Eficacia del tiempo de secado de la yodopovidona al 10% antes de la inserción de catéter venoso periférico: resultados preliminares de un estudio exploratorio casi-experimental

AIM: to investigate the effectiveness of 10% povidone-iodine after a 30-second or 2-minute drying time on microbial count reduction at the point of a Peripheral Intravascular Catheter (PIC) insertion. A quasi-experimental design was adopted. In total, 53 patients were enrolled, 25 were exposed to a 2-m drying time and 28 to a 30-s drying time. From the preliminary results of this study, no differences in the occurrence of contamination have emerged between patients receiving 30-s and 2-m drying time for 10% povidone-iodine solutions.OBJETIVO: investigar a eficácia da solução iodopovidona a 10% sobre a redução da contagem microbiana no ponto de inserção do Cateter Venoso Periférico após tempo de secagem de 30s ou 2 min. MÉTODO: desenho quase-experimental. Foram incluídos 53 pacientes no estudo: 25 foram expostos a 2min de secagem e 28 foram expostos a 30s de secagem. RESULTADOS: Os resultados preliminares não apresentaram diferenças na ocorrência de contaminação entre os pacientes que foram submetidos a 30s ou 2min de secagem após desinfecção com solução de iodopovidona a 10%.OBJETIVO: para investigar la eficacia de una solución yodopovidona al 10% tras tiempo de secado de 30 segundos o 2 minutos en la reducción del contaje microbiano en el local de inserción del Catéter Venoso Periférico, fue adoptado un diseño casi-experimental. Al total, fueron incluidos 53 pacientes, 25 expuestos a 2 min. de secado y 28 a 30 segundos. Con base en los resultados preliminares, no se encontraron diferencias en la ocurrencia de contaminaciones entre pacientes sometidos a un tiempo de secado de 30 s. o de 2 min tras desinfección con solución de yodopovidona al 10%

Unfinished nursing care reasons as perceived by nurses at different levels of Nursing Services: findings of a qualitative study

Aim: This study aimed to investigate reasons for unfinished nursing care across the whole levels of the nursing service as perceived by clinical nurses, ward managers and executive nurses. Background: Even though unfinished nursing care has been considered an issue affected by the system, no studies to date have attempted to investigate reasons across the whole levels of the nursing service by involving clinical nurses, ward managers and executive nurses. Method: A descriptive qualitative approach was performed in 2021 according to the COnsolidated criteria for REporting Qualitative research guidelines. A large public health care trust was approached, and a purposeful sample of clinical nurses, ward managers and executive nurses was invited to attend face-to-face or online interviews. Twenty-nine interviews were performed (19 clinical nurses, 7 ward managers and 3 executive nurses) and transcribed verbatim. Then, a content analysis was conducted by considering all narratives together followed by an analytic process to identify themes and subthemes at the clinical, ward manager and executive levels. Results: Reasons for unfinished nursing care have emerged at five levels: system (e.g., poor support towards nursing care), unit (e.g., ineffective models of nursing care delivery), nurse managers (e.g., inadequate nurse manager leadership), nurses (e.g., weaknesses in education) and patients (e.g., increased demand for patients’ care). Conclusion: The evidence available should be expanded to include also unfinished nursing care reasons identified at the system and at the ward manager levels, that both can complete the perceptions of the clinical nurses. Implications for Nursing Management: The actors composing the nursing service perceive different reasons and therefore should be involved in detecting and contrasting the unfinished nursing care. The reasons applied or established at the upper level influence the bedside levels: Therefore, strategies to prevent or minimize the unfinished nursing care should be designed at multi-levels in a system-inclusive approach

Detecting delirium in patients with acute stroke: a systematic review of test accuracy

Patients with acute stroke are particularly vulnerable to delirium episodes. Although delirium detection is important, no evidence-based recommendations have been established to date on how these patients should be routinely screened for delirium or which tool should be used for this purpose in this population. Therefore, the aim of this study was to identify delirium screening tools for patients with acute stroke and to summarise their accuracy

Digital Health Competencies Among Health Care Professionals: Systematic Review

Digitalization is not fully implemented in clinical practice, and several factors have been identified as possible barriers, including the competencies of health care professionals. However, no summary of the available evidence has been provided to date to depict digital health competencies that have been investigated among health care professionals, the tools used in assessing such competencies, and the effective interventions to improve them

Identifying longitudinal sustainable hierarchies in activities of daily living

© 2017 Elsevier B.V. Activities of daily living serve as an indicator of progression in disability and rehabilitation. It is know that some of the measurement scales used show hierarchical properties indicating that activities of daily living are lost and gained in a consistent pattern. Few studies have investigated the extent to which these patterns are sustained across time and across a range of disability. The study aimed to investigate the hierarchical properties of the activity of daily living items in the ValGraf functional ability scale, to establish if there is a hierarchy of items in the scale and to study the sustainability of the hierarchy over time. Secondary analysis of a retrospective database from 13,113 people over 65 years in 105 nursing homes in northern Italy, between 2008 and 2013 was conducted. Data were gathered 6-monthly and analysed using Mokken scaling to identify a hierarchy of items in the scale and if this was sustainable over time. A sustainable hierarchy of items was observed running in difficulty from urinary incontinence to feeding. The hierarchical structure of the activities of daily living observed in the present study is stable over time meaning that changes in total score for these items can be compared meaningfully across time

Enhancing independent eating among older adults with dementia: A scoping review of the state of the conceptual and research literature

BackgroundAddressing eating difficulties among older individuals with dementia living in nursing homes requires evidence-based interventions. However, to date, there is limited evidence of effective interventions designed to maintain and/or increase independent eating. In a field in which evidence is still lacking, a critical analysis of the state of research describing its main features can help identify methodological gaps that future studies should address. Hence, the aim of this study was to map the state of the research designed to maintain and/or promote independent eating in older individuals with dementia living in nursing homes.MethodsA scoping review was performed by following the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Reviews and conceptual analyses performed with different methodological approaches, published in indexed journals, and written in English were included. Keywords Were searched for in the MEDLINE, the Cumulative Index of Nursing and Allied Health, and in the Scopus databases to identify papers published up to 31 May 2018.Results17 reviews were included, assessing interventions’ effectiveness (n = 15) and providing conceptual frameworks for eating/mealtime difficulties (n = 2). Conceptual frameworks supporting interventions’ effectiveness have rarely been described in available studies. Moreover, interventions tested have been categorized according to non-homogeneous frameworks. Their effectiveness has been measured against (1) eating performance, (2) clinical outcomes, and (3) adverse event occurrence.ConclusionAn increased use of conceptual frameworks in studies, as well as greater clarity in intervention categorization and outcomes, is necessary to enhance the reviews’ value in providing useful cumulative knowledge in this field. Interventions delivered should embody different components that integrate individual, social, cultural, and environmental factors, while when evaluating an intervention’s effectiveness, eating performance, clinical outcomes and adverse events should be considered. Together with more robust studies, involving clinicians could prove to be useful, as their knowledge of practice developed from direct experience can help develop innovative research questions

Family Visiting Restrictions and Postoperative Clinical Outcomes: A Retrospective Analysis

In the last two years, all hospitals have adopted restricted visitation policies due to the coronavirus disease 2019. The objective of this study was to assess the consequences of hospital visitation restrictions on the most common outcome measures on adult patients who underwent surgery. A retrospective study design was conducted according to the STrengthening the Reporting of OBservational studies in Epidemiology statements in 2021. Forty patients exposed to a no-visitors policy and forty unexposed patients (1:1) were enrolled. Patients who were not allowed to receive family visits were more likely to report disorientation/agitation episodes (n = 25, 62.5% vs. n = 12, 30.0%; p < 0.01), spend more sleepless nights (n = 10, 25.0% vs. n = 1, 2.5%; p < 0.01), be restrained (n = 8, 20.0% vs. n = 1, 2.5%; p = 0.02), incur device-removal incidents (n = 14, 35.0% vs. n = 5, 12.5%; p = 0.01) compared to unexposed patients. Conversely, pain episodes were significantly more frequent in the unexposed group (n = 7.1, SD = 7.9 vs. n = 2.4, SD = 2.8; p < 0.01), and there was lower clinical deterioration risk (NEWS of 0–4 average 19.5, SD = 12.2 evaluations vs. 12.3, SD = 8.6; p < 0.01) compared to exposed patients. According to the results, family visiting restrictions should be measured against their possible advantages in order to prevent negative outcomes for surgical patients and to improve the quality of care

Instruments evaluating the quality of the clinical learning environment in nursing education: A systematic review of psychometric properties

Background The clinical learning environment is fundamental to nursing education paths, capable of affecting learning processes and outcomes. Several instruments have been developed in nursing education, aimed at evaluating the quality of the clinical learning environments; however, no systematic review of the psychometric properties and methodological quality of these studies has been performed to date. Objectives The aims of the study were: 1) to identify validated instruments evaluating the clinical learning environments in nursing education; 2) to evaluate critically the methodological quality of the psychometric property estimation used; and 3) to compare psychometric properties across the instruments available. Design A systematic review of the literature (using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines) and an evaluation of the methodological quality of psychometric properties (using the COnsensus-based Standards for the selection of health Measurement INstruments guidelines). Data sources The Medline and CINAHL databases were searched. Eligible studies were those that satisfied the following criteria: a) validation studies of instruments evaluating the quality of clinical learning environments; b) in nursing education; c) published in English or Italian; d) before April 2016. Review methods The included studies were evaluated for the methodological quality of the psychometric properties measured and then compared in terms of both the psychometric properties and the methodological quality of the processes used. Results The search strategy yielded a total of 26 studies and eight clinical learning environment evaluation instruments. A variety of psychometric properties have been estimated for each instrument, with differing qualities in the methodology used. Concept and construct validity were poorly assessed in terms of their significance and rarely judged by the target population (nursing students). Some properties were rarely considered (e.g., reliability, measurement error, criterion validity), whereas others were frequently estimated, but using different coefficients and statistical analyses (e.g., internal consistency, structural validity), thus rendering comparison across instruments difficult. Moreover, the methodological quality adopted in the property assessments was poor or fair in most studies, compromising the goodness of the psychometric values estimated. Conclusions Clinical learning placements represent the key strategies in educating the future nursing workforce: instruments evaluating the quality of the settings, as well as their capacity to promote significant learning, are strongly recommended. Studies estimating psychometric properties, using an increased quality of research methodologies are needed in order to support nursing educators in the process of clinical placements accreditation and quality improvement

Nursing-Sensitive Outcomes among Patients Cared for in Paediatric Intensive Care Units: A Scoping Review

: Measuring the effectiveness of nursing interventions in intensive care units has been established as a priority. However, little is reported about the paediatric population. The aims of this study were (a) to map the state of the art of the science in the field of nursing-sensitive outcomes (NSOs) in paediatric intensive care units (PICUs) and (b) to identify all reported NSOs documented to date in PICUs by also describing their metrics. A scoping review was conducted by following the framework proposed by Arksey and O\u2019Malley. Fifty-eight articles were included. Publications were mainly authored in the United States and Canada (n = 28, 48.3%), and the majority (n = 30, 51.7%) had an observational design. A total of 46 NSOs were documented. The most reported were related to the clinical (n = 83), followed by safety (n = 41) and functional (n = 18) domains. Regarding their metrics, the majority of NSOs were measured in their occurrence using quantitative single measures, and a few validated tools were used to a lesser extent. No NSOs were reported in the perceptual domain. Nursing care of critically ill children encompasses three levels: improvement in clinical performance, as measured by clinical outcomes; assurance of patient care safety, as measured by safety outcomes; and promotion of fundam