Alcune riflessioni sulla ricerca qualitativa.<BR>Intervista di Luisa Saiani a Luigina Mortari

Luigina Mortari, nota a livello internazionale nell\u2019ambito dell\u2019epistemologia e della ricerca qualitativa, \ue8 stata intervistata per raccogliere le sue opinioni su alcuni aspetti della ricerca qualitativa: quando una domanda di ricerca pu\uf2 essere considerata rilevante; quali sono gli aspetti irrinunciabili nella metodologia ed i problemi etici negli studi qualitativi

Instruments evaluating the quality of the clinical learning environment in nursing education: A systematic review of psychometric properties

Background The clinical learning environment is fundamental to nursing education paths, capable of affecting learning processes and outcomes. Several instruments have been developed in nursing education, aimed at evaluating the quality of the clinical learning environments; however, no systematic review of the psychometric properties and methodological quality of these studies has been performed to date. Objectives The aims of the study were: 1) to identify validated instruments evaluating the clinical learning environments in nursing education; 2) to evaluate critically the methodological quality of the psychometric property estimation used; and 3) to compare psychometric properties across the instruments available. Design A systematic review of the literature (using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines) and an evaluation of the methodological quality of psychometric properties (using the COnsensus-based Standards for the selection of health Measurement INstruments guidelines). Data sources The Medline and CINAHL databases were searched. Eligible studies were those that satisfied the following criteria: a) validation studies of instruments evaluating the quality of clinical learning environments; b) in nursing education; c) published in English or Italian; d) before April 2016. Review methods The included studies were evaluated for the methodological quality of the psychometric properties measured and then compared in terms of both the psychometric properties and the methodological quality of the processes used. Results The search strategy yielded a total of 26 studies and eight clinical learning environment evaluation instruments. A variety of psychometric properties have been estimated for each instrument, with differing qualities in the methodology used. Concept and construct validity were poorly assessed in terms of their significance and rarely judged by the target population (nursing students). Some properties were rarely considered (e.g., reliability, measurement error, criterion validity), whereas others were frequently estimated, but using different coefficients and statistical analyses (e.g., internal consistency, structural validity), thus rendering comparison across instruments difficult. Moreover, the methodological quality adopted in the property assessments was poor or fair in most studies, compromising the goodness of the psychometric values estimated. Conclusions Clinical learning placements represent the key strategies in educating the future nursing workforce: instruments evaluating the quality of the settings, as well as their capacity to promote significant learning, are strongly recommended. Studies estimating psychometric properties, using an increased quality of research methodologies are needed in order to support nursing educators in the process of clinical placements accreditation and quality improvement

Human osteoblasts within soft peptide hydrogels promote mineralisation in vitro

Biomaterials that provide three-dimensional support networks for the culture of cells are being developed for a wide range of tissue engineering applications including the regeneration of bone. This study explores the potential of the versatile ionic-complementary peptide, FEFEFKFK, for such a purpose as this peptide spontaneously self-assembles into β-sheet-rich fibres that subsequently self-associate to form self-supporting hydrogels. Via simple live/dead cell assays, we demonstrated that 3 wt% hydrogels were optimal for the support of osteoblast cells. We went on to show that these cells are not only viable within the three-dimensional hydrogel but they also proliferate and produce osteogenic key proteins, that is, they behave like in vivo bone cells, over the 14-day period explored here. The gel elasticity increased over time when cells were present – in comparison to a decrease in control samples – indicating the deposition of matrix throughout the peptide scaffold. Moreover, significant quantities of calcium phosphate were deposited. Collectively, these data demonstrate that ionic-complementary octapeptides offer a suitable three-dimensional environment for osteoblastic cell function

Il sistema grade

Il Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE Working Group) ha sviluppato un sistema per graduare la qualit\ue0 delle prove di efficacia. Il GRADE \ue8 stato adottato da pi\uf9 di 20 organizzazioni, compresa l\u2019Organizzazione Mondiale della Sanit\ue0. La qualit\ue0 di una prova prevede che vengano presi in esame i problemi metodologici dello studio (qualit\ue0 metodologica), l\u2019orientamento dei risultati, l\u2019eterogeneit\ue0, la precisione della stima dell\u2019effetto, e il rischio di bias di pubblicazione, per ogni singolo esito valutato. Il sistema GRADE assegna 4 livelli di qualit\ue0: le sperimentazioni cliniche, che sono in cima alla piramide delle prove di efficacia, possono essere declassate se hanno problemi metodologici. Viene presentata una breve rassegna del sistema GRADE

Leggibilit\ue0 e comprensione delle linee guida sull\u2019igiene delle mani: confronto tra le linee guida OMS(2009) e del CDC (2002)

Introduzione. L\u2019aggiornamento di una linea guida (LG) \ue8 fondamentale per garantire la validit\ue0 delle raccomandazioni. L\u2019aggiornamento per\uf2 dovrebbe essere reso esplicito e i cambiamenti fatti resi evidenti nel testo. Obiettivo. Confrontare le LG sull\u2019igiene delle mani dell\u2019Organizzazione Mondiale della Sanit\ue0 del 2009 e dei Centres for Disease Control del 2002, per identificare le discrepanze e le novit\ue0 introdotte. Risultati. Anche se comparabili per molte raccomandazioni, le LG del CDC e OMS usano una differente terminologia: nelle prime per lavaggio delle mani si intende quello con acqua e sapone, nelle seconde anche con sapone antimicrobico: ignorare il glossario pu\uf2 rendere ambigua l\u2019interpretazione. Vengono segnalati i problemi nell\u2019individuazione delle prove alla base delle raccomandazioni. Conclusioni. Si dovrebbe porre molta attenzione quando si decide di applicare una linea guida aggiornata e cercare di capire quali sono le novit\ue0 introdotte. Si raccomanda la necessit\ue0 di linee guida snelle e facili da consultare, dove vengono messi in luce in principali cambiamenti fatti

Familiari e badanti: nostri alleati o concorrenti?

Molte Regioni hanno affrontato con vari interventi il sostegno della permanenza a domicilio dei pazienti con malattie croniche invalidanti e bisogni assistenziali complessi. Tali interventi vanno dall\u2019accesso facilitato ai servizi di assistenza domiciliare integrata pubblici o convenzionati, o da forme di assistenza indiretta come l\u2019erogazione di un assegno di cura mensile, ad azioni di formazione rivolte ai soggetti con funzioni di caregiver. Alcune Regioni, in risposta alle richieste delle Associazioni di malati e familiari, hanno assunto delle decisioni per preparare e autorizzare i caregiver a svolgere attivit\ue0 sanitarie. In questo editoriale si propongono alcune riflessioni a partire da una iniziativa della Regione Emilia-Romagna, che ha sollevato un vivace dibattito e che vogliamo utilizzare come occasione per riflettere sui rapporti tra infermieri e caregiver: tematica sulla quale la professione ha molta esperienza nella pratica quotidiana, ma ha ancora molte pagine da scrivere per esplicitare come pensa di relazionarsi nella complessit\ue0 di bisogni e interventi di cui sempre pi\uf9 le famiglie si fanno carico e per cui rivendicano un ruolo pi\uf9 attiv

Osteogenic differentiation of human mesenchymal stem cells promotes mineralization within a biodegradable peptide hydrogel

An attractive strategy for the regeneration of tissues has been the use of extracellular matrix analogous biomaterials. Peptide-based fibrillar hydrogels have been shown to mimic the structure of extracellular matrix offering cells a niche to undertake their physiological functions. In this study, the capability of an ionic-complementary peptide FEFEFKFK (F, E, and K are phenylalanine, glutamic acid, and lysine, respectively) hydrogel to host human mesenchymal stem cells in three dimensions and induce their osteogenic differentiation is demonstrated. Assays showed sustained cell viability and proliferation throughout the hydrogel over 12 days of culture and these human mesenchymal stem cells differentiated into osteoblasts simply upon addition of osteogenic stimulation. Differentiated osteoblasts synthesized key bone proteins, including collagen-1 (Col-1), osteocalcin, and alkaline phosphatase. Moreover, mineralization occurred within the hydrogel. The peptide hydrogel is a naturally biodegradable material as shown by oscillatory rheology and reversed-phase high-performance liquid chromatography, where both viscoelastic properties and the degradation of the hydrogel were monitored over time, respectively. These findings demonstrate that a biodegradable octapeptide hydrogel can host and induce the differentiation of stem cells and has the potential for the regeneration of hard tissues such as alveolar bon

Clinical Learning Environment and Supervision plus nurse Teacher (CLES+T) scale: testing the psychometric characteristics of the Italian version.

A clinical learning environment is an \u201cinteractive network of forces within the clinical setting that influence the students\u2019 learning outcomes\u201d. International research indicates the Clinical Learning Environment, Supervision and Nurse Teacher scale (CLES+T) as the gold standard tool to assess the forces involved in defining a good clinical learning environment. This study aimed to evaluate the psychometric proprieties of CLES+T Italian version. 875 Bachelor in Nursing students in 3 Universities in Italy partecipated in the study. Cronbach\u2019s alpha, item to total correlations, shape indexes were calculated and factor analysis was performed using Principal Axis Factoring and an oblique rotation method. Results showed an internal reliability for the total scale of 0.95, with subscales ranging from 0.80 to 0.96 among factors; all items add value to the scale and the distribution of answers have good shape indexes. Factor analysis showed a 7-factors model as explaining more than 67% of the variance, the higher variance was found in the \u201cpedagogical atmosphere\u201d factor (37.61%). The nurse teacher factor in the Italian model is split into 3 sub-factors: theory-practice integration, cooperation with ward staff and relationship with mentor and student. These results enable an international debate concerning the theoretical structure of CLES+T and enable a wider comparison on supervisory models in guiding students\u2019 clinical learning

Competenze e ruoli dei laureati magistrali nella pratica quotidiana. Studio descrittivo multicentrico

Introduzione. Non si hanno molte informazioni su ruolo e attivit\ue0 degli infermieri dopo il conseguimento della laurea magistrale. Obiettivo. Documentare quali competenze acquisite nel Corso di Laurea Magistrale vengono utilizzate nella pratica quotidiana e i cambiamenti di ruolo dei laureati magistrali. Metodo. Studio descrittivo multicentrico su 7 coorti consecutive (dal 2004/2005 al 2011/2012) di laureati magistrali di 3 universit\ue0 del nord Italia. L\u2019applicazione delle competenze manageriali, didattiche, di ricerca e cliniche acquisite nel corso di studi ed i cambiamenti di ruolo sono stati rilevati attraverso un questionario semistrutturato. Risultati. Hanno partecipato 232/285 laureati. Duecentosei (88.8%) hanno dichiarato di aver applicato competenze manageriali, 178 (76.7%) didattiche, 122 (52.6%) cliniche e 115 (49.5%) di ricerca. Conclusi gli studi, 80 laureati (34.4%) hanno cambiato ruolo. Sono aumentati coloro che ricoprono un ruolo manageriale (da 89 a 212; + 123, 14.5%) e didattico (da 33 a 44, + 11, 4.8%) mentre sono diminuiti coloro che occupano un ruolo clinico (da 110 a 65, -45, -19.4%). I cambiamenti di ruolo si verificano tre anni dopo il conseguimento del titolo (p = 0.006) e la frequenza varia in base alle sedi di formazione (p = 0.018). Conclusioni. Se fino ad ora il principale ambito di lavoro dei laureati magistrali era nell\u2019area manageriale, con i cambiamenti dei bisogni delle organizzazioni, i piani di studio dovrebbero dare una maggiore attenzione alle competenze cliniche. Sarebbe utile descrivere le caratteristiche dei contesti che facilitano o ostacolano l\u2019utilizzo delle competenze acquisite e le progressioni di carriera