Assistenza Infermieristica E Ricerca最新文献

. Nosocomial infections during the COVID-19 outbreak. Observational study in an Italian ICU.

Introduction: Infections are common among ICU patients.

Aim: The purpose of this study is to examine the incidence of nosocomial infections among patients admitted to the ICU with SARS-CoV-2 infection.

Methods: A prospective observational study in adults with confirmed SARS-CoV-2 infection requiring intensive care unit (ICU) admission was performed. From May 2020 to October 2021, a total of 109 admitted patients were included.

Results: The incidence rate of new infections was 39.4%. The main infections observed were multidrug-resistant germs infections (39.5%), catheter-related blood infections(24.4%), pneumonia (VAP)(18.6%), and urinary tract infections (17.4%). The overall mortality rate was 32.1% (n= 35) and was significantly higher in patients who had a new infection during hospitalization (n= 26/43, 60.4%) than in patients who did not have a new infection (n= 9/66, 13.6%) (RR = 4.43; 95% CI = 2.31-8.52; p <.001).

Conclusions: Our data suggest that secondary infections are associated with a longer duration of mechanical ventilation and hospital stay and may negatively impact patient survival. However, larger studies are needed.

. Introducing clinical nurse specialists (CNS) in the ambulatory setting: the experience of a Research Cancer Center in Italy.

Introduction: In 2018 the role of clinical nurse specialist (CNS) was implemented in an ambulatory setting at our cancer institute.

Objectives: To describe the CNS role implementation and the indicators to measure and the impact of the CNS after one year.

Methods: Indicators for the implementation: CNS interface mapping in disease pathways, participation in multidisciplinary team (MDT) meetings, and number of training hours per CNS on specific cancers. Indicators for the impact: patient satisfaction with CNS (survey), compliance with for waiting times for the first visit, number of documented CNS-patient communications and number of improvement projects in which CNSs were involved.

Results: One year after CNS introduction, pathway mapping was 100%; MDT meeting participation 95%; training hours 40.5/CNS vs. standard 30 hours; 83.2% of interviewed patients were very satisfied with CNSs. On average 27 face to face and 126 phone interviews per month were performed. The number of first visits increased of 13% componed to the previous year.

Conclusions: CNSs were successfully introduced into disease pathways and played an active role in the MDTs. The positive impact observed suggests that this new role could represent a response to the need to design patient centered services for cancer diseases. Measuring the CNSs activities and their impact on the patient outcomes and on system efficiency is the key for defining nursing staffing standards in the disease pathways, tailored on patients and organization characteristics.

. Radial artery occlusion after a radial access procedure: pilot study comparing eco Doppler and Inverse Barbeau Test assessments.

Introduction: Radial artery occlusion (RAO) after a radial access procedure can compromise the distal flow and hamper any possible reuse of the radial artery. Ultrasound examination is the gold standard for identifying RAO, but requires special equipment and expertise. An indirect test to estimate radial flow is the Inverse Barbeau Test (IBT), which evaluates the radial oximetry waveform during ulnar artery compression.

Aim: To determine the incidence of RAO and to compare the results obtained with the ultrasound and IBT tests.

Methods: Between November 2017 and February 2018, 50 patients undergoing radial access angiography were enrolled. Radial flow was assessed using both ultrasound and IBT, at three times: before the procedure (T0), at 24 hours (T1) and at 30 days (T2).

Results: The incidence of RAO obtained by ultrasound was no cases at T0, 3 (6%) at T1 and 1 (2.4%) at T2. IBT identified 14 (28%), 33 (66%) and 10 (23.8%) cases respectively. Some cases with no occlusion with the ultrasounds, 14 (28%), 30 (60%) and 9 (21.4%) respectively, resulted occluded by IBT.

Conclusions: The incidence of RAO is comparable to that reported in the literature (<10%). The IBT correctly identifies the presence of flow, but overestimates radial occlusion.

. The Productive Ward programme to provide high quality care: findings from a scoping review.

Introduction: The Productive Ward: Releasing Time to CareTM is a ward processes- and environments- improvement program intended to help nurses to spend more time on patient care, thus promoting patient safety.

Aims: To define the state-of-science in research on the Productive Ward (PW) program, the set of outcomes documented to date, as well as the factors facilitating or hindering its implementation in practice.

Methods: A scoping review based on the framework proposed by Levac et al. in 2010, further refined by the Joanna Briggs Institute in 2017, was performed on 2021. Methods and findings have been reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses - Scoping Reviews statement.

Results: 11 studies have been published from 2014 to 2021, mainly in Europe and England. According to the findings, the PW program has an impact on nurses, patients and the organization. Factors facilitating the PW programme implementation rely on engaging communication, the leadership, the organizational and the managerial support, the additional human and financial resources as well as on the feature of the context and its culture. Resistance to change is the most investigated barrier of PW implementation.

Conclusions: Although limited, the evidence suggests that the PW experiences are positive. Factors facilitating and hindering the implementation suggest a map of possible elements to consider before and during the implementation process.

. Welcome. The publication of a structured and detailed report on the general policy and on model (positive and negative) experiences of 'welcome' directed to the spectrum of human groups (from migrants to marginalised minorities) over the last 2 years in Italy, provides the opportunity of a comprehensive and critical reflection on the impact of a culture of 'emergency' on societal values: a choice between diffuse (institutional and general) strategies of care, and widespread practices of violations of human rights. The nursing world should be a qualified and active actor in this highly conflicting scenario.