Michela Piredda

‘If it is not recorded, it has not been done!’? consistency between nursing records and observed nursing care in an Italian hospital

AIMS The aim of this study is to evaluate the consistency between the care given to patients and that documented, by comparing care observations with nursing records and describing which interventions were reported and which were omitted. BACKGROUND Assumptions have been made about the relationship between documentation and care actually delivered, but there is insufficient evidence on the relationship between the actual care given and its recording. DESIGN Observational study of the care given, completed by interviews and retrospective survey of records. METHODS Structured observation during day shifts in the first six days of admission of pre and postsurgical care provided to 21 consecutive patients undergoing major abdominal surgery and audit of their nursing records. Each observation was completed by short interviews to nurses to ensure observations validity. RESULTS Only 40% of nursing activities observed were included in the nursing records (37% of the assessments and 45% of the interventions). This indicated that nurses carry out more activities than they report. Consistency between performed and recorded care decreased significantly during the days when a higher number of activities were performed. Consistency between recording and observation of assessment activities was 38% for physical needs and 0% for educational needs. Consistency was higher for the assessments of physical signs/symptoms and risk factors for complications compared to the assessment of basic needs and pain. Consistency was 47% for technical interventions and 3% for educational activities. CONCLUSIONS Nursing records were not found to be an adequate tool for quality care evaluation, because they did not include all the caring activities that the nurses had carried out. RELEVANCE TO CLINICAL PRACTICE This study supports the need to identify documentation systems that are easy to complete. Moreover, nursing education should pay more attention to the competences in the field of holistic care and patient education.

Meeting information needs on cancer-related fatigue: an exploration of views held by Italian patients and nurses

BackgroundInterest in cancer-related fatigue has been growing over the last two decades and efforts have been dedicated to investigate this topic. However, research addressing the adequacy of educational resources for patients with this distressing and common symptom is lacking. Only one study has been undertaken and this explored Swiss and British patients’ views.Materials and methodsThe current study replicated and extended the study previously undertaken in the United Kingdom (UK) and Switzerland. It sought views on the adequacy of materials on cancer-related fatigue available to patients with cancer living in Italy, and to determine the educational preferences and needs of Italian patients with cancer-related fatigue. These were attained through conduct of two focus groups. One was undertaken with Italian patients and the other with a group of Italian nurses.Main resultsFindings from this study supported patients’ desire for timely, accurate and individualised information. Barriers to effective fatigue education included the limited dialogue regarding fatigue initiated in clinical settings. It appeared that nurses and patients held different priorities in symptom management. Further, it was acknowledged that there was often insufficient time to inform patients adequately about fatigue. Participants considered written materials as helpful complements to oral information, thus supporting the provision of information in both forms. However, it was clear that fewer written resources concerning cancer-related fatigue were available in Italy compared to either in Switzerland or in the UK.ConclusionThe study supported the view within the current literature that whilst cancer-related fatigue is recognised as a frequent and disruptive symptom, patient education about this symptom and its management still needs to be enhanced. The resources available to educate patients about cancer-related fatigue should be improved and made more accessible to patients who experience it.

Psychometric evaluation of the Newcastle Satisfaction with Nursing Scales

This study tested the psychometric properties of the Italian version of the Newcastle Satisfaction with Nursing Scales through factor analysis with 659 medical and surgical inpatients. One factor was found for the Scale Satisfaction and 4 factors for the Scale Experiences: Carelessness, Emotional support, Relationship/information, and Caring times. This validation makes available to nurses and managers a multidimensional tool able to discriminate between different care experiences and to identify areas for care improvement.

Tuning Nursing Educational in an Italian academic context.

BACKGROUND The European Union Bologna Process has laid the foundation for a common European competence-based educational framework. In many countries, nursing education is in transition from vocational to higher education, with many diverse systems. The competence-based approach provided by the project Tuning Educational Structures offers a common and coherent framework able to facilitate the implementation of the principles underpinning the Bologna Process reform. OBJECTIVES This study aimed to ascertain the relevance that Italian nursing university lecturers attributed to the 40 competences of the Italian version of the nursing Bachelors and Masters Degrees. These competences were developed through adoption of the Tuning Methodology in the nursing context. SETTING The study was conducted in the 4 universities of one region of Italy which offer nursing Bachelors and Masters Degrees. PARTICIPANTS A total of 164 Italian university nursing lecturers. METHODS Using a four point scale, a cross sectional survey was conducted from March 2011 to April 2012. Participants evaluated each competence according to its relevance for Bachelors or Masters Education. Frequency analysis was conducted. RESULTS The significance for each competence of Tuning was rated very high by Italian lecturers and appeared to overlap partially with the original European study. In Italy, the most relevant competences for Bachelors Degree were the skills associated with the use of appropriate interventions, activities and skills in nursing and the skills associated with nursing practice and clinical decision-making. For Masters Degree, leadership, management and team competences were the most important. CONCLUSIONS The Tuning Nursing Project was accepted by the Italian lecturers. The competence-based approach was considered by Italian lectures as a support enabling to reflect on the current Italian nursing education cycles of study and to ensure shared visions and common approaches between Italian and European lecturers.

Patients’ Perception of Time in Palliative Care: A Metasynthesis of Qualitative Studies

Time perception in palliative care is modified by the prospect of death and by uncertainty about the future. Patients’ perceptions of time have been explored within individual qualitative studies reporting fragmented evidence. This study aimed to synthesize available qualitative literature on patients’ perception of time in palliative care using the Johanna Briggs Institute integrative approach. An extensive search was conducted within the major biomedical databases using the key words “time perception,” “palliative care,” and “patients.” Seven studies were included. Four main themes emerged from the metasynthesis. “The suspended time of waiting” was a central theme because of its importance in patients’ accounts and also because it was susceptible to change by health professionals. The other 3 themes were “the time of the diseased body,” “perspectives change with time,” and “from the end to the aim of time.” This study shows the interconnected nature of physical, social, and emotional aspects of time perception and the profound social impact of providing and receiving care. Knowledge of patients’ time perceptions in palliative care can help health professionals respect them and improve their care.

Anxiety, depression and quality of life in chronic obstructive pulmonary disease patients and caregivers: an actor–partner interdependence model analysis

PurposeWe aimed to assess the influence of anxiety and depression on the physical and mental quality of life (QoL) in patient with chronic obstructive pulmonary disease (COPD) and caregiver dyads, detect the simultaneous effect of anxiety and depression of each partner on the other’s QoL and determine the dyadic patterns.MethodsA cross-sectional descriptive design was used. The actor–partner interdependence model estimated by structural equation modeling was used for the dyadic analysis. Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and 12-Item Short-Form Health Survey (SF-12) were used to measure depression, anxiety and QoL, respectively.ResultsEighty COPD dyads were enrolled in the study. Patients presented higher depression symptoms and poorer physical and mental QoL than their caregivers, whereas comparable levels of anxiety were found in patients and caregivers. The model exploring the effects of depression and anxiety on mental QoL found that patients’ depressive symptoms negatively influence their mental QoL, and caregivers’ anxiety and depression symptoms negatively impact their mental QoL. The model exploring the effects of anxiety and depression on physical QoL detected one statistically significant actor effect with patients’ depressive symptoms negatively influencing their physical QoL, and two partner effects with caregivers’ anxiety worsening patients’ physical QoL and caregivers’ depression improving patients’ physical QoL.ConclusionsThe results suggest that caregivers’ psychological distress influences caregivers’ mental QoL and patients’ physical QoL. Therefore, health-care professionals should assess and treat anxiety and depression in both members of the COPD dyad to improve their QoL.

Translation and Testing of the Italian Version of FAMCARE-2: Measuring Family Caregivers’ Satisfaction With Palliative Care

Family satisfaction is an important outcome of palliative care and is a critical measure for health care professionals to address when assessing quality of care. The FAMCARE-2 is a widely used measure of family satisfaction with the health care received by both patient and family in palliative care. In this study, a team of Italian researchers culturally adapted the FAMCARE-2 to the Italian language and psychometrically tested the instrument by measuring satisfaction of 185 family caregivers of patients admitted into two palliative care services. FAMCARE-2 showed excellent levels of internal consistency (Cronbach’s α coefficient = .96) and test–retest reliability (r = .98, p < .01). The confirmatory factor analysis showed a single-factor structure with good fit. Satisfaction levels were significantly correlated with family caregivers being females with less education, patient length of care, and place of assistance and death. This scale can help health care professionals identify which aspects of care need improvement and enable family caregivers to manage their challenging role.