Alvisa Palese

Surgical Patient Satisfaction as an Outcome of Nurses’ Caring Behaviors: A Descriptive and Correlational Study in Six European Countries

Purpose: Theoretically, patient satisfaction is correlated with nursing care, but there is not sufficient evidence to support it. The aim of this study was to address three research questions: (a) What is the correlation between caring as perceived by patients and patient satisfaction? (b) Are there differences across various countries on the correlation on caring as perceived by patients and patient satisfaction? (c) Do caring behaviors affect patient satisfaction? Design: A multicenter correlational design was adopted involving surgical patients from six European countries: Cyprus, Czech Republic, Greece, Finland, Hungary, and Italy. Methods: A convenience sample of 1,565 patients was recruited in autumn 2009. The short version of the Caring Behaviours Inventory (CBI; 24 items) and Patient Satisfaction Scale (PSS; 11 items) were used. Data analysis included descriptive statistics, as well as correlation analysis and stepwise multiple regression, to examine relations between caring behaviors and patient satisfaction. Findings: According to the patients involved, nurses performed caring behaviors between very frequently (score = 5) and always (score = 6). Patient satisfaction with nursing care was also high, between satisfied (score = 3) and very satisfied (score = 4). A positive correlation emerged between CBI and PPS (r= 0.66, p < .01) ranging between countries from 0.27 to 0.85 (Czech Republic r= 0.27, Cyprus r= 0.76, Finland r= 0.71, Greece r= 0.85, Hungary r= 0.63, and Italy r= 0.45 [p < .01]). Among the CBI dimensions, “connectedness” mainly explains patient satisfaction (R2= 0.404, p < .001), followed by “assurance” (R2= 0.032, p < .001) and “respectful” (R2= 0.005, p < .001). Conclusions: Caring behaviors enacted by nurses determine a consistent proportion of patient satisfaction. This association between them suggests several implications for nursing education, practice, and management. Clinical Relevance: The results may be utilized by policymakers, nurse ward managers, nurse educators, and clinical nurses as a background for taking appropriate measures to improve nursing care provided, thereby enhancing patient satisfaction.

Factors associated with nursing students' academic success or failure: A retrospective Italian multicenter study

With the increasing standardization of nursing education in Europe under the Bologna Process Declaration (1999), there is a growing interest in defining a common concept of academic success and/or failure, measuring associated factors and comparing differences and similarities between different countries. While there is literature available on these issues from other countries, the phenomenon has not been studied in Italy. The aim of this study was to define the factors associated with academic success or failure in an Italian cohort of nursing students on a bachelors degree course. A retrospective multicenter study design was adopted. All students enrolling in the academic year 2004-05 on two different bachelors courses in the north of Italy were interviewed. Only 81 of the 117 students considered (69.2%) concluded their course in three years. Multivariate analysis identified two factors determining academic success/failure: good results in the entry examination for the bachelors degree in nursing sciences were associated with academic success (OR 4.217, IC(95%) 1.501-11.84), while family commitments, e.g. caring for children or elderly people were associated with academic failure (OR 0.120, IC(95%) 0.03-0.471). Academic failure has a strong impact on students, their families, the teaching faculties and the community, and its prevention is a challenge in the countries with a shortage of nurses.

Patients’ and nurses’ perceptions of respect and human presence through caring behaviours: A comparative study:

Although respect and human presence are frequently reported in nursing literature, these are poorly defined within a nursing context. The aim of this study was to examine the differences, if any, in the perceived frequency of respect and human presence in the clinical care, between nurses and patients. A convenience sample of 1537 patients and 1148 nurses from six European countries (Cyprus, Czech Republic, Finland, Greece, Hungary and Italy) participated in this study during autumn 2009. The six-point Likert-type Caring Behaviours Inventory-24 questionnaire was used for gathering appropriate data. The findings showed statistically significant differences of nurses’ and patients’ perception of frequency on respect and human presence. These findings provide a better understanding of caring behaviours that convey respect and assurance of human presence to persons behind the patients and may contribute to close gaps in knowledge regarding patients’ expectations.

The effectiveness of the ultrasound bladder scanner in reducing urinary tract infections: a meta-analysis

AIM To synthesise the evidence available in the literature on the effectiveness of the ultrasound bladder scanner in reducing the risk of urinary tract infection. BACKGROUND Acute urinary retention is the inability to empty the bladder notwithstanding it being full and is frequent in the postoperative period. Using the ultrasound bladder scanner for the measurement of urinary residue, nurses are able to evaluate the presence of urinary retention, monitor the volume and the excessive relaxation of the bladder and avoid unnecessary catheterisations. The association between urinary catheterisation and urinary tract infection is well documented in the literature. DESIGN A meta-analysis was conducted. METHOD An extensive review was carried out by two researchers using multiple databases, including all articles published from 1 January 1986-8 February 2008. No restrictions were adopted with regard to language. Studies on (1) documenting hospitalised patients with a need to evaluate bladder urinary volume, (2) comparing the use of the ultrasound bladder scanner vs. the clinical judgment of the nurses in the evaluation of acute urinary retention followed by a decision regarding whether or not to apply a bladder catheter and (3) those documenting the impact on urinary tract infection associated with catheterisation were included. RESULTS A total of 61 articles were retrieved, of which 58 were excluded because they did not meet the inclusion criteria. The overall effectiveness of the bladder ultrasound scanner in the reduction of urinary tract infection associated with catheterisation was OR 0.27 (IC95% 0.16-0.47; p-value 0.00000294, variance 0.08, weight 12.50). DISCUSSION The ultrasound bladder scanner helps to define and monitor bladder urinary volume and therefore, to catheterise patients only when necessary. Although there were numerous factors affecting the clinical heterogeneity of the included studies, the reduction in risk of urinary tract infection associated with catheterisation was consistent. CONCLUSION The use of the ultrasound bladder scanner for evaluating and monitoring the residue volume in immediate postoperative patients, aged 18 or above, reduces unnecessary catheterisations and therefore the risk of urinary tract infection associated with catheterisation. RELEVANCE TO CLINICAL PRACTICE The systematic use of the ultrasound bladder scanner in the peri-operative period could increase the appropriateness of catheterisation and reduce patient discomfort, costs and days of hospitalisation associated with urinary tract infection associated with catheterisation.

Paradoxical effects of a hospital‐based, multi‐intervention programme aimed at reducing medication round interruptions

AIM The main aim of the present study was to evaluate interruptions that occurred during medication rounds within a hospital-based, multi-intervention programme. BACKGROUND There are no standardized ways to reduce medication interruptions during medication rounds and no guidelines or standards on the use of tabards during medication rounds. MATERIALS AND METHODS In 2006, a preliminary baseline evaluation (T0) was conducted at the hospital level observing the occurrence of interruptions during medication rounds in daily practice. Subsequently, a hospital-based policy for a multi-intervention medication round programme was implemented at of the beginning of 2008 (T1). After 18 months, an evaluation of the frequency of interruptions was repeated (T2). RESULTS At T0, 298 interruptions were observed for 945 medications administered, or one for every 3.2 medications given. At T2, 385 interruptions were observed for 895 medications given, an interruption for every 2.3 medications administered (P = 0.041). At T0, the mean interruption duration per medication round was 10.48 min whereas at T2 it was 5.08 min. Patient interruptions were reduced (26.5-14.0%, P = 0.05); in spite of this effect, staff member interruptions increased (15.8-40.5%, P = 0.01). CONCLUSIONS With the implementation of the multi-intervention programme, the interruptions changed their pattern. While wearing the red tabard was paradoxically effective with patients, it was ineffective with other staff members. IMPLICATIONS FOR NURSING MANAGEMENT Before introducing new strategies, an evaluation of their appropriateness with regard to the culture of the patients and nurses is recommended: in the present study, patients seem to have considered the warning message worn by nurses as mainly intended for them.

Self-directed learning competence assessment within different healthcare professionals and amongst students in Italy

In the last few years the significance of life-long learning skills has been greatly realised with regard to adult learning, which is based on self-motivation, engagement in learning and making full use of a persons resources. In this context, it is paramount that healthcare professionals take responsibility for their profession by being innovative, creative and flexible to change in order to facilitate the adaptation process and encourage responsiveness to change. The main principles can be summarized as lifelong learning, which are strictly linked to self-directed learning. The aims of this study were to describe (a) the self-directed learning competence of nurses (registered nurse, RN) and radiologist technicians (RT); (b) the self-directed learning competence of RN and RT students before their graduation. A comparative cross-sectional study approach was adopted; a consecutive sample of RNs and RTs attending continuing education seminars, workshops and other initiatives from 2009 to 2010 were considered for this study. Moreover, all nursing and radiology technicians students about to graduate in the same course and studying in the same region were included. The self-rating scale of self-directed learning (SRSSDL) was used to collect data for the purpose of the study. Eight hundred and forty-seven participants were involved (453 RNs, 141 RTs, 182 RN students and 68 RT students) who obtained an average SRSSDL score of 224.7 (±25.0). RNs and RTs got on average a medium-high score (229.1 ± 22.9 and 219.6 ± 29.2, respectively) and the majority of them (63.8-51.1%) reached a high level of self-directed learning. In order to promote tailored continuing education programs and interprofessional continuing education strategies, and identify the support to offer to healthcare workers according to their needs, educators should be aware of their self-directed learning skills. Therefore, individuals with high competence should adopt different strategies from those who have limited skills. Reflecting on self-directed learning competence of students before their graduation incorporates self-directed learning into the professional continuum and clarifies the Universitys contribution in developing this important skill.

A review of nurse educator career pathways: a European perspective

Abstract In 1999, the Bologna declaration was established to increase standardisation of higher education including nursing education across Europe. This process encourages improved workforce mobility within the European Union as qualifications become increasingly recognised across a number of European countries. This article identifies current intelligence around a specific discipline in nursing: regarding the nurse educator, what is written and known about career pathways, the underlying influences within nurse training and further opportunities for study at the higher academic levels. A study of the literature across European countries together with a focus group workshop of nurse educators held in Udine, Italy, in November 2007 has enabled the authors to review the position and status of nurse educators across a number of European countries and identify factors affecting nurse educator mobility. Common themes and shared concerns have been identified as has recommendations for future research.

Patterns of clinical mentorship in undergraduate nurse education: A comparative case analysis of eleven EU and non-EU countries.

BACKGROUND In spite of the number of studies available in the field and policy documents developed both at the national and the international levels, there is no reliable data available regarding the variation of roles occupied by clinical mentors (CMs) across countries. OBJECTIVES To describe and compare the CMs role; responsibilities; qualifications; employment requirements and experience in undergraduate nurse education as enacted in 11 European Union (EU) and non- EU countries. DESIGN A case study design. PARTICIPANTS AND SETTING A panel of expert nurse educators from 11 countries within and outside of the EU (Croatia, Czech Republic, England, Iceland, Ireland, Italy, Poland, Serbia, Slovenia, Spain, and the USA). METHODS A questionnaire containing both quantitative and qualitative questions was developed and agreed by the panel using a Nominal Group Technique (NGT); four cycles of data collection and analysis were conducted involving key experts in nursing education in each country. RESULTS In all countries, there are at least two types of clinical mentorship dedicated to undergraduate nursing students: the first is offered by higher education institutions, and the second is offered by health care providers. Variation was noted in terms of profile, responsibilities and professional requirements to act as a CM; however, the CM role is mainly carried out by registered nurses, and in most countries there are no special requirements in terms of education and experience. Those who act as CMs at the bedside continue to manage their usual caseload, thus the role adds to their work burden. CONCLUSIONS Whilst it is imperative to have respect for the different national traditions in undergraduate nurse education, the globalisation of the nursing workforce and greater opportunities for student mobility during the course of their undergraduate education suggests that in areas such as clinical mentorship, jurisdictions, particularly within the EU, should work towards greater system harmonisation.

The Self-Rating Scale of Self-Directed Learning (SRSSDL): A factor analysis of the Italian version

BACKGROUND The development of self-directed learning (SDL) is a growing priority among nurses and other health care workers: they need to be prepared in order for their university education to be effective and relevant to their lifelong learning. To learn in a self-directed manner, it is necessary to develop an awareness of ones ability to self-learn and then to implement appropriate and effective strategies; progress must be assessed using validated measurement tools. OBJECTIVES The aim of this study was to examine the factor structure of the Italian version of the Self-Rating Scale of Self-directed Learning (SRSSDL(Ita)), and to provide evidence of its validity. DESIGN A cross-sectional design was undertaken. PARTICIPANTS Given that the instrument is composed of 60 items, a total of 600 to 900 participants were targeted. In addition, according to the theoretical assumption that self-directed learning - as a crucial component of lifelong learning - is a measurable skill that is developed across the individuals professional life, a maximum variation sample was examined. Therefore, 847 participants were involved, including 453 nurses, 141 radiology technicians, 182 nursing students and 68 radiology technician students. METHODS Principal component analysis and factor analysis were performed. RESULTS The Italian version of the SRSSDL Scale consists of 40 items composed of eight factors: Awareness (α=0.805), Attitudes (α=0.778), Motivation (α=0.789), Learning Strategies (α=0.789), Learning Methods (α=0.781), Learning Activities (α=0.676), Interpersonal Skills (α=0.684), and Constructing Knowledge (α=0.732). CONCLUSIONS The SRSSDLIta consists of 40 items across eight factors. The shorter Italian version might reduce the time needed to complete, thereby making the tool faster and easier to use.

Risk factors of falls in elderly population in acute care hospitals and nursing homes in North Italy: A retrospective study

A retrospective comparative study was conducted in Italy to determine whether the risk of accidental falls is the same in acute care hospitals as in nursing homes. Accidental falls were significantly related to women older than 80 years and to a hospital stay 10 days or longer, with an increased risk related to stroke, arterial hypertension, and a Norton Scale score greater than 15. Prevention strategies need to be based on the context and specific intrinsic and extrinsic factors influencing the risk of falls in elderly patients.