The portfolio as a tool of professional development in Intensive Care

The portfolio is \u201ca strictly personal tool aimed to promote a wider awareness of one\u2019s own skills, potential and aspirations, in order to develop a personal, social and professional project for life\u201d (Pellerey 2004). The portfolio is acknowledged as essential also for the nurse as it enables them to define their individual professional abilities and to promote their professional development. It allows, in particular, a skill-evaluation, encouraging the ability to think, to analyze and trace back one\u2019s own skills, as well as the ability to plan and organize. In the professional worker it can develop the awareness of his/her resources dealing with the working context, it can display the educational needs, orientate towards lifelong learning, and it helps self-education.The analysis of the data showed that the portfolio is a useful tool, that filling it in encourages the reflection upon one\u2019s own professional experience, the self-evaluation of one\u2019s own skills, it allows to observe step by step the abilities gained and to foresee their development. The portfolio makes the nurse aware of his/her professional path and it allows to plan the one to undertake, through reflection. This is particularly perceived by expert nurses. The novices actually state that the portfolio is a useful tool especially to single out the abilities learnt in the training. Both novices and experts agree in saying that the portfolio helps fostering the culture of educational needs definition, it orientates towards self-education and lifelong learning. Filling in this form has shown some negative aspects, as it is perceived as a laborious process that makes one live again some emotionally demanding experiences, anyway these difficulties didn\u2019t stop the nurses from filling it in. Considering the difficulties the participants found filling in the portfolio, it would be advisable to use some \u201cguidelines\u201d that would make it easier, as suggested by many authors (McCready 2007). The findings of this experimental study, even if limited by the low number of participants, foresee its systematic use in Intensive Care

Survival rate, prognostic factors and economical aspects in patients with intestinal failure

Background.Intestinalfailure impairs nutritional status and survival expectance. Though intestinal adaptation and enteral independence may be achieved, artificial nutrition is needed in about half of the patients. Aims. This study is aimed at assessing the causes of death, survivalrate, enteral independence in time, and factors affecting the clinical outcome in a group of patients with intestinal insufficiency. Patients. Sixty-eight patients with intestinal insufficiency, due to major intestinal resection in 60 cases (short bowel syndrome) (remnant intestine length 101\u2013150 cm in 31 cases, 50\u2013100 cm in 23 cases, <50 cm in 6 cases), and due to chronic idiopathic pseudo-obstruction in 8 cases, were enrolled and followed-up for (median) 36 months (25th and 75th percentile in 12 and 60 months, respectively). In 60 short bowel syndrome patients, the main conditions that led to intestinalfailure were ischemic bowel (28), major surgery complications or severe adhesions (17), radiation enteritis (10), Chron\u2019s disease, intestinal tuberculosis, small bowel lymphoma and trauma (others). Methods. Seventeen variables age, underlying disorders, length of remnant bowel, type of surgery, hospital stay, type of nutrition (hospital and home) and its variations in time, causes of death, survivalrate and time were considered. Statistical analysis was carried out by Mann\u2013Whitney U-test, Pearson \u3c72, Spearman correlation test, Kaplan\u2013Meyer method and Cox\u2019s proportion hazards regression model. Results. At the time of admission to the hospital, none of the patients had nutritional independence, 54 (79.4%) were on parenteral nutrition and 14 (20.6%) were on enteral nutrition. At the time of discharge, 23 (33.8%) patients showed enteral independence, 39 were on home parenteral nutrition, 3 on enteral nutrition + i.v. feeding, 1 on enteral nutrition, and 2 needed oral supplementation with hydroelectrolyte solutions only. After a median value of 36 months, 30 and 2 patients were on home parenteral nutrition and enteral nutrition + i.v. feeding, respectively, 2 on enteral nutrition, 2 on oral supplementation with hydroelectrolyte solutions, and 26 cases reached enteral independence. A significant relationship was detected between the length of remnant bowel and types of nutrition at both admission (r=0.38; P=0.001) and discharge (r=0.48; P=0.001), parenteral nutrition being more frequent in patients with very short bowel. Twenty-two patients (32.4%) died (4 from newly occurring malignancies), 40 (58.8%) survived, and 6 (8.8%) were lost to the follow-up. Eleven of 22 patients died from conditions related to intestinalfailure (8 cases) and/or home parenteral nutrition complications (3 cases). At 12, 24, 36, 48, 60 and 72 months, survivalrates were 95.4, 93.3, 88.1, 78.6, 78.6 and 65.5%, respectively, but it was significantly lower for patients with <50 cm of remnant bowel than those with longer residual intestine (P<0.05), and in patients who started home parenteral nutrition above the age of 45 years (P<0.02). Survivalrate was higher in patients with enteral independence than those with enteral dependence (P<0.05). Better survivalrates were registered in patients with chronic obstructive intestinal pseudo-obstruction and major surgery complications, whereas ischemic bowel and even more radiation enteritis were associated with a lower survival expectance. Conclusions. Actuarial survivalrate of patients with intestinalfailure quotes 88 and 78% at 3 and 5 years, respectively. It is influenced by the length of remnant intestine, age at the start of home parenteral nutrition, enteral independence and, to some extent at least, by the primary disorder. Enteral independence can be achieved in time by about 40% of the patients with intestinal insufficiency, but for home parenteral nutrition-dependent cases, intravenous feeding can be stopped in less than one out of five patients during a median 3-year period

Nursing student plans for the future after graduation: a multicentre study

Background: When modelling the nursing workforce, estimations of the numbers and characteristics of new graduates over the forecast period are assumed on the basis of previous generations; however, new graduates may have different plans for their future than those documented previously in different socio-economical contexts. Aims: To explore (a) nursing student plans after graduation and factors influencing their plans, and (b) factors associated with the intention to emigrate. Methods: A survey questionnaire was developed and distributed to students attending their final third year of nursing education in seven universities in Italy in 2015. Nine hundred and twenty-three (90.4%) students participated. Findings: Four different plans after graduation emerged: about two-thirds reported an intention to look for a nursing job in Italy; the remaining reported (a) an intention to emigrate, looking for a nursing job abroad, (b) an intention to search for a nursing job in both Italy and abroad, and (c) while a few an intention to continue nursing education in Italy. Having previous experience abroad, the need to grow and be satisfied, trusting the target country and a desire to increase knowledge encouraged an intention to emigrate, whereas the desire to stay in a comfortable environment and nurture personal relationships prevented the desire to migrate. Conclusion: Nursing students may have different plans after graduation, and this should be considered when modelling the nursing workforce of the future. Implications for nursing/health policy: Policymakers should be aware of different plans after graduation to guide healthcare human resource strategies. Knowing these trajectories allows policymakers to estimate the appropriate nursing workforce, and also to act at both macro- and meso-levels, on work environments and opportunities for professional development, according to the different levels of expectations

Raccomandazioni e standard italiani per dotazioni infermieristiche ospedaliere sicure: esiti di una consensus conference

Nurse staffing levels have always heea an issue and the optimal level and mix of nurses required to deliver quality care as cost-effectively as possible continues to be discussed at both national and international levels. In Italy, a network of experts rom ten local health and hospital authorities was set up in June 2010. The, main objectives of the network were to define, validate and approve a panel of relevant indicators, identity minimum standards of safety and develop recommendation to guide decision-making regarding hospital nurse staffing levels. The indicators and recommendation developed by the network are presented in this paper

Raccomandazioni e standard italiani per dotazioni infermieristiche ospedaliere sicure: esiti di una consensus conference

I livelli di dotazione organica sono da sempre un problema rilevante e quali siano gli standard e lo skill mix ottimali per fornire un'assistenza costo-efficace è ampiamente discusso sia a livello nazionale che internazionale. In Italia, nel giugnop 2010 è stato creato un network, costituito da 10 strutture ospedaliere pubbliche e private e da 3 università del nord-centro Italia. L'obiettivo principale era quello di definire, validare e approvare una serie di indicatori e identificare gli standard minimi di dotazione del personale e di skill mix per garantire un'assistenza efficace

Nursing care as a predictor of phlebitis as related to insertion of a peripheral venous cannula in emergency departments: findings from a prospective study

18Background: To date, few studies have investigated the occurrence of phlebitis related to insertion of a peripheral venous cannula (PVC) in an emergency department (ED). Aim: To describe the natural history of ED-inserted PVC site use; the occurrence and severity of PVC-related phlebitis; and associations with patient, PVC and nursing care factors. Methods: A prospective study was undertaken of 1262 patients treated as urgent cases in EDs who remained in a medical unit for at least 24. h. The first PVC inserted was observed daily until its removal; phlebitis was measured using the Visual Infusion Phlebitis Scale. Data on patient, PVC, nursing care and organizational variables were collected, and a time-to-event analysis was performed. Findings: The prevalence of PVC-related phlebitis was 31%. The cumulative incidence (78/391) was almost 20% three days after insertion, and reached >50% (231/391) five days after insertion. Being in a specialized hospital [hazard ratio (HR) 0.583, 95% confidence interval (CI) 0.366-0.928] and receiving more nursing care (HR 0.988, 95% CI 0.983-0.993) were protective against PVC-related phlebitis at all time points. Missed nursing care increased the incidence of PVC-related phlebitis by approximately 4% (HR 1.038, 95% CI 1.001-1.077). Conclusions: Missed nursing care and expertise of the nurses caring for the patient after PVC insertion affected the incidence of phlebitis; receiving more nursing care and being in a specialized hospital were associated with lower risk of PVC-related phlebitis. These are modifiable risk factors of phlebitis, suggesting areas for intervention at both hospital and unit level.reservedmixedPalese A; Ambrosi E; Fabris F; Guarnier A; Barelli P; Zambiasi P; Allegrini E; Bazoli L; Casson P; Marin M; Padovan M; Picogna P; Taddia P; Salmaso S; Chiari C; Marognolli O; Canzan F; Saiani LPalese, A; Ambrosi, E; Fabris, F; Guarnier, A; Barelli, P; Zambiasi, P; Allegrini, E; Bazoli, L; Casson, P; Marin, M; Padovan, M; Picogna, P; Taddia, P; Salmaso, S; Chiari, C; Marognolli, O; Canzan, F; Saiani,

Prevalence and incidence density of unavoidable pressure ulcers in elderly patients admitted to medical units

To describe the prevalence and incidence density of hospital-acquired unavoidable pressure sores among patients aged 6565 years admitted to acute medical units. A secondary analysis of longitudinal study data collected in 2012 and 2013 from 12 acute medical units located in 12 Italian hospitals was performed. Unavoidable pressure ulcers were defined as those that occurred in haemodynamically unstable patients, suffering from cachexia and/or terminally ill and were acquired after hospital admission. Data at patient and at pressure ulcer levels were collected on a daily basis at the bedside by trained researchers. A total of 1464 patients out of 2080 eligible (70.4%) were included. Among these, 96 patients (6.5%) hospital-acquired a pressure ulcer and, among 19 (19.7%) were judged as unavoidable. The incidence of unavoidable pressure ulcer was 8.5/100 in hospital-patient days. No statistically significant differences at patient and pressure ulcers levels have emerged between those patients that acquired unavoidable and avoidable pressure sores. Although limited, evidence on unavoidable pressure ulcer is increasing. More research in the field is recommended to support clinicians, managers and policymakers in the several implications of unavoidable pressure ulcers both at the patient and at the system level