Publications by authors named "Antonello Cocchieri"

28 Publications

  • Page 1 of 1

Translation and cross-cultural adaptation of the Clinical Care Classification system.

Int J Med Inform 2021 09 16;153:104534. Epub 2021 Jul 16.

Saint Camillus International University of Health Sciences, Via di Sant'Alessandro 8, Rome 00131, Italy.

Introduction: The Clinical Care Classification (CCC) system is one of the standard nursing terminologies recognized by the American Nurses Association, developed to describe nursing care through electronic documentation in different healthcare settings. The translation of the CCC system into languages other than English is useful to promote its widespread use in different countries and to provide the standard nursing data necessary for interoperable health information exchange. The aim of this study was to translate the CCC system from English to Italian and to test its clinical validity.

Methods: A translation with cross-cultural adaptation was performed in four phases: forward-translation, back-translation, review, and dissemination. Subsequently a pilot cross-mapping study between nursing activities in free-text nursing documentation and the CCC interventions was conducted.

Results: All elements of the CCC system were translated into Italian. Semantic and conceptual equivalences were achieved. Altogether 77.8% of the nursing activities were mapped into CCC interventions.

Conclusions: The CCC system, and its integration into electronic health records, has the potential to support Italian nurses in describing and providing outcomes and costs of their care in different healthcare settings. Future studies are needed to strengthen the impact of the CCC system on clinical practice.
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http://dx.doi.org/10.1016/j.ijmedinf.2021.104534DOI Listing
September 2021

Diabetic education in nursing: A Rodgers' evolutionary concept analysis.

Nurs Forum 2021 Jun 2. Epub 2021 Jun 2.

School of Nursing, Università Cattolica del Sacro Cuore, Rome, Italy.

Aim: This concept analysis aims to clarify the concept of diabetic education in nursing to provide guidance for the further conceptualization and clarification of diabetic education in nursing.

Background: Patient education is a fundamental component of diabetes care. Nurses have taken up a major role in educating people with diabetes to manage their conditions. However, the exact meaning of diabetic education in nursing remains challenging.

Design: Rodgers' evolutionary method of concept analysis was performed to explore the concept of diabetic education in nursing.

Data Source: We conducted a literature search on Cumulative Index to Nursing and Allied Health Literature (CINAHL), MedLine, and PsycInfo for works published until October 2020 using "patient education," "diabetes," and "nursing" as key terms.

Results: The concept analysis revealed that key attributes of diabetic education in nursing include patient-centered and interactive approaches, planning, and problem solving. Antecedents related to individuals with diabetes are their backgrounds, needs, and motivations, while the antecedents related to nurses are experience and attitude. Finally, three different consequences of the concept emerged: an increase in knowledge and skills, a behavioral change, and the improvement of clinical outcomes.
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http://dx.doi.org/10.1111/nuf.12620DOI Listing
June 2021

Knowledge of Diagnostic and Therapeutic Aspects of IBD Among Nurses Working in Digestive Endoscopy: A Nationwide Italian Survey.

Gastroenterol Nurs 2021 May-Jun 01;44(3):E59-E66

Daniele Napolitano, RN, is a research nurse and ibd-nurse, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.

The importance of inflammatory bowel disease (IBD) dedicated nurses in endoscopy services is poorly explored. Non-IBD healthcare professionals who work in endoscopy units may underestimate the discomfort and the secondary psychological distress that endoscopic procedures cause in IBD patients. We performed a nationwide survey to evaluate the level of knowledge of nurses working in endoscopy facilities throughout Italy related to IBD patients' needs undergoing endoscopic procedures. A non-validate 45 items questionnaire divided into six sections was assembled by a group of experts and supervised by nurses and IBD-physicians as part of the board of IGIBD, ANOTE-ANIGEA and AGGEI. The questionnaire was sent to 397 nurses of which 335 (84.4%) responded to the questionnaire. The median level of knowledge registered was 29 ± 12, corresponding to a medium level of knowledge based on the scores described in the method section. One hundred eighty-three nurses (54.6%) reported a high score, 113 (33.7%) a medium score, and 39 (11.6%) a low score. The majority of nurses worked in high volume endoscopy centers, where the 48% were educated in IBD management. A Low level of knowledge was recorded regarding disease severity definition, bowel preparation strategies in severe colitis and evaluation of perianal fistula. This nationwide survey clearly shows that there is a need for endoscopic nurses to acquire specific knowledge in the IBD field. Dedicated pathways for IBD management in endoscopy, continuous educational programs for nurses and further studies to improve nurse education are needed.
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http://dx.doi.org/10.1097/SGA.0000000000000593DOI Listing
June 2020

Diagnostic features of SARS-COVID-2-positive patients: A rapid review and meta-analysis.

J Clin Nurs 2021 Jul 17;30(13-14):1826-1837. Epub 2021 Feb 17.

School of Nursing, Università Cattolica del Sacro Cuore, Rome, Italy.

Aims: To identify the main diagnostic features of SARS-CoV-2-positive patients at the time of hospitalisation and their prevalence.

Background: Since the COVID-19 outbreak in China in December of 2019, several studies attempted to identify the epidemiological, viral and clinical characteristics of SARS-CoV-2. Given the rapid widespread transmission of the COVID-19 disease worldwide, a more comprehensive and up-to-date understanding of its features is needed to better inform nurses, clinicians and public health policy makers.

Methods: A rapid review and meta-analysis were carried out to identify the main diagnostic features of SARS-CoV-2-positive patients at the time of hospitalisation. All case series, cross-sectional, case-control and cohort studies published from 01/01/2020 till 30/06/2020 in English and Chinese that stated all or at least two of the outcomes of interest (clinical features, laboratory and radiological findings) were included. We performed a random-effects model meta-analysis to calculate pooled prevalence and 95% confidence intervals. Conduction of the review adheres to the PRISMA checklist.

Results: 21 studies involving 8837 patients were included in the quantitative synthesis. Fever, cough and fatigue were the most common clinical features, while the most relevant laboratory abnormalities at the time of hospitalisation were lymphopenia, elevated C-reactive protein and lactate dehydrogenase. CT images showed a bilateral lung involvement, with ground glass infiltrates and patchy shadows on most patients.

Conclusion: This review provides an up-to-date synthesis of main diagnostic features of SARS-CoV-2-positive patients at the time of hospitalisation.

Relevance To Clinical Practice: Our findings could provide guidance for nurses and clinicians to early identification of positive patients at the time of the hospitalisation through a complete definition of main clinical features, laboratory and CT findings.
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http://dx.doi.org/10.1111/jocn.15688DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014443PMC
July 2021

The awareness of the IBD nurse position among patients from an Italian tertiary IBD centre.

Prof Inferm 2020 Jun-Sep;73(3):213-218

Istituto di Patologia Speciale Medica, University Cattolica del Sacro Cuore, Rome, Italy.EMail:

Background: Inflammatory Bowel Disease (IBD) is a chronic condition characterized by acute relapses which have an important impact on the quality of life of patients, both physically and psychologically. In the personalized care of IBD patients, a key role is covered by the IBD nurse, who provides psychological and educational support, as well as a source of contact for all patients.

Aim: Aim of the present study was to assess the perception of IBD patients about roles, competences and abilities of the IBD nurses in a specialized center. This is the base for further programs aiming to improve quality of care.

Methods: A questionnaire composed of 15 statements regarding the role of the IBD nurse in their treatment was offered to all patients attending this IBD center over a 3-month period. Results were showed comparing those of patients currently receiving treatment with a biologic therapy to those receiving non-biologic therapy.

Results: Patients in this center have a poor awareness of the IBD nurse role, particularly those not receiving biologic treatment. Although most patients are aware that they can use the IBD nurse as a point of contact, the majority are not aware of the qualifications of the IBD nurse to discuss their treatment options and provide psychological support.

Conclusion: Our survey shows that the figure of the IBD nurse is still poorly recognised by patients, with a likely resultant underutilisation of the services of a highly skilled and educated professional. Several key issues for improvement for the IBD nurse service have been raised by this study and warrant similar investigation in other centres.
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http://dx.doi.org/10.7429/pi.2020.733213DOI Listing
December 2020

Meta-Synthesis of the Needs of Women Cared for by Midwives During Childbirth in Hospitals.

J Obstet Gynecol Neonatal Nurs 2021 01 17;50(1):6-19. Epub 2020 Nov 17.

Objective: To identify and meta-synthesize results of qualitative studies on the needs of women cared for by midwives during childbirth in hospitals.

Data Sources: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and the Cochrane Library.

Study Selection: We restricted the bibliographic search to articles published in English to July 31, 2020. The initial search yielded 6,407 articles, and after 2,504 duplicates were removed, we screened the titles and abstracts of 3,903 articles. We conducted a full-text review of 89 articles and included 13 qualitative studies about the needs of women who were hospitalized during childbirth and had midwives as their primary maternity care providers.

Data Extraction: We extracted data (e.g., authors, publication date, type of study, sample size, results, and quotes) from the full text of each article into a standardized table. Two authors reviewed all articles using the Critical Appraisal Skills Programme tool to assess study quality and to independently score each study.

Data Synthesis: We analyzed the findings of each study and synthesized them to develop themes. We found 14 major themes that reflected the needs of women during hospitalization for childbirth: Nutrition, Hygiene, Privacy, Information, Bodily Respect, Respect for Social Role, Family Intimacy, Shelter, Pain Management, Partnership, Movement, Reassurance, Support, and Empowerment. We categorized these themes in Maslow's hierarchy of needs to better understand the phenomenon.

Conclusion: We identified 14 needs that midwives and nurses can meet when they care for women in hospitals during childbirth. Standardized methods to assess these needs and to link them to specific interventions can be used by midwives and nurses, which will likely affect women's satisfaction with their experience and overall quality of care.
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http://dx.doi.org/10.1016/j.jogn.2020.10.005DOI Listing
January 2021

The association between personality trait and the development of postoperative complications in enterostomized patients. Systematic review of literature.

Ann Ital Chir 2020 ;91:74-87

Aim: To investigate the presence of association between the personality trait and the onset of postoperative complications in patients undergoing enterostomy packaging.

Materials And Methods: Systematic review of the literature.

Results: Type D personality traits and those with a low tendency to optimism and temperament (ex. anxiety-depressive syndrome) would seem to be associated with an increased risk of developing postoperative psychiatric morbidity and reduced levels of health-related quality of life (HRQoL) in enterostomized patients for colorectal cancer (CRC). Also, type-D personality, has been associated with greater risk of multiple comorbidities including an increased risk of heart failure unrelated to other sociodemographic causes 32-34-35. Personality with little tendency to optimism may represent a predictive factor on the development of psychological suffering one year after the diagnosis of CRC 3. Patients with personality traits associated with reduced levels of life satisfaction and / or reduced coping capacity require longer hospitalization time 26.

Discussion: Several studies highlight the presence of association between personality traits oriented to performance, persistence and extroversion and outcomes in various areas of surgery 14,2,-27,30. However, in almost all cases, the outcomes measured do not correspond to the early post-operative complications defined in the inclusion criteria but to mediumlong term psychological and rehabilitative outcomes.

Conclusions: From the review study, no sources were found concerning the association between the personality trait and the onset of early postoperative complications in enterostomised patients, highlighting, furthermore, a lack of data on the subject involving the entire field of abdominal surgery.

Key Words: Personality trait, Enterostomy, Post-operative complications.
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January 2021

Enhancing the performance of predictive models for Hospital mortality by adding nursing data.

Int J Med Inform 2019 05 26;125:79-85. Epub 2019 Feb 26.

Saint Camillus International University of Health Sciences, Via di Sant'Alessandro, 8, 00131 Rome, Italy. Electronic address:

Background: Mortality is the most considered outcome for assessing the quality of hospital care. However, hospital mortality depends on diverse patient characteristics; thus, complete risk stratification is crucial to correctly estimate a patient's prognosis. Electronic health records include standard medical data; however, standard nursing data, such as nursing diagnoses (which were considered essential for a complete picture of the patient condition) are seldom included.

Objective: To explore the independent predictive power of nursing diagnoses on patient hospital mortality and to investigate whether the inclusion of this variable in addition to medical diagnostic data can enhance the performance of risk adjustment tools.

Methods: Prospective observational study in one Italian university hospital. Data were collected for six months from a clinical nursing information system and the hospital discharge register. The number of nursing diagnoses identified by nurses within 24 h after admission was used to express the nursing dependency index (NDI). Eight logistic regression models were tested to predict patient mortality, by adding to a first basic model considering patient's age, sex, and modality of hospital admission, the level of comorbidity (CCI), and the nursing and medical condition as expressed by the NDI and the All Patient Refined-Diagnosis Related Group weight (APR-DRGw), respectively.

Results: Overall, 2301 patients were included. The addition of the NDI to the model increased the explained variance by 20%. The explained variance increased by 56% when the APR-DRGw, CCI, and NDI were included. Thus, the latter model was nearly highly accurate (c = 0.89, 95% confidence interval: 0.87-0.92).

Conclusion: Nursing diagnoses have an independent power in predicting hospital mortality. The explained variance in the predictive models improved when nursing data were included in addition to medical data. These findings strengthen the need to include standardized nursing data in electronic health records.
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http://dx.doi.org/10.1016/j.ijmedinf.2019.02.009DOI Listing
May 2019

[Development and implementation of pediatric and neonatal nursing information system in an hospital setting: the pediatric PAI].

Ig Sanita Pubbl 2018 Jul-Aug;74(4):315-328

Direttore delle Professioni Sanitarie, Fondazione Policlinico A. Gemelli, Roma, Italia.

The Professional Assessment Instrument (PAI) is a clinical nursing information system used in the adult inpatient units of the A. Gemelli university hospital in Rome (Italy). The PAI allows for the systematic collection of nursing care data in order to improve the quality of care. So far, few clinical nursing information systems have been developed in the neonatal and pediatric care setting. The aim of this study is to describe the development and implementation of a clinical nursing information system (PAIped) for the neonatal and pediatric care setting.

Methods: The Patient-and Family-Centered Care model was used to develop the contents of the PAIped. A web platform application was developed for the PAIped. The standard nursing terminology Clinical Care Classification System was used. A decisionmaking support system was developed within the PAIped to support nurses in making diagnoses and in selecting the most appropriate nursing interventions.

Results: A clinical nursing information system using a standard nursing terminology was developed in the pediatric and neonatal care setting. After a test phase, the PAIped was implemented in all the pediatric and neonatal inpatient units of the A. Gemelli university hospital.

Conclusion: The development and implementation of the PAIped in the A. Gemelli university hospital allowed the monitoring of nursing care processes and accurate nursing documentation.
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October 2019

Nursing Diagnoses as Predictors of Hospital Length of Stay: A Prospective Observational Study.

J Nurs Scholarsh 2019 01 9;51(1):96-105. Epub 2018 Nov 9.

Adjunct Professor, School of Nursing, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.

Purpose: To investigate whether the number of nursing diagnoses on hospital admission is an independent predictor of the hospital length of stay.

Design: A prospective observational study was carried out. A sample of 2,190 patients consecutively admitted (from July to December 2014) in four inpatient units (two medical, two surgical) of a 1,547-bed university hospital were enrolled for the study.

Methods: Data were collected from a clinical nursing information system and the hospital discharge register. Two regression analyses were performed to investigate if the number of nursing diagnoses on hospital admission was an independent predictor of length of stay and length of stay deviation after controlling for patients' sociodemographic characteristics (age, gender), clinical variables (disease groupers, disease severity morbidity indexes), and organizational hospital variables (admitting inpatient unit, modality of admission).

Findings: The number of nursing diagnoses was shown to be an independent predictor of both the length of stay (β = .15; p < .001) and the length of stay deviation (β = .19; p < .001).

Conclusions: The number of nursing diagnoses is a strong independent predictor of an effective hospital length of stay and of a length of stay longer than expected.

Clinical Relevance: The systematic inclusion of standard nursing care data in electronic health records can improve the predictive ability on hospital outcomes and describe the patient complexity more comprehensively, improving hospital management efficiency.
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http://dx.doi.org/10.1111/jnu.12444DOI Listing
January 2019

Nursing Diagnoses, Interventions, and Activities as Described by a Nursing Minimum Data Set: A Prospective Study in an Oncology Hospital Setting.

Cancer Nurs 2019 Mar/Apr;42(2):E39-E47

Author Affiliations: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy (Drs Sanson, Vellone, Maurici, D'Agostino and Alvaro); University of Colorado College of Nursing, Aurora (Dr Welton); and University Hospital Agostino Gemelli, Rome, Italy (Drs Cocchieri and Zega).

Background: Oncological diseases affect the biopsychosocial aspects of a person's health, resulting in the need for complex multidisciplinary care. The quality and outcomes of healthcare cannot be adequately assessed without considering the contribution of nursing care, whose essential elements such as the nursing diagnoses (NDs), nursing interventions (NIs), and nursing activities (NAs) can be recorded in the Nursing Minimum Data Set (NMDS). There has been little research using the NMDS in oncology setting.

Objective: The aim of this study was to describe the prevalence and distribution of NDs, NIs, and NAs and their relationship across patient age and medical diagnoses.

Methods: This was a prospective observational study. Data were collected between July and December 2014 through an NMDS and the hospital discharge register in an Italian hospital oncology unit.

Results: On average, for each of 435 enrolled patients, 5.7 NDs were identified on admission; the most frequent ND was risk for infection. During the hospital stay, 16.2 NIs per patient were planned, from which 25.2 NAs per day per patient were delivered. Only a third of NAs were based on a medical order, being the highest percentage delivered on nursing prescriptions. The number of NDs, NIs, and NAs was not related to patient age, but differed significantly among medical diagnoses.

Conclusions: An NMDS can depict patient needs and nursing care delivered in oncology patients. Such data can effectively describe nursing contribution to patient care.

Implications For Practice: The use of an NMDS raises the visibility of nursing care in the clinical records. Such data enable comparison and benchmarking with other healthcare professions and international data.
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http://dx.doi.org/10.1097/NCC.0000000000000581DOI Listing
February 2020

Neonatal intensive care parent satisfaction: a multicenter study translating and validating the Italian EMPATHIC-N questionnaire.

Ital J Pediatr 2018 Jan 5;44(1). Epub 2018 Jan 5.

Plymouth University, Faculty of Health and Human Sciences, School of Nursing and Midwifery, Plymouth, UK.

Background: In Neonatal Intensive Care Units (NICUs), parent satisfaction and their experiences are fundamental to assess clinical practice and improve the quality of care delivered to infants and parents. Recently, a specific instrument, the EMpowerment of PArents in THe Intensive Care-Neonatology (EMPATHIC-N), has been developed in the Netherlands. This instrument investigated different domains of care in NICUs from a family-centered care perspective. In Italy, no rigorous instruments are available to evaluate parent satisfaction and experiences in NICU with family-centered care. The aim of this study was to translate and validate the EMPATHIC-N instrument into Italian language measuring parent satisfaction.

Methods: A psychometric study was conducted in nine Italian NICUs. The hospitals were allocated across Italy: four in the North, four in Central region, one in the South. Parents whose infants were discharged from the Units were enrolled. Parents whose infants died were excluded.

Results: Back-forward translation was conducted. Twelve parents reviewed the instrument to assess the cultural adaptation; none of the items fell below the cut-off of 80% agreement. A total of 186 parents of infants who were discharged from nine NICUs were invited to participate and 162 parents responded and returned the questionnaire (87%). The mean scores of the individual items varied between 4.3 and 5.9. Confirmatory factor analysis was performed and all factor loadings were statistically significant with the exception of item 'Our cultural background was taken into account'. The items related to overall satisfaction showed a higher trend with mean values of 5.8 and 5.9. The Cronbach's alpha's (at domain level 0.73-0.92) and corrected item-total scale correlations revealed high reliability estimates.

Conclusions: The Italian EMPATHIC-N showed to be a valid and reliable instrument measuring parent satisfaction in NICUs from a family-centered care perspective. Indeed, it had good psychometric properties, validity, and reliability. Furthermore, this instrument is fundamental for further research and internationally benchmarking.
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http://dx.doi.org/10.1186/s13052-017-0439-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756347PMC
January 2018

[Standardization of data collection in midwifery care: a literature review].

Ig Sanita Pubbl 2017 Jul-Aug;73(4):311-324

Professore Associato in Scienze Infermieristiche, Dipartimento di Biomedicina e Prevenzione, Università degli studi di Roma Tor Vergata, Italia.

Introduction: midwifery records currently do not systematically collect data regarding midwifery care provided. Midwifery Minimum Data Sets (MMDS) have been developed to perform uniform and standardized data collection.

Aim: to describe features, purposes and use of MMDSs in obstetrical care.

Method: a literature review was conducted using Medline, CINAHL and Scopus databases. The following key words were used: "data set", "midwifery" and "maternity care.

Results: twelve of 752 potentially eligible articles were included. Six MMDS were identified: Nurse - Midwifery Clinical Data Set, Optimality Index-United States, ACNM Benchmarking Data Collection Form, Midwives Alliance of North America Data Set, American Association of Birth Centers Uniform Data Set, Women's Health Care Minimum Data Set. Overall, the purpose of the different MMDSs was to record systematically the midwifery care provided and patient outcomes. The various MMDS had differing features; different data were collected related to women (e.g. socio-demographic data, anamnesis), their newborns (e.g. Apgar score, weight) and the midwifery care provided in different phases (e.g. antepartum, intrapartum). Generally, MMDS were used in north-American countries and their use showed the efficacy of midwifery interventions and the importance of systematic data collection.

Discussion: an organized and standardized approach is needed to provide accurate data collection of maternal and neonatal health outcomes and midwifery care. The development and validation of MMDS in the Italian context is needed.
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October 2019

Patterns of self-care and clinical events in a cohort of adults with heart failure: 1 year follow-up.

Heart Lung 2018 Jan - Feb;47(1):40-46. Epub 2017 Oct 18.

Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. Electronic address:

Background: Heart failure (HF) self-care is important in reducing clinical events (all-cause mortality, emergency room visits and hospitalizations). HF self-care behaviors are multidimensional and include maintenance (i.e. daily adherence behaviors), management (i.e. symptom response behaviors) and consulting behaviors (i.e. contacting a provider when appropriate). Across these dimensions, patterns of successful patient engagement in self-care have been observed (e.g. successful in one dimension but not in others), but no previous studies have linked patterns of HF self-care to clinical events.

Objectives: To identify patterns of self-care behaviors in HF patients and their association with clinical events.

Methods: This was a prospective, non-experimental, cohort study. Community-dwelling HF patients (n = 459) were enrolled across Italy, and clinical events were collected one year after enrollment. We measured dimensions of self-care behavior with the Self-Care of HF Index (maintenance, management, and confidence) and the European HF Self-care Behavior Scale (consulting behaviors). We used latent class mixture modeling to identify patterns of HF self-care across dimensions, and Cox proportional hazards modeling to quantify event-free survival over 12 months of follow-up.

Results: Patients (mean age 71.8 ± 12.1 years) were mostly males (54.9%). Three patterns of self-care behavior were identified; we labeled each by their most prominent dimensional characteristic: poor symptom response, good symptom response, and maintenance-focused behaviors. Patients with good symptom response behaviors had fewer clinical events compared with those who had poor symptom response behaviors (adjusted hazard ratio = 0.66 [0.46-0.96], p = 0.03). Patients with poor symptom response behaviors had the most frequent clinical events. Patients with poor symptom response and those with maintenance-focused behaviors had a similar frequency of clinical events.

Conclusions: Self-care is significantly associated with clinical events. Routine assessment, mitigation of barriers, and interventions targeting self-care are needed to reduce clinical events in HF patients.
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http://dx.doi.org/10.1016/j.hrtlng.2017.09.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6497061PMC
December 2017

Prevalence of nursing diagnoses as a measure of nursing complexity in a hospital setting.

J Adv Nurs 2017 Sep 27;73(9):2129-2142. Epub 2017 Mar 27.

University Hospital Agostino Gemelli, Rome, Italy.

Aims: To describe the prevalence of nursing diagnoses on admission among inpatient units and medical diagnoses and to analyse the relationship of nursing diagnoses to patient characteristics and hospital outcomes.

Background: Nursing diagnoses classify patients according to nursing dependency and can be a measure of nursing complexity. Knowledge regarding the prevalence of nursing diagnoses on admission and their relationship with hospital outcomes is lacking.

Design: Prospective observational study.

Methods: Data were collected for 6 months in 2014 in four inpatient units of an Italian hospital using a nursing information system and the hospital discharge register. Nursing diagnoses with prevalence higher or equal to 20% were considered as 'high frequency.' Nursing diagnoses with statistically significant relationships with either higher mortality or length of stay were considered as 'high risk.' The high-frequency/high-risk category of nursing diagnoses was identified.

Results: The sample included 2283 patients. A mean of 4·5 nursing diagnoses per patient was identified; this number showed a statistically significant difference among inpatient units and medical diagnoses. Six nursing diagnoses were classified as high frequency/high risk. Nursing diagnoses were not correlated with patient gender and age. A statistically significant perfect linear association (Spearman's correlation coefficient) was observed between the number of nursing diagnoses and both the length of stay and the mortality rate.

Conclusion: Nursing complexity, as described by nursing diagnoses, was shown to be associated with length of stay and mortality. These results should be confirmed after considering other variables through multivariate analyses. The concept of high-frequency/high-risk nursing diagnoses should be expanded in further studies.
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http://dx.doi.org/10.1111/jan.13285DOI Listing
September 2017

[Definition and variables of complexity of nursing care: a literature review].

Ig Sanita Pubbl 2016 May-Jun;72(3):233-48

RN, PhD Direttore delle Professioni sanitarie, Policlinico A. Gemelli, Roma, Italia.

Complexity of nursing care represents an important indicator in the planning and management of nursing resources and healthcare management. However, the term is not clearly defined in the literature. The aim of this article is to outline the main concepts associated with complexity of nursing care, trying to shed light on the different variables that constitute it. We conducted a review of the literature and selected 12 articles. The terms associated with the concept of complexity of nursing care include nursing intensity, nursing work, nursing workload, patient acuity and severity of illness. The literature review indicates that complexity of nursing care appears to be one of the variables of care intensity, the latter being defined as a commitment of care delivered to the patient. It is associated with the concepts of nursing work, nursing workload, patient acuity and severity of illness. Understanding and clarifying the concept of complexity of care is fundamental in order to measure and evaluate the real demand for nursing care by individual patients.
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February 2017

Nursing diagnoses and theoretical frameworks in neonatal units: a literature review.

Prof Inferm 2016 Jan-Mar;69(1):44-55

RN, MSN Associate Professor, Department of Biomedicine and Prevention,University of Rome Tor Vergata, Rome, Italy.

Aim: To identify nursing diagnoses and theoretical frameworks used in neonatal units through a literature review.

Method: Cinahl, Medline and Lilacs, database were used to perform this study. The descriptors used were: "Nursing Diagnosis" AND "Models, Nursing" OR "Nursing Theory" AND "Infant" OR "Newborn". The search was limited to articles published from 2000 to November 2013. Studies were selected only if they were written in English, Spanish, Portuguese and Italian.

Results: In the literature review two taxonomies and six major theoretical frameworks were identified. The most frequently detected nursing diagnoses were: activity intolerance, impaired spontaneous ventilation, ineffective breathing pattern, risk for aspiration, delayed growth and development, Ineffective breastfeeding, Ineffective infant feeding pattern, hyperthermia / hypothermia, risk for infection, impaired tissue integrity, Interrupted family processes, risk for impaired parenting, risk for impaired attachment, interrupted family processes. Diagnoses applying to parents' psychosocial sphere were identified, enabling the newborn's integral evaluation, including the family.

Conclusions: Nursing diagnoses provide nurses working in neonatal units the opportunity of an effective management of the care process as well as the availability of the needed data in order to continuously improve a quality-based nursing care. The use of one model or more reference models represents a way to help professional action.
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http://dx.doi.org/10.7429/pi.2016.6910044DOI Listing
February 2017

A Dyadic Approach to Managing Heart Failure With Confidence.

J Cardiovasc Nurs 2015 Jul-Aug;30(4 Suppl 1):S64-71

Karen S. Lyons, PhD Associate Professor, School of Nursing, Oregon Health & Science University, Portland, OR, USA. Ercole Vellone, PhD, RN Research fellow, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy. Christopher S. Lee, PhD, RN, FAHA, FAAN Associate Professor, School of Nursing, Oregon Health & Science University, Portland. Antonello Cocchieri, PhD, RN Consultant, Nursing Service, Catholic University, Rome, Italy. Julie T. Bidwell, BSN, RN PhD Student, School of Nursing, Oregon Health & Science University, Portland. Fabio D'Agostino, PhD, RN Research fellow, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy. Shirin O. Hiatt, MPH, MS, RN Research Associate, School of Nursing, Oregon Health & Science University, Portland. Rosaria Alvaro, MSN, RN Associate Professor, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy. Raul Juarez Vela, PhD, RN Research Fellow, Faculty of Health Sciences, University San Jorge, Zaragoza, Spain. Barbara Riegel, PhD, RN, FAHA, FAAN Professor, School of Nursing, University of Pennsylvania, Philadelphia.

Background: The majority of heart failure (HF) self-care research remains focused on patients, despite the important involvement of family caregivers. Although self-care confidence has been found to play an important role in the effectiveness of HF self-care management on patient outcomes, no known research has examined self-care confidence within a dyadic context.

Objective: The purpose of this study was to identify individual and dyadic determinants of self-care confidence in HF care dyads.

Methods: Multilevel modeling, which controls for the interdependent nature of dyadic data, was used to examine 329 Italian HF dyads (caregivers were either spouses or adult children).

Results: Both patients and caregivers reported lower-than-adequate levels of confidence, with caregivers reporting slightly higher confidence than patients. Patient and caregiver levels of confidence were significantly associated with greater patient-reported relationship quality and better caregiver mental health. Patient confidence in self-care was significantly associated with patient female gender, nonspousal care dyads, poor caregiver physical health, and low care strain. Caregiver confidence to contribute to self-care was significantly associated with poor emotional quality of life in patients and greater perceived social support by caregivers.

Conclusions: Findings are supportive of the need for a dyadic perspective of HF self-care in practice and research as well as the importance of addressing the needs of both members of the dyad to maximize optimal outcomes for both.
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http://dx.doi.org/10.1097/JCN.0000000000000234DOI Listing
March 2016

Patterns and predictors of patient and caregiver engagement in heart failure care: a multi-level dyadic study.

Int J Nurs Stud 2015 Feb 13;52(2):588-97. Epub 2014 Nov 13.

University of Pennsylvania, Philadelphia, PA, USA.

Background: Heart failure is a burdensome clinical syndrome, and patients and their caregivers are responsible for the vast majority of heart failure care.

Objectives: This study aimed to characterize naturally occurring archetypes of patient-caregiver dyads with respect to patient and caregiver contributions to heart failure self-care, and to identify patient-, caregiver- and dyadic-level determinants thereof.

Design: Dyadic analysis of cross-sectional data on patients and their caregivers.

Setting: Outpatient heart failure clinics in 28 Italian provinces.

Participants: 509 Italian heart failure patients and their primary caregivers.

Methods: Multilevel and mixture modeling were used to generate dyadic averages and incongruence in patient and caregiver contributions to heart failure self-care and identify common dyadic archetypes, respectively.

Results: Three distinct archetypes were observed. 22.4% of dyads were labeled as novice and complementary because patients and caregivers contributed to different aspects of heart failure self-care that was generally poor; these dyads were predominantly older adults with less severe heart failure and their adult child caregivers. 56.4% of dyads were labeled as inconsistent and compensatory because caregivers reported greater contributions to the areas of self-care most insufficient on the part of the patients; patients in these dyads had the highest prevalence of hospitalizations for heart failure in the past year and the fewest limitations to performing activities of daily living independently. Finally, 21.2% of dyads were labeled as expert and collaborative because of high contributions to all aspects of heart failure self-care, the best relationship quality and lowest caregiver strain compared with the other archetypes; patients in this archetype were likely the sickest because they also had the worst heart failure-related quality of life.

Conclusion: Three distinct archetypes of dyadic contributions to heart failure care were observed that represent a gradient in the level of contributions to self-care, in addition to different approaches to working together to manage heart failure. Interventions and clinical programs that involve heart failure dyads should tailor strategies to take into consideration these distinct archetypes and their attributes.
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http://dx.doi.org/10.1016/j.ijnurstu.2014.11.005DOI Listing
February 2015

Describing self-care in Italian adults with heart failure and identifying determinants of poor self-care.

Eur J Cardiovasc Nurs 2015 Apr 23;14(2):126-36. Epub 2013 Dec 23.

Department of Biomedicine and Prevention, Faculty of Medicine, University of Rome Tor Vergata, Italy

Background: Self-care improves outcomes in patients with heart failure; however, no studies have been conducted on this topic in Italy.

Aims: We aimed to describe self-care in Italian adults with heart failure and to identify sociodemographic and clinical determinants of self-care.

Methods: A cross-sectional design was used to study 1192 heart failure patients enrolled across Italy. We measured self-care using the Self-Care of Heart Failure Index version 6.2, which measures self-care maintenance, management and confidence. Sociodemographic and clinical data were tested as potential determinants of self-care.

Results: The mean age of the sample was 72 (SD = 11) years; 58% were male. In the three areas of self-care, scores ranged from 53.18 to 55.26 and few people were adequate in self-care (14.5% to 24.4% of the sample). Self-care behaviours particularly low in this population were symptom monitoring, exercise, use of reminders to take medicines and symptom recognition. Confidence in the ability to keep oneself free of symptoms and relieve symptoms was low. Taking fewer medications, poor cognition, older age, having a caregiver, being male and having heart failure for a shorter time predicted poor self-care maintenance. Poor cognition, not being employed, being male, and having worse New York Heart Association class predicted poor self-care management. Poor cognition, taking fewer mediations, older age, and male gender predicted poor self-care confidence.

Conclusion: Self-care is poor in Italian heart failure patients. Determinants of poor self-care identified in this study can help to target patients' education. Male gender and poor cognition were consistently associated with poor self-care maintenance, management and confidence.
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http://dx.doi.org/10.1177/1474515113518443DOI Listing
April 2015

[Educational interventions in patients with heart failure: a review of the literature].

Ig Sanita Pubbl 2013 Sep-Oct;69(5):557-74

Dipartimento Cardiovascolare, U.O. Chirurgia Vascolare, A.O. Cannizzaro Catania.

Patient education is recognized as a central component of heart failure care and reduces hospital readmissions. Nurses have an important role in providing patient education and modifying self-care behaviors. The aim of this article is to examine characteristics of educational interventions for heart failure patients, their measured outcomes and the role of nurses in providing education. We conducted a literature review of the last 10 years and considered 30 articles. Multisession motivational interventions, repeated over time and with different follow-up interventions seem to produce the best results. However, some aspects remain controversial.
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September 2014

Hospital discharge: results from an Italian multicenter prospective study using Blaylock Risk Assessment Screening Score.

Int J Nurs Knowl 2014 Feb 3;25(1):14-21. Epub 2013 Dec 3.

Biella Hospital, University of "Piemonte Orientale", Biella, Italy.

Purpose: To analyze the predictive validity and reliability of the Blaylock Risk Assessment Screening Score (BRASS) Index in a large group of patients.

Methods: Prospective multicenter observational study was conducted in six Italian hospitals. Data were collected in three phases.

Findings: Seven hundred eleven patients were recruited. The mean length of hospitalization for low-risk patients was significantly shorter than those in the medium and high-risk groups. Patients with a BRASS Index lower than 10, unlike those with a higher BRASS Index, were mainly discharged home.

Conclusions: Our results indicate that the BRASS Index is useful to identify patients at risk for prolonged hospitalization.

Clinical Relevance: The use of a validated BRASS instrument can be useful to screen the patients, improving individual discharge planning.
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http://dx.doi.org/10.1111/2047-3095.12016DOI Listing
February 2014

Effects of self-care on quality of life in adults with heart failure and their spousal caregivers: testing dyadic dynamics using the actor-partner interdependence model.

J Fam Nurs 2014 Feb 4;20(1):120-41. Epub 2013 Nov 4.

1Tor Vergata University, Rome, Italy.

Emotions are contagious in couples. The purpose of this study was to analyze the manner in which adults with chronic heart failure (HF) and their informal caregivers influence each other's self-care behavior and quality of life (QOL). A sample of 138 HF patients and spouses was enrolled from ambulatory centers across Italy. The Actor-Partner Interdependence Model (APIM) was used to analyze dyadic data obtained with the Self-Care of Heart Failure Index (SCHFI), the Caregivers Contribution to the SCHFI, and the Short Form 12. Both actor and partner effects were found. Higher self-care was related to lower physical QOL in patients and caregivers. Higher self-care maintenance in patients was associated with better mental QOL in caregivers. In caregivers, confidence in the ability to support patients in self-care was associated with improved caregivers' mental QOL, but worsened physical QOL in patients. Interventions that build the caregivers' confidence are needed.
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http://dx.doi.org/10.1177/1074840713510205DOI Listing
February 2014

The European Heart Failure Self-care Behaviour Scale: new insights into factorial structure, reliability, precision and scoring procedure.

Patient Educ Couns 2014 Jan 25;94(1):97-102. Epub 2013 Sep 25.

Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy.

Objective: To evaluate a new factorial structure of the European Heart Failure Self-care Behaviour Scale 9-item version (EHFScBS-9), and to test its reliability, floor and ceiling effect, and precision. To propose a new 0-100 score with a higher score meaning better self-care.

Methods: A sample of 1192 Heart Failure (HF) patients (mean age 72 years, 58% male) was enrolled. Psychometric properties of the EHFScBS-9 were tested with confirmative factor analysis, factor score determinacy, determining the floor and ceiling effect, and evaluating the precision with the standard error of measurement (SEM) and the smallest real difference (SRD).

Results: We identified three well-fitting factors: consulting behaviour, autonomy-based adherence, and provider-based adherence (comparative fit index=0.96). Reliability ranged from 0.77 to 0.95. The EHFScBS-9 showed no floor and ceiling effect except for the provider-based adherence which had an expected ceiling effect. The SEM and the SRD indicated good precision of the EHFScBS-9.

Conclusion: The new factorial structure of the EHFScBS-9 showed supportive psychometric properties.

Practice Implications: The EHFScBS-9 can be used to compute a total and specific scores for each identified factor. This may allow more detailed assessment and tailored interventions to improve self-care. The new score makes interpretation of the EHFScBS-9 easier.
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http://dx.doi.org/10.1016/j.pec.2013.09.014DOI Listing
January 2014

Psychometric testing of the Self-Care of Heart Failure Index Version 6.2.

Res Nurs Health 2013 Oct 7;36(5):500-11. Epub 2013 Jul 7.

Department of Biomedicine and Prevention, University Tor Vergata, Via Montpellier, 1, Rome 00133, Italy.

The Self-Care of Heart Failure Index Version 6.2 (SCHFI v.6.2) is widely used, but its psychometric profile is still questioned. In a sample of 659 heart failure patients from Italy, we performed confirmatory factor analysis (CFA) to test the original construct of the SCHFI v.6.2 scales (Self-Care Maintenance, Self-Care Management, and Self-Care Confidence), with limited success. We then used exploratory factor analysis to determine the presence of separate scale dimensions, followed by CFA in a separate sub-sample. Construct validity of individual scales showed excellent fit indices: CFI = .92, RMSEA = .05 for the Self-Care Maintenance Scale; CFI = .95, RMSEA = .07 for the Self-Care Management Scale; CFI = .99, RMSEA = .02 for the Self-Care Confidence scale. Contrasting groups validity, internal consistency, and test-retest reliability were supported as well. This evidence provides a new understanding of the structure of the SCHFI v.6.2 and supports its use in clinical practice and research.
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http://dx.doi.org/10.1002/nur.21554DOI Listing
October 2013

Structural equation model testing the situation-specific theory of heart failure self-care.

J Adv Nurs 2013 Nov 21;69(11):2481-92. Epub 2013 Mar 21.

School of Nursing, University Tor Vergata, Rome, Italy.

Aim: To test the situation-specific theory of heart failure self-care with structural equation modelling.

Background: Several authors have proposed theories on heart failure self-care, but only the situation-specific theory of heart failure self-care by Riegel and Dickson is focused on the process that patients use to perform self-care. This theory has never been tested with structural equation modelling.

Design: A secondary analysis of data from a cross-sectional study.

Methods: Patients with heart failure were recruited in 21 cardiovascular centres across Italy during 2011. Data were collected with a sociodemographic questionnaire, chart abstraction for clinical data and the Self-Care of Heart Failure Index v.6.2.

Results: A sample of 417 participants was enrolled in the study (59% males, mean age 72 years). The following propositions were tested and supported: Symptom monitoring correlates with treatment adherence; symptom monitoring and treatment adherence have a direct, positive relationship with symptom recognition and evaluation that in turn have a direct, positive relationship with treatment implementation; treatment implementation has a direct, positive relationship with treatment evaluation. In addition, the following three relationships were found: Symptom monitoring has a direct, positive relationship with treatment implementation; symptom recognition and evaluation have direct, positive relationships with treatment evaluation and symptom monitoring correlates with treatment evaluation. [Correction added on 9th April 2013, after first online publication: '…symptom monitoring correlates with treatment implementation.' has been corrected to read '…symptom monitoring correlates with treatment evaluation.']

Conclusion: The data support the situation-specific theory of heart failure self-care with the addition of three new relationships that emerged from the analysis. Results of this study lend further support to the use of the situation-specific theory of heart failure self-care in research and practice.
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http://dx.doi.org/10.1111/jan.12126DOI Listing
November 2013

Validity and reliability of the caregiver contribution to self-care of heart failure index.

J Cardiovasc Nurs 2013 May-Jun;28(3):245-55

School of Nursing, University Tor Vergata, Rome, Italy.

Background: Caregivers make an important contribution to the self-care of patients with heart failure (HF), but few instruments are available to measure this contribution.

Objective: The objective of this study was to test the psychometric properties of the Caregiver Contribution to Self-care of Heart Failure Index (CC-SCHFI), an instrument derived from the Self-care of Heart Failure Index version 6.2. The CC-SCHFI measures the contribution of caregivers to the self-care maintenance and self-care management of HF patients, as well as their confidence in their ability to contribute to the patients' HF self-care.

Methods: A cross-sectional design was used to study 291 Italian caregivers whose HF patients were cared for in 17 cardiovascular centers across Italy. Caregivers completed the CC-SCHFI and a sociodemographic questionnaire. Caregivers were retested on the CC-SCHFI 2 weeks later to assess test-retest reliability.

Results: Most caregivers were women (66%) with a mean age of 59 years. First- and second-order confirmatory factor analysis (CFA) for each CC-SCHFI scale showed good model fit: χ2 = 37.22, P = .08, Comparative Fit Index (CFI) = 0.97, Non-Normed Fit Index (NNFI) = 0.96 for caregiver contribution to self-care maintenance (second-order CFA); χ2 = 14.05, P = .12, CFI = 0.96, NNFI = 0.93 for caregiver contribution to self-care management (first-order CFA); and χ2 = 10.63, P = .15, CFI = 0.99, NNFI = 0.98 for caregiver confidence in contributing to self-care (second-order CFA). The CC-SCHFI was able to discriminate statistical and clinical differences between 2 groups of caregivers who had received or not received HF self-care education. Internal consistency reliability measured by factor score determinacy was more than .80 for all factors and scales except for 1 factor in the caregiver contribution to self-care management scale (.65). Test-retest reliability computed by intraclass correlation coefficient was high (>0.90) for most factors and scales.

Conclusion: The CC-SCHFI showed good psychometric properties of validity and reliability and can be used to measure the contribution of caregiver to HF patient self-care.
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http://dx.doi.org/10.1097/JCN.0b013e318256385eDOI Listing
October 2013

Positive and negative impact of caregiving to older adults: a structural equation model.

Prof Inferm 2011 Oct-Dec;64(4):237-48

University Tor Vergata, School of Nursing, Rome, Italy.

Caregivers represent an important source of care for older adults. Many studies focused on the negative aspects of elder caregiving but few studies have analyzed also the positive effects. In addition, no studies have considered contemporarily the positive and the negative impact of caregiving to elderly people on the same people using a structural equation modeling. The purpose of this study was to examine the contribution of elder care recipient factors, caregiver factors and caregiving factors in determining the positive and negative impact of informal caregiving to older adults using a structural equation model. A cross-sectional design was used to study eighty caregivers of older people. Several instruments were used to measure elder care recipient factors (functionality, cognition, behavior); caregiver factors (socio-demographics, depression, stress, quality of life, and perceived health); caregiving factors (time from caregiving, time of care, social restriction, place of living, expenses, and living with the elder care recipient); and the positive and the negative impact of caregiving. Caregivers were 59.7 years old while elderly people were 84.0. Several factors were significantly correlated with the positive and negative impact of caregiving. However, when these factors were entered in a structural equation model, only female gender and social restriction predicted the negative impact, while caregiver's quality of life and caregiving expenses predicted both the positive and the negative impact. The results of this study suggest a new framework of caregiving to older adults where the outcomes depend more on caregiver and caregiving factors than on older person characteristics. More research is needed with a larger sample to test further the model outlined in this study.
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April 2013
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