Nursing Education: challenges and perspectives in a COVID-19 age

The COVID-19 outbreak deeply changed our lives on different levels. Social restrictions and distancing shaped in a different way our view of social relationships and behaviours. Like many aspects of daily life, also education has undergone radical changes. Nursing care was strongly affected by the outbreak, not only due to the risks in everyday practice, the heavy workload or the impact on nurses’ daily lives outside the healthcare settings, but also because nursing is caring profession and it embeds in its roots the close relationship with the patient, the touch, the patients’ body proximity as a way to communicate and to deliver an effective nursing care. All these issues, when brought in nursing education are also a learning opportunity for students and a way to develop their professional identity and to focusing on the nursing role. The COVID-19 outbreak heavily hit the clinical learning environments, as they are healthcare settings. The situation affected students’ learning opportunities, since clinical placements were suspended, Universities closed and in-person courses moved into online teaching. While lessons and courses rapidly switched into online teaching, in order to safeguard students’ education and faculty’s activity, it was not possible to manage the pre-clinical activities, such as simulations and labs, in order to support technical and relational competences. Most of all, it was not possible to arrange the clinical placements due to the uncertainty of the healthcare settings and the social and organizational restrictions to limiting unnecessary accesses to the services, as recommended by the American Association of Colleges of Nursing (2020). Recently, many authors have explored the issues related to the future of nursing education. In detail, an emerging issue is how it will be possible to educating nurses in a society facing isolation and social distance measures, but at the same time, in a society that needs more and more prepared clinical nurses (Dewart et al. 2020). Challenges connected to clinical learning environments Nursing curricula at the European level need to spend at least half of the overall education into clinical practice (European Directive 2013/55/EU). The COVID-19 outbreak affected the possibility to fulfil the criteria and it should be necessary to delay the graduation of undergraduate nursing students to achieve the formal standards for nursing education. Furthermore, it is not clear the impact of this situation in achieving and in maintaining the nursing students’ clinical competences. Competence development and maintenance both require a constant exposure to clinical practice, especially in the last year students, which need soon to face the professional role. Competence is considered as a setting- and time- specific concept where knowledge, skills and behaviours merge together. However, even in professional practice, there are no clear standards to certify competence maintenance over time (Casey et al., 2017). The effect of the break from clinical learning imposed by the outbreak is far to be measured, but we could reasonably suppose that students’ competences are not still stable over time in undergraduate education and they could be affected by a mastery loss. On the other side, the first year students need clinical practice to adjust into the nursing role and, often, to be aware of their choice in nursing, in order to possibly change their educational career. At the beginning of nursing education students experience uncertainty and the behavioural answer to these feeling depend on their motivation and their coping strategies with the academic and the nursing practice’s demands (Ha & Pepin, 2018). When the direct relationship with the academic and the clinical environment is lost or switched to a virtual one, students lose an opportunity to cope and to test their expectations with the choice they made. The first clinical internship experience represents, in a sense, an imprinting moment for the professional future. Due to COVID-19 pandemic, many students not only have lost meaningful chances of clinical learning, but they will also not be able to recover them, with important implications to their competencies acquisition and professional identity, that can be built only in the real clinical settings. Perspectives to push forward nursing education The COVID-19 outbreak also highlighted the relevance of nurses in facing the pandemic: nurses have been in the frontline in critical care, in supporting the community health, in preventing the contagion spread in the population. In this vein, the current pandemic represents an opportunity to drawing attention to the community-based nursing care, where nurses play a pivotal role in maintaining public health and to effectively manage further potential health emergencies. These all are relevant insights of the nursing role and they state the need to re-think nursing curricula and the education in facing infective diseases and in managing public health. Moreover, nurses demonstrated their readiness in facing public health issues on many levels, on broader levels than hospital care. This could have an impact on society’s perception of nurses and nursing and it could motivate the new generations to start a nursing career. The next year will tell us if this will be true or not, but for sure, now, nursing education has a chance to innovate both the study plan and the way to plan differently clinical learning. The study plans should implement more public health contents by educating students also in contact tracing activities and the inter-professional collaboration with public health assistants. Nurses could play a pivotal role in educating people at home in managing health at home, especially with chronically ill patients. Furthermore, nurses have a broader view on the community healthcare services to taking care of people at home when disability, chronic diseases, or social issues occur. COVID-19 outbreak deeply changed our healthcare systems’ view and so should change our nursing education view, in a way to highlight more the nursing role outside the hospital in integrating different views of care and healthcare professional collaboration. Nursing curricula should also focus more on patients’ empowerment and self-care. Healthcare communication has been crucial in promoting healthy and safe behaviours in the population during the outbreak. The roots of nursing are embedded into the proximity to patients’ needs and in finding the right way to improve people’s healthy behaviours. This pandemic brought us to disclose more these roots. The clinical nursing environments should also be re-though in order to enhance the healthcare settings’ integration and the transition of care. Nursing students should be more prepared to deepen patients’ biography, to conduct an in-depth interview useful to understand their habits, the contacts they had, in order to take in charge also the family members, especially when a contagion risk is a concrete possibility. The hospital-oriented education could had weakened a comprehensive view of patient’s history. This pandemic shifted also the focus on how hospital care is deeply linked with public health issues and on how public health issues affect nursing care. If holistic care was a statement and a value of nursing care and nursing education, now holistic care is an imperative need to deliver effective nursing care. Nursing education has to be set for at least 50% in clinical practice, but until now no further details have been stated about the distribution of this 50% in different clinical areas. Clinical competences should be coherent with the population needs and the priorities of the society; nursing education has the duty to provide nurses educated to face the worldwide priorities. It should be clear now that nursing education need to be specific to the area of nursing being practiced in the community and hospital environments. Clinical learning needs to consider how these times differently shaped the society’s needs. Further strategies should be also implemented to improve digitalization into clinical learning. In virtual education there are many factors, which contribute to effective and active learning and which should be considered in the implementation of the virtual learning environment. In detail it is important to consider technological barriers, student expectations and the students’ engagement in simulated environments. Moreover, the planning of virtual clinical educational programs should include effective student-to-teacher and student-to-student communication strategies and the design of specific activities to ensure students’ support (Jowsey et al. 2020). The idea to implement virtual clinical education is not new: both technical and relational skills can be exercised virtually and this was acknowledged as a useful way to test and to educate clinical competences in a safe and non-threatening environment. Although these technological resources are known and available, during the COVID-19 pandemic, heterogeneity has emerged within the nursing faculties. Not all academic institutions have effectively implemented technology to support students’ learning, perhaps because of the sudden and unexpected changes in the education system, which have imposed the use of technological resources not always recognized as regulatory requirements within the faculties. Indeed, the rapid transition from face to face education to virtual education has highlighted several problems related to virtual learning. Following the pandemic, many universities were able to offer education in an emergency distance learning programs but not a structured online education based on “well-considered, durable learning plans” (Morin, 2020). However, COVID-19 is an ongoing crisis but it could be the catalyst that drives nursing education towards innovations and a flexible but effective use of online learning. In spite of the potential of a well-planned online education, we should also consider the risk of inequality issues affecting students’ capability to achieve their learning outcomes; especially when they live in disadvantaged social contexts, with any access to Internet or Wi-Fi or obsolete computer. To encourage a more inclusive distance education some strategies should be implemented, as: to create small classes; to promote new teaching methods as inter-professional education; to create a structured mentoring program in supporting the relationship with students; to provide immediate and constructive feedback; to re-learn how to manage time, while supporting participative learning. On the other hand, distance learning might curb the burden of tuition fees, which could make higher education inaccessible for many individuals. In this vein, virtual teaching could allow more flexibility and a wider access to education (Murphy, 2020). For these reasons, it is possible that the future of undergraduate nursing education will strongly consider distance learning, and it will improve a blended approach to teaching clinical competences. This could represent an opportunity, as long as more efforts are made to improve transparency, accountability, service orientation and inclusion to education but also associated with some fears in respect to surveillance and control, privacy issues, power relations, and inequalities (Murphy, 2020). Conclusions The COVID-19 outbreak deeply affected nursing education, anyway together with the challenges, many new perspectives have been disclosed to reform nursing curricula or to implement new strategies in clinical learning. Those challenges and perspectives should push nursing education forward to innovate and they could shape new approaches to implement contents and competences in tune with the evolution of the societal needs. The new generations of graduate nurses will face a new normality. As the way of thinking nursing care changed, nursing education and clinical learning are the first drivers to shape this new normality in nursing. This historical period shapes a new educational environment deeply embedded in strong roots, and ready to face new perspectives to developing nursing care. The COVID-19 outbreak deeply changed our lives on different levels. Social restrictions and distancing shaped in a different way our view of social relationships and behaviours. Like many aspects of daily life, also education has undergone radical changes. Nursing care was strongly affected by the outbreak, not only due to the risks in everyday practice, the heavy workload or the impact on nurses’ daily lives outside the healthcare settings, but also because nursing is caring profession and it embeds in its roots the close relationship with the patient, the touch, the patients’ body proximity as a way to communicate and to deliver an effective nursing care. All these issues, when brought in nursing education are also a learning opportunity for students and a way to develop their professional identity and to focusing on the nursing role. The COVID-19 outbreak heavily hit the clinical learning environments, as they are healthcare settings. The situation affected students’ learning opportunities, since clinical placements were suspended, Universities closed and in-person courses moved into online teaching. While lessons and courses rapidly switched into online teaching, in order to safeguard students’ education and faculty’s activity, it was not possible to manage the pre-clinical activities, such as simulations and labs, in order to support technical and relational competences. Most of all, it was not possible to arrange the clinical placements due to the uncertainty of the healthcare settings and the social and organizational restrictions to limiting unnecessary accesses to the services, as recommended by the American Association of Colleges of Nursing (2020). Recently, many authors have explored the issues related to the future of nursing education. In detail, an emerging issue is how it will be possible to educating nurses in a society facing isolation and social distance measures, but at the same time, in a society that needs more and more prepared clinical nurses (Dewart et al. 2020). Challenges connected to clinical learning environments Nursing curricula at the European level need to spend at least half of the overall education into clinical practice (European Directive 2013/55/EU). The COVID-19 outbreak affected the possibility to fulfil the criteria and it should be necessary to delay the graduation of undergraduate nursing students to achieve the formal standards for nursing education. Furthermore, it is not clear the impact of this situation in achieving and in maintaining the nursing students’ clinical competences. Competence development and maintenance both require a constant exposure to clinical practice, especially in the last year students, which need soon to face the professional role. Competence is considered as a setting- and time- specific concept where knowledge, skills and behaviours merge together. However, even in professional practice, there are no clear standards to certify competence maintenance over time (Casey et al., 2017). The effect of the break from clinical learning imposed by the outbreak is far to be measured, but we could reasonably suppose that students’ competences are not still stable over time in undergraduate education and they could be affected by a mastery loss. On the other side, the first year students need clinical practice to adjust into the nursing role and, often, to be aware of their choice in nursing, in order to possibly change their educational career. At the beginning of nursing education students experience uncertainty and the behavioural answer to these feeling depend on their motivation and their coping strategies with the academic and the nursing practice’s demands (Ha & Pepin, 2018). When the direct relationship with the academic and the clinical environment is lost or switched to a virtual one, students lose an opportunity to cope and to test their expectations with the choice they made. The first clinical internship experience represents, in a sense, an imprinting moment for the professional future. Due to COVID-19 pandemic, many students not only have lost meaningful chances of clinical learning, but they will also not be able to recover them, with important implications to their competencies acquisition and professional identity, that can be built only in the real clinical settings. Perspectives to push forward nursing education The COVID-19 outbreak also highlighted the relevance of nurses in facing the pandemic: nurses have been in the frontline in critical care, in supporting the community health, in preventing the contagion spread in the population. In this vein, the current pandemic represents an opportunity to drawing attention to the community-based nursing care, where nurses play a pivotal role in maintaining public health and to effectively manage further potential health emergencies. These all are relevant insights of the nursing role and they state the need to re-think nursing curricula and the education in facing infective diseases and in managing public health. Moreover, nurses demonstrated their readiness in facing public health issues on many levels, on broader levels than hospital care. This could have an impact on society’s perception of nurses and nursing and it could motivate the new generations to start a nursing career. The next year will tell us if this will be true or not, but for sure, now, nursing education has a chance to innovate both the study plan and the way to plan differently clinical learning. The study plans should implement more public health contents by educating students also in contact tracing activities and the inter-professional collaboration with public health assistants. Nurses could play a pivotal role in educating people at home in managing health at home, especially with chronically ill patients. Furthermore, nurses have a broader view on the community healthcare services to taking care of people at home when disability, chronic diseases, or social issues occur. COVID-19 outbreak deeply changed our healthcare systems’ view and so should change our nursing education view, in a way to highlight more the nursing role outside the hospital in integrating different views of care and healthcare professional collaboration. Nursing curricula should also focus more on patients’ empowerment and self-care. Healthcare communication has been crucial in promoting healthy and safe behaviours in the population during the outbreak. The roots of nursing are embedded into the proximity to patients’ needs and in finding the right way to improve people’s healthy behaviours. This pandemic brought us to disclose more these roots. The clinical nursing environments should also be re-though in order to enhance the healthcare settings’ integration and the transition of care. Nursing students should be more prepared to deepen patients’ biography, to conduct an in-depth interview useful to understand their habits, the contacts they had, in order to take in charge also the family members, especially when a contagion risk is a concrete possibility. The hospital-oriented education could had weakened a comprehensive view of patient’s history. This pandemic shifted also the focus on how hospital care is deeply linked with public health issues and on how public health issues affect nursing care. If holistic care was a statement and a value of nursing care and nursing education, now holistic care is an imperative need to deliver effective nursing care. Nursing education has to be set for at least 50% in clinical practice, but until now no further details have been stated about the distribution of this 50% in different clinical areas. Clinical competences should be coherent with the population needs and the priorities of the society; nursing education has the duty to provide nurses educated to face the worldwide priorities. It should be clear now that nursing education need to be specific to the area of nursing being practiced in the community and hospital environments. Clinical learning needs to consider how these times differently shaped the society’s needs. Further strategies should be also implemented to improve digitalization into clinical learning. In virtual education there are many factors, which contribute to effective and active learning and which should be considered in the implementation of the virtual learning environment. In detail it is important to consider technological barriers, student expectations and the students’ engagement in simulated environments. Moreover, the planning of virtual clinical educational programs should include effective student-to-teacher and student-to-student communication strategies and the design of specific activities to ensure students’ support (Jowsey et al. 2020). The idea to implement virtual clinical education is not new: both technical and relational skills can be exercised virtually and this was acknowledged as a useful way to test and to educate clinical competences in a safe and non-threatening environment. Although these technological resources are known and available, during the COVID-19 pandemic, heterogeneity has emerged within the nursing faculties. Not all academic institutions have effectively implemented technology to support students’ learning, perhaps because of the sudden and unexpected changes in the education system, which have imposed the use of technological resources not always recognized as regulatory requirements within the faculties. Indeed, the rapid transition from face to face education to virtual education has highlighted several problems related to virtual learning. Fo

Relationship between peripheral insertion site and catheter-related phlebitis in adult hospitalized patients: a systematic review - Relazione tra sito anatomico di inserimento del catetere venoso periferico e flebite catetere correlata nei pazienti adulti ospedalizzati: una revisione sistematica

AIM. To explore the relationship between the anatomical site of peripheral venous catheteriza- tion and risk of catheter-related phlebitis.BACKGROUND. Peripheral venous catheterization is frequently associated with phlebitis. Recent guidelines, recommend the use of an upper-extremity site for catheter insertion but no univocal consensus exists on the anatomical site with lower risk of phlebitis.DESIGN. Systematic review.METHODS: We searched Medline (PubMed) and CINAHL (EBSCOhost) databases until the end of January 2017. We also reviewed the reference lists of retrieved articles and gray literature was excluded. Searches were limited to articles published in English with no restriction imposed to date of publication. The primary outcome was the incidence of phlebitis associated with anato- mical site of peripheral catheterization. We included randomized controlled trials and observa- tional studies on adult patients who required a peripheral catheter for the administration of medi- cation, intermittent or continuous fluid infusion.RESULTS. Antecubital fossa veins are associated with lower phlebitis rates, while hands veins are the most risky sites to develop phlebitis. There is no consensus regarding vein in forearm.CONCLUSION. Choosing the right anatomical site to insert a peripheral venous catheter is impor- tant to decrease phlebitis rate. Further studies should compare indwelling time in different anato- mical sites with phlebitis rate. A more standardized approach in defining and assessing phlebitis among studies is recommended.KEY WORDS: systematic review, phlebitis, peripheral venous catheterization, anatomical sites.RIASSUNTOOBIETTIVO. Esplorare la relazione tra il sito anatomico di inserimento del catetere venoso peri- ferico e il rischio di flebite correlata.INTRODUZIONE. Il cateterismo venoso periferico è spesso associato a flebiti. Linee Guida recenti raccomandano l'utilizzo delle vene degli arti superiori per l'inserimento del catetere ma non esiste univoco consenso circa il sito anatomico correlato al minor rischio di sviluppare flebite.METODI. Abbiamo effettuato una revisione sistematica della letteratura consultando i database Medline (PubMed) e CINAHL (EBSCOhost) fino al termine del mese di Gennaio 2017. Inoltre, abbiamo revisionato le citazioni bibliografiche degli articoli reperiti e la letteratura grigia è stata esclusa. Sono stati ricercati articoli pubblicati in lingua inglese, senza limiti posti per la data di pubblicazione. Abbiamo incluso: gli studi che riportavano dati sui tassi di flebite associati al sito anatomico di cateterismo periferico; gli studi clinici randomizzati controllati e gli studi osserva- zioni condotti su pazienti adulti che necessitavano dell'inserimento di un catetere venoso perife- rico per la somministrazione intermittente o continua di liquidi e farmaci.RISULTATI. L'inserimento del catetere venoso periferico nelle vene della fossa antecubitale è asso- ciato ad un minor tasso di flebiti, mentre le vene della mano sono il sito a maggior rischio di sviluppare flebite. Non esiste consenso circa le vene dell'avambraccio.CONCLUSIONI. La scelta del sito anatomico corretto per l'inserimento di un catetere venoso peri- ferico è importante per diminuire i tassi di flebite. Ulteriori studi dovrebbero comparare i tassi di flebite associati al tempo di permanenza dei cateteri venosi periferici inseriti in differenti siti anatomici. Si raccomanda, inoltre, un approccio maggiormente standardizzato nella definizione e valutazione del grado di flebite all'interno dei diversi studi.PAROLE CHIAVE: revisione sistematica, flebiti, cateterismo venoso periferico, siti anatomici

Pre-registration nursing students’ anxiety and academic concerns after the second wave of COVID-19 pandemic in Italy: A cross-sectional study

Background: The pandemic and its related social restrictions have led to many uncertainties in nurse education, including the fear of infection in clinical learning settings and the challenge of remote learning. The modification of clinical and academic environments generated anxiety and academic concerns among nursing students. Objectives: To explore the main determinants of anxiety related to the clinical and classroom environments in nurse education after the second wave of the COVID-19 Pandemic. Design: Multicentre cross-sectional study. Settings: Ten universities offering nursing bachelor programs in central and southern Italy. Participants: A convenience sample of 842 nursing students. Methods: From April to July 2021, the Self-Rating Anxiety Scale and the Altered Student Study Environment Tool were administered to assess, respectively, students’ anxiety and their concerns about the study environment. A regression model was tested. Results: Most of the nursing students were female (76.6 %), living with family (70.9 %), and full-time students (85.7 %); 44.6 % were third-year of Bachelor in Nursing students. The majority of the participants (88.5 %) showed a level of anxiety. The statistically significant predictors of anxiety levels were concerns about grade attainment (β=0.42, p < 0.001) in the total sample, and, among the first-year students, the completion of clinical placement (β=0.14, p = 0.047). Conclusions: Results suggest a need for the redesign of teaching activities and clinical learning experiences to ensure academic outcomes and to preserve students’ psychological well-being. Models of learning environments’ dynamic adaptation and ongoing psychological support should be implemented to develop tailored interventions

Developing mentorship in clinical practice: Psychometrics properties of the Mentors' Competence Instrument

Clinical placements are an important part of nursing education to developing nursing students' competencies. In enhancing clinical learning, to focus on mentors' competences is pivotal as they are the main role models and experts in guiding. This study is validated the Italian version of the Mentors' Competence Instrument. A sampling frame of 648 mentors was involved. The final sample included 291 mentors (response rate 45%). Confirmatory Factor Analysis was performed. Fit indices were also calculated to evaluate validity. The scale demonstrated optimal fit indexes and its validity was confirmed by psychometrical testing. In detail, Root Mean Square Error of Approximation is 0.058, Standardized Root Mean Residual is 0.046, Comparative Fit Index is 0.893 and Tucker-Lewis Index 0.886. Cronbach's alpha ranges from 0.77 to 0.95 among factors. This is the first validation of the scale performed in a different country from the original study. The performed psychometric testing showed that the scale is valid and reliable, as well as consistent with the theoretical structure reported for a different national context. This scale can be beneficial for comparing mentors' competencies across different clinical learning environments and could be used to build a broader model of mentors' competencies

Pre-registration nursing students' anxiety and academic concerns after the second wave of COVID-19 pandemic in Italy: A cross-sectional study

Background The pandemic and its related social restrictions have led to many uncertainties in nursing education, including the fear of infection in clinical learning settings and the challenge of remote learning. The modification of clinical and academic environments generated anxiety and academic concerns among nursing students. Objectives To explore the main determinants of anxiety related to the clinical and classroom environments in nursing education after the second wave of the COVID-19 Pandemic. Design Multicentre cross-sectional study. Settings Ten Universities offering nursing bachelor programs in central and southern Italy. Participants A convenience sample of 842 nursing students. Methods From April to July 2021, the Self-Rating Anxiety Scale and the Altered Student Study Environment Tool were administered to assess, respectively, students' anxiety and their concerns about the study environment. A regression model was tested. Results Most of the nursing students were female (76.6 %), living with family (70.9 %), and full-time students (85.7 %); 44.6 % were third-year of Bachelor in Nursing students. The majority of the participants (88.5 %) showed a level of anxiety. The statistically significant predictors of anxiety levels were concerns about grade attainment (β=0.42, p < 0.001) in the total sample, and, among the first-year students, the completion of clinical placement (β=0.14, p = 0.047). Conclusions Results suggest a need for the redesign of teaching activities and clinical learning experiences to ensure academic outcomes and to preserve students' psychological well-being. Models of learning environments' dynamic adaptation and ongoing psychological support should be implemented to develop tailored interventions

Effectiveness of a family nurse‐led programme on accuracy of blood pressure self‐measurement: A randomised controlled trial

Aims and objectives: To evaluate the effectiveness of a Family Nurse Practitioner (FNP)-led programme on the degree of adherence of current recommendations on home blood pressure self-measurement (HBPM) as compared to routine care and management. Background: HBPM plays an important role for monitoring hypertensive patients; however, patients’ adherence to current guidelines is unsatisfactory. A nurse-led training programme in the community setting could be an effective strategy to achieve high level of patients’ adherence to recommendations. Design: A multicentre randomised controlled trial was carried out from September 2016 to September 2017.MethodsIn total, 170 patients were randomly allocated into the intervention group (n = 83) and the usual care (n = 87). All participants received usual care (written and verbal information on HBPM recommendations); subjects in the intervention group also received 1-hour training session on how to correctly self-measure BP. Clinical trial registration was done (ClinicalTrials.gov.: NCT04681703). The CONSORT checklist for randomised controlled trials was used in this study. Results: At baseline, the level of adherence to the recommendation was similar in the two groups (p 5 min before performing the measurement (all p < .05). Conclusions: The FNP-led programme is effective in improving patients’ adherence to guidelines on the correct technique to self-measure BP at home. Relevance to clinical practice: This programme may be added to the existing interventions in the community setting or considered into specifically nurse-led hypertension management models

Percezione degli ambienti di tirocinio e soddisfazione degli studenti infermieri nel primo tirocinio clinico: studio osservazionale

RiassuntoBackground. Gli ambienti di apprendimento clinico sono definiti come una rete di fattori interagenti nel contesto, in grado di influenzare gli esiti dell'apprendimento degli studenti. La soddisfazione degli studenti è considerata un indicatore del raggiungimento degli esiti dell'apprendimento ed è determinante a partire dalla prima esperienza di tirocinio. Scopo. Analizzare l'esperienza di apprendimento clinico degli studenti infermieri del primo anno di corso dopo il primo tirocinio clinico ed identificare i principali determinanti della soddisfazione degli studenti. Metodo. Lo studio osservazionale è stato realizzato in cinque sedi universitarie italiane del Corso di Laurea in Infermieristica. 420 studenti hanno compilato la versione italiana della "Clinical Learning Environment, Supervision and plus Nurse Teacher (CLES+T) scale" al termine del primo tirocinio clinico. Risultati. I punteggi medi assegnati alle dimensioni della scala variano da 4.02 (clima di apprendimento) a 3.30 (relazione di tutorato). La maggior parte degli studenti è soddisfatto della propria esperienza di tirocinio (75.6%), ma sono emerse differenze in relazione alle diverse sedi di tirocinio clinico (F = 4.210, p-value = 0.002). Discussione. I principali determinanti della soddisfazione sono lo stile di leadership del coordinatore infermieristico e l'integrazione teoria-pratica nella relazione fra tutor clinico, universitario e studente. Conclusioni. I risultati dello studio contribuiscono alla comprensione della prima esperienza di tirocinio degli studenti. Tuttavia, sono necessarie ulteriori ricerche per determinare le variabili organizzative specifiche e i modelli tutoriali in grado di aumentare la soddisfazione degli studenti, per sviluppare strategie formative basate sull'integrazione tra tutor universitari e guide di tirocinio.Parole chiave. Ambiente di apprendimento clinico, formazione infermieristica, tirocinio clinico, soddisfazione.Abstract Background. Clinical learning environments are defined as an interactive network of forces within the clinical context that influence students' learning outcomes. Nursing students' satisfaction could be strictly related to their learning outcomes. Aim. To analyze the first year nursing students' clinical learning experience and to identify the main determinants of students' satisfaction. Methods. The observational study was carried out in five Italian nursing degree courses. 420 students filled out the validated Italian version of the "Clinical Learning Environment and Supervision plus Nurse Teacher (CLES+T) scale" after the conclusion of their first clinical placement. Results. The mean values of the main sub-dimensions of CLES+T varied from 4.02 (pedagogical atmosphere) to 3.30 (supervisory relationship). Students were mainly satisfied with their clinical placement, however the findings showed statistical significantly differences among the five nursing courses (F = 4.210, p-value = 0.002). Discussion. The main determinants of the overall students' satisfaction are the nurse manager's leadership style and the integration between theoretical knowledge and everyday practice of nursing through the relationship among students, clinical tutors and nurse teacher. Conclusion. Our results may contribute to better understand nursing students' perception of their first clinical placement. However, further research are needed to evaluate which organizational factors and clinical training models may enhance the clinical learning experience. Keywords. Clinical learning environment, nurse education, clinical placement, personal satisfaction

Morality traits for an ideal nurse manager: A multicentre cross‐sectional study

Aims To investigate which morality traits are more important for nurses to determine positive opinions of their nurse manager. Background People selected morality more often than sociability and competence when forming a positive opinion towards an ideal or a newcomer manager. Methods A multicentre, cross-sectional study was carried out by administering two questionnaires to 775 nurses on the influence of morality, sociability and competence traits on their impression formation processes. Results Regarding nurses' perceptions about the morality, sociability and competence traits of an ideal nurse manager, the total score for morality was 20.0; for sociability, it was 14.2; and for competence, it was 19.6. For nurses' opinions about a new nurse manager, the total score of the morality section was 16.2, which was very similar to the total score of the competence section (mean = 16.1). Conclusion Morality positively influences nurses' initial impression of an ideal manager, and though it seems to be a necessary condition, it is not sufficient by itself to support the nursing staff's perception towards a new manager. Implications for Nursing Management Our findings could be useful in better understanding the role of morality in social perceptions and behavioural consequences of staff nurses towards their nurse manager

Immersive and Non-Immersive Virtual Reality for Pain and Anxiety Management in Pediatric Patients with Hematological or Solid Cancer: A Systematic Review

Invasive and painful procedures, which often induce feelings of anxiety, are necessary components of pediatric cancer treatment, and adequate pain and anxiety management during these treatments is of pivotal importance. In this context, it is widely recognized that a holistic approach, including pharmacological and non-pharmacological modalities, such as distraction techniques, should be the standard of care. Recent evidence suggested the use of virtual reality (VR) as an effective non-pharmacological intervention in pediatrics. Therefore, this systematic review aims to analyze previously published studies on the effectiveness of VR for the management of pain and/or anxiety in children and adolescents with hematological or solid cancer. Medline, SCOPUS, Web of Science, ProQuest, CINAHL, and The Cochrane Central Register of Controlled Trials were used to search for relevant studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Randomized controlled trial, crossover trial, cluster randomized trial, and quasi-experimental studies were included. Thirteen studies, published between 1999 and 2022, that fulfilled the inclusion criteria were included. Regarding the primary outcomes measured, pain was considered in five studies, anxiety in three studies, and the remaining five studies analyzed the effectiveness of VR for both pain and anxiety reduction. Our findings suggested a beneficial effect of VR during painful vascular access procedures. Limited data are available on the reduction of anxiety in children with cancer

L'Indice di Complessití Assistenziale come strumento organizzativo in un contesto chirurgico: uno studio osservazionale

Introduzione. Fra i vari metodi per la classificazione dell'assistenza infermieristica, l'Indice di Complessití  Assistenziale (ICA) è uno strumento operativo che consente di valutare l'appropriatezza delle azioni infermieristiche in rapporto alle prestazioni, integrare l'équipe di supporto e avviare il monitoraggio delle professionalití  richieste dal processo di assistenza. Lo scopo dello studio, è stato quello di sperimentare la metodologia ICA in un contesto chirurgico marchigiano (Italia), al fine di determinare il fabbisogno di risorse umane deputate all'assistenza. Metodo. Sono stati raccolti i dati di tutti i pazienti ricoverati in regime ordinario, dal 1 gennaio al 30 aprile 2010, al fine di determinare cinque classi di gravití  media modale per ciascun paziente e procedere quindi al calcolo del fabbisogno di personale. Risultati. Dai risultati è emerso un totale organico pari a 11 unití  infermieristiche mediante il metodo ICA, tre in meno rispetto alla situazione attuale. Le azioni che si sono verificate con maggior frequenza sono state: "Applicare posture per favorire la respirazione" (83%), "Preparare/fornire cibi appropriati in temperatura/consistenza/quantití " (100%); "Fornire ausili per l'eliminazione" (80.7%); "Aiuto nella vestizione" (82.7%); "Trasferimento dalla barella a letto" (83.4%); "Rifacimento letto/unití  malato" (100%); "Controllo dei parametri vitali" (100%); "Educazione sanitaria" (100%); "Accertamento infermieristico" (100%); "Gestione della terapia e dei dispositivi intravascolari" (100%); "Esecuzione di esami strumentali" (100%) Conclusioni. Individuare le azioni che si verificano con più frequenza consente di identificare le competenze dei professionisti, ridistribuire meglio le attivití  ed individuare quelle prescrivibili all'équipe di supporto. Parole chiave: fabbisogno di personale infermieristico, complessití  assistenziale, indice di complessití  assistenziale, carico di lavoro infermieristico, sistema di classificazione dei pazienti, studio osservazionaleABSTRACT Introduction. Among different methods of nursing classification, the Index of Caring Complexity (ICC) is a management tool to evaluate appropriateness of nursing procedures, integrate health-care support workers and to monitor the need of nursing staff. The objective of this observational study was to apply the ICC method in a surgical ward of the Marche Region (Italy), to determine the nursing staff level. Methods. From 1 January to 30 April 2010, all data of patients admitted for more than 48 hours were collected. The determination of nursing staff level derived from the five patient classification on the basis of the complexity/gravity "scores" of data flow obtained during the caring process. Result. The ICC method showed a staffing of 11 nurses: a staff shortage of three nurse, if compared to the actual staff. The ICC method also demonstrate its strength as a useful tool to reorganize care. The ICA showed that the most frequent nursing activities :"Apply postures to facilitate breathing "(83%),"Prepare/provide appropriate foods in temperature/texture/quantity "(100%); "Providing aids for elimination needs" (80.7%); "Help in dressing" (82.7%); "Transfer from stretcher to bed" (83.4%); "Remaking bed/unit sick" (100%); "Monitoring of vital signs" (100%); "Health Education" (100%); "Nursing Assessment" (100%); "Management and treatment of intravascular devices" (100%); "Performing instrumental exams". Conclusion: Assess the most frequent nursing activities, allows: to better distribute activities among professionals, identify nurses' competencies and activities to be prescribed to health-care support workers.Keywords: nursing staff level, complexity of care, index of caring complexity, nursing workload, patient classification system, observational stud