Alessandra Zampieron

Perceived aggression towards nurses: study in two Italian health institutions

AIMS The goal of the present study was to quantify the perceived aggression towards nurses working in two Italian health care institutions and to verify the hypothesis of an association between the characteristics of aggressors and the type of aggression. BACKGROUND Violence and aggressiveness, particularly aimed at nurses, are a common, but inadequately investigated phenomenon in Italian health care institutions. DESIGN A cross-sectional study. METHODS The study was performed, studying a sample of 700 nurses (37% of the personnel in 94 units) in two health care institutions in northeast Italy using an anonymous multiple-choice questionnaire. RESULTS Forty-nine percent of the nurses responded that they had experienced aggression in the previous year, 82% of that was only verbal. This happened more often to female nurses working in the emergency department and in geriatric and psychiatric units. A statistically significant association (p < 0.001) was found between the perception of fatigue, stress and work dissatisfaction and the frequency of aggression. Aggressors were usually patients or their relatives (57%) and were mainly men (66%). Fifty-three percent of assaulted nurses did not ask for help after the event. CONCLUSIONS This study confirms the high incidence of perceived, mainly verbal aggression towards nurses. RELEVANCE TO CLINICAL PRACTICE Action to prevent aggressive episodes may include concentrating on job motivation, encouraging participatory leadership and promoting the best possible working conditions. The absence of any systematic event reporting and documentation makes the assaulted workers feel defenceless.

An update review on risk factors and scales for prediction of deep sternal wound infections

Surgical site infections are the most common nosocomial infections in surgical patients. The preventable and the unmodifiable risk factors for deep sternal wound infections (DSWI) have been amply assessed in the literature. The aim of this review was to describe the results of the numerous published studies to describe all the DSWI risk factors and the scales devised to predict SWI, with a view to providing an update on this issue. A comprehensive search of the Medline and Embase databases was performed (considering studies from January 1995 to April 2011); and a manual search was also conducted using references cited in original publications and relevant review articles. There are several risk factors associated with DSWI, which could be classified in four categories as demographic (e.g. sex and age), behavioural (e.g. smoking and obesity), baseline clinical conditions (e.g. diabetes, hypertension and COPD) and surgical operative risk factors (e.g. duration of operation and emergency operation). Six scales for predicting the risk of DSWI are described in the literature: they vary not only in accuracy but also in ease of application and they are applied at different times (some only preoperatively and others also postoperatively). This study provides a broad update on our knowledge of the risk factors for DSWI and the scales for prediction with a view to improving the management of infections at cardiosurgery units.

Quick change versus double pump while changing the infusion of inotropes: an experimental study

BACKGROUND Quick change (QC) and double pumping (DP) are common methods of substituting the infusion of inotropes given through intravenous pump. AIMS The aim of the study was to compare two methods in respect with the variation in mean arterial pressure (MAP). The hypothesis was that the DP method could be the most effective in achieving haemodynamic stability. DESIGN The study is a randomized research in an open randomized clinical trial. METHODS The study took place at the Paediatric Intensive Care Unit of Padua Hospital. It considered patients of 0-36 months, not premature, treated with inotropic infusion with monitoring of blood pressure. The research obtained the approval of the Hospital Research Ethics committee and parents signed informed consent. Comparison of the two groups made use of the Wilcoxon test for the continuous variables and the Fishers exact test for the comparison of frequencies, at significance value of 5%. The data were registered in an Excel spreadsheet and analysed with SAS. RESULTS The sample comprised 30 patients of age between 1 and 27 months, of whom 13 (43%) were male. They were all affected by cardiac, respiratory or infective pathology, all of them intubated and on artificial respiratory support, sedated and infused with dopamine. The characteristics of the patients of the two groups did not differ significantly. The percentage variation of the baseline value of MAP after 30 min from starting the treatment between the two methods was not statistically significant (p = 0.85). The 95% confidence interval for the difference in the percentage variation of MAP between the two groups was (-3.1, +3.7). From a clinical perspective, the methods are to be considered equivalent. CONCLUSIONS The study was conducted on a limited sample; no statistically significant differences were detected; QC is the quickest and more cost-effective method.

Socio-demographic factors and processes associated with stages of change for smoking cessation in pregnant versus non-pregnant women

BackgroundThe tobacco control community assumes that the most effective interventions are personalized. Nevertheless, little attention is paid to understanding differences between pregnant and non-pregnant European women in terms of the social factors that influence tobacco use and the processes of change used to quit smoking.MethodsThe study consecutively enrolled 177 pregnant women who acknowledged smoking the year before pregnancy and 177 non-pregnant women who acknowledged smoking the year before their clinic visit for a Pap test.ResultsWith respect to socio-demographic factors, the stages of change in pregnant women were associated with level of education, marital status, and the presence of roommates, partners and friends who smoke. In pregnant women, there was no statistically significant difference in the processes used to stop smoking among the stages of change. Furthermore, behavioral processes were higher in non-pregnant women than in pregnant women, and the difference was statistically significant in the advanced stages of behavioral change. Both pregnant and non-pregnant women showed higher levels of acceptance towards smoking in the earlier stages of change, but the acceptability of smoking in the pre-contemplative stage was higher in non-pregnant women. Greater craving was detected in non-pregnant vs. pregnant women at all stages and reached a statistically significant level at the pre-contemplative stage.ConclusionPregnancy is a favorable time to stop smoking since pregnant women are more likely to be in an advanced stage of behavioral change. Pregnant and non-pregnant women are distinct populations in the types and processes of change involved in smoking cessation. The intervention programs to promote smoking cessation and prevent relapses will need to take these differences into account.

Strain and health implications of nurses’ shift work

ObjectivesThe study investigated whether nurses’ different working schedules are associated with different levels of job-related strain, health symptoms and behavior. No reports have been accessible in the relevant literature on the possible association between shift work and job-related strain in nurses.Materials and MethodsThis was a cross-sectional study conducted at a large university hospital in North-East Italy, involving 806 nurses working in selected departments. A multilevel logistic regression was applied to assess the association between work shift conditions and selected outcomes.ResultsNight shifts were associated not only with higher odds of having a high Job Demand, but also with lower odds of having a high Decision Authority and consequently with a stronger likelihood of having higher levels of Job Strain (high Job Demand score ≥ 38 and Low Decision Authority). The night shift was associated with various symptoms, particularly exhaustion (p = 0.039) and gastric pain (p = 0.020). Nurses’ working schedules did not affect their job satisfaction scores.ConclusionsIt has been confirmed that night shifts are a risk factor for nurses’ health perception and working night shifts carries a considerable degree of strain. This is a condition that hospital nursing managements need to consider carefully to avoid burnout in nursing personnel and prevent an excessive turnover in this profession, which is a recurring problem for health care organizations.

Quality of life in adult celiac disease in a mountain area of northeast Italy.

The aim of this study was to evaluate the health-related quality of life in patients diagnosed as having celiac disease and to study the factors involved in its impairment of quality of life. We conducted a cross-sectional study in a randomized sample of patients with celiac disease by administering the Celiac Disease Questionnaire distributed by mail. The association between the quality of life and sociodemographic and clinical variables was verified by means of a stepwise multiple regression model. One hundred ninety-one questionnaires were returned (participation rate = 63.66%), and 187 were analyzed. Women comprised 78.61% of the participants, and the median age was 36 years, 10 months. The mean summary total score in the Celiac Disease Questionnaire was 154.53 (possible range 1–196; higher scores equate with higher quality of life), and the score was lower in the subscale of emotion. Women scored significantly lower than men. Participants with the symptomatic disease scored significantly lower than the nearly asymptomatic patients in the total score and in all the subscales. Symptomatic patients need interventions for improving their quality of life, in particular psychological support.

Survey on violence and aggression prevention and management strategies in European renal units

GOALS This descriptive survey aims to explore strategies for the prevention and management of violence and aggression in renal units in 12 European countries. METHOD The convenience sample consisting of dialysis, nephrological and transplantation units in European countries was used. A questionnaire, developed with the collaboration of National Associations, was used. Data were analysed using STATA software. A preliminary descriptive variable analysis was performed followed by a verification of the association between variables; values of p < 0.002 were considered statistically significant. RESULTS A total of 436 completed questionnaires were received (participation rate: 22%). Written policies and procedures regarding violence and aggression are present in 18% of units. Educational strategies are available in less than 20% of units. Incidents are prevented by security staff (48%) or pharmacological treatment (66%). Incident reporting is mandatory for any violent and aggressive behaviour in 66% of units. There are differences between European countries. DISCUSSION AND CONCLUSION Violence and aggression prevention and management strategies are not widely implemented throughout Europe. The dissemination of information on the prevention and management of violence and aggression is vital.

AN INTERNATIONAL SURVEY ON ATTITUDES OF RENAL NURSES TOWARDS OLDER PEOPLE

BACKGROUND Previous studies have indicated that healthcare providers do not enjoy taking care of older people, because of poor attitudes towards the elderly. AIM The purpose of this cross-sectional study is to identify and describe the attitudes of a worldwide sample of renal nurses towards older people. METHOD A convenience sample composed of renal nurses worldwide completed a socio-demographic questionnaire and the Kogans Attitude towards Old People Scale (KOAP). RESULTS We received 1,061 completed questionnaires from nurses in 12 countries. Participants were mainly female (81%), their average age being 42.69 (SD ± 8.70); 74% of nurses had older people in their families and 51% had lived with older people. The sample reported slightly positive attitudes towards the elderly [mean score (± SD) = 151.50 (± 17.9)]. Attitudes were influenced by continent, country, religion, presence of older people in the family and level of nursing education (p < 0.0001). CONCLUSION Our study has shown that renal nurses have slightly positive attitudes towards older people but attitudes could be improved with specific information being provided to renal nurses, to obtain better care.

Comparison of nephrology nursing interventions across five European countries.

Comparing nursing interventions between different countries is helpful towards developing a common nursing culture within Europe. The aim of the study was to compare the frequency of 14 specific nursing interventions indicators across five European countries (Belgium, Scotland, Czech Republic, Greece and the North of England). Data were collected as an integral part of the European Practice Database Project across two cycles (2005 and 2006) involving 172 renal centres. Using Pearsons chi-square and descriptive statistics the frequency of 11 out of the 14 nurse intervention indicators was found to vary significantly across the five countries. Indeed specific nurse interventions such as delegation, telephone consultations and laboratory data interpretation potentially identify where nurse activity is changing in response to pressures such as advancing nurse roles, staff shortages and increased patient demand.

Valuing dignity in patients in a vegetative state on an intensive rehabilitation ward: improvement project.

AIM To identify the causes that could hinder the provision of dignified care to patients in a vegetative state. BACKGROUND In Italy, the incidence and prevalence of people in a vegetative state are increasing. The team members have a clear understanding of the meaning of being mortal and the value of human dignity. METHODS A descriptive study design was used in an intensive care ward in Northern Italy. An anonymous list with negative factors must be drawn up. RESULTS Thirty-two team members participated in the study. A lack of time and specific knowledge regarding the care of patients in a vegetative state, involvement of the family and repetition in assistance delivery were the most frequent causes that hinder provision of care to patients in a vegetative state. DISCUSSION AND CONCLUSIONS The provision of dignity for patients is not an issue related only to the staff in direct contact with patients/clients, but also concerns the entire health care facility (physical structure and organisation). IMPLICATIONS FOR NURSING MANAGEMENT The nursing coordinator has an important role in the promotion of care based on the respect for the patients dignity, in the active involvement of staff and in the delivery of quality services to users.