Patrizia Taddia

Factors affecting in-hospital informal caregiving as decided by families: findings from a longitudinal study conducted in acute medical units.

BACKGROUND Informal caregiving offered by family members has been widely studied in the community setting, but little attention to date has been dedicated to that offered at the hospital level. AIMS To describe the proportion of patients admitted to acute medical units receiving care from informal caregivers as decided by the family and to identify the factors affecting the numbers of care shifts performed by informal caregivers. DESIGN AND METHODS A longitudinal study was performed involving 12 acute medical units located in 12 northern Italian hospitals. RESULTS All patients (N = 1464) admitted to medical units were included, and 77.1% of them received at least one shift of informal care during their in-hospital stay, especially during the mornings and afternoons. At the patient level, those at higher risk of prolonged hospitalisation and difficult discharge at admission, and those reporting higher occurrence of adverse events, such as pressure sores, confusion events and use of physical restraints during hospitalisation, were more likely receiving informal care. At the nursing care level, a higher amount of missed nursing care was associated with an increased number of care shifts offered by informal caregivers during patient hospitalisation, whereas the amount of care offered by staff was a protective factor. CONCLUSIONS Families play a care role in the care of older patients admitted to acute medical units. They contribute substantially to the care of patients, especially during morning and afternoon shifts.

Studio di coorte prospettico multicentrico per la validazione italiana della Braden Q per la valutazione del rischio di lesioni da decubito nei neonati e nei bambini fino ad 8 anni

I bambini ricoverati in particolari contesti quali le terapie intensive, le oncologie e le neurologie/neurochirurgiche sono a rischio di sviluppare lesione da pressione. Obiettivo. Validare la versione italiana della Braden Q per la valutazione del rischio di sviluppare lesioni da pressione nei bambini. Metodi. La popolazione e costituita da bambini da 21 giorni agli 8 anni, ricoverati nelle terapie intensive e subintensive. Sono esclusi i bambini prematuri, i ricoverati con lesioni da pressione e anamnesi positiva per cardiopatie congenite. Lo studio e di coorte prospettico, multicentrico con valutazioni del rischio ripetute. La prima rilevazione e stata effettuata dopo 24 ore dal ricovero, con la Braden Q nella versione di Suddaby. Le lesioni da pressione sono state valutate con la Skin Assessment Tool (SAT) e stadiate secondo la National Pressure Ulcer Advisory Panel. Risultati. Su 157 casi sono state eseguite 524 osservazioni. L’incidenza delle lesioni da pressione e del 17.2%. Solo l’analisi per specifiche sottocategorie rileva una buona accuratezza diagnostica: nei bambini dai 3 agli 8 anni l’accuratezza e del 71.4%; nei reparti di terapia sub-intensiva e dell’85.6%. Il valore massimo dell’accuratezza diagnostica (86.2%) e con i bambini dai 3 agli 8 anni ricoverati nei reparti sub intensivi. Conclusione. La scala Braden Q puo essere usata affidabilmente ed ha buoni valori di accuratezza diagnostica con i bambini da 3 a 8 anni ricoverati nelle terapie sub-intensive, nei reparti di oncologia o di onco-ematologia pediatrica e di neurologia infantile.

Prevalence and incidence density of unavoidable pressure ulcers in elderly patients admitted to medical units

To describe the prevalence and incidence density of hospital-acquired unavoidable pressure sores among patients aged ≥65 years admitted to acute medical units. A secondary analysis of longitudinal study data collected in 2012 and 2013 from 12 acute medical units located in 12 Italian hospitals was performed. Unavoidable pressure ulcers were defined as those that occurred in haemodynamically unstable patients, suffering from cachexia and/or terminally ill and were acquired after hospital admission. Data at patient and at pressure ulcer levels were collected on a daily basis at the bedside by trained researchers. A total of 1464 patients out of 2080 eligible (70.4%) were included. Among these, 96 patients (6.5%) hospital-acquired a pressure ulcer and, among 19 (19.7%) were judged as unavoidable. The incidence of unavoidable pressure ulcer was 8.5/100 in hospital-patient days. No statistically significant differences at patient and pressure ulcers levels have emerged between those patients that acquired unavoidable and avoidable pressure sores. Although limited, evidence on unavoidable pressure ulcer is increasing. More research in the field is recommended to support clinicians, managers and policymakers in the several implications of unavoidable pressure ulcers both at the patient and at the system levels.

Nursing care as a predictor of phlebitis related to insertion of a peripheral venous cannula in emergency departments: findings from a prospective study.

BACKGROUND To date, few studies have investigated the occurrence of phlebitis related to insertion of a peripheral venous cannula (PVC) in an emergency department (ED). AIM To describe the natural history of ED-inserted PVC site use; the occurrence and severity of PVC-related phlebitis; and associations with patient, PVC and nursing care factors. METHODS A prospective study was undertaken of 1262 patients treated as urgent cases in EDs who remained in a medical unit for at least 24h. The first PVC inserted was observed daily until its removal; phlebitis was measured using the Visual Infusion Phlebitis Scale. Data on patient, PVC, nursing care and organizational variables were collected, and a time-to-event analysis was performed. FINDINGS The prevalence of PVC-related phlebitis was 31%. The cumulative incidence (78/391) was almost 20% three days after insertion, and reached >50% (231/391) five days after insertion. Being in a specialized hospital [hazard ratio (HR) 0.583, 95% confidence interval (CI) 0.366-0.928] and receiving more nursing care (HR 0.988, 95% CI 0.983-0.993) were protective against PVC-related phlebitis at all time points. Missed nursing care increased the incidence of PVC-related phlebitis by approximately 4% (HR 1.038, 95% CI 1.001-1.077). CONCLUSIONS Missed nursing care and expertise of the nurses caring for the patient after PVC insertion affected the incidence of phlebitis; receiving more nursing care and being in a specialized hospital were associated with lower risk of PVC-related phlebitis. These are modifiable risk factors of phlebitis, suggesting areas for intervention at both hospital and unit level.

Overcoming redundancies in bedside nursing assessments by validating a parsimonious meta-tool: findings from a methodological exercise study.

Rationale There is growing interest in validating tools aimed at supporting the clinical decision-making process and research. However, an increased bureaucratization of clinical practice and redundancies in the measures collected have been reported by clinicians. Redundancies in clinical assessments affect negatively both patients and nurses. Methods To validate a meta-tool measuring the risks/problems currently estimated by multiple tools used in daily practice. A secondary analysis of a database was performed, using a cross-validation and a longitudinal study designs. In total, 1464 patients admitted to 12 medical units in 2012 were assessed at admission with the Brass, Barthel, Conley and Braden tools. Pertinent outcomes such as the occurrence of post-discharge need for resources and functional decline at discharge, as well as falls and pressure sores, were measured. Explorative factor analysis of each tool, inter-tool correlations and a conceptual evaluation of the redundant/similar items across tools were performed. Therefore, the validation of the meta-tool was performed through explorative factor analysis, confirmatory factor analysis and the structural equation model to establish the ability of the meta-tool to predict the outcomes estimated by the original tools. Results High correlations between the tools have emerged (from r 0.428 to 0.867) with a common variance from 18.3% to 75.1%. Through a conceptual evaluation and explorative factor analysis, the items were reduced from 42 to 20, and the three factors that emerged were confirmed by confirmatory factor analysis. According to the structural equation model results, two out of three emerged factors predicted the outcomes. Conclusions From the initial 42 items, the meta-tool is composed of 20 items capable of predicting the outcomes as with the original tools.RATIONALE There is growing interest in validating tools aimed at supporting the clinical decision-making process and research. However, an increased bureaucratization of clinical practice and redundancies in the measures collected have been reported by clinicians. Redundancies in clinical assessments affect negatively both patients and nurses. METHODS To validate a meta-tool measuring the risks/problems currently estimated by multiple tools used in daily practice. A secondary analysis of a database was performed, using a cross-validation and a longitudinal study designs. In total, 1464 patients admitted to 12 medical units in 2012 were assessed at admission with the Brass, Barthel, Conley and Braden tools. Pertinent outcomes such as the occurrence of post-discharge need for resources and functional decline at discharge, as well as falls and pressure sores, were measured. Explorative factor analysis of each tool, inter-tool correlations and a conceptual evaluation of the redundant/similar items across tools were performed. Therefore, the validation of the meta-tool was performed through explorative factor analysis, confirmatory factor analysis and the structural equation model to establish the ability of the meta-tool to predict the outcomes estimated by the original tools. RESULTS High correlations between the tools have emerged (from r 0.428 to 0.867) with a common variance from 18.3% to 75.1%. Through a conceptual evaluation and explorative factor analysis, the items were reduced from 42 to 20, and the three factors that emerged were confirmed by confirmatory factor analysis. According to the structural equation model results, two out of three emerged factors predicted the outcomes. CONCLUSIONS From the initial 42 items, the meta-tool is composed of 20 items capable of predicting the outcomes as with the original tools.

Studio per documentare l’esperienza dell’inserimento degli infermieri case manager in reparti per acuti e post acuti: il punto di vista degli operatori, dei pazienti ed i risultati clinico-organizzativi

Dal 2000 nel Policlinico S. Orsola di Bologna sono stati introdotti gli Infermieri Case Manager (ICM). Obiettivo. L’obiettivo di questo studio e valutare l’associazione dell’ICM ad alcuni esiti clinici e alla soddisfazione di operatori sanitari e pazienti. Materiali e metodi. Sono stati valutati la degenza media, il numero di dimissioni pianificate e di cadute l’anno precedente e successivo l’introduzione dell’ICM, in 14 reparti. La soddisfazione di infermieri e medici dei cambiamenti positivi apportati dal case manager e stata valutata in 13 reparti con un questionario, e la soddisfazione dei pazienti in 8 reparti con la Newcastle satisfaction with nursing scale. Risultati. Non sono state osservate differenze nella degenza media, solo piccole differenze nel numero di dimissioni pianificate (+8.2%) ed una diminuzione (-24%) del numero di cadute. I risultati del questionario sulla percezione dei cambiamenti indicano un’elevata soddisfazione di tutti gli operatori (in particolare degli infermieri coordinatori) con un accordo >2.8 su una scala da 1 a 4, per gli esiti sull’organizzazione e sul paziente. Non e stato percepito nessun cambiamento positivo sullo stress e sul carico di lavoro. Conclusioni. Non e semplice scegliere indicatori per dimostrare cambiamenti organizzativi. Sono stati dimostrati cambiamenti positivi solo sulla percezione degli operatori e sulle cadute. Occorrono altri studi per confermare alcuni esiti positivi osservati.