Milko Zanini

The general results of the RN4CAST survey in Italy.

The issue of health workforce shortage and in particular of nurses, has been debated globally for almost three decades (Aiken & Mullinix 1987, Aiken et al. 1996, 2001, 2010), and has been exacerbated by the recent global financial crisis. The European RN4CAST project has shifted focus from considering only nursing workforce planning and workforce volumes to considering the impact of adequate nurse-patient ratios and work environment on patient safety and the quality of care (Sermeus et al. 2011).

The life experience of nutrition impact symptoms during treatment for head and neck cancer patients: a systematic review and meta-synthesis

PurposeIn the literature, there is limited research about the changed meaning of food, the eating and the eating experience during treatment in patients with head and neck cancer. This systematic review includes findings from a qualitative research synthesis to gain a deeper understanding of the influence and experiences of dysphagia, dysgeusia, oral mucositis and xerostomia in head and neck cancer patients (HNC) and suggests recommendations for care practice.MethodA systematic review and meta-synthesis techniques were adopted to identify, appraise and synthesize the relevant literature regarding the experience of nutritional symptoms of HNC patients conducted according to the PRISMA guidelines. Several electronic databases such as PubMed, CINAHL, Scopus, PsycINFO and the Cochrane Library databases were searched.ResultsA systematic search yielded 121 papers, of which 12 met the inclusion criteria. A thematic account of shared nutritional symptom experiences reported across studies is highlighted and presented. Eight major themes covering three key supportive care domains were identified: impact of symptoms (symptoms during treatment, symptoms working together, affecting daily living activities and physical changes, symptoms and food changes), changing social networks and support (social life restrictions, support of peers), nutritional concerns and strategies (coping strategies, professional support).ConclusionsDysphagia, dysgeusia, oral mucositis and xerostomia negatively affected the patients’ quality of life throughout the period of treatment. The patients’ nutritional symptom experiences do not occur in isolation. Therefore, acknowledging the patients’ eating difficulties and challenges can guarantee appropriate management and support to best manage symptoms in a timely manner.

What are the components of interventions focused on quality-of-life assessment in palliative care practice? A systematic review

Quality-of-life assessment is a central concept in palliative care. Clinical interventions focused on assessing quality of life are complex interventions. Current research is insufficient to determine how to implement interventions focused on quality-of-life assessment in palliative care. To explore the different components of interventions focused on quality-of-life assessment in palliative care, a systematic review and 5 databases were searched. Publications included were analyzed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Framework Programme 7 practical guidance on using patient-reported outcome measurements in palliative care and the Quality of Life Assessment Principles in Palliative Care. Interventions and their components were identified and discussed. Identifying problems and monitoring change or response to treatment, screening for hidden problems, and facilitating communication were the 3 different types of intervention identified. None of the interventions fulfilled all the 11 Quality of Life Assessment Principles in Palliative Care. Overall, 6 characteristics of the components were identified: the quality-of-life measure, educational training, completing the measure (patients or proxy), collecting quality-of-life data (baseline and further assessment), identifying a coordinator, and presenting quality-of-life data. Because of heterogeneity of interventions, it is not possible to recommend 1 preferred intervention.

Preparing healthcare students who participate in interprofessional education for interprofessional collaboration: A constructivist grounded theory study protocol

ABSTRACT This article presents a qualitative research protocol to explore and understand the interprofessional collaboration (IPC) preparation process implemented by clinical tutors and students of different professions involved in interprofessional education (IPE). Many studies have shown that IPE initiatives improve students’ understanding of the roles and responsibilities of other professionals. This improves students’ attitudes towards other professions, facilitating mutual respect, and IPC. However, there is limited information about how students are prepared to work collaboratively within interprofessional teams. This is a constructivist grounded theory (GT) study, which will involve data collection through in-depth semi-structured interviews (to 9–15 students and 6–9 clinical tutors), participant observations, and the analysis of documentation. After analysing, coding, integrating, and comparing the data if necessary, a second round of interviews could be conducted to explore any particularly interesting aspects or clarify any issues. This will then be followed by focused and theoretical coding. Qualitative data analysis will be conducted with the support of NVivo 10 software (Victoria, Australia). A better conceptual understanding will help to understand if IPE experiences have contributed to the acquisition of competencies considered important for IPC, and if they have facilitated the development of teamwork attitudes.

Including qualitative research in Randomized Controlled Trials (RCT): opportunities for nursing researchers

The Randomized Controlled Trial (RCT) has long been recognized as the gold standard approach to testing the efficacy of medicines. More recently the method is being used to test other health care interventions - such as surgical interventions, medical devices, wound management techniques and also nursing interventions. For many years the RCT has been seen as an exclusively quantitative approach - possibly as a result of its use predominantly by medical researchers and laboratory scientists - schooled in a particularly positivist research culture. This article is protected by copyright. All rights reserved.

RN4CAST@IT-Ped: nurse staffing and children's safety

Some authors argue that it is not longer ethically correct to expose hospitalized patients to death risks associated with understaffing (Nickitas, 2014). Also the Care Quality Commission (CQC, an independent regulator of all health and social care services in England) has included staffing levels as one of the auditing quality standards when inspecting hospitals and health centres. The Royal College of Nursing, in its document Mandatory Nurse Staffing Levels (RCN, 2012), clearly defined which nurse staffing levels should be adopted by policy makers to ensure the provision of safe care. However, even in the UK where such pressure exists there are no legally defined nurse staffing levels.

The Edinburgh Feeding Evaluation in Dementia Scale: A Longitudinal Study in Nursing Home Residents

Aims/Background: The Edinburgh Feeding Evaluation in Dementia (EdFED) scale has been shown to have good psychometric properties using a range of methods including Mokken scaling. We aimed to study the Italian version of the EdFED using Mokken scaling. Methods: Data were gathered at 7 time points from 401 nursing home residents affected by dementia in the course of a 6-month intervention study using analysis of variance, Mokken scaling, and person-item fit statistics. Results: The properties of the EdFED-I scale were stable over the course of the study with 4 items showing invariant item ordering at all time points. Some items behaved differently at different levels of difficulty in the scale and also depending on the mean level of feeding difficulty. The test information function showed a dip in the mid-range of difficulty scores.

Exploring the Interaction Between Nursing Decision Making and Patient Outcomes in 2 European Cancer Centers: A Qualitative Study

Background: In some clinical settings, nurses have difficulty describing the outcomes of their caring activities. Understanding the reasons for this could help nurse leaders to improve the effectiveness and visibility of nursing practice and safeguard nurses’ working conditions. Objective: The aims of this study were to understand how nurses working in 2 different adult cancer centers make healthcare decisions and assess the respective outcomes on their patients. Methods: Through a constructivist grounded theory approach, we involved 15 clinical cancer nurses with different experiences and educational backgrounds and 6 nurse managers, working in 2 comprehensive cancer centers, 1 in Italy and 1 in Switzerland. Data were collected in 2 phases using 20 semistructured interviews and 9 field observations. Results: Six macrocategories emerged: interacting with situational factors, deciding relevant interventions, using multiple decision-making approaches, evaluating interventions and reporting them, pursuing healthcare outcomes, and clarifying professional identity and roles. Nurses’ decision-making processes varied and were influenced by various factors, which mutually influenced one another. This process was interpreted using an explicative theory called “dynamic decision-making adaptation.” Conclusions: The present study showed how the aims, contents, and degree of autonomy in the nurses’ decision-making process are strongly influenced by the dialectic interaction between professional and contextual factors, such as competency and professional identity. Implications for Practice: Cancer nurses could influence their clinical practice by developing nursing competencies that effectively resolve patients’ problems. This is a key factor that nurses govern autonomously and therefore a responsibility that involves the entire nursing educational, organizational, and scientific leadership.

Does education in Italy produce nurses fit for future healthcare needs

Does education in Italy produce nurses fit for future healthcare needs? In Italy, a policy-level debate is underway on the future of nursing practice and its ability to address the public’s healthcare needs. New ways of delivering care need to be developed given the demographic changes in the Italian population which, in common with the rest of Europe, is ageing (Eurostat 2016) and that Italian health budgets are limited (Sasso et al. 2016). Naturally, Italy must develop a policy to suit its particular needs. However, a contribution to this debate could be drawn from other countries by seeing how they have addressed similar issues and determining whether the actions they adopted could be appropriate for Italy. Whatever policy is adopted regarding nursing practice, it is likely to have implications for nursing education. But is the present educational framework for nursing education in Italy appropriate for the purpose of producing nurses fit for future health needs? In theory, across Europe, we have the Bologna process (European Commission 2016a) ratified by all European countries, which matches eight different levels of education within the European Qualifications Framework (European Commission 2016b). This provides for bachelor’s (level 6) and master’s degree (level 7) education and, largely, nursing education fits within this model. In most European countries, entry to the nursing register is at the bachelor’s degree level or progress is being made towards that, and the master degree level education is available, but the content and purpose of master’s education differs across Europe. Level 7 education for nurses in the UK is far from uniform, but models exist that deliver education at level 7, develop advanced competencies and are closely linked to practice. Students can exit with specific advanced qualifications and competence only, but have the possibility of adding a year and completing their level 7 education with a master’s degree. Clinical skills delivered at the master’s degree level prepare nurses for higher levels of practice, which may be specialized or advanced, and include nurse prescribing. The boundaries between specialized and advanced practice are blurred, but specialist roles may include a focus on specific aspects of clinical practice where nursing skills are especially needed. These include chronic conditions such as diabetes care and rheumatology where nurses lead clinics in these specialities. Advanced practice encompasses areas such as emergency and critical care, and endoscopy where nurses can assume many of the diagnostic and decision-making functions previously the physician’s preserve and provide extended care to patients from admission to discharge. Nurse prescribing, initially proposed in DHSS (1986) and limited to very few medications (DoH 1999), is now virtually unrestricted (PSNC 2016) provided nurses work and prescribe within their area of competence. There is evidence to support the work of nurses in these areas. While reviews have shown little difference between nurse-led and physician-led clinics in terms of clinical outcomes, patients are always more satisfied with nurse-led clinics (APPG 2016), often because nurses can take more time with each patient. Randomized controlled trials of advanced nurse practice show similar outcomes, for example in nurseversus physician-performed endoscopy (Williams et al. 2009). With regard to nurse prescribing, these are very early days in terms of evaluation, but so far, the evidence of safety and efficacy is good and one thing is clear – in common with all of the above – it is more cost-effective than physician prescribing (APPG 2016; Kroezen et al. 2012) NHS-HENW 2015). In Italy, master’s degrees in nursing totally lack subjects that could enable postgraduate students to gain higher levels of clinical skills and thereby gain more ‘advanced’ knowledge and competence related to clinical skills learned during their bachelor’s programme. Instead, in Italy, master’s degrees in nursing focus only on providing additional methodological, managerial and didactic competencies. There has long been an international (including Europe) debate around the definition of ‘competence’ (Watson et al. 2002). However, some agreement exists with regard to the definition of advanced nursing practice, which includes the following core competencies: direct clinical practice, expert coaching and advice, consultation, research skills, clinical and professional leadership, collaboration and ethical decisionmaking (Spross & Larson 2005). It is recommended that

European Academy of Nursing Science 2016 Summer Conference

Background Nurses have a twofold role in healthcare. On one hand, they provide care to patients who are not able to take care of themselves. On the other hand nurses play a vital role as guardians of patient safety. It is mainly on the second role of nurses that the EU funded RN4CAST project is focusing. Materials and methods Data from more than 33,000 nurses and 11,000 patients in 500 hospitals from 12 European countries were collected from 2009 until 2011. It is one of the largest databases in the world on nurses staffing and its impact on patient safety. Results One of the main results [1] is that an increase in a nurses’ workload by one patient increases the likelihood of an inpatient dying within 30 days of admission by 7%. And every 10% increase in bachelor’s degree nurses is associated with a decrease in this likelihood by 7%. Relating this finding to the human error theory of James Reason, there seem to be a knowledge problem in early detecting of risks and adverse events. Secondly there are some slips and lapses in execution because of a too high workload. As an example, one out of four nurses say that they didn’t have the time to perform proper patient surveillance [2]. Again, this is explained by nurse staffing, education, working environment and non-nursing tasks to be performed. Discussion and conclusions In the follow-up of the report of the Institute of Medicine on “to err is human” [3], the crucial role of nurses in patient safety is highly underestimated [4]. This is mainly because the evidence is recent and mainly based on observational data. But the evidence is growing and consistent and strong evaluated against the Bradford-Hill criteria of causation (1965), showing that mechanisms are well understood, can be replicated across populations and settings and are time and dose-response related. Based on the available evidence, we see that some countries are adapting already their legislation to provide safe nurse staffing ratios to create a safe environment for their patients.