Publications by authors named "Valentina Zeffiro"

11 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijmedinf.2021.104534DOI Listing
September 2021

Characteristics of Patients Who Do Not Respond to Motivational Interviewing for Heart Failure Self-care.

J Cardiovasc Nurs 2021 Jul 23. Epub 2021 Jul 23.

Michael A. Stawnychy, PhD, CRNP Postdoctoral Research Fellow, School of Nursing, University of Pennsylvania, Philadelphia. Valentina Zeffiro, PhD, RN Postdoctoral Research Fellow, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. Paolo Iovino, MSN, RN PhD student, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy, and School of Nursing, Midwifery and Paramedicine Faculty of Health Science, Australian Catholic University, Melbourne, Australia. Ercole Vellone, PhD, RN, FAAN, FESC Associate Professor in Nursing Science, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. Barbara Riegel, PhD, RN, FPCNA, FAHA, FAAN Edith Clemmer Steinbright Professor of Gerontology, School of Nursing, University of Pennsylvania, Philadelphia, and Professorial Fellow, Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.

Background: Motivational interviewing (MI) improves heart failure (HF) self-care for most yet fails to work for some patients. Identifying patients less likely to benefit from MI would save time in identifying a more suitable treatment for these patients.

Objective: The aim of this study was to identify the characteristics of adults with HF less likely to clinically improve self-care after MI.

Methods: This was a secondary intervention group analysis (n = 230) of MOTIVATional intErviewing to improve self-care in Heart Failure patients (MOTIVATE-HF), a trial evaluating MI in improving HF self-care maintenance and management. Self-care was measured with the Self-care of Heart Failure Index v. 6.2 at baseline and 3 months from enrollment. Participants were dichotomized into MI nonresponder (standardized score change <8 points) or MI responder (score change ≥8 points). Logistic regression, adjusted for group differences, identified determinants of nonresponse (odds ratio [95% confidence interval]).

Results: Significant risk factors for self-care maintenance nonresponse 3 months after the intervention were nonischemic HF (2.58 [1.33-5.00], P = .005) and taking fewer medications (0.83 [0.74-0.93], P = .001). These variables explained 29.6% of the variance in HF self-care maintenance. Risk factors for self-care management nonresponse were living alone (4.33 [1.25-14.95], P = .021) and higher baseline self-care management (1.06 [1.02-1.09], P < .001), explaining 35% of the variance in HF self-care management.

Conclusions: Motivational interviewing may be less beneficial in patients with nonischemic HF and taking fewer medications. Patients with HF living alone with relatively better self-care management may be at risk for MI treatment failure. Identifying characteristics of nonresponders to MI in HF contributes to clinical decision making and personalized interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JCN.0000000000000840DOI Listing
July 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ehf2.13373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318502PMC
August 2021

The influence of dyadic congruence and satisfaction with dyadic type on patient self-care in heart failure.

Eur J Cardiovasc Nurs 2021 03;20(3):268–275

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

Background: Chronic illness management is increasingly carried out at home by individuals and their informal caregivers (dyads). Although synergistic in concept, the nuances of dyadic congruence in caring for patients with heart failure are largely unexamined.

Aims: The purpose of this study was to examine the role of dyadic-type congruence on patient self-care (maintenance, symptom perception, and management) while controlling for actor and partner effects.

Methods: This secondary data analysis of 277 dyads consisted of a series of multilevel models to examine the impact of dyadic congruence on a patient's self-care maintenance, symptom perception, and self-care management. Patient-level and caregiver-level data were input into each model simultaneously to account differential appraisals of factors related to the dyad.

Results: Bivariate analyses yielded dyad congruence which was associated with better patient self-care maintenance, symptom perception and management. However, after multilevel models were constructed, dyad congruence was found to be a significant predictor of patient's symptom perception scores, but not self-care maintenance or management scores. Caregiver's satisfaction with the dyad was differentially and significantly associated with self-care - it was inversely associated with patient self-care maintenance and positively associated with patient self-care management.

Conclusion: This is the first study, to our knowledge, reporting that congruence in heart failure dyads is associated with better patient symptom perception and this advances our prior hypothesis that dyad typologies could be used to predict patient self-care performance. Since symptom perception is the key to preventing heart failure exacerbation, screening heart failure patient and caregiver dyads for congruence is important in clinical settings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1474515120960002DOI Listing
March 2021

The Self-Care of Heart Failure Index version 7.2: Further psychometric testing.

Res Nurs Health 2020 12 3;43(6):640-650. Epub 2020 Nov 3.

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

Clinicians and researchers need valid and reliable instruments to evaluate heart failure (HF) self-care. The Self-Care of Heart Failure Index (SCHFI) is a theoretically driven instrument developed for this purpose. The SCHFI measures self-care with three scales: self-care maintenance, measuring behaviors to maintain HF stability; symptom perception, measuring monitoring behaviors; and self-care management, assessing the response to symptoms. After the theory underpinning the SCHFI was updated, the instrument was updated to version 7.2 but it was only tested in the United States. In this study we tested the psychometric characteristics (structural and construct validity, internal consistency, and test-retest reliability) of the SCHFI v.7.2 in an Italian population of HF patients. We used a cross-sectional design to study 280 HF patients with additional data collected after 2 weeks for test-retest reliability. Adults with HF (mean age 75.6 (±10.8); 70.8% in New York Heart Association [NYHA] classes II and III) were enrolled from six centers across Italy. Confirmatory factor analysis showed supportive structural validity in the three SCHFI v.7.2 scales (CFI from 0.94 to 0.95; RMSEA from 0.05 to 0.07). Internal consistency reliability estimated with Cronbach's α and composite reliability ranged between .73 and .88; test-retest reliability ranged between 0.73 and 0.92. Construct validity was supported with significant correlations between the SCHFI v.7.2 scale scores and quality of life, brain natriuretic peptide levels and NYHA class. This study further supports the psychometric characteristics of the SCHFI v.7.2, illustrating that it can be used in clinical practice and research also in an Italian population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/nur.22083DOI Listing
December 2020

Predictive factors of a prolonged length of stay in a community Nursing-Led unit: A retrospective cohort study.

J Clin Nurs 2020 Dec 4;29(23-24):4685-4696. Epub 2020 Oct 4.

UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy.

Aims And Objectives: To describe the care provided to patients admitted into a community Nursing-Led inpatient unit and to identify factors predicting a length of stay exceeding an established threshold.

Background: Few studies have been conducted to describe the care provided in a Nursing-Led unit. No studies have investigated factors affecting length of stay in these services.

Design: Retrospective cohort study.

Methods: Consecutive patients admitted to a community Nursing-Led unit between 2009-2015 were enrolled. Sociodemographic, medical and nursing care (diagnoses and activities) variables were collected from electronic health records. Descriptive analysis and a backward stepwise logistic regression model were applied. The study followed the STROBE guidelines.

Results: The study enrolled 904 patients (mean age: 77.7 years). The most frequent nursing diagnoses were bathing self-care deficit and impaired physical mobility. The nursing activities most provided were enteral medication administration and vital signs measurement. Approximately 37% of the patients had a length of stay longer than the established threshold. Nine covariates, including being discharged to home, having an impaired memory nursing diagnosis or being treated for advanced wound care, were found to be independent predictors of prolonged length of stay. Variables related to medical conditions did not affect the length-of-stay threshold.

Conclusions: The length of stay in the community Nursing-Led unit was mainly predicted by conditions related to sociodemographic factors, nursing complexity and functional status. This result confirms that the medical and nursing needs of a community Nursing-Led unit population substantively differ from those of hospitalised acute patients.

Relevance To Clinical Practice: The nursing complexity and related nursing care to be provided may be adopted as a criterion to establish the appropriate length of stay in the community Nursing-Led unit for each individual patient.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jocn.15509DOI Listing
December 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ehf2.12733DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261532PMC
June 2020

Validity and Reliability of the Caregiver Contribution to Self-Care of Heart Failure Index Version 2.

J Cardiovasc Nurs 2020 May/Jun;35(3):280-290

Background: Lay caregivers are important in contributing to self-care of patients with heart failure (HF). The Caregiver Contributions to Self-Care of Heart Failure Index (CC-SCHFI) measures these contributions, but after developing the Situation-Specific Theory of Caregiver Contributions to Heart Failure Self-Care, the CC-SCHFI needed updating to reflect the theory.

Objective: The aim of this study was to test the psychometric characteristics of the CC-SCHFI 2 that measures caregiver contributions (CC) to HF self-care with 3 scales: CC to self-care maintenance, CC to symptom perception, and CC to self-care management.

Methods: This is a cross-sectional study. We tested the CC-SCHFI 2 with confirmatory factor analysis, internal consistency, item-total correlations, and test-retest reliability. With the CC-SCHFI 2, we also administered the Self-Care of Heart Failure Index v.7.2 to patients and the Caregiver Contribution to Heart Failure Self-Care Scale to caregivers to assess concurrent validity.

Results: A sample of 277 caregivers was enrolled (mean [SD] age, 52.7 [14.9] years; 70.4% female). In confirmatory factor analysis, each CC-SCHFI 2 scale had supportive fit indices: comparative fit index ranged between 0.94 and 0.95, and root mean square error of approximation ranged between 0.05 and 0.07. Internal consistency of the 3 scales was evident with a Cronbach α between .81 and .83 and a global reliability index between 0.79 and 0.86. Item-total correlations were all greater than 0.30. In concurrent validity testing, there were significant correlations between the CC-SCHFI 2 and the Self-Care of Heart Failure Index v.7.2 and the Caregiver Contribution to Heart Failure Self-Care Scale. Test-retest reliability showed intraclass correlation coefficients between 0.72 and 0.91.

Conclusions: Testing of the CC-SCHFI 2 supported validity and reliability, indicating that the instrument can be used in clinical practice and research to evaluate CC to the self-care of patients with HF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JCN.0000000000000655DOI Listing
September 2021

[The nursing-led in-patient unit: a descriptive study of nursing care delivered].

Ig Sanita Pubbl 2018 Jul-Aug;74(4):359-376

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

Chronic diseases require continuous healthcare that is not fully guaranteed by the Italian Health System which is more oriented towards acute care. In the Lazio region (city of Palombara Sabina), a Nursing-Led in-patient unit is present with the aim to care for patients affected by chronic diseases. The aim of this study was to describe the type of healthcare delivered by this unit. A descriptive-comparative design was used. All 290 patients admitted to the Nursing-Led Unit, during 2014 and 2015 participated in the study. The following variables were analyzed: socio-demographic characteristics of patients, reasons for admission, nursing diagnoses and interventions, medical diagnoses and interventions, Barthel index, length of stay, mortality rate, and discharge rate to acute care hospitals. The mean age of participants was 78 years old (SD 11,4) and the most frequent reason for admission was the need to receive a medium-high intensity nursing care (14,5%). The most frequent nursing diagnoses were bathing/hygiene self-care deficit (78,3%) and impaired physical mobility (74,8%). Hypertensive heart disease was the most frequent medical diagnosis (32,4%). The mean length of stay was 19 days, the mortality rate was 2,1% and the discharge rate to an acute care hospital was 9%. Significant improvements in patient dependency levels, as measured by the Barthel index, were observed at discharge with respect to admission (p < 0,001). The NursingLed Unit seems to be strategic in the delivery of care to older adults affected by multiple chronic diseases, in some phases of their condition. The results of this study indicate that the Palombara Sabina's nursing-led unit may contribute in reducing hospital admissions and achieving favorable patient outcomes when additional nursing interventions are needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2019

Cross-Mapping of Nursing Care Terms Recorded in Italian Hospitals into the Standardized NNN Terminology.

Int J Nurs Knowl 2020 Jan 12;31(1):4-13. Epub 2018 Jan 12.

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

Purpose: To evaluate if nursing diagnoses, interventions, and outcomes, as recorded by nurses in Italian hospitals, were semantically equivalent to the NANDA-I, NIC, and NOC (NNN) terminology.

Methods: A cross-mapping study using a multicenter design. Terms indicating nursing diagnoses, interventions, and outcomes were collected using the D-Catch instrument. Cross-mapping of these terms with NNN terminology was performed.

Findings: A sample of 137 nursing documentations was included. Over 80% of nursing diagnostic terms, interventions, and outcomes were cross-mapped into NNN terminology.

Conclusions: The study showed that most of the natural terms used by nurses were semantically equivalent to the standardized terms of NNN terminology.

Implications For Nursing Practice: In Italy, the use of NNN terminology is recommended; however, further development of this terminology is needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/2047-3095.12200DOI Listing
January 2020

[Clinical audit as a quality improvement tool in the emergency setting. A systematic review of the literature].

Ig Sanita Pubbl 2016 Sep-Oct;72(5):443-479

Istituto di Sanità Pubblica - Sezione di Igiene, Università Cattolica del Sacro Cuore, Roma , Italia.

According to the National Institute for Health and Care Excellence, "Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change…Where indicated, changes are implemented at an individual, team, or service level and further monitoring is used to confirm improvement in healthcare delivery". According to the scientific literature, clinical audit is more commonly used in secondary care with respect to primary care, probably because of the high variability that characterizes the latter. The aim of this study was to investigate, through a systematic literature review, the use and effectiveness of clinical audit in a particular field such as that of healthcare emergency.
View Article and Find Full Text PDF

Download full-text PDF

Source
June 2017
-->