1,721,018 research outputs found
Describing Nurses’ Competence in Primary Nursing Care Model: A Cross-sectional Study Conducted in an Italian Teaching Hospital
Full text linkIntroduction:
Primary Nursing (PN) is a patient-focused nursing model that improves the quality of care. It has been defined over the years as a model to develop nurses’ personal knowledge, but the relationship between different nursing care models and nurses’ competence or experience still requires study.
Objectives:
The study aimed to describe nurses’ perceptions of their competence in the primary nursing care model and to identify sociodemographic and organisational predictors of nurses’ competence.
Methods:
A cross-sectional design was used to recruit nurses from wards using the PN care model and wards in which a team nursing care model was applied. A convenience sample of 142 nurses completed a self-administered questionnaire composed of a sociodemographic survey and the Nurse Competence Scale (NCS). Nurses’ age, gender, education degree, years as a registered nurse, months as a registered nurse under the specific nursing model, and type of employment contract were tested as potential independent predictors of nurses’ competence.
Results:
The PN nurses reported a better perception of their competence in all seven NCS categories. Independent predictors of a high level of competence in managing situations were an open-ended employment contract, greater work experience, working in a PN care model, and male gender. Predictors of a high level of competence in ensuring quality were greater work experience and working in a PN care model. Finally, an open-ended employment contract and working in a PN care model were both associated with a higher level of helping role, teaching–coaching, diagnostic functions, therapeutic interventions, and work role. The variables explained from 10% to 26% of the variance in all categories.
Conclusion:
PN model was found to be significantly positively correlated with nursing competence development. Advanced skills are involved in practising a personalized nursing care plan
Can an increase in nursing care complexity raise the risk of intra-hospital and intensive care unit transfers in children? A retrospective observational study
No full textIntroduction: Intra-hospital patient transfers (IPTs) and transfers to intensive care units (ICUs) are high-risk events in pediatric care. Nursing care complexity, reflected by nursing diagnoses (NDs) and nursing actions (NAs), may influence the frequency of these transfers. This study explores the association between nursing care complexity and IPTs, including ICU transfers, in hospitalized children. Materials and methods: A retrospective observational study was conducted at a tertiary care university hospital in Italy. Data from 1013 children aged 2 to 12 years were collected from electronic health records. Sociodemographic, clinical, and nursing data, including NDs and NAs, were analyzed. Latent Class Analysis classified nursing care complexity, while backward elimination regression and binary logistic regression identified predictors of IPTs and ICU transfers. Results: Significant positive correlations were found between IPTs and both NDs (rs = 0.326, p < 0.001) and NAs (rs = 0.428, p < 0.001). Key predictors of IPTs included Diagnosis Related Groups (DRG) weight, total comorbidities, surgical DRG, the number of medications used, and high nursing care complexity. ICU-transferred patients had significantly higher nursing care complexity (6.54 vs. 3.46 NDs, p < 0.001; 31 vs. 16 NAs, p < 0.001). High nursing care complexity increased the likelihood of ICU transfer by 18 times (OR = 18.413, p < 0.001). Conclusion: Nursing care complexity strongly influences IPTs and ICU transfers. Close monitoring of patients with high nursing care complexity is essential to anticipate transfers and reduce clinical risks
Exploring the Association between Complexity of Care, Medical Complexity, and Length of Stay in the Paediatric Setting Using a Nursing Minimum Data Set: A Study Protocol
Full text linkBackground/Objectives: The complexity of care requires systematic documentation to fully understand its relationship with medical complexity and its impact on patient outcomes. The Nursing Minimum Data Set (NMDS) plays a crucial role by capturing essential nursing data, enabling a detailed analysis of care and its impact on outcomes, such as length of stay (LOS). However, despite its potential, the use of NMDS in paediatric care remains limited. This study aims to explore the association between nursing and medical complexities and LOS in paediatric patients. Methods: A descriptive, retrospective, monocentric study will be conducted. The data will be collected through a nursing information system (Professional Assessment Instrument (PAIped)) and the hospital discharge register of patients admitted to the paediatric department in 2022 in an Italian university hospital. Conclusions and Expected Results: The use of PAIped will allow for the description of the complexity of care and enable an analysis of its relationship with medical complexity and LOS
Effectiveness and Consequences of Direct Access in Physiotherapy: A Systematic Review
Full text linkAbstract: Background. Direct access in physiotherapy (DAPT) occurs when a patient has the ability
to self-refer to physical therapy without a physician referral. This model of care in musculoskeletal
diseases (MSDs) has shown better outcomes than the traditional-based medical model of care that
requires physician referral to access physiotherapist services. This traditional physician referral
often results in a delay in care. Unfortunately, DAPT is still not permitted in many countries.
Objectives. The primary objective of this systematic review was to compare the effectiveness, safety,
and accuracy of DAPT compared to the physician-led model of care for the management of
patients with musculoskeletal disorders. The secondary objective of the present study is to define
the physiotherapists’ characteristics or qualifications involved in DAPT. Materials and methods.
Databases searched included: Medline, Scopus, and Web of Science. Databases were searched from
their inception to July 2022. Research strings were developed according to the PICO model of clinical
questions (patient, intervention, comparison, and outcome). Free terms or synonyms (e.g., physical
therapy; primary health care; direct access; musculoskeletal disease; cost-effectiveness) and when
possible MeSH (Medical Subject Headings) terms were used and combined with Boolean operators
(AND, OR, NOT). Risk of bias assessment was carried out through Version 2 of the Cochrane risk-
bias tool (ROB-2) for randomized controlled trials (RCTs) and the Newcastle Ottawa Scale (NOS)
for observational studies. The authors qualitatively analyzed the results through narrative
analysis and narrative synthesis. The narrative analysis was provided for an extraction of the key
concepts and common meanings of the different studies, while the summary narrative provided
a textual combination of data. In addition, a quantitative analysis was conducted comparing the
analysis of the mean and differences between the means. Results. Twenty-eight articles met the
inclusion criteria and were analyzed. Results show that DAPT had a high referral accuracy and
a reduction in the rate of return visits. The medical model had a higher use of imaging, drugs,
and referral to another specialist. DAPT was found to be more cost-effective than the medical
model. DAPT resulted in better work-related outcomes and was superior when considering patient
satisfaction. There were no adverse events noted in any of the studies. Regarding health outcomes,
there was no difference between the models. ROB-2 shows an intermediate risk of bias risk for the RCTs
with an average of 6/9 points for the NOS scale for observational studies. Conclusion. DAPT is a
safe, less expensive, reliable triage and management model of care that results in higher levels of
satisfaction for patients compared to the traditional medical model. Prospero Registration Number:
CRD42022349261
Psychometric Properties of Pain Scales in Inpatient Settings: An Umbrella Review
No full textAims: To identify the pain assessment scales with the best psychometric properties to be used by nurses in an inpatient setting. Design: Umbrella review. Methods: A comprehensive search of four databases was conducted for systematic reviews published from July 2013 to November 2024, focusing on psychometric properties of pain scales used in inpatient settings. Inclusion criteria required scales to assess subjective or behavioural pain and be nurse-administered, while reviews without detailed psychometric data were excluded. Screening, quality appraisal (JBI checklist), and data extraction were performed independently by two researchers. Data synthesis combined qualitative and quantitative approaches, with psychometric properties evaluated using the COSMIN checklist. The study was reported in accordance with the Preferred Reporting Items for Overviews of Reviews (PRIOR) statement. Results: Seventeen articles met the inclusion criteria, identifying 41 scales used across various patient populations, including critical care, paediatric, postoperative, cancer, cerebral palsy, disorders of consciousness, low back and neck pain, stroke and verbal communication disorders. The Paediatric Pain Profile, the Breakthrough Pain Assessment Tool and the Questionnaire on Pain caused by Spasticity demonstrated adequate psychometric properties, although the positive findings for the latter two should be confirmed by at least one additional study. Most of the scales (n = 36) require further studies to validate their use in clinical practice. For two scales, their clinical use remains questionable. Conclusion: The Paediatric Pain Profile, the Breakthrough Pain Assessment Tool, and the Questionnaire on Pain caused by Spasticity can be recommended for use. Unidimensional scales should complement, rather than replace, multidimensional scales to ensure a comprehensive pain assessment. Standardising documentation with validated scales enhances clinical decision-making, care quality, research usability, and reduces documentation burden
Self-care in patients affected by inflammatory bowel disease and caregiver contribution to self-care (IBD-SELF): a protocol for a longitudinal observational study
No full textIntroduction: Supporting patient self-care and the contribution of their caregivers is crucial in chronic illness care. Inflammatory bowel disease (IBD) is a chronic condition whose prevalence is expected to double, especially in Western countries. IBD symptoms can negatively impact patients' well-being, causing high anxiety, depression, stress and reduced quality of life. These symptoms also affect the health of family members and friends, who often take on caregiving roles during exacerbations. Knowledge about self-care in IBD (IBD-SELF) is limited, and few studies have explored this context. This paper outlines a research protocol for a multicentre longitudinal study to investigate patient self-care and caregiver contributions to IBD-SELF. Methods and analysis: A sample of 250 consecutive patients diagnosed with IBD and their caregivers will be recruited from 9 dedicated IBD units in northern, central and southern Italy during outpatient visits. Data collection will occur at baseline, 6 and 12 months after enrolment. Multivariable regressions, path analyses and structural equation models will identify predictors (eg, health literacy, caregiver burden and depression) and outcomes (use of healthcare services, disease severity and quality of life) of self-care and caregiver contributions. Dyadic analyses will control for the interdependence of dyad members. Ethics and dissemination: Ethical approval was obtained from the Territorial Ethics Committee (Lazio 3) N. 0023486/23 and registered on ClinicalTrials.gov (Identifier number: NCT06015789). This study will enhance our understanding of the self-care process in the patient-caregiver dyad in IBD, aiding the design of future educational interventions and promoting greater patient and caregiver involvement in the care pathway. Trial registration number: ClinicalTrials.gov: NCT06015789
Prevalence and accuracy of nursing diagnoses in patients with malignant bronchial and lung cancer: A retrospective observational study
No full textPurpose: To describe the prevalence and accuracy of nursing diagnoses (NDs) in adult patients with malignant bronchial and lung cancer. Methods: A retrospective, observational, monocentric study was conducted at the largest university hospital in Rome, Italy. Electronic health records (EHRs) of adult inpatients (≥18 years) hospitalized in 2022 with malignant bronchial and lung cancer were analyzed. NDs were documented using the Professional Assessment Instrument (PAI), a clinical nursing information system based on the Clinical Care Classification (CCC) standardized nursing terminology. The accuracy of nursing documentation was assessed with the D-Catch instrument, evaluating record structure, admission data, ND formulation, interventions, progress/outcome evaluations, and legibility. Descriptive statistics were used to analyze ND prevalence and documentation accuracy. Results: A total of 682 EHRs were examined, identifying 3510 NDs across 34 distinct labels. Patients had a mean of 5.15 NDs (SD: 2.99; range: 1–16). Ten high-frequency NDs were identified, with Infection Risk (76.7 %), Fall Risk (66.6 %), and Acute Pain (53.1 %) emerging as the most prevalent. Overall documentation accuracy was high across most dimensions; however, ND formulation showed comparatively lower accuracy (mean score: 6.38; SD: 0.98). Conclusions: Evaluating the prevalence and accuracy of nursing diagnoses enhances the understanding of the complex care needs of patients with malignant bronchial and lung cancer, a population marked by significant clinical vulnerability and multidimensional care requirements. Strengthening diagnostic reasoning—through structured documentation systems and continuous training—may improve care planning, facilitate interdisciplinary communication, and ultimately optimize patient outcomes
Deciphering the Link Between Diagnosis-Related Group Weight and Nursing Care Complexity in Hospitalized Children: An Observational Study
Full text linkBackground/Objectives: The increasing medical and nursing care complexity in hospitalized children represents a significant challenge for healthcare systems. However, the link between these two dimensions remains partially explored. This study aims to decipher the relationship between Diagnosis-Related Group (DRG) weight and nursing care complexity in hospitalized children and to identify the determinants of medical complexity. Methods: This retrospective study, conducted in an Italian university hospital, included children aged 2 to 11 years admitted to the hospital in 2022 with a minimum hospital stay of 2 days. Data were gathered from the Neonatal Pediatric Professional Assessment Instrument and the Hospital Discharge Register. DRG weight was used as an indicator of medical complexity, while the number of nursing diagnoses (NDs) documented in the first 24 h from hospital admission and the nursing actions (NAs) recorded during the patient’s hospital stay were used to measure nursing care complexity. Correlation analyses were conducted to explore the associations between DRG weight, NDs, and NAs. Stepwise regression was run to identify the key determinants of medical complexity across sociodemographic, clinical, organizational, and nursing variables. Results: Among 914 patients (mean age of 6.11 ± 2.90 years), the median DRG weight was 0.6982 (IQR: 0.5522). Patients had an average of 3.89 ± 2.83 NDs and a median of 17 NAs (IQR: 8). Significant correlations were found between NDs and NAs (rs = 0.507; p < 0.001), as well as between DRG weight and the frequency of NDs (rs = 0.232; p < 0.001) and NAs (rs = 0.184; p < 0.001). Stepwise regression indicated that the number of NAs, surgical DRG, scheduled admissions, and ND frequency were significant determinants of DRG weight (R2 = 0.311; adjusted R2 = 0.308; p < 0.001). Conclusions: In children, DRG weight is also influenced by nursing care complexity, alongside clinical and organizational factors. An integrated approach is essential to enhance pediatric care and patient outcomes
Standardized Nursing Diagnoses in a Surgical Hospital Setting: A Retrospective Study Based on Electronic Health Data
No full textIntroductionIn electronic health records (EHRs), standardized nursing terminologies (SNTs), such as nursing diagnoses (NDs), are needed to demonstrate the impact of nursing care on patient outcomes. Unfortunately, the use of NDs is not common in clinical practice, especially in surgical settings, and is rarely included in EHRs.
Objective(s)The aim of the study was to describe the prevalence and trend of NDs in a hospital surgical setting by also analyzing the relationship between NDs and hospital outcomes.
MethodsA retrospective study was conducted. All adult inpatients consecutively admitted to one of the 15 surgical inpatient units of an Italian university hospital across 1 year were included. Data, including the Professional Assessment Instrument and the Hospital Discharge Register, were collected retrospectively from the hospital's EHRs.
ResultsThe sample included 5,027 surgical inpatients. There was a mean of 6.3 ± 4.3 NDs per patient. The average distribution of NDs showed a stable trend throughout the year. The most representative NANDA-I ND domain was safety/protection. The total number of NDs on admission was significantly higher for patient whose length of stay was longer. A statistically significant correlation was observed between the number of NDs on admission and the number of intra-hospital patient transfers. Additionally, the mean number of NDs on admission was higher for patients who were later transferred to an intensive care unit compared to those who were not transferred.
ConclusionNDs represent the key to understanding the contribution of nurses in the surgical setting. NDs collected upon admission can represent a prognostic factor related to the hospital's key outcomes.
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Validity and Reliability of the Self-Care of Chronic Illness Inventory in Patients Living With Inflammatory Bowel Disease
No full textAim: To test the psychometric properties of the Self-Care of Chronic Illness Inventory (SC-CII) in patients living with inflammatory bowel disease (IBD). Design: A cross-sectional, multicenter study. Methods: A total of 452 IBD patients were recruited from nine centres across Italy. Participants completed the SC-CII, the Self-Care Self-Efficacy Scale (SCSES), and a sociodemographic questionnaire. Structural validity was assessed using confirmatory factor analysis (CFA). Reliability was evaluated with Cronbach's alpha and McDonald's Omega. Construct validity was determined through correlations between SC-CII and SCSES scores. Results: CFA confirmed the SC-CII's structural validity, demonstrating its multidimensional self-care maintenance, self-care monitoring, and self-care management structure. Reliability scores were satisfactory, with robust internal consistency. Significant positive correlations between SC-CII and SCSES scores confirmed its construct validity. Conclusion: The SC-CII is a valid and reliable tool for assessing self-care behaviours in IBD patients. Its application in clinical and research settings can facilitate the evaluation of self-care practices, supporting the development of targeted interventions to improve patient outcomes. Implications for the profession and/or patient care: The SC-CII helps identify self-care deficits in IBD patients, enabling tailored interventions for better patient-centred care. Impact: The study addressed the need for validated tools to assess self-care in IBD patients, crucial for managing conditions like IBD. The SC-CII proved valid and reliable, with CFA confirming its structure and correlations with self-efficacy supporting validity. It offers a robust tool to assess and promote self-care behaviours. Reporting method: The STROBE checklist ensured accurate and comprehensive reporting. Patient or public contribution: IBD patients helped align the SC-CII with their experiences, ensuring its relevance. Trial registration: ClinicalTrials.gov identifier: NCT06015789
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