[Investing in healthcare professionals. The motivation for enrollment in bachelor nursing courses: results from a pilot study]. / Investire sul personale sanitario: motivi di iscrizione al corso di laurea in Infermieristica. Risultati dello studio pilota.

. Investing in healthcare professionals. The motivation for enrollment in bachelor nursing courses: results from a pilot study. INTRODUCTION: Understanding the reasons for enrolling in a Bachelor of Science in Nursing (BSc Nursing) is crucial for devising strategies to stimulate enrollment and counteract the current decline in applications. A multi-center longitudinal study was initiated to explore motivations for enrollment and dropout rates. The results of the pilot study focusing on enrollment motives are presented. OBJECTIVE: To identify the reasons for enrolling in BSc Nursing programs at five Italian universities. METHODS: First-year BSc Nursing students enrolled in the academic year 2022-2023 completed an online questionnaire exploring socio-demographic and personal information, priority criteria for their choice, information sources, and the following reasons for enrolling (Likert scale 1-5): altruistic motivations, personal interests, preferences, past experiences, job security, advice, fallback options, and the social image of nursing. RESULTS: 759 questionnaires were analyzed (78% of those involved). 64.7% of the students indicated nursing as their first choice, while one-third enrolled as a fallback option, by chance, or because they were uncertain. Altruism was the primary motivation for enrollment (91.8%), but 74.2% of students enrolled to secure a good job or to pursue a career (52.3%), or due to curriculum counseling sessions (13.7%). Some differences were observed between geographical areas. CONCLUSIONS: Students primarily enroll in BSc Nursing programs due to altruism, personal experience, and job prospect. These findings may be valuable for guiding and tailoring information campaigns, and for enhancing the appeal of nursing courses.

Patients' reports on their delusional memories from the intensive care unit: A systematic review of qualitative studies.

OBJECTIVE: To critically summarise the qualitative literature to understand patients' experiences of delusional memories during their Intensive Care Unit stay. RESEARCH METHODOLOGY: A systematic review of qualitative studies with meta-synthesis and meta-summary. We searched MEDLINE (via PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Web of Science to July 2022. All studies that provided qualitative insights into the subjective experience of adult patients with delusional memories in the Intensive Care Unit were selected. The Critical Assessment Skills Programme checklist was used for the quality assessment. RESULTS: Fourteen studies were included. The 33 codes that emerged from the inductive thematic analysis were grouped into three themes: 'The sense of danger and the terrifying aspect of death' (feeling in danger, surrounded by death, persecuted by people around, and feeling unsafe), 'The presence of someone or something nearby' (perceiving the loved ones, feeling overwhelmed by scary creatures, and being neglected by those around me), and 'The reality behind the world perceived by the senses' (travelling the world, stimulating the senses, feeling peaceful, and living in a fantasy world). The most frequent code in the studies was 'Be with a family member', with an intensity of 35.7%. CONCLUSION: The patient's experience described as delusional is considered a real event by the person experiencing it. Further research is needed to investigate the extent to which these experiences lead to poorer early and late outcomes for patients, and to test strategies to prevent this. IMPLICATIONS FOR CLINICAL PRACTICE: A deeper understanding of the phenomenon may help healthcare professionals to recognise precursors, symptoms and consequences of delusional memories and intervene with appropriate help. One strategy would be to further humanise care and focus on family involvement and communication with patients to overcome the factual events that can potentially alter patients' quality of life.

Diarrhoea and constipation during artificial nutrition in intensive care unit: A prospective observational study.

PURPOSE: To describe the occurrence of gastrointestinal (GI) complications, specifically diarrhoea and constipation, in artificially (enterally or parenterally) fed critically ill patients within their first seven-day stay in Intensive Care Unit (ICU). METHODS: Observational prospective study conducted from September 1st to October 30th, 2019 and from August 1st to October 30th, 2021, in an ICU of a 1000-bed third-level hospital. General characteristics, nutritional variables, and medications administered were recorded and analysed. This study was registered on ClinicalTrials.gov (Identifier: NCT05473546). RESULTS: In total, 100 critically ill patients were included. Diarrhoea was present in 44 patients (44.0%), while constipation occurred in 22 (22.0%) patients. Patients with diarrhoea were generally those admitted for respiratory failure, whereas patients without diarrhoea were mostly affected by neurological disorders (22.7% vs 25%, respectively; p = 0.002). Likewise, patients with constipation were primarily those admitted for trauma (36.4%). Trauma patients were almost 24 times more likely to be constipated than patients with respiratory failure (OR 23.99, CI 1.38-418.0) and patients receiving diuretics were over 16 times more likely to have diarrhoea than patients not receiving diuretics (OR 16.25, IC 1.89-139.86). CONCLUSION: GI complications of enteral nutrition represent still a very common issue in ICU. The main predictor of constipation was an admission for trauma whereas the main predictor of diarrhoea was the use of diuretics. Clinicians should consider and integrate these findings into more personalized nutritional and management protocols to avoid gastrointestinal complications.

The first COVID-19 new graduate nurses generation: findings from an Italian cross-sectional study.

BACKGROUND: Nursing education has been disrupted by the onset of the COronaVIrus Disease 19 (COVID-19) pandemic, potentially impacting learning experiences and perceived competencies at the time of graduation. However, the learning experiences of students since the onset of COVID-19, their perceived competences achieved and the employment status one month after graduation, have not been traced to date. METHODS: A cross sectional online survey measured the individual profile, the learning experience in the last academic year and the perceived competences of the first COVID-19 new nursing graduates in two Italian universities. Details relating to employment status and place of employment (Covid-19 versus non-COVID-19 units) one month after graduation were also collected and the data compared with those reported by a similar cohort of new graduates pre-pandemic in 2018-2019. All those who graduated in November 2020 and attended their third year after the onset of the COVID-19 pandemic were eligible. The online survey included individual, nursing programme and first working experience variables alongside the Nurse Competence Scale (NCS). Descriptive and inferential statistical analyses were performed. RESULTS: A total of 323 new graduates participated. In their last academic year, they experienced a single, long clinical placement in non-COVID-19 units. One month after graduation, 54.5% (n = 176) were working in COVID-19 units, 22.9% (n = 74) in non-COVID-19 units and 22.6 (n = 73) were unemployed. There was no statistical difference among groups regarding individual variables and the competences perceived. Fewer new graduates working in COVID-19 units experienced a transition programme compared to those working in non-COVID-19 units (p = 0.053). At the NCS, the first COVID-19 new graduate generation perceived significantly lower competences than the pre-COVID-19 generation in the 'Helping role' factor and a significant higher in 'Ensuring quality' and 'Therapeutic interventions' factors. CONCLUSIONS: The majority of the first COVID-19 new graduate generation had been employed in COVID-19 units without clinical experience and transition programmes, imposing an ethical debate regarding (a) the role of education in graduating nurses in challenging times with limited clinical placements; and (b) that of nurse managers and directors in ensuring safe transitions for new graduates. Despite the profound clinical placement revision, the first COVID-19 new graduate generation reported competences similar to those of the pre-COVID-19 generation, suggesting that the pandemic may have helped them to optimise the clinical learning process.

The Use of Physical Restraints in Italian Intensive Care Units: Results From a Multicenter Observational Study.

BACKGROUND: The use of physical restraints (PRs) varies across countries and clinical settings, with intensive care units having the highest frequency. Although many investigations on the use of PRs have been conducted worldwide, few studies are reported in the Italian context. OBJECTIVES: The aims of this study were to describe PR rates and types and to observe the factors associated with PR use. METHODS: In this observational study, 2 methods were used to collect data: direct observation and review of patients' documentations. RESULTS: We performed 328 observations on 146 critically ill patients. Physical restraints were applied in 56.7% (n = 186) of these observations. Bilateral wrist ties were used for most PR episodes (n = 135, 72.6%), followed by unilateral wrist ties (12.9%). The most documented reasons were preventing patients from self-extubation (n = 93, 50.0%) and preserving indwelling lines and tubes (n = 60, 32.2%). In the multivariate logistic regression analysis, patients who were cared for during the night shift were almost 4 times more likely to be restrained than patients in the morning shifts (odds ratio, 3.84; P = .001) and patients with endotracheal tube were 3.5 times more likely to be restricted than spontaneously breathing patients (odds ratio, 3.59; P < .001). DISCUSSIONS: Physical restraints are commonly used among critically ill patients in Italian intensive care units. There is a need to share the metrics for an efficient and accurate measurement of PR usage and trends and to document the reason for restraints, type of restraints, timeframe, and decision-making criteria.

Nursing-Sensitive Outcomes among Patients Cared for in Paediatric Intensive Care Units: A Scoping Review.

Measuring the effectiveness of nursing interventions in intensive care units has been established as a priority. However, little is reported about the paediatric population. The aims of this study were (a) to map the state of the art of the science in the field of nursing-sensitive outcomes (NSOs) in paediatric intensive care units (PICUs) and (b) to identify all reported NSOs documented to date in PICUs by also describing their metrics. A scoping review was conducted by following the framework proposed by Arksey and O'Malley. Fifty-eight articles were included. Publications were mainly authored in the United States and Canada (n = 28, 48.3%), and the majority (n = 30, 51.7%) had an observational design. A total of 46 NSOs were documented. The most reported were related to the clinical (n = 83), followed by safety (n = 41) and functional (n = 18) domains. Regarding their metrics, the majority of NSOs were measured in their occurrence using quantitative single measures, and a few validated tools were used to a lesser extent. No NSOs were reported in the perceptual domain. Nursing care of critically ill children encompasses three levels: improvement in clinical performance, as measured by clinical outcomes; assurance of patient care safety, as measured by safety outcomes; and promotion of fundamental care needs, as measured by functional outcomes. Perceptual outcomes deserve to be explored.

The experience of individuals placed in quarantine: A systematic review, meta-summary, and meta-synthesis.

OBJECTIVE: To summarize the experience of individuals placed in quarantine during an outbreak. DESIGN: A meta-summary and a meta-synthesis based upon a systematic review of qualitative studies. SAMPLE: The Cumulative Index of Nursing and Allied Health Literature, MEDLINE, and Scopus databases were all searched up to April 2020. MEASUREMENTS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed; then, the methodological quality of the studies included was assessed with the Critical Appraisal Screening Programme tool for qualitative studies. RESULTS: Five studies have been included documenting the experience of 125 adult individuals. A total of 16 codes emerged: in the meta-summary, the most and least frequent codes were "Thinking about quarantine" (80%) and "Emotional roller coaster," "Being alert for any symptom," "Trusting or not?," "Knowing who brought the infection," and "Living in a surreal world" (20%). The codes which emerged were categorized into three main themes which summarized the whole experience of being placed in quarantine: (a) "Being swamped with a thousand emotions"; (b) "Being restrained"; and (c) "Needing to be considered." CONCLUSIONS: The experience of quarantine for people is a long journey which can feel chaotic due to uncertainty about the consequences on health, work, and the future. The findings of this study can help nurses in caring for quarantined individuals by enabling them to understand people's need for educational and emotional support. Ensuring the supply of consistent information is also important to increase people's compliance.

Pressure Injuries Due to Personal Protective Equipment in COVID-19 Critical Care Units.

BACKGROUND: Caring for patients with COVID-19 requires wearing a full set of personal protective equipment (PPE) to avoid contamination. Personal discomfort has been associated with use of PPE, and anecdotal reports describe pressure injuries related to wearing PPE. OBJECTIVES: To investigate the occurrence of device-related pressure injuries due to wearing PPE among Italian nurses caring for patients with COVID-19 in critical care settings. METHODS: This descriptive study used an online survey investigating both the demographic characteristics of respondents and complications related to wearing PPE, including the development of pressure injuries. RESULTS: A total of 266 nurses throughout Italy completed the survey; 32% of respondents were men. Nurses' median age was 36 years (range 22-59 years), and the median time spent working in their current clinical setting (an intensive care or high-dependency unit) was 3 years (range 0-32 years). Personal protective equipment was worn for a median duration of 5 hours (range 2-12 hours). While wearing PPE, 92.8% of nurses experienced pain and 77.1% developed device-related pressure injuries, mainly on the nose, ears, and forehead. Pain was more frequent among nurses with such injuries. Transparent dressings, emollient cream, and no dressing were associated with development of device-related pressure injury. CONCLUSIONS: Pressure injuries related to PPE represent an important adverse effect for nurses caring for patients with COVID-19. This topic deserves study to determine adequate solutions for preventing and treating such injuries and their potential influence on nurses' work tolerance.

Nurses' experiences of being recruited and transferred to a new sub-intensive care unit devoted to COVID-19 patients.

AIM: To describe the experiences of Italian nurses who have been urgently and compulsorily allocated to a newly established COVID-19 sub-intensive care unit. BACKGROUND: In the context of the COVID-19 pandemic, no studies have documented the experience of nurses urgently reallocated to a newly created unit. METHOD: A qualitative descriptive study. Twenty-four nurses working in a sub-intensive care unit created for COVID-19 patients participated in four focus groups. Audio-recorded interviews were verbatim-transcribed; then, a thematic analysis was performed. RESULTS: The experience of nurses was summarized along three lines: (a) 'becoming a frontline nurse', (b) 'living a double-faced professional experience' and (c) 'advancing in nursing practice'. CONCLUSIONS: Nurses who experienced being mandatorily recruited and urgently reallocated to a COVID-19 unit lived through a mix of negative feelings in the early stages, a double-faced situation during the episode and, at the end, the perception of global growth as a person, as a team and as a professional. IMPLICATION FOR NURSING MANAGEMENT: Nurse managers could play a key role in identifying and preparing nurses in advance to mitigate their concerns and their sense of unpreparedness. The value attributed to nursing care should be promoted both during and after the current COVID-19 pandemic.

Missed nursing education: Findings from a qualitative study.

AIM: To understand what nursing education activities are missed in the daily life of nursing programmes, by also identifying antecedents and consequences of missed educational activities. DESIGN: A descriptive qualitative study according to the COnsolidated criteria for REporting Qualitative research guidelines. METHODS: A purposeful sample of 32 participants with different roles (nurse educators, clinical nurses, students, and administrative personnel) and working in different settings (university, administrative, healthcare service levels) were involved in three focus groups and nine face-to-face interviews from 2019-2020. Both focus groups and face-to-face interviews were audio-recorded and transcribed verbatim. The data that emerged were thematically categorized by induction. FINDINGS: Missed Nursing Education reflects those educational activities needed in the process of nursing education that are missed or delayed. Direct educational activities missed include clinical rotations, classroom teaching and students' overall learning experience. Indirect missed educational activities concern continuing professional development of nursing faculty members, nursing discipline development and the organizational processes of the nursing programme. As antecedents, missed nursing education is triggered by factors at the organizational, nursing faculty, and student levels. Consequences have been reported for students, nursing faculty, clinical nurses, and patients. CONCLUSIONS: Missed Nursing Education can be considered a multifaceted, multicausal phenomenon, with multitargeted consequences. IMPACT: To date, missed nursing care has only been investigated in clinical practice. However, care also permeates the relationship between nurse educators and students. Thus, at the point of 'educational care' delivery, aspects can also be omitted. Educational activities at risk of being missed or delayed affect the quality of nursing education and, in the short- and in the long- terms, also the quality of patient care. Some Missed Nursing Education antecedents can be modified by appropriate strategies that should be addressed by policy, health care and academic institutions.

[Prevalence of mobile phone use among drivers: direct observation in Udine (Northern Italy)]. / Prevalenza dell'utilizzo del telefono cellulare durante la guida: osservazione diretta a Udine.

OBJECTIVES: to measure the prevalence of hand-held mobile phone use among drivers in Udine, Italy. Such behaviour is prohibited by law. DESIGN: direct roadside observation of car drivers. SETTING AND PARTICIPANTS: groups of nursing students on the roadside observed car drivers either waiting at red traffic lights or driving in selected major urban streets of the city of Udine and of two smaller neighboring towns, in one-hour time slots in different days in November and December 2018, for a total of 24 hours of observation. MAIN OUTCOME MEASURES: prevalence of use of handheld mobile phone either for calling or for activities implying visuo-manual interaction (texting or social media browsing), both among drivers waiting at red traffic lights and among those driving along the streets. RESULTS: overall, 8,240 observations of vehicles were carried out. The prevalence of mobile phone use was 9.9% among drivers waiting at red traffic lights and 6.5% among those moving along the streets in Udine; the prevalence was higher in the smaller neighboring towns. Among 6,116 drivers, the type of use has also been recorded: prevalence of texting was 7.2% at traffic lights and 5.0% in moving vehicles; prevalence of phone calls was 3.3% and 3.6%, respectively. Texting represented 68.4% of mobile phone use among drivers waiting at traffic lights and 57.8% among moving drivers. Behaviors of female and male drivers were similar. CONCLUSION: the use of mobile phones among drivers is very common in Udine, particularly for activities involving both the hands and the eyes. Since the increased risk of road accidents caused by this type of distraction from driving activities is well known, interventions discouraging the use of mobile phones among drivers are needed.

Depicting clinical nurses' priority perspectives leading to unfinished nursing care: A pilot Q methodology study.

AIMS: To highlight (a) trends common to all nurses on priorities attributed to interventions, and (b) whether there are profiles of nurses working in the same context who prioritize interventions in a similar way. BACKGROUND: The underlying prioritization of interventions leading to unfinished nursing care has been minimally investigated. METHODS: A 2017 pilot Q methodology study. Full-time nurses, with at least 6 months of experience in a surgical unit, were involved. Eleven nurses rated the priority given in daily practice (from -3 as the lowest to +3 as the highest) to 35 Q-sample statements representing nursing care, non-nursing and organisational interventions. RESULTS: Overall, the intervention receiving the lowest priority was 'Providing patient hygiene', while the highest was 'Answering phone calls'. In the by-person factor analysis (total variance = 60.79%), three profiles of nurses emerged, (a) 'Patient safety-oriented' (variance = 31.66%); (b) 'Nursing task-oriented' (=16.32%); and (c) 'Team process-oriented' (=12.81%). CONCLUSIONS: Three profiles of nurses emerged in the same setting with significant differences both in the statistical order of priorities and in their practical implications. IMPLICATIONS FOR NURSING MANAGEMENT: Understanding levels of prioritization, which are not only affected by the unit but also by sub-groups of nurses who rank priorities in a similar way, can support nurse managers in their role.

Understanding patients' experiences of being mechanically ventilated in the Intensive Care Unit: Findings from a meta-synthesis and meta-summary.

AIMS AND OBJECTIVES: To synthesise the evidence reported in qualitative studies concerning the lived experiences of adult patients receiving mechanical ventilation in Intensive Care Unit (ICU). BACKGROUND: Critically ill patients receiving mechanical ventilation in the ICU have been reported to suffer from severe physical and emotional responses such as hopelessness, anxiety, high levels of frustration and stress. Recent improvements in the field of mechanical ventilation and sedative medications as experienced by patients that can inform nursing care have not been summarised to date. DESIGN: A systematic review of qualitative studies followed by a meta-synthesis and a meta-summary was performed. METHODS: Four electronic databases were searched by two authors in June 2019. A total of nine studies were included and evaluated based on their methodological quality using the Critical Appraisal Skills Programme checklist. RESULTS: A total of 24 codes emerged from the abstraction process, which were categorised into 11 categories and four themes: (a) "The effect of the intense stress on the body's systems," (b) "The induced negative emotional situations," (c) "The feeling of being cared for in a hospital setting" and (d) "The perceived support from the family and loved ones." Furthermore, the most frequent codes across studies were "Being afraid," "Feeling supervised," "Feeling comforted," "Failing to communicate," and "Experiencing difficulties in breathing," with an intensity of 66.6%. CONCLUSION: Patients receiving mechanical ventilation have expressed a general sense of vulnerability, of which critical care nurses need to be aware. RELEVANCE TO CLINICAL PRACTICE: Findings suggest the need for improvements at the nursing, unit, educational and policy levels; furthermore, more research is also required at the international levels given the current trends towards no sedation protocols for the management of ICU patients: listening to their experiences becomes imperative, in order to ensure an awake, comfortable and ventilator-tolerant patient.

Changing the syringe pump: A challenging procedure in critically ill patients.

INTRODUCTION: In the literature, the change of a syringe pump is described as a dangerous situation, especially in the case of vasoactive drug administration. METHODS: Different variables have been studied (central venous pressure, pump displacement in relation to the patient position, utilization of a stopcock, or a neutral displacement needle-free connector between the syringe and the infusion tubing) to understand their influence on medication administration in terms of backflow or bolus creation when changing the syringe. RESULTS: We performed 576 measurements with different combinations. With respect to all the observations, in comparison with "time zero," we found the following differences expressed in microliters: 0 (±1) at the plunger opening; 0 (±3) at the syringe extraction from the pump; 0 (±7) at the syringe disconnection from the infusion tubing; 0 (±11) at the syringe reconnection to the infusion tubing; 1 (±7) at the syringe insertion in the pump; 3 (±23) at the plunger closing; 8 (±33) at the stabilization at the maneuver end. CONCLUSION: The syringe change can be a very critical moment given different influencing variables. Syringe pump position, displaced higher than the patient level, always generates a medication bolus that is higher at the lowering of the central venous pressure value. The presence of a neutral displacement needle-free connector reduces the incidence of boluses. When the pump is placed at the patient level, the presence of neutral displacement needle-free connector reduces the establishment of boluses, even in a central venous pressure of -5 mmHg simulations.

Prone Position in Acute Respiratory Distress Syndrome Patients: A Retrospective Analysis of Complications.

BACKGROUND: Early application of prolonged prone positioning has been shown to improve patient survival in moderate to severe adult respiratory distress syndrome (ARDS) patients. Prone position is a key component of lung protective mechanical ventilation in association with low tidal volume and neuromuscular blocking agents in patients with severe ARDS. Pressure sores are the major prone position complication. The rate of complication is lowering with the increase in center expertise. AIMS: The aim of this study was to examine the onset of pressure sores and other complications caused by the use of prone position in patients having ARDS. DESIGN: This is a single-center, retrospective, observational study. RESULTS: One hundred seventy patients were enrolled, with a median age of 49 years (interquartile range [IQR], 38-63). Of all participants, 58% (n = 98) survived the intensive care unit recovery. The total prone position maneuvers were 526, with a median of 2 prone position sessions for each patient (IQR, 1-3). The median length of the prone position session was 9 hours (IQR, 7-12). Twenty-three patients developed pressure sores after prone position (14%). The anatomical positions of pressure sores were as follows: face/chin, 5% (n = 8); face/cheekbones, 6% (n = 11); thorax, 2% (n = 3); trochanter, 1% (n = 1); and other sites, 5% (n = 8). Complications were observed in 1% (n = 6) of all pronation maneuvers (vomit, 2%; respiratory device removal, 0.4%). No removal of intravascular catheter was observed. CONCLUSIONS: The onset rate of complications given by the use of prone position in ARDS patients is similar to data reported by previous literature. The implementation of a dedicated protocol in specialized centers and the involvement of 5 trained and skilled professionals while moving the patient in the prone position are recommended to prevent the occurrence of similar adverse events.

Sleep deprivation determinants as perceived by intensive care unit patients: Findings from a systematic review, meta-summary and meta-synthesis.

OBJECTIVES: To summarise evidence on sleep deprivation and/or poor sleep determinants as experienced by intensive care unit patients. RESEARCH METHODOLOGY/DESIGN: A systematic review of qualitative studies identified through PubMed, CINAHL and Scopus databases published in English up to 2018 was performed following PRISMA guidelines. The included studies were critically evaluated by using the Critical Appraisal Screening Programme tool. Study findings were then subjected to a meta-summary and a meta-synthesis. SETTING: Intensive Care Units. MAIN OUTCOME MEASURES: Critically ill patients' experiences of sleep deprivation. RESULTS: Seven qualitative studies were included documenting the experience of 109 adult patients. A total of 12 codes emerged as causes of sleep deprivation and 'feeling fear/concern' was reported with the greatest frequency (71.4%) in the meta-summary. The 12 codes were categorised into three main themes influencing both directly and also interdependently the quality of sleep: (1) Experiencing complex interactions with the environment (nursing activities, frightening or disturbing sounds, acceptable sounds, time and space disorientation); (2) Undergoing intensive emotions and feelings (fear/concerns, state of abandon, inexplicable insomnia, inability to move, inability to talk) and (3) Receiving an appropriate standard of care (physical pain, feeling safe/unsafe). CONCLUSIONS: Despite the increased relevance of sleep deprivation and poor sleep quality, only a few studies have been performed to date aimed at identifying the factors involved in the phenomenon according to patient experience. The majority of determinants as identified from patients' perspective are modifiable.

Nursing Activity Score for estimating nursing care need in intensive care units: findings from a face and content validity study.

AIM: To re-evaluate the face and content validity of the Nursing Activity Score currently adopted in evaluating activities that best describe workloads in intensive care units and their weight in describing average nursing time consumption. BACKGROUND: The Nursing Activity Score calculates the amount of nursing time that each patient will require over the next 24 hours. It has been widely used around the world since its first validation in 2003. However, no re-evaluation of its validity with regard to the advancements achieved in intensive care units nursing care has been documented to date. METHOD: A research project was undertaken from 2012 to 2015, aimed at critically evaluating and validating this tool in the current context of Italian intensive care units nursing care. The 23 items were translated forward and backward into the Italian language, then a panel of 10 experts in critical care evaluated the face validity. Content validity was evaluated through focus groups involving seven critical care expert registered nurses. FINDINGS: The Nursing Activity Score instrument has been considered as not fully adequate to measure current intensive care units nursing activities and their weightings have been considered not fully adequate to score average nursing time consumption. From the content validity process, lack of adequacy has emerged with respect to the concept of nursing care underpinning the tool, the interventions included, its capability to predict the nursing resources needed, advancements achieved in intensive care units nurses' roles and competences, and the contextual factors that may influence consumption of nursing time. CONCLUSIONS: Development of the Nursing Activity Score tool both conceptually and in its structure, in view of the innovations that have occurred in the context of intensive care units, is necessary to continue to have a common tool to help clinicians and managers to capture accurately and compare nursing care required by patients in critical care settings. IMPLICATIONS FOR NURSING MANAGEMENT: There is a need to revise the Nursing Activity Score tool, enabling its use in estimating nursing workloads in current Italian intensive care units practice. A taskforce of clinical nurses and nursing managers, capable of protecting the valuable original Nursing Activity Score project and to advance its further development is recommended.