Emergency department visits by nursing home residents. A retrospective Italian study of administrative databases from 2015 to 2019.

BACKGROUND: Visits to Emergency Departments (ED) can be traumatic for Nursing Home (NH) residents. In Italy, the rate of ED visits by NH residents was recently calculated as 3.3%. The reduction of inappropriate ED visits represents a priority for National Healthcare Systems worldwide. Nevertheless, research on factors associated with ED visits is still under-studied in the Italian setting. This study has two main aims: (i) to describe the baseline characteristics of NH residents visiting ED at regional level; (ii) to assess the characteristics, trends, and factors associated with these visits. METHODS: A retrospective study of administrative data for five years was performed in the Piedmont Region. Data from 24,208 NH residents were analysed. Data were obtained by merging two ministerial databases of residential care and ED use. Sociodemographic and clinical characteristics of the residents, trends, and rates of ED visits were collected. A Generalized Linear Model (GLM) regression was used to evaluate the factors associated with ED visits. RESULTS: In 5 years, 12,672 residents made 24,609 ED visits. Aspecific symptoms (45%), dyspnea (17%) and trauma (16%) were the most frequent problems reported at ED. 51% of these visits were coded as non-critical, and 58% were discharged to the NH. The regression analysis showed an increased risk of ED visits for men (OR = 1.61, 95% CI 1.51-1.70) and for residents with a stay in NH longer than 400 days (OR = 2.19, 95% CI 2.08-2.31). CONCLUSIONS: Our study indicates that more than half of NH residents' ED visits could potentially be prevented by treating residents in NH. Investments in the creation of a structured and effective network within primary care services, promoting the use of health technology and palliative care approaches, could reduce ED visits and help clinicians manage residents on-site and remotely.

Experiences of people with spinal cord injuries readmitted for continence-related complications: a qualitative descriptive study.

STUDY DESIGN: Qualitative descriptive. OBJECTIVES: To describe the experiences of people with Spinal Cord Injury (SCI) re-admitted to the hospital due to continence-related complications. SETTING: Inpatient service of a large spinal unit in North-West of Italy. METHODS: Semi-structured interviews were conducted on a purposive sample of people with SCI (n = 11; age range 22-66 years, n = 5 females, n = 6 with cervical injuries), audio-recorded, and transcribed verbatim (duration range 38-52 min). Data were analysed inductively using the thematic analysis approach as described by Braun and Clarke. RESULTS: Three main themes were identified: (i) managing the frustration of continence-related complications; (ii) finding your way to deal with continence-related complications; (iii) identifying precise needs to deal with continence-related complications. Obtained findings highlighted the perceived emotional and physical burden suffered by people with SCI and their caregivers regarding the constant look for solutions and renounces to social participation, the different strategies implemented to address continence-related complications, and the unmet or partially met needs of people with SCI regarding support in transition to the community, infrastructure, and reliable information or education. CONCLUSIONS: Continence-related complications have a significant impact on the lives of people with SCI and their families. Interventions using technological tools and peer participation could reduce the burden associated with continence-related complications. Specific instruments are needed to facilitate evaluation, goal setting, and promote discussion of continence to allow HCPs to support people with SCI. Structured follow-up for SCI survivors should also focus on their needs to improve knowledge, facilitate decision making, and promote preventive behaviours.

Quality improvement interventions to prevent the use of hospital services among nursing home residents: protocol for a systematic review and meta-analysis.

INTRODUCTION: Quality improvement interventions are a promising strategy for reducing hospital services use among nursing home residents. However, evidence for their effectiveness is limited. It is unclear which characteristics of the quality improvement intervention and activities planned to facilitate implementation may promote fidelity to organisational and system changes. This systematic review and meta-analysis will assess the effectiveness of quality improvement interventions and implementation strategies aimed at reducing hospital services use among nursing home residents. METHODS AND ANALYSIS: The MEDLINE, CINAHL, Cochrane Library, Embase and Web of Science databases will be comprehensively searched in September 2023. The eligible studies should focus on the implementation of a quality improvement intervention defined as the systematic, continuous approach that designs, tests and implements changes using real-time measurement to reduce hospitalisations or emergency department visits among long-stay nursing home residents. Quality improvement details and implementation strategies will be deductively categorised into effective practice and organisation of care taxonomy domains for delivery arrangements and implementation strategies. Quality and bias assessments will be completed using the Quality Improvement Minimum Quality Criteria Set and the Joanna Briggs Institute Critical Appraisal Tools.The results will be pooled in a meta-analysis, by combining the natural logarithms of the rate ratios across the studies or by calculating the rate ratio using the generic inverse-variance method. Heterogeneity will be assessed using the I2 or H2 statistics if the number of included studies will be less than 10. Raw data will be requested from the authors, as required. ETHICS AND DISSEMINATION: Ethical approval is not required. The results will be published in a peer-review journal and presented at (inter)national conferences. PROSPERO REGISTRATION NUMBER: CRD42022364195.

[Patient and public involvement in research]. / Il coinvolgimento della popolazione e dei pazienti nella ricerca.

. Patient and public involvement in research. Patient and public involvement (PPI) entails research being carried out 'with' members of the public, rather than 'to', 'about' or 'for' them. The word public can refer to patients, potential patients, carers and people who use health and social care services, people from organisations that represent people who use services as well as members of the public. People with lived experience of a particular service or health condition may add value to the research and even influence the research question. The involvement may occurr in any stage of the research process, but preferably since the very start, when the study is designed. To obtain a real involvement and participation some practical tips are suggested. In this paper advantages but also difficulties related to PPI are presented, based both on the literature but also from the authors' experience.

[The use of health information systems for planning community care]. / L'uso dei sistemi informativi sanitari come strumento di pianificazione territoriale.

. The use of health information systems for planning community care. The health information system (HIS) integrates data collection, processing, reporting, and use of the information useful to measure and assess health and social care for improving their management. HIS has great potential to reduce healthcare costs and improve outcomes. Information may be used to plan community-based care interventions by identifying populations at risk, especially by community healthcare professionals (e.g., family/community nurses). In Italy, HIS collects health and social information of individuals cared by the National Health Service. This paper has two main objectives: (i) to provide an overview of the main existing health and social HIS Italian databases; (ii) to describe the experiences of use of the information of HIS databases in the Piedmont Region.

A Situation-Specific Theory of End-of-Life Communication in Nursing Homes.

High-quality end-of-life communication between healthcare professionals (HCPs), patients and/or their family caregivers (FCs) improves quality of life and reduces non-beneficial care at the end of life. Nursing homes (NHs) are among the contexts at the forefront of these conversations. Having a solid theoretical basis for the role of end-of-life communication in NHs in transitioning to palliative-oriented care can offer indications for research, practice, education, and policy related to geropalliative care. This study aimed to develop a situation-specific theory of end-of-life communication in NHs by refining an existing theory. A four-step integrative approach was employed that included: (1) checking the assumptions for theorization; (2) exploring the phenomenon through multiple sources; (3) theorizing; and (4) reporting. All elements of the existing end-of-life communication theory in NHs were confirmed: end-of-life communication improved the understanding of FCs about their relatives' health conditions, shared decision-making, and reflections on the desired preferences of residents/FCs for care at the end of life. Furthermore, the family environment affected the burden of FCs in the decision-making process. Finally, time and resource constraints, regulations, visitation restrictions due to the COVID-19 pandemic, and social and cultural values influenced the quality and timing of communication. The study findings confirmed the impact of the political, historical, social, and cultural context on end-of-life communication, thus providing the basis for a situation-specific theory.

The Contribution of Dance Movement Therapy in Promoting Nursing Students' Interpersonal Skills during the COVID-19 Pandemic: A Descriptive Phenomenological Study.

During the COVID-19 pandemic, most universities closed or reduced clinical placements (CPs), limiting nursing students' opportunities to practice communication and interpersonal skills before graduating. When applied in nursing curriculums, Dance Movement Therapy (DMT) enhances students' understanding of the theoretical concepts of communication and interpersonal skills, representing a valuable educational tool when CPs are reduced, as during the COVID-19 pandemic. This descriptive phenomenological study aims to describe the contribution of DMT in promoting third-year nursing students' relational skills during the COVID-19 pandemic. Thirty-four nursing students who attended a DMT workshop completed a reflective journal. Data were analysed using content analysis. Three themes emerged: struggling to care for patients during the COVID-19 pandemic, lived experience of DMT, and professional identity development. The first theme illustrates the connection participants made between their experiences during the DMT workshop and the caregiving challenges imposed by the pandemic; the second theme describes how the workshop fostered emotional and physical connections among its participants; the third theme focuses on the awareness participants acquired regarding their professional role during the workshop. When CPs opportunities are limited, DMT workshops can represent an educational tool to promote interpersonal and communication skills among nursing students, facilitating their transition into the profession.

Association between sleep quality and participation in people with spinal cord injury: A preliminary study.

Objective: To explore the association between perceived sleep quality and participation in people with spinal cord injury (SCI).Design: Cross-sectional study.Setting: Spinal unit at the Città della Salute e della Scienza University Hospital of Turin, Italy.Participants: From May to July 2019, 55 consecutive outpatients were recruited.Outcome measures: A set of structured questionnaires was administered. It included sociodemographic data, the Pittsburgh Sleep Quality Index, the Utrecht Scale for Evaluation of Rehabilitation-Participation, the Spinal Cord Independence Measure Self-Report, the Short Form version 12.2, and the Hospital Anxiety and Depression Scale. T-tests were used to highlight differences between participation and participant characteristics. Bivariate analyses and linear regressions were performed to identify associations between sleep quality and participation.Results: Differences in participation occurred mainly in individuals with a higher level of injury, caregiver dependency, and lower functional level. Participants reporting better sleep quality had more frequent (r = -0.36, P < 0.01), less restricted (r = -0.32, P < 0.05), and more satisfactory participation (r = -0.33, P < 0.01). Linear regression analyses showed that poor sleep quality was significantly associated with reduced participation frequency (ß = -0.30, P = 0.03) and less satisfaction with participation (ß = -0.49, P < 0.001). Moreover, age, number of hours slept at night, and time since injury were associated with satisfaction with participation.Conclusions: An association was found between sleep quality and participation in people with SCI. Given the high prevalence of sleep problems and their association with all dimensions of participation, the promotion of sleep quality should be encouraged because it may positively affect participation.

Incidence and mortality of spinal cord injury from 2008 to 2020: a retrospective population-based cohort study in the Piedmont Region, Italy.

STUDY DESIGN: Retrospective population-based cohort study. OBJECTIVES: To determine the incidence and mortality of spinal cord injuries (SCI) in the Piedmont Region of Northwestern Italy. SETTING: Publicly-funded SCI rehabilitation centres in the Piedmont Region. METHODS: Administrative databases were used to identify individuals at their first admission to a SCI rehabilitation centre from January 1st, 2008 to December 31st, 2020. Cases were stratified by age and aetiology (traumatic SCI, TSCI; non-traumatic SCI, NTSCI). Age- and aetiology-specific incidence rate and person-year mortality rates were calculated for each year. Case lethality was reported as deaths among prevalent cases for each year. RESULTS: A total of 892 cases were identified (56.4% TSCI). The average annual crude incidence rate was 17.9 per million population, decreasing from 26.0 in 2008 to 10.8 in 2020. Young adults and the elderly represented the majority of TSCI and NTSCI cases, respectively. Of the 235 individuals who died during the study period, 58.3% had NTSCI. The mortality rate per 1000 person-years decreased from 16.3 in 2009 to 8.5 in 2020, while case lethality more than tripled (from 17.2 in 2009 to 57.1 in 2020). CONCLUSIONS: We identified a decreasing trend in SCI incidence and mortality rates, with an increased case lethality over the study period, especially in NTSCI. Given these changes in the epidemiology of SCI, community services offered after rehabilitation should be strengthened to enhance their effectiveness and contribute to increased survival in this population.

Ten-Year Trend in Emergency Department Visits for Sexually Transmitted Infections among Adolescents: A Retrospective Cross-Sectional Study in Italy.

Sexually transmitted infections (STIs) are frequently underdiagnosed, representing a serious public health concern, especially during adolescence and in more vulnerable communities. AIM: to describe the last ten years of emergency department (ED) visits for STIs among adolescents. METHODS: a retrospective cross-sectional observation was carried out in the Piedmont region in Italy. Data were retrieved through the Italian National Information System database. ED visits related to specific ICD-9-CM codes carried out on 11 to 19-year-old youths between 2011 and 2020 were investigated. Age-specific, crude, and standardized rates and admission ratios, with 95% confidence intervals (CIs), were calculated to estimate the STI trend. RESULTS: from a total of 1,219,075 ED visits, 339 were related to STIs, representing an increasing ratio of 28 per 100,000 visits, primarily in females. Most infections occurred in girls (83.5%) and among 17 to 19-year-olds (71.5%). A drop in both ED visits and STI cases was observed in 2020. Genital Herpes and Genital Warts were more frequent in girls while Gonorrhea was more frequent in boys. CONCLUSIONS: the increasing trend of ED visits for STIs, particularly in girls, represents an emerging relevant public health issue that needs to be urgently tackled.

[Community as learning opportunity for nursing students: The Lavàl Project of Val Chiusella]. / La comunità come occasione di tirocinio per gli studenti infermieri:Il progetto La Vàl. della Val Chiusella.

. Community as learning opportunity for nursing students: The LaVàl. project of Val Chiusella. INTRODUCTION: The new competencies required for Family and Community Nurses (FFCN) involve the ability to make a community diagnosis. AIM: To describe the steps in designing an innovative internship for university students (nurses, anthropologists, educators, sociologists etc.). METHODS: After involving the municipalities, associations and local community networks, the students were asked to enter the community, keep a diary of what they had done and observed, and the nursing students were asked to produce a report based on the synthesis of the diaries, in which they would highlight the specific features, strengths, weaknessess and potentials for development of the observed community. RESULTS: As of 31 March 2022, 50 nursing students and 6 FFCN Master's students had thier practical training in addition to anthropology, sociology, geology an occupational therapist students. By 30 September 2022, 20 nursing students, 10 Master's and Master's degree students, are expected. 96 hours of interviews were carried out with local residents, meetings were held with 30 Associations and 40 events, meetings and assemblies, 12 meetings for Walking Groups, Adapted Physical Activity and Pilates, 70 hours of direct observation in the five pharmacies and 100 hours of debriefing, supervision and multidisciplinary discussion to rework and systematise the information acquired were conducted. CONCLUSIONS: An innovative experience of training in making community diagnosia and projects for solutions for a community is feasible. However, both the organisational and local concertation prerequisites are necessary to make these experiences possible.

[Census of experiences implemented during the Covid period in the Novara, vercelli, Vallemaggia and Locarno areas]. / Censimento delle esperienze attuate in epoca Covid nei territori di Novara, Vercelli, Vallemaggia e Locarno.

. Experiences implemented during the Covid period in the Novara, Vercelli, Vallemaggia and Locarno areas. INTRODUCTION: The Covid-19 pandemic promoted the organization of several initiatives for the elderly. AIM: To map the local district initiatives for citizens >65 years active during the Covid pandemic in 3 districts of Piedmont and Ticino Canton. METHODS: The data were collected through interviews, contacting local Institutions, volunteer organisations and associations and through free research on the web and on institutional websites. RESULTS: The 26 interviews were conducted between August and September 2022: 16 in the Novara area, 4 in Vercelli and 6 in Canton Ticino. Forty-six initiatives were collected, mainly addressing social-healthcare needs, of which seven were already active in the pre-covid period; overall eight are still ongoing. The initiatives consisted of listening windows, home support (meals, shopping, face-masks, delivery of clean clothes to hospitalized patients). 31 were activated by public services with the collaboration of voluntary services. CONCLUSIONS: The mapping of the initiatives showed their heterogeneity and the fundamental role of volunteering in guaranteeing the continuity of supporting services. These experiences should be consolidated over time by institutions and the public health service, enhancing the contribution of volunteers.

Emergency Department Visits Before, After and During Integrated Home Care: A Time Series Analyses in Italy.

BACKGROUND: Integrated home care (IHC) is one strategy to provide care to people with multiple chronic conditions, and it contributes to the reduction of unnecessary emergency department (ED) use, but there are conflicting results on its effectiveness. In this study, we assessed the frequency and characteristics of ED visits occurring before, during, and after IHC in a large cohort of IHC patients enrolled over 6 years. METHODS: The analysis included 39 822 IHC patients identified in Italian administrative databases. Patients were grouped in tertiles according to IHC duration (short, intermediate, and long) and the number of ED visits during IHC was compared to that the 12 months before IHC enrolment and in the 12 months after IHC discharge across IHC duration groups. RESULTS: We observed a reduction in ED visits during IHC. IHC was significantly associated with a reduction in ED visits in the long and short IHC duration groups. A non-significant reduction in ED visits was observed in the intermediate IHC duration group. A 90% reduction in ED visits during IHC and a 45% reduction after IHC was observed in the short IHC duration group. Corresponding reductions were 17% and 64% during and after IHC, respectively, in the long IHC duration group. CONCLUSION: IHC was effective in reducing ED visits, but expansion of IHC to include additional necessary services could further reduce ED visits. Investment in the creation of a structured, effective network of engaged professionals (including community care services and hospitals) is crucial to achieving this.

Trajectories and determinants of emergency department use among nursing home residents: a time series analysis (2012-2019).

BACKGROUND: Emergency department (ED) use among nursing home (NH) residents is an internationally-shared issue that is understudied in Italy. The long term care in Italy is part of the health system. This study aimed to assess trajectories of ED use among NH residents and determinants between demographic, health supply, clinical/functional factors. METHODS: A pooled, cross-sectional, time series analysis was performed in an Italian region in 2012/2019. The analysis measured the trend of ED user percentages associated with chronic conditions identified at NH admission. A GLM multivariate model was used to evaluate determinants of ED use. The variables collected were sex, age, assistance intensity, destination after discharge from NH, chronic conditions at NH admission, need for daily life assistance, degree of mobility, cognitive impairments, behavioural disturbances and were taken from two databases of the official Italian National Information System (FAR and C2 registries) that were combined to create a unique and anonymous code for each patient. RESULTS: A total of 37,311 residents were enrolled; 55.75% (20,800 residents) had at least one ED visit. The majority of the residents had cardiovascular (25.99%) or mental diseases (24.37%). In all pathologies, the percentage of ED users decreased and the decrease accelerated over time. These results were confirmed in the fixed effects regression model (coefficient for linear term (b = - 3.6177, p = 0, 95% CI = [- 5.124, - 2.1114]); coefficient for quadratic term = - 0.7691, p = 0.0046, 95% CI = [- 1.2953, - 0.2429]). Analysis showed an increased odds of ED visits involving males (OR = 1.27, 95% CI 1.24;1.30) and patients affected by urogenital diseases (OR = 1.16, 95% CI [1.031-1.314]). The lowest odds of ED visits were observed among subjects aged > 90 years (OR = 0.64, 95% CI [0.60-0.67]), who required assistance for their daily life activities (OR = 0.86; 95% CI = [0.82, 0.91]), or with serious cognitive disturbances (OR = 0.86; 95% CI = [0.84, 0.89]), immobile (OR = 0.93; 95% CI = [0.89, 0.96]), or without behavioural disturbances (OR = 0.92; 95% CI = [0.90, 0.94]). CONCLUSIONS: The percentage of ED users has decreased, through support from the Italian disciplinary long-term care system. The demographic, clinical/functional variables associated with ED visits in this study will be helpful to develop targeted and tailored interventions to avoid unnecessary ED use.

Impact of the Timing of Integrated Home Palliative Care Enrolment on Emergency Department Visits.

BACKGROUND: The association between timing of integrated home palliative care (IHPC) enrolment and emergency department (ED) visits is still under debate, and no studies investigated the effect of the timing of IHPC enrolment on ED visits, according to their level of emergency. This study aimed to investigate the impact of the timing of IHPC enrolment on different acuity ED visits. METHODS: A retrospective, pre-/post-intervention study was conducted from 2013 to 2019 in Italy. Analyses were stratified by IHPC duration (short ≤30 days; medium 31-90 days; long >90 days) and triage tags (white/green: low level of emergency visit; yellow/red: medium-to-high level). The impact of the timing of IHPC enrolment was evaluated in two ways: incidence rate ratios (IRRs) of ED visits were determined (1) before and after IHPC enrolment in each group and (2) post-IHPC among groups. RESULTS: A cohort of 17 983 patients was analysed. Patients enrolled early in the IHPC programme had a significantly lower incidence rate of ED visits than the pre-enrolment period (IRR=0.65). The incidence rates of white/green and yellow/red ED visits were significantly lower post-IHPC enrolment for patients enrolled early (IRR=0.63 and 0.67, respectively). All results were statistically significant (P<.001). Comparing the IHPC groups after enrolment versus the short group, medium and long IHPC groups had a significant reduction of ED visits (IRR=0.37, IRR=0.14 respectively), showing a relation between the timing of IHPC enrolment and the incidence of ED visits. A similar trend was observed after accounting for triage tags of ED visits. CONCLUSION: The timing of IHPC enrolment is related with a variation of the incidence of ED visits. Early IHPC enrolment is related to a high significant reduction of ED visits when compared to the 90-day pre-IHPC enrolment period and to late IHPC enrolment, accounting for both low-level and medium-to-high level emergency ED visits.

Providing Spiritual Care to In-Hospital Patients During COVID-19: A Preliminary European Fact-Finding Study.

Historically, there has be a close relationship between the nursing services and spiritual care provision to patients, arising due to the evolvement of many hospitals and nursing programmes from faith-based institutions and religious order nursing. With increasing secularism, these relationships are less entwined. Nonetheless, as nurses typically encounter patients at critical life events, such as receiving bad news or dying, nurses frequently understand the need and requirement for both spiritual support and religious for patients and families during these times. Yet there are uncertainties, and nurses can feel ill-equipped to deal with patients' spiritual needs. Little education or preparation is provided to these nurses, and they often report a lack of confidence within this area. The development of this confidence and the required competencies is important, especially so with increasingly multicultural societies with diverse spiritual and religious needs. In this manuscript, we discuss initial field work carried out in preparation for the development of an Erasmus Plus educational intervention, entitled from Cure to Care Digital Education and Spiritual Assistance in Healthcare. Referring specifically to post-COVID spirituality needs, this development will support nurses to respond to patients' spiritual needs in the hospital setting, using digital means. This preliminary study revealed that while nurses are actively supporting patients' spiritual needs, their education and training are limited, non-standardised and heterogeneous. Additionally, most spiritual support occurs within the context of a Judeo-Christian framework that may not be suitable for diverse faith and non-faith populations. Educational preparation for nurses to provide spiritual care is therefore urgently required.

Challenges Experienced by Italian Nursing Home Staff in End-of-Life Conversations with Family Caregivers during COVID-19 Pandemic: A Qualitative Descriptive Study.

End-of-life conversations are among the most challenging of all communication scenarios and on the agenda of several healthcare settings, including nursing homes (NHs). They may be also difficult for experienced healthcare professionals (HCPs). This study explores the difficulties experienced by Italian NH staff in end-of-life conversations with family caregivers (FCs) during COVID-19 pandemic to uncover their educational needs. A qualitative descriptive study based on inductive thematic analysis was performed. Twenty-one HCPs across six Italian NHs were interviewed. Four themes described their experiences of end-of-life conversations: (1) communicating with FCs over the overall disease trajectory; (2) managing challenging emotions and situations; (3) establishing a partnership between HCPs and FCs; (4) addressing HCPs' communication skills needs. HCPs had to face multiple challenging situations that varied across the care period as well as complex emotions such as anxiety, guilt, uncertainty, fear, anger, or suffering, which required tailored answers. COVID-19 pandemic increased FCs' aggressive behaviors, their distrust, and uncertainty due to visitation restrictions. HCPs had to overcome this by developing a set of strategies, including adoption of an active-listening approach, supportive communication, and explicit acknowledgement of FCs' emotions. Since communication needs were mostly practical in nature, HCPs valued practical communication training.

Exploring the Use and Usefulness of Educational Resources Among Nurses During the First Wave of the COVID-19 Pandemic: A Cross-Sectional Study.

Nurses needed to learn rapidly how to care for patients with coronavirus disease 2019 (COVID-19). This cross-sectional study identified the educational resources RNs used to learn how to care for these patients, measured the perceived usefulness of the content of these resources, and explored the most relevant educational content sought during the first wave of the pandemic. A total of 799 RNs completed an online survey. Significant differences were found in the educational resources used between RNs who cared for patients with COVID-19 and RNs who did not, as well as for RNs who changed units following the pandemic. The educational resources most often used were also ranked as most useful. The most relevant educational content sought was related to respiratory care techniques and infection containment. These findings provide insight into the educational resources available during the first wave of the COVID-19 pandemic. They could help in developing educational programs relevant to nurses' needs during future pandemics. [J Contin Educ Nurs. 2022;53(2):63-69.].