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

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

Exploring the lived experiences of pregnancy and early motherhood in Italian women with congenital heart disease: an interpretative phenomenological analysis

Objective This study explored the lived experiences of women with congenital heart disease (CHD) during pregnancy and early motherhood. Design Qualitative study using semistructured interviews. Data were analysed according to interpretative phenomenological analysis. Setting San Donato Milanese, Italy. Participants 12 adult women during pregnancy or early motherhood. Results Three main themes emerged from the analysis that were labelled as follows: ‘Being a woman with CHD’; ‘Being a mother with CHD’; and ‘Don’t be alone’. Mothers described both positive and negative feelings about their pregnancies and transitions from childless women to mothers with CHD. They needed supportive care to improve the management of their health during pregnancy and early motherhood. Conclusion This study explored the lived experiences of women with CHD during pregnancy and early motherhood. The emerged themes represent an initial framework for implementing theory-grounded educational and supportive strategies that improve self-care, engagement and quality of life for women with CHD. Furthermore, the study’s results provide guidance for operationalising the described experiences into items and domains for future cross-national surveys

Patient Engagement in Oncology Practice: A Qualitative Study on Patients’ and Nurses’ Perspectives

Patient engagement has gained increasing attention in cancer care as it is widely acknowledged as an essential element of high-quality care. There are limited data on how oncology nurses might apply techniques that encourage patient engagement. Therefore, this study aims to understand which nursing strategies can favour patient engagement in oncological care from patients’ and nurses’ perspectives. We conducted a qualitative study involving oncology patients and oncology nurses. Patients were interviewed, while nurses were involved in focus groups (FGs). Both interviews and FGs were analysed by the means of thematic analysis. We interviewed six patients and conducted two FGs, involving 17 nurses. Five themes were identified from patients’ interviews: effective information, having the opportunity to choose, being considered a person, trusted relationship with nurses, and receiving support and advice. Additionally, five themes were identified from the FGs: the nurse–patient relationship, personalisation of care, information style, engagement strategies, and the team. The participants highlighted the importance of comprehensive information in order for patients to feel more involved. Great importance was given to the nurse–patient relationship, which must be based on trust and mutual respect. Both nurses and patients emphasised the importance of person-centred care. A more systematic implementation of suggestions from the participants in this study is desirable for the future

Studio con metodo misto sequenziale sulle barriere che ostacolano l'implemen tazione di un nuovo modello organizzativo patient centred care: la prospettiva infermieristica

Introduzione: L'implementazione dei modelli patient centred care può essere minata dalla percezione intra-professionale di barriere che non sempre vengono riconosciute. Infatti, in letteratura sono molto scarse le descrizioni di tali barriere. Per questo motivo, l'obiettivo principale di questo studio è indagare nel contesto italiano le barriere che ostacolano l'implementazione di un nuovo modello organizzativo patient centred care (Synergy Model), secondo la prospettiva intra-professionale infermieristica.Metodo: Lo studio segue un disegno con metodo misto sequenziale. La prima fase ha un disegno qualitativo e la seconda fase un disegno quantitativo, osservazionale e trasversale e mono-centrico (unico ospedale nord Italia). Nella fase qualitativa sono stati coinvolti 9 infermieri, mentre nella fase quantitativa 117 infermieri.Risultati: Sono state condotte 9 interviste nella prima fase. I 3 temi principali, risultati dall'analisi tematica sono: (a) lavoro improprio, (b) in¬concludenza attivití  lavorative e (c) scarso valore aggiunto. Nella seconda fase, 117 infermieri hanno risposto ad un questionario creato ad hoc (21 item). Il questionario risulta avere una buona validití  di facciata e di contenuto. Tramite l'analisi fattoriale esplorativa (EFA) sono stati identificati i seguenti domini: (a) organizzazione lavorativa (X=3,21±0,64), (b) competenza infermieristica (X=3,14±0,30), (c) crescita professionale (X=3,48±0,74), che descrivono le barriere percepite dal personale infermieristico all'implementazione di modelli assistenziali patient centred care.Le barriere indagate dovranno esser prese in considerazione per pianificare interventi formativi ed organizzativi. La creazione del questionario e la sua validití  saranno utili per avere nel tempo la misurazione di tali barriere. La presa di coscienza di queste barriere rientra nella logica di creare una cultura organizzativa in salute, sensibile alla personalizzazione delle cure.Parole Chiave: Metodo misto; Modelli assistenziali; Nursing; Personalizzazione dell'assistenza abstractMixed method sequential study on the barriers underpinning a new patient centred care model implementation: the nurses' perspectivesIntroduction: The patient centred care models implementation could be undermined by the intra-professional perception of barriers. Moreover, the literature has paid little attention in describing those one. For this reason, the aim of this study is to describe the main barriers underpinning the implementation of patient centred care models.Method: This study follows the Mixed-Methods Sequential Explanatory method. Phase one has a qualitative design. Phase two has a quantitative, observational, cross-sectional and mono-centric design. The phase 1 involved nine nurses, while 117 nurses were enrolled for the phase 2.Results: Nine interviews were conducted in phase one. Three main themes were carried out by the thematic analysis: (a) improper work, (b) inconclusiveness of working activities, (c) poor added value. In phase two, 117 nurses answered to a questionnaire created ad hoc (21 items). The questionnaire showed good face and content validity. The Exploratory Factorial Analysis (EFA) showed three dimensions: (a) working organization (X=3,21±0,64), (b) nursing competence (X=3,14±0,30), and (c) professional improvement (X=3,48±0,74), which described the nurses' perceived barriers to implement a new patient centred model.Conclusion: The described barriers should be considered to design educational and organizational interventions. The development and the validity of the questionnaire used in this study will be useful to measure those barriers over the time. The awareness related to those barriers is in line with the purpose of enhancing the overall organizational health, particularly focused on personalization of care delivery. Key words: Mixed methods; Nursing Models; Nursing; Patient-Centered Car

Italian Validation of the Healthcare Needs Scale for Youth with Congenital Heart Disease and Its Short-Form Development

Aims: This study aimed at providing an Italian short version of the 'healthcare needs scale for youth with congenital heart disease' (I-HNS-CHD-s), describing its construct validity and reliability. Methods: A multi-method and multi-phase design were adopted. Phase one referred to the cultural-linguistic validation of the original scale into Italian Phase two tasted content and face validity of the Italian-translated scale. Phase three included the psychometric validation process of scale, encompassed two different steps: first cross-sectional data collection (sample A) purposed at determining the psychometric characteristics of the I-HNS-CHD-s, using an exploratory factor analysis (EFA). Then, a second round of cross-sectional data collection (sample B) was performed using the version of I-HNS-CHD-s derived from the previous step, and it purposed at confirming the scale factor structure and at assessing its reliability. Results: IHNS-CHD-s showed evidence of face and content validity, adequate construct and internal consistency and stability. Specifically, I-HNS-CHD-s had 14 items kept by four domains, labelled as follows: Healthcare education, clinical support, emotional support, continuum of care. These domains were predicted by a secondorder factor, which was labelled as Healthcare needs. Overall I-HNS-CHD-s encompassed only the items that showed high performance in the psychometric analysis. Accordingly, I-HNS-CHD-s is a shorter form of the original scale (14 items instead of 25). Conclusions: I-HNS-CHD-s is a psychometrically robust measure of the healthcare and psychosocial needs of Italian adolescents and young adults with congenital heart disease

Burnout syndrome and its determinants among healthcare workers during the first wave of the Covid-19 outbreak in Italy: a cross-sectional study to identify sex-related differences

Introduction: Several studies described burnout levels of healthcare workers (HCWs) during the COVID-19 pandemic; however, sex-related differences remain poorly investigated. Objective: To describe sex-related differences in burnout and its determinants among HCWs during the first pandemic wave of the COVID-19 in Italy. Methods: A cross-sectional study was performed between April and May 2020. The framework given by the Job Demands Resources (JD-R) model was used to assess burnout determinants (risk and protective factors). Results: Male HCWs (n=133) had higher levels of depersonalization than female HCWs (P=0,017) and female HCWs (n=399) reported greater emotional exhaustion rates (P=0,005). Female nurses were the most exposed to burnout (OR=2,47; 95%CI=1,33-4,60; P=0,004), emotional exhaustion (OR=1,89; 95% CI=1,03-3,48; P=0,041), and depersonalization (OR=1,91; 95% CI=1,03-3,53; P=0,039). Determinants of burnout differed between sexes, and some paradoxical associations were detected: the score of job demands was a protective factor in females for burnout, emotional exhaustion, and depersonalization, resilience was a risk factor for males. Conclusions: This study reveals that the stressors in male and female HCWs tended to be associated with burnout differently. Both sexes showed alarming burnout levels, even if the weights of emotional exhaustion and depersonalization acted in different ways between the sexes. The revealed paradoxical effects in this study could reflect the study's cross-sectional nature, highlighting that more resilient and empathic individuals were more consciously overwhelmed by the challenges related to the COVID-19 pandemic, thus reporting higher scores of emotional exhaustion and burnout. Future in-depth and longitudinal analyses are recommended to further explore sex-related differences in burnout among HCWs

Factors associated with emotional exhaustion in healthcare professionals involved in the COVID-19 pandemic: an application of the job demands-resources model

Purpose The purpose of the present cross-sectional study is to investigate the role of perceived COVID-19-related organi- zational demands and threats in predicting emotional exhaustion, and the role of organizational support in reducing the negative influence of perceived COVID-19 work-related stressors on burnout. Moreover, the present study aims to add to the understanding of the role of personal resources in the Job Demands-Resources model (JD-R) by examining whether personal resources\u2014such as the professionals\u2019 orientation towards patient engagement\u2014may also strengthen the impact of job resources and mitigate the impact of job demands. Methods This cross-sectional study involved 532 healthcare professionals working during the COVID-19 pandemic in Italy. It adopted the Job-Demands-Resource Model to study the determinants of professional\u2019s burnout. An integrative model describing how increasing job demands experienced by this specific population are related to burnout and in particular to emotional exhaustion symptoms was developed. Results The results of the logistic regression models provided strong support for the proposed model, as both Job Demands and Resources are significant predictors (OR = 2.359 and 0.563 respectively, with p < 0.001). Moreover, healthcare profes- sionals\u2019 orientation towards patient engagement appears as a significant moderator of this relationship, as it reduces Demands\u2019 effect (OR = 1.188) and increases Resources\u2019 effect (OR = 0.501). Conclusions These findings integrate previous findings on the JD-R Model and suggest the relevance of personal resources and of relational factors in affecting professionals\u2019 experience of burnout