Misurare l'impatto dell'assistenza infermieristica sulla salute: una revisione della letteratura

Misurare il contributo dell'assistenza infermieristica ai risultati conseguiti dai servizi sanitari rappresenta un interesse primario per la ricerca infermieristica a livello internazionale. Lo scopo di questa revisione della letteratura è stato quello di delineare i principali filoni o ambiti di ricerca che hanno studiato gli effetti dell'assistenza infermieristica sulla salute. Una ricerca bibliografica è stata condotta nelle principali banche dati di interesse infermieristico e sanitario e nei siti di autorevoli associazioni e societí  scientifiche internazionali. I principali filoni di ricerca individuati in letteratura sono quattro e hanno studiato: la numerosití  e la tipologia del personale impiegato nell'assistenza; la definizione del livello di assistenza infermieristica necessario per garantire i risultati attesi in ambito ospedaliero; le caratteristiche dell'ambiente di lavoro e l'organizzazione dell'assistenza; l'impiego di terminologie e classificazioni nella descrizione dei risultati assistenziali. Sebbene i ricercatori riportino la necessití  di rafforzare le prove di efficacia disponibili su questo argomento, le raccomandazioni suggeriscono di sostenere lo sviluppo del gruppo professionale infermieristico nell'area clinica, formativa, organizzativa e nella definizione delle politiche sanitarie allo scopo di tendere ai migliori risultati di salute per le comunití .Parole Chiave: risultati per i pazienti, risultati sensibili all'assistenza infermieristica, risultati relativi al personale, ambiente di lavoro positivo, classificazioni infermieristiche, definizione degli organici infermieristici, revisione della letteratura.Measuring the impact of nursing on health: a literature reviewMeasuring nursing contribution to health services' outcomes represents a primary issue for nursing research internationally. The aim of this literature review was to outline main research lines studying the effect of nursing practice on health. A search of the literature was performed asking health and nursing-specific major database and consulting websites of authoritative nursing associations and scientific societies. Four main nursing research lines were found in literature and they concerned, nurse staffing and patient and staff-related outcomes; level of nursing care needed to achieve attended outcomes in hospitals; practice environments and patient and staff-related outcomes; the use of nursing terminologies and classifications to describe nursing-specific and nursing sensitive outcomes. Although researchers report the need to strengthen available evidences, recommendations suggest to empower nurses and nursing in clinical, educational, organizational and policy-making settings in order to draw toward the best health outcomes for communities.Key words: patient outcomes, nursing sensitive outcomes, staff-related outcomes, positive practice environment, nursing classifications; nurse staffing, literature review

Vita Associativa

CNAI e RAPPORTI INTERNAZIONALI Sempre intensa l’ attività Cnai in ambito internazionale partecipando a gruppi di lavoro e meeting: Enrica Capitoni, vicepresidente CNAI, insieme ai rappresentanti di Spagna, Portogallo, Grecia hanno collaborato con il Royal College of Nursing (RCN), con l’ obiettivo di condividere le esperienze dei Paesi rappresentati che vedono infermieri lasciare il proprio Paese d’origine per trovare lavoro in UK. Visto l’ incremento del fenomeno, il RCN ha predisposto una guida: "Internationally recruited nurses RCN guidance for RCN representatives, UK employers and nursing staff considering work in the UK” il documento può essere scaricato da: http://www.cnai.info/images/stories/annunci/2016/rcnguide.pdf La Dr.ssa Judith Shamian, Presidente del Consiglio Internazionale degli Infermieri (ICN), è stata scelta per far parte della High-Level Commission delle Nazioni Unite che si occupa di salute occupazione e crescita economica. Molti noi ricorderanno che la Presidente ICN il 23 novembre 2013 incontrò una delegazione CNAI dove furono rappresentati problemi comuni di immagine e di rappresentanza delle Associazioni infermieristiche. Ginevra ha ospitato una serie di incontri organizzati, dal 18 al 22 maggio dal Consiglio Internazionale degli Infermieri (ICN) insieme a Organizzazione mondiale della sanità (WHO), Associazioni Infermieristiche Nazionali (NNA) e International Confederation of Midwives (ICM), propedeutici all'Assemblea Mondiale della Sanità dove è stata evidenziata la necessità per i governi di investire su Infermieri e Ostetriche al fine ottenere una Copertura Sanitaria Universale (UHC) e Obiettivi di Sviluppo Sostenibili (OSS) (SDGs). La nostra Presidente Cecilia Sironi con Davide Ausili (Executive Editor, Professioni infermieristiche) ha partecipato il 18 e 19 maggio al Meeting NNA dove 81 rappresentanti delle associazioni infermieristiche nazionali di ICN (NNA) provenienti da 47 paesi diversi si sono incontrati per discutere rafforzamento e l'influenza politica delle NNA, nonché indirizzare il contributo del personale infermieristico e ostetrico ai mandati di salute globale del UHC e l'OSS Fra i temi discussi nella riunione NNA i problemi emergenti e come far crescere l'influenza delle NNA: • gli argomenti strategici dell'OMS su accreditamento e normativa basata sull’ evidenza per il rafforzamento delle professioni a protezione dei cittadini; • far convergere lo sviluppo delle due professioni nell’ ambito dei mandati di salute globale. Per la prima volta in assoluto, il 18 e 19 maggio, grazie all’ invito della Presidente CNAI, Maurizio Zega e la collega e traduttrice Simona Parisi rappresentando la FNC-IPASVI, hanno partecipato al Credentialing and Regulators Meeting, incontro dei rappresentanti degli enti regolatori nazionali (Ordini, Federazioni. Enti regolatori professionali o organismi preposti per la tutela del cittadino e della professione infermieristica nei diversi Paesi). Approfondimenti in italiano grazie all’articolo di Davide Ausili, cronista per l’occasione, e sul sito: http://www.icn.ch/events/icn-meetings-a-events

Vita Associativa

CNAI e RAPPORTI INTERNAZIONALI Sempre intensa l' attivití  Cnai in ambito internazionale partecipando a gruppi di lavoro e meeting: Enrica Capitoni, vicepresidente CNAI, insieme ai rappresentanti di Spagna, Portogallo, Grecia hanno collaborato con il Royal College of Nursing (RCN), con l' obiettivo di condividere le esperienze dei Paesi rappresentati che vedono infermieri lasciare il proprio Paese d'origine per trovare lavoro in UK. Visto l' incremento del fenomeno, il RCN ha predisposto una guida: "Internationally recruited nurses RCN guidance for RCN representatives, UK employers and nursing staff considering work in the UK" il documento può essere scaricato da: http://www.cnai.info/images/stories/annunci/2016/rcnguide.pdf La Dr.ssa Judith Shamian, Presidente del Consiglio Internazionale degli Infermieri (ICN), è stata scelta per far parte della High-Level Commission delle Nazioni Unite che si occupa di salute occupazione e crescita economica. Molti noi ricorderanno che la Presidente ICN il 23 novembre 2013 incontrò una delegazione CNAI dove furono rappresentati problemi comuni di immagine e di rappresentanza delle Associazioni infermieristiche. Ginevra ha ospitato una serie di incontri organizzati, dal 18 al 22 maggio dal Consiglio Internazionale degli Infermieri (ICN) insieme a Organizzazione mondiale della sanití  (WHO), Associazioni Infermieristiche Nazionali (NNA) e International Confederation of Midwives (ICM), propedeutici all'Assemblea Mondiale della Sanití  dove è stata evidenziata la necessití  per i governi di investire su Infermieri e Ostetriche al fine ottenere una Copertura Sanitaria Universale (UHC) e Obiettivi di Sviluppo Sostenibili (OSS) (SDGs). La nostra Presidente Cecilia Sironi con Davide Ausili (Executive Editor, Professioni infermieristiche) ha partecipato il 18 e 19 maggio al Meeting NNA dove 81 rappresentanti delle associazioni infermieristiche nazionali di ICN (NNA) provenienti da 47 paesi diversi si sono incontrati per discutere rafforzamento e l'influenza politica delle NNA, nonché indirizzare il contributo del personale infermieristico e ostetrico ai mandati di salute globale del UHC e l'OSS Fra i temi discussi nella riunione NNA i problemi emergenti e come far crescere l'influenza delle NNA: "¢ gli argomenti strategici dell'OMS su accreditamento e normativa basata sull' evidenza per il rafforzamento delle professioni a protezione dei cittadini; "¢ far convergere lo sviluppo delle due professioni nell' ambito dei mandati di salute globale. Per la prima volta in assoluto, il 18 e 19 maggio, grazie all' invito della Presidente CNAI, Maurizio Zega e la collega e traduttrice Simona Parisi rappresentando la FNC-IPASVI, hanno partecipato al Credentialing and Regulators Meeting, incontro dei rappresentanti degli enti regolatori nazionali (Ordini, Federazioni. Enti regolatori professionali o organismi preposti per la tutela del cittadino e della professione infermieristica nei diversi Paesi). Approfondimenti in italiano grazie all'articolo di Davide Ausili, cronista per l'occasione, e sul sito: http://www.icn.ch/events/icn-meetings-a-events

Measuring self-care in the general adult population : Development and psychometric testing of the Self-Care Inventory

Background Self-care is important at all stages of life and health status to promote well-being, prevent disease, and improve health outcomes. Currently, there is a need to better conceptualize self-care in the general adult population and provide an instrument to measure self-care in this group. Therefore, the aim of this study was to develop and evaluate the Self-Care Inventory (SCI), a theory-based instrument to measure self-care in the general adult population. Methods Based on the Middle Range Theory of Self-Care, the 20-item SCI was developed with three scales: Self-Care Maintenance (8 items), Self-Care Monitoring (6 items), and Self-Care Management (6 items). A cross sectional study with a US-based sample (n = 294) was conducted to test the SCI. Internal validity was assessed with Confirmatory Factor Analysis. Internal consistency reliability was assessed with Cronbach alpha for unidimensional scales or composite reliability and the global reliability index for multidimensional scales. Construct validity was investigated with Pearson correlation to test the relationship between general self-efficacy, positivity, stress, and self-care scores. Results The Self-Care Maintenance and Management scales were multidimensional and the Self-Care Monitoring scale was unidimensional. The global reliability index for multidimensional scales was 0.85 (self-care maintenance) and 0.88 (self-care management). Cronbach alpha coefficient of the self-care monitoring scale was 0.88. Test-retest reliability was 0.81 (self-care maintenance), 0.91 (self-care monitoring), and 0.76 (self-care management). The General Self-Efficacy Scale was positively related to all three self-care scale scores: self-care maintenance r = 0.46, p < 0. 001, self-care monitoring r = 0.31, p < 0. 001, and self-care management r = 0.32, p < 0. 001. The positivity score was positively related to self-care maintenance (r = 0.42, p < 0. 001), self-care monitoring (r = 0.29, p < 0. 001), and self-care management (r = 0.34, p < 0. 001) scores. The perceived stress was positively related to the self-care management (r = 0.20, p < 0. 001) score. Conclusions The SCI is a theoretically based instrument designed to measure self-care in the general adult population. Preliminary evidence of validity and reliability supports its use in the general adult population

How to Design a Qualitative Health Research Study. Part 1: Design and Purposeful Sampling Considerations

In this first part of the article, we aim to provide health researchers with an understanding of how to design a qualitative health research study, including: topic identification, design selec- tion, and engagement in reflexivity. We offer practical guidance for writing an overarching question using a novel framework that helps develop a clearly articulated question that includes the following elements: emphasis, purposeful sampling, phenomenon of interest, and context. We then expand on specific methodological issues: study designs, contexts, sampling, and recruitment. Finally, we provide examples of qualitative health research studies that illustrate the application of different research designs. In part two of this article, we will discuss how to prepare for going into the field, how to generate, manage and analyse data, and plan for the dissemination of qualitative health research. Keywords: Research Methodology, Qualitative Research, Qualitative Health Research, Research Design, Purposeful Sample, RecruitmentCome Disegnare uno Studio di Ricerca Sanitaria Qualitativa. Parte 1: Considerazioni sui Disegni e sul Campionamento PropositivoAttraverso le nostre esperienze di insegnamento della ricerca qualitativa agli studenti in varie discipline sanitarie, abbiamo concluso che molti ricercatori alle prime armi richiedono un supporto chiaro, pratico e focalizzato per sviluppare protocolli di ricerca. In questa prima parte di articolo, miriamo a fornire ai ricercatori sanitari una comprensione di come proget- tare uno studio qualitativo sulla ricerca sanitaria, tra cui: identificazione dell'argomento, sele- zione del disegno e del coinvolgimento nella riflessività. Offriamo una guida pratica per scri- vere una domanda utilizzando una nuova framework che aiuta a sviluppare una domanda chiaramente articolata che include i seguenti elementi: enfasi, campionamento propositivo, fenomeno di interesse e contesto. Quindi, esponiamo questioni metodologiche specifiche: disegno di studio, contesti, campionamento e reclutamento. Infine, forniamo esempi di studi qualitativi di ricerca sanitaria tratti dalla letteratura. Nella seconda parte dell'articolo, discu- teremo come prepararsi per andare sul campo, come generare, gestire e analizzare i dati e pianificare la diffusione della ricerca qualitativa sanitaria. Parole Chiave: Metodologia della ricerca, Ricerca Qualitativa, Ricerca Sanitaria Qualitativa, Disegni di Ricerca, Campionamento Propositivo, Reclutamento

Modified Research Utilization Questionnaire: Development and Validation Study among Italian Nurses

Purpose: The purpose of this study was to develop the modified research utilization questionnaire (M-RUQ) and to establish its content and face validity, construct validity, and reliability. Methods: This study has a multiphase (three phases), methodological, and cross-sectional design. First, research utilization questionnaire (RUQ) was translated into Italian, which is the target language to develop the M-RUQ. Second, the RUQ psychometric proprieties were assessed using exploratory factorial analysis to identify ambiguous or problematic items (e.g., cross-loadings) (cross-sectional sampling A). The RUQ modification (i.e., item deleting, wording modification, and scoring procedure) represented the development of the M-RUQ among Italian nurses. The third phase was aimed to confirm the construct validity of the M-RUQ and to test its stability and internal consistency (cross-sectional sampling B). Results: This study's findings show that M-RUQ has a three-dimensional structure and a total of 22 items. The M-RUQ shows evidence of validity and reliability. Precisely, the factorial structure coming from an exploratory factorial analysis on the first sample (n = 504) was confirmed by a final model of confirmatory factorial analysis (CFA) on a second sample (n = 362). The final CFA model showed adequate goodness of fit, where all the factor loadings showed values higher than .40. Cronbach's α was satisfactory for each domain and for the overall scale. Furthermore, the M-RUQ showed good stability described by the test–retest. Conclusion: The M-RUQ should be used to assess research utilization among nurses for educational or research purposes to address the practice. Further research about its validity and reliability is suggested. Keywords: evidence-based nursing, nursing, psychometric

Symptom Recognition as a Mediator in the Self-Care of Chronic Illness

The recognition of a symptom is needed to initiate a decision to engage in a behavior to ameliorate the symptom. Yet, a surprising number of individuals fail to detect symptoms and delay in addressing early warnings of a health problem

Clinical and Socio-Demographic Determinants of Self-Care Behaviours in Patients with Heart Failure and Diabetes Mellitus: A Multicentre Cross-Sectional Study

Background Self-care is vital for patients with heart failure to maintain health and quality of life, and it is even more vital for those who are also affected by diabetes mellitus, since they are at higher risk of worse outcomes. The literature is unclear on the influence of diabetes on heart failure self-care as well as on the influence of socio-demographic and clinical factors on self-care. Objectives (1) To compare self-care maintenance, self-care management and self-care confidence of patients with heart failure and diabetes versus those heart failure patients without diabetes; (2) to estimate if the presence of diabetes influences self-care maintenance, self-care management and self-care confidence of heart failure patients; (3) to identify socio-demographic and clinical determinants of self-care maintenance, self-care management and self-care confidence in patients with heart failure and diabetes. Design Secondary analysis of data from a multicentre cross-sectional study. Setting Outpatient clinics from 29 Italian provinces. Participants 1192 adults with confirmed diagnosis of heart failure. Methods Socio-demographic and clinical data were abstracted from patients’ medical records. Self-care maintenance, self-care management and self-care confidence were measured with the Self-Care of Heart Failure Index Version 6.2; each scale has a standardized score from 0 to 100, where a score \u3c70 indicates inadequate self-care. Multiple linear regression analyses were performed. Results Of 1192 heart failure patients, 379 (31.8%) had diabetes. In these 379, heart failure self-care behaviours were suboptimal (means range from 53.2 to 55.6). No statistically significant differences were found in any of the three self-care measures in heart failure patients with and without diabetes. The presence of diabetes did not influence self-care maintenance (p = 0.12), self-care management (p = 0.21) or self-care confidence (p = 0.51). Age (p = 0.04), number of medications (p = 0.01), presence of a caregiver (p = 0.04), family income (p = 0.009) and self-care confidence (p \u3c 0.001) were determinants of self-care maintenance. Gender (p = 0.01), number of medications (p = 0.004) and self-care confidence (p \u3c 0.001) were significant determinants of self-care management. Number of medications (p = 0.002) and cognitive function (p \u3c 0.001) were determinants of self-care confidence. Conclusions Self-care was poor in heart failure patients with diabetes mellitus. This population needs more intensive interventions to improve self-care. Determinants of self-care in heart failure patients with diabetes mellitus should be systematically assessed by clinicians to identify patients at risk of inadequate self-care

The Effectiveness of a Motivational Interviewing Intervention on Mutuality Between Patients With Heart Failure and Their Caregivers

background mutuality, defined as "the positive quality of the relationship between a caregiver and a care receiver", was found to be associated with self-care and caregiver contribution to self-care in heart failure (HF). however, no studies were conducted to evaluate whether motivational interviewing (MI) can improve mutuality in patients with HF and caregivers. objectives the aim of this study was to evaluate the effectiveness of MI on mutuality in HF patient-caregiver dyads. methodsThis is a secondary outcome analysis of the MOTIVATE-HF randomized controlled trial, the primary aim of which was to evaluate the effect of MI on improving self-care in patients with HF. participants were randomized into 3 arms: (1) MI for patients only, (2) MI for both patients and caregivers, and (3) standard care. to assess the HF patients' and caregivers' mutuality, the mutuality scale was used in its patient and caregiver versions. results patients with HF had a median age of 74 years, and there were more men (58%). most patients were retired (76.2%). caregivers had a median age of 55 years and were mostly women (75.5%). most patients were in new york heart association class II (61.9%) and had an ischemic HF etiology (33.6%). the motivational interviews did not show any impact on changes in the patient and caregiver mutuality during the follow-up time (3, 6, 9, and 12 months from baseline). the condition of living together between the patient and the caregiver was significantly associated with better mutuality between the patient and the caregiver. conclusions motivational interviewing performed by nurses was not effective in improving mutuality in patients with HF and caregivers, but the target variable of the intervention was patient self-care. stronger effects of MI on mutuality were observed in patients with HF and caregivers who live together. future studies should target mutuality to see whether MI is really effective

MOTIVATional intErviewing to Improve Self-Care in Heart Failure Patients (MOTIVATE-HF): Study Protocol of a Three-Arm Multicenter Randomized Controlled Trial

Aims Heart Failure (HF) self-care improves patient outcomes but trials designed to improve HF self-care have shown inconsistent results. Interventions may be more effective in improving self-care if they mobilize support from providers, promote self-efficacy, increase understanding of HF, increase the family involvement, and are individualized. All of these elements are emphasized in motivational interviewing (MI); few trials have been conducted using MI in HF patients and rarely have caregivers been involved in MI interventions. The aim of this study will be to evaluate if MI improves self-care maintenance in HF patients, and to determine if MI improves the following secondary outcomes: a) in HF patients: self-care management, self-care confidence, symptom perception, quality of life, anxiety/depression, cognition, sleep quality, mutuality with caregiver, hospitalizations, use of emergency services, and mortality; b) in caregivers: caregiver contribution to self-care, quality of life, anxiety/depression, sleep, mutuality with patient, preparedness, and social support. Methods A three-arm randomized controlled trial will be conducted in a sample of 240 HF patients and caregivers. Patients and caregivers will be randomized to the following arms: 1) MI intervention to patients only; 2) MI intervention to patients and caregivers; 3) standard of care to patients and caregivers. The primary outcome will be measured in patients 3 months after enrollment. Primary and secondary outcomes also will be evaluated 6, 9 and 12 months after enrollment. Conclusion This study will contribute to understand if MI provided to patients and caregivers can improve self-care. Because HF is rising in prevalence, findings can be useful to reduce the burden of the disease