation efficient vs dedicating more time. Some convergences have emerged and a set of indications for introducing electronic records when based on standardized languages. CONCLUSIONS: The introduction of electronic documentation requires the use of homogeneous languages. The debate on the potential and limits of SNL is still open and requires reflection among researchers, trainers, clinicians, and coordinators/managers of nursing care regarding the choices to be made which may have long-term effects on many nurses.

The Reasons for Unfinished Nursing Care during the COVID-19 Pandemic: An Integrative Review.

Background: The concept of unfinished nursing care (UNC) describes nursing interventions required by patients and families that nurses postpone or omit. UNC reasons have been documented; however, no studies have summarised the underlying factors triggering the UNC during the pandemic. Therefore, the aim was to synthesise the available studies exploring factors affecting UNC during a pandemic. Methods: We conducted an integrative review following Whittemore and Knafl's framework according to the Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Scopus databases were searched for primary studies that collected data from 1 January 2020 to 1 May 2023. Both qualitative and quantitative studies assessing the reasons for UNC were eligible and evaluated in their quality using the Critical Appraisal Skills Programme and the Mixed Methods Appraisal Tool. Results: Four studies were included-three qualitative and one cross-sectional. The reasons for UNC have been documented at the following levels: (a) system (e.g., new healthcare system priorities); (b) unit (e.g., ineffective work processes); (c) nurse management (e.g., inadequate nurse manager's leadership); (d) nurse (e.g., nurses' attitudes, competences, performances); and (e) patient (increased demand for care). Conclusion: The reasons for UNC during the COVID-19 pandemic are different to those documented in the pre-pandemic times and reflect a pre-existing frailty of the National Health Service towards nursing care.

Perceived competences by graduated nurses before and during COVID-19 restrictions: A repeated cross-sectional study from 2019 to 2022.

AIMS: To explore the differences, if any, in the competences perceived by newly graduated nurses who attended their education before and during the COrona VIrus Disease 19 (COVID-19) restrictions. BACKGROUND: Nursing education has undergone significant changes because of the COVID-19 restrictions. However, to date the perceived competences at the point of graduation have not been investigated over the restrictions years compared with the pre-restrictions era. DESIGN: A repeated cross-sectional study followed by a pseudo-panel analysis. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used. Data on individual, nursing programme and perceived competences with Nurse Competence Scale (NCS) were collected and analysed by also using a pseudo-panel approach. METHODS: Two universities were involved. Those eligible were nursing students who graduated: (1) in 2020 (=323) as the first post-COVID-19 group, who were studying in the 3rd year at the onset of the restrictions; (2) in 2021 (=250) as the second post-COVID-19 graduated group, who were in the 2nd year at the restrictions onset; and (3) in 2022 (=247) as the third post-COVID-19 group, attending the 1st year of nursing education at the onset of the restrictions. Data were compared with those who graduated in 2019 (=336, pre-COVID-19 group). RESULTS: The overall NCS score was higher in the pre-COVID-19 group (68 out of 100, 95 % Confidence of Interval [IC] 66.4-69.5), lower in the first post-COVID-19 graduates (62.9, 95 % CI 60-65.8), higher in the second (66.6, 95 % CI 63.6-69.4) and lower again in the third post-COVID-19 group (63.8, 95 % CI 60.9-66.5). A sinusoidal pattern also emerged for the frequency of use of the competences from the pre-COVID-19 (2.3 out of 3) and the first group (2.1) and increased between the second and the third group (from 2.1 to 2.3) (p< 0.001). These sinusoidal trends are also evident in the pseudo-panel analysis. CONCLUSIONS: A different degree of perceived competences at the point of graduation emerged, with higher competences in the pre-restrictions group, lower in the first post-COVID-19 generation, higher again in the second and third group. However, all scores were over 60 points out of 100, thus indicating sufficient competences. The frequency of use of such competences slightly changed over the years with limited practical relevance. The findings may inform reflections regarding innovations in the clinical placements pathways as well as in the strategies supporting newly graduates nurses in their transition from education to health-care settings.

COVID-19-induced neuropsychiatric symptoms can persist long after acute infection: a 2-year prospective study of biobehavioral risk factors and psychometric outcomes.

OBJECTIVES: To assess the prevalence of neuropsychiatric symptoms 2 years after the COVID-19 acute phase and to identify biobehavioral risk factors. METHODS: This 2-year prospective study assessed adult individuals with COVID-19 via face-to-face interview and laboratory testing at onset, and via telephone interview at 2-year follow-up. Data collected included COVID-19 severity and management at onset, as well as depression, anxiety, insomnia, cognitive failure, and fatigue at follow-up using standardized assessment tools. RESULTS: Out of 1,067 screened COVID-19 patients, 230 completed the 2-year follow-up (female, 53.5%; aged>40, 80.9%; native Italian, 94.9%; medical comorbidity, 53.5%; chronic medication, 46.3%; moderate to severe COVID-19, 24.9%; hospital admission, 28.7%; ICU, 5.2%). At follow-up, 9.1% had anxiety, 11.3% depression, 9.1% insomnia, 18.3% cognitive failure, and 39.1% fatigue, of clinical relevance. Headache (OR = 2.49, 95% CI = 1.01-6.16, p = 0.048), dyspnea (OR = 2.55, 95% CI = 1.03-6.31, p = 0.043), and number of symptoms (OR = 1.23, 95% CI = 1.01-1.51, p = 0.047) at onset were associated with anxiety at follow-up; dyspnea at onset was associated with depression at follow-up (OR = 2.80, 95% CI = 1.22-6.41, p = 0.015); number of comorbidities at onset was associated with insomnia at follow-up (OR = 1.48, 95% CI = 1.06-2.08, p = 0.022); female gender (OR = 2.39, 95% CI = 1.14-5.00, p = 0.020) and number of symptoms (OR = 1.20, 95% CI = 1.02-1.42, p = 0.026) at onset was associated with cognitive failure at follow-up; number of comorbidities (OR = 1.33, 95% CI = 1.03-1.73, p = 0.029) and symptoms (OR = 1.19, 95% CI = 1.04-1.37, p = 0.013) and raised interleukin 6 levels (OR = 4.02, 95% CI = 1.42-11.36, p = 0.009) at onset was associated with fatigue at follow-up. CONCLUSIONS: COVID-19 survivors, especially if female, with preexisting health problems, and with a more severe acute phase, may present with long-lasting neuropsychiatric sequalae, urging interventions to sustain recovery particularly in these higher risk individuals.