[The most cited themes in the research in the field of Mental Health: analyses of six international nursing and medical journals]. / I temi più citati nella ricerca nell'ambito della Salute Mentale: analisi di sei riviste internazionali infermieristiche e mediche.

INTRODUCTION: The review aimed to identify and analyse the future development on the topic by analysing the main themes discussed in number of scientific journal focused on Mental Health both by nurses and physicians.. METHOD: 4 international journals focused on Mental health and psychiatry International Journal of Mental Health Nursing, Archives of Psychiatric Nursing, American Journal of Psychiatry, Australian and New Zeland Journal of Psychiatry as well as two journal focused generically on health, Journal of Advanced Nursing and Lancet were scrutinized. We have analysed the papers of 2012-2015 for the specialised journals and last and first 6 months of 2012 and 2013 and 2014-2015 for the generic. Editorials, comments and contributions regarding theoretical models were exluded. From the analysis we identified 9 themes and for each theme the pertinent category. For the diagnostic grouping we used the International Statistical Classification of Diseases and Related Health Problems 10th Revision. RESULTS: A trend in research about mood disorders, schizophrenia and addictions and comorbidity emerged according to the 2099 abstracts analysed. Within medical research antidepressants were the most studied psychotropic medication and cognitive behaviour therapy was the most studied psychotherapy. Within nursing research: the nurse-patient relationship, adherence and monitoring of pharmacological therapy, the treatment planning and the working environment, the nursing training and its efficacy. The clinical research trials were twice as frequent in the medical versus nursing research where qualitative research prevails. CONCLUSION: The research challenge will be to find a new paradigm fit for the future psychiatry having at its disposition the patient's genoma, and needing to routinely use biomarkers for a personalised therapy. A further challenge might be the promotion of interprofessional research between doctors and nurses and the acquisition of new competences of health professionals needed to tackle the reduced life expectancy of psychiatric patients and to address not only their mental illnesses but also their physical ailments.

Health Promotion in Nursing Education: attitudes among nurse students.

BACKGROUND: The World Health Organization (WHO) European Strategy for Nursing and Midwifery has called for the explicit inclusion and application of health promotion in all nursing curricula. However, research indicates that there are deficiencies in nursing education regarding health promotion in both the theoretical and practical elements of education. Insight into the experiences of European nursing students' attitudes, positive or negative, about working in health promotion may provide a clue whether health promotion will be regarded as an important task and to what extent it will have priority in different parts of Europe. AIM: The aim of this study was to compare Italian and Swedish nursing students' attitudes towards health promotion practice on matriculation to nursing school and after a three-year nursing education, and to explore whether attitudes towards health promotion practice correlate with BMI and smoking. METHOD: The study involved students who started their nursing education in autumn 2009 (n =240). Data were collected via a questionnaire. RESULTS: The results show that the Swedish students had a more positive stance on health promotion than Italian students did. After completion of a three-year nursing education programme, Italian students' attitudes on health promotion had improved, while no such development was seen in Sweden. Further, no correlation between lifestyle issues and attitudes to health promotion was found. CONCLUSION: Health promotion in nursing education may have important influence on students' attitudes and thereby on the quantity and quality of future health promotion practice.

Empathy and burnout: an analytic cross-sectional study among nurses and nursing students.

BACKGROUND AND AIM: Empathy is an essential element of good nursing care associated with increased patient satisfaction. Burnout represents chronic occupational stress which diminishes interest in work and reduces patient safety and satisfaction. The purpose of this study was to evaluate the correlation between empathy and burnout in nursing students and nurses. METHOD: This cross-sectional research was conducted in a sample of 298 nurses and 115 nursing students. Socio-demographic and career information was collected. Balanced Emotional Empathy Scale (BEES) and Maslach Burnout Inventory (MBI) were administered. Data were statistically analysed. RESULTS: 63% of our sample answered questionnaires (54% of nurses and 84% of students). The BEES global mean score was slightly inferior to empathy cut-off of 32. In the student group, two BEES dimension scores were statistically significantly higher than nurses (p=0.011 and p=0.007 respectively, t-test). Empathy was negatively related to age (p=0.001, ANOVA). Emotional exhaustion (EE) scores of MBI reported statistically significantly lower levels for students (p<0.0001, t-test). EE was negatively related to BEES mean total score in students (r=-0.307, p<0.002) and nurses (r=-0.245, p<0.002), personal accomplishment of MBI presented positive correlation with BEES mean total scores in students (r=0.319, p<0.002) and nurses (r=0.266, p<0.001, Pearson's correlation). Female students showed superior empathy capacity in comparison to male students in all 5 dimensions of BEES (p<0.001), whereas females nurses in only one dimension (p<0.001). CONCLUSIONS: Our data suggest empathy declines with age and career. High levels of empathy can be protective against burnout development, which, when presents, reduces empathy.

[Exploring moral distress among clinical nurses]. / Esplorando il distress morale tra gli infermieri clinici.

Moral distress in nursing practice is described as a suffering situation that arises when the nurse is unable to act her/his ethical choices, when institutional constraints interfere with acting in the way she/he believes to be right. The aim is to describe nursing practice situations causing moral distress resulting from the recognition of the ethical appropriate actions combined with the impossibility to pursue it; to describe how nurses manage moral distress situations and the strategies to cope with them. A focus group was conducted in three wards of a large teaching-hospital in the north of Italy. In another ward the nurses were asked to write a moral distress experience. A total of 40 nurses were involved and 50 experiences collected. The experiences' analysis has shown 5 source areas of moral distress: 1) clinical decision; 2) nursing competences; 3) nurse-physician collaboration; 4) organization of care; 5) safe care. For each area the most frequent themes were highlighted.Areas of clinical decision, nursing competences, nurse-physician collaboration involve nurse leaders in identification and implementation of strategies for managing moral distress.

Developing empathy in nursing students: a cohort longitudinal study.

AIMS AND OBJECTIVES: To determine whether a specific training course will enhance empathic skills in student nurses during a 3-year degree course. The study considers levels of empathy in student nurses and assesses whether these can be increased. BACKGROUND: Empathy is accepted as a critical component of supportive relationships. Many scholars have argued that empathy provides health professionals with the capacity to improve the health of patients, so it should ideally be taught to make health professionals more responsive to patient needs. DESIGN: Cohort longitudinal study. METHODS: Data were collected using the Italian version of the Balanced Emotional Empathy Scale (BEES). The study was designed to guarantee repeated measurements of levels of emotional empathy in the pre- and postintervention phases. This allowed us to evaluate the development and improvement of empathy and to measure the effects of extra training on the students' empathy skills. Two groups took part in the study: the Intervention and the Control Groups. Students in the Intervention Group attended additional seminars and laboratories in small groups with tutors to learn and develop communicative and empathic abilities. RESULTS: One hundred and three participants (76% women) completed the study. Data showed that the training course was effective, especially for women: BEES scores 31.60 at pre-intervention phase and 42.91 at the end of the academic course. Results regarding men were less clear, and the study discusses these unexpected, anomalous findings. CONCLUSION: According to literature, men and women have different empathic traits, and we found that they show disparate empathic tendencies. More women than men took advantage of the training course. In any case, our data show that specific training courses are effective. RELEVANCE TO CLINICAL PRACTICE: As our study shows, empathy is a skill that may be taught. So it would be advisable to introduce these into the traditional nursing curriculum.

Clinical learning environment and supervision plus nurse teacher (CLES+T) scale: testing the psychometric characteristics of the Italian version.

BACKGROUND: A clinical learning environment is an "interactive network of forces within the clinical setting that influence the students' learning outcomes". International research indicates the Clinical Learning Environment and Supervision plus Nurse Teacher scale (CLES+T) as the gold standard to assess a good clinical learning environment. AIM: This study aims to evaluate the psychometric proprieties of CLES+T Italian version. METHODS: 875 students attending the Bachelor in Nursing in 3 Universities in Italy participated in the study. Cronbach's alpha, item to total correlations, skewness and kurtosis were calculated; factor analysis was performed using Principal Axis Factoring and an oblique rotation method. RESULTS: Results showed a Cronbach's alpha of 0.95 of the scale and ranging from 0.80 to 0.96 among factors; all items verified item to total correlation and answers' variability criteria. Factor analysis showed a 7-factors model as explaining more than 67% of the variance, the higher variance was explained by the "pedagogical atmosphere" factor (37.61%). The nurse teacher factor in the Italian model is split into 3 sub-factors: theory-practice integration, cooperation with ward staff and relationship with mentor and student. CONCLUSION: These results enable an international debate concerning the theoretical structure of CLES+T and provide a reliable and valid tool for the comparison of supervisory models in guiding nursing students' clinical learning.

Incontinence pad use in patients admitted to medical wards: an Italian multicenter prospective cohort study.

PURPOSE: The purpose of the study was to evaluate the incidence of incontinence pad use among patients admitted to medical wards, the reasons why nurses decide to use an incontinence pad, the extent to which the use of pads is avoidable, and the outcome of inappropriate pad use after discharge from the hospital. METHODS: A prospective cohort study was conducted; patients admitted to medical wards were observed during hospitalization and a 7-day follow-up period after discharge. SUBJECTS AND SETTING: The study was conducted in 2 acute-care units in Northern Italy. All new patients admitted to the units were recruited. RESULTS: At the time of admission to the hospital, in addition to the 120 patients who already used incontinence pads, there was a 34% incidence of new cases (98/286). The most frequent reason why nurses decided to use this aid was incontinence caused by space-time disorientation, followed by limited mobility, incontinence, patient request, nursing shortage, and involuntary urine leakage not perceived by patient. Seventy patients out of 208 used incontinence pads unnecessarily for a total of 544 days. CONCLUSIONS: Decisions about the use of the incontinence pads are not always consistent with research-based or literature-based suggestions. Nurses should develop clinical guidelines or protocols for the appropriate use of incontinence pads.

[Relatives of hospitalized geriatric patients: their needs of information, counseling, and access]. / I familiari del paziente geriatrico in ospedale: i loro bisogni di informazione, counselling e accessibilità.

The perception of needs of relatives of patients admitted to geriatric units was investigated by interviewing 70 relatives of patients admitted to the geriatric ward of Verona hospital, over 45 consecutive days. The self compiled questionnaire used for the survey included a list of 22 potential needs referring to three categories: information, counselling and accessibility. Relatives were asked to rate them, on a scale from 1 to 4, according to the perceived priority and level of satisfaction. The relatives rank as most important the information need: the need of receiving information on the illness and its' course; of being contacted and informed on every clinically relevant change in health-illness status and being sure that the patient receives the best possible care. The level of satisfaction for information, counselling and accessibility is low. The perception of needs is influenced by the level of education or the relative.