Measuring the therapeutic properties of nursing home environments in the Italian context: findings from a validation and cross-sectional study design.

BACKGROUND: The social and the physical features of the nursing home (NH) environment can offer a therapeutic support capable of maximising residents' physical and cognitive functions. A total of 23 instruments evaluating the therapeutic properties of a NH has been documented to date; among them, the most recent and widely used is the Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH) composed of 13 domains and 84 items: higher scores in each domain indicate a higher presence of therapeutic principles. Validating the Italian version of TESS-NH tool and describing the therapeutic properties of Italian NH environments were the aims of this study. STUDY DESIGN: A validation and a cross-sectional study design, undertaken in 2017. METHODS: After having ensured the cross-cultural and the conceptual equivalence, together with the face and the content validation, 13 NHs accounting for 1,161 beds and articulated in 31 units have been evaluated with the TESS-NH tool via direct observation by trained researchers. Inter-rater reliability, test-retest, criterion validity, inter-dimension correlations and internal consistency were measured. Descriptive statistics was also calculated. RESULTS: The inter-rater reliability was Pearson (r) >0.917 for continuous variables and weighted kappa statistics (k) of > 0.779 for non-continuous variables; the test-retest reliability was r > 0.848 and k of > 0.778, respectively. The criterion validity was r > 0.500 between each dimension and the single TESS-NH global item; moreover, correlations among the domains varied from not significant to significantly strong, while the internal consistency resulted in all evaluable dimensions in Cronbach alpha > 0.600. In the involved NH units, the TESS-NH total score was on average 122.19 out of the possible score from 0 to 149 (confidence interval (CI) 95%, 115.89-128.49). 25% of the units (=7) reported a total score of ≤ 113, and another 25% reported scores ≥ 133, thus from poor to excellent therapeutic properties. CONCLUSION: The TESS-NH tool can be used in Italian facilities to support managers and researchers in evaluating the therapeutic properties of NH environments. Furthermore, the tool can support the evaluation of the effectiveness of interventional studies or quality improvement projects aimed at improving the NH's environment.

[What criteria are used by home care nurses to decide about frequency of home visits in the follow-up of patients with heart failure?]. / Quali sono i criteri utilizzati dagli infermieri di assistenza domiciliare per decidere la frequenza di accesso nei pazienti con scompenso cardiaco?

BACKGROUND: Factors that directly or indirectly influence nurses' decisions regarding aspects of in-hospital care are well-known. On the other hand, little is known about which elements/criteria are used by home-care nurses to make decisions about the frequency of follow-up visits. OBJECTIVES: The objective of this study was to identify the criteria used for defining the frequency of follow-up visits in patients with heart failure. METHODS: Different study methods were used. A cross-sectional questionnaire study was performed to identify what specific aspects are considered for deciding to provide homecare to patients with heart failure. Three focus groups were then held with homecare nurses with experience with heart failure patients, to discuss and reach a consensus regarding the criteria for frequency of follow-up visits. RESULTS: The criteria that guide decision-making about the frequency of follow-up home visits are: a) clinical condition of the patient, b) presence of a caregiver, c) compliance/adherence to drug therapy, d) characteristics of the patient, e) workload, f) professional experience of the healthcare operator, f) assessment by the patient's general practitioner. CONCLUSIONS: The study identified which factors influence home-care nurses' decision-making in defining the frequency of follow-up for patients with heart failure. The decision-making process is based on the evaluation of multiple factors and also considers the organizational context in which home-care nurses work and their workload. Accurate criteria need to be defined.

Becoming a nurse in Italy: a multi-method study on expenditures by families and students.

Potential nursing students and their families are faced with difficult decisions regarding the amount of time and money required to complete the nursing programme and the availability of funds to cover the costs and this seems to have received little no attention to date. With the aim of describing the costs incurred by Italian nursing students and/or their families per academic year and compare cost trends incurred from 2004-05 to 2010-11, a multi-centre qualitative/quantitative study design was adopted. Italian Nursing students attending the first, second and third academic years in 2004-05 and those attending the first, second and third academic years in 2010-11 were eligible. Five hundred and six students were involved: 215 (out of 300 eligible, 71.6%) attended the bachelor's degree in nursing in 2004-05 and 291 (out of 383 eligible, 75.9%) in 2010-11. On an annual basis, the average annual expenditures increased by 12% for nursing education from 2004-05 to 2010-11. Given that qualification as a nurse requires at least three years, and considering inflation, for a student who matriculated in 2005 an average of 2485.7€ per year (7457.0€ in total) was required. Data suggest that students have modified their spending behaviour (limiting lunches at public bars, buying books and photocopies) in order to handle the rise of non-discretionary costs, such as tuition fees and the costs of attending lectures and hospital/district trainings. Policies supporting nursing education in general and for those students who are motivated but unable to undertake the course for economic reasons are urgently needed.