Assistenza infermieristica e ricerca: AIR (ASSIST INFERM RIC )


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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: . The ISP (Safe Insertion of PICCs) protocol: a bundle of 8 recommendations to minimize the complications related to the peripherally inserted central venous catheters (PICC). Introduction. The insertion of a peripherally inserted central venous catheter (PICC) is not without risks. Aim. The Italian Group for the Study of Long-Term Central Venous Access Devices (GAVeCeLT) has developed a protocol (SIP: Safe Implantation of PICCs) with the aim of minimizing the risks which may be associated with the placement of PICCs. Methods. The protocol is based on recommendations available in the literature and on the main clinical practice guidelines. Results. The SIP protocol, a bundle of evidence-based recommendations, it is is easy to use, inexpensive, and cost-effective. Conclusions. If routinely used and carefully inplemented, it greatly reduces complications such as failure of venipuncture, accidental arterial puncture, damage of median nerve, infection and catheter related venous thrombosis.
    Assistenza infermieristica e ricerca: AIR 04/2014; 33(2):82-9.
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    ABSTRACT: . Update on anticancer drugs. A thorough review of the clinical trials published over the last two years in major medical and oncological journals on a comprehensive spectrum of oncological conditions aims to provide at the same time (as the authors are well known representatives of the critical and complementary competences of clinical care and research methodology) an interesting double opportunity of update on: a) what is truly (i.e.documented and reliable) innovative and deserves adoption in daily care,vs what is either purely suggestive or clearly misleading; b) what are the methological, concrete, simple rules to observe in a field which is certainly moving fast, but at the same time generates highly controversial behaviors in research as well as in daily practices. The accompanying editorial (pag 60-63) further illustrates the way and the yield of using this material and approach both in the areas of nursing sciences and practice.
    Assistenza infermieristica e ricerca: AIR 04/2014; 33(2):97-115.
  • Assistenza infermieristica e ricerca: AIR 04/2014; 33(2):60-3.
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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.
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    ABSTRACT: . Early implementation of home care and 30 day readmissions in >65 years Veneto region patients discharged for heart failure and with disability. Introduction. The effectiveness of Home care (HC) on preventing rehospitalizations in patients discharged for heart failure (HF) are uncertain. Aim. The aim of the study was to measure the impact of HC on early rehospitalizations of patients discharged for HF and with disabilities. Methods. Cohort retrospective study on >65 years patients, discharged at home and with a Barthel index <50. Variables considered were: previous hospitalizations for ischaemic cardiopathy ad/or chronic obstructive pulmonary disease, number of hospital admissions in the previous year, length of index hospitalization; outcomes considered were: hospital readmissions and days of hospitalizations 30 days from hospital discharge in patients with or without a home care visit within two days from hospital discharge. Results. Of the 5.094 patients (60%>85 years), 14.8% received a HC visit within 2 days from discharge (43.7% from a nurse); 18.3% of patients (933) were readmitted within one month. In multivariate analyses an HC access within 2 days did not reduce the risk for readmission (although with better results in younger males but not in older women). An early HC visit reduced the days of hospital stay in males of all ages (65-74 years IRR 0.53 CI 95% 0.37-0.75; 75-84 years IRR 0.71 CI95% 0.60-0.83; 85+ years IRR 0.79 CI 95% 0.67-0.93) while in >75 years females there was a significant increase. Conclusions. An early HC visit (within two days from discharge) may have positive effects on males, but not in older women, possibly for the coexistence of socio-economic factors.
    Assistenza infermieristica e ricerca: AIR 04/2014; 33(2):67-73.
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    ABSTRACT: . The assessment of newly qualified nurses in competitive exams for hospital employment: a descriptive study. Background. In the public sector the selection of the health personnel is based on qualifications and exams with a written, an oral and practical test, on contents selected by the committee. The level of complexity and contents of the tests is very variable across committees. Aim. To analyze the tests for the selection of nurses, the level of complexity and contents assessed. Methods. A sample of tests was analysed and for each item, the cognitive level tested, according to Bloom's taxonomy, areas and health problems investigated. Results. One-hundred-twenty-eight selection tests of 14 hospitals and districts were analysed. Open questions are used in the majority of tests to assess mainly knowledge and not complex cognitive functions or problem solving skills. The contents vary widely and are not focused on priority health problems. Questions on prevention, health education and symptoms monitoring are missing. Conclusions. Written, oral and practical tests focus on the same contents and test mainly knowledge.
    Assistenza infermieristica e ricerca: AIR 10/2012; 31(4):191-199.
  • Assistenza infermieristica e ricerca: AIR 10/2012; 31(4):190.
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    ABSTRACT: . Determinants of the choice of part time employment and nurses' satisfaction: a multicentre descriptive study. Aims. To describe the main determinants for the choice of part time employment in Italian nurses and its' impact on work satisfaction. Methods. The main factors were identified with a focus-group. A questionnaire with 26 items for the choice of part time and 24 for work satisfaction was then devised and administered to part time nurses (503) of 5 North Italian hospitals. Results. Two-hundred fifty-five nurses/471 answered the questionnaire. The choice of part time was voluntary for the large majority of nurses (251, 98.4%) except for 4 (1.6%) that asked for it for health problems (personal or of the spouse). Part time nurses are more satisfied for the relationships with colleagues (average 3; SD 0.6), the opportunity to deal with responsibilities (2.9; SD 0.6) and to have free time (2.9; SD 0.6). Conclusions. Part time is a need for mothers. Part time nurses complain for lack of access to information on patients and lack of involvement in ward projects and planned changes, possibly to be considered signals of isolation.
    Assistenza infermieristica e ricerca: AIR 10/2012; 31(4):207-213.
  • Assistenza infermieristica e ricerca: AIR 10/2012; 31(4):170-171.
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    ABSTRACT: . The concept of missed care: a literature review. Aim. To describe the concept and consequences of missed nursing care. Methods. A literature review was conducted searching on Medline, Trip Database, Cinahl, Cochrane, with the following key words: missed care, missed nursing care. Results. Any needed nursing intervention omitted (totally or in part) or postponed is considered missed care. The causes of missed care are the scarcity of human resources, of equipments or communication, but also the criteria for setting priorities and the relationships with nurses aids may also have an impact. The missed care may be measured with the Misscare tool: those more frequently missed are deambulation, passive mobilization, hygiene and oral care. Conclusions. A description of the interventions omitted or only postponed at international level, a measurement of the variability of missed care according to the number of nurses, and their impact on patients'outcomed could improve a better understanding of this problem.
    Assistenza infermieristica e ricerca: AIR 10/2012; 31(4):234-239.
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    ABSTRACT: . The evolution of nursing shortage and strategies to face it: a longitudinal study in 11 hospitals. Aim. To describe the perception of the evolution of nursing shortage from 2000 to 2009 according to Nursing Coordinators and the strategies to face it. Methods. Nursing coordinators of 11 hospitals or districts of Friuli Venezia Giulia, Trentino Alto Adige and Veneto regions were interviewed in 2000, 2004 and 2009 to collect data and assess their perception on nurses' shortage. Results. In the first interview the medium gap between staff planned and in service was -5.4%; in 2004 -9.4% and in 2009 -3.3%. The shortage, once with a seasonal trend is now constant and appreciated in all the wards. In years 2000 and 2004 on average 5 strategies to face the shortage were implemented, in 2009 7. No systematic strategies have been used with the exception of the unification of wards, mainly during summer for letting people go on holydays. According to Nursing Coordinators the effects of the shortage are already observable (although not quantified) on patients and nurses. Conclusions. The nurses' shortage has been one of the challenges of the last 10 years. Its causes have changed but not the strategies implemented.
    Assistenza infermieristica e ricerca: AIR 10/2012; 31(4):200-206.
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    ABSTRACT: . The worries and anxieties of nurses involved in the reorganization of a department. Introduction. The change process generally elicits reactions not always positive, although expected. Aim. To describe the reactions to change before and after one year from implementation. Methods. A questionnaire was administered to a group of nurses before and after their wards was moved to a new surgical department with a totally different organization. Results. The nurses remained moderately worried before and after the change. Worries for the impact of the change on the patients and themselves significantly increased. Nurses with 4-14 years of experience expressed higher levels of concern. Conclusions. The worries are a normal reaction but their better understanding may give indications on support strategies.
    Assistenza infermieristica e ricerca: AIR 10/2012; 31(4):184-189.
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    ABSTRACT: . Health projects managed by Nursing Coordinators: an analysis of contents and degree of success. Aim. To describe the evolution and results of health projects run in hospitals and managed by Nursing Coordinators. Methods. A convenience sample of 13 north Italian hospital, and a sample of 56 Nursing Coordinators with a permanent position from at least 1 year, was contacted. The following information was collected with a structured interview: projects run in 2009, topic, if bottom up or top down, number of staff involved and state (ended, still running, stopped). Results. In 2009 Nursing Coordinators started 114 projects (mean 1.8±1.2 each): 94 (82.5%) were improvement projects, 17 (14.9%) accreditation, and 3 (2.6%) research. The projects involved 2.732 staff members (73.7%; average commitment 84 hours); 55 (48.2%) projects were still running, 52 (45.6%) completed, for 5 (4.4%) there was no assessment and 2 (1.8%) had been stopped. Conclusions. Nurses are regularly involved in several projects. A systematic monitoring of the results obtained and stabilization strategies are scarce. Due to the large number of resources invested, a correct management and the choice of areas relevant for patients' problems and needs are pivotal.
    Assistenza infermieristica e ricerca: AIR 10/2012; 31(4):177-183.

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