Nurses' attitudes towards COVID-19 vaccines: A qualitative study (PROACTIVE-study).

AIM: To explore the attitudes of healthcare workers towards COVID-19 vaccines. DESIGN: A qualitative descriptive design was used. METHODS: Five focus groups were conducted between October and November 2021, with a total of 30 nurses from different contexts in Northern Italy. Thematic analysis was used to analyse the transcripts. RESULTS: Three main themes were identified: 'favourable', 'unsure' and 'contrary to' COVID-19 vaccines. The favourable position was underpinned by trust in science, research and vaccination; protection for themselves, their families, patients and the population; duty as professionals; necessity to set an example for others. Participants who were unsure had doubts about the composition, safety and efficacy of the vaccine and were sometimes afraid that media provided incomplete information. The main reason why nurses were against was the feeling that being forced to vaccinate perceived as blackmail. Favourable or unsure nurses struggled to deal with those who were against and developed a series of emotions that ranged from respect and attempt to rationalize, to frustration and defeat. CONCLUSIONS: Identifying the areas of hesitation is essential to understand what affects the choices of acceptance, delay or refusal of vaccination. The issues that emerged regarding proper communication within the vaccination campaign highlights the key importance of adequate vaccination strategies. IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE: Understanding attitudes towards vaccine and related motivations among healthcare workers could help develop more specific and targeted vaccination campaigns that can ensure proper vaccination coverage rates and avoid hesitancy or refusal. IMPACT: Healthcare workers experiences of COVID-19 vaccines, their views and know how they feel during COVID-19 vaccinations. Healthcare workers had three different positions in COVID-19 vaccination. This research will guide and target future vaccination campaigns. REPORTING METHOD: The study is reported using the Standards for Reporting Qualitative Research (SRQR). PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

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.

Communication experiences of tracheostomy patients with nurses in the ICU: A scoping review.

INTRODUCTION: The quality of care for tracheostomy and mechanically ventilated patients in intensive care units (ICUs) has improved considerably. However, the communication barrier attributable to these procedures generates many problems for patients, as they are unable to communicate effectively with family members and ICU healthcare professionals, especially nurses. AIMS: To describe (1) tracheostomy patients' needs, emotions and difficulties when communicating with ICU nurses and (2) which strategies nurses and patients have adopted to improve their communication. METHODS: A scoping review was completed using the Joanna Briggs Institute method and following the PRISMA-ScR Checklist. The research question was developed using the Population, Concept and Context framework. Five databases were searched. After screening, two researchers independently analysed the 75 papers, and finally, 19 studies were included in this review. RESULTS: All studies used a qualitative design. Seven adopted a phenomenological and two a hermeneutic approach, involving a total of 265 patients. Two main themes and four subthemes were identified: (1) the tracheostomy patients' needs, emotions and difficulties communicating with ICU nurses (patients' emotions, communication needs, and their content and difficulties) and (2) strategies that nurses and patients adopted to improve communication (communication strategies). CONCLUSIONS: It is essential to develop effective communication with tracheostomy patients to ensure they feel relieved, safe and considered. Communication content should focus on information relating to the person's personal condition and active involvement in care. RELEVANCE TO CLINICAL PRACTICE: It is important to prioritise the communication process in tracheostomised patients and create the organisational conditions that foster effective communication processes. Developing training programmes for new or practising nurses is essential to instil greater awareness about this crucial fundamental need.

Predictors of events of violence or aggression against nurses in the workplace: A scoping review.

AIM: To identify predictors and consequences of violence or aggression events against nurses and nursing students in different work contexts. BACKGROUND: Workplace violence against nurses and nursing students is a very common and widespread phenomenon. Actions to manage or prevent violent events could be implemented knowing the risk factors and consequences. However, there is a lack of systematic reviews that summarize knowledge on the predictors and consequences of workplace violence. EVALUATION: A scoping review was conducted using electronic databases including APA PsycInfo, CINAHL, Cochrane, Ovid Medline, PubMed and Scopus. KEY ISSUES: After full text analysis, 87 papers were included in the current scoping review. Risk factors of horizontal violence were grouped into 'personal' and 'Environmental and organizational', and for violence perpetrated by patients into 'personal', 'Environmental and organizational' and 'Characteristics of the perpetrators'. CONCLUSIONS: The results of this scoping review uncover problems that often remain unaddressed, especially where these episodes are very frequent. Workplace violence prevention and management programmes are essential to counter it. IMPLICATIONS FOR NURSING MANAGEMENT: The predictors and the consequents identified constitute the body of knowledge necessary for nurse managers to develop and implement policy and system actions to effectively manage or prevent violent events.

Nursing management of fatigue in cancer patients and suggestions for clinical practice: a mixed methods study.

BACKGROUND: Fatigue is a complex and frequent symptom in cancer patients, influencing their quality of life, but it is still underestimated and undertreated in clinical practice. The aims of this study were to detect the presence of fatigue in cancer patients, describe how patients and nurses perceived it and how nurses managed fatigue. METHODS: This is a mixed methods study. Data were collected in two oncological wards using the Brief Fatigue Inventory (BFI), an ad hoc questionnaire, patient interviews, focus groups with nurses and the review of nursing records. Interviews and focus groups were analysed through thematic analysis. We used SPSS 22.0 for quantitative data and Nvivo 10 for qualitative data analysis. RESULTS: A total of 71 questionnaires were analysed (39 males, mean age 65.7 years). Fatigue was reported 5 times (7%) in nursing records, while in 17 cases (23.9%) problems associated to it were reported. Twelve patients were interviewed. Five themes were identified: feeling powerless and aggressive, my strategies or what helps me, feeling reassured by the presence of family members, feeling reassured by nurses' gestures, and being informed. Three themes were identified through the focus groups: objectivity and subjectivity in the assessment of fatigue, nurses' contribution to the multidisciplinary management of fatigue, and difficulty in evaluating outcomes. CONCLUSIONS: The approach to the management of fatigue was unstructured. Patients were satisfied with the care they received but needed more information and specific interventions. Useful aspects were identified that could be used to change health professionals' approach towards the management of fatigue.

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

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

Reducing Pain During Emergency Arterial Sampling Using Three Anesthetic Methods: A Randomized Controlled Clinical Trial.

BACKGROUND: Taking a sample of arterial blood is widely reported as a cause of significant pain. OBJECTIVES: To compare three anesthetic methods with standard practice (no anesthesia) to establish which was the most effective in reducing pain caused by radial artery puncture in patients requiring an arterial blood gas test in the emergency department (ED). METHODS: A randomized controlled trial was conducted to compare the effectiveness between anesthetic cream, cryoanalgesia, and subcutaneous mepivacaine in reducing pain caused by radial artery puncture in ED patients. RESULTS: After comparing perceived pain during arterial puncture, the lowest median score was obtained in the mepivacaine group (1 interquartile range 0.6-1.3) and the highest median score in the control group (5 interquartile range 4.0-7.0). When comparing the control group with the three intervention groups, the Kruskal-Wallis test showed that mepivacaine (p = 0.023) and cryoanalgesia (p = 0.012) were associated with significantly lower pain scores. The anesthetic cream (p = 0.861) intervention group did not produce a statistically significant median difference compared with the control group. CONCLUSIONS: The results of this study encourage the use of anesthetic methods like cryoanalgesia or mepivacaine for their proven effectiveness in reducing or eliminating pain during arterial puncture.

[Patients and caregivers experience on Nursing in Italy: scoping review]. / L'infermieristica in Italia attraverso l'esperienza di pazienti e caregivers: scoping review.

INTRODUCTION: Comparison of the state of nursing in Italy with other countries has shown that theory development in Italian nursing remains quite undeveloped. Theory development in Italian nursing will need to consider local cultural and professional aspects, specific to the Italian practice context, by drawing on known health needs, experiences and nursing approa- ches. The aim of this investigation was to map current knowledge related to nursing in Italy, based on the experiences of patients, families and communities, to provide a basis on which nursing theories could be developed. METHODS: Scoping Review was selected as the best method for this knowledge mapping. Fawcett's nursing metaparadigm was chosen as a broad guide and means by which the litera- ture analysis could be structured. RESULTS: Twenty-two studies were retained and examined in this analysis, including contexts relating to acute care, chronic conditions, as well as emergency and home care services. We defined themes in line with the nursing metaparadigm. Although these definitions are partial, referring only to certain contexts specific to some aspects of nursing care, the original contributions of this investigation provides an important starting point for theory development in Italian nursing, based on the Italian context. CONCLUSION: Strong and credible theory development, that can be readily adapted to practice, requires a rigorous analysis of the points of view of all actors involved in the nursing care process.

Health Care Professionals Attitudes Towards Mental Illness: Observational Study Performed at a Public Health Facility in Northern Italy.

The United Nations Convention on the Rights of Persons with Disabilities Defines stigma as the process of social oppression barring persons with mental illness from enjoying social interaction through discrimination, exclusion and denial of human and social rights. Modern stereotypes still portray the mentally ill as guilty, unpredictable and violent. Observational studies report how healthcare professionals, including nurses, are often part of the stigma. Such phenomenon belittles the needs of people seeking mental care. The aim of this study is to describe attitudes held by psychiatric nurses and mental care professionals from different care settings of an Italian Healthcare Facility, towards the mentally ill and to identify any associated factors. Mental health care professionals were recruited for this observational study from 10 Italian different psychiatric care units. The Italian version of the Community Attitudes Mentally Ill inventory (CAMI-I) was validated and used for this study. 120 completed questionnaires were deemed valid. Optimal internal consistency (α=0.856) was measured by calculating Cronbach's Alpha for the CAMI-I. Demographic variables were correlated to items grouped into three factors of the CAMI-I (authoritarian attitudes, benevolence, social restrictiveness). Parametric test (ANOVA) highlight significant differences between CAMI-I results for different demographic variables. Significant data were obtained by comparing responses for each factor of the CAMI-i per professional profile. All healthcare professionals studied show sensitivity and positive attitude towards mental illness. Positive approaches to mental illness contribute towards easing therapeutic care and recovery in patient-centred care. CAMI-I will be a useful tool to identifying discriminatory approaches and sensitize health professionals in Italy.

Developing an instrument to measure emotional behaviour abilities of meaningful learning through the Delphi technique.

AIM: To identify items for a new instrument that measures emotional behaviour abilities of meaningful learning, according to Fink's Taxonomy. BACKGROUND: Meaningful learning is an active process that promotes a wider and deeper understanding of concepts. It is the result of an interaction between new and previous knowledge and produces a long-term change of knowledge and skills. To measure meaningful learning capability, it is very important in the education of health professionals to identify problems or special learning needs. For this reason, it is necessary to create valid instruments. DESIGN: A Delphi Study technique was implemented in four phases by means of e-mail. METHODS: The study was conducted from April-September 2015. An expert panel consisting of ten researchers with experience in Fink's Taxonomy was established to identify the items of the instrument. Data were analysed for conceptual description and item characteristics and attributes were rated. Expert consensus was sought in each of these phases. An 87·5% consensus cut-off was established. RESULTS: After four rounds, consensus was obtained for validation of the content of the instrument 'Assessment of Meaningful learning Behavioural and Emotional Abilities'. This instrument consists of 56 items evaluated on a 6-point Likert-type scale. Foundational Knowledge, Application, Integration, Human Dimension, Caring and Learning How to Learn were the six major categories explored. CONCLUSIONS: This content validated tool can help educators (teachers, trainers and tutors) to identify and improve the strategies to support students' learning capability, which could increase their awareness of and/or responsibility in the learning process.

Instruments for measuring meaningful learning in healthcare students: a systematic psychometric review.

AIM: To identify, evaluate and describe the psychometric properties of instruments that measure learning outcomes in healthcare students. BACKGROUND: Meaningful learning is an active process that enables a wider and deeper understanding of concepts. It is the result of an interaction between new and prior knowledge and produces a long-standing change in knowledge and skills. In the field of education, validated and reliable instruments for assessing meaningful learning are needed. DESIGN: A psychometric systematic review. DATA SOURCES: MEDLINE CINAHL, SCOPUS, ERIC, Cochrane Library, Psychology & Behavioural Sciences Collection Database from 1990-December 2013. REVIEW METHOD: Using pre-determined inclusion criteria, three reviewers independently identified studies for full-text review. Then they extracted data for quality appraisal and graded instrument validity using the Consensus-based Standards for the selection of the health status Measurement INstruments checklist and the Psychometric Grading Framework. RESULTS: Of the 57 studies identified for full-text review, 16 met the inclusion criteria and 13 different instruments were assessed. Following quality assessment, only one instrument was considered of good quality but it measured meaningful learning only in part; the others were either fair or poor. The Psychometric Grading Framework indicated that one instrument was weak, while the others were very weak. No instrument displayed adequate validity. CONCLUSIONS: The systematic review produced a synthesis of the psychometric properties of tools that measure learning outcomes in students of healthcare disciplines. Measuring learning outcomes is very important when educating health professionals. The identified tools may constitute a starting point for the development of other assessment tools.

Patient safety competencies in undergraduate nursing students: a rapid evidence assessment.

AIMS: To identify patient safety competencies, and determine the clinical learning environments that facilitate the development of patient safety competencies in nursing students. BACKGROUND: Patient safety in nursing education is of key importance for health professional environments, settings and care systems. To be effective, safe nursing practice requires a good integration between increasing knowledge and the different clinical practice settings. Nurse educators have the responsibility to develop effective learning processes and ensure patient safety. DESIGN: Rapid Evidence Assessment. DATA SOURCES: MEDLINE, CINAHL, SCOPUS and ERIC were searched, yielding 500 citations published between 1 January 2004-30 September 2014. REVIEW METHODS: Following the Rapid Evidence Assessment process, 17 studies were included in this review. Hawker's (2002) quality assessment tool was used to assess the quality of the selected studies. RESULTS: Undergraduate nursing students need to develop competencies to ensure patient safety. The quality of the pedagogical atmosphere in the clinical setting has an important impact on the students' overall level of competence. Active student engagement in clinical processes stimulates their critical reasoning, improves interpersonal communication and facilitates adequate supervision and feedback. CONCLUSION: Few studies describe the nursing students' patient safety competencies and exactly what they need to learn. In addition, studies describe only briefly which clinical learning environments facilitate the development of patient safety competencies in nursing students. Further research is needed to identify additional pedagogical strategies and the specific characteristics of the clinical learning environments that encourage the development of nursing students' patient safety competencies.

Instruments measuring meaningful learning in undergraduate healthcare students: a systematic review protocol.

AIM: To establish the psychometric properties of instruments to measure learning outcomes in healthcare students. BACKGROUND: Meaningful learning is an active process that promotes a wider and deeper understanding of concepts. It is the result of an interaction between new and previous knowledge. Meaningful learning produces a long-term change in knowledge and skills, which is underpinned by willingness to learn and experience and it is exclusively built by the learner. DESIGN: Systematic psychometric review protocol developed from Cochrane Effective Practice and Organization of Care guidance. METHOD: Searches of MEDLINE, CINAHL, SCOPUS, ERIC, PsycINFO, Cochrane Library, Psychology & Behavioral Sciences Collection Database between 1990-2013. Selected studies will be evaluated with the Consensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. Funding for the review was confirmed on January 2011 by the Centre of Excellence for Nursing Scholarship in Rome. RESULTS: The systematic review will produce a synthesis of the data related to the instruments that measure learning outcomes. These data will help us decide which tools to use and identify the state of knowledge in this field. CONCLUSIONS: Measuring learning outcomes is very important for the large amount of human and financial resources employed in educating and training health professionals and this requires reliable and valid instruments.

A cross-sectional study of pedagogical strategies in nursing education: opportunities and constraints toward using effective pedagogy.

BACKGROUND: The continuous, rapid evolution of medical technology, the public need for ever more complex health-care services and the stagnant global economic situation have posed difficult new challenges for the nursing profession. The need to integrate knowledge, technical skill and ethical conduct in nursing practice has become ever more evident, particularly in response to the emerging challenges over recent years. Major research studies have highlighted that high-quality responses to health needs is highly dependent on both the education received by health care professionals and the pedagogical strategies employed in such training. The aim of this study was to identify the pedagogical strategies used by teachers in nursing programs in the Italian university system and to classify them according to the didactic architectures that are used. METHODS: The study sample was recruited from the entire population of nursing instructors teaching in all years of their respective programs, in every Italian university with a nursing program. A three-part questionnaire, based on a Calvani taxonomy, was designed to collect both demographic and cultural information on the sample subjects, as well as the pedagogical strategies that they may have used in their teaching practices, was administered to all nursing instructors. A five-point Likert scale was used to measure the frequency of use of different pedagogical strategies. RESULTS: On the whole, 992 teachers participated in the study (80.1% of the teachers contacted). Experience data suggest a highly-educated overall instructor population. The settings in which the participants carried out their teaching activities were represented mostly by large lecture halls and the number of students in their classes were for the most part rather large; over 60. Frequency of use revealed that the most commonly used method was the traditional lecture. Indeed, 85.7% of the respondents "often" or "always" used pedagogical strategies belonging to a 'receptive architecture'. CONCLUSIONS: Any redefining of approaches to nursing education must consider several key factors to ensure the promotion of student-focused pedagogical strategies. Only through the implementation of such pedagogical practices will it be possible to generate the knowledge and skills necessary for future professionals to be able to adequately respond to the ever more complex health care needs of the population.

The role of simulation in developing communication and gestural skills in medical students.

BACKGROUND: International studies have shown that laboratory training, particularly through the application of the principles of simulation learning, is an effective means of developing the communication and gestural skills of healthcare professionals. At the Advanced Simulation Center of the University of Genoa we have therefore established the first clinical skill laboratory with medical school students and an interprofessional team of trainers, as the first step towards developing simulation training of both medical and nursing students at our University.The aim of this study was to assess student satisfaction with laboratory training in an Advanced Simulation Center. METHODS: All of the third-year students of the Medical School (n = 261) were invited to participate in the laboratory sessions at the Advanced Simulation Center. They were divided into groups and attended the Center for one week. The team of trainers included medical doctors and nurses involved in teaching at the University Medicine and Nursing programs. At the end of the week, the students were administered an anonymous questionnaire made up of two sections: the first one was on the content of individual laboratory sessions; the second on the training methods, materials used and the trainers. A five-point Likert scale was used to measure satisfaction. RESULTS: According to the students all of the topics covered by the laboratory sessions were irreplaceable. Questionnaire results showed a high level of satisfaction with the methods used, the instruments developed, and with the expertise and approachability of the educators. Almost all of the students wanted to participate in similar laboratory activities in the future. CONCLUSIONS: The study highlighted the need to permanently integrate laboratory training sessions into the curriculum of medical students, who found them very useful and stimulating. The limit of this study was that only the teaching staff was interprofessional, and the students were only 3rd Year students of medicine.In the future, we hope to include also nursing students because they will need to learn how to deal with aspects of their clinical practice that require an interprofessional approach.

The effectiveness of continuing professional development for the residential long-term care workforce: A systematic review.

OBJECTIVES: To investigate the effectiveness of continuing professional development in residential long-term care. DESIGN: Systematic review. DATA SOURCES: PubMed, Cumulative Index to Nursing & Allied Health (CINAHL), and Web of Science. REVIEW METHODS: Empirical studies published between 2003 and 2023 describing the effectiveness of continuing professional development in long-term care were selected according to PRISMA guidelines. The type, topic, and effectiveness of continuing professional development activities in long-term care were analysed, in addition to facilitators and barriers. The protocol of this review is registered in PROSPERO. RESULTS: A total of 155 studies were selected, including over 17,000 participants the majority of whom were nurses. The most common topics were 'dementia care' (n = 22; 14.2 %), and restraint use (n = 14; 9 %). The impact of continuing professional development was mainly evaluated in terms of 'participant satisfaction with continuing professional development' (n = 5; 3 %), 'staff knowledge' (n = 57; 37 %), 'staff competencies and skills' (n = 35; 23 %), 'resident outcomes' (n = 45; 29 %), and 'staff wellbeing' (n = 12; 8 %). A total of 64 (41 %) studies evaluated if impact of continuing professional development was sustained over time. 'Good organisation', 'a supportive learning environment', 'expressing personal preferences', and 'management support' were described as facilitators of continuing professional development. CONCLUSIONS: Increasing numbers of long-term care residents with complex health conditions require nurses with advanced skills, such as dementia care. To improve the effectiveness of continuing professional development, support from managers, who adopt relational leadership styles, is instrumental to integrate new knowledge and skills into practice. This needs to be linked to career progression, and consequently increase the attractiveness of working in the long-term care sector. This could meet the dual goal of improving outcomes for residents and nurses' job satisfaction.

Correlation between surgical position and neck pain in patients undergoing thyroidectomy: a prospective observational study.

BACKGROUND: Thyroid diseases are one of the most common health problems worldwide. Although they represent a necessary step in order to perform thyroidectomy, hyperextension of the neck can potentially increase postoperative pain. The aim of this study is to determine a correlation between the degree of neck hyperextension on the operative table and the postoperative pain in patients undergoing open thyroidectomy. METHODS: Patients were prospectively enrolled from the cohort of patients operated at the Endocrine Surgery Unit of the University Hospital of Pisa, between May and July 2021. Both of patients who underwent total thyroidectomy or hemi-thyroidectomy were recruited. The following data were analysed in order to find a correlation with postoperative pain at 24 h: age, gender, type of surgery, BMI, operative time, and degree of neck extension. RESULTS: Overall, 195 patients were enrolled. A direct, statistically significant correlation emerged between the degree of neck hyperextension and the postoperative pain 24 h after surgery, regardless of the pain of the surgical wound (p < 0.001; beta 0.270). CONCLUSIONS: A direct correlation emerges between neck tilt angle and postoperative neck pain. Moreover, total thyroidectomy (TT) predisposes more to postoperative neck pain, considering the type of surgery.

Assessing triage efficiency in Italy: a comparative study using simulated cases among nurses.

BACKGROUND: Emergency Departments (EDs) across Italy use different triage systems, which vary from region to region. This study aimed to assess whether nurses working in different EDs assign triage codes in a similar and standardized manner. METHODS: A multicenter observational simulation study involved the EDs of Bolzano Hospital, Merano Hospital, Pisa University Hospital, and Rovereto Hospital. All participating nurses were given 30 simulated clinical cases (vignettes) and asked to assign triage codes according to the triage systems used in their EDs. Subsequently, we assessed inter-rater agreement and evaluated if code assignment had different performance among hospitals in relation to different clinical outcomes. RESULTS: Eighty-seven nurses participated in this study. There was marked variation in assigned triage codes both across hospitals and among individual operators. The kappa values for inter-rater agreement were 0.632 for Bolzano Hospital, 0.589 for Merano Hospital, 0.464 for Pisa University Hospital, and 0.574 for Rovereto Hospital. Sensitivity and specificity levels varied considerably for the same outcomes when comparing different hospitals. CONCLUSION: There is a high degree of subjectivity in triage code assignment by ED nurses. In the interest of equitable care for patients, this variability within the same country is hardly acceptable.

Teaching and learning modalities for continuing professional development in the long-term care: A rapid synthesis review.

AIM: To describe the various teaching and learning modalities for the delivery of Continuing Professional Development activities for health care professionals in the long-term care sector. BACKGROUND: Continuing Professional Development is a key activity that organisations undertake to achieve effective workforce planning, recruitment, retention and upskilling strategies in long-term care settings. During the Covid-19 pandemic there was a rapid move to online modalities of Continuous Professional Development, but there is a paucity of evidence in relation to their effectiveness compared with face-to-face, or in-class learning. DESIGN: A rapid synthesis review. METHODS: MEDLINE, CINAHL and HEALTH BUSINESS ELITE databases were used to identify relevant articles that were published between 2016 and 2022. Original studies of any design investigating Continuing Professional Development activities, with or without a comparison between interventions or activities were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed. The Kirkpatrick model was adopted as a globally recognised method for evaluating training programmes. RESULTS: After a full text analysis, 34 papers were included in the review. Face to face was the most common method of delivery followed by online, while blended (a mix of face-to-face and online delivery) was the least common method used. The teaching modalities were not associated with specific learning contents, but were used for a range of content. Most studies obtained positive outcomes following implementation of the educational interventions. Kirkpatrick Level 4 (results) was the most commonly measured outcome. CONCLUSIONS: While blended learning was the least common method of delivery, it was found to be more beneficial for learners than face-to-face or online exclusively. There are now new spaces to learn and new technologies that allow us to 'reimagine' where, when and how we teach. This requires Continuing Professional Development providers to design and tailor their courses according to health professionals' learning needs and the clinical contexts where they work. We recommend that Continuing Professional Development providers involve employers when designing teaching and learning activities for Long Term Care workers, to decide which modalities enable effective knowledge translation.