Showing papers by "Ercole Vellone published in 2018"

Quality of life, anxiety, depression and burden among stroke caregivers: A longitudinal, observational multicentre study.

Abstract: Aim: To longitudinally describe stroke caregivers’ quality of life, anxiety, depression and burden and to identify predictors of stroke caregivers’ quality of life, anxiety, depression and burden. Background: Caregivers have a key role in stroke survivor care and the first year of caregiving is the most challenging. To give tailored interventions, it is important to capture changes and identify predictors of caregiver quality of life, anxiety, depres- sion and burden during the first year. Design: A 12-month longitudinal study. Data were collected between June 2013– May 2016. Methods: Changes in stroke caregiver quality of life, anxiety and depression and burden and their predictors were identified using linear mixed-effects models. Results: The caregivers (N = 244) were 53 years old and mostly female. Caregiver quality of life did not change significantly over the 12 months, anxiety and depres- sion decreased up to 9 months and caregiver burden decreased from baseline to 3 months, then increased up to 9 months. Higher caregiver quality of life was pre- dicted by caregiver younger age, higher education, living with a stroke survivor, sur- vivor older age and higher physical functioning; higher anxiety and depression were predicted by older caregiver age and younger survivor age; higher burden was pre- dicted by caregiver male gender, the caregiver not living with survivor and survivor lower physical functioning. Conclusion: The first 9 months of caregiving are particularly problematic for care- givers. The trajectories of the above variables and their predictors may be useful for policy makers, clinicians, investigators and educators to give better care to stroke caregivers and their survivors

Active Ageing in Europe: Adding Healthy Life to Years.

Abstract: The European Union (EU) is a conglomerate of more than 500 million people, 19.2% (approximately 100 million) of whom are older adults (1). The ageing population is triggering dramatic demographic, epidemiological, and anthropological changes, highlighting the importance of active and healthy ageing (AHA). In Europe, the most common household type is single occupancy (33.4% of the total number of households) (2). This household type also recorded the highest increase from 2005 to 2015 (3). These findings highlight several questions from both an individual and public perspective. Who will take care of the current generation as we become older? What types of health and social organisations should we develop to preserve the quality of life of an ageing population and sustain our health care systems over the medium and long term? Supporting AHA is one answer to these questions: an AHA population is a resource that benefits all of society. Maintaining a healthy ageing population may also lower demands for health care services. In addition, in many cases, older adults in good health are able to support their fellow generation and represent a strength dedicated to the common well-being.

Socio-demographic and clinical determinants of self-care in adults with type 2 diabetes: a multicentre observational study.

Abstract: To describe self-care as defined by the Middle Range Theory of Self-Care of Chronic Illness and to identify clinical and socio-demographic determinants in a T2DM population. A multicentre observational cross-sectional study was conducted involving 540 adults with a confirmed diagnosis of T2DM from six outpatient diabetes services in Italy. Socio-demographic and clinical data were collected from medical records. The Self-Care of Diabetes Inventory (SCODI) was used to measure self-care maintenance, monitoring, management, and confidence dimensions. For each separate scale, scores were standardized 0–100 with higher SCODI scores indicating better self-care; a score ≥ 70 is adequate. Multiple quantile regression models were performed to identify determinants of each self-care dimension. Self-care maintenance (median = 81.3) and self-care confidence (median = 79.5) were adequate in most of the subjects. Self-care monitoring was adequate in only half of the sample (median = 70.6). Self-care management was poor (median = 59.4). Lower self-care maintenance was associated with lower self-care confidence (p < 0.001). Lower self-care monitoring was associated with being male (p < 0.001), having lower self-care confidence (p < 001), and having diabetes for < 10 years (p < 0.001). Lower self-care management was associated with being male (p = 0.002), being older (p = 0.005), having a low income (p = 0.030), being employed (p = 0.008), having missed diabetes education in the last year (p = 0.002), and lower self-care confidence (p < 0.0001). Lower self-care confidence was associated with having diabetes for < 10 years (p = 0.008), and having at least one comorbid condition (p = 0.006). Determinants of self-care maintenance, monitoring, management and confidence include both clinical and socio-demographic variables. Modifiable determinants such as self-care confidence and diabetes self-care management education could be used to tailor interventions to improve diabetes self-care.

The Influence of Mutuality on Self-Care in Heart Failure Patients and Caregivers: A Dyadic Analysis:

Abstract: Mutuality in patient–caregiver dyad may improve heart failure (HF) patient self-care and caregiver contribution to self-care, but literature is scarce. We evaluated the influence of mutuality and i...

Psychometric evaluation of the Multidimensional Scale of Perceived Social Support (MSPSS) in people with chronic diseases.

Abstract: Purpose: This study aimed to evaluate the psychometric characteristics of the Multidimensional Scale of Perceived Social Support (MSPSS) in patients with chronic diseases. Methods: Patients (n = 236) with chronic diseases completed the MSPSS and the36-item Short Form Health Survey (SF-36). MSPSS factorial structure was analysed using Confirmatory Factor Analysis (CFA), and internal consistency reliability was evaluated with Cronbach’s alpha, the factor score determinacy coefficient, and the model-based internal consistency index. Concurrent validity was performed correlating the MSPSS scores with the SF-36 scores. Results: CFA supported the three-factor structure of the MSPSS (CFI = 0.97; RMSEA= 0.058). Cronbach’s alpha, the factor score determinacy coefficient, and the model-based internal consistency index were ³0.89. Concurrent validity was supportive with significant correlations between the MSPSS and SF-36 scores. Conclusions: The MSPSS has supportive validity and reliability and can be used to evaluate perceived social support that is received by chronic patients.

Trajectories of self-care confidence and maintenance in adults with heart failure: a latent class growth analysis

Abstract: Heart failure (HF) affects up to 14% of the elderly population and its prevalence is increasing. Self-care is fundamental to living successfully with this syndrome, but little is known about how self-care evolves over time. The present study aimed to (a) identify longitudinal trajectories of self-care confidence and maintenance among HF patients, (b) investigate whether each trajectory is characterized by specific sociodemographic and clinical patients’ characteristics, and (c) assess the association between the self-care confidence and maintenance trajectories. We conducted a prospective descriptive study of 225 HF patients followed for 6 months with data collected at baseline and 3 and 6 months. Latent class growth analysis (LCGA) was used to identify longitudinal trajectories. ANOVA and contingency tables were used to characterize trajectories and investigate their association. Three self-care confidence (persistently poor, increasingly adequate, and increasingly optimal) and three self-care maintenance (persistently poor, borderline but improving, and increasingly good) trajectories were identified. Married individuals were less likely to be in the persistently poor trajectory of self-care confidence. Patients with persistently poor self-care maintenance took fewer medications than patients with one of the better self-care maintenance trajectories. The two sets of trajectories were significantly and meaningfully associated. Patients in a poor self-care trajectory (confidence or maintenance) are at high risk to stay there without improving over time. These results can be used to develop tailored and potentially more effective health care interventions.

The effect of the burden of caregiving for people with spinal cord injury (SCI): A cross-sectional study

Abstract: Aim: To assess the caregiver burden (CB) of caregivers for people with Spinal Cord Injury (SCI) and to examine the psychological impact of the burden of caregiving. Materials and Methods: Cross-sectional study. A set of structured questionnaires was administered to 55 family caregivers of individuals with SCI. The Modified Barthel Index was used to evaluate the independence of care recipients. The Caregiver Burden Inventory was modified and used to assess the CB. The Family Strain Questionnaire – Short Form was administered to measure the psychological impact of CB. The Short Form 36 was used to assess the health status of the participants. Results: CB affects mainly the domains related to time management, the physical condition of caregivers and their sense of personal failure. An increased level of CB and the dependency level of SCI survivors is significantly correlated (p < 0.01) with an increase in the need of psychological support and a decrease in perceived health and quality of life. Conclusions: Caregiving for people with SCI implies the occurrence of CB. The contribution of caregivers should be recognised and supported with tailored relief interventions.

Nurses' beliefs about nursing diagnosis: A study with cluster analysis.

Abstract: Aims To identify clusters of nurses in relation to their beliefs about nursing diagnosis among two populations (Italian and Spanish); to investigate differences among clusters of nurses in each population considering the nurses' socio-demographic data, attitudes towards nursing diagnosis, intentions to make nursing diagnosis and actual behaviours in making nursing diagnosis. Background Nurses' beliefs concerning nursing diagnosis can influence its use in practice but this is still unclear. Design A cross-sectional design. Methods A convenience sample of nurses in Italy and Spain was enrolled. Data were collected between 2014-2015 using tools, that is, a socio-demographic questionnaire and behavioural, normative and control beliefs, attitudes, intentions and behaviours scales. Results The sample included 499 nurses (272 Italians & 227 Spanish). Of these, 66.5% of the Italian and 90.7% of the Spanish sample were female. The mean age was 36.5 and 45.2 years old in the Italian and Spanish sample respectively. Six clusters of nurses were identified in Spain and four in Italy. Three clusters were similar among the two populations. Similar significant associations between age, years of work, attitudes towards nursing diagnosis, intentions to make nursing diagnosis and behaviours in making nursing diagnosis and cluster membership in each population were identified. Conclusion Belief profiles identified unique subsets of nurses that have distinct characteristics. Categorizing nurses by belief patterns may help administrators and educators to tailor interventions aimed at improving nursing diagnosis use in practice.

A nursing clinical information system for the assessment of the complexity of care.

Abstract: Background The complexity of care can be described through a clinical nursing information system, in particular through the Professional Assessment Instrument -PAI-, encoding each health care activity in time units and analysing the relationship of observed time to patient characteristics in relation to the functional models of care needs. Designs Observational study. Methods Data were collected for 11 months in 2016-17 in four inpatient units of an Italian hospital using the Professional Assessment Instrument, and a survey grid to measure the time of the nursing activities delivered. All activities with a frequency of 20 or more have been included. The Work Sampling technique was used for time-tracking. Results The sample included 2765 nursing activities. The mean times for each care activity were compared showing significant differences. A statistically significant correlation (Sperman's correlation coefficient) was observed both between the observed time and the level of illness severity and between time and functional models. Conclusions Patient complexity, both in terms of illness severity and level of dependence, can be coded through a clinical nursing information system. This facilitates the classification and measurement of nursing care delivered, which includes the entire care process.

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

Abstract: The Professional Assessment Instrument (PAI) is a clinical nursing information system used in the adult inpatient units of the A. Gemelli university hospital in Rome (Italy). The PAI allows for the systematic collection of nursing care data in order to improve the quality of care. So far, few clinical nursing information systems have been developed in the neonatal and pediatric care setting. The aim of this study is to describe the development and implementation of a clinical nursing information system (PAIped) for the neonatal and pediatric care setting. Methods The Patient-and Family-Centered Care model was used to develop the contents of the PAIped. A web platform application was developed for the PAIped. The standard nursing terminology Clinical Care Classification System was used. A decisionmaking support system was developed within the PAIped to support nurses in making diagnoses and in selecting the most appropriate nursing interventions. Results A clinical nursing information system using a standard nursing terminology was developed in the pediatric and neonatal care setting. After a test phase, the PAIped was implemented in all the pediatric and neonatal inpatient units of the A. Gemelli university hospital. Conclusion The development and implementation of the PAIped in the A. Gemelli university hospital allowed the monitoring of nursing care processes and accurate nursing documentation.

Impact of an Electronic Nursing Documentation System on the Nursing Process Accuracy

Abstract: While the nursing process provides a framework for documenting nursing practice and delivering patient-focused care, nurses often have difficulty applying the nursing process in clinical practice. Fortunately, electronic nursing documentation using clinical decision support systems (END-CDSS) can improve the accuracy of recorded nursing process. To date, however, no study has evaluated nursing documentation accuracy over time following END-CDSS implementation. Accordingly, the aim of this study was to evaluate if the Professional Assessment Instrument (PAI) END-CDSS improved the accuracy of nursing documentation in an Italian hospital cardiology inpatient unit. A quasi-experimental longitudinal design was conducted. A random sample of 120 nursing documentations was collected and evaluated using the D-Catch instrument. A significant improvement (p < .001) in nursing documentation accuracy scores was shown after PAI implementation. These results suggest that an END-CDSS can support nurses in the nursing process by improving their clinical reasoning skills.

Le competenze infermieristiche avanzate nel trattamento dello stroke in fase acuta in Italia. Strategia per l’identificazione (I parte)

Abstract: Introduzione: lo scopo di questo studio e descrivere la strategia per l’identificazione di indicatori delle competenze infermieristiche avanzate nello stroke care in una realta italiana ed elaborare uno strumento per la rilevazione.

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

Abstract: 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.

La Salute Organizzativa degli infermieri di Area Critica: studio comparativo nell’ambito dell’emergenza sanitaria

Abstract: Introduzione : e stato ampiamente riconosciuto che l'ambiente di lavoro e fondamentale nella genesi di stress e nell'insorgere di sindromi e disturbi di vario genere, che possono influenzare la salute lavorativa degli infermieri. Lo specifico contesto lavorativo e le diverse funzioni svolte dal personale infermieristico, sono inoltre considerati predittori positivi o negativi di salute organizzativa, tanto da indurre gli autori della presente ricerca a studiare il fenomeno in tre gruppi di infermieri dell’area dell’emergenza: le Camere Operatorie, i Pronto Soccorso e le Terapie Intensive.