Publications by authors named "Davide Ausili"

66 Publications

Characteristics of dyadic care types among patients living with multiple chronic conditions and their informal caregivers.

J Adv Nurs 2021 Sep 6. Epub 2021 Sep 6.

Research Unit of Nursing Science, Campus Bio-Medico University of Rome, Rome, Italy.

Aims: To examine the distribution of dyadic care types in multiple chronic conditions, compare self-care and caregiver contributions to patients' self-care in each care type and identify the patient and caregiver characteristics associated with each care type.

Design: Secondary analysis of a multicentre, cross-sectional study.

Methods: Patient-caregiver dyads were enrolled from outpatient clinics and community settings. The Dyadic Symptom Management Type Scale was used to categorize dyads by type. Self-care, self-efficacy, comorbidities and cognitive impairment were measured in patients, whereas caregiver contributions to patient self-care, self-efficacy, caregiver burden and hours of caregiving were measured in caregivers. Sociodemographic characteristics perceived social support and mutuality were measured in both patients and caregivers. Univariate and multivariate analyses were performed.

Results: A sample of 541 patient-caregiver dyads was examined. The most frequent dyadic care type was the collaborative-oriented (63%). In the patient-oriented type, patients scored higher on self-care compared with caregivers; in the caregiver-oriented and collaborative types, caregivers scored higher than patients supporting the typology. The patient-oriented type was associated with younger, healthier male patients with better cognitive status, who scored higher for mutuality and whose caregivers scored lower for burden. The caregiver-oriented type was associated with older, less educated patients, with caregivers experiencing higher burden and unemployment. The collaborative type was associated with sicker patients, with the caregiver more probably to be female and employed, with higher perceived social support, mutuality and burden. The incongruent dyadic care type was associated with lower caregiver mutuality.

Impact: In the context of multiple chronic conditions, clinicians should consider targeting any educational interventions aimed at improving patient self-care and caregiver contributions to self-care by dyadic care types.
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http://dx.doi.org/10.1111/jan.15033DOI Listing
September 2021

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

Effectiveness of motivational interviewing on health-service use and mortality: a secondary outcome analysis of the MOTIVATE-HF trial.

ESC Heart Fail 2021 Aug 4;8(4):2920-2927. Epub 2021 Jun 4.

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

Aims: Intense health-care service use and high mortality are common in heart failure (HF) patients. This secondary analysis of the MOTIVATE-HF trial investigates the effectiveness of motivational interviewing (MI) in reducing health-care service use (e.g. emergency service use and hospitalizations) and all-cause mortality.

Methods And Results: This study used a randomized controlled trial. Patients and caregivers were randomized to Arm 1 (MI for patients), Arm 2 (MI for patients and caregivers), or Arm 3 (control group). Data were collected at baseline and at 3, 6, 9, and 12 months. Face-to-face MI plus three telephone calls were performed in Arms 1 and 2. The sample consisted of 510 patient (median age 74 years, 58% male patients) and caregiver dyads (median age 55 years, 75% female patients). At 12 months, 16.1%, 17%, and 11.2% of patients used health-care services at least once in Arms 1, 2, and 3, respectively, without significant difference. At 3 months, 1.9%, 0.6%, and 5.1% of patients died in Arms 1, 2, and 3, respectively. Mortality was lower in Arm 2 vs. Arm 3 at 3 months [hazard ratio (HR) = 0.112, 95% CI: 0.014-0.882, P = 0.04]; no difference was found at subsequent follow-ups. Mortality was lower in Arm 1 vs. Arm 3 at 3 months but did not reach statistical significance (HR = 0.38, 95% CI: 0.104-1.414, P = 0.15).

Conclusion: This study suggests that MI reduces mortality in patients with HF if caregivers are included in the intervention. Further studies with a stronger intervention and longer follow-up are needed to clarify the benefits of MI on health-care service use and mortality.
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http://dx.doi.org/10.1002/ehf2.13373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318502PMC
August 2021

Living with Heart Failure during the COVID-19 Pandemic: An Interpretative Phenomenological Analysis.

Clin Nurs Res 2021 09 19;30(7):1071-1078. Epub 2021 May 19.

University of Pavia, Pavia, Italy.

This study aimed to explore lived experience of patients with heart failure (HF) during the COVID-19 pandemic. A qualitative study was conducted using an interpretative phenomenological analysis (IPA). Data collection performed in March-May 2020, using in-depth, semi-structured interviews on a purposive sample. Data were analyzed according to the IPA methodology, and triangulation, bracketing, journaling, and member checking were used to assure rigor. 14 patients with HF were enrolled, and three main themes described their lived experience during the COVID-19 pandemic: Vulnerability, Hanging in the balance, and Coping strategies. These people felt particularly vulnerable to the novel virus and experienced uncertainty due to hospital organization changes. Because of this, they felt like they were hanging in the balance, experiencing various negative feelings. Nevertheless, they managed to deal with this challenging situation by implementing some peculiar coping strategies. The COVID-19 represents a significant challenge for patients with HF, impacting significantly on their lives.
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http://dx.doi.org/10.1177/10547738211016614DOI Listing
September 2021

Association between sleep quality and self-care in adults with heart failure: A systematic review.

Eur J Cardiovasc Nurs 2021 03;20(3):192–201

Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.

Background: Sleep disturbance is one of the most common symptoms among heart failure patients. Sleep disturbance reduces quality of life and leads to higher rates of mortality. It may affect the ability of patients to perform adequate self-care. Although some research has evaluated the association between sleep quality and heart failure self-care, a synthesis of the most recent available evidence is lacking.

Aims: This systematic review aimed to assess the association between sleep quality and self-care in adults with heart failure.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology was used. Medline, CINAHL, PsycINFO and SCOPUS were searched. Observational, case-control and cohort studies were considered. The quality of the studies was evaluated with the Joanna Briggs Institute's Critical Appraisal Tools.

Results: Six articles were included. Association between sleep quality and self-care was reported by three studies. One of these did not find an association between sleep disturbance and heart failure self-care, while the other two studies did. An association between sleep quality and medication adherence was reported by three studies. All three of these studies found associations between these two variables. Studies have measured similar but different constructs. Two studies assessed sleep quality, while four other studies measured excessive daytime sleepiness. Half of the studies examined self-care, while the other half measured medication adherence.

Conclusions: Although the evidence should be strengthened, sleep quality seems to affect self-care in heart failure patients. The mechanism underlying the effect of sleep quality on heart failure self-care remains unclear. Future longitudinal interaction analyses could be useful to clarify this mechanism.
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http://dx.doi.org/10.1177/1474515120941368DOI Listing
March 2021

Information before discharge in geriatric patients in Italy: cultural adaptation and validation of the Patient Continuity of Care Questionnaire.

Eur J Ageing 2021 Mar 22;18(1):99-107. Epub 2020 Jul 22.

Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy.

Our aim is to culturally adapt the first section of the Patient Continuity of Care Questionnaire (PCCQ) for use among older Italian patients with chronic diseases and to test its psychometric properties. The PCCQ was translated, adapted to the Italian context, and completed by 236 older inpatients with chronic diseases at the point of discharge through a cross-sectional multi-centre validation study. Face and content validity were assessed. Exploratory factor analysis (EFA) with Mplus MLr estimator was conducted. Internal consistency was analysed through Cronbach's alpha and factor score determinacy coefficients. The overall content validity index of the 15-item Italian version of the questionnaire was 0.9. The EFA revealed a four-factor model yielding adequate fit indices. The factor score determinacy coefficients ranged from 0.87 to 0.94. The Cronbach's alpha coefficients ranged from 0.71 to 0.86 showing good reliability. The study provides health professionals with an instrument with adequate psychometric properties to assess patients' perception of the information received before hospital discharge.
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http://dx.doi.org/10.1007/s10433-020-00576-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925798PMC
March 2021

Personal values among first-year medical and nursing students: A cross-sectional comparative study.

Nurse Educ Today 2021 May 27;100:104827. Epub 2021 Feb 27.

Department of Medicine and Surgery, University of Milano - Bicocca, Italy; ASST Monza, San Gerardo Hospital, Italy. Electronic address:

Background: Collaboration in healthcare is essential but differences in personal values can be a potential source of disagreements between physicians and nurses.

Objectives: The purpose of this study was to verify if and to what extent there were divergences in the personal values profile between medical and nursing students at the beginning of their education and training. A second aim was to explore gender differences in personal values.

Design: This is an observational cross-sectional study.

Settings: This study was conducted at one University in northern Italy.

Participants: We compared the personal values of 393 first-year medical students with those of 403 first-year nursing students.

Methods: The Portrait Values Questionnaire-40 was administered and analyses of variance were performed to assess degree group and gender differences in terms of personal values.

Results: Medical students scored significantly higher than nursing ones on values related to dominance over others and personal success. Female students significantly outscored males on personal values that reflect other-oriented and social focus, whereas male students obtained higher scores than females on personal values related to personal and selfish orientation.

Conclusions: Schwartz's Theory of Basic Human Values may be a valuable theoretical framework for interprofessional education to promote a common reflection on personal values held by medical and nursing students since the early years of study.
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http://dx.doi.org/10.1016/j.nedt.2021.104827DOI Listing
May 2021

Effectiveness of motivational interviewing on anxiety, depression, sleep quality and quality of life in heart failure patients: secondary analysis of the MOTIVATE-HF randomized controlled trial.

Qual Life Res 2021 Jul 22;30(7):1939-1949. Epub 2021 Feb 22.

Department of Medicine and Surgery, University of Milano - Bicocca, Via Cadore 48, 20900, Monza, Italy.

Purpose: Anxiety, depression, poor sleep quality and lower quality of life (QOL) are associated with worse outcomes in heart failure (HF) patients. Motivational interview (MI) has been effective in different patient populations to promote self-care. However, its effect on anxiety, depression, sleep quality and QOL in HF patients is unknown. The aim of this study was to evaluate the effect of MI on anxiety, depression, sleep quality and QOL over 12 months from the intervention.

Methods: This was a planned, secondary outcome analysis of the MOTIVATE-HF study, a three-arm randomized controlled trial (1:1:1) evaluating the effect of MI in improving self-care in HF patients. In Arm 1, the patient received MI, while in Arm 2, the patient and the caregiver received MI. Arm 3, the control group, received standard treatment. Endpoints were evaluated with the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI), the 12-Item Short-Form Health Survey (SF-12) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) every three months for one year.

Results: We enrolled and randomized 510 HF patient and caregiver dyads (155 dyads in Arm 1, 177 dyads in Arm 2, and 178 dyads in Arm 3). A total of 238 HF patients and 235 caregivers completed the 12-month trial. No significant changes were seen in anxiety, depression and sleep quality over time among the three study arms, but disease-specific QOL improved in the intervention groups, especially in Arm 2.

Conclusion: Clinicians may want to include both patients and caregivers when providing MI interventions. Further research is needed to investigate the required intensity of MI to be effective on sleep quality, anxiety and depression (ClinicalTrials.gov Identifier: NCT02894502).
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http://dx.doi.org/10.1007/s11136-021-02788-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233269PMC
July 2021

"The light at the end of the tunnel". Discharge experience of older patients with chronic diseases: A multi-centre qualitative study.

J Adv Nurs 2021 May 16;77(5):2417-2428. Epub 2021 Feb 16.

Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy.

Aim: To explore the experiences of being discharged from hospital of older patients with chronic diseases at time of discharge.

Design: Multi-centre descriptive qualitative study.

Methods: Semi-structured interviews were conducted with older patients with chronic diseases discharged from two Italian university hospitals, between March 2017 and October 2019. The interviews were audio-recorded, transcribed verbatim and analysed using inductive content analysis. Several strategies were used to ensure the credibility, dependability, confirmability, authenticity and transferability of the findings. The study was reported in accordance with Standards for Reporting Qualitative Research and Consolidated criteria for reporting qualitative research.

Results: Sixty-five patients participated in the study. Six main categories emerged: feelings, need for information, time of fragility, need for support, need for trusting relationships, and home as a caring place.

Conclusion: Older patients with chronic diseases are patients who require quality discharge planning with a patient-centred care vision. Healthcare professionals should intervene more extensively and deeply in the discharge process, balancing the patients' perception of their needs against organizational priorities and the wish to return home with that of not being abandoned.

Impact: Discharge from hospital remains an area of concern as older people have varying degrees of met and unmet needs during and following hospital discharge. Discharge is characterized by conflicting feelings of patients, who need information and support of healthcare professionals through trusting and continuous relationships. Understanding the experience of discharge is essential to support older patients with chronic diseases, considering that discharge from hospital is not an end point of care but a stage of the process involving care transition. The reframing of discharge as another transition point is crucial for healthcare professionals, who will be responsible for making their patients fit for discharge by preparing them to manage their chronic condition at home.
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http://dx.doi.org/10.1111/jan.14790DOI Listing
May 2021

Self-care and type 1 diabetes mellitus: systematic review of sex-related differences.

Panminerva Med 2021 Jan 25. Epub 2021 Jan 25.

Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.

Background: Self-care is associated with clinical outcomes of adults with T1DM. Some evidence highlighted significant sex-related differences in self-care behaviors in this population. However, the literature on this topic has not been synthesized before. This study aimed to summarize, critically review, and interpret evidence regarding sex-related differences in adults' self-care behaviors with type 1 diabetes mellitus (T1DM).

Methods: A systematic search of articles in the following databases was performed: PubMed, Scopus, Embase, and CINAHL. Articles published from 2009 to 2019 were reviewed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and flowchart were used to support the systematic review and study reporting. Two reviewers independently screened and extracted data from the included articles.

Results: From the 596 identified records, only 15 articles were included because pertinent to this review. Both females and males with T1DM must improve their ability to respond to signs and symptoms when they occur. Females are more likely to perform adequate blood glucose monitoring and adequate diet than males. In contrast, males are more likely to show more adequate levels of physical activity.

Conclusions: Clinicians should pay greater attention to supporting females with T1DM to enhance their behaviors for maintaining an adequate health status and glycemic control. Likely, greater attention is required to sustain males to monitor changes in their signs and symptoms. Self-care management should be improved in both sexes.
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http://dx.doi.org/10.23736/S0031-0808.21.04134-3DOI Listing
January 2021

The impact of the COVID-19 pandemic on people with diabetes and diabetes services: A pan-European survey of diabetes specialist nurses undertaken by the Foundation of European Nurses in Diabetes survey consortium.

Diabet Med 2021 05 30;38(5):e14498. Epub 2020 Dec 30.

King's College London, London, UK.

Aim: To describe diabetes nurses' perspectives on the impact of the COVID-19 pandemic on people with diabetes and diabetes services across Europe.

Methods: An online survey developed using a rapid Delphi method. The survey was translated into 17 different languages and disseminated electronically in 27 countries via national diabetes nurse networks.

Results: Survey responses from 1829 diabetes nurses were included in the analysis. The responses indicated that 28% (n = 504) and 48% (n = 873) of diabetes nurses felt the COVID-19 pandemic had impacted 'a lot' on the physical and psychological risks of people with diabetes, respectively. The following clinical problems were identified as having increased 'a lot': anxiety 82% (n = 1486); diabetes distress 65% (n = 1189); depression 49% (n = 893); acute hyperglycaemia 39% (n = 710) and foot complications 18% (n = 323). Forty-seven percent (n = 771) of respondents identified that the level of care provided to people with diabetes had declined either extremely or quite severely. Self-management support, diabetes education and psychological support were rated by diabetes nurse respondents as having declined extremely or quite severely during the COVID-19 pandemic by 31% (n = 499), 63% (n = 1,027) and 34% (n = 551), respectively.

Conclusion: The findings show that diabetes nurses across Europe have seen significant increases in both physical and psychological problems in their patient populations during COVID-19. The data also show that clinical diabetes services have been significantly disrupted. As the COVID-19 situation continues, we need to adapt care systems with some urgency to minimise the impact of the pandemic on the diabetes population.
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http://dx.doi.org/10.1111/dme.14498DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883040PMC
May 2021

Cross-cultural applicability of the Self-Care Self-Efficacy Scale in a multi-national study.

J Adv Nurs 2021 Feb 9;77(2):681-692. Epub 2020 Dec 9.

School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.

Aim: The Self-Care Self-Efficacy Scale (SCSES) was newly developed as a self-report measure for self-care self-efficacy for chronic illness. This study investigated its measurement equivalence (ME) in different cultural groups, including United States, China (Hong Kong), Italy, and Brazil.

Design: A multi-national study for cross-cultural validation of the Scale.

Methods: From January 2015 - December 2018, investigators recruited 957 patients (United State: 200; Hong Kong: 300; Italy: 285; and Brazil: 142) with chronic illness from inpatient and outpatient settings. The SCSES was administered and clinical and demographic data were collected from participants. Based on the Meredith framework, multi-group confirmatory factor analysis evaluated the configural, metric, scalar, and strict invariance of the scale across the four populations through a series of nested models, with evaluation of reliability and coherence of the factor solution.

Results: The mean ages of the groups ranged from 65-77 years, 56.4% was male. The Cronbach's alpha coefficients of the single-factor SCSES were 0.93, 0.89, 0.92, and 0.90 for the United States, China (Hong Kong), Italy, and Brazil, respectively. Three of the four levels of ME were partially or totally supported. The highest level achieved was partial scalar invariance level (χ [52] = 313.4, p < 0.001; RMSEA = 0.067; 95% CI = 0.056-0.077; CFI = 0.966; TLI = 0.960, SRMR = 0.080).

Conclusion: Patients from the four countries shared the same philosophical orientation towards scale items, although some of the items contributed differently to represent the concept and participants shared the same schemata for score interpretation.

Impact: Self-efficacy is important in producing effective and sustainable self-care behavioural changes. Cultural ideation shapes the ways individuals interpret and report their self-care self-efficacy. The study findings support cross-cultural and cross-national utility of the SCSES for research on self-care across United States, China (Hong Kong), Italy, and Brazil.
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http://dx.doi.org/10.1111/jan.14617DOI Listing
February 2021

Prevalence of celiac disease in Iranian patients with type 1 diabetes: A systematic review and meta-analysis.

Indian J Gastroenterol 2020 Oct 1;39(5):419-425. Epub 2020 Dec 1.

Social Determinants of Health Research Center, School of Allied Medical Sciences, Shahrekord University of Medical Sciences, Shahrekord, Iran.

Patients with type 1 diabetes mellitus (T1DM) are at high risk for celiac disease (CD) due to the common genetic background and interaction between environmental and immunological factors. The purpose of this systematic review and meta-analysis was to estimate the prevalence of CD among Iranian patients with type 1 diabetes. The search for articles was conducted using the following keywords: "celiac disease," "celiac," "coeliac disease," "diabetes," "Iran," and all other possible combinations of these terms. The following databases were searched from inception to June 2019: Scientific Information Database (SID), MagIran, Web of Science, PubMed, and Scopus. Meta-analysis was performed using the random-effects models, and the heterogeneity of results across the studies was assessed using the Cochran's Q test and quantified by the I statistic. Data analysis was performed by Stata version 14. A total of 14 papers were included in the meta-analysis, involving 2030 Iranian patients with T1DM. The pooled prevalence of CD in patients with T1DM was 5% (95% CI 3-7). The prevalence of CD in Tehran (4%; 95% CI 1-6) was lower than in other provinces of the country (6%; 95% CI 4-8). Meta-regression analysis showed that, with increasing sample size, the prevalence of  CD was significantly reduced (p = 0.018).Given the adverse effects of CD , such as osteoporosis and malignancy (especially lymphoma), patients with T1DM must be screened for CD .
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http://dx.doi.org/10.1007/s12664-020-01046-7DOI Listing
October 2020

The association of the level of self-care on adherence to treatment in patients diagnosed with type 2 diabetes.

Acta Diabetol 2021 Apr 29;58(4):437-445. Epub 2020 Nov 29.

Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland.

Aims: The study aimed to assess the impact of self-care on adherence to treatment in patients diagnosed with type 2 diabetes and effect of complex interaction of social, lifestyle, economic, environmental and behavioural.

Methods: The study was carried out between June 2018 and May 2019 on 324 patients (162 females, 162 males) with type 2 diabetes. To measure the levels of self-care, the Self-Care of Diabetes Index (SCODI) questionnaire was used. Adherence to treatment was assessed with the Adherence in Chronic Diseases Scale (ACDS).

Results: The highest scores of health behaviour were on the subscale of adherence with the mean value of 68.37, and the lowest results on the subscale of blood sugar self-monitoring, with the mean of 56.05. We found that low adherence to treatment was present in 52.47% of respondents, the moderate level in 39.20%, while only 8.33% of patients showed the high level. There were significant positive correlations between the ACDS and SCODI subscales (p < 0.05): self-care maintenance (0.436), self-care management (0.413), self-care monitoring (0.384), and self-care confidence (0.453).

Conclusions: Self-care affects on adherence in patients with type 2 diabetes. The higher self-efficacy in each of the areas of functioning, the higher the level of adherence to treatment. We found that demographic variables such as female sex, education and employment status can influence self-care in managing chronic illnesses such as type 2 diabetes.
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http://dx.doi.org/10.1007/s00592-020-01628-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053648PMC
April 2021

Self-care is Renouncement, Routine, and Control: The Experience of Adults with Type 2 Diabetes Mellitus.

Clin Nurs Res 2021 Jul 11;30(6):892-900. Epub 2020 Nov 11.

Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.

Type 2 Diabetes Mellitus can cause serious complications; it has a severe impact on the quality of life and high costs. One of the key strategies to manage diabetes is self-care, a complex multifactorial process influenced by personal, cultural, and systemic factors, that comprises self-care maintenance, self-care monitoring, and self-care management. Few patients perform adequate self-care. To deepen our understanding of patients' experiences of self-care maintenance, self-care monitoring, and self-care management, we conducted the first qualitative study on this topic. This study used Interpretive Phenomenological Analysis, informed by the Middle-range Theory of Self-care of Chronic Illness, to explore the experience and meaning of self-care maintenance, self-care monitoring, and self-care management in adults with T2DM (n = 10). Three themes were identified: self-care is renouncement, self-care is routine, and self-care is control. A cross-cutting moral pattern connects the three themes. Our findings corroborate the Middle-range Theory of Self-care of Chronic Illness in the field of diabetes self-care and could inform practitioners in understanding the experience of self-care as a complex phenomenon and in developing tailored interventions.
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http://dx.doi.org/10.1177/1054773820969540DOI Listing
July 2021

Development and Psychometric Testing of the Self-Care in COVID-19 (SCOVID) Scale, an Instrument for Measuring Self-Care in the COVID-19 Pandemic.

Int J Environ Res Public Health 2020 10 26;17(21). Epub 2020 Oct 26.

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

Aim: To develop the Self-Care in COVID-19 (SCOVID) scale and to test its psychometric characteristics in the general population.

Methods: We tested SCOVID scale content validity with 19 experts. For factorial and construct validity, reliability, and measurement error, we administered the 20-item SCOVID scale to a sample of 461 Italians in May/June 2020 (mean age: 48.8, SD ± 15.8).

Results: SCOVID scale item content validity ranged between 0.85-1.00, and the total scale content validity was 0.94. Confirmatory factor analysis supported SCOVID scale factorial validity (comparative fit index = 0.91; root mean square error of approximation = 0.05). Construct validity was supported by significant correlations with other instrument scores measuring self-efficacy, positivity, quality of life, anxiety, and depression. Reliability estimates were good with factor score determinacy, composite reliability, global reliability index, Cronbach's alpha, and test-retest reliability ranging between 0.71-0.91. The standard error of measurement was adequate.

Conclusions: The SCOVID scale is a new instrument measuring self-care in the COVID-19 pandemic with adequate validity and reliability. The SCOVID scale can be used in practice and research for assessing self-care in the COVID-19 pandemic to preventing COVID-19 infection and maintaining wellbeing in the general population.
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http://dx.doi.org/10.3390/ijerph17217834DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7663643PMC
October 2020

[Accuracy of hospital nursing documentation: a multi-center observational study].

Prof Inferm 2020 Apr-Jun;73(2):81-88

RN, MSc. Professore associato in scienze infermieristiche presso l'Università degli Studi di Milano􏰀Bicocca. Corrispondence:

Introduction: In literature it is reported that accurate nursing documentation improves patients' outcomes but nursing planning data is seldom available. The accuracy of nursing documentation in hospitals has been assessed in many healthcare settings through the detection of three key elements of nursing decision-making: diagnoses, interventions and outcomes. However, studies conducted in Italy are scant and none of them have been conducted in Lombardy Region.

Aim: the aim of this study is to assess the accuracy of nursing documentation in six hospitals. Accuracy in documentation's compilation was sought, as well as the three essential elements expected in the nursing decision-making process: diagnoses, interventions and outcomes.

Method: a multicentre retrospective observational study was conducted on a sample of 430 computerized and paper-based nursing records in surgical and medical areas. D-Catch instrument was used to evaluate documentation's accuracy. This instrument is divided into six sections, with scores ranging from one to four: a higher score corresponds to a greater accuracy of the documentation. The six sections assess whether the documentation structure and the assessment are accurate, the presence of a nursing diagnosis, the accuracy of interventions and assessments and documentation's clarity and legibility.

Results: it emerged that in the six hospitals there is a structured and personalized nursing documentation. From the 430 nursing documentations, a total of 623 nursing diagnoses were observed. Diagnoses reached an average score of 2.5, with significant differences between surgical and medical areas and between computerized and paper documentations. Interventions also showed significant differences between surgical and medical areas, and between computerized and paper documentation, with an average score of 2.04. The outcomes received the lowest scores with an average of 1.75.

Conclusions: the specific nursing data that would make the care process evident are hardly visible and, despite the nursing records of the six hospitals being oriented by a conceptual model, there is no shared terminology that helps nurses to describe univocally the care process. The introduction of a standardized nursing language and an integrated computerized medical record could help to improve the accuracy of the documentation.
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http://dx.doi.org/10.7429/pi.2020.732081DOI Listing
October 2020

Self-care in Iranian patients with diabetes: A systematic review and meta-analysis.

Prim Care Diabetes 2021 02 10;15(1):80-87. Epub 2020 Sep 10.

Spiritual Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran. Electronic address:

Objectives: Self-care is a major factor in managing diabetes. This study aimed to determine the self-care status of Iranian patients with diabetes and to estimate the percentage of self-care in these individuals through a systematic review and meta-analysis.

Methods: In this systematic review and meta-analysis 53 domestic articles published in Farsi and English were evaluated. We conducted database searches in domestic and foreign databases of Scientific Information Database (SID), MagIran, Google Scholar, Web of Science, Pub Med, and Scopus with no time limit. Data analysis was performed in Stata version 12 using meta-analysis method and the random effects model.

Results: A total of 50 articles (53 groups) with a sample size of 9565 were systematically reviewed. The percentage of self-care in patients with diabetes was reported to be 48.86 (95% confidence interval [CI]: 43.79-53.94). According to the results, the percentage of self-care score was higher in patients with type I diabetes (55.53) when compared with patients with type II diabetes (49.26).

Conclusions: Since patients with diabetes obtained only half of the self-care score and given the importance of self-care in controlling and treating diabetes, it is necessary to perform actions to improve self-care such as benefiting from health facilities, and social and family support.
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http://dx.doi.org/10.1016/j.pcd.2020.08.013DOI Listing
February 2021

Polish Adaptation of the Self-Care of Diabetes Inventory (SCODI).

Patient Prefer Adherence 2020 31;14:1341-1350. Epub 2020 Jul 31.

Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland.

Purpose: As the guidelines indicate, education and self-care in diabetic patients are essential elements in the treatment process. The efficient evaluation of the level of self-care will enable the patient's needs to be identified and education and care to be optimised. The Self-Care of Diabetes Inventory (SCODI) is a valid and reliable tool which can measure self-care behaviours among patients with diabetes. The purpose of this study was to assess the reliability of the Polish version of the SCODI.

Methods: The World Health Organization (WHO) translation protocol was used for the translation and cultural adaptation of the English version of the SCODI into Polish. The study included 276 Polish patients with type 2 diabetes (mean age 61.28±12.02 years). There were 145 men and 131 women in the study. The internal consistency of the SCODI was evaluated using Cronbach's Alpha.

Results: The original four actor tool structure was confirmed. The mean overall levels of self-care in the four SCODI scales in the study group were self-care maintenance (67.66 pts; SD=18.55), self-care monitoring (61.81 pts; SD=24.94), self-care management (54.65 pts; SD=22.98) and self-care confidence (62.86 pts; SD=20.87). The item-total correlations were positive, so there is no need to change the scales of any of the questions. The overall consistencies for individual scales were assessed using Cronbach's Alpha: self-care maintenance (0.759), self-care monitoring (0.741), self-care management (0.695) and self-care confidence (0.932). Exploratory factor analysis and item factor loadings of the individual items ranged from 0.137 to 0.886 and, with two exceptions (questions number 23 and 32), were statistically significant (p<0.05).

Conclusion: The SCODI questionnaire has acceptable internal consistency and reliability in assessing self-care among diabetic patients in the Polish population. This reliable research tool can be managed in planned studies of Polish patients with diabetes.
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http://dx.doi.org/10.2147/PPA.S253444DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402854PMC
July 2020

Perceived social support and health-related quality of life in older adults who have multiple chronic conditions and their caregivers: a dyadic analysis.

Soc Sci Med 2020 10 29;262:113193. Epub 2020 Jul 29.

Research Unit of Nursing Science, Campus Bio-medico University of Rome, Via Alvaro del Portillo, 21 00128, Rome, Italy. Electronic address:

Rationale: Patients who have multiple chronic conditions (MCCs) and their informal caregivers experience poorer health-related quality of life (HRQOL). Perceived social support has been shown to influence HRQOL.

Objectives: This study aimed at identifying the differences between patients' and caregivers' physical and mental HRQOL; and determining the association between their perception of social support from different sources, and their own and their dyad partner's HRQOL.

Method: Patients with MCCs and their caregivers (345 dyads) were enrolled in a multicenter cross-sectional study conducted in Italy. The Multidimensional Scale of Perceived Social Support measured perceived social support from family, friends, and significant others, and the 12-Item Short-Form Health Survey measured the physical and mental component of HRQOL in dyads. The dyadic analysis was conducted using the Actor-Partner Interdependence Model through structural equation modelling.

Results: Family support perceived by each member of the dyad was associated positively with their own mental HRQOL, and that family support perceived by caregivers was also associated positively with patients' mental HRQOL. Greater family support perceived by caregivers was also associated with better physical HRQOL in both caregivers and patients. Moreover, greater friend-support perceived by each member of the dyad was positively associated with own physical HRQOL.

Conclusions: The study suggests the reciprocal influence of perceived social support from family and friends on physical and mental HRQOL in MCC dyads. Healthcare professionals should identify those people who are the main sources of support for each member of the dyad, and develop care plans that promote the maintenance and enhancing of this support.
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October 2020

Psychometric characteristics of the caregiver contribution to self-care of chronic illness inventory.

J Adv Nurs 2020 Sep 21;76(9):2434-2445. Epub 2020 Jul 21.

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

Aim: The purpose of the this study was to test the factorial structure, internal consistency reliability and concurrent validity of the Caregiver Contribution to Self-Care Chronic Illness Inventory.

Background: Existing measures of caregiver contribution to self-care are disease-specific or behaviour-specific; no generic measures exist.

Design: A cross-sectional study.

Method: Between April 2017 - December 2018, we enrolled a convenience sample of 358 patients with chronic illnesses and their caregivers. Patients completed the Self-Care of Chronic Illness Inventory while caregivers completed the Caregiver Contribution to Self-Care of Chronic Illness Inventory, a modification of the Self-Care of Chronic Illness Inventory, which includes three scales as follows: the Caregiver Contribution to Self-Care Maintenance, the Caregiver Contribution to Self-Care Monitoring and the Caregiver Contribution to Self-Care Management. Of each scale, we tested the factorial structure with confirmatory factor analysis and reliability with the factor score determinacy coefficient, the global reliability index for multidimensional scale and Cronbach's alpha. Also, we used Pearson's correlations for concurrent validity purposes.

Results: Confirmatory factor analysis supported the two-factor structure of the Caregiver Contribution to Self-Care Maintenance and Management scales and the one-factor structure of the Caregiver Contribution to Self-Care Monitoring scale. A simultaneous confirmatory factor analysis on the combined set of items supported the more general model (Comparative Fit Index = 0.933). Reliability estimates ranged between 0.701 and 0.961 across the three scales. Concurrent validity of Caregiver Contribution to Self-Care of Chronic Illness Inventory with the Self-Care of Chronic Illness Inventory was not sufficiently supported since weak correlations were found.

Conclusion: The Caregiver Contribution to Self-Care of Chronic Illness Inventory is valid and reliable and can be used in clinical practice and research.

Impact: The Caregiver Contribution to Self-Care of Chronic Illness Inventory is an useful instrument to evaluate the extent to which caregivers contribute to patient self-care in chronic illnesses.
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http://dx.doi.org/10.1111/jan.14448DOI Listing
September 2020

Clinical and Socio-demographic Determinants of Self-care Maintenance, Monitoring and Management in US Adults with Type 2 Diabetes Mellitus.

Clin Nurs Res 2021 03 8;30(3):285-292. Epub 2020 Jun 8.

School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.

The aims of this study were to describe self-care in US T2DM patients and to identify clinical and sociodemographic determinants of self-care maintenance, monitoring, and management in US T2DM patients. A secondary analysis was performed using data from a cross-sectional study done to test the psychometric performance of the Self-Care of Diabetes Inventory in US English speaking adults with diabetes. In our sample ( = 207), self-care maintenance was adequately performed (median = 75), self-care monitoring was borderline (median = 67.6) and self-care management was poor (median = 55.6). Low income ( = .0019) and low self-care confidence ( < .0001) were associated with relatively lower self-care maintenance. Not taking insulin ( = .0153) and low self-care confidence ( < .0001) were associated with relatively low self-care monitoring. Low self-care confidence ( < .0001) was associated with low self-care management. Self-care confidence is a strong determinant of self-care. Interventions designed to improve self-care confidence are urgently needed.
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http://dx.doi.org/10.1177/1054773820916987DOI Listing
March 2021

How do self-care maintenance, self-care monitoring, and self-care management affect glycated haemoglobin in adults with type 2 diabetes? A multicentre observational study.

Endocrine 2020 09 5;69(3):542-552. Epub 2020 Jun 5.

Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.

Purpose: To evaluate how self-care maintenance, self-care monitoring, and self-care management affect glycated haemoglobin in type 2 diabetes mellitus patients and to set cut-off points of the Self-Care of Diabetes Inventory scales using glycated haemoglobin as outcome of interest.

Methods: A secondary analysis of a previous multicentre observational cross-sectional study was conducted. Overall, 540 adults with type 2 diabetes mellitus confirmed diagnosis were involved. Socio-demographic and clinical data were collected. Self-care maintenance, self-care monitoring, and self-care management were measured by the Self-Care of Diabetes Inventory. Linear regression models were performed to assess the relationship between self-care maintenance, self-care monitoring, and self-care management and glycated haemoglobin. Receiver operating characteristics curves were carried out to identify the best cut-off score for each self-care scale considering glycated haemoglobin >7% as outcome of interest.

Results: Self-care monitoring and self-care management were associated to glycated haemoglobin in both patients without (self-care monitoring p = 0.0008; self-care management p = 0.0178) and with insulin therapy (self-care monitoring p = 0.0007; self-care management p = 0.0224). Self-care maintenance was associated to glycated haemoglobin in patients without insulin therapy (p = 0.0118). Cut-off scores providing the best performance were 70 points for self-care maintenance and self-care monitoring, and 60 points for self-care management.

Conclusions: Self-care maintenance, self-care monitoring, and self-care management differently affect glycated haemoglobin in patients with type 2 diabetes mellitus. Clinicians could implement tailored interventions to improve glycaemic control considering the lacking area of self-care.
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http://dx.doi.org/10.1007/s12020-020-02354-wDOI Listing
September 2020

Personal values among undergraduate nursing students: A cross-sectional study.

Nurs Ethics 2020 Sep 5;27(6):1461-1471. Epub 2020 May 5.

9305University of Milano-Bicocca, Italy.

Background: Personal values influence nursing students' development of professional values, which affect professional outcomes, and how nursing students react to different situations. Personal values can be shaped by different factors, including culture, gender, and age.

Aims: To explore personal values held by nursing students, and to verify if and how gender and year of study affect nursing students' personal values.

Research Design: A multicenter, cross-sectional study was used.

Participants And Research Context: The whole population of nursing undergraduate students available at the time was recruited from eight centers of two Universities, composing a sample of 947 students. Demographic data were collected and it was administered the Portrait Values Questionnaire.

Ethical Considerations: Ethical approval was obtained from the Institutional Review Boards of the University of the participating centers.

Findings: The study sample was mainly composed of young (92.6%, n = 877), female (77.3%, n = 732), Italian (95.8%, n = 907), and unmarried (98.6%, n = 934) nursing students. The most important value for nursing students, consistently through the years of nursing school, was Self-transcendence, which has the motivational emphasis on helping others and selflessness. Then, we found that male students had higher levels of Power (p < 0.001) and Achievement (p = 0.031), while female students outscored male students in Benevolence (p = 0.005) and Security (p = 0.006). Year of study showed no statistically significant difference.

Discussion: Nursing students express high levels in hetero-directed values. Male nursing students, although they choose a stereotypically feminine profession, outscored females in stereotypical masculine values such as dominance and success. This is the first study that describes the personal value profile of undergraduate nursing students, according to the Theory of Basic Human Values, and it is a starting point for future research.

Conclusion: Nursing educators might want to consider the findings from this study while guiding students in developing awareness for their personal values.
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http://dx.doi.org/10.1177/0969733020914350DOI Listing
September 2020

Motivational interviewing to improve self-care in heart failure patients (MOTIVATE-HF): a randomized controlled trial.

ESC Heart Fail 2020 06 28;7(3):1309-1318. Epub 2020 Apr 28.

School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.

Aims: Self-care, an essential component of heart failure (HF) treatment, is inadequate in most patients. We evaluated if motivational interviewing (MI) (i) improves patient self-care maintenance (primary endpoint; e.g. taking medications), self-care management (e.g. responding to symptoms) and self-care confidence (or self-efficacy) 3 months after enrolment; (ii) changes self-care over 1 year, and (iii) augments patient self-care if informal caregivers are involved.

Methods And Results: Parallel randomized controlled trial (1:1:1). A sample of 510 patients (median 74 years, 58% male) and caregivers (median 55 years, 75% female) was randomized to Arm 1 (MI only for patients), Arm 2 (MI for patients and caregivers), or Arm 3 (usual care). The intervention in Arms 1 and 2 consisted of one face-to-face MI session with three telephone contacts. Self-care was evaluated with the Self-Care of HF Index measuring self-care maintenance, management, and confidence. Scores on each scale range from 0 to 100 with higher scores indicating better self-care; ≥70 is considered adequate. At 3 months, self-care maintenance improved 6.99, 7.42 and 2.58 points in Arms 1, 2, and 3, respectively (P = 0.028). Self-care maintenance was adequate in 18.4%, 19.4%, and 9.2% of patients in Arms 1, 2 and 3, respectively (P = 0.016). Over 1 year, self-care maintenance, management, and confidence scores in Arms 1 and 2 were significantly higher than in Arm 3 in several follow-ups. Over 1 year, Arm 2 had the best scores in self-care management.

Conclusions: MI significantly improved self-care in HF patients. Including caregivers may potentiate the effect, especially in self-care management. ClinicalTrial.gov, identifier: NCT02894502.
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http://dx.doi.org/10.1002/ehf2.12733DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261532PMC
June 2020

Depression and self-care in older adults with multiple chronic conditions: A multivariate analysis.

J Adv Nurs 2020 Jul 23;76(7):1668-1678. Epub 2020 Apr 23.

University of Pennsylvania, Philadelphia, PA, USA.

Aims: To investigate the relationship between depression and self-care behaviours in older individuals with multimorbidity.

Design: Cross-sectional study. Data were collected between April 2017 - June 2019.

Methods: Patients were enrolled from community and outpatient settings and included if they were ≥65 years, affected by heart failure, diabetes mellitus or chronic obstructive pulmonary disease and at least another chronic condition. They were excluded if they had dementia and/or cancer. Patient Health Questionnaire-9 was used to measure depression and Self-Care of Chronic Illness Inventory was used to measure self-care maintenance, monitoring, and management. The relationship between depression and self-care was evaluated by performing two sets of univariate analyses, followed by multivariate and step-down analyses. The second set was performed to control for the number of chronic conditions, age, and cognitive function.

Results: The sample (N = 366) was mostly female (54.2%), with a mean age of 76.4 years. Most participants (65.6%) had mild to very severe depressive symptoms. Preliminary analysis indicated a significant negative association between depression and self-care maintenance and monitoring and a significant negative association between depression and multivariate self-care. Step-down analysis showed that self-care maintenance was the only dimension negatively associated with depression, even after controlling for the number of chronic conditions, age, and cognitive function.

Conclusion: In multimorbid populations, depression is more likely to be associated with self-care maintenance than the other self-care dimensions. Therefore, self-care maintenance behaviours (e.g., physical activity and medication adherence) should be prioritized in assessment and focused on when developing interventions targeting depressed older adults with multimorbidity.

Impact: The results of this study may help guide clinical practice. In patients with depressive symptoms, self-care maintenance behaviours should be assessed first, as a potential first indicator of poor self-care.
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http://dx.doi.org/10.1111/jan.14385DOI Listing
July 2020

Patient and caregiver contributions to self-care in multiple chronic conditions: A multilevel modelling analysis.

Int J Nurs Stud 2021 Apr 14;116:103574. Epub 2020 Mar 14.

Campus Bio-Medico University of Rome, Rome, Italy. Electronic address:

Background: Multiple chronic conditions (MCC) are highly prevalent worldwide, especially among older populations. Patient self-care and care partner (or caregiver) contributions to self-care are recommended to reduce the impact of MCC and improve patients' outcomes.

Objectives: To describe patient self-care and care partner contributions to self-care and to identify determinants of patient self-care and care partner contributions to self-care at the patient and care partner level.

Design: Multicentre cross-sectional study.

Setting: Outpatient and community settings in Italy.

Participants: A sample of 340 patients with MCC and care partner dyads was recruited between 2017 and 2018.

Methods: We measured patient's self-care and care partner contributions to self-care in dyads using the Self-care of Chronic Illness Inventory and the Caregiver Contribution to Self-care of Chronic Illness Inventory. To control for dyadic interdependence, we performed a multilevel modelling analysis.

Results: Patients' and care partners' mean ages were 76.65 (± 7.27) and 54.32 (± 15.25), respectively. Most care partners were female and adult children or grandchildren. The most prevalent chronic conditions in patients were diabetes (74%) and heart failure (34%). Patients and care partners reported higher levels of self-care monitoring than self-care maintenance and management behaviours. Important patient clinical determinants of self-care included cognitive status, number of medications and type of chronic condition. Care partner determinants of self-care contributions included age, gender, education, perceived income, care partner burden, caregiving hours per week and the presence of a secondary care partner.

Conclusions: Our findings support the importance of taking a dyadic approach when focusing on patients with MCC and their care partners. More dyadic longitudinal research is recommended to reveal the modifiable determinants of self-care and the complex relationships between patients and care partners in the context of MCC.
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http://dx.doi.org/10.1016/j.ijnurstu.2020.103574DOI Listing
April 2021

Predictors of psychological distress amongst nursing students: A multicenter cross-sectional study.

Nurse Educ Pract 2020 Mar 13;44:102758. Epub 2020 Mar 13.

Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore, 48, 20900, Monza, MB, Italy. Electronic address:

Undergraduate nursing students show high-stress levels. In students, stress has been linked to adverse physical and psychological health outcomes and academic and clinical demands. To date, there are few studies dealing with psychological predictors of stress amongst nursing students. This study aimed to assess psychological distress in a sample of Italian nursing students and to explore its relationship with sociodemographic and psychological factors, specifically dispositional mindfulness, emotional regulation difficulties, and empathy. A multicenter cross-sectional survey design was employed. Participants were recruited from five teaching hospitals associated with a public university in northern Italy. A sample of 622 undergraduate nursing students was recruited. Participants were recruited on campus and completed a paper-and-pencil survey. More than 70% of nursing students reported meaningful levels of psychological distress. Students with higher dispositional mindfulness scores had lower psychological distress, whereas emotional regulation difficulties and empathic personal distress were positively associated with perceived stress. No gender differences were found in stress levels, but senior students showed lower psychological distress than more junior students. Interventions aimed at increasing mindfulness facets and improving emotional regulation strategies may help to reduce perceived psychological stress in nursing students.
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http://dx.doi.org/10.1016/j.nepr.2020.102758DOI Listing
March 2020

Complexity of nursing care at 24 h from admission predicts in-hospital mortality in medical units: a cohort study.

BMC Health Serv Res 2020 Mar 6;20(1):181. Epub 2020 Mar 6.

School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.

Background: The Informative System of Nursing Performance was developed to measure complexity of nursing care based on the actual interventions performed by nurses at the point of care. The association of this score with in-hospital mortality was not investigated before. Having this information is relevant to define evidence-based criteria that hospital administrators can use to allocate nursing workforce according to the real and current patients' need for nursing care. The aim of this study is to assess the association between complexity of nursing care and in-hospital mortality.

Methods: Register-based cohort study on all patients admitted to acute medical wards of a middle-large hospital in the North of Italy between January 1, 2014, to December 31, 2015 and followed up to discharge. Out of all the eligible 7247 records identified in the Hospital Discharge Register, 6872 records from 5129 patients have been included. A multivariable frailty Cox model was adopted to estimate the association between the Informative System of Nursing Performance score, both as continuous variable and dichotomized as low (score < 50) or high (score ≥ 50), and in-hospital mortality adjusting for several factors recorded at admission (age, gender, type of admission unit, type of access and Charlson Comorbidity Index).

Results: The median age of the 5129 included patients was 76 [first-third quartiles 64-84] and 2657(52%) patients were males. Over the 6872 admissions, there were 395 in-hospital deaths among 2922 patients at high complexity of nursing care (13.5%) and 74/3950 (1.9%) among those at low complexity leading to a difference of 11.6% (95% CI: 10.3-13.0%). Adjusting by relevant confounders, the hazard rate of mortality in the first 10 days from admission resulted 6 times significantly higher in patients at high complexity of nursing care with respect to patients at low complexity (hazard ratio, HR 6.58, 95%CI: 4.50;9.62, p < 0.001). The HR was lower after 10 days from admission but still significantly higher than 1. By considering the continuous score, the association was confirmed.

Conclusion: Complexity of nursing care is strongly associated to in-hospital mortality of acute patients admitted to medical departments. It predicts in-hospital mortality better than widely used indicators, such as comorbidity.
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http://dx.doi.org/10.1186/s12913-020-5038-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7059664PMC
March 2020

Adults Living With a Retro-auricular Left Ventricular Assist Device as Destination Therapy: An Interpretive Description.

J Cardiovasc Nurs 2020 Nov/Dec;35(6):E62-E69

Michela Luciani, PhD, MScN, RN Research Fellow, Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy. Alessia Martina Trenta, MScN, RN Nurse, Department of Heart Failure, Cardiology Center Monzino IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy; and PhD Student, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. Susan Michelle Jack, PhD, BScN, RN Professor, School of Nursing, McMaster University, Hamilton, Ontario, Canada. Massimo Moro, MScN, RN Nurse Director, Cardiology Center Monzino IRCCS, Milan, Italy. Sara Patella, MScN, RN Nursing Direction Staff Nurse, Cardiology Center Monzino IRCCS, Milan, Italy. Stefania Di Mauro, MScN, RN Associate Professor, Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy. Davide Ausili, PhD, MScN, RN Assistant Professor, Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.

Background: Increasingly, there is a trend toward the use of left ventricular assist devices (LVADs) for treating advanced heart failure, as both bridge-to-transplant therapy and destination therapy. Living with an LVAD profoundly influences patients' lives. Only a few study authors investigated the experience of people with abdominal LVADs, and nothing is known about the unique experience of those with retro-auricular LVADs.

Objective: The aim of this study was to explore and describe experiences and lifestyle adjustments in adults with retro-auricular LVADs implanted as destination therapy.

Methods: Interpretive description methodology was used to explore the experiences of a purposeful sample of 10 individuals with retro-auricular LVADs implanted as destination therapy. Data were collected using in-depth semistructured interviews. Data collection and analysis were simultaneous. Triangulation, journaling, and the "thoughtful clinician test" were used to increase trustworthiness of the findings.

Results: Three primary themes describing the experience of people with retro-auricular LVADs were developed: "a new life," "self-care," and "resilience"; in addition, a crosscutting theme was identified: "support system." This article focuses on the theme "a new life," described as a continuum of events. Individuals with advanced heart failure struggle with symptom burden and consider the implantation of the device as the final option to delay death; then, they wait for the surgery that represents a turning point, after which they begin to recover through a process of adjustment until they reach a new normality.

Conclusions: Living with a retro-auricular LVAD impacts every aspect of people's lives. Knowing their experiences can help clinicians to develop targeted interventions and offer tailored support.
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http://dx.doi.org/10.1097/JCN.0000000000000648DOI Listing
February 2020
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