Marco Tomietto

An exploration of the clinical learning experience of nursing students in nine European countries

The overall aim of the study was to develop a composite and comparative view of what factors enhance the learning experiences of student nurses whilst they are in clinical practice. The study involved students undertaking general nurse training programmes in nine Western European countries. The study focused on: (1) student nurse experiences of clinical learning environments, (2) the supervision provided by qualified nurses in clinical placements, and (3) the level of interaction between student and nurse teachers. The study utilised a validated theoretical model: the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale. The evaluation scale has a number of sub-dimensions: Pedagogical atmosphere on the ward; Supervisory Relationships; the Leadership Style of Ward Managers; Premises of Nursing; and the Role of the Nurse Teacher. Data (N=1903) was collected from Cyprus, Belgium, England, Finland, Ireland, Italy, Netherlands, Spain and Sweden using web-based questionnaire 2007-2008. The findings revealed that respondents were generally satisfied with their clinical placements. There was clear support for the mentorship approach; 57% of respondents had a successful mentorship experience although some 18% of respondents experienced unsuccessful supervision. The most satisfied students studied at a university college, and had at least a seven week clinical placement supported by individualised mentorship relationships. Learning to become a nurse is a multidimensional process that requires both significant time being spent working with patients and a supportive supervisory relationship.

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.

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.

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.

The cost of the objective structured clinical examination on an Italian nursing bachelor's degree course

The OSCE (Objective Structured Clinical Examination) is considered the most valid and reliable method for assessing the clinical skills of students training for health professions, but its use is limited by the related high costs. We analyzed the cost retrospectively of using an OSCE designed for second-year students (2009) in our degree course, adopting the Reznick et al. guidelines (1993), which recommend assessing both high-end costs and low-end costs. The high-end costs adopting the OSCE amounted to € 145.23 per student, while the low-end costs were € 31.51 per student. Considering the economic crisis and the cost-containment measures applied also in nursing education, strategies for further reducing costs are discussed.

The Relationship Between Surgical Patients and Nurses Characteristics With Their Perceptions of Caring Behaviors A European Survey

The purpose of this European survey was to examine the relationship of surgical patients’ and nurses’ personal characteristics with their perceptions of caring behaviors. Caring Behaviors Inventory (CBI) was completed by convenience samples of 1,659 patients and 1,195 nurses from six countries of Europe. The results showed that the older the patients, the more positive were their evaluations of CBI. Those with planned admission and good/very good health conditions gave higher ratings compared to those with an emergency and poor health conditions. Type of admission, age, and health conditions explained 5.2% of CBI variance. Nurses with more work experience and experience in the unit gave significantly higher ratings compared to nurses with less experience. Nurses’ total experience and gender explained 2.3% of the variance of perceived care. Therefore, in a multinational surgical environment, caring behaviors may be influenced by other variables, better captured by using different research methods.

Physical assessment techniques performed by Italian registered nurses: a quantitative survey

AIMS AND OBJECTIVES The aims of the study were to describe which of the core techniques of the physical assessment are regularly performed by a sample of Italian nurses, and to investigate the potential predictors of a more complete examination. BACKGROUND Physical examination is among the essential tasks of nursing professionals, who are requested to perform a correct and complete physical assessment. DESIGN Cross-sectional survey. METHODS The study was performed between August 2013 and January 2014 in 17 Italian regions. A total of 1182 questionnaires were collected. RESULTS Most participants were females (age range 41-50 years), and worked in Internal Medicine, Intensive Care and Surgical hospital units. Of the 30 core techniques that are currently taught and performed according to the Italian Baccalaureate degree requirements, 20 were routinely performed, 6 were seldom used and 4 were learnt but almost never performed (auscultation of lung, heart and bowel sounds and spine inspection). Graduate and postgraduate nurses, working in Intensive Care Units and Nursing Homes, were more prone than the others to carry out a more complete physical assessment. CONCLUSIONS The skills to perform a physical assessment are suboptimal among this sample of Italian nurses. Health and educational providers should pose more attention and efforts to provide nurses with an acceptable training in physical examination practice. RELEVANCE TO CLINICAL PRACTICE This study describes the specific physical techniques performed by nurses in real practice and provides information on which skills require more attention in nursing educational programmes.