Stefania Di Mauro

Development and psychometric testing of a theory-based tool to measure self-care in diabetes patients: the Self-Care of Diabetes Inventory

BackgroundSelf-care is essential for patients with diabetes mellitus. Both clinicians and researchers must be able to assess the quality of that self-care. Available tools have various limitations and none are theoretically based. The aims of this study were to develop and to test the psychometric properties of a new instrument based on the middle range-theory of self-care of chronic illness: the Self-Care of Diabetes Inventory (SCODI).MethodsForty SCODI items (5 point Likert type scale) were developed based on clinical recommendations and grouped into 4 dimensions: self-care maintenance, self-care monitoring, self-care management and self-care confidence based on the theory. Content validity was assessed by a multidisciplinary panel of experts. A multi-centre cross-sectional study was conducted in a consecutive sample of 200 type 1 and type 2 diabetes patients. Dimensionality was evaluated by exploratory factor analyses. Multidimensional model based reliability was estimated for each scale. Multiple regression models estimating associations between SCODI scores and glycated haemoglobin (HbA1c), body mass index, and diabetes complications, were used for construct validity.ResultsContent validity ratio was 100%. A multidimensional structure emerged for the 4 scales. Multidimensional model-based reliabilities were between 0.81 (maintenance) and 0.89 (confidence). Significant associations were found between self-care maintenance and HbA1c (p = 0.02) and between self-care monitoring and diabetes complications (p = 0.04). Self-care management was associated with BMI (p = 0.004) and diabetes complications (p = 0.03). Self-care confidence was a significant predictor of self-care maintenance, monitoring and management (all p < 0.0001).ConclusionThe SCODI is a valid and reliable theoretically-grounded tool to measure self-care in type 1 and type 2 DM patients.

Complessita’ assistenziale e l’appropriatezza organizzativa assistenziale: indagine conoscitiva nelle Unità di Medicina di nove ospedali di Regione Lombardia - [Complexity of care and organizational effectiveness: a survey among medical care units in nine Lombardy region hospitals]

AIM Eleven medical care units of nine Lombardy Region hospitals organized by levels of care model or by the traditional departmental model have been analyzed, in order to evaluate if methods for complexity of patient-care evaluation represent an index factor of nursing organizational effectiveness. METHOD Survey with nine Nurses in managerial position was conducted between Nov. 2013-Jan. 2014. The following factors have been described: context and nursing care model, staffing, complexity evaluation, patient satisfaction, staff well-being. Data were processed through Microsoft Excel. RESULTS Among Units analysed ,all Units in levels of care and one organized by the departmental model systematically evaluate nursing complexity. Registered Nurses (RN) and Health Care Assistants (HCA) are on average numerically higher in Units that measure complexity (0.55/ 0.49 RN, 0.38/0.23 HCA - ratio per bed). Adopted measures in relation to changes in complexity are:rewarding systems, supporting interventions, such as moving personnel within different Units or additional required working hours; reduction in number of beds is adopted when no other solution is available. Patient satisfaction is evaluated through Customer Satisfaction questionnaires. Turnover, stress and rate of absenteeism data are not available in all Units. CONCLUSIONS Complexity evaluation through appropriate methods is carried out in all hospitals organized in levels of care with personalized nursing care models, though complexity is detected with different methods. No significant differences in applied managerial strategies are present. Patients satisfaction is evaluated everywhere. Data on staffing wellbeing is scarcely available. Coordinated regional actions are recommended in order to gather comparable data for research, improve decision making and effectiveness of Nursing care.

[L'impiego dell'ICNP® nella formazione infermieristica con modelli teorici infermieristici: una revisione della letteratura]

INTRODUCTION The International Classification for Nursing Practice (ICNP®) is the only nursing terminology that has been accepted within the Family of International Classification of the World Health Organization. The academic teaching of ICNP® could contribute to improve nursing clinical practice. However, standards for its implementation in undergraduate nursing education together with a nursing theoretical model are not available. AIM To know the state of the art about the use of ICNP® in undergraduate nursing education and its use with a nursing theoretical model. METHOD A narrative literature review was conducted searching main health scientific databases and including monographs, statements from international associations, and published conference papers. RESULTS Available literature about ICNP® implementation in nursing education and its use with theoretical models is limited. Results supported the organization of a specific course on ICNP® before clinical teaching programs, the development of paper or electronic ICNP® based educational tools, and the use of active learning strategies. Only three experiences reporting the use of ICNP® with theoretical models have been found. CONCLUSIONS Both the use of ICNP® in nursing undergraduate education and its use according to one or more nursing theoretical models, could help students to learn nursing process. However, weak recommendations can be found in the literature to orient ICNP® implementation in undergraduate nursing education and/or with an explicit theoretical framework. Further studies focusing on these issues are strongly needed.

Il contributo allo sviluppo della professione infermieristica delle congregazioni religiose del XIX secolo.

The purpose of this historical research project is to examine the contribution of 19th-century religious congregations in the development of the nursing profession, based on the historical example of the Sisters of Charity of Sts. Bartolomea Capitanio and Vincenza Gerosa (or the Sisters of the Holy Child Mary). To this end, sixty three volumes were analysed, all taken from the historical archive of the Generalate of the Sisters of the Holy Child Mary in Milan, in via S. Sofia n.13, with the exception of just one, taken from the Braidense National Library, also in Milan. This research project has highlighted the sociological contribution provided by the Sisters of the Holy Child Mary to the professional nature of nursing, and to the development of the distinctive features of the nursing profession (Greenwood, 1980). All documentary sources were analysed in line with the Chabod historical research method (2006), and for their critical interpretation, a scheme of analysis was created. Two lines of investigation emerged from the data collected: the role of Sister Emilia Vinante as an expert with regard to the nursing profession, and the professional strategies promoted by FIRO (Federation of Italian Religious Nurses). Based on the conclusions of the research project, it may be stated that religious congregations contributed greatly to the nursing profession, leaving a decisive mark on the cultural and professional development of nurses.