Assistenza infermieristica e ricerca: AIR (ASSIST INFERM RIC )


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Publications in this journal

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    ABSTRACT: . The local adaptation of clinical practice guidelines. The ADAPTE process is a systematic approach to adapting guidelines produced in one setting for use in a different cultural and organizational context. It ensures that the guideline addresses specific health questions relevant to the context, accounting for the needs, priorities, legislation, policies, and resources in the targeted setting. The ADAPTE process was developed to meet the needs of different user groups, including guideline developers, health care providers, and policy makers at the local, national, and international level. The process is flexible; the transparent and explicit reporting enhances the quality and validity of the adapted guideline. The ADAPTE process is briefly described.
    Assistenza infermieristica e ricerca: AIR 10/2014; 33(4):232-5.
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    ABSTRACT: . Critical issues and limits in the production and implementation of clinical practice guidelines. The introduction of clinical practice guidelines, initially welcomed as the solution for improving the quality of care, left space to a rising debate on the problems and pitfalls of guidelines production and implementation. In this contribute some of the main criticisms (the quality of the guidelines, their real implementation in practice, the misconceptions that they should be rigidly implemented, that should limit the variability of practices…) are addressed and discussed.
    Assistenza infermieristica e ricerca: AIR 10/2014; 33(4):175-82.
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    ABSTRACT: . Protocol based care and organizations: strengths and limits. A protocol based care may impact on the organization under several aspects. In this contribution, starting from real life experiences, the impact on the implementation of guidelines and recommendations on the use of resources and costs is explored, underlying strengths and weaknesses. A judicious and tailored implementation of these instruments is warranted. However, the transformation of some guidelines in laws and decrees may limit their local adaptation.
    Assistenza infermieristica e ricerca: AIR 10/2014; 33(4):203-7.
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    ABSTRACT: . The implementation of recommendations in daily practice: the experience of the nurses of the Oncology institute of Southern Switzerland. Introduction. In spite of the wide spread and availability of the clinical practice guidelines, several problems limit and influence their implementation. Several studies explored how a protocol based care may influence nurses' decision making processes, while only few studies explored how it is used in everyday practice. Aim. This paper explores how the nurses of the Oncology Institute of Southern Switzerland implement the care protocols and problems encountered. Methods. Information on the frequency of use of protocols in the previous month, the need and reasons for modifications were collected with a semistructured questionnaire. Nurses were asked to briefly describe the situations that required a change of the protocol. The nurses'perceptions on the use of protocols in clinical practice were further explored with a focus group. Results. Of the 47 questionnaires distributed 38 were returned and 18 cases briefly described. In general, the protocols were widely used but at the same time, frequently adapted mainly by expert nurses (although 19/39 nursed declared that protocols were never modified). Reasons for modifications were mainly related to the clinical situation of the patient, to his/her values and preferences. Conclusions. Instruments that standardize patients' care are frequently modified to account for patients preferences and characteristics. The nurses acknowledged the need of flexible instruments (and not hard rules) to guide their professional practice.
    Assistenza infermieristica e ricerca: AIR 10/2014; 33(4):189-97.
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    ABSTRACT: . Where and how to retreive clinical practice guidelines. Indications on how to retrieve clinical practice guidelines are offered, presenting the main agencies that produce guidelines and the trip database. A google search with the key word nursing guidelines, after a selection of agencies with multiprofessional groups, with an explicit process of bibliographic search and a grading of recommendations produced the selection of 4 agencies.
    Assistenza infermieristica e ricerca: AIR 10/2014; 33(4):227-31.
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    ABSTRACT: . Clinical practice guidelines: juridical and medico legal issues in health care malpractice liability. Clinical Practice Guidelines are clinical tools addressed to medical and health professionals and are normally employed to improve quality and safety of diagnostic and therapeutical procedures but may sometimes limit the autonomy of medical and other health care professionals. The adherence to Clinical Practice Guidelines should not be an exclusive step to evaluate the liability and respect of standards of care in case of medico-legal investigations being each clinical case very specific. Medical liability and respect of standards of care should be evaluated with the support of Clinical Practice Guidelines and the extensive examination of all specific features, professional background and experience requested to treat each single patient.
    Assistenza infermieristica e ricerca: AIR 10/2014; 33(4):208-13.
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    ABSTRACT: . Critical issues in clinical practice guidelines for geriatric care. Behavioral and psychological symptoms of dementia(BPSD) are one of the most disturbing issues in the management of patients, both for caregivers and health care personnel. Aim of this paper is to critically appraise the available guidelines on the non pharmacological management of BPSD. Some effective interventions such as person centred care, communication skills e dementia care mapping are not mentioned while interventions of dubious efficacy (aromatherapy, per therapy, light therapy or music therapy) are proposed. The variability in the expression of behavioral disorders and the different causes suggest an accurate tailoring of the interventions, based on the assessment of the patient, the organization and the environment. Further studies are necessary to improve the implementation of the non drug strategies for the management of BPSDs.
    Assistenza infermieristica e ricerca: AIR 10/2014; 33(4):198-202.
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    ABSTRACT: . Planning and implementation of an open door psychiatric ward: the assessment of an experience in Piedmont. Aims. The planning of the structure and the activity of a newly created psychiatric ward are reported. Methods. Several choices characterized the activity of the ward: to have open doors, newly employed nurses or without experience in psychiatry, a structure that favour the contact between health professionals (HP) and patients. The education of the nurses consisted in the discussion of general principles that guided the clinical practice: the patient is a legal person, his freedom should be guaranteed as well as his right of self determination. Results. The ward was opened in April 2008. Over 55 months 722 patients were admitted (31 compulsory admission). Only 8 patients were restrained and 4 aggressions occurred; 14 patients left the ward without authorization. Pharmacological deep sedation was used only in exceptional circumstances. Conclusions. Patients can be cared, safely for patients and PS in an open doors psychiatric ward. The planning of physical spaces is fundamental in guaranteeing a care respectful of patients' rights.
    Assistenza infermieristica e ricerca: AIR 07/2014; 33(3):134-41.
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    ABSTRACT: . Digital interactive technologies for physical exercise with the elderly: literature review and research proposal. One of the final products of an experience of education to research for expert nurses and health care professionals is presented: a of the literature review, mainly aiming at identifying open questions and of the research protocol is proposed. The topic is innovative, as the project deals with the use of exergaming, on top of the rehabilitation programs, with elderly patients in Nursing homes. The aim is to assess the compliance with the gaming and its potential transferability in Ticino Nursing Homes, and the contribution of gaming to the accomplishment of rehabilitation goals.
    Assistenza infermieristica e ricerca: AIR 07/2014; 33(3):147-54.
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    ABSTRACT: . The role of mind and survival in cancer patients. A relationship between psychological reactions and survival in cancer patients has been shown in several studies. A recent editorial illustrates how interventions providing social and emotional support at the end of life may positively influence the physiological stress response systems that can affect survival.
    Assistenza infermieristica e ricerca: AIR 07/2014; 31(3):151-3.
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    ABSTRACT: . Do patient information sheets for randomized controlled trial provide clear information? Aim. To assess whether patient information sheets (PIS) for randomized controlled trials (RCT) submitted during 2012 to a large Italian Ethics Committee provided clear information. Methods. One hundred and seven PIS for RCT involving adult subjects were obtained from the Ethics Committee Office. Using a five-point scale, two observers with education in nursing assessed the overall PIS comprehensibility and the clarity of information provided about the following items: rational of the study, aims, procedures, randomization, placebo, blindness, anticipated benefits, potential risks. Two further items focused on whether it was clear who promoted/sponsored the study and that the researcher/hospital would receive a fee/refund by the sponsor (clear/not clear). Results. At least 87% of PIS were rated as sufficiently clear regarding aims, procedures, placebo, potential risks, and who promoted/sponsored the study. Information about fee/refund to researcher/hospital, randomization, rational of the study, blindness, and anticipated benefits was rated as sufficiently clear in 61%, 60%, 53%, 50%, and 29% of PIS respectively. Overall comprehensibility was sufficient for 93% of PIS. Overall agreement between raters was on average 84%. Interobserver reliability was moderate or substantial for most items, and fair for randomization and blindness. Conclusions. Many PIS do not provide clear information about several issues important to allow informed consent, especially regarding anticipated benefits. Nurses may offer consistent opinion in PIS assessment.
    Assistenza infermieristica e ricerca: AIR 07/2014; 33(3):120-6.
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    ABSTRACT: . Safety and comfort of patients mobilized 24 and 48 hours after a pacemaker implantation: a retrospective study. Background. In Italy bed rest times after a pacemaker implantation (PI) may vary between 24 and 72 hours, although previous studies showed that early mobilization does not increase the risk of complications. Objective. To observe the safety and comfort of mobilization 24 and 48 hours after PI. Methods. Observational retrospective study on clinical records of consecutive patients undergoing PI from January 2009 to April 2012 in Monzino Hospital in Milan and with a bed rest of 24 or 48 hours. Results. A total of 411 patients were included (Group 48h n=251, Group 24h: n=160). Complications occurred more frequently in the Group 48h: haematomas (3.2% vs 1.9% OR:1.71, p=0.4269); lead dislocations (1.9% vs. 0.6%; OR:3.23 p=0.2863). Patients with longer bed rest received more analgesics for back pain (BP) or pacemaker pocket pain (PPP) (BP: 12% vs 3.1%; OR:4.21; p=0.0036; PPP 13.1% vs 3.7% OR:3.88; p=0.0029). Conclusions. The mobilization after 24 hours to PI increased patients' comfort without increasing risks. Future studies are warranted to explore the effects of a bed rest shorter than 24 hours.
    Assistenza infermieristica e ricerca: AIR 07/2014; 33(3):127-33.
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    ABSTRACT: . Education to research: an experience in Ticino Region. General principles and results. Introduction. Education to research is a challenge as learning should be guided by practice and research problems. Aim. To briefly describe the experience of a research course for nurses, physiotherapists and occupational therapists and propose some reflections on the experience. Method. The course was aimed at producing research projects on the elderly population. It was attended by expert geriatric nurses and educators of health professions. After an initial course of 40 hours on the bases of research methodology and statistics, all the course was organized with workgroups supervised by experts. Results. Sixteen participants started the course and 11 completed it. Three research areas were identified: epidemiology and control of behavioral disturbances; the use of wii technologies with the elderly; and the care provided in special care units for dementia patients. After a literature review, two protocols were produced. Conclusions. An adult education to research should start from real problems, relevant for the patients but also for the local organization, and the education should be organized starting from the problems selected.
    Assistenza infermieristica e ricerca: AIR 07/2014; 33(3):142-6.
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    ABSTRACT: . GAZA 2014. In the last few months the dramatic events of Gaza were brought to the attention of the public. In a report published in the Lancet, a group of health professionals and scientists denounced the slaughter of civilians affirming that health care professionals cannot be silent in a world that is cancelling our culture and the inviolability of right to life and to his dignity, in the name of other interests. The articles of a woman, journalist, Judish, Amira Hass, are reported. She tells of the astonishment and the horror, of the politics and its' responsibilities, but also of names, faces and stories.
    Assistenza infermieristica e ricerca: AIR 07/2014; 31(3):118-22.
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    ABSTRACT: . Readability and comprehension of guidelines for hand hygiene: a comparison between WHO (2009) and CDC (2002) guidelines. Introduction. Updating clinical practice guidelines (CPGs) is a crucial process for maintaining the validity of recommendations. However, the updating process should be explicit and changes made highlighted in the updated text. Aim. To confront and compare two CPGs on hand hygiene (World Health Organization, WHO, 2009 and Centres for Disease Control, CDC 2002), to identify discrepancies and changes made. Results. Although mostly comparable, CDC and WHO guidelines use a different terminology on hand hygiene which could be confounding: in the former handwashing includes the use of plain soap in the latter also the use of an antimicrobial soap. The lack of a glossary may render tricky the interpretation. Some problems in retrieving the evidence base of a recommendation are highlighted. Conclusions. Great attention should be paid before implementing an updated guideline. The need of essential and easy to consult guidelines, where in the updated version the news and modifications are highlighted are stressed.
    Assistenza infermieristica e ricerca: AIR 07/2014; 33(3):116-9.
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    ABSTRACT: Over the past 15 years, the model of medical and nursing care changed from being exclusively oriented to the diagnosis and treatment of acute illness, to the achievement of outcomes by preventing iatrogenic complications (Hospital Acquired Conditions). Nursing Sensitive Outcomes show as nursing is directly involved in the development and prevention of these complications. Many of these complications, including falls from the bed, use of restraints, urinary catheter associated urinary infections and intravascular catheter related sepsis, are related to basic nursing care. Ten years ago in critical care, a school of thought called get back to the basics, was started for the prevention of errors and risks associated with nursing. Most of these nursing practices involve hygiene and mobilization. On the basis of these reflections, Kathleen Vollman developed a model of nursing care in critical care area, defined Interventional Patient Hygiene (IPH). The IPH model provides a proactive plan of nursing interventions to strengthen the patients’ through the Evidence-Based Nursing Care. The components of the model include interventions of oral hygiene, mobilization, dressing changes, urinary catheter care, management of incontinence and bed bath, hand hygiene and skin antisepsis. The implementation of IPH model follows the steps of Deming cycle, and requires a deep reflection on the priorities of nursing care in ICU, as well as the effective teaching of the importance of the basic nursing to new generations of nurses.
    Assistenza infermieristica e ricerca: AIR 06/2014; 33(2):90-96.
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    ABSTRACT: Introduction. Nursing diagnoses share some common defining characteristics. Objective. To identify key defining characteristics for the nursing diagnosis “Impaired gas exchange". Method. Systematic review with meta-analysis of three studies in samples with different clinical profiles. The relevance and quality of the studies were assessed according the QUADAS protocol. Results. Two studies were on children with acute respiratory infection and one on adults with mechanical ventilation. The heterogeneity statistic test suggested that the studies are homogeneous. The defining characteristics with higher accuracy were: headaches upon waking, irritability and tachycardia. Discussion. The clinical indicators headache, irritability and tachycardia are signals secondary to hypoxia. Although of different magnitudes according to the age, they are the body's physiological responses. Conclusions. A comparison of the defining characteristics of “Impaired gas exchange" showed their accuracy. Obtaining summary measures can contribute to a better identification of this nursing diagnosis.
    Assistenza infermieristica e ricerca: AIR 04/2014; 33(1):29-35.
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    ABSTRACT: . Roles and competences of nurses with postgraduate master degree in nursing science in everyday practice. Multicentre descriptive survey. Introduction. Few information are available on the role and activities of Italian nurses with Laurea Magistrale (postgraduate master degree in nursing science). Aim. To describe the implementation of the advanced competences acquired after Laurea Magistrale by nurses, as well as changes in their professional career. Methods. A multicenter descriptive study on 7 consecutive cohorts (from 2004/2005 to2011/2012) of nurses of 3 universities of northern Italy was conducted. Data on managerial, teaching, research and clinical competences and changes in the professional role were collected with semi-structured questionnaires. Results. 232/285 graduates completed the questionnaire; 216 (88.8%) used their managerial competences, 178 (76.7%) educational competences, 122 (52.6%) clinical competences and 115 (49.5%) research competences. Eigthy graduates (34.4%) changed their professional roles, occupying managerial positions (from 89 to 212, +123, 14.5%) and in the education field (from 33 to 44 +11, 4.8%) while the number of nurses with a clinical role decreased (from 110 to 65, -45, -19.4%). The role changes occured mainly after three years from graduation (p = 0.006) with significant differences across areas (p = 0.018). Discussion. Until recently the main field of occupation of Laureati magistrali was in management but the changing needs of the organizations require a major focus on the clinical competences. The characteristics of contexts that favour or prevent the implementation of the new compentences and the upgrade of the roles should be studied.
    Assistenza infermieristica e ricerca: AIR 04/2014; 33(2):74-81.