Maria Matarese

Predictive validity of the Hendrich fall risk model II in an acute geriatric unit

BACKGROUNDnFalls are the most common adverse events reported in acute care hospitals, and older patients are the most likely to fall. The risk of falling cannot be completely eliminated, but it can be reduced through the implementation of a fall prevention program. A major evidence-based intervention to prevent falls has been the use of fall-risk assessment tools. Many tools have been increasingly developed in recent years, but most instruments have not been investigated regarding reliability, validity and clinical usefulness.nnnOBJECTIVESnThis study intends to evaluate the predictive validity and inter-rater reliability of Hendrich fall risk model II (HFRM II) in order to identify older patients at risk of falling in geriatric units and recommend its use in clinical practice.nnnDESIGNnA prospective descriptive design was used.nnnSETTINGnThe study was carried out in a geriatric acute care unit of an Italian University hospital.nnnPARTICIPANTSnAll over 65 years old patients consecutively admitted to a geriatric acute care unit of an Italian University hospital over 8-month period were enrolled.nnnMETHODSnThe patients enrolled were screened for the falls risk by nurses with the HFRM II within 24h of admission. The falls occurring during the patients hospital stay were registered. Inter-rater reliability, area under the ROC curve, sensitivity, specificity, positive and negative predictive values and time for the administration were evaluated.nnnRESULTSn179 elderly patients were included. The inter-rater reliability was 0.87 (95% CI 0.71-1.00). The administration time was about 1min. The most frequently reported risk factors were depression, incontinence, vertigo. Sensitivity and specificity were respectively 86% and 43%. The optimal cut-off score for screening at risk patients was 5 with an area under the ROC curve of 0.72. The risk factors more strongly associated with falls were confusion and depression.nnnCONCLUSIONSnAs falls of older patients are a common problem in acute care settings it is necessary that the nurses use specific validate and reliable fall risk assessment tools in order to implement the most effective prevention measures. Our findings provided supporting evidence to the choice of the HFRM II to screen older patients at risk of falling in acute care settings.

Nursing student attitudes towards older people: validity and reliability of the Italian version of the Kogan Attitudes towards Older People scale

AIMnThis paper reports a study testing the validity and reliability of the Italian version of the Kogan Attitude towards Older People scale.nnnBACKGROUNDnNursing students attitudes towards older people can affect their preference for working with them. One of the most common instruments used to assess these attitudes is the Kogan Attitude towards Older People scale. Previous validation studies performed on college students internationally have demonstrated good reliability and validity. The psychometric properties of the Italian version have not yet been tested.nnnDESIGNnA cross-sectional, descriptive study.nnnMETHODnThe study was conducted from March-June 2010 with a convenience sample of nursing students attending two Italian universities. Reliability was evaluated using internal consistency and item-to-total correlation. Content and construct validity were evaluated using a content validity index and principal factor analysis.nnnRESULTSnA total of 1637 nursing students participated in the study. Two factors were extracted from the factor analysis: prejudice describing a negative disposition and appreciation indicating a favourable feeling and opinion towards older people.nnnCONCLUSIONnThe Kogan Attitude towards Older People scale applied to Italian nursing students exhibited good internal consistency. The two-dimensional construct of the scale was congruent with some, but not all, results of previous studies due to methodological differences among the studies. Based on the study findings, the scale can be recommended for future research studies in Italy including use as pre/post-test measurement associated with nursing education programmes.

The experiences of self-care in community-dwelling older people: A meta-synthesis

OBJECTIVESnTo identify, critically appraise and synthesize qualitative evidence of self-care experiences in health promotion for home-dwelling elders.nnnDESIGNnA meta-synthesis was conducted following the Joanna Briggs Institute guidelines and using Qualitative Assessment and Review Instrument Software.nnnDATA SOURCESnThe literature search was conducted on PubMed, CINHAL, Embase, PsycInfo, Eric and ILISI databases from inception up until March 2015. Other articles were searched on Scopus and Web of Knowledge. The reference list of all the identified articles was also searched for additional studies. Studies published in English, Italian, French, Portuguese, and Spanish were considered for inclusion in the review.nnnREVIEW METHODSnData from the selected qualitative articles were extracted independently by two reviewers using the data extraction tool of the Joanna Briggs Institute-Qualitative Assessment and Review Instrument. The meta-synthesis involved the following three steps: the production of a set of statements representing the aggregated data obtained by assembling the findings of qualitative studies; the categorization of findings on the basis of similarity in meaning; and the aggregation of these categories to produce a comprehensive set of synthesized findings. No studies were excluded due to methodological quality.nnnRESULTSnOf the 4001 records identified, 11 articles met the inclusion criteria. Most articles were conducted in Scandinavian countries and used a phenomenological design. Most elders in the sample were middle-class, cognitively intact, independent, and in good health. The meta-synthesis revealed that older people living at home make decisions about their self-care activities on the basis of their attitudes toward their life and future. These self-care activities are directed toward holistic wellness, prevention and treatment of aging effects, obtaining a sense of satisfaction, and self-realization. Furthermore, self-care activities are settled in a social and relational network that allows old people to take care of themselves and of others or to be cared for by others.nnnCONCLUSIONSnThis meta-synthesis presents the perspectives of home-dwelling old people on health-promoting self-care experiences. Such information can help healthcare professionals to maintain long-term autonomy of elders in self-care and to promote healthy aging. Further qualitative research describing self-care experiences of home-dwelling elders from different cultures, education levels, and social backgrounds is needed.

Self-Care of People with Chronic Obstructive Pulmonary Disease: A Meta-Synthesis

BackgroundSelf-care in people with chronic obstructive pulmonary disease (COPD) can improve health-related quality of life, reduce hospital admissions and decrease dyspnoea.ObjectiveThis review aimed to systematically identify, evaluate and synthesise the qualitative literature on the self-care behaviours and strategies used by people with COPD.MethodsThe Joanna Briggs Institute (JBI) meta-aggregative method was followed. An electronic search of six relevant databases was conducted. The search was limited to articles published from January 1996 to January 2016. Reference lists of all identified articles were searched to find additional literature. Two independent reviewers analysed the studies against the inclusion criteria, extracted the data and assessed the methodological quality of the 14 identified papers using the JBI qualitative assessment and review critical appraisal instrument. Findings were synthesised using a meta-aggregation process.ResultsFour synthesised findings emerged from the aggregation of 114 findings: self-care is directed towards the prevention, control and management of the physical consequences of COPD; self-care focuses on the management of the psychological effects of COPD; self-care is aimed at reducing the impact of COPD on social life; and self-care is influenced by contact with healthcare services and requires the acquisition of knowledge and skills.ConclusionsThis meta-synthesis provides evidence on the self-care behaviours and strategies that people with COPD perform to prevent, control and manage the physical, psychological and social consequences of the disease. The findings of this meta-synthesis could help healthcare professionals to tailor self-care educational programmes to the experiences, preferences and priorities of people with COPD.

Measurement properties of instruments evaluating self-care and related concepts in people with chronic obstructive pulmonary disease: A systematic review

The use of valid and reliable instruments for assessing self-care is crucial for the evaluation of chronic obstructive pulmonary disease (COPD) management programs. The aim of this review is to evaluate the measurement properties and theoretical foundations of instruments for assessing self-care and related concepts in people with COPD. A systematic review was conducted of articles describing the development and validation of self-care instruments. The methodological quality of the measurement properties was assessed using the COSMIN checklist. Ten studies were included evaluating five instruments: three for assessing self-care and self-management and two for assessing self-efficacy. The COPD Self-Efficacy Scale was the most studied instrument, but due to poor study methodological quality, evidence about its measurement properties is inconclusive. Evidence from the COPD Self-Management Scale is more promising, but only one study tested its properties. Due to inconclusive evidence of their measurement properties, no instrument can be recommended for clinical use.

Cross-validation of the Self-care Ability Scale for Elderly (SASE) in a sample of Italian older adults

The assessment of self-care among older adults is important as it permits the tailoring of educational interventions directed to prevent health deterioration and contrast the effects of ageing. The Self-care Ability Scale for the Elderly (SASE) was developed to assess the perceived self-care ability in older adults. Its psychometric properties were tested only in Scandinavian countries and China. This research was a cross-validation of the SASE on 402 Italian adults aged 65 and older recruited in hospitals, clinics and homes, from September 2016 to February 2017. We performed exploratory and confirmatory factor analyses on two subsamples and identified three factors, self-care ability to perform ADLs, self-care ability to achieve well-being and self-care ability to set personal goals, with a good model fit (CFI > 0.93; RMSEA = 0.07; SRMR = 0.06). We eliminated four items, however, to improve the structural validity. Internal consistency for the three factors of the Italian version of the SASE (SASE-I) ranged from 0.72 to 0.92. The test-retest reliability indicated good stability of the scale (ICC coefficient = 0.92). We assessed convergent validity by comparing the SASE-I with the Katz Index of Independence in Activities of Daily Living and the Lawton Instrumental Activities of Daily Living Scale, showing moderate-to-strong correlations. In addition, the SASE-I discriminated the self-care ability in groups with different ages, levels of education and settings. Our study produced a 13-item version of the SASE with good psychometric properties that could be recommended for use in clinical practice and research after further validation on different populations and settings.

A Systematic Review and Integration of Concept Analyses of Self‐Care and Related Concepts

PURPOSEnThis systematic review identified, synthesized, and integrated concept analyses on self-care and related concepts.nnnDESIGNnThe guidelines for systematic literature reviews of the Joanna Briggs Institute were followed.nnnMETHODSnThe Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, PsycINFO, and EMBASE databases were searched for concept analyses published in the past 20 years.nnnFINDINGSnA total of 26 concept analyses were identified that had been published on self-care, self-care agency, self-monitoring, self-management, self-management support, symptom management, and self-efficacy. Differences and commonalities in the examined literature were identified, and a model was delineated, explaining the relations among the various concepts from the nursing perspective.nnnCONCLUSIONSnThe healthcare literature has broadly described self-care and related concepts; however, consensus on the definitions remains beyond our reach and should not be expected, due to the different perspectives and paradigms from which the concepts are interpreted. From a nursing perspective, self-care can be considered a broad concept encompassing the other concepts, which describe more specific individual levels of activities and processes.nnnCLINICAL RELEVANCEnNurses are actively involved in disease management and self-management support as well as in promoting self-care in healthy and sick people. Referring to a model on self-care and related concepts could avoid misinterpretations in nursing practice, research, and policy.

The Unmet Needs of People with Chronic Obstructive Pulmonary Disease: A Systematic Review of Qualitative Findings

ABSTRACT The complexity of chronic obstructive pulmonary disease (COPD) can negatively impact the lives of people with the condition and compromise their capacity to take care of their needs. Unmet needs can then lead to significant morbidity, unpleasant emotional experiences and a poor quality of life; thus this systematic review aimed to identify, evaluate and synthesise the qualitative literature on the unmet needs of people with COPD. A qualitative meta-synthesis was performed according to the Joanna Briggs Institute method. A systematic search of five databases was conducted, searching for articles published from January 1995 to May 2017. Eight papers were identified. Two researchers extracted the data and independently assessed their quality. The total sample of people with COPD included was 108. Nine categories were derived from 49 findings, and aggregated into three synthesised findings: (1) people with COPD have unmet needs regarding information about the disease; (2) people with COPD have unmet physical, emotional and social needs, due to the disease symptoms and treatments; and (3) people with COPD have unmet care needs. This review showed qualitative evidence regarding the dimensions in which people with COPD express their unmet needs. The needs that are mainly unsatisfied include physical, psychosocial, informational and practical aspects, as well as the need for healthcare professional care. A global approach, which includes the areas identified by our findings, could lead to an improvement in the care of people with COPD and could improve the self-care management of those individuals who do not correctly identify their needs.