Valuing dignity in patients in a vegetative state on an intensive rehabilitation ward: improvement project.

AIM: To identify the causes that could hinder the provision of dignified care to patients in a vegetative state. BACKGROUND: In Italy, the incidence and prevalence of people in a vegetative state are increasing. The team members have a clear understanding of the meaning of being mortal and the value of human dignity. METHODS: A descriptive study design was used in an intensive care ward in Northern Italy. An anonymous list with negative factors must be drawn up. RESULTS: Thirty-two team members participated in the study. A lack of time and specific knowledge regarding the care of patients in a vegetative state, involvement of the family and repetition in assistance delivery were the most frequent causes that hinder provision of care to patients in a vegetative state. DISCUSSION AND CONCLUSIONS: The provision of dignity for patients is not an issue related only to the staff in direct contact with patients/clients, but also concerns the entire health care facility (physical structure and organisation). IMPLICATIONS FOR NURSING MANAGEMENT: The nursing coordinator has an important role in the promotion of care based on the respect for the patient's dignity, in the active involvement of staff and in the delivery of quality services to users.

Strain and health implications of nurses' shift work.

OBJECTIVES: The study investigated whether nurses' different working schedules are associated with different levels of job-related strain, health symptoms and behavior. No reports have been accessible in the relevant literature on the possible association between shift work and job-related strain in nurses. MATERIALS AND METHODS: This was a cross-sectional study conducted at a large university hospital in North-East Italy, involving 806 nurses working in selected departments. A multilevel logistic regression was applied to assess the association between work shift conditions and selected outcomes. RESULTS: Night shifts were associated not only with higher odds of having a high Job Demand, but also with lower odds of having a high Decision Authority and consequently with a stronger likelihood of having higher levels of Job Strain (high Job Demand score ≥ 38 and Low Decision Authority). The night shift was associated with various symptoms, particularly exhaustion (p = 0.039) and gastric pain (p = 0.020). Nurses' working schedules did not affect their job satisfaction scores. CONCLUSIONS: It has been confirmed that night shifts are a risk factor for nurses' health perception and working night shifts carries a considerable degree of strain. This is a condition that hospital nursing managements need to consider carefully to avoid burnout in nursing personnel and prevent an excessive turnover in this profession, which is a recurring problem for health care organizations.

Nurse managers' preferred and perceived leadership styles: a study at an Italian hospital.

AIM: The aim of this cross-sectional descriptive study was to compare the different leadership styles based on perceptions of nurse managers and their staff. BACKGROUND: Nurse managers' styles are fundamental to improving subordinates' performance and achieving goals at health-care institutions. METHODS: This was a cross-sectional study. A questionnaire developed by Ekvall & Arvonen, considering three leadership domains (Change, Production and Employee relations), was administered to all nurse managers and to their subordinates at a city hospital in north-east Italy. RESULTS: The comparison between the leadership styles actually adopted and those preferred by the nurse managers showed that the preferred style always scored higher than the style adopted, the difference reaching statistical significance for Change and Production. The leadership styles preferred by subordinates always scored higher than the styles their nurse managers actually adopted; in the subordinates' opinion, the differences being statistically significant in all three leadership domains. IMPLICATION FOR NURSING MANAGEMENT: The study showed that nurse managers' expectations in relation to their leadership differ from those of their subordinates. These findings should be borne in mind when selecting and training nurse managers and other personnel, and they should influence the hospital's strategic management of nurses.

An international survey on attitudes of renal nurses towards older people.

BACKGROUND: Previous studies have indicated that healthcare providers do not enjoy taking care of older people, because of poor attitudes towards the elderly. AIM: The purpose of this cross-sectional study is to identify and describe the attitudes of a worldwide sample of renal nurses towards older people. METHOD: A convenience sample composed of renal nurses worldwide completed a socio-demographic questionnaire and the Kogan's Attitude towards Old People Scale (KOAP). RESULTS: We received 1,061 completed questionnaires from nurses in 12 countries. Participants were mainly female (81%), their average age being 42.69 (SD ± 8.70); 74% of nurses had older people in their families and 51% had lived with older people. The sample reported slightly positive attitudes towards the elderly [mean score (± SD) = 151.50 (± 17.9)]. Attitudes were influenced by continent, country, religion, presence of older people in the family and level of nursing education (p < 0.0001). CONCLUSION: Our study has shown that renal nurses have slightly positive attitudes towards older people but attitudes could be improved with specific information being provided to renal nurses, to obtain better care.

An update review on risk factors and scales for prediction of deep sternal wound infections.

Surgical site infections are the most common nosocomial infections in surgical patients. The preventable and the unmodifiable risk factors for deep sternal wound infections (DSWI) have been amply assessed in the literature. The aim of this review was to describe the results of the numerous published studies to describe all the DSWI risk factors and the scales devised to predict SWI, with a view to providing an update on this issue. A comprehensive search of the Medline and Embase databases was performed (considering studies from January 1995 to April 2011); and a manual search was also conducted using references cited in original publications and relevant review articles. There are several risk factors associated with DSWI, which could be classified in four categories as demographic (e.g. sex and age), behavioural (e.g. smoking and obesity), baseline clinical conditions (e.g. diabetes, hypertension and COPD) and surgical operative risk factors (e.g. duration of operation and emergency operation). Six scales for predicting the risk of DSWI are described in the literature: they vary not only in accuracy but also in ease of application and they are applied at different times (some only preoperatively and others also postoperatively). This study provides a broad update on our knowledge of the risk factors for DSWI and the scales for prediction with a view to improving the management of infections at cardiosurgery units.

A retrospective study of nursing diagnoses, outcomes, and interventions for patients admitted to a cardiology rehabilitation unit.

PURPOSE: The aim of this study was to describe the use of nursing terminologies in the care plans made for patients in a cardiology rehabilitation unit. METHODS: We retrospectively examined the clinical documentation for all patients admitted to a cardiology program in a small hospital in the northeast of Italy in 2008. FINDINGS: The sample included 76 patients (87% male) with an average age of 60 years. Care plans included 21 NANDA-I nursing diagnoses and three collaborative problems, 45 Nursing Outcomes Classifications (NOC) and 46 Nursing Intervention Classifications (NIC). The most frequent diagnoses were the following: decreased cardiac output, activity intolerance, and risk for or presence of imbalanced nutrition (more than body requirements). The prevalent outcomes were related to cardiopulmonary physiological health and knowledge about cardiac disease management and diet. The most frequent nursing interventions were the following: exercise promotion, energy management, weight management, medication management, cardiac precautions, cardiac care (rehabilitative), teaching (prescribed activity/exercise and diet), and vital signs monitoring. CONCLUSIONS AND IMPLICATIONS FOR NURSING PRACTICE: Nurses in rehabilitative cardiology care are aware of patients' problems, but projects can improve the coherence between concepts, the attention to psychological problems, and self-care.

Quality of life in adult celiac disease in a mountain area of northeast Italy.

The aim of this study was to evaluate the health-related quality of life in patients diagnosed as having celiac disease and to study the factors involved in its impairment of quality of life. We conducted a cross-sectional study in a randomized sample of patients with celiac disease by administering the Celiac Disease Questionnaire distributed by mail. The association between the quality of life and sociodemographic and clinical variables was verified by means of a stepwise multiple regression model. One hundred ninety-one questionnaires were returned (participation rate = 63.66%), and 187 were analyzed. Women comprised 78.61% of the participants, and the median age was 36 years, 10 months. The mean summary total score in the Celiac Disease Questionnaire was 154.53 (possible range 1-196; higher scores equate with higher quality of life), and the score was lower in the subscale of emotion. Women scored significantly lower than men. Participants with the symptomatic disease scored significantly lower than the nearly asymptomatic patients in the total score and in all the subscales. Symptomatic patients need interventions for improving their quality of life, in particular psychological support.

Socio-demographic factors and processes associated with stages of change for smoking cessation in pregnant versus non-pregnant women.

BACKGROUND: The tobacco control community assumes that the most effective interventions are personalized. Nevertheless, little attention is paid to understanding differences between pregnant and non-pregnant European women in terms of the social factors that influence tobacco use and the processes of change used to quit smoking. METHODS: The study consecutively enrolled 177 pregnant women who acknowledged smoking the year before pregnancy and 177 non-pregnant women who acknowledged smoking the year before their clinic visit for a Pap test. RESULTS: With respect to socio-demographic factors, the stages of change in pregnant women were associated with level of education, marital status, and the presence of roommates, partners and friends who smoke. In pregnant women, there was no statistically significant difference in the processes used to stop smoking among the stages of change. Furthermore, behavioral processes were higher in non-pregnant women than in pregnant women, and the difference was statistically significant in the advanced stages of behavioral change. Both pregnant and non-pregnant women showed higher levels of acceptance towards smoking in the earlier stages of change, but the acceptability of smoking in the pre-contemplative stage was higher in non-pregnant women. Greater craving was detected in non-pregnant vs. pregnant women at all stages and reached a statistically significant level at the pre-contemplative stage. CONCLUSION: Pregnancy is a favorable time to stop smoking since pregnant women are more likely to be in an advanced stage of behavioral change. Pregnant and non-pregnant women are distinct populations in the types and processes of change involved in smoking cessation. The intervention programs to promote smoking cessation and prevent relapses will need to take these differences into account.

[Student nurses' percepted evaluation toward on clinical tutors]. / Valutazione percepita degli studenti infermieri sui tutor clinici.

The practice of assigning a tutor to nursing students is becoming more common. The aim of this study was to assess how nursing students perceived their tutors in the light of the personal and professional characteristics of both trainers and trainees. Nursing students were asked to anonymously fill in a questionnaire to evaluate how they perceived their tutors that included an Italian translation of the Nursing Students' Perceptions of Instructor Caring -Short Version (NSPIC). A total of 243 students , predominantly female (74%) with an average age of 24.6 years were included in the study. On the whole ,tutor evaluation was positive (average 146.3 on a scale ranging from 31-186) and results showed that the personal and professional characteristics of trainers and trainees are not very influential.

Survey on violence and aggression prevention and management strategies in European renal units.

GOALS: This descriptive survey aims to explore strategies for the prevention and management of violence and aggression in renal units in 12 European countries. METHOD: The convenience sample consisting of dialysis, nephrological and transplantation units in European countries was used. A questionnaire, developed with the collaboration of National Associations, was used. Data were analysed using STATA software. A preliminary descriptive variable analysis was performed followed by a verification of the association between variables; values of p < 0.002 were considered statistically significant. RESULTS: A total of 436 completed questionnaires were received (participation rate: 22%). Written policies and procedures regarding violence and aggression are present in 18% of units. Educational strategies are available in less than 20% of units. Incidents are prevented by security staff (48%) or pharmacological treatment (66%). Incident reporting is mandatory for any violent and aggressive behaviour in 66% of units. There are differences between European countries. DISCUSSION AND CONCLUSION: Violence and aggression prevention and management strategies are not widely implemented throughout Europe. The dissemination of information on the prevention and management of violence and aggression is vital.

Perceived aggression towards nurses: study in two Italian health institutions.

AIMS: The goal of the present study was to quantify the perceived aggression towards nurses working in two Italian health care institutions and to verify the hypothesis of an association between the characteristics of aggressors and the type of aggression. BACKGROUND: Violence and aggressiveness, particularly aimed at nurses, are a common, but inadequately investigated phenomenon in Italian health care institutions. DESIGN: A cross-sectional study. METHODS: The study was performed, studying a sample of 700 nurses (37% of the personnel in 94 units) in two health care institutions in northeast Italy using an anonymous multiple-choice questionnaire. RESULTS: Forty-nine percent of the nurses responded that they had experienced aggression in the previous year, 82% of that was only verbal. This happened more often to female nurses working in the emergency department and in geriatric and psychiatric units. A statistically significant association (p < 0.001) was found between the perception of fatigue, stress and work dissatisfaction and the frequency of aggression. Aggressors were usually patients or their relatives (57%) and were mainly men (66%). Fifty-three percent of assaulted nurses did not ask for help after the event. CONCLUSIONS: This study confirms the high incidence of perceived, mainly verbal aggression towards nurses. RELEVANCE TO CLINICAL PRACTICE: Action to prevent aggressive episodes may include concentrating on job motivation, encouraging participatory leadership and promoting the best possible working conditions. The absence of any systematic event reporting and documentation makes the assaulted workers feel defenceless.

Evaluation of psychological outcomes following the intervention 'teaching group': study on predialysis patients.

GOALS: Aims of the study were to evaluate the effects of the intervention 'Group education' (NIC 5604) on patients' coping, fear control, anxiety and the association between demographic and clinical variables with the outcomes. MATERIALS AND METHODS: We studied all predialysis patients treated, at Lleida University Hospital, from 1 January 2007 till 31 March 2008, who received the total intervention for six months. RESULTS: There were 41 patients, 33 male and 8 female. They had a mean age of 60.56 years (SD 13.96); 66% declared family support. Forty-one percent had a low educational level. The Charlson Comorbidity test showed a mean of 5.07 (SD 1.77). All patients were independent, using the Karnofsky scale and Barthel index. Patients reported a significant improvement in all the outcomes evaluated (anxiety, coping and fear response). Logistic regression showed that the reduction in anxiety and the improved nursing outcomes were not related to demographic and clinical variables. CONCLUSION: The group educational programme was effective on the defined psychological outcomes in predialysis patients. Hence, it should be available for all clients.

Quick change versus double pump while changing the infusion of inotropes: an experimental study.

BACKGROUND: Quick change (QC) and double pumping (DP) are common methods of substituting the infusion of inotropes given through intravenous pump. AIMS: The aim of the study was to compare two methods in respect with the variation in mean arterial pressure (MAP). The hypothesis was that the DP method could be the most effective in achieving haemodynamic stability. DESIGN: The study is a randomized research in an open randomized clinical trial. METHODS: The study took place at the Paediatric Intensive Care Unit of Padua Hospital. It considered patients of 0-36 months, not premature, treated with inotropic infusion with monitoring of blood pressure. The research obtained the approval of the Hospital Research Ethics committee and parents signed informed consent. Comparison of the two groups made use of the Wilcoxon test for the continuous variables and the Fisher's exact test for the comparison of frequencies, at significance value of 5%. The data were registered in an Excel spreadsheet and analysed with SAS. RESULTS: The sample comprised 30 patients of age between 1 and 27 months, of whom 13 (43%) were male. They were all affected by cardiac, respiratory or infective pathology, all of them intubated and on artificial respiratory support, sedated and infused with dopamine. The characteristics of the patients of the two groups did not differ significantly. The percentage variation of the baseline value of MAP after 30 min from starting the treatment between the two methods was not statistically significant (p = 0.85). The 95% confidence interval for the difference in the percentage variation of MAP between the two groups was (-3.1, +3.7). From a clinical perspective, the methods are to be considered equivalent. CONCLUSIONS: The study was conducted on a limited sample; no statistically significant differences were detected; QC is the quickest and more cost-effective method.

Comparison of nephrology nursing interventions across five European countries.

Comparing nursing interventions between different countries is helpful towards developing a common nursing culture within Europe. The aim of the study was to compare the frequency of 14 specific nursing interventions indicators across five European countries (Belgium, Scotland, Czech Republic, Greece and the North of England). Data were collected as an integral part of the European Practice Database Project across two cycles (2005 and 2006) involving 172 renal centres. Using Pearson's chi-square and descriptive statistics the frequency of 11 out of the 14 nurse intervention indicators was found to vary significantly across the five countries. Indeed specific nurse interventions such as delegation, telephone consultations and laboratory data interpretation potentially identify where nurse activity is changing in response to pressures such as advancing nurse roles, staff shortages and increased patient demand.

[The waiting process in relatives of patients submitted to surgery: staff perceptions]. / L'attesa dei familiari dei pazienti sottoposti a chirurgia: indagine sulle percezioni del personale.

Waiting for a close relative undergoing health treatment is an issue mainly considered in the light of intensive care structures whereas litte attention had been paid to the waiting process during surgery, particularly with reference to health workers. The aim of this study was to describe how health workers perceived this process and how they behaved, in a small hospital in North-Eastern Italy, by means of a semi-structured interview. The problems and needs perceived by the 41 health workers were mainly psychological: anxiety and stress due to waiting ,lack of information about the operation and post-operative conditions. Results showed that no specific action was taken regarding relatives: information was provided on an individual basis and almost always once the operation had ended. Nurses sustained that this information should be provided by physicians. These results are similar to those published in the literature. Health workers were however aware of the need to provide relatives with adequate support during operations.

Access to intensive care units: a survey in North-East Italy.

The factors associated with policies for allowing visitors into intensive care units (ICUs) are a debated issue in the nursing literature. The aim of this survey was to describe visiting policies in the ICUs of North-East Italy and to verify the hypothesis of an association between attitudes regarding accessibility to visitors and environmental, organisational or logistic variables. Data were collected by means of questionnaires sent by mail to head nurses of ICUs. The questionnaires were completed for 104 of the 110 ICUs contacted (94.5%). Visiting hours were generally less than 4h a day (86%) and only 14% of the ICUs reported imposing no restrictions. Children under 12 years old were rarely admitted (22%). Twenty-one percent of the ICUs reported always allowing exceptions, while 77% did so only under 'particular' circumstances. Visiting times were not associated with logistic and organisational factors, but rather with the type of ICU (p=0.000), city setting (p=0.009), exceptions to rules (p=0.029), allowing more than one person (p=0.016) and opening to children (p=0.001). Restrictive visiting policies emerged; paediatric units were generally more flexible. The association between the variables regarding visiting policy, such as visiting times and exceptions to rules, or allowing more than one person or children, seem to confirm how the rules are influenced mainly by the staff's attitude, which could be changed by continuing professional education.

[Pain and treatment satisfaction: an observational study]. / Dolore e percezione di efficacia del trattamento: indagine osservazionale.

The study has evaluated the subjective pain treatment perception in hospitalized patients with an observational cross-sectional design, using a measurement model based on the American Pain Society-Pain Outcome Modified-Questionnaire (APS-POQ-M). The survey has been designed accordingly with other published studies for results comparison. Data were collected from 350 hospitalized patients - with diagnoses highly related to pain - in 46 medical-surgical units in a large university hospital. Results revealed that 73% of the interviewed declared pain. Current pain, ranged from 0-10, had a median score of 3.8. The worst pain over the last 24 hours scored 6.8 where the 24-hours average pain was 4.9. The patients surveyed reported interference caused by pain in the daily activity, however, they were also generally satisfied with the ongoing pain control treatment. Statistically significant relationships have been found between level of satisfaction with treatment and mood and relationships but none with pain.

[The course from Registered Nurse to Bachelor in Science of Nursing: analysis of four years of experience in the Nursing School of Padua University (Italy)]. / Il perscorso straordinario per l'integrazione dei titoli di studio precedenti: analisi di quattro anni di esperienza del corso di Laurea in Infermieristica dell'Università di Padova.

This article describes the results obtained in four years of rn-bsn course in the nursing school of padua university. From the academic years 2001-02, 2002 students obtained the degree, with good results (medium degree mark: 98/110). Student evaluation of the course was good.

[Survey about the comfort level according to Kolcaba on a sample of oncologic patients]. / Indagine sul livello di comfort secondo Kolcaba su un campione di pazienti oncologici.

Comfort is a basic concept for nursing, studied by many authors; among them Kathy Kolcaba has elaborated a middle range theory about the phenomenon from which she has created various measurement instruments. An explorative analysis has been done to measure the comfort level of 106 patients with cancer, hospitalized in the medical units of an oncologic center of the North-East of Italy. The instrument used was the GCQ, created by Kolcaba and translated in italian. Patients had a medium age of 54 years, they were male in 47%, they were affected by cancer and mostly treated with chemotherapy. The level of comfort was averagely high (7,7 on a scale 1-10), without apparent variations for apparatus affected by cancer, sex and years of disease. There are doubts about the instrument's discrimination skills, probably due to the necessity of a less literal translation and to an adaptation to the Italian context.

European Practice Database: comparative results of the year 1 pilot project.

The European Practice Database (EPD) project, developed by the Research Board (RB) of EDTNA/ERCA, intended to collect data on renal practice at centre level in different European countries. During the pilot phase of the project (2002-2003), Czech Republic, Italy (North East) and England (North) participated with two thirds of all their eligible dialysis centres. Comparative results presented in this paper focus on centre size and patient characteristics, peritoneal and haemodialysis techniques, transplantation, infection control and the employment of technicians, dietitians and social workers in dialysis centres. At centre level, EPD results will enable in-depth evaluation of personal practice. International comparison of the results will stimulate further research and the development of new guidelines.