Tools used to assess comfort among patients undergoing high flow nasal cannula: A scoping review

Objective: The aims were twofold: (a) to map tools documented in the literature to evaluate comfort among patients undergoing high flow nasal cannula (HFNC) treatment; and (b) to assess if the retrieved tools have been validated for this purpose. Methods: A scoping review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). In July 2023, PubMed, Scopus, CINAHL and Cochrane Library were consulted. Studies assessing comfort in adult, paediatric, and neonatal patients undergoing HFNC were included. Results: Seventy-four articles were included, among which nine (12.2 %) investigated comfort as the primary aim. Twenty-five different tools were found, classifiable into 14 types, mostly unidimensional and originating from those measuring pain. The most widely used was the Visual Analogic Scale (n = 27, 35.6 %) followed by the Numerical Rating Scale (n = 11, 14.5 %) and less defined generic tools (n = 10, 13.2 %) with different metrics (e. g. 0–5, 0–10, 0–100). Only the General Comfort Questionnaire and the Comfort Scale were specifically validated for the assessment of comfort among adults and children, respectively. Conclusion: Although the comfort of patients undergoing HFNC is widely investigated in the literature, there is a scarcity of tools specifically validated in this field. Those used have been validated mainly to assess pain, suggesting the need to inform patients to prevent confusion while measuring comfort during HFNC and to develop more research in the field. Implications for clinical practice: Comfort assessment is an important aspect of nursing care. Given the lack of validation studies in the field, efforts in research are recommended

Virtual Reality for Cardiopulmonary Resuscitation Healthcare Professionals Training: A Systematic Review

Introduction: Virtual reality (VR) is becoming increasingly popular to train health-care professionals (HCPs) to acquire and/or maintain cardiopulmonary resuscitation (CPR) basic or advanced skills. Aim: To understand whether VR in CPR training or retraining courses can have benefits for patients (neonatal, pediatric, and adult), HCPs and health-care organizations as compared to traditional CPR training. Methods: A systematic review (PROSPERO: CRD42023431768) following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. In June 2023, the PubMed, Cochrane Library, Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched and included studies evaluated in their methodological quality with Joanna Briggs Institute checklists. Data were narratively summarized. Results: Fifteen studies published between 2013 and 2023 with overall fair quality were included. No studies investigated patients' outcomes. At the HCP level, the virtual learning environment was perceived to be engaging, realistic and facilitated the memorization of the procedures; however, limited decision-making, team building, psychological pressure and frenetic environment were underlined as disadvantages. Moreover, a general improvement in performance was reported in the use of the defibrillator and carrying out the chest compressions. At the organizational level, one study performed a cost/benefit evaluation in favor of VR as compared to traditional CPR training. Conclusions: The use of VR for CPR training and retraining is in an early stage of development. Some benefits at the HCP level are promising. However, more research is needed with standardized approaches to ensure a progressive accumulation of the evidence and inform decisions regarding the best training methodology in this field

Between mandatory and aspirational ethics in nursing codes: a case study of the Italian nursing code of conduct

Background: Over the years, national and international nurses' organisations have drawn up Codes of Conduct and Codes of Ethics. A new differentiation has emerged over time between mandatory and aspirational approaches underlying how nurses can be supported by documents with rules to be respected (mandatory ethics) or by incentives (aspirational ethics). However, to date, no research has applied these approaches to analyse available Codes and to identify which approach are predominantly used. Methods: In this case study, the Italian Nursing Code of Conduct (NCC), published in 2019, composed of 53 articles distributed in eight chapters, was first translated, and then analysed using a developed matrix to identify the articles that refer to mandatory or aspirational ethics. A nominal group technique was used to minimise subjectivity in the evaluation process. Results: A total of 49 articles addressing the actions of the individual nurse were considered out of 53 composing the NNC. Articles were broken down into 97 units (from one to four for each article): 89 units (91.8%) were attributed to a unique category, while eight (8.2%) to two categories according to their meaning. A total of 38 units (39.2%) were categorised under the mandatory ethics and 58 (59.8%) under the aspirational ethics; however, one (1.0%) reflected both mandatory and aspirational ethics. Conclusions: According to the findings, the Italian Professional Body (FNOPI) has issued a modern code for nursing professionals in which an aspirational perspective is dominant offering a good example for other nursing organisations in the process of updating their codes when aimed at embodying an aspirational ethics

Challenges and opportunities of micro-credentials as a new form of certification in health science education—a discussion paper

: Micro-credentials are an element of the European Skills Agenda 2020. This five-year plan aims to develop improved applied and broader work skills in response to system demands from employers, industry and communities. Within the labour market, employees increasingly want to obtain new skills-based qualifications in a relatively short period of time. Micro-credentials, as a form of lifelong learning, in the health care sector provide significant opportunities for upskilling the workforce in response to rapid changes in health care and service delivery. Moreover, micro-credentials have also been introduced in the context of undergraduate and postgraduate education within the process of accelerated digitalisation during the pandemic. However, despite its relevance, there is limited discussion about the implications and challenges of micro-credentials in the healthcare sciences. According to the findings that emerged from a review of policy documents and scientific papers, a reflective exercise has been conducted to debate the possibilities and challenges of emerging education based on micro-credentials within health care education and employment. Health care delivery is multidisciplinary and statutorily regulated to protect citizens. In such a complex sector, developing a micro-credential friendly ecosystem will require cooperation between various stakeholders if its potential is to be effectively realised

A point prevalence study of catheter associated urinary tract infections among patients admitted in an university hospital

Background: Urinary tract infections (UTIs) are the most common type of healthcare associated infection in acute care hospitals. Most involve urinary drainage devices, such as urinary catheter. The objective of this study was to investigate the prevalence of catheter-associated urinary tract infections in adult patients of a tertiary level university hospital.Methods: The point prevalence study was conducted in one single day and included all adult patients admitted in medical, surgical wards and intensive care units. The Centre for Disease Control (CDC) criteria were adopted to classify the different type of UTIs.Results: Out of a total of 497 adult inpatients, 94 patients had a urinary catheter for at least 48 hours. The prevalence of symptomatic urinary tract infection (SUTI) in this sample is 17%. Escherichia coli (31.2%), Enterococcus faecium (25.0%) and Enterococcus faecalis (12.5%) are the most common pathogens found.Conclusions: The main isolated uropathogens in this study are Gram-negative and Escherichia coli remains one of the most frequent cause of UTIs in human. Gram-negative pathogens have multiple virulent factors responsible for their adherence to uroepithelium and urinary catheter positioning facilitates the transmission of these pathogens to urinary tract. Urinary catheterization is frequently used as solution to facilitate continence and maintain skin integrity in elderly patients. Urinary incontinence frequently is an example of inappropriate use of urinary catheter: for that reason, urinary catheter should be considered as the last option if other solution, like incontinence pads, are not indicated

Self‐Directed Learning and Competencies as Perceived by New Graduates Before and After the Pandemic: A Repeated Cross‐Sectional Study

Background: The COVID-19 pandemic led to significant changes in nursing education; however, their impact on competencies and self-directed learning (SDL) skills achieved at the point of graduation has been limitedly investigated. Aims: To compare the perceived SDL skills and competencies at the time of graduation between pre- and postpandemic graduates; and to assess correlations, if any, between the SDL skills and competencies in both groups. Design: A repeated cross-sectional study design following the Strengthening of the Reporting of Observational Studies in Epidemiology checklist. Methods: All 2019 (prepandemic) and 2023 (postpandemic group) new graduates from two Italian Universities and willing to participate were included. The Self-Rating Scale of SDL (SRSSDLITA) and the Nurse Competence Scale (NCS) were administered. Descriptive and inferential statistics were used. Results: Postpandemic graduates reported slightly lower SDL scores (pre- 4.27 vs. postpandemic 4.18 out of 5, p = 0.030), with significant declines in "Awareness" (p = 0.005), "Learning Strategies" (p < 0.001), and "Interpersonal Skills" factors (p = 0.007). Perceived overall competence as measured with the NCS was higher in the postpandemic group (pre- 68.01 out of 100 vs. post- 71.08, p = 0.020), with significant gains in "Helping Role" (p = 0.005), "Teaching-Coaching" (p < 0.001), and "Ensuring Quality" dimensions (p < 0.001). Correlations between SDL skills and competencies perceived were weaker in the postpandemic group. Conclusions: The perceived competencies have improved while the SDL skills slightly declined in the postpandemic group, suggesting new needs of graduates in the transition to their professional role. The weak correlation between SDL skills and competencies in the postpandemic group underlines the importance of clinical experience in promoting self-direct learning. Implications for Nursing Management: Nurse Managers are required to develop tailored strategies to support the transition process beyond the development of clinical competencies, with greater support for independence in learning-a crucial skill to become resilient and adaptable and to continually face the complexities of modern healthcare

Pressure ulcers after prone positioning in patients undergoing extracorporeal membrane oxygenation: A cross-sectional study

Background: The combination of prone positioning and extracorporeal membrane oxygenation (ECMO) in patients with acute respiratory distress syndrome (ARDS) is recognized as safe but its use has been limited due to potential complications. Objective: To report the prevalence of pressure ulcers and other complications due to prone positioning in adult patients receiving veno-venous ECMO. Methods: This cross-sectional study was conducted in a tertiary level intensive care unit (ICU) in Milan (Italy), between January 2015 and December 2019. The study population was critically ill adult patients undergoing veno-venous ECMO. Statistical association between pressure ulcers and the type of body positioning (prone versus supine) was explored fitting a logistic model. Results: In the study period, 114 patients were treated with veno-venous ECMO and 62 (54.4%) patients were placed prone for a total of 130 prone position cycles. ECMO cannulation was performed via femoro-femoral configuration in the majority of patients (82.4%, 94/114). Pressure ulcers developed in 57.0% of patients (95%CI: 44.0%-72.6%), most often arising on the face and the chin (37.1%, 23/62), particularly in those placed prone. The main reason of prone positioning interruption was the decrease of ECMO blood flow (8.1%, 5/62). The fitted model showed no association between body position during ECMO and occurrence of pressure ulcers (OR 1.3, 95%CI: 0.5-3.6, p&nbsp;=&nbsp;.532). Conclusion: Facial pressure ulcers were the most frequent complications of prone positioning. Nurses should plan and implement evidence-based care to prevent such pressure injuries in patients undergoing ECMO. Relevance to clinical practice: The combination of prone positioning and ECMO shows few life-threating complications. This manoeuvre during ECMO is feasible and safe when performed by experienced ICU staff

Ten years of Basic Life Support provider course: results and challenges from the Italian Resuscitation Council's experience

Introduction: Widespread basic life support (BLS) training plays a central role in improving cardiac arrest (CA) survival. This study presents an extensive analysis of numbers, candidates’ characteristics, and outcomes over 10 years of BLS provider courses organized by the Italian Resuscitation Council (IRC) in Italy. Method: This is a retrospective analysis of data recorded in the national IRC BLS training database from January 2014 to December 2023. Candidates’ demographic and professional factors were analyzed with regional differences and course outcomes. Results: Over the study period, a total 906,686 candidates attended the course, 646,743 (71.3%) of whom were healthcare professionals (HP) and 259,943 (28.8%) non-healthcare professionals (NHP). The percentage of candidates passing the final exam was 99.5% for HP and 99.8% for NHP. The rate per 1000 HP per year of physicians and nurses attending the BLS course varied considerably across the Italian regions, ranging from 4.2 in central Italy to 669.7 in some northern areas. The rate per 1000 inhabitants of NHP per year attending the BLS course was also different among regions, varying from 0.1 in the southern and central regions up to 1.7 in the northern and northeastern ones. Conclusion: The pass rate of the BLS provider course is overall very high, indicating that it provides an easy and accessible set of skills for both HP and NHP candidates. Regional disparities (e.g. the rates of trained individuals and distribution between HP and NHP) and the low attendance of retraining courses represent important challenges that need to be addressed. Analysing training registers is a valuable tool for better planning future training projects

Recommendations to promote the digital healthcare transformation in the clinical practice: findings from an international consensus development method

Consensus development method; Digital health; Digital transformation; Health personnel; RecommendationsMètode de desenvolupament de consens; Salut digital; Transformació digital; Personal sanitari; RecomanacionsMétodo de desarrollo de consenso; Salud digital; Transformación digital; Personal de salud; RecomendacionesBackground: Healthcare professionals are a fundamental component of the digital health transformation in all healthcare systems. However, the barriers still affecting the digital transformation in the healthcare sector suggest that the processes used to develop policies, mainly top-down, require some innovation. Objective: Development and validation of recommendations to support healthcare professionals in the digital transformation of their daily practice, involving multisectoral and international stakeholders. Methods: A consensus development method covering the years 2021 to 2023, combining top-down and bottom-up approaches, was employed by the Digital EducationaL programme InvolVing hEalth pRofessionals (DELIVER) consortium. Policy, literature and needs analyses were conducted at national level and then combined at international level to develop recommendations. Subsequently, experts in the field of digital health, healthcare professionals, managers and others were involved in the final DELIVER Transnational Consensus Development Conference to validate the recommendations developed. Results Ten recommendations classified into three main domains were validated: (a) encouraging healthcare professionals to welcome the digitalization of the workplace (three recommendations); (b) ensuring basic/advanced and general/specific competencies (four recommendations); and (c) offering technical and organizational support (three recommendations).Funded by European Union in the context of Digital EducationaL programme InvolVing hEalth pRofessionals (DELIVER) project and Dynamic Digital Skils for Medical and Allied Professions (DDS-MAP) project