The concept of care complexity: a qualitative study

Background: Hospital organisations based on the level of care intensity have clearly revealed a concept, that of care complexity, which has been widely used for decades in the healthcare field. Despite its wide use, this concept is still poorly defined and it is often confused with and replaced by similar concepts such as care intensity or workload. This study aims to describe the meaning of care complexity as perceived by nurses in their day-to-day experience of hospital clinical care, rehabilitation, home care, and organisation. Design and methods: Fifteen interviews were conducted with nurses belonging to clinical-care areas and to heterogeneous organisational areas. The interview was of an unstructured type. The participants were selected using a propositional methodology. Colaizzi’s descriptive phenomenological method was chosen for the analysis of the interviews. Results: The nurses who were interviewed predominantly perceive the definition of care complexity as coinciding with that of workload. Nevertheless, the managerial perspective does not appear to be exclusive, as from the in-depth interviews three fundamental themes emerge that are associated with the concept of care complexity: the patient, the nurse and the organisation. Conclusions: The study highlights that care complexity consists of both quantitative and qualitative aspects that do not refer only to the organisational dimension. The use of the terminology employed today should be reconsidered: it appears to be inappropriate to talk of measurement of care complexity, as this concept also consists of qualitative – thus not entirely quantifiable – aspects referring to the person being cared for. In this sense, reference should instead be made to the evaluation of care complexity, which would also constitute a better and more complete basis for defining the nursing skills required in professional nursing practice

Psychometric properties of the Jefferson Scale of Empathy-Health Professional Student's version: an Italian validation study with nursing students.

This methodological study was conducted to test the psychometric properties of the Jefferson Scale of Empathy - Health Professional Student's version (JSE-HPS). It used a convenience sample of 797 Italian nursing students and also aimed to describe their empathic engagement. Data were subjected to exploratory and confirmatory factor analysis, test-retest, correlation analysis, t-test, and analysis of variance method. Principal component factor extraction with Oblimin rotation on the first half of the sample was conducted. The analysis suggested a three-factor solution for 14 items: compassionate care/emotional engagement, perspective-taking, and standing in the patient's shoes. Confirmatory factor analysis on the second half of the sample showed good fit indexes for the 14-item solution, indicated by the exploratory factor analysis, and the 20 item solution of the scale, with the exception of one item. Test-retest correlation was 0.50 (P < -0.001) for the overall scale. Results from group comparisons and correlations are also provided and discussed. The Italian version of the JSE-HPS is a psychometrically sound tool. The translated 20-item solution is also suitable to carry out cross-cultural comparisons

Measuring nursing care workload in non-intensive cardiac surgery: an observational study

Background: An understanding of the time nurses spend assessing and meeting patients’ needs is key to improve nursing outcomes and support organizational well-being. Aims and objectives: The study was designed to determine whether the use of an assessment scale with some clinical parameters indicative of hemodynamic, neurological, respiratory and mobility functions could be able to estimate nursing care workload in non-intensive cardiac surgery patients. Methods: A correlational descriptive study was designed. Two types of inpatients were included in the study: those waiting for cardiac surgery and those who had already undergone cardiac surgery. Using specific indicators, patient’s clinical status was classified in 10 levels of complexity and nursing care interventions were divided into three categories: clinical activities, educational activities and organizational activities. For each of this categories the correlation coefficient between the nursing time and the level of patient’s complexity was measured. Results: Per hour of hospitalization, nurses spent an average of 11 minutes and 49 seconds providing care to each patient. A good correlation coefficient between the amount of the nursing time spent for clinical activities and the level of patient’s complexity was found. Educational activities were minimal compared with the clinical and organizational activities, but they were mostly conducted during the preoperative phase. Conclusions: The assessment scale tested in this study, including some information about the patient's clinical status, allowed to estimate clinical nursing workload in non-intensive cardiac surgery patients.Keywords: Nursing in cardiology setting; health status indicators; severity of illness index; nursing care complexity; non-intensive cardiac surgery unit. RIASSUNTO Background: la quantificazione del tempo impiegato dagli infermieri per valutare e trattare i bisogni dei pazienti rappresenta un fattore chiave per migliorare gli esiti assistenziali e favorire il benessere organizzativo delle strutture sanitarie. Obiettivi: lo studio è stato eseguito per verificare se l'uso di una scala di indicatori della funzione emodinamica, neurologica, respiratoria e motoria, possa consentire di stimare il carico di lavoro infermieristico richiesto dai pazienti cardiochirurgici ricoverati nelle unità di degenza non intensive. Metodi: per lo scopo del lavoro è stato disegnato uno studio descrittivo-correlazionale. Sono stati osservati pazienti in fase preoperatoria e postoperatoria. Utilizzando una scala di indicatori specifici, lo stato clinico del paziente è stato suddiviso in 10 livelli di complessità assistenziale; mentre le attività infermieristiche sono state classificate in 3 categorie: cliniche, educative e gestionali. Per ognuna di queste categorie è stato misurato il coefficiente di correlazione tra il tempo assistenziale erogato ed il livello di complessità rilevato. Risultati: per ogni ora di ricovero gli infermieri hanno erogato mediamente a ciascun paziente 11 minuti e 49 secondi di assistenza. Il tempo impiegato in attività assistenziali cliniche è risultato correlato al livello di complessità rilevato. Le attività educative sono risultate prevalenti nella fase preoperatoria, ma il tempo ad esse dedicato è risultato minimo rispetto a quello impiegato in attività cliniche e gestionali. Conclusioni: la scala di indicatori clinici testata ha consentito di stimare il carico di lavoro infermieristico di tipo clinico richiesto dai pazienti cardiochirurgici ricoverati nelle unità di degenza non intensive.Parole chiave: infermieristica in cardiologia, indicatori clinici, indice di gravità della malattia, complessità infermieristica, unità di cardiochirurgia non intensiv

Measuring nursing care workload in non-intensive cardiac surgery: an observational study

Background: An understanding of the time nurses spend assessing and meeting patients' needs is key to improve nursing outcomes and support organizational well-being. Aims and objectives: The study was designed to determine whether the use of an assessment scale with some clinical parameters indicative of hemodynamic, neurological, respiratory and mobility functions could be able to estimate nursing care workload in non-intensive cardiac surgery patients. Methods: A correlational descriptive study was designed. Two types of inpatients were included in the study: those waiting for cardiac surgery and those who had already undergone cardiac surgery. Using specific indicators, patient's clinical status was classified in 10 levels of complexity and nursing care interventions were divided into three categories: clinical activities, educational activities and organizational activities. For each of this categories the correlation coefficient between the nursing time and the level of patient's complexity was measured. Results: Per hour of hospitalization, nurses spent an average of 11 minutes and 49 seconds providing care to each patient. A good correlation coefficient between the amount of the nursing time spent for clinical activities and the level of patient's complexity was found. Educational activities were minimal compared with the clinical and organizational activities, but they were mostly conducted during the preoperative phase. Conclusions: The assessment scale tested in this study, including some information about the patient's clinical status, allowed to estimate clinical nursing workload in non-intensive cardiac surgery patients.Keywords:"ˆNursing in cardiology setting; health status indicators; severity of illness index; nursing care complexity; non-intensive cardiac surgery unit. RIASSUNTO Background: la quantificazione del tempo impiegato dagli infermieri per valutare e trattare i bisogni dei pazienti rappresenta un fattore chiave per migliorare gli esiti assistenziali e favorire il benessere organizzativo delle strutture sanitarie. Obiettivi: lo studio è stato eseguito per verificare se l'uso di una scala di indicatori della funzione emodinamica, neurologica, respiratoria e motoria, possa consentire di stimare il carico di lavoro infermieristico richiesto dai pazienti cardiochirurgici ricoverati nelle unití  di degenza non intensive. Metodi: per lo scopo del lavoro è stato disegnato uno studio descrittivo-correlazionale. Sono stati osservati pazienti in fase preoperatoria e postoperatoria. Utilizzando una scala di indicatori specifici, lo stato clinico del paziente è stato suddiviso in 10 livelli di complessití  assistenziale; mentre le attivití  infermieristiche sono state classificate in 3 categorie: cliniche, educative e gestionali. Per ognuna di queste categorie è stato misurato il coefficiente di correlazione tra il tempo assistenziale erogato ed il livello di complessití  rilevato. Risultati: per ogni ora di ricovero gli infermieri hanno erogato mediamente a ciascun paziente 11 minuti e 49 secondi di assistenza. Il tempo impiegato in attivití  assistenziali cliniche è risultato correlato al livello di complessití  rilevato. Le attivití  educative sono risultate prevalenti nella fase preoperatoria, ma il tempo ad esse dedicato è risultato minimo rispetto a quello impiegato in attivití  cliniche e gestionali. Conclusioni: la scala di indicatori clinici testata ha consentito di stimare il carico di lavoro infermieristico di tipo clinico richiesto dai pazienti cardiochirurgici ricoverati nelle unití  di degenza non intensive.Parole chiave: infermieristica in cardiologia, indicatori clinici, indice di gravití  della malattia, complessití  infermieristica, unití  di cardiochirurgia non intensiv

Unsupervised inference approach to facial attractiveness

The perception of facial beauty is a complex phenomenon depending on many, detailed and global facial features influencing each other. In the machine learning community this problem is typically tackled as a problem of supervised inference. However, it has been conjectured that this approach does not capture the complexity of the phenomenon. A recent original experiment (Ib\'a\~nez-Berganza et al., Scientific Reports 9, 8364, 2019) allowed different human subjects to navigate the face-space and ``sculpt'' their preferred modification of a reference facial portrait. Here we present an unsupervised inference study of the set of sculpted facial vectors in that experiment. We first infer minimal, interpretable, and faithful probabilistic models (through Maximum Entropy and artificial neural networks) of the preferred facial variations, that capture the origin of the observed inter-subject diversity in the sculpted faces. The application of such generative models to the supervised classification of the gender of the sculpting subjects, reveals an astonishingly high prediction accuracy. This result suggests that much relevant information regarding the subjects may influence (and be elicited from) her/his facial preference criteria, in agreement with the multiple motive theory of attractiveness proposed in previous works.Comment: main article (10 pages, 4 figures) + supplementary information (22 pages, 10 figures). minor typos corrected. Federico Maggiore added as autho

Empathy Levels in Albanian Health Professional Students: An Explorative Analysis Using the Jefferson Scale of Empathy:

The study aims were to define the psychometric properties of the Albanian Jefferson Scale of Empathy–Health Professional Students' version, compare empathy levels among Albanian Health Professional students, and explore any relationship among students' characteristics and their empathy levels. To achieve these aims, a comparative cross-sectional study was conducted. A preliminary exploratory factor analysis was conducted to determine the factor structure of the scale, while group comparisons of empathy scores were examined using t-test and ANOVA F-test. A total of 1,240 students were enrolled in the study. Psychometric properties of the scale were confirmed. Midwifery, physiotherapy, and female students showed higher levels of empathy than other groups. Similarly, third-year students showed higher empathy than first- and second-year students. Monitoring empathy levels is fundamental to the adoption of useful educational strategies by faculties to improve empathy skills in Health Professional students and guarantee better care of patients, especially those in need of psychological support

Progressive Patient Care e organizzazione ospedaliera per intensití di cure: revisione narrativa della letteratura

Scopo del presente articolo è riassumere la letteratura relativa alla Progressive Patient Care con particolare attenzione alle sue caratteristiche concettuali e pratiche, all'implementazione nel corso degli anni e agli effetti che ha avuto sugli attuali sistemi di erogazione della salute.E' stata condotta una Revisione integrativa-narrativa della letteratura.La Progressive Patient Care è un modello che ha la finalití  di raggruppare i pazienti secondo il grado di complessití  che essi presentano. Tale organizzazione è finalizzata alla collocazione del paziente nel setting di cura più appropriato. Il modello originale prevede cinque livelli di unití  assistenziali: intensive care, intermediate care, self-care, long term care, organized home care. In Italia il modello di organizzazione ospedaliera per intensití  di cura può essere considerato come una contestualizzazione della Progressive Patient Care alla realtí  nazionale, date le similitudini sia dal punto di vista delle finalití  che il modello si pone, sia per la tipologia di livelli di assistenziali.La riorganizzazione per intensití  di cure rappresenta un'opportunití  per l'Italia di operare nella direzione di un'assistenza che si basi sul concetto di continuití  di cure, dal momento che si pone l'accento sui processi di cura e di assistenza a partire dai bisogni dei pazienti, piuttosto che sulla  suddivisione ospedaliera secondo criteri di specialití  disciplinare.Parole chiave: Cure progressive, Italia, Continuití  delle cure, Assistenza centrata sul paziente Progressive Patient Care Model and its application into hospital organization: a narrative review ABSTRACTAim of this article is to review the literature about the Progressive Patient Care Model, in particular its conceptual and practical characteristics, its implementation and effects on the current health care organization. Was conducted by an integrative-narrative literature review.The Progressive Patient Care is a model which aims at group patients according to their complexity in order to place patients in the most appropriate care setting.The original model consists on five care levels: intensive care, intermediate care, self-care, long term care, home care.In Italy the above mentioned model can be considered as a contextualization of Progressive Patient Care in the light of similarities both in terms of model purposes and care levels classification.The organization for intensive care levels is an opportunity for Italian healthcare facilities to reach continuity of care. This model emphazises care processes looking to patients' needs rather than a division according to criteria of specialties.Keywords: Progressive Patient Care, Italy, Continuity of Patient Care, Patient Centered Car

Need for ethics support in clinical practice and suggestion for an Ethics Consultation Service: views of Nurses and Physicians working in Italian Healthcare Institutions

Introduction. Ethics Consultation Services (ECS) and Ethical Committees manage several aspects of clinical ethical issues. In Italy there are only Ethical Committees, and, although they should also perform ethical consultations, their activity is limited to approving clinical trial protocols. Aim. To analyse the opinions of a sample of Nurses and Physicians about their motivations to ask for an ethical consultation. Methods. A cross-sectional study was conducted on a sample of Italian Nurses and Physicians. Results. Respondents would request ethical consultations mainly for end-of-life issues and, secondarily, for conflicts with patients’ families. Respondents identified the provision of suggestions for hospital policy, the development of ethical guidelines, and the counselling for individual cases requested by clinicians, patients or families as the most important functions of ECS. Conclusions. ECS activities should focus on counselling and support to decisions in complex ethical situations according to institutional policies and guidelines self-developed.

Protocol for evaluating quality and safety for the public through home care nursing in Italy: a multicentre cross-sectional descriptive observational study (AIDOMUS-IT)

introduction: considering the increasing complexity of care and workload for home care nurses due to the ageing of the population, it is crucial to describe the work environment and the community care setting. the aim of this study protocol is to map the characteristics and identify gaps of home care in the community to design future interventions aimed at ensuring quality and safety. methods and analysis: this is a national cross-sectional descriptive observational study using the survey method. nurses from all participating community care centres will be recruited through convenience sampling by the coordinators of each centre, who will act as facilitators for this study. all community care recipients and their informal carers during the study period will be invited to complete a survey.to map the characteristics and identify gaps of home care in the community, three sources of data will be collected: (1) organisational characteristics, professional satisfaction, intention to leave and burn-out; (2) experience of care recipients and their informal carers and (3) improper access to the emergency department, readmission to hospital, comorbidities, services offered and users' level of autonomy, and main and secondary diagnoses.considering the total italian nursing population of approximately 450 000 registered nurses, a sample size of 1% of this population, equal to approximately 4600 nurses, was hypothesised.This study started in July 2022 and is planned to end in december 2023.data will be analysed using descriptive and inferential statistics. ethics and dissemination: this study protocol was approved by the liguria regional ethics committee in november 2022. informed consent will be obtained from participants and confidentiality will be ensured. data collected for this study will be kept anonymised in a protected database.the results of the study will be disseminated mainly through conferences, publications and meetings with government representatives

L'immagine dell'infermiere in Italia dall'analisi dell'archivio storico di un quotidiano nazionale

RiassuntoScopo. Descrivere l'immagine dell'infermiere delineata da uno dei principali quotidiani nazionali. Metodo. Studio retrospettivo condotto attraverso l'analisi degli articoli pubblicati nel periodo compreso tra il 1906 e il 2005 sul quotidiano nazionale "La Stampa". Risultati.Dall'analisi dei 2017 articoli sono emerse 11 categorie tematiche. Gli articoli a maggior occorrenza sono stati quelli relativi alla tematica "cronaca", che hanno registrato un importante incremento a partire dalla seconda metí  degli anni '80, seguiti da "condizioni di lavoro", che hanno mostrato massima diffusione a partire dagli anni '90. Gli articoli a minore occorrenza, invece, sono stati quelli riguardanti "estetica" e "concorsi". Oltre la metí  degli articoli inerenti la "carenza infermieristica" riferivano di disservizi da essa provocati. La quasi totalití  degli articoli relativi a casi di "malasanití " evidenziava l'inadeguata assistenza erogata dagli infermieri con un trend di pubblicazione omogeneo a partire dagli anni '50. Gli articoli categorizzati nella tematica "carenza infermieristica", "innovazione", e "formazione", hanno avuto la loro massima diffusione a partire dagli anni '90. Conclusioni. L'analisi condotta attraverso gli articoli apparsi sul quotidiano "La Stampa" ha consentito di leggere la storia della professione infermieristica come travagliata, fatta di conquiste professionali ottenute con lotte, rivendicazioni e innumerevoli cambiamenti, sia di tipo organizzativo che in ambito formativo, anche se gli articoli esaminati non sempre hanno contribuito a far apprezzare la professione per i suoi reali contenuti e contributi forniti al miglioramento della salute nella popolazione.Parole chiave: immagine infermieristica, quotidiani, infermieri, studio retrospettivo AbstractPurpose. The main aim is to describe the nursing profession image as it appears in one of the main national newspaper. Method. A retrospective study has been conducted through the analysis of 2017 articles published between 1906 and 2005 on the national newspaper "La Stampa". Results. 11 thematic clusters emerged from the analysis. The articles published with a higher frequency were those concerning "news and chronicle", with a relevant increase after the second half of the '80s, followed by "working conditions" with a maximum spread during the '90s. Instead the articles that rarely appeared on the newspaper were those concerning, "aesthetic" and "contests". More than half of the articles concerning "staff shortage" reported consequent disruptions. Almost all the articles concerning "malpractice" highlighted the inadequate care delivered from nurses and they have been published with constant trend starting from the a '50s. The articles concerning "staff shortage", "innovation", and "education", showed their maximum spread starting from the '90s. Conclusions. The analysis of the articles published in the newspaper "La Stampa" allowed to read the nursing profession story as troubled, made of professional achievements obtained from struggles, claims and countless educational and organizational changes though many of the analyzed articles did not contributed to show, and consequently to appreciate, the nursing profession for its real content and contributions to the population's health.Keywords: nursing image, newspaper, articles, nurses, retrospective stud