Davide Ausili

Roles of Changing Physical Function and Caregiver Burden on Quality of Life in Stroke: A Longitudinal Dyadic Analysis

Background and Purpose— The purpose of this study was to examine changes in stroke survivor and caregiver quality of life (QOL) and to determine whether changes in survivor physical functioning and caregiver burden (ie, the impact of the physical, psychological, and social demands of caregiving) influence changes in QOL. Methods— Longitudinal design with 226 stroke survivor–caregiver dyads enrolled at survivor discharge from rehabilitation hospitals. Data collection was performed over 12 months. We measured survivor physical functioning, caregiver burden, and QOL (physical, psychological, social, and environmental) in both survivor and caregiver. Multilevel modeling was used to control for the interdependence of the data. Results— Survivors (50% male sex) and caregivers (66% female sex) were 70.8 (SD=11.9) and 52.4 (SD=13.1) years old, respectively. Over the 12 months, stroke survivor’s physical (&ggr;=1.59; P<0.001) and psychological (&ggr;=0.86; P<0.05) QOL significantly improved; social and environmental QOL did not P>0.05. Caregiver QOL, on average, did not significantly change over time P>0.05. Improvements in survivor physical functioning were associated with increases in survivor and caregiver physical and psychological QOL and survivor environmental QOL. Decreases in caregiver burden were significantly associated with improvements in caregiver physical, psychological, and environmental QOL but not with survivor QOL. Conclusions— QOL of stroke survivors and caregivers covaries and is greatly impacted by the physical function changes of the survivor. Dyadic approaches to stroke rehabilitation that acknowledge the interdependence of dyads are needed.

MOTIVATional intErviewing to improve self-care in Heart Failure patients (MOTIVATE-HF): Study protocol of a three-arm multicenter randomized controlled trial

AIMS Heart Failure (HF) self-care improves patient outcomes but trials designed to improve HF self-care have shown inconsistent results. Interventions may be more effective in improving self-care if they mobilize support from providers, promote self-efficacy, increase understanding of HF, increase the family involvement, and are individualized. All of these elements are emphasized in motivational interviewing (MI); few trials have been conducted using MI in HF patients and rarely have caregivers been involved in MI interventions. The aim of this study will be to evaluate if MI improves self-care maintenance in HF patients, and to determine if MI improves the following secondary outcomes: a) in HF patients: self-care management, self-care confidence, symptom perception, quality of life, anxiety/depression, cognition, sleep quality, mutuality with caregiver, hospitalizations, use of emergency services, and mortality; b) in caregivers: caregiver contribution to self-care, quality of life, anxiety/depression, sleep, mutuality with patient, preparedness, and social support. METHODS A three-arm randomized controlled trial will be conducted in a sample of 240 HF patients and caregivers. Patients and caregivers will be randomized to the following arms: 1) MI intervention to patients only; 2) MI intervention to patients and caregivers; 3) standard of care to patients and caregivers. The primary outcome will be measured in patients 3months after enrollment. Primary and secondary outcomes also will be evaluated 6, 9 and 12months after enrollment. CONCLUSION This study will contribute to understand if MI provided to patients and caregivers can improve self-care. Because HF is rising in prevalence, findings can be useful to reduce the burden of the disease.

Measuring elderly care through the use of a nursing conceptual model and the international classification for nursing practice

INTRODUCTION   Nursing models and terminologies can contribute to research the nature of nursing care. AIM   The aim of this study was to describe nursing diagnoses in acute- and long-term elderly care. METHODS   A point prevalence survey was conducted on 240 patients. The International Classification for Nursing Practice was used to describe nursing diagnoses, and a conceptual model was used to categorize them in nursing needs. RESULTS   A total of 2,673 diagnoses were detected. Mean was higher in nursing home than in hospital (t test =-3.688; p = .0003). Prevalent diagnoses were significantly different. DISCUSSION   High complexity, with different issues for nurses, was observed both in acute- and in long-term settings. CONCLUSION   The results could help to comprehend the nature of older persons needs and could contribute to the development of an International Classification for Nursing Practice catalogue for elderly care.

Development and psychometric testing of a theory-based tool to measure self-care in diabetes patients: the Self-Care of Diabetes Inventory

BackgroundSelf-care is essential for patients with diabetes mellitus. Both clinicians and researchers must be able to assess the quality of that self-care. Available tools have various limitations and none are theoretically based. The aims of this study were to develop and to test the psychometric properties of a new instrument based on the middle range-theory of self-care of chronic illness: the Self-Care of Diabetes Inventory (SCODI).MethodsForty SCODI items (5 point Likert type scale) were developed based on clinical recommendations and grouped into 4 dimensions: self-care maintenance, self-care monitoring, self-care management and self-care confidence based on the theory. Content validity was assessed by a multidisciplinary panel of experts. A multi-centre cross-sectional study was conducted in a consecutive sample of 200 type 1 and type 2 diabetes patients. Dimensionality was evaluated by exploratory factor analyses. Multidimensional model based reliability was estimated for each scale. Multiple regression models estimating associations between SCODI scores and glycated haemoglobin (HbA1c), body mass index, and diabetes complications, were used for construct validity.ResultsContent validity ratio was 100%. A multidimensional structure emerged for the 4 scales. Multidimensional model-based reliabilities were between 0.81 (maintenance) and 0.89 (confidence). Significant associations were found between self-care maintenance and HbA1c (p = 0.02) and between self-care monitoring and diabetes complications (p = 0.04). Self-care management was associated with BMI (p = 0.004) and diabetes complications (p = 0.03). Self-care confidence was a significant predictor of self-care maintenance, monitoring and management (all p < 0.0001).ConclusionThe SCODI is a valid and reliable theoretically-grounded tool to measure self-care in type 1 and type 2 DM patients.

Cross-Mapping of Nursing Care Terms Recorded in Italian Hospitals into the Standardized NNN Terminology: Cross-Mapping of Italian Nursing Care Terms

PURPOSE To evaluate if nursing diagnoses, interventions, and outcomes, as recorded by nurses in Italian hospitals, were semantically equivalent to the NANDA-I, NIC, and NOC (NNN) terminology. METHODS A cross-mapping study using a multicenter design. Terms indicating nursing diagnoses, interventions, and outcomes were collected using the D-Catch instrument. Cross-mapping of these terms with NNN terminology was performed. FINDINGS A sample of 137 nursing documentations was included. Over 80% of nursing diagnostic terms, interventions, and outcomes were cross-mapped into NNN terminology. CONCLUSIONS The study showed that most of the natural terms used by nurses were semantically equivalent to the standardized terms of NNN terminology. IMPLICATIONS FOR NURSING PRACTICE In Italy, the use of NNN terminology is recommended; however, further development of this terminology is needed.

Impact of an Electronic Nursing Documentation System on the Nursing Process Accuracy

While the nursing process provides a framework for documenting nursing practice and delivering patient-focused care, nurses often have difficulty applying the nursing process in clinical practice. Fortunately, electronic nursing documentation using clinical decision support systems (END-CDSS) can improve the accuracy of recorded nursing process. To date, however, no study has evaluated nursing documentation accuracy over time following END-CDSS implementation. Accordingly, the aim of this study was to evaluate if the Professional Assessment Instrument (PAI) END-CDSS improved the accuracy of nursing documentation in an Italian hospital cardiology inpatient unit. A quasi-experimental longitudinal design was conducted. A random sample of 120 nursing documentations was collected and evaluated using the D-Catch instrument. A significant improvement (p < .001) in nursing documentation accuracy scores was shown after PAI implementation. These results suggest that an END-CDSS can support nurses in the nursing process by improving their clinical reasoning skills.

[L'impiego dell'ICNP® nella formazione infermieristica con modelli teorici infermieristici: una revisione della letteratura]

INTRODUCTION The International Classification for Nursing Practice (ICNP®) is the only nursing terminology that has been accepted within the Family of International Classification of the World Health Organization. The academic teaching of ICNP® could contribute to improve nursing clinical practice. However, standards for its implementation in undergraduate nursing education together with a nursing theoretical model are not available. AIM To know the state of the art about the use of ICNP® in undergraduate nursing education and its use with a nursing theoretical model. METHOD A narrative literature review was conducted searching main health scientific databases and including monographs, statements from international associations, and published conference papers. RESULTS Available literature about ICNP® implementation in nursing education and its use with theoretical models is limited. Results supported the organization of a specific course on ICNP® before clinical teaching programs, the development of paper or electronic ICNP® based educational tools, and the use of active learning strategies. Only three experiences reporting the use of ICNP® with theoretical models have been found. CONCLUSIONS Both the use of ICNP® in nursing undergraduate education and its use according to one or more nursing theoretical models, could help students to learn nursing process. However, weak recommendations can be found in the literature to orient ICNP® implementation in undergraduate nursing education and/or with an explicit theoretical framework. Further studies focusing on these issues are strongly needed.