1,721,342 research outputs found
[Large scale nursing competitions for a permanent job: a symptom of lack of strategies on nurses?] I mega-concorsi: sintomo di un paese che non ha una strategia sugli infermieri?
No full textEditoriale, non presente abstract.abstract no availabl
Indagine sulle decisioni degli infermieri sull’assistenza del paziente con demenza avanzata
No full textL’obiettivo assistenziale per la maggior
parte dei pazienti con demenza avanzata dovrebbe essere
il comfort, il controllo ottimale della sintomatologia e
l’astensione da trattamenti futili e/o invasivi. Obiettivo. Descrivere
le decisioni degli infermieri delle RSA (Residenze
Sanitarie Assistenziali) rispetto ad alcune situazioni critiche
per il paziente con demenza avanzata. Metodi. Agli infermieri
di 12 RSA è stato somministrato un questionario con
7 casi clinici con risposte chiuse ed 1 domanda aperta. I casi
descrivevano una situazione comune o esemplare per un
paziente con demenza molto avanzata (stadio FAST >7a) e
ridotta aspettativa di vita. Tra i 4 comportamenti proposti,
uno garantiva il comfort e tre avevano un approccio interventista.
Risultati. Hanno partecipato 63/92 (68.5%) infermieri.
La maggioranza 39 (61.9%) garantirebbe l’alimentazione
fino al decesso, 53 (84.1%) ricovererebbero il paziente
o lo rianimerebbero in caso di aggravamento, mentre 55
(87.3%) somministrerebbero un antibiotico per la polmonite,
anche in assenza di distress. Con una prognosi <15 giorni,
34 (54%) ritengono indicata la sedazione palliativa per
sintomi refrattari e 35 (55.6%) sospenderebbero le terapie
inutili (solo 4 sceglierebbero la via sottocutanea). In caso di
agitazione 32 (50.8%) valuterebbero il dolore e 28 (44.4%)
ricorrerebbero alla contenzione. La formazione è associata
a comportamenti più paliativi, in particolare per la sedazione
(P=0.01) e la revisione delle terapie (P=0.05). Conclusioni.
Gli infermieri hanno una parziale competenza nel garantire
un’assistenza palliativa. Visto il ruolo determinante
della formazione, occorre progettare percorsi formativi, per
sviluppare una cultura di assistenza del morente e a sensibilizzare
sull’evoluzione naturale della demenz
The emergency department visits of nursing home residents: Descriptive study in a nursing home
No full textUnlabelled: . The Emergency Department visits of Nursing Home residents: descriptive study in a Nursing Home. Introduction: Many Emergency Departments (ED) transfers of Nursing Home (NH) residents are potentially avoidable or even inappropriate since problems could be prevented or managed in the NH. Aim: To describe characteristics and outcomes of NH residents transferred to ED for respiratory, cardiovascular and neurological problems and symptoms of infection. Methods: A retrospective descriptive study using clinical records data from 2013-2016 of a NH was conducted. Results: In 4 years (2013-2016), 143 ED accesses occurred, 55 (38.6%) for medical problems in 48 residents. The residents were mainly women, with advanced age. Forty-two/55 accesses (76.4%) resulted in an hospital admission and 16 residents (38.1%) died in hospital; of the 13 discharged, 3 died the NH after a few days. The most frequent reason for hospitalization was an infection (22): respiratory (18), urinary (2) or both (2). The week before ED admission 1/3 of residents was asymptomatic, 1/3 had only one typical symptom accompained by drowsiness or agitation (7), gastrointestinal problems (5), or other non-specific symptoms. On ED admission prevalent signs and symptoms were desaturation (13), dyspnea (10) and fever (9). Six/22 residents had started an antibiotic treatment in the NH. Conclusions: Proactive management policies need to be promoted for residents with infections, based on explicit criteria to promptly monitor changes in clinical conditions and on the education educate professionals to suspect an infection even with non-specific symptoms
Missed Nursing Care in a Sample of High-Dependency Italian Nursing Home Residents: Description of Nursing Care in Action
No full textOBJECTIVE:
The aim of the study was to describe omitted or delayed nursing care (i.e., missed nursing care [MNC]) in a sample of Italian nursing homes (NHs).
METHODS:
Nurses from 50 NHs located in Northern Italy selected the 20 most dependent residents in their care and reported instances of MNC for three to five consecutive shifts. They described the type of MNC, its cause(s), management, recurrence, and severity of possible consequences for the resident. Information on the residents and the NH was also collected. The instances of MNC were classified as potentially avoidable/preventable or not.
RESULTS:
Overall, 266 (85.3%) of 312 nurses participated and 1000 residents were observed during 381 shifts (164 mornings, 164 afternoons, and 53 nights); 101 (38%) nurses reported 223 instances of MNC among 175 residents (17.5%). Ninety-seven omissions and 109 delays occurred during the day shift (56 omissions were delegated to the next shift). The most frequent MNC was drug administration (n = 71, 34.5%). In 24 (44.4%) of 54 instances of delayed drug administration, the delay was less than 30 minutes. Nurses rated approximately 20% of MNC (n = 41) as highly severe because of the discomfort caused to the resident, the clinical impact, or the repetitiveness of the situation. Nurses ascribed almost half of MNC (n = 100, 48.5%) to inadequate staffing, and they categorized 26 (11.6%) instances of MNC as unavoidable.
CONCLUSIONS:
The number of nurse-reported instances of MNC we reported was much lower than that previously collected with available instruments. Most MNC did not impact the comfort and safety of residents. A certain proportion of MNC was unavoidable
Association Between End-of-Life Conversations in Nursing Homes and End-of-Life Care Outcomes: A Systematic Review and Meta-analysis
Full text linkObjective: Less aggressive end-of-life (EOL) care has been observed when health care professionals discuss approaching EOL and preferences about life-sustaining treatments with nursing home (NH) residents or their families. We performed a comprehensive systematic review to evaluate the association between health care professionals-residents and health care professionals-family EOL conversations and EOL care outcomes.Design: Systematic review with meta-analysis.Setting and Participants: Seven databases were searched in December 2017 to find studies that focused on health care professionals-residents (without oncologic disease) and health care professionals-family EOL conversations and aimed to explore the impact of EOL conversations on resident's or family's EOL care outcomes.Measures: Random effects meta-analyses with subsequent quality sensitivity analysis and meta-regression were performed to assess the effects of EOL conversations on the decision to limit or withdraw life-sustaining treatments. A funnel plot and Eagger test were used to assess publication bias.Results: 16 studies were included in the qualitative and 7 in the quantitative synthesis. Health care professionals-family EOL conversations were positively associated with the family's decision to limit or withdraw life-sustaining treatments (odds ratio = 2.23, 95% confidence interval: 1.58-3.14). The overall effect of health care professionals-family EOL conversations on the family's decision to limit or withdraw life-sustaining treatments remained stable in the quality sensitivity analysis. In the meta-regression, family members with a higher level of education were less influenced by EOL conversations with health care professionals when making decisions about limiting or withdrawing life-sustaining treatments. No publication bias was detected (P = .4483).Conclusions/Implications: This systematic review shows that EOL conversations promote palliative care. Structured conversations aimed at exploring NH resident preferences about EOL treatment should become routine. NH administrators should offer health care professionals regular training on EOL conversations, and resident-centered care that involves residents and their families in a shared decision-making process at EOL needs to be promoted. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine
Determinants Associated With the Risk of Emergency Department Visits Among Patients Receiving Integrated Home Care Services: A 6-Year Retrospective Observational Study in a Large Italian Region
Full text linkBACKGROUND: Allowing patients to remain at home and decreasing the number of unnecessary emergency room visits have become important policy goals in modern healthcare systems. However, the lack of available literature makes it critical to identify determinants that could be associated with increased emergency department (ED) visits in patients receiving integrated home care (IHC).METHODS: A retrospective observational study was carried out in a large Italian region among patients with at least one IHC event between January 1, 2012 and December 31, 2017. IHC is administered from 8 am to 8 pm by a team of physicians, nurses, and other professionals as needed based on the patient's health conditions. A clinical record is opened at the time a patient is enrolled in IHC and closed after the last service is provided. Every such clinical record was defined as an IHC event, and only ED visits that occurred during IHC events were considered. Sociodemographic, clinical and IHC variables were collected. A multivariate, stepwise logistic analysis was then performed, using likelihood of ED visit as a dependent variable.RESULTS: A total of 29 209 ED visits were recorded during the 66 433 IHC events that took place during the observation period. There was an increased risk of ED visits in males (odds ratio [OR]=1.29), younger patients, those with a family caregiver (OR=1.13), and those with a higher number of cohabitant family members. Long travel distance from patients' residence to the ED reduced the risk of ED visits. The risk of ED visits was higher when patients were referred to IHC by hospitals or residential facilities, compared to referrals by general practitioners. IHC events involving patients with neoplasms (OR=1.91) showed the highest risk of ED visits.CONCLUSION: Evidence of sociodemographic and clinical determinants of ED visits may offer IHC service providers a useful perspective to implement intervention programmes based on appropriate individual care plans and broad-based client assessment
Hospital volunteering experiences suggest that new policies are needed to promote their integration in daily care: Findings from a qualitative study
Full text linkObjective: To explore Hospital Volunteers’ (HVs) motivations and experiences, as well as the strategies they
adopt to overcome challenging situations during volunteering and the needs they perceive.
Methods: Eleven Italian HVs were purposively approached between January and July 2016, using face-to-face
semi-structured interviews. The interviews were audio-recorded, transcribed verbatim and analysed using the
descriptive phenomenological approach.
Results: Hospital volunteering emerged as a complex experience characterised by five themes: (a) becoming
a volunteer; (b) developing skills; (c) experiencing conflicting emotions; (d) overcoming role difficulties by
enacting different resources and strategies; and (e) addressing emerging needs.
Conclusions: According to the findings, hospital policies aimed at promoting volunteer integration in daily care
are needed and should be based on (a) a shared vision between the hospital and the volunteer associations
regarding the HVs’ role and skills; (b) the development of integrated models of care combining different
workforces (i.e. professionals and volunteer staff); (c) appropriate training of HVs at baseline; (d) individualised
continuous education pathways aimed at supporting HVs both emotionally and in the development of the
required skills; and (e) tailored education that is directed to health-care staff aimed at helping them to value
the service provided by HVs
LE CARATTERISTICHE DEGLI ACCESSI AI DIPARTIMENTI DI EMERGENZA DEGLI OSPITI DELLE RESIDENZE SANITARIE ASSISTENZIALI: UNO STUDIO RETROSPETTIVO OSSERVAZIONALE DAL 2015 AL 2019
No full textBriefing and debriefing in protected learning during simulations for the healthcare professions: a literature review
Full text linkPremessa. Il briefing e il debriefing sono metodi considerati parte integrante e fondamentale del processo di simulazione per
lo sviluppo delle “technical e non technical skills” degli studenti e dei professionisti della cura. L’obiettivo di questo lavoro è
ricercare, valutare e sintetizzare le principali evidenze bibliografiche disponibili relative all’efficacia del briefing e del debriefing
nella simulazione per l’apprendimento dei professionisti sanitari. Materiali e metodi. Attraverso la consultazione della banca
dati Medline/PubMed, Cinahl e Scopus, sono stati rilevati e selezionati per l’analisi undici articoli ritenuti pertinenti per lo
studio che si intendeva sviluppare. Risultati. Sono emerse tre categorie di articoli: simulazione interprofessionale, (4 studi di cui
2 descrittivi, una survey e un pre- post study design); briefing (2 studi di cui una review e uno studio qualitativo); debriefing (5
studi di cui 2 review, uno studio qualitativo, una survey e un mixed method study). I risultati emersi dall’analisi della letteratura
supportano l’ipotesi diffusa che il briefing e il debriefing siano una componente importante della simulazione. Nella maggior
parte degli studi il briefing permette agli studenti di attivare una pre-riflessione, esprimendo le proprie incomprensioni circa ciò
che si andrà a fare durante lo scenario e consente al tutor/istruttore di rielaborare le istruzioni utili alla pratica clinica. Il debriefing
viene inteso come riflessione sull’esperienza svolta, anche attraverso l’analisi di emozioni e sentimenti, ed è considerato
dagli studenti negli studi esaminati come il miglior metodo per sviluppare il giudizio clinico. Conclusioni. I benefici del briefing e
debriefing, realizzati in differenti contesti e modalità, vengono descritti in letteratura, ma non è stata valutata lo loro efficacia in
termini di impatto formativo di fondamentale importanza è il ruolo del tutor/facilitatore che, attraverso le riflessioni guidate, fa
raggiungere agli studenti gli obiettivi formativi prefissati e li sostiene nella ricerca dell’autodeterminazion
When and how clinical nurses adjust nursing care at the end-of-life among patients with cancer: Findings from multiple focus groups
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