Staffing e skill-mix del personale di assistenza: qualit\ue0 delle cure e benessere organizzativo in ospedali per acuti italiani

Background Several studies have measured the impact of nursing skill mix and nursing staffing levels on clinical, organizational and economic outcomes but the heterogeneity in approaches to measuring skill-mix variable leads to a lack of consistent evidence (Griffiths et al., 2014). The impact of skill mix on hard outcomes such as mortality has been studied and addressed in scientific literature (Aiken et al., 2017, Blegen et al., 2011, Needleman et al., 2011, Sales et al., 2008, Sochalski et al., 2008) but in Italy no studies were conducted analyzing these relationships. There is a lot of interest in understanding how the mixture of professions may influence clinical and process outcomes and if one staff group could be substituted by another one to achieve cost-effectiveness results. The scoping review conducted for this thesis, as a background of the RN4CAST@IT results, reported that the evidence is consistent in pointing to the benefit of increasing skill mix either through increasing the absolute or relative number of registered nurses in a nursing team that includes registered nurses, lower grades of nursing staff and assistants. Methods We have conducted a large multisite observational cross-sectional study (called RN4CAST@IT) in thirteen regions in Italy, in 2015. A three-levels survey (patient, nurse and organizational level) was performed through paper-based and electronic tools; for this thesis we have analyzed the relationships between nursing staffing levels, skill mix and some of the most important clinical and organizational nursing sensitive outcomes from the nurse-level database using the statistic software \u201cR\u201d. Finally, the relationship between mortality and nursing skill mix was investigated using organizational data. Results Relevant outcomes have significant relationships with nursing staffing levels and nursing skill mixes. For example: nurses in RNstaff2 and RNstaff3 have a risk of declaring its Intention to Leave of 20% and 50%; nurses in RNstaff2 and RNstaff3 have a risk of declaring a condition of poor/fair quality of nursing care of 40% and 70%, respectively, higher than those in situations of RNstaff1. Relationships between nursing skill mix and mortality were studied through 235.007 records of two Italian regions discharged data. In structures with an average skill mix between 0.60 and 0.62 Therefore in hospitalizations with a hospital stay of more than 6 days, the increase in skill mix determines a significant reduction (-34%) in mortality compared to structures that have an average skill mix between 0.55 and 0.59. Discussion and Conclusion Our study has heilightened that better conditions of nursing staffing levels and nursing skill mixes lead to better clinical, organizational and process outcomes. Mortality is one of the most relevant indicators for quality of care; as reported for other countries, also for Italy mortality is less when nursing skill mix is better (with more registered nurse and less health care assistants). These results, for the first time in our country, give the clear and demonstrated need to improve strategies to maintain nursing staff on safety levels to promote quality of care, well-being environment for patient and nurses and to reduce risks of adverse outcomes. As done in other countries, Italian decision makers, university and the government now have the basis on update staffing and skill mix standards for hospitals, nursing homes and all the institutions for acute and chronical patients with in mind that the economic perspectives should be cost-effectiveness in long-time and supporting quality of care

Experiences of participating in intergenerational interventions in older people's care settings: A systematic review and meta-synthesis of qualitative literature

Aims: To synthesize the findings of qualitative research exploring the experiences of being involved in intergenerational interventions in older people's care settings. Design: A meta-synthesis of the qualitative literature, employing Sandelowski and Barroso's method, was conducted. Data Sources: Eight databases were searched in March 2017. Review Methods: The PRISMA statement was used for reporting the different phases of the literature search and the Critical Appraisal Skills Programme (CASP) qualitative research checklist was used as an appraisal framework. Data synthesis was conducted using Sandelowski and Barroso's method. Results: Four qualitative studies were included in the meta-synthesis. Thematic analysis revealed four themes: ‘Recreating the family’; ‘Building intergenerational empathy and respect’;‘Uplifting and energizing’; and ‘Engagement risks and challenges’. Conclusion: The meta-synthesis strengthens the evidence that intergenerational interventions can be positive. However, it also shows that there may also be some negative aspects if not planned or managed carefully. Impact: This review contributes to the body of evidence by synthesizing the experiences of older people and children involved in intergenerational interventions. Although qualitative literature supports the quantitative evidence that intergenerational interventions can have a positive effect, intergenerational interventions could also have negative effects on some participants. Older people may feel tired, or experience feelings of infantilization. Practitioners need to be more aware of the potential negative effects of intergenerational interventions and include risk assessment, possibly by requiring ethical scrutiny

The contribution of nursing doctoral schools to the development of evidence 10 years after their establishment in Italy: An exploratory descriptive survey of former and current doctoral students’ publications

AimTo analyse through an exploratory descriptive survey how former and current doctoral students’ publications have contributed to the development of evidence between the establishment of the doctoral schools of nursing between 2006 - 2015.Design An exploratory descriptive survey.Methods We analysed the papers published in peer-reviewed journals by the four Italian PhD Schools of Nursing between 2006 - 2015. Additional missing information was retrieved from Web of Science.Results We identified 478 scientific papers. The papers increased from 12 in 2006 to 110 in 2015. Most are published in 29 journals, of which 15 have an impact factor ranging between 0.236-3.755. These results show the increasingly significant contribution of nursing doctoral programs to the production of evidence, which can be used to improve the quality of nursing and inform health policies. Nursing doctoral schools deserve a greater recognition, especially by Italian funding agencies and political institutions

Colistin resistance in carbapenem-resistant Klebsiella pneumoniae isolates from a pediatric hospital from Corrientes, Argentina

Introducción: Existe un incremento de las infecciones por Klebsiella pneumoniae resistente a carbapenémicos (KPRC) en la población pediátrica y los datos epidemiológicos son limitados. Objetivos: Conocer la frecuencia de KPRC en pacientes pediátricos, determinar la actividad in vitro de colistina y detectar el gen mcr-1 en dichos aislados. Materiales y Métodos: Se estudiaron 220 aislados de K. pneumoniae en un hospital pediátrico durante los años 2018 y 2019. La susceptibilidad antimicrobiana se determinó por microdilución en caldo según CLSI y EUCAST. Los genes blaKPC, blaNDM, blaIMP, blaVIM, blaOXA-48 y mcr-1 se analizaron mediante reacción de polimerasa en cadena de (PCR). Resultados: El 9,5% (n: 21) de los aislados fueron caracterizados como KPRC, donde se observó una resistencia a colistina de 47,6% (10/21) con valores de CIM50 de 2 μg/mL y CIM90 de ˃4 μg/mL. En todos los aislados de KPRC se caracterizó el gen blaKPC y no se detectó el gen mcr-1. El perfil de resistencia observado en otros antimicrobianos fue el siguiente: gentamicina 100% (n: 21), ciprofloxacina 100% (n: 21), cotrimoxazol 100% (n: 21) y amikacina 19% (n: 4). Se observó 100% de sensibilidad a tigeciclina y ceftazidima/avibactam. Conclusión: Este estudio demuestra un valor significativo de la resistencia a colistina en comparación a ceftazidima/avibactam y tigeciclinaBackground: There is an increase of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections in the pediatric population and epidemiological data are limited. Aim: To calculate the frequen-cy of CRKP in pediatric patients, to determine the in vitro activity of colistin and to detect the presence of mcr-1 gene in said isolates. Methods: 220 isolates of K. pneumoniae were studied in a pediatric hospital between January 2018 and December 2019. Antimicrobial susceptibility was determined by microdilution in broth according to guidelines of CLSI and EUCAST. The genes blaKPC, blaNDM, blaIMP, blaVIM, blaOXA-48 and mcr-1 were detected by polymerase chain reaction (PCR). Results: 9.5% (n: 21) of the isolates were characterized as CRKP, where was observed a resistance to colistin of 47.6% (10/21) with values of MIC50 of 2 μg/mL and MIC90 of ≥ 4 μg/mL. In 100% of CRKP strains the blaKPC gene was detected and the mcr-1 gene was not found. The resistance profile to other antimicrobials was as follow: gentamicin 100% (n: 21), trimethoprim/sulfamethoxazole 100% (n: 21), ciprofloxacin 100% (n: 21), amikacin 19% (n: 4). All of the isolates were sensitive to ceftazidime/avibactam and tigecycline. Conclusion: This study demonstrates a significant value of resistance to colistin in pediatric patients compared to other last line antimicrobial such as ceftazidime/avibactam and tigecycline.Fil: Pellegrini, Juan Leandro. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; Argentina. Universidad Nacional del Nordeste. Instituto de Medicina Regional; ArgentinaFil: Aguirre, Clarisa. Hospital Pediatrico Juan Pablo Ii ; Gobierno de la Provincia de Corrientes;Fil: Soto, Susana Marina. Provincia de Corrientes. Ministerio de Salud Publica. Laboratorio Central de Redes y Programas; ArgentinaFil: Lovera, Laura Marcela Ramona. Hospital Pediatrico Juan Pablo Ii ; Gobierno de la Provincia de Corrientes;Fil: Lösch, Liliana Silvina. Universidad Nacional del Nordeste. Instituto de Medicina Regional; ArgentinaFil: Di Conza, José Alejandro. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Merino, Luis Antonio. Universidad Nacional del Nordeste. Instituto de Medicina Regional; Argentin

La concettualizzazione dell'assistenza infermieristica nella letteratura italiana: un'analisi integrativa a supporto dello sviluppo di una teoria

Introduction: Nursing theories are essential for orienting nursing practice. To date, three models for nursing practice have been developed in Italy. In addition, significant epistemological reflections have been published, sparking a rich professional debate regarding the theoretical foundations of nursing in Italy. However, conceptual models from other countries are often still used, despite many difficulties associated with applying them in practice. In order to investigate and redress this ‘theoretical gap’ and related implications for intervention, three scoping reviews of the Italian nursing literature were conducted to examine three categories of nursing knowledge: (a) nursing practice in Italy; (b) the basic nursing concepts of person, health, environment and nursing; and (c) regulatory/normative statements regarding what nursing practice should be in Italy. Objective: The purpose of this investigation was to identify how nursing is conceptualized in the Italian literature through an integrative narrative analysis of three scoping reviews. Methods: The Scoping Review according to the recommendations published by Arksey and O'Malley and subsequently implemented by Levac et al. has been selected as the optimal methodology for mapping nursing knowledge. At the end of the reviews carried out to answer the three research questions, the researchers integrated the results by conducting a coding of the results. Results: The narrative synthesis highlighted a systemic conception of persons in their social context, ‘incorporated’ within relational systems. Persons are imagined as active agents with self-determination toward promoting their own health. Health, derived from levels of equilibrium between multiple systemic components and based on the person's holistic view, is a fundamental right and a collective social interest. Maintaining or promoting a person’s health requires careful consideration of all these constitutive and integral elements. The nursing process is implemented through technical acts as well as relational and caring skills. Professional autonomy, influenced by clinical and organizational contexts, is expressed in collaboration with other professionals who contribute to the healthcare process. The results of this integrative narrative analysis suggest the need for a holistic vision of persons, with an active role in their health management, indissociable from the system of relationships in which this is contextualized, within which nurses are embedded. Conclusion: In light of the results of our investigation, the promotion of a conceptualization of nursing based on the centrality of the person-social relational system and on the active role of persons that nurses work with, this could guide approaches used in nursing education and administration. This could help enhance care provided by nurses and persons' participation in decisions regarding their own health. Keywords: nursing theory, nursing discipline, review, metaparadigm Introduzione: Le teorie infermieristiche costituiscono un riferimento imprescindibile per la prassi infermieristica. In Italia sono stati elaborati e proposti tre modelli professionali italiani. Oltre ad essi, il dibattito professionale si è arricchito anche di significative riflessioni di tipo epistemologico. Tuttavia, ancora oggi risultano essere spesso adottati modelli concettuali provenienti da altri Paesi con la difficoltà del loro utilizzo nella prassi infermieristica. Allo scopo di studiare e approfondire “questo divario teorico” e le possibili linee di intervento sono state realizzate tre revisioni della produzione scientifica infermieristica italiana su tre categorie di conoscenze infermieristiche: la pratica infermieristica in Italia, i concetti fondanti di persona, salute, ambiente e assistenza e tutte le dichiarazioni normative riguardo a cosa dovrebbe essere in Italia la pratica infermieristica. Obiettivo: Lo scopo di questo studio è la produzione di una sintesi narrativa che identifica la concezione di infermieristica nella letteratura italiana attraverso un’analisi integrativa di scoping reviews. Metodi: La Scoping Review secondo le raccomandazioni pubblicate da Arksey and O’Malley e successivamente implementate da Levac et al. è stata selezionata come la metodologia ottimale per eseguire la mappatura delle conoscenze infermieristiche. Al termine delle revisioni realizzate per rispondere alle tre domande di ricerca, i ricercatori hanno integrato i risultati conducendo una codifica dei risultati. Risultati: La sintesi narrativa ha evidenziato una concezione sistemica di base riguardante le persone nel loro contesto sociale, “incorporate” nei sistemi di relazioni. La persona è identificata come agente attivo nell'autoderminazione della salute. La salute derivante da livelli di equilibrio tra più componenti sistemiche e basata sulla visione olistica della persona è un bene fondamentale e un interesse sociale collettivo. Mantenere o promuovere la salute della persona richiede un'attenta considerazione di tutti quelli elementi che ne sono parte costituiva e integrante. La processualità dell'assistenza è messa in atto attraverso atti di natura tecnica e attraverso competenze relazionali e di caring. L'autonomia professionale, influenzata dai contesti clinici e organizzativi si esprime anche nella collaborazione con gli altri professionisti che contribuiscono alla realizzazione del processo di cura. I risultati di questa analisi integrativa suggeriscono la necessità di una visione olistica della persona, del suo ruolo attivo nella gestione della salute e della sua inscindibilità dal sistema di relazioni in cui questa è contestualizzata e del quale l’infermiere entra a far parte. Conclusione: Alla luce dei risultati del nostro studio, la promozione di una concezione di assistenza infermieristica basata sulla centralità dell’intero sistema persona-relazioni sociali e sul ruolo attivo della persona assistita potrebbero orientare sia i processi formativi sia le amministrazioni infermieristiche così da consentire e valorizzare la presa in carico globale da parte dei professionisti infermieri e la partecipazione della persona alla presa di decisioni riguardanti la propria salute

Bibliografía colombina existente en Mendoza

Fil: Herrera, Ramona del Valle.Fil: Pellegrini, Adela.Fil: Perassi, Susana.Fil: Simón, Margarita

Mixed method research in nursing-a critical review

This paper critically reviews the use of mixed method research in nursing with a particular focus on the extent to which current practice informs nurse researchers. It also aims to highlight gaps in current knowledge, understanding and reporting of this type of research

A review of the role of nurse leadership in promoting and sustaining evidence-based practice

Aim: This integrative review aims to explore how nursing leadership influences evidence-based practice in contemporary health care settings. Background: Although managers and environmental ward culture have long been identified as being among the main barriers to evidence-based practice, there is little overall conceptualization and understanding of the specific role of nurse leaders in directly influencing and supporting this. Evaluation: The team carried out an integrative literature review (n = 28) utilizing PubMed, CINAHL and the Cochrane Library (2006\u20132016). Key Issues: The key role of leadership, the methodology used, and understanding and addressing barriers to or facilitators of the implementation of evidence-based practice emerged as key issues. Conclusion: Nurse managers have a particular influential role on the implementation of evidence-based practice in terms of providing a supportive culture and environment. For this they need to have an underlying knowledge but also to be aware of and address barriers to implementation, and understand the key role of nurse managers in creating and supporting the optimum environment. Implications for Nursing Management: Nurse managers need to facilitate and enhance nurses\u2019 use of evidence-based practice. Both managers and nurses need to have the necessary academic preparation, support and resources required for practising using an evidence base