Scenario® - Il Nursing nella sopravvivenza
SCENARIO®. Il Nursing nella sopravvivenza (ISSN 1592-5951; ISSN Online 2239-6403) is the official journal of Aniarti (Italian Association Critical Care Nurses - www.aniarti.it). The journal publishes in Italian, although articles in English are accepted; the journal encourages contributions from international collaborators and researchers from all specialisations involved in the care of the critically ill; authors are invited to submit manuscripts for peer-review. SCENARIO®. Il Nursing nella sopravvivenza publishes original articles, review articles, case reports, short reports, guest editorials, letters to editors, and editorials related to the practice, teaching and environment of nursing and the practice of evidence-based care.
The first Urban Search and Rescue (USAR) Tuscany mission for the earthquake in Turkey: the perception of the work of a mixed team and nursing care provided directly under the rubble in the red zone
Introduction: the study focuses on emergency response in urban settings, with particular attention to integrating Firefighters and Medical Components into a single team, known as USAR (Urban Search and Rescue)After the team's training in Tuscany, there was an opportunity to apply the skills acquired during the earthquake in Turkey in February 2023. Materials and Methods: a specific questionnaire was used to assess the perception of work within a multidisciplinary team and the benefits of advanced healthcare in rescuing people trapped under rubble. Additionally, the questionnaire investigated the need for improvements after the first experience of the Tuscan USAR team in Turkey. Results: the results of the study highlighted the importance of the role of nurses within the USAR team and the psychological support provided during stressful and uncertain situations. Furthermore, the group benefited from the communication skills of emergency nurses, which contributed to concentration and efficiency. It was also observed that less experienced members of the team showed a greater predisposition to burnout syndrome, emphasizing the importance of ongoing training and skill development. Conclusions: In conclusion, the healthcare operator with USAR training was considered crucial in rescuing people trapped under rubble. However, deficiencies in the preparation of the USAR team and the need for further training to address extreme scenarios emerged. Additionally, psychological support and non-technical skills of emergency nurses were found to be fundamental.
Copyright (c) 2026 The Author(s) https://creativecommons.org/licenses/by-nc/4.0
Quality management, clinical risk, and accreditation: the role of scientific societies and the specialist nurse
Quality and patient safety currently represent the foundation of the effectiveness of healthcare systems and constitute an indispensable strategic pillar for all healthcare organizations. They are key indicators of the ability to respond to population health needs in an appropriate, safe, and sustainable manner. Within this context, clinical governance emerges as the conceptual framework that integrates clinical accountability, performance evaluation, risk management, continuing professional development, and active engagement of healthcare professionals. It is not merely an organizational model, but rather a cultural approach that requires methodological rigor, advanced competencies, and a systemic vision capable of overcoming the fragmentation of care processes. Within the clinical governance framework, clinical risk management plays a central role. It enables structured analysis of care processes, identification of critical issues, assessment of adverse events and near misses, and the implementation of measurable and evidence-based improvement actions. The Italian regulatory framework has progressively consolidated this approach: Law No. 24/2017 recognized patient safety as an integral component of the right to health and as a shared responsibility between professionals and healthcare organizations, while Legislative Decree No. 502/1992 and Ministerial Decree No. 70/2015 established quality-, transparency-, and appropriateness-oriented standards and accreditation requirements. [...]
Copyright (c) 2025 The Author(s) https://creativecommons.org/licenses/by-nc/4.0
Detection of risk factors for the development of catheter-related bloodstream infections and catheter-related thrombosis in patients with peripherally inserted central venous catheters: a scoping review
Introduction: in recent decades, the Peripherally Inserted Central Venous Catheter (PICC) has been recognized as an effective and safe vascular access device. Despite the great advantages, PICC are not free from complications. The most common complications include Catheter-Related Bloodstream Infections (CRBSI) and Catheter-Related Venous Thrombosis (CRT). The literature still lacks a comprehensive synthesis of the multiple factors associated with these complications and shows considerable heterogeneity in CRBSI and CRT rates. This scoping review aims to identify the causes that determine the onset of complications. Materials and Methods: the following databases were consulted: PubMed, CINAHL, Scopus and Web of Science. Study selection and data extraction were performed independently by two authors. Results: 19 final articles allowed us to identify factors related to the implant, the patient or the management that affect the onset of complications. Insertion technique, choice of vascular device, patient pathology and therapy were found to be key factors in the development of complication rates. Discussion: Knowledge of the root causes of PICC complications is essential to improve clinical practice and patient outcomes. Further studies are needed to analyze how the experience of implanters affects complications.
Peripherally inserted central venous catheter
The thousand faces of the critical area: the roots
Modern nursing has its roots in often dramatic historical experiences: battlefields, theaters of war, and contexts characterized by scarcity of resources, poverty, and high mortality rates. The evolution of the discipline is closely intertwined with these events, particularly with war and emergency scenarios. The wars of the 19th and 20th centuries, despite their drama, represented moments of development and experimentation with clinical, care, and organizational techniques.[...]
Mapping the skills of emergency room nurses at the Mantua ASST: designing the tool and method for cataloging knowledge and skills
Introduction: mapping the skills of healthcare professionals plays a central role in quality assurance systems as it allows for the evaluation of staff and planning of professional development through the identification of skills and knowledge. The aim of the present work was the creation of a skills mapping tool for the Emergency Department (ED) nurse of the ASST of Mantua in order to have a vision of the knowledge and skills of the nursing group that allows to orient and develop training paths by developing the potential of the group. Materials and Methods: a narrative review of the literature was performed to identify existing mappings of the skills of the ED nurse. A skills map was then created using the mappings found in the literature. The mapping was reviewed by a panel of experts, who evaluated each item using a score ranging from 0 to 2 (0: item inconsistent with the context, 1: not very coherent, 2: coherent). The skills were then divided into ‘basic skills’ (skills to be acquired as a priority for a new employee) and ‘expert skills’ (skills that can be acquired through experience, clinical practice and time) through a focus group. Results: five mappings from international literature were identified. No mappings of emergency nurse skills were identified in Italy. A mapping was created using the Royal College of Nursing mapping subdivision. The skills were divided into three main sections: core skills, transversal skills and specific emergency care skills. For each of these sections, the domains were then identified, represented by the integration of two components (knowledge and skills), and the items from the narrative review documents were placed within these. The 276 items of the mapping were reviewed by an expert panel of 12 professionals. 9 items were found to be reformulated, 1 item to be eliminated and 11 items to be added. In a second review with the expert panel, all 20 added and reformulated items reached an average between 1.6 and 2. The focus group was formed by 5 professionals from the expert panel who identified 190 ‘basic’ items and 92 ‘expert’ items. Discussion: the mapping created was calibrated on the ED of the ASST of Mantua and is therefore a situated context. In fact, the skills are closely connected to the context in which they are applied. The method used, however, allows a common vision in identifying the skills. Continuous review and updating of the standards will also be necessary to ensurethat practice develops in line with the context of care.
The role of caring nurse in the emergency department: a descriptive analysis of patient satisfaction in the waiting area
Introduction: overcrowding and staff shortages in Emergency Departments negatively affect waiting times, the perceived quality of care, and the safety of healthcare professionals. The introduction of the caring nurse, dedicated to providing information and emotional support to patients in the waiting room, may improve the care experience. Materials and Methods: this descriptive observational study was conducted in December 2024 at the Emergency Department of a university hospital in Lombardy, Italy. Adult patients triaged with a priority code between 3 and 5 and managed by the caring nurse were invited to complete a satisfaction questionnaire. Results: during the study period, 4,613 patients were registered at triage, and 330 (7.1%) completed the questionnaire. The majority of patients (86.7%) perceived a high level of availability from the caring nurse, and 75.8% reported having received support in understanding the assigned triage code. Among the 164 open-ended responses analyzed, 124 expressed appreciation for the caring nurse, particularly highlighting professionalism, empathy, and clarity; whereas only 40 comments pointed out critical issues such as prolonged waiting times, insufficient information, and limited understanding of the clinical pathway. Conclusions: the findings highlight the value of the caring nurse in improving the patient experience in the Emergency Department waiting area by addressing informational, emotional, and care-related needs. However, the success of this intervention depends on appropriate organizational support and resource allocation.
Out-of-hospital cardiac arrest: a retrospective study in the population of Modena
Introduction: cardiac arrest is the third leading cause of death in industrialized countries and in Italy it affects about 60,000 people every year. It is a time-dependent pathology, therefore, the timeliness of the actions that form the "chain of survival" is essential: early access, early CPR (Cardio-pulmonary Resuscitation), early defibrillation, early advanced care. The ERC guidelineshighlight how the first 2 links in the chain are essential to increase the chances of survival by up to four times, as well as avoiding or delaying the onset of anoxic brain damage. The study aims to analyze out-of-hospital cardiac arrest in the area of Modena in 2022, assessing the frequency of patients who received chest compressions from bystanders and the frequency of patients who received resuscitation maneuvers only from healthcare professionals. The frequency of patients resuming spontaneous cardiac circulation (Return Of Spontaneous Circulation, ROSC) was also evaluated, dividing the ROSCs according to the intervention or not of bystanders. Materials and Methods: data on cardiac arrests was collected by examining patient records relating to the interventions of 16 nursing ambulances and 5 medical ambulances from Modena and its province. All the files relating to the missions of the ambulances of the volunteers of Modena and its province and the nursing ambulances present in the urban area of Modena have been omitted from the search as they intervene in conjunction with an advanced rescue vehicle. The variables taken in consideration were: age, sex, assessmentode, subject performing resuscitation maneuvers, rhythm of onset, place of the event. Results and Conclusions: the results of the study show that the percentage of ROSC in patients who received an early massage from bystanders is 12% higher than in patients who received resuscitation maneuvers exclusively from healthcare personnel (26% vs 14%), emphasizing the importance of training and first aid courses aimed at citizens, regardless of age.
Return Of Spontaneous Circulation (ROSC)
HumanITA-ICUs: humanizing Italian intensive care units. A survey study protocol
Introduction: in recent years, humanizing care in Intensive Care Units (ICSs) has become a focal point of research worldwide. Key determinants for improving ICU experiences include patient-centred factors (sleep, pain, PTSD prevention), family involvement (visitation policies, communication), and healthcare professional well-being (training, emotional support). This study aims to study the organizational and behavioral characteristics related to humanization and comfort in Italian ICUs. Materials and Methods: a national cross-sectional survey, based on a specific framework, will be conducted from December 2024 to June 2025, involving ICUs’ head nurses across Italy. Results: the study will provide a detailed overview of organizational and behavioral practices in Italian ICUs, identifying regional and structural variations, highlighting limitations, and outlining future projects to improve clinical, behavioral, and organizational practices. Conclusions: the national analysis of organizational and behavioral aspects related to humanization in Italian ICUs will focus on the experiences of patients, families, and healthcare professionals. These findings will help to identify best practices and areas requiring improvement, supporting training and organizational interventions to foster a new approach to intensive care.
The many faces of critical care: history, present and future
[...] Critical care is much more than a healthcare discipline: it is a crossroads between advanced technology, timely decisions and humanity that can never be put on the back burner. In intensive care units, emergency rooms, resuscitation rooms and on the street, nurses face scenarios every day where life and death hang in the balance. Every intervention in critical care can become a race against time. Staff must master cutting-edge equipment, apply complex protocols and make decisions, sometimes in a matter of seconds. But the technical aspect, however essential, is only part of the picture. Behind every beeping monitor, behind every emergency manoeuvre, there is a patient, a person with a history and emotions. [...]
Use of video training in continuous education in critical care: a scoping review
Introduction: multimedia technology is increasingly used in healthcare education. During the pandemic, videos and web-based simulations supported clinical training and were later implemented in hospital and university settings. The literature highlights that video, when integrated into traditional training, enhance procedural learning and allow for the standardization of competencies. However, their use in critical care settings remains underexplored. This study investigates video training as an educational tool in this context. Materials and Methods: a scoping review was conducted using PRISMA guidelines within PubMed, Cinahl, and Scopus (2019-2024), including studies on the use of video training for critical care healthcare professionals while excluding simulation-based studies. Three researchers independently assessed study eligibility, analyzing setting, training objectives, content, and outcomes. Results: a total of 20 studies were selected, with 16 focused on nurses. The primary settings were intensive care units (n=12) and neonatal intensive care units (n=6). Videos were mostly integrated into structured training programs (n=11), recorded lectures (n=4), or online platforms (n=3). Training was predominantly delivered online (n=13). Videos proved effective in improving knowledge and clinical skills, particularly when combined with other educational methods. Conclusions: video training in critical care is a valuable educational tool, especially if integrated with classical training methods. Further research is needed to assess its impact on clinical practice.
Proposta di uno schema decisionale per la classificazione del trasporto su strada in biocontenimento mediante l’impiego di un isolatore
Introduzione: il trasporto su strada in biocontenimento è essenziale per la gestione di pazienti affetti da patologie altamente trasmissibili, tuttavia nella letteratura civile mancano strumenti decisionali standardizzati a supporto dei trasferimenti su strada. Questo studio si propone di sviluppare un modello operativo per supportare le decisioni cliniche e logistiche in tali trasporti. Materiali e Metodi: è stato elaborato uno schema decisionale attraverso un'analisi retrospettiva di 1.994 trasferimenti effettuati in regime di biocontenimento in Sicilia tra dicembre 2020 e marzo 2022. Le variabili principali includevano le condizioni del paziente, l’impiego di dispositivi di supporto vitale e le caratteristiche logistiche del trasferimento. Il modello è stato perfezionato attraverso briefing strutturati post-missione, arrivando a classificare i trasferimenti in tre livelli di complessità (C1-C3) in base a criteri clinici e logistici. Risultati: i pazienti sono stati classificati in funzione della capacità di camminare, della necessità di monitoraggio o supporto vitale e del rischio infettivo. Sono stati identificati 590 trasferimenti ad alta complessità eseguiti mediante l’utilizzo di isolatori, mentre 1.403 casi a bassa complessità sono stati gestiti con un minibus di biocontenimento. Non sono stati registrati guasti alle apparecchiature critiche. Lo schema decisionale ha supportato una pianificazione coerente e ha migliorato la sicurezza operativa. Discussione: Il confronto con le principali raccomandazioni presenti in letteratura ha confermato la validità del modello e ha messo in evidenza criticità operative come la comunicazione inefficace e l’integrazione delle apparecchiature. Si propone l'integrazione dell’indice NEWS2 per migliorare la classificazione del rischio clinico. Conclusioni: lo schema decisionale proposto fornisce uno strumento riproducibile per classificare la complessità del trasporto sanitario in biocontenimento. È necessaria una validazione prospettica del modello al fine di garantirne l’applicabilità in contesti sanitari più ampi.
How to write a successful conference abstract: a practical guide and a few tips
Writing an abstract for a conference may seem a complex task, especially for beginners or those lacking specific academic training or experience. However, with a clear and structured approach, it is possible to create an effective abstract that captures the scientific committee’s and conference participants’ attention. The abstract serves as the “showcase” of a scientific study, a kind of business card that introduces readers to the study’s content and stimulates their initial interest. A well-written abstract provides a clear and accurate summary of the work and highlights the study’s importance, attracting potential collaborators and sparking scientific discussion.1,2 Presenting research findings at conferences is not only an opportunity to share knowledge but also represents a significant recognition of the nursing profession in defining and enhancing its professional context. Disseminating the results of clinical studies and projects helps to consolidate the role of nurses as professionals engaged in research and innovation, improving healthcare quality, advancing the discipline, and becoming key references in specific clinical, educational, and organizational areas. In this editorial, we provide a practical guide for writing an abstract, highlighting key elements to include and offering practical tips to improve structure and content quality. The goal is to present research clearly and convincingly and to actively contribute to the sharing of experiences and the growth of the nursing community.[...]
Translation and reliability of the Richmond Agitation-Sedation Scale in an Italian neurological intensive care unit: a pilot study
Introduction: among patients with acquired brain injuries, agitation is a frequent behavioral problem, which often requires the use of sedation. The Richmond Agitation-Sedation Scale (RASS) is commonly used to assess the level of alertness and agitated behavior in critically ill patients. The aims of this study were to translate the RASS into Italian and to test its interrater reliability among sedated patients in an Italian neurological Intensive Care Unit (nICU). Materials and Methods: a translation (I-RASS) of the RASS from English into Italian was carried out. The inter-rater reliability testing was conducted in an Italian nICU. From May 2022 to October 2024, 21 sedated patients were included and evaluated using the I-RASS by four investigators; the inter-rater reliability was tested using intraclass correlation coefficient (ICC) and Fleiss’ kappa statistics. Results: the I-RASS was found to be satisfactory and well applicable in a nICU. When tested for inter-rater reliability, ICC and Fleiss’ kappa were compatible with a substantial agreement among investigators (ICCs = 0.9786; ICCa = 0.9946; k=0.769). In addition, a post-hoc analysis on traumatic brain injury (TBI) patients was performed. Conclusions: the I-RASS, showing excellent inter-rater reliability values, can be useful for sedation and agitation assessment purposes in Italian nICUs.
Open intensive care: are we still in doubt?
We receive several papers from colleagues on this topic, and we have contributed as many. It is a subject that has been dear to us for many years, I would say about twenty. But what are open intensive care units? Open ICUs are a care model in which intensive care units allow more flexible access to patients' relatives, promoting a more human and person-centred approach. This model contrasts with the traditional rigidity of visiting hours in closed intensive care units[...].
Nursing telephone follow-up and outcomes in heart failure patients: a retrospective observational study
Introduction: Heart Failure (HF) is associated with high rates of rehospitalization and mortality. Nursing telephone follow-up is rec- ognized as effective in ensuring adequate continuity of care and reducing post-discharge complications. Objective: to evaluate the impact of a nurse-led telephone follow-up program on reducing hospital readmissions and mortality at 6 and 12 months after hospital discharge for HF. Materials and Methods: the retrospective observational cohort study was conducted at the Cardiology outpatient clinic of a spoke hospital in northeastern Italy. Two groups of patients with heart failure (HF) were compared, one of which underwent telephone fol- low-up. Results: in the first 6 months, the group without follow-up had an average of 0.56 hospital readmissions compared to 0.2 in the fol- low-up group (P=0.004). Six-month mortality was 20% in the group without follow-up and 4% in the follow-up group (P=0.014). Between 7 and 12 months, differences in readmissions and mortality were not statistically significant. Conclusions: telephone follow-up conducted by trained nursing staff, aimed at comprehensive care including symptom monitoring and nursing coaching, during the 6 months following hospitalization for acute HF has a significantly positive impact on the number of hospital readmissions and mortality.
Back to basics: caring trajectories and opportunities in the emergency department
Dear Editor, The Italian nursing community has been engaged in a lively debate regarding specialized competencies for some time now. This discussion has led to the emergence of dedicated movements, reflections on professional development opportunities, and controversies among different professional communities. While the authors remain skeptical about the widespread applicability of so-called "specialized competencies," they are nonetheless enthusiastic supporters of the concept. This is despite the evident imbalance caused by the lack of career progression in clinical practice, which is well-structured in more advanced countries such as Spain and the United Kingdom but remains insufficiently addressed by the new Collective Agreement. Despite significant differences in educational backgrounds and training, professionals have been treated equally in terms of responsibilities and remuneration for decades.[...]
Improve continuity of care through the use of a checklist for Nurse-To-Nurse Handover with SBAR method in Intensive Care. A single-center observational study
Introduction: the World Health Organization promotes the SBAR (Situation Background Assessment Recommendation) method as a standard for handover communication between healthcare professionals. However, in Intensive Care Units (ICUs), there is no universally shared checklist to guide nursing handovers. This study aims to implement an SBAR-based checklist and evaluate its adherence within the sample, as well as measure the effectiveness of a dedicated training program. Materials and Methods: this is a monocentric observational study with a four-phase design, involving a sample of 28 ICU nurses. Results: the checklist showed an adherence rate of 68% (n=407). The training program demonstrated a significant increase in the nurses' knowledge (pre-training mean: 6.2; post-training mean: 8.5; p=0.02). Discussion: the adoption of the checklist, supported by a tailored training course, facilitated a more standardized handover process. It guided nurses in conveying critical patient information in the ICU, improving the completeness of the information shared and reducing the risk of errors. Conclusion: The implemented checklist proves to be a promising tool for ensuring continuity of care and patient safety in the ICU, underscoring the importance of training for its effective implementation
Use of intraosseous access in clinically deteriorated patients admitted in general wards: a scoping review protocol
Introduction: Intraosseous (IO) access is a non-collapsible vascular access technique primarily used in emergency and urgent care settings. However, its utilisation and potential usefulness in general hospital wards remain unclear. The aim of this scoping review protocol is to map the available evidence on the use of IO access in hospitalised patients experiencing sudden clinical deterioration. The aim is to investigate what evidence is available on intraosseous access in patients with clinical deterioration admitted to ordinary wards. Materials and Methods: the databases PubMed, CINAHL, Scopus, Embase, Web of Science, Cochrane, Open Dissertations, and CENTRAL will be searched. The review will include quantitative, qualitative, and mixed-method studies, literature reviews, grey literature, as well as guidelines and recommendations from scientific societies. The review will be conducted following JBI guidelines, and the selection process will be illustrated using the PRISMA flow diagram. The findings will be presented descriptively, incorporating graphs and figures where appropriate, in accordance with PRISMA-ScR guidelines. Conclusions: this scoping review may identify gaps in the existing literature and contribute to defining future research directions.
Improving healthcare processes through lean methodology: the case of the Orbetello emergency department
Introduction: there is an increasing need to ensure a patient-centered approach that defines the most suitable pathway for each patient from the first contact. In the Orbetello Emergency Room (ER), a passive waiting period often occurred between the triage phase and the blood test procedure, negatively impacting patients' length of stay in the ER. This problem led to the development of a Lean improvement project. Materials and Methods: a structured project was carried out following the Lean methodology, aiming to eliminate the waiting time between triage and blood sampling and, consequently, reduce the length of stay in the ER. Results: the project allowed for a reorganization of the blood testing process in the ER, reducing passive waiting times and patients’ overall length of stay. Discussion: to improve the quality of care provided in the ER, it is essential to rethink the organization of processes to reduce waiting times and waste, placing the patient at the center of the organizational structure. Conclusions: the implemented Lean project fostered greater awareness among the entire ER medical and nursing team about the importance of continuously working on and revising processes for ongoing improvement.
The effects of the introduction of the single-family room in neonatal intensive care and paediatric intensive care on the outcomes of paediatric patients, families, staff, and organizations: a mixed method systematic review protocol
Introduction: the design of neonatal and paediatric neonatal intensive care significantly impacts the outcomes of the families, workers, and organizations. The aim of this review is to identify the effects of the introduction of the single-family room in neonatal intensive care and paediatric intensive care on the outcomes of paediatric patients, families, staff, and organizations. Materials and Methods: we structured this work as a systematic review, registered on PROSPERO (CRD42024501520). This review has been developed using Joanna Briggs Institute recommendations. The database search will include PubMed, CINAHL, SCOPUS, EMBASE, PsycINFO, Web of Science. Documents published in English, Italian and Spanish from 2009 will be included. Results: the results of this review will provide insights on the effects of the introduction of single-family room assessment. This could help nursing stakeholders to effectively evaluate and eventually plan the transition to single-family room assessment to ensure quality of care, user and staff satisfaction. Discussion: the introduction of single-family room structure plays a pivotal role in family involvement and active participation in their child’s care. Also, this requires modifications in healthcare professionals’ way of approaching and planning patient care. Considering the importance and the substantial changes that single-family room could bring to patients, families, staff and organizational outcomes, this review may provide important insights for the introduction of single-family room on patients, families, staff, and organizations building a rationale on the introduction of this new organizational structure.