Le competenze infermieristiche avanzate nel trattamento dello stroke in fase acuta in Italia. Strategia per l’identificazione (I parte)

Introduction: the goal of this study was to describe advanced nursing competences indicators for identification strategy in the stroke care in Italy and develop a survey tool. Problem: the new structure of the NHS and the needs expressed by patients increasingly require an advancement of the skills of health professionals. To this end the authors have identified and described a method for the detection of advanced nursing skills. Starting from the theoretical structure of AB Hamric have been identified analyzed and compared documents of a professionalizing and clinical from which have identified some categories. For each indicator have been identified one or more items and has been developed ad hoc questionnaire. At the end this was validated. Discussion: the methodology for the identification of the indicators has been efficacy in achieving the objectives. The strategy used in the study is reproducible, since traced to a theoretical model, and contextualized to any clinical setting, where there are secondary sources of evidencebased. It can also be adapted to post basic training course of a single reality. Conclusions: advanced clinical knowledge and skills, frequently without a formal recognition because of the complexity and instability of the patient, are used in the stroke care. Itís hoped to use the tool to verify the effectiveness and then play back the path in other clinical setting

The T.O.S.C.A. Project: Research, Education and Care

Despite recent and exponential improvements in diagnostic- therapeutic pathways, an existing “GAP” has been revealed between the “real world care” and the “optimal care” of patients with chronic heart failure (CHF). We present the T.O.S.CA. Project (Trattamento Ormonale dello Scompenso CArdiaco), an Italian multicenter initiative involving different health care professionals and services aiming to explore the CHF “metabolic pathophysiological model” and to improve the quality of care of HF patients through research and continuing medical education

Meeting sustainable development goals via robotics and autonomous systems

Robotics and autonomous systems are reshaping the world, changing healthcare, food production and biodiversity management. While they will play a fundamental role in delivering the UN Sustainable Development Goals, associated opportunities and threats are yet to be considered systematically. We report on a horizon scan evaluating robotics and autonomous systems impact on all Sustainable Development Goals, involving 102 experts from around the world. Robotics and autonomous systems are likely to transform how the Sustainable Development Goals are achieved, through replacing and supporting human activities, fostering innovation, enhancing remote access and improving monitoring. Emerging threats relate to reinforcing inequalities, exacerbating environmental change, diverting resources from tried-and-tested solutions and reducing freedom and privacy through inadequate governance. Although predicting future impacts of robotics and autonomous systems on the Sustainable Development Goals is difficult, thoroughly examining technological developments early is essential to prevent unintended detrimental consequences. Additionally, robotics and autonomous systems should be considered explicitly when developing future iterations of the Sustainable Development Goals to avoid reversing progress or exacerbating inequalities

Empowerment strutturale e soddisfazione sul lavoro tra gli infermieri coordinatori: uno studio pilota

INTRODUCTION: In literature, the structural empowerment and the job satisfaction have been studied in many different work settings but more need to be done in the setting of Head Nurses. OBJECTIVE: The goal of the study is to evaluate the structural empowerment level of head nurses and if it impacts on the job satisfaction. METHODS: A cross sectional design study was used. We enrolled 125 head nurses from three different hospitals of Rome. To collect the data we used a questionnaire that included both a part of the collection of sociopersonal data and the two scales (job satisfaction and structural empowerment). We used the SPSS19.0 statistical Software for data analysis to detect significant results. RESULTS: Head Nurse declared to be not enough satisfied at work (mean=3.43) and their structural empowerment level resulted moderate (mean=3.16). The structural empowerment of head nurses impacts their job satisfaction especially concerning opportunities for social and professional interactions, praises, awards, audit and responsibilities. CONCLUSIONS: Results underline structural empowerment relevance in head nurses job satisfaction. Healthcare organizations need to address job satisfaction to improve quality of care and more specifically that of head nurses since they directly impact on nurses job satisfaction

Does nurse-led interventions improve self-care behaviors among patients with heart failure? Results of a systematic review and meta-analysis

Background Heart failure is the most common cause of hospitalization for adults over the age of 65 years. The World Health Organization Report on therapeutic patient education recognizes the importance of patient centered education in the effective management of chronic diseases. It has been recognized that adoption of self-management skills by persons with chronic diseases is necessary to enable them to manage their condition. This meta-analysis evaluates the effectiveness of the nurse-led self-management interventions to improve self-care behaviors among patients. Methods Relevant major electronic databases were searched from inception to February 2014. All randomized controlled trials (RCTs) that compared nurse led self-management education with routine treatment were included in the systematic review. For meta-analyses of continuous data, standardized mean difference (SMD), along with 95% confidence interval (CI), was calculated because the same underlying concept was measured using different outcome measurements. Results Seven studies were included in the meta-analysis for a total of 942 participants, 493 (52.3%) of which were in the intervention group. Four studies involving 406 participants assessed the self-care abilities at 3 months (short term). The SMD was 0.64 (95%CI 0.19–1.10) in favor of the self-management education intervention. Four studies with a total of 707 participants reported on self-care abilities at 6-9 months (intermediate term) while the long-term effect of the educational intervention was assessed by two studies, with not statistically significant results in both cases (SMD 0.45; 95%CI -0.12–1.02 and SMD 0.06; 95%CI -0.15–0.26, respectively). Conclusions Supportive nursing educational interventions improve the selfcare behavior in patients with heart failure but only in the short period. Educational interventions should be reconsidered in a perspective of continuity of care. For this reason an effective discharge planning is crucial to guarantee continuity in an intermediate care framework. Key message Promoting self-care in chronic patients is necessary to enable them to manage their condition

Le competenze infermieristiche avanzate nel trattamento dello stroke in fase acuta in Italia. Strategia per l’identificazione (II parte)

Introduzione. Lo scopo di questo lavoro è è stato evidenziare le competenze infermieristiche all'interno del percorso clinico assistenziale dello stroke, per trovare strategie efficaci di trattamento dei pazienti, utili per garantirgli maggiori possibilità di guarigione e di recupero funzionale. Questo attraverso tre obiettivi: evidenziare la presenza e l’utilizzo di strumenti di pratica clinica avanzata; indagare alcune conoscenze fondamentali per la cura dello stroke; sondare la presenza e la tipologia di formazione post base e la frequenza ai corsi di aggiornamento. Materiale e metodi: il disegno di studio è stato di tipo trasversale osservazionale. Il campione di convenienza è stato di 109 infermieri operanti in tre realtà sanitarie romane nelle diverse aree che costituiscono il percorso del paziente con stroke. Le variabili sono state misurate utilizzando un questionario elaborato ad hoc, da settembre 2011 a gennaio 2012. Risultati: gli infermieri che lavorano in emergenza (Emergenza Sanitaria 118 pari al 91% e Dipartimento Emergenza Accettazione pari al 81%) utilizzano la Cincinnati Prehospital Scale e la Glascow Coma Scale; in Stroke Unit il 98% usa l’Italian National Institute of Health Stroke Scale (NIHSS). Una bassa percentuale di professionisti utilizza gli strumenti della Clinical Governance come l’audit clinico (37%) e l’Evidence Based Nursing-EBN (33%). Per quanto riguarda l’assistenza, il 70% riconosce nella Tomografia Computerizzata del cranio senza mezzo di contrasto, l’esame diagnostico di elezione per determinare la natura della lesione e l’80% sa che la finestra temporale per la somministrazione del trattamento tromboembolitico con rtPA (Recombinant Tissue Plasminogen Activator) è di 3 ore. Il 33% degli intervistati ha una formazione post base a livello di master, privilegiando l’area critica; il 46% ha partecipato di recente a corsi di aggiornamento, l’8% ha scelto corsi sull’ictus. Discussione: l’infermiere con competenze avanzate è colui che deve accrescere il proprio expertise ed estendere il proprio ruolo attraverso una formazione clinica specifica. Inoltre deve espanderle attraverso l’acquisizione di conoscenze di livello superiore che gli permetteranno di acquisire gli strumenti necessari per la governance della pratica clinica avanzata. Conclusioni: nell’ambito dell’assistenza allo stroke vengono messe in campo conoscenze e competenze cliniche avanzate, spesso senza riconoscimento formale, per la complessità e l’instabilità del paziente

Le competenze infermieristiche avanzate nel trattamento dello stroke in fase acuta in Italia. Strategia per l’identificazione (I parte)

Introduction: the goal of this study was to describe advanced nursing competences indicators for identification strategy in the stroke care in Italy and develop a survey tool. Problem: the new structure of the NHS and the needs expressed by patients increasingly require an advancement of the skills of health professionals. To this end the authors have identified and described a method for the detection of advanced nursing skills. Starting from the theoretical structure of AB Hamric have been identified analyzed and compared documents of a professionalizing and clinical from which have identified some categories. For each indicator have been identified one or more items and has been developed ad hoc questionnaire. At the end this was validated. Discussion: the methodology for the identification of the indicators has been efficacy in achieving the objectives. The strategy used in the study is reproducible, since traced to a theoretical model, and contextualized to any clinical setting, where there are secondary sources of evidencebased. It can also be adapted to post basic training course of a single reality. Conclusions: advanced clinical knowledge and skills, frequently without a formal recognition because of the complexity and instability of the patient, are used in the stroke care. Itís hoped to use the tool to verify the effectiveness and then play back the path in other clinical setting

Le competenze infermieristiche avanzate nel trattamento dello stroke in fase acuta in Italia. Strategia per l’identificazione (II parte)

Introduzione. Lo scopo di questo lavoro è è stato evidenziare le competenze infermieristiche all'interno del percorso clinico assistenziale dello stroke, per trovare strategie efficaci di trattamento dei pazienti, utili per garantirgli maggiori possibilità di guarigione e di recupero funzionale. Questo attraverso tre obiettivi: evidenziare la presenza e l’utilizzo di strumenti di pratica clinica avanzata; indagare alcune conoscenze fondamentali per la cura dello stroke; sondare la presenza e la tipologia di formazione post base e la frequenza ai corsi di aggiornamento. Materiale e metodi: il disegno di studio è stato di tipo trasversale osservazionale. Il campione di convenienza è stato di 109 infermieri operanti in tre realtà sanitarie romane nelle diverse aree che costituiscono il percorso del paziente con stroke. Le variabili sono state misurate utilizzando un questionario elaborato ad hoc, da settembre 2011 a gennaio 2012. Risultati: gli infermieri che lavorano in emergenza (Emergenza Sanitaria 118 pari al 91% e Dipartimento Emergenza Accettazione pari al 81%) utilizzano la Cincinnati Prehospital Scale e la Glascow Coma Scale; in Stroke Unit il 98% usa l’Italian National Institute of Health Stroke Scale (NIHSS). Una bassa percentuale di professionisti utilizza gli strumenti della Clinical Governance come l’audit clinico (37%) e l’Evidence Based Nursing-EBN (33%). Per quanto riguarda l’assistenza, il 70% riconosce nella Tomografia Computerizzata del cranio senza mezzo di contrasto, l’esame diagnostico di elezione per determinare la natura della lesione e l’80% sa che la finestra temporale per la somministrazione del trattamento tromboembolitico con rtPA (Recombinant Tissue Plasminogen Activator) è di 3 ore. Il 33% degli intervistati ha una formazione post base a livello di master, privilegiando l’area critica; il 46% ha partecipato di recente a corsi di aggiornamento, l’8% ha scelto corsi sull’ictus. Discussione: l’infermiere con competenze avanzate è colui che deve accrescere il proprio expertise ed estendere il proprio ruolo attraverso una formazione clinica specifica. Inoltre deve espanderle attraverso l’acquisizione di conoscenze di livello superiore che gli permetteranno di acquisire gli strumenti necessari per la governance della pratica clinica avanzata. Conclusioni: nell’ambito dell’assistenza allo stroke vengono messe in campo conoscenze e competenze cliniche avanzate, spesso senza riconoscimento formale, per la complessità e l’instabilità del paziente

Is the task-shifting in self-management support effective? A systematic review and meta-analysis

Background Nurses play a key role in primary care, especially in long term care programs for patients with chronic diseases. The taskshifting from medical doctors to appropriately trained nurses could be a possible way to reduce doctors’ workload and direct cost of care, keeping quality, health outcomes and patient satisfaction constant. Systematic review and meta-analysis was carried out to assess the effectiveness of nurse-led selfmanagement interventions in community setting. Methods Most important biomedical databases were searched for Randomized Control Trials (RCTs) of nurse-led self-management interventions performed in community setting on patients with a diagnosis of chronic disease or multimorbidity. Primary outcomes of the studies were our outcomes of interest. Pooled mean difference (MD), along with 95% confidence interval (CI) was calculated, as appropriate. Results Globally, 29 RCTs were included involving 10,240 participants. Six studies reported as outcomes the levels of HbA1c, 10 the systolic (SBP) and diastolic blood pressure (DBP). The pooled MD showed a reduction in HbA1c and in SBP in the experimental groups. Meta-analyses of subgroups showed a statistically significant effect of the interventions for SBP among diabetic patients (MD -2.56, 95% CI -4.82—-0.31). A reduction of the DBP was found on the overall group (MD - 1.42, 95% CI -1.42—-0.49) and in the subgroup of patients with cardiovascular diseases (-2.09, 95% CI -4.11—-0.07). All-cause mortality was found significantly lower in two studies out of four. Quality of life in the experimental groups was significantly higher than in the control group only in one RCT out of three. Conclusions The results support the effectiveness of a nurse-led approach in the management of clinical outcomes in chronic patients. In particular, the nurse-led approach has positive effects on the DBP and SBP control and Hb1AC level in patients with cardiovascular diseases or diabetes. Key messages: Task-shifting from doctors to nurses in educational and selfmanagement programs in community settings can improve clinical outcomes in chronic patients Further research to evaluate cost-effectiveness of taskshifting interventions in the management of chronic patients is strongly neede