Evaluating the effects of polices on nursing care as promoted by the Veneto region: the research protocol and its implications for public health.

Study design: Multi-centre mixed-method study design organised into several phases. Background: The Veneto region has recently defined a set of policies on nursing care by determining the needed amount of daily care in minutes and by initiating a systematic measurement of nursing outcomes; also, with a more recent policy, missed nursing care (MNC) has been established as a process measure of interest. To measure the effect of these policies, a research protocol - aimed at evaluating several end points - has been designed, involving a large target population and hospital units. The aim of this manuscript is to briefly present the research protocol and to discuss the public health implications of its expected end-points. Methods: The endpoints of the protocol are: (a) to describe the frequency of MNC as perceived by nurses; (b) to identify contributing factors; (c) to identify practices adopted in low-occurrence MNC units and to assess the effectiveness of implementing them in units with higher levels of MNC; (d) to explore the relationship between the amount of nursing care provided, MNC, and patient outcomes; and (e) to validate a tool that measures MNC as perceived by patients/caregivers. A total of 3,460 nurses, 5,000 patient/day and 160 nursing coordinators of the medical and surgical units of public hospitals in the Veneto Region will be included. Conclusions: Measuring the association between the amount of nursing care and patient outcomes, as well as evaluating the role of MNC as perceived by nurses and patients in hindering or increasing the risk of some patient outcomes can provide a body of evidence capable of further informing policies in the field, both at the national and at the international level. Moreover, emerging good practices capable of preventing or minimising MNC, sharing and implementing them in other units where high levels of missed care are reported and evaluating their effectiveness, can also inform public health policies.

[Concept analysis of the nursing profession, published from 1994 to 2008]. / Concept analysis sulla disciplina infermieristica pubblicate dal 1994 dal 2008.

Concept analysis is a research method in which concepts are examined in a logical and systematic fashion to form clear and rigorous conceptual definitions. To describe the concept analyses published between 1994 and 2008 and identify the emerging tendencies in the Nursing discipline, a two-staged study has been developed. In the first stage a systematic review of the literature was conducted: research published in the journals indexed in the MedLine, CINAHL and Cochrane databases were judged eligible, if they reported the theme of 'concept analysis' and 'nursing' in the title or in their key words and were published in English language. In the second stage, the articles that emerged were subjected to a content analysis. Some 158 concept analyses emerged, on average 10/year (range 1-22, median 11, +/- 5.6): these regarded 129 different concepts. Ninety-one (57.6%) concepts were focused on the nursing profession, while 67 (42.4%) were focused on the patients. Although in a few cases the effort made by the researchers moved toward the definition of new concepts, in others it appeared oriented toward including in Nursing some typical concepts from other disciplines, thus tracing an expansion of the domain of the Nursing discipline. Monitoring over time the concepts analysed constitutes an important research area to comprehend, both at a national and international level, the progressive evolution of the Nursing discipline.

Development and validation of a test for the assessment of knowledge learned by healthcare students during an online course on COVID-19: cross-sectional study.

ABSTRACT: Many Italian universities during the COVID-19 pandemic had numerous students attending hospital wards. The training of health care students was necessary to prepare for good practices in implementing knowledge about COVID-19 and minimizing contagion among students who carried out the internship. In February 2020, a course aiming to guide health personnel so that they can appropriately address the health emergency posed by the new coronavirus was created, making use of the scientific evidence currently available as well as official sources of information and updates. The aim of this study was the development and validation of a useful tool to evaluate the progress in knowledge regarding COVID-19 of students in degree courses for the health care professions. The reliability of the test was assessed using Cronbach's alpha (α) coefficient, while the responsiveness of the test between T0 and T1 was measured with a student t test. The standard error of measurement was used to calculate the minimal detectable change of the tool. The test is made up of 31 items with four multiple-choice answers, one of which is correct. Fifteen bachelor's degree courses at the Sapienza University of Rome were enrolled, for a total population of 1,017 students from different course years. The test showed good internal consistency, with Cronbach's α values of 0.82. The item-total analysis also showed good results, with homogeneous α values from 0.80 to 0.82 for each item. The student t test showed a difference of 3.59 between T0 and T1 (p < 0.001). The minimal detectable change was 0.47. The test is a useful tool for assessing progress in skills regarding COVID-19 for students from bachelor's degree courses in the health professions. It allows the improvement and acquisition of skills as well as a qualitative analysis of the organization of internship degree courses.

[Assessing quality in clinical educational setting: Italian validation of the clinical learning environment and supervision (CLES) scale]. / La valutazione dellA qualità degli ambienti di apprendimento clinico: studio di validazione del Clinical Learning Environment and Supervision (CLES) nel contesto Italiano.

The clinical learning in the wards is one of the most important moment in nursing education: Instruments assessing the quality of the clinical settings as perceived by students may inform and support the best didactic and tutorial choices. In the last 10 years, three clinical learning environment assessment tools for Bachelor Nursing students has been validated. The aim of this study was to validate in the Italian context the Clinical Learning Environment and Supervision scale (CLES) developed in Finland and considered the gold standard within the instruments available. CLES's face and content validity has been evaluated with forward and backward translation and involving a selected group of experts in the field. 117 Bachelor Nursing Students from Udine and Verona University have been enrolled in the study. 28 out of 117 students have filed the instrument twice in order to measure test-retest reliability. The internal consistency has been evaluated with Cronbach alpha. Kurtosis and skewness was measured in order to verify the answers variability distribution. The CLES Cronbach' alpha was 0.96 and the test-retest reliability was r = -0.89. The validity and reliability of the scale has been confirmed. Further research is needed to define a cut-off in order to recognize positive clinical learning environments. The CLES practical use could support in the process of the teaching hospital accreditation and in the evaluation of the effectiveness of the tutorial strategies activated in the wards.

Nursing care as a predictor of phlebitis related to insertion of a peripheral venous cannula in emergency departments: findings from a prospective study.

BACKGROUND: To date, few studies have investigated the occurrence of phlebitis related to insertion of a peripheral venous cannula (PVC) in an emergency department (ED). AIM: To describe the natural history of ED-inserted PVC site use; the occurrence and severity of PVC-related phlebitis; and associations with patient, PVC and nursing care factors. METHODS: A prospective study was undertaken of 1262 patients treated as urgent cases in EDs who remained in a medical unit for at least 24h. The first PVC inserted was observed daily until its removal; phlebitis was measured using the Visual Infusion Phlebitis Scale. Data on patient, PVC, nursing care and organizational variables were collected, and a time-to-event analysis was performed. FINDINGS: The prevalence of PVC-related phlebitis was 31%. The cumulative incidence (78/391) was almost 20% three days after insertion, and reached >50% (231/391) five days after insertion. Being in a specialized hospital [hazard ratio (HR) 0.583, 95% confidence interval (CI) 0.366-0.928] and receiving more nursing care (HR 0.988, 95% CI 0.983-0.993) were protective against PVC-related phlebitis at all time points. Missed nursing care increased the incidence of PVC-related phlebitis by approximately 4% (HR 1.038, 95% CI 1.001-1.077). CONCLUSIONS: Missed nursing care and expertise of the nurses caring for the patient after PVC insertion affected the incidence of phlebitis; receiving more nursing care and being in a specialized hospital were associated with lower risk of PVC-related phlebitis. These are modifiable risk factors of phlebitis, suggesting areas for intervention at both hospital and unit level.

Impairment of brain neurotransmitter receptors in aged rats.

Dopamine and gamma-aminobutyric acid (GABA) receptor functions have been measured in various brain areas of aged rats. [3H] Spiroperidol binding is decreased in various dopaminergic brain areas, particularly in striatum and tuberculum olfactorium. In striatum the number of binding sites for [3H] spiroperidol is similar in both groups of animals, while the affinity is reduced in senescent rats. Moreover, in the pituitary a 50% increase of [3H] spiroperidol binding was detected in the group of senescent animals. On the other hand, [3H] GABA binding is significantly decreased in substantia nigra and hypothalamus of aged rats, while it is unmodified in cerebral cortex, cerebellum, striatum and nucleus accumbens.

[Met5]-enkephalin-like peptides of the adrenal medulla: release by nerve stimulation and functional implications.

In adrenal chromaffin cells, various molecular forms of polypeptides cross-reacting with [met5]-enkephalin antisera are stored in granules together with catecholamines and soluble proteins. Splanchnic nerve stimulation increases the release of enkephalin-like peptides from the adrenal gland into the adrenal vein. The release of these peptides appears to be mediated by a cholinergic nicotinic receptor. Fractionation of plasma extracts on Bio-gel P-2 shows the presence of only low molecular weight peptides in the resting condition. The low molecular weight fraction contains mainly [met5]-enkephalin and [leu5]-enkephalin. When the splanchnic nerve is stimulated high and low molecular weight peptides are released and the amount of low molecular weight peptides in plasma is increased. The content of enkephalin-like peptides in adrenal venous plasma was similar in control and reserpinized dogs. Splanchnic nerve stimulation increased the peptide content but not the epinephrine content of plasma in reserpinized dogs. This also caused a fall of arterial blood pressure which could be prevented by pretreatment with naloxone. A decrease in blood pressure was also directly elicited by the injection of [met5]-enkephalin-[arg6-phe7]. The duration of the hypotensive effect of this peptide was prolonged by prior injection of captopril.

Bromocriptine and lisuride stimulate the accumulation of cyclic AMP in intact slices but not in homogenates of rat neostriatum.

The effects of bromocriptine and lisuride on cyclic AMP concentrations in homogenates and in intact slices of rat neostriatum were investigated. Significant increases in cyclic AMP concentration were found after a 10-min exposure to bromocriptine and lisuride in striatal intact slices. On the contrary, as previously found, the two dopaminergic ergot derivatives did not stimulate dopamine-senstiive adenylate cyclase present in striatal homogenates. The stimulatory effects observed only in intact tissues were blocked by the specific dopamine receptor blocking agent fluphenazine. It is tempting to conclude that dopaminergic ergot derivatives have a site of action different from that stimulated by classic dopamine agonists in tissue homogenates.

Cotransmitters: pharmacological implications.

The discovery that two or more neuroactive substances coexist in the same nerve terminal suggests that two or more neuroactive compounds can be released by nerve impulses simultaneously and probably act cooperatively at postsynaptic sites. This interaction changes the models of synaptic transmission we have used in the past and imposes a reevaluation of current understanding of synaptic pharmacology. Neuroactive substances co-existing in the same axon terminal can function as "primary transmitter" if they activate the receptor-transducer system or as "cotransmitter" if they modulate the gain of the system. Two examples of synaptic mechanisms in which two neuroactive substances coexisting in the same axon terminal appear to function as primary transmitter and cotransmitter are discussed. These examples are: 1. the modulation of the function of nicotinic receptors of chromaffin cells by endogenous opiate peptides stored in the splanchnic nerve and 2. the modulation of GABA receptor function by benzodiazepines. The understanding of the mechanisms by which primary transmitter and cotransmitter interact at the postsynaptic site may be of obvious importance in elucidating the integrative and discriminative function of the nervous system, in interpreting the action of drugs and in developing new therapeutic agents devoid of untoward side effects.

[Debate in the USA on nurses' delegation of duties to assistants]. / Il dibattito negli USA sulla "delega" delle attività assistenziali.

In the today's rapidly changing practice environment, more nurses than ever are facing delegation dilemmas. The main issues of the debate on delegation of task and activities from nurses to less qualified personnel are reported. Nurses can delegate tasks but remain accountable for the final result. The main rules for delegation are discussed and the need for a correct communication and education to delegate is stressed.

[Characteristics of nursing students attending the University Courses for Nursing Diploma at Trento: reasons for their choices in the first trimester]. / Caratteristiche dei frequentanti e della scelta del D.U.S.I.: il primo triennio a Trento.

Motivations and reasons for the choice of the nursing course were explored in the students applying for the university nursing courses from 1995 to 1998. Aim of the study was to trace a picture of students' characteristics but also to have elements to promote campaigns for increasing the number of applicants. Overall, 183 first year students (70 in 1995; 60 in 1996 and 53 in 1997) were administered a questionnaire with questions related to socioanagraphic data, reasons for the choice of the University Diploma in Nursing Sciences (DUSI) and aspects of the nursing profession considered positive and negative. The 87% of the students had previous work experiences, more than 20% in the health field and a larger number in the social field. The main reasons for choosing the DUSI are the strong connections between theory and practice and the opportunity of working soon after the course. Fifty per cent of the students make definitely up their mind on the final choice of becoming a nurse during the course: in fact only 55% of the students are moderately-strongly convinced of practising the nursing profession when they enter the curriculum. The data are commented on with special attention to the implications for the contents and strategies of a campaign or ad hoc initiatives aimed at increasing the number of students that apply to the nursing courses.

[The needs of relatives of patients admitted to intensive care units in the Trentino region]. / I bisogni dei familiari dei pazienti ricoverati nelle terapie intensive del Trentino.

The perception of needs of relatives of patients admitted to the Coronary Care Units (CCUs) and Intensive Care Units (ICUs) of the Trentino region was investigated by interviewing 50 relatives and 72 nurses. The questionnaire used for the survey included a list of 31 potential needs of a relative. Relatives and nurses were asked to select 10 needs and rank them according to the perceived priority; the nurses were also requested to rate the level of satisfaction related to each need, on a scale from 1 to 4. The data were collected over a period of 50 days, from the end of May to the beginning of July. The priority ranking of needs by relatives was as follows: being sure that the patient receives the best possible care; that the relative could see a doctor at least once a day; and being contacted and informed on every clinically relevant change in the health-illness status of the hospitalised relative. There was a good correspondence between relatives and nurses' perceptions while no significant differences in the perception of needs was observed between relatives interviewed in CCUs and ICUs, neither between nurses with different levels of expertise. Nurses perceive that the priority needs identified by the relatives are reasonably satisfied.

[PARI-ETLD (Therapeutic Approach and Nursing Research -- Epidemiology and Treatment of Decubitus Lesions]. / PARI-ETLD (Percorsi Assistenziali e Ricerca Infermieristica--Epidemiologia e Trattamento delle Lesioni da Decubito).

Pressure sores are one of the preferred nursing research topics but, in spite of the large number of studies, most questions related to the prevention and treatment of pressure sores remain unanswered. Well designed clinical trials and on sufficiently large samples are very rare and most treatments are routinely used even without a reliable evidence of their efficacy. The PARI-ETLD trial is the occasion for: a. evaluating the efficacy of the Fitostimoline, in the ri-epitelization of superficial pressure sores; b. starting a clinical trial conducted by nurses; c. building a multicentre nursing network for collecting data on the epidemiology of pressure sores and for evaluating the effectiveness of caring strategies and treatments. The protocol presented, with the data collection forms, is an example of feasibility of clinical trials in the nursing practice and offers examples of ways for overcoming common problems related to the implementation of clinical trials in everyday practice.

Securing of naso-gastric tubes in adult patients: a review.

OBJECTIVES: To establish the most effective securing devices and techniques for preventing nasogastric tube displacement or inadvertent extubation, mucosa and skin lesions, discomfort, and complications (ab ingestis pneumonia, reduced caloric intake, mortality) in adult patients. DESIGN: Systematic review of published and unpublished reports in any language, identified by searching 5 electronic databases, websites, reference lists, and existing systematic reviews and papers identified by experts in the field. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Systematic reviews, randomised controlled trials, and comparative studies that compared ≥2 techniques or devices to secure nasogastric tubes in patients 18 years old or older. RESULTS: Five studies (of which two were randomised controlled trials) were included. Four studies reported on bridle versus the tape technique (unbridled). The studies' population was comprised of mostly Intensive Care Unit patients. Four studies measured unintentional dislodgement or removal and found a statistically significant advantage in favour of the bridle. Three studies measured time until failure: two studies compared the bridle versus tape technique whereas the other compared different types of tape. One study did not find any significant difference between the two groups of patients whereas the second demonstrated a significantly longer time until failure in the bridled patients. Three studies comparing bridled and unbridled patients measured adverse events such as external nasal ulceration, epistaxis and sinusitis, and there was no agreement between their results. One study measured caloric intake and found that bridled patients received a higher percentage of their caloric goal than unbridled patients. Only one study analysed the cost-effectiveness of the bridle versus the tape technique and found a cost saving by implementing routine bridling of nasoenteric feeding tubes. Discomfort was not measured in the included studies. CONCLUSIONS: Despite the large number of patients receiving this intervention, there is insufficient evidence to suggest one securing technique or device over another. Data are lacking on the beneficial effects of the various methods or systems. There is little or no statistically significant evidence regarding bridling of nasogastric tubes but more research is needed. There is a need for more well-designed studies conducted in various clinical settings.

Factors associated with nursing students' academic success or failure: a retrospective Italian multicenter study.

With the increasing standardization of nursing education in Europe under the Bologna Process Declaration (1999), there is a growing interest in defining a common concept of academic success and/or failure, measuring associated factors and comparing differences and similarities between different countries. While there is literature available on these issues from other countries, the phenomenon has not been studied in Italy. The aim of this study was to define the factors associated with academic success or failure in an Italian cohort of nursing students on a bachelor's degree course. A retrospective multicenter study design was adopted. All students enrolling in the academic year 2004-05 on two different bachelor's courses in the north of Italy were interviewed. Only 81 of the 117 students considered (69.2%) concluded their course in three years. Multivariate analysis identified two factors determining academic success/failure: good results in the entry examination for the bachelor's degree in nursing sciences were associated with academic success (OR 4.217, IC(95%) 1.501-11.84), while family commitments, e.g. caring for children or elderly people were associated with academic failure (OR 0.120, IC(95%) 0.03-0.471). Academic failure has a strong impact on students, their families, the teaching faculties and the community, and its prevention is a challenge in the countries with a shortage of nurses.

[Professional and working conditions of newly licensed nurses in the province of Trento]. / Condizione lavorativa e professionale degli infermieri neodiplomati in provincia di Trento.

Aim of the survey was to gather information on the occupational situation of recently trained registered nurses of the Trento Province. 484 questionnaires were mailed to all the nurses that obtained their diploma from 1993 to 1995; 379 questionnaires (78%) were returned. Among the 70 subjects not working as nurses, 19 are unemployed, 12 study full time, 26 work full time in other professions, 11 are in the army, all the others work occasionally, but not as nurses. 46% are unsatisfied or partially satisfied with their job; 87.3% would choose again the nursing profession. 20% of the nurses would prefer to work on a part time basis.

[Factors influencing the learning process during apprenticeship. Study of the nursing students' perceptions in the Trento Nursing School]. / I fattori che influenzano i processi di apprendimento in tirocinio. Indagine sulle percezioni degli studenti infermieri nella scuola di Trento.

The characteristics of teaching wards perceived by third year students of Trento nursing school as favouring the clinical teaching and learning were studied. The aim of the study was to identify the characteristics that favour or hamper the learning processes in order to identify the criteria for selecting the teaching wards. An open ended questionnaire was administered to the 60 third year students in may 1996. The most important variables favouring the learning processes were the opportunity to work with a registered nurse and the willingness of the medical and nursing personnel to teach in the word. Sixty-six percent of the respondents consider as pivotal to have a reference person or guidance (head nurses, clinical supervisors, expert nurses); 71.6% of the students find very valuable the variety of clinical cases and technique performed in the wards. Eighty-eight per cent of the students perceive that a good interpersonal relationship between the team and the students is a very important factor while a negative "social climate" has a negative impact on learning. Thirty-six per cent of the students state that a very high workload in the ward does not allow the student to pursue the aims of the educational project.

[Forms and methods of tutorship in the university nursing diploma. Consensus conference in San Miniato, November 1997)]. / Figure e metodi della tutorship nel diploma universitario per l'infermiere. Consensus conference di S. Miniato (Novembre 1997).

The contribution presented is the result of a workshop with the participation of nurses, educationalists and course directors involved in the education of student nurses. The different educational experiences and organizational styles adopted in nursing schools were compared and some reflections on the role and expected competences of the nurse tutor, responsible of the theoretical and practical training of student nurses are formulated. The consensus document analyzes the implications related to the different definitions of the role of the nurse-tutor and each different role is discussed according to the theoretical model it derives from. Different educational strategies are discussed and eventually proposals on the education and educational requirements of the nurse-tutor are made.