The risk and prevalence of pressure injuries in older people in the home care service: a cross-sectional study.

OBJECTIVE: This study aimed to understand the risk of developing pressure injuries (PIs) and their prevalence rate in older adults in Italy who received public funded home care services and who were often living alone. METHOD: In May 2019, a cross-sectional study was performed according to the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines. The data collection included demographic variables, a PI risk assessment using the Braden Scale score, the type of mobility devices available, the wound description detailing the PI category, body location and ongoing treatment. Data analysis was conducted using non-parametric descriptive statistics. RESULTS: Of the 2223 patients who participated in the study, the risk of developing a PI as measured with the Braden Scale sore was: 'absent' for 37.7%; 'mild' for 25.8%; 'moderate' for 13.8%; 'high' for 15.5%; and 'severe' for 7.1% of patients. The PI prevalence in the sample of home care service patients was 26%, of which 46% were inpatients with a Braden Scale score of <14. Of the PIs that developed during the study, 65% of these developed in patients in home care and of these, 81% had a Braden Scale score of ≤9. CONCLUSION: PIs developed not only during hospitalisation but at home. Assessing the commitment of patients and caregivers to PI prevention and treatment strategies in home care services could be key to reducing PI prevalence, hospital admissions for PIs, related complications for older people living at home, and the severity of the PI category.

Reporting quality of abstracts from randomised controlled trials published in leading critical care nursing journals: a methodological quality review.

OBJECTIVES: To evaluate the methodological quality of randomised controlled trial (RCT) abstracts in leading critical care nursing journals against the Consolidated Standards of Reporting Trials-Abstracts (CONSORT-A) checklist and to identify variables related with abstract reporting quality. DESIGN: Descriptive methodological quality review. DATA SOURCE: We searched the PubMed database and the websites of each included journal. ELIGIBILITY CRITERIA: We included RCT abstracts published between 2011 and 2021 in the first 11 Scopus-ranking (2021) critical care nursing journals that reported the results of RCTs in English that referred to the care of adult patients with acute/critical illness or their relatives and/or caregivers and conducted in ICUs. DATA EXTRACTION AND SYNTHESIS: Two independent investigators extracted the data using a prespecified 17-item checklist directly derived from CONSORT-A. For the primary outcome, each item was evaluated whether it was adequately reported or not and descriptive statistics were reported. An overall score was calculated by summing the results of all items and multivariate linear regression was conducted to detect potential predictors. RESULTS: Seventy-eight RCT abstracts were included in this review. The items with the highest CONSORT-A adherence were authors, objective, conclusion, participants, interventions and outcome. The randomisation item had the lowest CONSORT-A adherence, followed by trial registration, funding source, harms or side effects, recruitment, blinding and outcome results. The average CONSORT-A score was 8.5±1.5 points (of the maximum 17.5 points). Multivariate analysis indicated that the categorised word score and publication date were positively associated with the overall CONSORT-A score, while the first author's country being in Asia was negatively associated with the overall CONSORT-A score. CONCLUSIONS: The 78 RCT abstracts showed poor overall adherence to CONSORT-A. The results indicate that the methodological reporting quality of RCT abstracts in critical care nursing journals requires improvement to facilitate assessment of the applicability and relevance of the results reported.

[How nurses spend their time-shift and the strategies adopted to maximize it: a scoping review]. / Come spendono il tempo-lavoro gli infermieri e quali strategie utilizzano per ottimizzarlo: una scoping review.

. How nurses spend their time-shift and the strategies adopted to maximize it: a scoping review. INTRODUCTION: Investigating how nurses spend their time during the shifts has become important mainly recently, due to the nursing shortage. AIM: The aims of the study were to map and summarise, (a) how nurses use their time-shift in different care settings, and (b) the time-shift management strategies implemented. METHOD: A scoping review according to the Arksey and O'Malley framework, integrated by Levac and colleagues and the Preferred Reporting Items for Systematic review and Meta-analysis extension-Scoping reviews guideline was conducted in 2021. RESULTS: Thirty-one studies were included (30 primary studies, one secondary), published from 1987 to 2021, mainly conducted in USA, UK and Sweden. Most of them were based on quantitative designs (23/30). In critical and psychiatric settings, the nursing time is dedicated almost equally in direct and indirect care; in the medical, surgical, and oncological units, the direct care activities occupy around the 30% of the nursing time-shift, whereas the indirect care activities increase. In long-term settings the indirect care reaches the 60% of nursing time while in home care around one third of time is spent in direct care. Nurses enact different time-management strategies during the shift. CONCLUSION: Nurses spend limited time at the bedside, as perceived also in the Italian nursing practice; making more visible to patients and their caregivers the value of the indirect care performed by nurses is necessary.

Anticipated nursing care as perceived by nursing students: Findings from a qualitative study.

AIM: To explore the perceptions of nursing students on the phenomenon of anticipated nursing care. DESIGN: A descriptive-qualitative study was performed in 2019 according to the Consolidated Criteria for Reporting Qualitative Research principles. METHODS: Data were collected using 16 face-to-face, audio-recorded interviews across four Italian Bachelor of Nursing degrees. Then, content analysis was performed, identifying, analysing and describing the anticipated nursing care phenomenon as perceived by nursing students. RESULTS: Administering medications, providing fundamentals of care, managing some clinical procedures, freeing up the patient's bed and starting the shifts early emerged as the most anticipated nursing interventions. Stable, older patients who were more functionally dependent were reported to receive some fundamental nursing care before the expected time, while older, stable and more independent patients were used to receiving medications in advance. Anticipated nursing care is triggered by factors at the time management, resource, programming, professional and organizational levels.

Anticipated nursing care: findings from a qualitative study.

BACKGROUND: Contrary to Missed Nursing Care, some anecdotal data and sparse evidence has documented the tendency of nurses to anticipate some nursing interventions. However, no study has been conducted to date with the purpose of understanding this phenomenon and its underlying mechanisms and consequences. The aim of this study was to describe the phenomenon of delivering anticipated nursing care, its antecedents and consequences as perceived by nurses. METHOD: A descriptive qualitative study. The Consolidated Criteria for Reporting Qualitative Research guidelines were followed. A purposeful sample of 17 clinical nurses and nurse managers working in three Italian hospitals were interviewed in depth in 2019. The audio-recorded interviews were verbatim transcribed and thematically analysed. RESULTS: 'Anticipated Nursing Care' is delivered significantly earlier than when expected by nurses in their care plan, by patients, by caregivers and by other members of the team. Medication administration, mobilisation of patients, hygiene care, changes of dressing, vital parameter monitoring, blood sampling and administrative activities were reported as interventions delivered before rather than when expected. Clinically stable patients have been reported to be at risk of receiving anticipated nursing care. Individual values and attitudes, group attitudes of being always ready for the "unexpected", implicit group norms to "leave the patients and the unit in order", high workloads, intertwined activities and work processes inside the units, have been reported as reasons for Anticipated Nursing Care. Effects of this phenomenon have been reported at the patients' and at the nurses' level. CONCLUSION: Anticipated Nursing Care occurs when nurses perform interventions earlier than expected according to an implicit or explicit decision and not as a consequence of a request. The phenomenon requires future studies to detect its diffusion and to accumulate evidence. Its presence in daily practice, if confirmed, suggests that Missed Nursing Care studies should also consider the combined effect of these two phenomena as, on one hand, there may be the tendency to postpone and, on the other hand, the tendency to anticipate interventions.

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.