Scenario® - Il Nursing nella sopravvivenza

Utopia: an ideal reflection on nursing

2024-10-23T12:06:49+00:00

The concept of utopia, understood as an ideal and perfect vision of society (named after the country that does not exist by Thomas More), is often evoked when reflecting on the future of the professions, especially in areas such as health care Nursing is a profession historically linked to the care and well-being of people and lends itself particularly well to these reflections

In a world where suffering and illness are present, where chronicity is increasingly a widespread condition, the nurse represents a fundamental figure, especially in a system that would like, at least in the standards, to change its paradigm on health, starting with the implementation of wellbeing, and health promotion But what would it mean to achieve this perfection in the context of an ever-changing health system? Would it really be imaginable [...]

High flow nasal cannula comparison to non-invasive ventilation in severe burns patients with acute respiratory failure: a literature review protocol

2024-09-04T19:43:02+00:00

Introduction: acute respiratory failure is generally defined as the new onset of a clinically significant disorder. It can be hypoxic, hypercapnic, or mixed. Among the treatment methods for hypoxemic acute respiratory failure, conventional oxygen therapy is included, which allows for an increase in the fraction of inspired oxygen (FiO₂) using simple interfaces. A valid alternative is represented by the use of high-flow nasal cannulas (HFNC), as it offers the possibility of delivering increasingly higher, humidified, and heated gas flows.

Materials and Methods: a preliminary search will be conducted to verify the presence of previous reviews on the topic and subsequently, a literature review comparing high-flow nasal cannulas to non-invasive positive pressure ventilation in critically burned patients with acute respiratory failure.

Results: the results that will emerge could potentially contribute to refining current theories on the indications for the use of HFNC in burn patients.

Discussion: the future implications for research and clinical practice must adopt an increasingly targeted approach in the use of effective interfaces to improve patient compliance in terms of enhancing gas exchange, while being comfortable in terms of reducing pressure injuries caused by prolonged use.

On the road

2024-07-02T13:09:22+00:00

Recently the FNOPI convened the council of scientific societies to 'chart the course' for the near future of nursing. Great changes await us, we are maturing a more specific professional culture, in which we rightly recognise colleagues who are experts in particular fields, we are becoming a community that talks and compares about evidence and good practice.

But are we sure we are ready for a new leap? I was struck by the remark of a communications expert who gave me, clearly at my express request, an image of us as a divided and quarrelsome profession, ready to follow particular interests without, often, even considering the overall horizon. It was not easy to be told like that, but I must admit that in some respects it is profoundly true. [...]

Principles and tools of Lean Thinking for patient flow management in Emergency Rooms. A narrative review of literature

2024-07-29T09:28:55+00:00

Introduction: Lean Thinking can also be applied in Emergency Department, where overcrowding and workloads that exceed the availability of resources result in long waiting times, delays in treatments and increased length of hospital stays.

Materials and methods: a literature review was conducted by consulting Medline databases via PubMed, GoogleScholar, Scopus and Cinhal. The research was conducted between October/December 2022. Only works that concerned the clinical area of interest, in Italian and English, published in the last 5 years were included.

Results: 6 of the 14 articles identified during the search phase were included.

Discussion: by rigorously following the theoretical path, choosing the appropriate tools, involving front-line staff, who have a more in-depth vision of the processes and applying the principles and methodologies of Lean Thinking to healthcare processes, it is possible to increase the efficiency of services, reduce waste in terms of waiting and improve the quality of the working environment for operators.

Conclusions: the key elements of the Lean methodology in the Emergency Department are the ability to change, the involvement of leadership, a clear mapping of processes and the introduction of small improvements that are realistic and sustainable in the medium to long term.

Evaluating nurses' knowledge in assisting stroke patients in emergency situations: a survey

2024-07-29T09:19:24+00:00

Introduzione: in Italia, l'ictus è la seconda causa di morte dopo le malattie cardiache ischemiche, rappresentando il 9-10% di tutti i decessi ed essendo la principale causa di disabilità. A livello globale, l'Organizzazione Mondiale della Sanità riconosce l'ictus ischemico come una delle principali cause di morte. Le statistiche europee indicano che l'ictus è la seconda causa di morte, con una mortalità significativa tra uomini e donne. Garantire un'assistenza di alta qualità nella fase acuta successiva a un ictus è fondamentale per i risultati clinici dei pazienti. Questo studio ha l'obiettivo di valutare le abilità degli infermieri nei reparti di Emergenza/Urgenza nella gestione dei pazienti colpiti da ictus, identificando eventuali lacune formative e la necessità di aggiornamenti tra questi professionisti sanitari.

Materiali e Metodi: è stata condotta un'indagine rivolta agli infermieri dei reparti di Emergenza/Urgenza nelle regioni Puglia, Marche e Piemonte. È stato utilizzato un questionario appositamente progettato basato sulle ultime linee guida SPREAD. Il sondaggio includeva tre sezioni: dati socio-demografici, domande a scelta multipla sulla teoria riguardante la gestione dell'ictus e domande qualitative riguardanti l'esperienza professionale e le necessità di formazione.
I dati sono stati raccolti in forma anonima da febbraio a marzo 2022 e analizzati utilizzando Microsoft Excel® e Google Sheets.

Risultati: il sondaggio è stato completato da 172 infermieri. Nessun partecipante ha risposto correttamente a tutte le domande teoriche. Solo la metà ha ottenuto un punteggio pari o superiore al 60% nelle domande teoriche e solo 36 hanno superato l'85%. Il numero medio di risposte corrette è stato 5 su 10. Le percentuali più alte di risposte corrette riguardavano domande sulla terapia anticoagulante, il trattamento dell'ictus e le scale di valutazione dell'ictus. Tuttavia, sono state identificate significative lacune nella comprensione dei sintomi dell'ictus e degli strumenti diagnostici appropriati. La sezione qualitativa ha rivelato che, sebbene il 68% avesse esperienza con pazienti colpiti da ictus, solo il 23% aveva frequentato corsi di formazione specifici sulla gestione dell'ictus. Notoriamente, la maggioranza ha espresso interesse per ulteriori corsi di formazione.

Discussione: lo studio evidenzia una significativa carenza di conoscenze tra gli infermieri dei reparti di Emergenza/Urgenza riguardo alla gestione dell'ictus, sottolineando la necessità di programmi di formazione dedicati. Nonostante alcuni elementi di educazione sulla gestione dell'ictus siano presenti nei programmi universitari italiani, esiste una chiara domanda di formazione post-laurea. L'educazione continua è essenziale per i professionisti sanitari per rimanere aggiornati sulle migliori pratiche e sulle tecnologie emergenti, garantendo un'assistenza di alta qualità ai pazienti.

Conclusioni: è presente una sostanziale lacuna nelle conoscenze degli infermieri nella gestione dei pazienti colpiti da ictus nei reparti di Emergenza/Urgenza in Italia. Questo evidenzia l'urgente necessità di investimenti in programmi di formazione mirati e la promozione di standard uniformi su tutto il territorio nazionale. Migliorare le conoscenze degli infermieri nell'assistenza intensiva e affrontare le disparità regionali è fondamentale per migliorare la qualità delle cure e gli esiti clinici per i pazienti colpiti da ictus.

Cross-sectional study on health professionals’ perception of effectiveness in conducting cardiopulmonary resuscitation on adults

2024-06-16T19:09:08+00:00

Introduction: Cardiac arrest is one of the leading causes of death. Attitudes and practices of healthcare professionals influence survival after cardiac arrest, especially in intensive care units. Maintaining skills and attitudes after cardiopulmonary resuscitation training requires systematic refresh with appropriate methodology. The aim is to evaluate healthcare professionals' perception of the effectiveness of cardiopulmonary resuscitation in adults in order to optimize the design of training initiatives focused on addressing identified critical aspects.

Materials and Methods: A cross-sectional study was conducted on 655 healthcare professionals and technicians who participated in Basic Life Support and Defibrillation (BLS-d) training course between 2020 and the end of 2022. A questionnaire consisting of 65 variables was administered.

Results: 132 professionals answered. The most critical areas identified are the exclusive role of healthcare professionals in cardiopulmonary resuscitation, the presence of family, confidence in practice, ethical-legal aspects, and teamwork.

Conclusions: The BLS-d course is not able to address parallel aspects such as teamwork, ethical-legal aspects, preconceptions, and issues of self-confidence, which require alternative opportunities and experiences to be defined. The next step of this work will involve the entire team of BLS-d instructors to identify strategies for integrating content.

Artificial Intelligence and robot: are we ready? II part

2024-03-26T12:50:35+00:00

We have begun a reflection on the use of Artificial Intelligence (AI) and robots in healthcare, and the most important question remains how will care change through the use of these tools?
There are several considerations to be made.
The first thing to consider is the change in our skills.
Since time immemorial, the use of new technologies has changed not only skills but also competencies. While AI is being developed into systems to improve and speed up decision-making, diagnostic domains, control and monitoring systems, the same, applied to robotics, is implementing changes in the skills of those who use it, understood primarily as skills, mainly, for example, in the use in the operating room, or in the [...]

What are the risk factors for pressure injuries in intensive care? An observational retrospective study in an Italian intensive care

2024-05-27T16:19:16+00:00

Objective: the present study aims to identify the risk factors for the development of pressure ulcers in an Italian intensive care unit.

Materials and Methods: a retrospective observational study was carried out through the analysis of computerized medical records of patients hospitalized in an Italian multipurpose intensive care unit (ICU) in 2019. All patients admitted to the ICU in 2019 had no pressure ulcers at the time of admission and stayed in the hospital for at least 72 hours. Patients who developed ulcers during the first 72 hours of their stay and pediatric patients were excluded.

Results: of the 256 patients analyzed, 53 (20.7%) developed at least one pressure ulcer during hospitalization in the ICU. The lesions developed on the eighth day on average.

Conclusion: the univariate analysis revealed that age, (p = 0.025) length of stay (p = 0.001), mechanical ventilation (p = 0.035), serum albumin (p = 0.006), and the Simplified Acute Physiology Score (SAPS II) (p = 0.023) were the most influential risk factors for the development of pressure ulcers in our intensive care unit.

The use of the spinal immobilization in prehospital settings is still the most effective device for the patient’s safety? A narrative review of the literature

2024-05-20T09:31:26+00:00

Introduction: in out-of-hospital treatment, immobilization of the spine with the spinal board and cervical collar has been considered the best method to ensure patient safety for many years. In recent years, many doubts have arisen about the actual effectiveness of this practice. The aim of this paper is to find out if this garment is still the best for the patient and to find possible alternatives to its use.

Materials and Methods: a literature search was conducted by consulting Medline databases via PubMed, GoogleScholar, Web of science and Scopus. The search was conducted in the month of January 2023. Articles in Italian and English dealing with the use of the spinal board and other immobilization aids published within the last 5 years were included.

Results: 33 articles were identified in the various databases and 10 articles were subsequently included in the review.

Discussion: the use of the spinal board in the out-of-hospital setting is no longer the most effective method of ensuring patient safety and can only be used in certain cases. The use of spinal motion restriction takes the field as an alternative technique.

Conclusions: it is necessary that standard immobilization with a cervical collar and spinal board be performed only incases where it is considered truly necessary. Operators should use tools that help them identify such high-risk individuals.

Nursing management and prevention of complications in patients carrying Impella ventricular assistance device

2024-03-03T16:15:19+00:00

Introduction: recently, the use of the ventricular assistance device Impella in patients with acute heart failure has been reported to have benefits, such as increasing its use. However, the complications related to the Impella device are multiple and of different magnitudes. In light of all this, it is critical that the registered nurse be adequately trained to ensure proper care for the patient carrying such a device in any circumstance.

Aim: the purpose of the study is to identify the complications associated with the patient carrying the Impella device and the related monitoring, management and prevention methods the registered nurse is called to act upon.

Materials and Methods: the literature of the last 10 years in the main online databases, such as Pubmed and Google Scholar, was reviewed, and the PIO method was used for developing keywords.

Results: 29 articles were selected from the search. From these articles, it appears that the most common complications related to the Impella device concern bleeding, vascular injury, and ischemia of the limb, but infections and hemolysis are also worthy of attention.

Conclusions: analyzing the complications found in the literature suggests that these conditions require specific training of registered nurses in critical care, even simulations and checklists, given the absence of common international guidelines or protocols for the management of the patient carrying and Impella device. The study suggests a checklist drawn up from the evidence found in the literature.

COVID-19 pandemic impact on mothers of preterm newborns in NICU: observational study on experiences and maternal-infant attachment

2024-03-17T07:30:21+00:00

Introduction: the COVID-19 pandemic caused significant variations in health services and care pathways. Severe access restrictions to NICUs increased the risk of maternal-infant attachment breakdown.

Aim: to investigate the experiences of mothers of preterm infants admitted to NICUs during the pandemic.

Materials and methods: an observational study of mothers of preterm infants was conducted in a NICU in Naples from June 2021 to March 2022. Data were collected during and after hospitalization using two questionnaires and four evaluation scales.

Results: the results showed that more than 90% of the mothers suffered from post-traumatic stress disorder. Situational stress was high across all measured indices. The perceived nursing support was 3.57/5, and the postnatal maternal attachment was 82.95/93.

Discussion: stress and difficulty managing emotions had a significant negative impact on the mothers and their parental role; however, the nursing care received facilitated the development of a positive attachment with the newborn.

Conclusions: neonatal nurses provided valuable human and professional support to mothers of preterm infants. In the future, it will be necessary to implement organizational models that aim to reduce the separation of parents and infants.

Handover between community emergency and emergency room nurses: observational investigation of current critical issues and knowledge of the standardized Situation Background Assessment Recommendation method

2024-03-25T20:16:38+00:00

Introduction: the passage of a patient's information between healthcare professionals represents a focal point in the care process. Its importance is also underlined by the World Health Organization and the Joint Commission. The amount of information transmitted is of fundamental importance both to guarantee adequate continuity of care and to avoid the onset of errors. In the literature, the tool that is best suited to different care settings is represented by the SBAR (Situation, Background, Assessment, Recommendation), defined as simple and effective for interdisciplinary communication.

Materials and Method: descriptive-observational study with non-probability snowball sampling. For data collection, an ad hoc questionnaire was created consisting of 18 questions and subsequently administered to nurses belonging to the local emergency through the use of different communication channels that reliably lead back to the subjects of interest. A total of 132 responses were collected.

Results: the variables investigated concern topics such as operational difficulties, the current use of a specific tool, the presence of any interruptions during the handover phase, the possibility of omitting fundamental information during this process. From the analysis of the data obtained it was possible to appreciate various aspects. Operational difficulties emerged during the handover phase, the need for adequate education and training of nursing staff regarding standardized methodologies, in particular the SBAR method, and the need to improve communication between local emergency nurses and emergency room triad workers.

Conclusions: this survey contributed to highlighting the challenges and opportunities in the handover process between local emergency nurses and emergency room triage workers. The conclusions suggest that adequate training and attention to communication can contribute to improving the quality of care provided and guarantee a safer transition of the critically ill patient within the emergency-urgent system, also from a safety point of view. clinical risk management.

Artificial intelligence and robots: are we ready? Part one

2023-11-21T08:41:52+00:00

Today we hear about it everywhere, as if it had suddenly become the hot topic, with potential threats. An interesting thought is that several governments, including our own, are starting to think about specific laws to regulate its use.

The truth is that we are already fully immersed in the world of artificial intelligence (AI). How many times have you been on the internet and you are asked to prove that you are not a robot? The reality that surrounds us in everyday life is inescapably and inescapably intersected with so-called machine learning.

They manage the data needed to make our transport run safely (trains, planes, shipping), they allow us to find our way everywhere without needing to ask for help, or having a paper map to follow, they put us in communication with anyone across the globe, they manage our economic transactions and allow us to pay without physically using banknotes, and much more. [...]

Prevention of readmissions in people with heart failure thanks to education according to Gordon's Functional Models. Narrative literature review

2024-02-18T14:21:11+00:00

Introduction: heart failure (HF) leads to high rates of hospital readmission: almost 60% of discharged subjects are re-hospitalized within a year of the first hospitalization. Education on managing the pathology upon discharge becomes essential to prevent this phenomenon.

Objectives: describe the educational topics, according to Gordon's Functional Models, to be included in the educational intervention to prevent the patient with HF from being readmitted to the hospital.

Materials and Methods: a narrative review of the literature was conducted by consulting the MEDLINE and CINHAL databases.

Results: 28 articles were included in the review. From analyzing the materials concerning the Functional Models, the literature found investigates 9 out of 11. The models not paid attention to by discharge education are Sexuality and Reproduction and Values and Beliefs. Furthermore, the literature has underlined how a personalized educational process at discharge helps prevent hospital readmissions due to exacerbation of the pathology.

Conclusions: Therapeutic education organized according to the Gordon Models could improve the effectiveness of the intervention in preventing readmissions for HF. The fact that all aspects of the person are included improves the quality of life and allows effective coexistence with the disease.

Development and validation of a comprehensive tool for assessing emergency medical dispatch centres' organizational structure regarding pre-arrival instructions

2023-11-24T20:33:45+00:00

Introduction: pre-arrival instructions provided by emergency medical dispatch personnel have the potential to reduce outof- hospital cardiac arrest mortality and improve various outcomes. Despite international guidelines and existing regulations endorsing these interventions, tools for detecting and monitoring the organizational structure of emergency medical dispatch centres concerning pre-arrival instructions are currently unavailable.

Materials and Methods: a validation study of a questionnaire was conducted in three phases: i) identification of domains and specific questions, ii) content validation, and iii) face validation, involving expert nurses.

Results: the initial instrument, consisting of 30 questions across six domains, was modified based on experts’ feedback, resulting in a final set of 38 questions. The content validity of individual questions (I-CVI) ranged from 0.83 to 1, and the overall questionnaire validity (S-CVI) was 0.96. Face validation of the questions in the final version of the questionnaire yielded an average score of 3.71 (±0.53) on a scale from 1 to 4.

Conclusions: this validation study has led to the development of a comprehensive instrument, relevant in content and clear in form. The authors believe it could provide valuable informational support for implementing improvement projects and standardizing the delivery of pre-arrival instructions by emergency medical dispatch centres, not only for cardiac arrest victims, following Law 116/2021.

Nursing management of the patient undergoing ECMO: competences and treatment outcomes. A literature review

2023-11-07T13:10:10+00:00

Introduction: Extracorporeal membrane oxygenation (ECMO) is an external device that uses invasive technique to treat critically ill patients using mechanical support for respiratory and cardiovascular function when all other conventional treatments are ineffective. The management of these patients relies on a multidisciplinary and multispecialist team, to which the nurse belongs, and whose members must possess specific knowledge, supported by a programme of continuous training and updating.

Aim: Analyze the literature to explore, in depth, as a first aim what the nursing skills should be in the patient management of the undergoing ECMO of all types known to date and as a second aim the treatment outcomes in these high care complexity patients.

Methods: Literature review by consulting the main biomedical banks: PubMed, CINAHL, Cochrane Library, Embase and some peer-reviewed journals, as well as the Extracorporeal Life Support Organisation (ELSO) Guidelines. Inclusion criteria were applied with respect to English and Italian language, age 18 years or older.

Results: The analysis of the 17 studies included in this narrative review of the literature showed that the nursing activity performed by the nurse plays a key role in the management of these highly critical patients through the ability to manage all aspects of care. The nurse practitioner's skills include medication administration, possession of the specific technical knowledge for the safe use of the ECMO circuit, and a perfusion background for machine management. Prevention and early detection of caregiver complications are the key elements of successful, nursing care based on careful all-around monitoring. Adherence to existing guidelines and standardization of procedures implemented by the nurse are key elements, which reduce mortality and improve patient outcomes.

Conclusions: In order to care for patients undergoing ECMO, the nurse practitioner must be adequately trained and specialised. Continuous updating of knowledge and consolidation of skills increase the value of the nurse, who will be able to provide the patient with attentive, precise and informed care, with the aim of improving outcomes.

A survey on the critical care nurses’ training needs: a literature systematic review

2024-01-09T18:35:50+00:00

Introduction: critical care nurses must develop skills that ensure efficiency and quality in the care process. This review aims to identify the survey methods for the critical care nurses’ training needs, determine their necessary core skills, and highlight the importance of specific and standardized training programs.

Materials and Methods: a literature systematic review was conducted between January and April 2023, and it included studies published between 2013 and 2023 from four databases, excluding those relating to training on COVID-19 or to the pediatric/obstetrics-gynecology field.

Results: after a selection based on inclusion and exclusion criteria and qualitative evaluation, 23 studies that appropriately answered the research question were included.

Discussion and Conclusions: the analysis identified the most widely used survey methods for the critical care nurses’ training needs and determined their necessary core skills; moreover, it highlighted the importance of specific, permanent, and internationally standardized training programs to be developed from the detected nurses’ training needs.

Pain management in the Emergency Department: a phenomenological study on nurses’ experiences

2023-11-04T10:49:09+00:00

Introduction: pain is a subjective and complex phenomenon, representing the first cause of access to Emergency Departments. Early management of pain through nurse-led analgesia protocols improves outcomes and patient satisfaction.

Aim: this study aims to analyse the experiences of triage nurses regarding the pain of adult patients admitted to the Emergency Department, highlighting the main barriers to an objective pain assessment and the strategies adopted to manage it, to improve proper pain management.

Materials and Methods: this qualitative study has an interpretative phenomenological design; data is collected through semi-structured interviews. The study is reported according to the COREQ-32 checklist.

Results: twenty nurses in the Veneto region (Italy) Emergency Departments were interviewed. Seven themes were identified: nurse-led analgesia protocols, pain management in children, non-pharmacological interventions, differences between acute and chronic pain, the role of caregivers of elderly/cognitively impaired patients, nurses’ personal experience of pain, and objectivity of nurses’ pain assessment.

Conclusions: the interviews revealed a series of factors hindering optimal pain management related to the setting, such as Emergency Department overcrowding, or categories of difficult patients, such as children or elderly people with cognitive impairments. Positive experiences have also emerged, such as the usefulness of non-pharmacological techniques and the participatory role of family members and caregivers, during pain assessment of cognitively impaired patients.

Meritocracy and competency

2023-09-20T07:57:40+00:00

Art 3 of the Italian Constitution: "All citizens have equal social dignity and are equal before the law, without distinction of sex, race, language, religion, political opinion, personal and social conditions".¹

Meritocracy' is a concept, a principle that refers to a social or organisational system in which positions, opportunities and rewards are distributed according to individual merit, i.e. the skills, competencies and work done by each individual. In a meritocratic society, success, advancement and access to resources are determined by one's abilities and achievements, rather than by factors such as social origin, family background, gender or other personal characteristics not related to merit; however, the practical application of meritocracy can be complex and subject to different interpretations. The idea behind meritocracy is that by giving people the opportunity to progress according to their abilities, a fairer and more efficient system is created in which people who contribute more or show greater commitment receive greater rewards and more opportunities than those who do not. However, the practical realisation of meritocracy can be complex and contested, as challenges such as unequal access to education, structural inequalities and implicit biases that may influence the objective assessment of merit can arise. [...]

Advanced nursing competencies in critical care: education and evaluation tools. A narrative review

2023-09-12T13:01:51+00:00

Introduction: advanced nursing competencies refer to expanded and improved health care services and interventions delivered by nurses who, with advanced skills, influence clinical health outcomes and deliver direct health services to individuals, families, and communities. What distinguishes the critical care from other settings, where nurses can develop advanced skills, is its complexity and dynamism. The aim of this review is to outline the advanced skills in critical areas through training path description for their achievement and the tools used to evaluate them in the international context.

Materials and Methods: a narrative literature review has been performed. The main scientific databases were consulted (Medline/PubMed, CINAHL, Cochrane Library, EMBASE), selecting articles in English and Italian published in the last ten years, since the establishment of the working group for advanced skills of the European federation of Critical Care Nurses Association (EfCCNa). All the articles dealing with advanced skills in the critical area and the related evaluation tools were included.

Results: a total of thirtheen articles were selected, including two literature reviews.

Formal training programs for critical care nurses are present in 17 out of 24 European countries and critical care nursing has been recognized as a specialty in 13 of them. There are ten assessment tools for assessing advanced critical care skills.

Discussion: the educational status of critical care nurses in the EU is extremely varied and disomogeneus. Currently, the literature offers valid and reliable assessment tools for skills, but they are heterogeneous and not usable in every context.

Conclusions: it is necessary an institutional intervention at national and community level, aimed at regulating the training and recognition of nursing competencies in critical care also through a uniformity of evaluation tools.