Factors contributing to the promotion of moral competence in nursing

Ethics is a foundational competency in healthcare inherent in everyday nursing practice. Therefore, the promotion of qualified nurses’ and nursing students’ moral competence is essential to ensure ethically high-quality and sustainable healthcare. The aim of this integrative literature review is to identify the factors contributing to the promotion of qualified nurses’ and nursing students’ moral competence. The review has been registered in PROSPERO (CRD42023386947) and reported according to the PRISMA guideline. Focusing on qualified nurses’ and nursing students’ moral competence, a literature search was undertaken in January 2023 in six scientific databases: CINAHL, Cochrane Library, PsycINFO, PubMed Medline, Scopus and Web of Science. Empirical studies written in English without time limitation were eligible for inclusion. A total of 29 full texts were retrieved and included out of 5233 citations. Quality appraisal was employed using Joanna Briggs Institute checklists and the Mixed Method Appraisal Tool. Data were analysed using inductive content analysis. Research about the factors contributing to the promotion of qualified nurses’ and nursing students’ moral competence is limited and mainly explored using descriptive research designs. The contributing factors were identified as comprising two main categories: (1) human factors, consisting of four categories: individual, social, managerial and professional factors, and ten sub-categories; and (2) structural factors, consisting of four categories: educational, environmental, organisational and societal factors, and eight sub-categories. This review provides knowledge about the factors contributing to the promotion of qualified nurses’ and nursing students’ moral competence for the use of researchers, nurse educators, managers, organisations and policymakers. More research about the contributing factors is needed using complex intervention, implementation and multiple methods designs to ensure ethically sustainable healthcare

Antibody response and risk of reinfection over 2 years among the patients with first wave of COVID-19

Objectives: To describe the dynamics and factors related to natural and hybrid humoral response against the SARS-CoV-2 and risk of reinfection among first-wave patients. Methods: A prospective longitudinal study with periodic serological follow-up after acute onset of all recovered patients with SARS-CoV-2 infection cared in Udine Hospital (March–May 2020). Nucleocapsid (N) protein and spike receptor-binding domain (S-RBD) antibody tests were used to distinguish natural and vaccine-induced response. Results: Overall, 153 patients (66 men, mean age 56 years) were followed for a median of 27.3 (interquartile range 26.9–27.8) months. Seroreversion was 98.5% (95% CI: 96.8–99.4) for SARS-CoV-2-N IgM at 1 year and 57.4% (95% CI: 51.5–63.5) for SARS-CoV-2-N IgG at 2 years. Initial serological response (hazard ratio [HR]: 0.99, 95% CI: 0.99–0.99, p 0.002 for IgM and HR: 0.97, 95% CI: 0.97–0.98, p < 0.001 for IgG) and severity of acute infection (HR: 0.62, 95% CI: 0.39–0.96, p 0.033 for IgM and HR: 0.60, 95% CI: 0.37–0.99, p < 0.001 for IgG) were independently associated with persistent SARS-CoV-2-N IgM/IgG response. Older age and smoker status were associated with long-term SARS-CoV-2-N IgM and SARS-CoV-2-N IgG, respectively (HR: 0.75, 95% CI: 0.57–0.98, p 0.038; HR: 1.77, 95% CI: 1.19–2.61, p 0.004 respectively). All patients maintained SARS-CoV-2-S-RBD IgG response at 24-month follow-up. Reinfections occurred in 25 of 153 (16.3%) patients, mostly during the omicron circulation. Reinfection rates did not differ significantly between SARS-CoV-2-N IgG seronegative and seropositive patients (14/89, 15.7% vs. 10/62, 16.1%, p 0.947). Unvaccinated patients had higher risk of reinfection (4/7, 57.1% vs. vaccinated 21/146, 14.4%, p 0.014). Discussion: First-wave patients had durable natural humoral immunity in 40% and anti-S-RBD response in 100% up to 2 years after infection. Natural humoral response alone was not protective against reinfections with omicron SARS-CoV-2 variants, whereas vaccination was effective to reduce the risk of a new infection

Video calls between patients and families: a narrative review

Introduction. Many services have introduced video calls between patients and family members during the pandemic. Aim. To synthesize the literature on the use of video calls between patients and family members when “in presence” visits are limited or banned. Methods. A narrative review of the literature was conducted by searching Pub-Med and Cumulative Index to Nursing and Allied Health Literature databases using the keywords video call, covid, relative and similar terms. Articles on video calls between family members and patients referring to the 2020-2022 pandemic period have been included. Results. Eighteen studies were included: six descriptive qualitative, four case reports, three cross-sectional, three observational, a quasi-experimental and a commentary; most of them were from Italy and based in intensive care and long-term facilities. The most used term was video call. Studies investigated how to properly plan and conduct the video call, prepare the patient and his/her family, accounting for the technical aspects and devices. Video calls may generate positive effects on satisfaction, anxiety, depressive symptoms, and distress of patients and families; however, negative effects have been also documented. Discussion. The use of video calls in acute care and end-of-life settings implies a different complexity from nursing homes or long-term care facilities. The video call must be planned and evaluated as all other nursing interventions; it cannot be spontaneous and without a preliminary assessment of the potential benefits and risks; health care professionals should be properly trained

Unfinished Nursing Care and their consequences as perceived by nurses: a descriptive qualitative study. Unfinished Nursing Care e le conseguenze percepite dagli infermieri: uno studio qualitativo descrittivo

Unfinished Nursing Care, which expresses the nursing care planned but not delivered or delivered late, is a phenomenon of growing interest in recent years resulting in several conceptual frameworks, each of which has defined what are the consequences of the phenomenon. However, outcomes established to date have not been re-assessed over time and from different perspectives, including also the nurse managers and directors. The aim of the study was to describe the consequences of Unfinished Nursing Care in daily practice as perceived by clinical nurses, nurse managers and directors. A descriptive qualitative study based on interviews was conducted in 2021; data has been analyzed through content analysis, and reported here in accordance with the Consolidated criteria for reporting qualitative research (COREQ) guidelines. The consequences of Unfinished Nursing Care have been set at three levels: outcomes for the nurse (increased frustration, anxiety, helplessness, work overtime), outcomes for the patient (increased risk of infections related to care practices, bed rest syndrome; loss of independence and quality of life, disorientation; increase episodes of in undefined care pathways, aggression towards staff, decrease in compliance and increased the length of in-hospital stay) and outcomes affecting the relationship with family caregivers (difficulties in the relationship, disappointment, increased risk of complaints)

Nurse managers' strategies promoting a Fundamentals of Care-based approach among nurses: A scoping review

Introduction: In the last few years, shortcomings in caring for patient needs have promoted a growing interest in the Fundamentals of Care (FoC) to promote the quality of nursing care. However, which strategies nurse managers should implement to facilitate a FoC-based nursing care approach have not been mapped to date; therefore, the intent of this study was to map those strategies related to the nurse manager role that have been documented as being capable of promoting (or hindering), a FoC-based approach among nurses. Methods: A scoping review following the Preferred Reporting Items for Systematic Review and Meta- Analysis - Extension for Scoping Reviews (PRISMA-ScR) guidelines. The PubMed, CINAHL, Cochrane Library, Scopus and Web of Science databases and the conference proceedings of the International Learning Collaborative 2022 Annual International Conference were consulted. Studies exploring the relationship between FoC and nurse managers using any methodology, published from 2008 (year of birth of the FoC movement) to September 2022, in Italian or English, were eligible for inclusion. Findings were categorized narratively, according to their similarities and differences. Results: Four qualitative studies, four discussion papers, two reviews and one mixed-method study, published from 2017 to 2021, predominantly in Australia, were included. Several strategies have emerged as promoting a FoC-based care approach by nurse managers. At the macro level, there is a need to disseminate a culture of attention towards patients that should be incorporated in the strategy of the entire system; moreover, synergies and effective leadership styles should be promoted by also providing education both in the undergraduate and continuing education settings. At the micro levels, among others, the required resources should be available, and the quality of the environment promoted. Conclusion: Nurse managers may facilitate a FoC-based approach among nurses through a set of strategies that should be included and considered in their educational pathways

Nurses prioritization processes to prevent delirium in patients at risk: Findings from a Q-Methodology study

Background: This study aimed at (a) exploring how nurses prioritise interventions to prevent delirium among patients identified at risk and (b) describing the underlying prioritisation patterns according to nurses' individual characteristics. Methods: There was used the Q -methodology a research process following specific steps: (a) identifying the concourse, (b) the Q -sample, and (c) the population (P -set); (d) collecting data using the Q -sort table; (e) entering the data and performing the factor analysis; and (f) interpreting the factors identified. Results: There were involved 56 nurses working in medical, geriatric and log -term facilities (46; 82.2 %). The preventive intervention receiving the highest priority was 'Monitoring the vital parameters (heart rate, blood pressure, oxygen saturation)' (2.96 out of 4 as the highest priority; CI 95 %: 2.57, 3.36). Two priority patterns emerged among nurses (explained variance 44.78 %), one 'Clinical -oriented' (36.19 %) and one 'Family/caregiver-oriented' (8.60 %) representing 53 nurses out 56. Conclusion: Alongside the overall tendency to prioritise some preventive interventions instead of others, the priorities are polarised in two main patterns expressing two main individual characteristics of nurses. Knowing the existence of individual patterns and their aggregation informs how to shape educational interventions. (c) 2024 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/

Using Metaphors to Understand Suffering in COVID-19 Survivors: A Two Time-Point Observational Follow-Up Study

Accumulating evidence indicates that the COVID-19 pandemic carries risks to psychological health and represents a collective traumatic experience with consequences at the social, economic, and health levels. The primary aim of this study was to collect ongoing COVID-19 survivors' pandemic-related experiences as expressed through the use of metaphors; the secondary aim was to explore socio-demographic variables associated with the metaphor orientation as negative, positive or neutral. An observational follow-up survey was conducted and reported according to the STROBE guidelines. Patients &gt;= 18 years, who were treated for COVID-19 during the first wave (March/April 2020) and who were willing to participate in a telephone interview were involved and asked to summarize their COVID-19 experience as lived up to 6 and 12 months in a metaphor. A total of 339 patients participated in the first (6 months) and second (12 months) data collection. Patients were mainly female (51.9%), with an average age of 52.9 years (confidence interval, CI 95% 51.2-54.6). At 6 months, most participants (214; 63.1%) used a negative-oriented metaphor, further increasing at 12 months (266; 78.5%), when they used fewer neutral-/positive-oriented metaphors (p &lt; 0.001). At the 6-month follow-up, only three individual variables (female gender, education, and experiencing symptoms at the COVID-19 onset) were significantly different across the possible metaphor orientation; at 12 months, no individual variables were significantly associated. This study suggests increasingly negative lived experiences over time and the need for personalized healthcare pathways to face the long-term traumatic consequences of COVID-19