Telehealth vs in-person education for enhancing self-care of ostomy patients (Self-Stoma): Protocol for a noninferiority, randomized, open-label, controlled trial.

INTRODUCTION: Postoperative patients with ostomies experience significant changes in their lives as a result of the device implantation. Self-care is important to improve their health outcomes. Telehealth provides an opportunity to expand access to self-care education. AIM: This is a multicenter, non-inferiority randomized, open-label, controlled trial to evaluate the non-inferiority of a telehealth intervention to the standard in-person approach in improving self-care behaviors. METHODS AND ANALYSIS: Three hundred and eighty-four patients aged ≥ 18 years, with a recently placed ostomy, no stomal/peristomal complications, and documented cognitive integrity will be randomly assigned (1:1) to receive either a telehealth intervention (four remote educational sessions) or a standard educational approach (four in-person sessions) delivered in outpatient settings. Every session (remote and in-person) will occur on Days 25, 32, 40, and 60 after discharge. Follow-ups will occur 1, 3, and 6 months after the last intervention session. Primary outcome is self-care maintenance measured using the Ostomy Self-care Index (OSCI). Secondary outcomes include self-care monitoring, self-care management, self-efficacy (OSCI), quality of life (Stoma specific quality of Life), depression (Patient Health Questionnaire-9), adjustment (Ostomy Adjustment Inventory-23), stomal and peristomal complication rates, healthcare services utilization, mobility, and number of working days lost. Analyses will be performed per intention-to-treat and per protocol. ETHICS AND DISSEMINATION: This study has been approved by the Institutional Review Board of the main center (registration number: 119/22). Following completion of the trial, dissemination meetings will be held to share the results of the study with the participants and the health-care team. Adoption of telehealth technologies for ostomy patients can improve service organization by ensuring better integration and continuity of care. If the remote intervention produces comparable effects to the in-person intervention, it would be wise to make telehealth education an alternative treatment for addressing the educational needs of uncomplicated postoperative ostomy patients. TRIAL REGISTRATION: ClinicalTrials.gov (identifier number: NCT05796544).

Exploring Hypertension Patient Engagement Using mHealth. A Scoping Review.

INTRODUCTION: Widespread use of smartphone applications has opened new perspectives for home Blood Pressure monitoring based on mobile health (mHealth) technologies. Patient engagement has been dubbed 'the silver bullet of the century'. AIM: The aim was to identify the impact of engagement in patients with blood pressure using mHealth. METHODS: This scoping review was conducted in accordance with the Ark0sey and O'Malley framework. DATABASE: Pubmed, CINAHL, Scopus and PsycInfo. This review considered both qualitative and quantitative primary searches. We excluded articles belonging to grey literature, secondary literature and paediatric setting. Between September and November 2023, the review was carried out. RESULTS: A total of 569 documents were retrieved from the four databases. After the deduplication process, five articles were removed. The selection process based on titles and abstracts included 133 records. Ten studies were selected and analysed. The reviewers identified the following themes: device type and mobile applications, engagement, blood pressure control, health behaviours and hypertension knowledge. Self-management using digital technologies in the home is strongly linked to engagement, reduction and control of Blood Pressure, improved health practices and increased knowledge of hypertension. Healthcare interventions using IT platforms have had a significant impact on the health outcomes of patients diagnosed with hypertension. CONCLUSIONS: The review findings suggest the value of these technologies in improving patient engagement and, consequently, adherence to antihypertensive treatment and achieving blood pressure control rates, potentially reducing cardiovascular risk.

[New educational approaches to the patient. A scoping review of systematic reviews.] / Gamification: un nuovo approccio educativo al paziente. Una scoping review di revisioni sistematiche.

INTRODUCTION: New educational approaches are emerging to assist healthcare professionals in better personalizing patient's educational pathways. Specifically, "gamification" - the incorporation of game elements into non-game contexts - appears to be a novel and affordable approach. This scoping review aims to explore and map the literature that evaluates the efficacy of gamification in healthcare contexts. METHODS: A scoping review of reviews was conducted in MEDLINE, CINAHL, and PsycINFO using the JBI Manual for Evidence Synthesis guidelines and the PRISMA ScR checklist. RESULTS: A total of four systematic reviews and four meta-analyses were included. It appears that gamification, when used in conjunction with other conventional educational tools, improves physical activity, facilitates better self-management of type 2 diabetes, improves cognitive functions, and improves the quality of life, particularly among specific groups like the elderly. DISCUSSIONS: Gamification is an innovative educational approach that could be useful in patient's educational pathways. However, it seems that gamification is effective only in particular subgroups, and therefore the generalization of the results should also be assessed with caution due to the high risk of bias in the included studies and the small sample sizes considered. CONCLUSION: More randomized controlled trials and meta-analysis studies should be conducted to better understand the role and efficacy of gamification in patient education.

Working conditions, missed care and patient experience in home care nursing in Italy: An observational study.

INTRODUCTION: The aging of the population requires an appropriate knowledge of the type of care that needs to be provided to inform healthcare policies. In Italy, neither home care nursing, nor the patient experiences have ever been described. OBJECTIVES: To describe the characteristics of nurses and care recipients involved in home care. METHODS: A descriptive cross-sectional study conducted in 18 Italian Regions. Between April and October 2023, data from nurses and patients involved in home care were collected through two surveys. Psychosocial conditions in workplaces, missed care, and care experiences were assessed using validated tools. Descriptive statistics and Pearson's correlations were performed. RESULTS: A total of 46 local healthcare units were included in this study, with a total of 2549 nurses and 4709 care recipients. Nurses (mean age 46.60; 79.48% female; 44.68% regional nursing diploma as the highest qualification) reported good working conditions (42.37; SD = 12.25; range = 0-100) and a high mean number of missed care activities (5.11; SD = 3.19; range 0-9). Most nurses (83.41%) reported high levels of job satisfaction, while 20.28% intended to leave their job. Patients (mean age 75.18; 57.57% female; 36.95% primary school), on the other hand, rated positively the care they had received (8.23; range = 0-10). CONCLUSIONS: Despite the perception of critical issues at work and some missed care, satisfaction in nurses and patients was high. These data constitute a preliminary snapshot of the studied phenomena, which will be investigated through more in-depth analyses.

Role of emotions in the clinical decision-making process of the hospital nurse: A multicentre qualitative study.

While for a long-time emotional reaction and moral distress, have been primarily investigated for the possible outcomes of the nursing decision-making process rather than in terms of their role as antecedents of the final decision taken. The primary study's aim is to explore how inpatient nurses' decision-making takes place in different care settings, with a special focus on the role played by emotions during decision-making. The secondary aim is to explore the subjective experience of hospital nurses in relation to successful and unsuccessful decision-making situations. Multicentre qualitative study, consisting of three phases with different designs: participatory study, grounded theory study, and phenomenological study. Participants will be nurses and may be doctors with various levels of professional experience working in hospital, outpatient, or ward settings. Participants will be recruited through different sampling (purposive and convenience). Data will be collected through focus groups and in-depth interviews with nurses working in different hospital care settings. The researchers expect to find themes that will contribute to a better understanding of the role of emotions in decision-making. The results of this study have the potential of providing important implications to support nurses in the recognition and management of their emotions during the decision-making process.

Non-Pharmacological Management of Urge Urinary Incontinence in Women between 40 and 65 Years Old: A Systematic Review.

BACKGROUND: Urinary incontinence (UI) has been identified as a World Health Organization health priority. In particular, urge UI (UUI) refers to urine leakage associated with a sudden and compelling desire to void urine. It affects quality of life more than other kinds of UI, but it is not always treated adequately. For these reasons, this study aimed to evaluate the effectiveness of conservative treatment practices to counteract UUI in women aged 40-65 years old. METHODS: This systematic review was conducted following the Joanna Briggs Institute (JBI) methodology. According to the protocol registered in PROSPERO, a systematic search was carried out in the CINAHL, Embase, PubMed, PsycInfo, Scopus and Web of Science databases up to October 2022, to find primary studies meeting the inclusion criteria. RESULTS: Fourteen studies were included. The scientific literature reported different strategies dealing with the problem of UUI, some purely physical, others physical and psycho-educational and others exclusively psychological. CONCLUSION: Conservative treatments are useful to aid the reduction in UUI episodes in middle-aged women. However, none of them can be considered more effective than others due to the impossibility of conducting meta-analytical analyses. Further studies comparing the effectiveness of conservative treatments for UUI are needed.

Mindfulness-Based Interventions During Pregnancy and Long-Term Effects on Postpartum Depression and Maternal Mental Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Objectives: Preventing postpartum depression (PPD) is a public health goal. The scientific literature has demonstrated the short-term efficacy of Mindfulness-Based Interventions (MBIs) delivered during pregnancy on PPD. Nevertheless, the long-term outcomes of MBIs are still unclear. Design: Systematic review and meta-analysis of randomized controlled trials (RCTs). Four databases were searched to identify RCTs focused on describing the efficacy of MBIs on PPD and published in English up to February 2022. Settings/Location: The study was conducted globally. Subjects: Pregnant women who received MBIs. Interventions: MBIs were delivered during pregnancy in the included RCTs. Outcome Measures: Data collection and analysis effect size were combined using a random-effects model. The reporting in this study was consistent with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Results: Six studies were included. The overall effect size significantly reduced PPD symptoms severity in the MBI group versus the control group in the first 3 months after childbirth (standardized mean difference = -0.26; 95% confidence interval = -0.51 to -0.01; I2 = 30.65%). The effects of MBIs were significant in women who started MBIs with a low risk of developing PPD. Conclusions: MBIs delivered during pregnancy have long-term benefits for PPD. Implications for Practice: Further studies focused on testing MBIs starting during pregnancy and lasting over the postpartum and modulating the intensity of delivering MBIs based on the risk for developing PPD are needed to inform the practice with solid evidence.

Gamification as an Educational Approach for Oncological Patients: A Systematic Scoping Review.

BACKGROUND: Education plays a pivotal role in the care of oncological patients, reducing health costs, hospital readmission, and disease relapses. Education can be supportive in achieving multiple outcomes, improving symptom control and quality of life. A new approach is emerging in patient education: gamification. Gamification was defined as the "use of game elements in non-game contexts", including the application of games in serious contexts. The aim of this review is to explore the use of gamification in the oncology setting. METHODS: A systematic scoping review was conducted in the MEDLINE, CINAHL, PsychINFO, Embase, Scopus, and Cochrane Library databases using the JBI guidelines. RESULTS: The 13 included reports were critically appraised by two reviewers independently. It seems that gamification could be effective both in prevention and cancer treatments. Gamification also seems to improve chemotherapy-induced nausea and vomiting management, quality of life, and reduced anxiety levels in different cancer groups. Moreover, gamification seems effective in improving self-care in cancer patients, regardless of gender, age, and ethnicity. CONCLUSIONS: Gamification improves patient engagement and biopsychosocial outcomes and could represent a valid approach to cancer patient education; however, it is not a substitute for healthcare professionals, who remain the leaders in the education process.

[The Educational Aspect in Promoting a Low-Sodium Diet, Physical Activity and Therapy Adherence among Patients with Autosomal Dominant Polycystic Disease: A Literature Review].

Background. Polycystic kidney disease (ADPKD) is the most common monogenic cause of End Stage Renal Disease (ESRD), and, thus, of kidney transplantation and dialysis. Educational interventions aimed to improve adherence to therapy, physical performance, and adequate food intake in patients can slow down disease progression by developing self-care skills, which are useful to promote their autonomy while aligning their life plans and required treatments. The aim of this review is to analyze the adherence of patients with polycystic kidney to pharmacological therapy, low-sodium diet, and physical activity, as evidenced in the clinical literature to guide structured educational interventions. Methods. We conducted a literature review from 01/09/2021 to 30/12/2022 through the combination of free keywords and MeSH terms on the databases: PubMed, CINAHL and Cochrane. Results. Findings in medical literature show that physical activity can improve blood pressure control and a low-sodium diet can slow down the progression towards ESRD. Furthermore, although patients may adhere to the complex drug therapy, unresolved educational demands concern choices and behaviors of daily life that, involving the sphere of feelings and emotions, can evolve into manifestations of anxiety and stress. Conclusion. Among ADPKD patients a personalized educational support, considering disease stage and psychological factors, may enable them to acquire knowledge, skills, and behaviors that can improve clinical outcomes.

Transcultural Nursing in Italy: An Explorative Study.

The health profile of foreigners in Italy is affected by multiple factors and events, including environmental, microbiological, cultural, and behavioral. To explore nurses' basic cross-cultural knowledge, and their perceptions of problems that arise in encounters with clients from outside the country, and to suggest solution strategies, we enrolled 327 nurses in an observational, cross-sectional, multicenter study. The findings suggested a need to improve sociocultural skills related to working in a multiethnic society, as early as the first level courses and possibly continue with appropriate master's degrees and research projects.

Protocol for evaluating quality and safety for the public through home care nursing in Italy: a multicentre cross-sectional descriptive observational study (AIDOMUS-IT).

INTRODUCTION: Considering the increasing complexity of care and workload for home care nurses due to the ageing of the population, it is crucial to describe the work environment and the community care setting. The aim of this study protocol is to map the characteristics and identify gaps of home care in the community to design future interventions aimed at ensuring quality and safety. METHODS AND ANALYSIS: This is a national cross-sectional descriptive observational study using the survey method. Nurses from all participating community care centres will be recruited through convenience sampling by the coordinators of each centre, who will act as facilitators for this study. All community care recipients and their informal carers during the study period will be invited to complete a survey.To map the characteristics and identify gaps of home care in the community, three sources of data will be collected: (1) organisational characteristics, professional satisfaction, intention to leave and burn-out; (2) experience of care recipients and their informal carers and (3) improper access to the emergency department, readmission to hospital, comorbidities, services offered and users' level of autonomy, and main and secondary diagnoses.Considering the total Italian nursing population of approximately 450 000 registered nurses, a sample size of 1% of this population, equal to approximately 4600 nurses, was hypothesised.This study started in July 2022 and is planned to end in December 2023.Data will be analysed using descriptive and inferential statistics. ETHICS AND DISSEMINATION: This study protocol was approved by the Liguria Regional Ethics Committee in November 2022. Informed consent will be obtained from participants and confidentiality will be ensured. Data collected for this study will be kept anonymised in a protected database.The results of the study will be disseminated mainly through conferences, publications and meetings with government representatives.

How Do Nursing Students Perceive Moral Distress? An Interpretative Phenomenological Study.

BACKGROUND: Research shows that the longer nurses care for terminally ill patients, the greater they experience moral distress. The same applies to nursing students. This study aims to analyze episodes of moral distress experienced by nursing students during end-of-life care of onco-hematologic patients in hospital settings. METHODS: This study was conducted in the interpretative paradigm using a hermeneutic phenomenological approach and data were analyzed following the principles of the Interpretative Phenomenological Analysis. RESULTS: Seventeen participants were included in the study. The research team identified eight themes: causes of moral distress; factors that worsen or influence the experience of moral distress; feelings and emotions in morally distressing events; morally distressing events and consultation; strategies to cope with moral distress; recovering from morally distressing events; end-of-life accompaniment; internship clinical training, and nursing curriculum. CONCLUSIONS: Moral distress is often related to poor communication or lack of communication between health care professionals and patients or relatives and to the inability to satisfy patients' last needs and wants. Further studies are necessary to examine the quantitative dimension of moral distress in nursing students. Students frequently experience moral distress in the onco-hematological setting.

Training Ethical Competence in a World Growing Old: A Multimethod Ethical Round in Hospital and Residential Care Settings.

Ethical challenges are traditionally described in a negative light, even though moral conflict can express the individual ability to perceive when something is not working and promote change. The true question, therefore, is not to how to silence moral conflict but how to educate it. Although the need for ethical support of health- and social-care professionals in elderly care is clearly perceived, there is no universal method for providing effective interventions. The authors hypothesize that adequate training sessions can help care professionals enhance this skill, once clear goals and specific educational techniques are set. This research tests the hypothesis on twenty care professionals working in acute and residential care settings for the elderly, building on the ethics round method. Mixed methods drawn from literature and the experience of educators were adapted to meet different educational goals. Moral issues can hardly be removed from a context characterized by increasing demand and decreasing resources, but they can be recognized and addressed with common efforts, a critical attitude, and a growth mindset. Enhancing these skills in qualified workers can help them accept the reality of work, release pressure, and identify common team goals. Introducing these skills before graduation can help future workers avoid unreal expectations and reduce frustration and early job quit rates.

Self-care and type 1 diabetes mellitus: systematic review of sex-related differences.

INTRODUCTION: Self-care is associated with clinical outcomes of adults with T1DM. Some evidence highlighted significant sex-related differences in self-care behaviors in this population. However, the literature on this topic has not been synthesized before. This study aimed to summarize, critically review, and interpret evidence regarding sex-related differences in adults' self-care behaviors with type 1 diabetes mellitus (T1DM). EVIDENCE ACQUISITION: A systematic search of articles in the following databases was performed: PubMed, Scopus, Embase, and CINAHL. Articles published from 2009 to 2019 were reviewed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and flowchart were used to support the systematic review and study reporting. Two reviewers independently screened and extracted data from the included articles. EVIDENCE SYNTHESIS: From the 596 identified records, only 15 articles were included because pertinent to this review. Both females and males with T1DM must improve their ability to respond to signs and symptoms when they occur. Females are more likely to perform adequate blood glucose monitoring and adequate diet than males. In contrast, males are more likely to show more adequate levels of physical activity. CONCLUSIONS: Clinicians should pay greater attention to supporting females with T1DM to enhance their behaviors for maintaining an adequate health status and glycemic control. Likely, greater attention is required to sustain males to monitor changes in their signs and symptoms. Self-care management should be improved in both sexes.

Moral Distress of Intensive Care Nurses: A Phenomenological Qualitative Study Two Years after the First Wave of the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has imposed great pressure on healthcare facilities, exposing healthcare professionals to various challenges that may result in the onset of moral distress, a condition of psychological distress caused by the inability to act as it would be most morally appropriate. The purpose of this research was to investigate the experience lived by nurses who worked in an intensive care unit during the COVID-19 pandemic. METHODS: This is a phenomenological study using interpretative phenomenological analysis. Sixteen nurses who worked in the COVID-19 Intensive Care Unit of Northern Italian Hospitals from January to April 2022 were selected through purposive sampling. Data on experiences, thoughts, and symptoms were collected through semi-structured interviews with in-person and remote modalities. RESULTS: Five themes and fourteen subthemes emerged from the study. The themes are: (1) pride, isolation, and fear; (2) teamwork and organisation; (3) moral/ethical aspect; (4) true heroes; and (5) dignity. CONCLUSIONS: This study highlights the impact of the COVID-19 pandemic on intensive care unit nurses. It has emerged that the risk of moral distress is high among healthcare workers in the front line of the fight against the virus. This condition should be avoided and managed through early psychological interventions, sharing of experiences, and a good organization that supports decision-making and professional well-being.

Frontline Involvement in Population COVID-19 Vaccinations: Lived Experience of Nursing Students.

(1) Background: The globally promoted vaccination campaign has been shown to be the solution for the COVID-19 pandemic, reducing transmission, hospitalisation and the need for intensive care. Although several studies have examined the experiences of healthcare workers during the pandemic, few studies have investigated healthcare student experiences. The aim of this study is to explore the lived experience of third-year nursing students during the COVID-19 vaccination campaign. (2) Methods: A phenomenological qualitative method was adopted. The researchers selected third-year students undertaking a bachelor's nursing degree who took part in the COVID-19 vaccination campaign at a high-volume vaccination centre in the period from May to August 2021. (3) Results: Thirteen students were included in the study. Three themes and twelve subthemes emerged from the study. The themes were: a challenging experience; it is not as easy as it seems; a learning experience worth living; and teamwork and trust leading to professional development. (4) Conclusions: Participation in the vaccination campaign was a novelty for students in their degree program. Students emphasized the positive aspects of having the opportunity to participate in the vaccination campaign and help the entire community in the fight against COVID-19.

Moral Distress Scores of Nurses Working in Intensive Care Units for Adults Using Corley's Scale: A Systematic Review.

BACKGROUND: No systematic review in the literature has analyzed the intensity and frequency of moral distress among ICU nurses. No study seems to have mapped the leading personal and professional characteristics associated with high levels of moral distress. This systematic review aimed to describe the intensity and frequency of moral distress experienced by nurses in ICUs, as assessed by Corley's instruments on moral distress (the Moral Distress Scale and the Moral Distress Scale-Revised). Additionally, this systematic review aimed to summarize the correlates of moral distress. METHODS: A systematic search and review were performed using the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), the National Library of Medicine (MEDLINE/PubMed), and Psychological Abstracts Information Services (PsycINFO). The review methodology followed PRISMA guidelines. The quality assessment of the included studies was conducted using the Newcastle-Ottawa Scale. RESULTS: Findings showed a moderate level of moral distress among nurses working in ICUs. The findings of this systematic review confirm that there are a lot of triggers of moral distress related to patient-level factors, unit/team-level factors, or system-level causes. Beyond the triggers of moral distress, this systematic review showed some correlates of moral distress: those nurses working in ICUs with less work experience and those who are younger, female, and intend to leave their jobs have higher levels of moral distress. This systematic review's findings show a positive correlation between professional autonomy, empowerment, and moral distress scores. Additionally, nurses who feel supported by head nurses report lower moral distress scores. CONCLUSIONS: This review could help better identify which professionals are at a higher risk of experiencing moral distress, allowing the early detection of those at risk of moral distress, and giving the organization some tools to implement preventive strategies.

[The FRASNET study: identification of clinical and social factors of renal failure in an elderly population].

Background. Chronic renal failure is an epidemic in elderly patients. Older population have an increased prevalence of frailty and sarcopenia, associated with a wide range of adverse health outcomes such as falls, hospitalization, disability. Aim. Describe the sociodemographic and clinical variables of an elderly Lombard population and identify predictors of renal insufficiency. Materials and methods. Cross-sectional observational study conducted in hospitals, in recreational centers for the elderly, in the Universities of the Third Age of the provinces of Milan and Monza-Brianza conducted through a convenience sampling of 1250 subjects over the age of 65. Results. The study identified living alone, annual individual income < € 10,000, polypharmacy, sarcopenia and frailty as predictors of chronic kidney failure. The sample has a mean eGFR of 71.74 mL/min/1.73m2 (SD ± 16.56). Older people living alone are more likely to develop CRI (P = 0.031, confidence interval, CI [1.031-1.905]) as well as having an income < € 10,000 (P = 0.002, CI [0.392-0.923]). Taking more than 11 drugs a day increases the probability of having chronic renal failure by 16 times (P = 0.012, CI [1.155-3.16]). Sarcopenia and frailty increase the likelihood of having chronic renal failure (CRI) (P = 0.001, CI [1.198-2.095]). Conclusions. Identifying predictors of chronic kidney failure is a key step in introducing preventive measures and providing better care to the elderly population.

Risk factors and pooled incidence of intestinal stoma complications: systematic review and Meta-analysis.

OBJECTIVE: The present systematic review aimed to identify, critically assess and summarize which risk factors might determine the onset of ostomy complications, describing a pooled incidence and stratified incidences by each identified risk factor. METHODS: A systematic literature review with a meta-analysis of observational studies was performed by following the PRISMA statement and flow chart. The quality assessment of the included articles was performed through the Newcastle-Ottawa Scale (NOS). RESULTS: Sixteen articles published between 1990 and 2018 focused on the risk factors related to intestinal stomal complications, and the performed analysis led to identifying influenceable and non-influenceable risk factors. The median of the NOS evaluation was 6 (IQR = 5.75-6). Among 10,520 included patients, the pooled incidence of stomal complications was 35%, ranging from 9% to 63%, regardless of the nature of the complications. Analysis of the sub-groups highlighted obesity and ostomy surgery performed via laparoscopy or emergency conditions have significant incidences, respectively, of 66% and 68%. CONCLUSIONS: The pooled incidence of stomal complications requires greater attention for its relevant epidemiology. From the clinical point of view, patients with obesity and chronic conditions require more attention to prevent complications, possibly employing accurate educational interventions to enhance proper stoma management.