Efficacy of the Buzzy System for pain relief during venipuncture in children: a randomized controlled trial

Background and aim of the work: procedural pain is a significant issue for paediatric patients. In particular, needle pain is amongst the most stressful for children. Studies revealed that a large number of children do not receive adequate pain prevention during the procedures. Neglecting the prevention of needle pain can cause several psychological effects such as anxiety and phobias, and increase perceptions of pain in the future. We aimed to verify the efficacy of Buzzy System in reducing pain during venipuncture. Methods: A randomized control trial was conducted among 72 children aged 3 to 10 years undergoing venipuncture. Children were randomly assigned to The Buzzy with distraction cards group (experimental group) or to “magic gloves” group (control group). Perception of pain was measured through the Visual Analogue Scale (VAS), the Wong-Baker Scale (WBS) and the Numeric Rating Scale (NRS). Results: Sixty-four children participated in the study, 34 in the experimental group and 30 in the control group. The experimental group showed significantly lower levels of pain (p=.039; 95% CI: -2,11; -0,06) in terms of the mean=3.65±2.011; median=3, compared to the control group (mean: 4.67±2.14, median=4). Caregivers were satisfied with the Buzzy System. Conclusion: The Buzzy System combined to distraction cards showed a greater reduction of perceived pain than “magic glove” technique. This study underlines the importance of active involvement of caregivers during procedural pain in children. Pediatric nurses have an important role in empowering children and caregivers to be interactive during venipunctures

Distraction technique for pain reduction in Peripheral Venous Catheterization: randomized, controlled trial

Background and aim of the work: Procedural pain during Peripheral Venous Catheterization (PVC) is a significant issue for patients. Reducing procedure-induced pain improves the quality of care and reduces patient discomfort. We aimed to compare a non-pharmacological technique (distraction) to anaesthetic cream (EMLA) for the reduction of procedural pain during PVC, in patients undergoing Computerized Tomography (CT) or Nuclear Magnetic Resonance (NMR) with contrast. Methods: This is a Prospective, Randomized Controlled Trial. The study was carried out during the month of October 2015. A total of 72 patients undergoing PVC were randomly assigned to the experimental group (distraction technique, n=36) or control group (EMLA, n=36). After PVC, pain was evaluated by means of the numeric pain-rating scale (NRS). Pain perception was compared by means of Mann-Whitney Test. Results: The average pain in the distraction group was 0.69 (SD±1.26), with a median value of 0. The average pain in the EMLA group was 1.86 (SD±1.73), with a median value of 2. The study showed a significant improvement from the distraction technique (U=347, p<.001, r=.42) with respect to the local anaesthetic in reducing pain perception. Conclusions/Implication for practice: Distraction is more effective than local anaesthetic in reducing of pain-perception during PVC insertion. This study is one of few comparing the distraction technique to an anaesthetic. It confirms that the practitioner-patient relationship is an important point in nursing assistance, allowing the establishment of trust with the patient and increasing compliance during the treatment process

The psychosocial impact of flu influenza pandemics on healthcare workers and lessons learnt for the COVID-19 emergency: a rapid review

Objectives: during a pandemic, healthcare workers (HCWs) are essential to the health system response. Based on our knowledge, little information is available regarding the psychosocial impact on HCWs or interventions for supporting them during pandemics. Therefore, the study aimed to assess available literature on perceived stress and psychological responses to influenza pandemics in HCWs and identify implications for healthcare practice and future research. Methods: this is a rapid review of the literature. The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis. Results: across all the studies both qualitative and quantitative HCWs working during the epidemic reported frequent concerns regarding their own health and the fear of infecting their families, friends and colleagues. Moreover, social isolation, uncertainty, fears of stigmatization and reluctance to work or considering absenteeism were frequently reported. Moreover, many studies highlighted a high prevalence of high levels of stress, anxiety and depression symptoms, which could have long-term psychological implications in HCWs. Conclusions: this rapid review offers an overview of the major concerns regarding HCWs' psychosocial well-being and possible preventive strategies, which could be useful for the current COVID-19 outbreak and similar future pandemics. Studies suggested to invest on preventive psychological, social, family and physical support and to guaranteeing reasonable work conditions and others in order to protect HCWs from the long-lasting psychological effect of the COVID-19 pandemic. Electronic supplementary material: the online version of this article (10.1007/s00038-020-01463-7) contains supplementary material, which is available to authorized users

NURSES\u2019 INTERVENTIONS TO PROMOTE CANCER PATIENT ENGAGEMENT AND RELATED OUTCOMES: A SYSTEMATIC REVIEW AND META-ANALYSIS PROTOCOL

Background and aim of the work. Due to the ageing of cancer patients, new approaches that require a more active participation in the self-management of cancer treatment at home are needed. Nurses are strategic in improving the patient\u2019s engagement capability in this regard. Knowing which interventions are more effective for the promotion of patient engagement could be useful to improve the effectiveness of the care provided. Therefore, this study aims to systematically review nursing interventions or programs that promote patient engagement in oncological nursing care and summarizing the main evidence related to their impact on relevant clinical and psychosocial outcomes. Method. This is a systematic review and meta-analysis protocol based on Cochrane Handbook for the systematic review of interventions. We will search the most important electronic databases (PUBMED, CINAHL, EMBASE, SCOPUS, ISI Web of Science, Cochrane library) to find out which patient engagement interventions (active adult patient involvement) are implemented in oncological settings and understand what is the effectiveness of these interventions on the outcomes reported in the literature. The GRADE methodology will be used to synthetize the evidence. If possible, also a meta-analysis will be performed. We registered the study protocol on the PROSPERO database (N\ub0 CRD42020146189). Discussion and Conclusion. To our knowledge, this is the first systematic review to address this clinical question in the field of oncology. This review will offer health professionals indications on the most frequently adopted patient engagement interventions and verify their clinical effectiveness. Furthermore, any gaps in the scientific literature will be highlighted

Perceptions of Caring Behavior Among Undergraduate Nursing Students: A Three-Cohort Observational Study

Introduction: Increase in the knowledge of “caring science” among nurses plays a key role in ensuring a correct caring behavior towards patients. Caring training for students is a priority in nursing education, but unfortunately there are limited and conflicting studies which explore this outcome. The purpose of this observational study was to explore the perceptions of caring behaviors by nursing students during their clinical practice training in order to highlight if the level of caring behaviors changes as the nursing course progresses. Materials and Methods: The Caring Behaviors Inventory-24 (CBI-24) was administered to 331 students, enrolled in the three years of an Italian Nursing Course, who accepted to participate in the study (89.2% response rate). The data were analyzed using SPSS software version 26.0 (SPSS Inc., Chicago, IL). Results: The total mean score of CBI-24 was 4.82 in the first, 5.12 in the second and 5.26 in the third-year students. The CBI-24 dimensions “Responding to individual needs” and “Being with” obtained the highest scores among the students of the first year. At the end of the first year, our students were already able to perform expressive caring, whereas instrumental caring developed at a high level in the second and third years. We did not highlight any statistically significant difference between the two gender CBI-24 item scores. Conclusion: In light of our results, we put in evidence that Nursing Degree Programme favours the development in students of both relational and technical components of caring behaviors. We hope that in future students’ self-assessment of caring behaviors could be considered an educational outcome for Nursing Programme

Development of a screening tool to assess dehydration in hospitalized older population: a diagnostic, observational study

INTRODUCTION: dehydration is a frequent condition in older people and is associated with an increased risk of negative health outcomes. In order to adopt strategies to prevent complications, an early recognition of this status is of primary importance. For this reason, a comprehensive assessment tool to monitor hydration status in older people could be useful.AIM: to develop a screening tool to detect dehydration in older people in hospital settings.METHODS: this is a diagnostic, observational study. The new tool is a modified version of the Geriatric Dehydration Screening Tool (GDST), integrated with seven questions and two clinical signs based on updated literature. We tested the new tool with people aged 65 or over. We used as reference standard serum osmolarity. Cronbach's alpha was used to measure the tool's reliability and subscales. We calculated the Area Under ROC Curve (AUC) to choose the cut-off that gave the best balance between sensibility and specificity.RESULTS: 127 patients participated in the study. The reliability of the new GDST was acceptable (Cronbach's alpha 0.63). The diagnostic accuracy, measured with AUC analysis, was 0.83 ± 0.04, p&lt;0.0001 95% CI 0.72-0.87. The best cut-off value was 6 and showed a sensibility of 78%, specificity of 70%. Tongue dryness proved to be the most significant clinical sign associated with poor hydration status (AUC 0.78; p&lt;0.0001, 95% CI 0.69-0.86).CONCLUSION: The new GDST presented an acceptable reliability and diagnostic accuracy that increased with the assessment of some items, such as tongue dryness. This is the first screening tool that presents a promising cut-off value.KEYWORDS: dehydration, aged, screening, inpatients, sensibility, specificity.Sviluppo di uno strumento di screening per valutare la disidratazione nella popolazione anziana ospedalizzata: uno studio diagnostico, osservazionaleRIASSUNTOINTRODUZIONE: La disidratazione è una condizione comune nella persona anziana ed è associata a numerosi rischi per la salute e ad esiti negativi. È importante il precoce riconoscimento di questa condizione, al fine di adottare strategie per prevenirne le complicanze. Per questa ragione è necessario sviluppare strumenti validati per valutare il rischio di disidratazione nelle persone anzianeOBIETTIVO: sviluppare uno strumento di screening per individuare la disidratazione nelle persone anziane ospedalizzate.METODO: il disegno di studio adottato è di tipo diagnostico, osservazionale. Lo strumento creato è basato sul "Geriatric Dehydration Screening Tool" (GDST), che è stato modificato aggiungendo sette domande e due segni clinici, basati sulla letteratura recente. Lo strumento è stato testato in persone con un'etí  maggiore o uguale a 65 anni ospedalizzate. Come reference standard è stata usata l'osmolarití  sierica. È stato calcolato l'alfa di Cronbach per testare l'affidabilití  della consistenza interna dello strumento e delle sue sotto scale. È stata calcolata l'area sotto la curva di ROC (AUC) per individuare il cut-off che dava il miglior bilanciamento tra sensibilití  e specificití .RISULTATI: 127 pazienti hanno partecipato allo studio. L'affidabilití  dello strumento è risultata discreta (Alfa di Cronbach=0.63). L'accuratezza diagnostica, misurata con l'AUC era 0.83±0.04, p&lt;0.0001, 95% IC 0.72-0.87. Il cut-off migliore è risultato essere il valore 6, con una sensibilití  del 78% e specificití  70%. La secchezza della lingua è risultato essere il segno clinico più associato con uno stato di disidratazione (AUC 0.78, p&lt;0.0001 95%CI 0.69-0.86).CONCLUSIONI: il nuovo GDST ha dimostrato un'accettabile affidabilití  e accuratezza diagnostica che aumenta con la valutazione di alcuni items, come la secchezza della lingua. Questo è il primo strumento che presenta un valore di cut-off promettente.PAROLE CHIAVE: disidratazione, anziano, screening, pazienti ospedalizzati, sensibilití , specificití 

Protective factors of ethical conflict during a pandemic-quali-ethics-COVID-19 research part 2: an international qualitative study

Aims and Objectives: To determine which factors can be considered protective ofethical conflicts in intensive care unit healthcare professionals during a pandemic. Background: The COVID-19 pandemic gave rise to new ethical concerns in relation to the management of public health and the limitations on personal freedom. Continued exposure to ethical conflict can have a range of psychological consequences.Design: A qualitative design based on phenomenological approach.Methods: A total of 38 nurses and physicians who were regular staff members of Barcelona and Milan's public tertiary university hospitals and working in intensive care units during the first wave of the COVID-19 pandemic. Semi-structured online indepth interviews were conducted. A thematic analysis was performed by two independent researchers following the seven steps of Colaizzi's methods. We adhere COREQ guidelines.Results: One theme 'Protective factors of ethical conflict in sanitary crisis' and four subthemes emerged from the data: (1) knowledge of the infectious disease, (2) good communication environment, (3) psychological support and (4) keeping the same work team together. Conclusions: Four elements can be considered protective factors of ethical conflict for healthcare professionals during a sanitary crisis. While some of these factors have already been described, the joint identification of this set of four factors as a single element is, in itself, novel. This should help in ensuring the right mechanisms are inplace to face future pandemics and should serve to improve institutional organisation and guarantee safe and high-quality patient care in times of heath care crisis. Relevance to Clinical Practice: Future strategies for the prevention of ethical conflict during sanitary crises, pandemics or other catastrophes need to consider a set of four factors as a single element. These factors are the knowledge of the infectious disease,a good communication environment, psychological support and keeping the same work team together into joint consideration