What do family caregivers of people with dementia need? A mixed-method systematic review.

Caring for people with dementia is a major challenge for relatives and society worldwide. Understanding the family caregivers' needs is crucial to promote their care-giving role during the disease trajectory. The aim of this mixed-method systematic review was to identify and synthetise the existing literature on the needs of family caregivers of people with dementia at home. PubMed, CINAHL, Cochrane Database of Systematic Reviews and PsycINFO databases were systematically explored to find quantitative, qualitative and mixed-method studies published between 2009 and 2019. A total of 1,196 citations were retrieved and 34 studies were included in the review. The variety of interrelated needs emerged from studies has been summarised in four themes: (a) Being supported, (b) Receiving accessible and personalised information, (c) Being trained and educated to care for their beloved with dementia and (d) Finding a balance. Care-giving for individuals with dementia is an ever-changing process characterised by continuous adjustments to their needs. The majority of a family caregivers' needs are oriented towards receiving support, help in offering daily care and finding a balance between the care-giving role and their own personal needs. For family caregivers, receiving information is a priority to improve their knowledge and to develop coping abilities, care skills and strategies aimed at promoting a balance between care assistance duties and their own needs. They also need social, psychological and emotional support and access to flexible, tailored and timely formal care. Further studies are recommended to detect changes in family caregivers' needs throughout the disease progression in order to tailor formal care offered by social and healthcare services.

Influenza vaccination and absenteeism among healthy working adults: a cost-benefit analysis.

BACKGROUND: Seasonal influenza is a highly contagious infection that might lead to serious clinical complications and incurs a conspicuous socio-economic impact. Influenza vaccination is currently recommended only for specific groups of healthy adults (such as healthcare workers) even though it was demonstrated to be effective in reducing absenteeism and decreased workers' productivity during flu epidemic period. The main purpose of this study is to analyse the extent of absences due to illness following a voluntary flu immunization program among the Komatsu Italia Manufacturing company's personnel during the flu season 2017-2018. Secondly, we aimed at performing a cost-benefit analysis of the vaccination campaign from the company's perspective. STUDY DESIGN: This is an observational cohort study conducted during the period between the 14th week of 2017 and the 13th week of 2018 (from 03/04/2017 to 01/04/2018). The study population was the personnel of Komatsu Italia Manufacturing S.p.A. on duty during the study period. METHODS: For each subject the following data were collected: sex, date of birth, professional profile, seasonal influenza immunization status and sick-leave days. Sick-leave days were compared among the influenza epidemic period and the previous one between vaccinated and unvaccinated and any difference in days of absence was considered to be caused by seasonal influenza. RESULTS: Out of 408 employees, 60 (14.7%) accepted the voluntary influenza vaccination. In multivariate analysis (logistic model) an age ≥ 50 years was the only predictor for vaccination acceptance (ORM 3.11 p<0.001). During the flu period, the monthly mean of sick-leave days per employee was significantly lower among the vaccinated than the unvaccinated, respectively of 0.328 days/person vs 0.752 days/person (p = 0.022). Unvaccinated employees reported a higher average of sick-leave days during the flu period compared to the previous non-influenza period (0.752 days/month/person vs 0.337 days/month/person p <0.001). The monthly mean cost for sickness absences per employee was significantly higher for an unvaccinated subject compared to one vaccinated, respectively € 129.00 and € 54.00 (p = 0.028). The overall net saving estimated was € 314.00 per person vaccinated. CONCLUSIONS: Influenza vaccination proved to be an extraordinary preventive tool and a cost-effective intervention. However, influenza immunization seems to be unappealing among healthy adults and higher flu vaccination coverages could be achieved through educational interventions possibly addressing young employees who showed little interest in vaccination. Finally, among health promotion interventions, companies should point out the importance of flu vaccination both for the individual wellbeing and the company environment.

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.

Knowledge and competence with patient safety as perceived by nursing students: The findings of a cross-sectional study.

BACKGROUND: Ensuring safety in health-care settings is provoking improvements both in education and clinical practice. However, the studies available have not offered to date information regarding knowledge and competence on patient safety (PS) developed by nursing students over their academic career. There is no documentation of the amount of close calls and/or adverse events that students may have witnessed and the degree of safety perceived in the attended clinical settings. OBJECTIVES: To describe the perception of nursing students regarding their own knowledge and competence on PS and describe differences, if any, among students attending the first, second and third academic year. DESIGN: A cross-sectional study design was undertaken in 2013. PARTICIPANTS AND SETTING: A convenience sample of 621 nursing students of two bachelors nursing degrees located in two Italian universities, was the population target of the study. Students attending the first, second and third academic year, obtaining admission to the annual clinical competence examination, were eligible. METHODS: The Italian version of the Health Professional Education in Patient Safety Survey (H-PEPSSIta) and open-ended questions was administered to the students after having obtained their informed written consent. RESULTS: A total of 573 students (response rate 92.4%) participated. Around a quarter (28.8%) of students reported having experienced an adverse event or close call during their clinical experience. The settings where they learn were perceived as unsafe by 46.9% of students. PS knowledge and competence as perceived by students, was high (Median=4) in all factors and dimensions of the H-PEPSSIta tool. High PS knowledge and competence was reported by first-year students, moderate by second-year students and higher at the end of the third-year. CONCLUSIONS: Faculties and health-care institutions offering clinical placements have to share the responsibility of well-prepared future nurses, working together to improve PS through dialogue when issues are identified by students.