Quality of dying in hospital general wards: a cross-sectional study about the end-of-life care.

BACKGROUND: In the last decade, access to national palliative care programs have improved, however a large proportion of patients continued to die in hospital, particularly within internal medicine wards. OBJECTIVES: To describe treatments, symptoms and clinical management of adult patients at the end of their life and explore whether these differ according to expectation of death. METHODS: Single-centre cross-sectional study performed in the medical and surgical wards of a large tertiary-level university teaching hospital in the north of Italy. Data on nursing interventions and diagnostic procedure in proximity of death were collected after interviewing the nurse and the physician responsible for the patient. Relationship between nursing treatments delivered and patients' characteristics, quality of dying and nurses' expectation about death was summarized by means of multiple correspondence analysis (MCA). RESULTS: Few treatments were found statistically associated with expectation of death in the 187 patients included. In the last 48 h, routine (70.6%) and biomarkers (41.7%) blood tests were performed, at higher extent on patients whose death was not expected. Many symptoms classified as severe were reported when death was highly expected, except for agitation and respiratory fatigue which were reported when death was moderately expected. A high Norton score and absence of anti-bedsore mattress were associated with unexpected death and poor quality of dying, as summarized by MCA. Quality of dying was perceived as good by nurses when death was moderately and highly expected. Physicians rated more frequently than nurses the quality of dying as good or very good, respectively 78.6 and 57.8%, denoting a fair agreement between the two professionals (k = 0.24, P <  0.001). The palliative care consultant was requested for only two patients. CONCLUSION: Staff in medical and surgical wards still deal inadequately with the needs of dying people. Presence of hospital-based specialist palliative care could lead to improvements in the patients' quality of life.

[Education, motivations and working conditions of a cohort of nurses attending to an open-competition]. / Profilo formativo, motivazionale e occupazionale di una coorte di infermieri iscritti ad un maxiconcorso.

. Education, motivations and working conditions of a cohort of nurses attending to an open-competition. INTRODUCTION: In the last decade, the progressive reduction of staff turnover decreased together with the number of open competitions, now attended by thousands of candidates, portraying an image of massive unemployment in the nursing profession. AIM: To describe the socio-demographic profile, the studies, previous work experiences and motivations of a cohort of nurses participats a maxi-competition in Lombardy region. METHODS: A questionnaire with 38 questions was administered to collect the socio-demographic data, information on education and work activities, their experiences and skills and the motivations for participating to the competition. RESULTS: The 6365 candidates were mainly women; unmarried and young people (mean age 26 years), with a degree in nursing obtained mainly in three years (44%). Over all 80% of respondents started to work within 1 year post-graduation; 57% were participating for the first time to a competition; 27% of candidates were currently employed on a temporary or permanent basis. Nurses would like to work in specialty areas such as critical care units, emergency departments and operating rooms, although their practical training was mainly in medicines and general surgeries. CONCLUSIONS: Most nurses are employed few months after graduation. The massive participation to public competitions depends on the limited number of procedures and not on the excess of nurses. A public competition with thousands of candidates, does not allow to select the most competent nurses and should be reformed.