Digitalization is not fully implemented in clinical practice, and several factors have been identified as possible barriers, including the competencies of health care professionals. However, no ...summary of the available evidence has been provided to date to depict digital health competencies that have been investigated among health care professionals, the tools used in assessing such competencies, and the effective interventions to improve them. This review aims to summarize digital health competencies investigated to date and the tools used to assess them among health care professionals. A systematic review based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was performed. The MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Scopus databases were accessed up to September 4, 2021. Studies assessing digital health competencies with quantitative designs, targeting health care professionals, and written in English were included. The methodological quality of included studies was evaluated using the Joanna Briggs Institute tools. A total of 26 studies, published from 1999 to 2021, met the inclusion criteria, and the majority were cross sectional in design, while only 2 were experimental study designs. Most studies were assessed with moderate to low methodological quality; 4 categories and 9 subcategories of investigated digital health competencies have been identified. The most investigated category was “Self-rated competencies,” followed by “Psychological and emotional aspects toward digital technologies,” “Use of digital technologies,” and “Knowledge about digital technologies.” In 35% (9/26) of the studies, a previously validated tool was used to measure the competencies assessed, while others developed ad hoc questionnaires. Mainly descriptive studies with issues regarding methodology quality have been produced to date investigating 4 main categories of digital health competencies mostly with nonvalidated tools. Competencies investigated might be considered while designing curricula for undergraduate, postgraduate, and continuing education processes, whereas the methodological lacks detected might be addressed with future research. There is a need to expand research on psychological and emotional elements and the ability to use digital technology to self-learn and teach others.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
To assess the prevalence of and factors associated with post-coronavirus disease 2019 (COVID-19) syndrome 6 months after the onset.
A bidirectional prospective study. Interviews investigated symptoms ...potentially associated with COVID-19 6 months after the disease onset of all consecutive adult inpatients and outpatients with COVID-19 attending Udine Hospital (Italy) from March to May 2020. IgG antibodies against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) were also evaluated 6 months after the onset of symptoms, at the time of the interview.
A total of 599 individuals were included (320 female, 53.4%; mean age 53 years, SD 15.8) and interviewed 187 days (22 SD) after onset. The prevalence of post-COVID-19 syndrome was 40.2% (241/599). The presence of IgG antibodies was significantly associated with the occurrence of post-COVID-19 syndrome (OR 2.56, 95% CI 1.48–4.38, p 0.001) and median SARS-CoV-2 IgG titres were significantly higher in patients with post-COVID-19 syndrome than in patients without symptoms (42.1, IQR 17.1–78.4 vs. 29.1, IQR 12.1–54.2 kAU/L, p 0.004). Female gender (OR 1.55, 95% CI 1.05–2.27), a proportional increase in the number of symptoms at the onset of COVID-19 (OR 1.81, 95% CI 1.59–2.05) and ICU admission OR 3.10, 95% CI 1.18–8.11) were all independent risk factors for post-COVID-19 syndrome. The same predictors also emerged in a subgroup of 231 patients with the serological follow-up available at the time of the interview alongside the proportional increase in anti-SARS-CoV-2 IgG (OR 1.01, 95% CI 1.00–1.02, p 0.04).
Prospective follow-up could be offered to specific subgroups of COVID-10 patients, to identify typical symptoms and persistently high anti-SARS-CoV-2 IgG titres as a means of early detection of post-COVID-19 long-term sequelae.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Aims and objectives
To synthesise the evidence reported in qualitative studies concerning the lived experiences of adult patients receiving mechanical ventilation in Intensive Care Unit (ICU).
...Background
Critically ill patients receiving mechanical ventilation in the ICU have been reported to suffer from severe physical and emotional responses such as hopelessness, anxiety, high levels of frustration and stress. Recent improvements in the field of mechanical ventilation and sedative medications as experienced by patients that can inform nursing care have not been summarised to date.
Design
A systematic review of qualitative studies followed by a meta‐synthesis and a meta‐summary was performed.
Methods
Four electronic databases were searched by two authors in June 2019. A total of nine studies were included and evaluated based on their methodological quality using the Critical Appraisal Skills Programme checklist.
Results
A total of 24 codes emerged from the ion process, which were categorised into 11 categories and four themes: (a) “The effect of the intense stress on the body's systems,” (b) “The induced negative emotional situations,” (c) “The feeling of being cared for in a hospital setting” and (d) “The perceived support from the family and loved ones.” Furthermore, the most frequent codes across studies were “Being afraid,” “Feeling supervised,” “Feeling comforted,” “Failing to communicate,” and “Experiencing difficulties in breathing,” with an intensity of 66.6%.
Conclusion
Patients receiving mechanical ventilation have expressed a general sense of vulnerability, of which critical care nurses need to be aware.
Relevance to clinical practice
Findings suggest the need for improvements at the nursing, unit, educational and policy levels; furthermore, more research is also required at the international levels given the current trends towards no sedation protocols for the management of ICU patients: listening to their experiences becomes imperative, in order to ensure an awake, comfortable and ventilator‐tolerant patient.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Aim
To reflect upon the concrete implications of the COVID‐19 outbreak regarding ongoing health service and nursing management research (NMR) and to identify possible research priorities for the ...current and post‐pandemic era.
Background
Health service research and the nursing management research debate have received little attention to date, despite their relevance in responding to the increased demand of care during the COVID‐19 outbreak.
Methods
A critical analysis on experiences was performed while leading international‐funded studies at different degrees of complexity and targets, involving nurse managers, nurses, care processes and health care services in the last year.
Results
Ongoing research projects have been profoundly affected by the COVID‐19 outbreak in their aims, methods, management processes, feasibility and outcomes.
Conclusions
The COVID‐19 outbreak is an unprecedented stress test for the health care sector and for the nursing services. Its onset and persistence have rendered more easily to see what prevails in terms of effectiveness and what fails in our health care services.
Implications for Nursing Management
Nurse managers have lived and are still living through this crisis, given their omnipresence in the health care systems. Therefore, setting NMR priorities and working together to imagine and design the post‐COVID‐19 era is essential.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Unfinished nursing care is becoming increasingly more of a concern in worldwide healthcare settings. Given their negative outcomes, it is crucial to continuously assess those nursing interventions ...that are commonly postponed or missed, as well as the underlying reasons and consequences. The worldwide COVID-19 pandemic has made it difficult for health facilities to maintain their sustainability and continuity of care, which has also influenced the unfinished nursing care phenomenon. However, no summary of the studies conducted during the COVID-19 pandemic was produced up to now. The main aim of this study was to systematically review the occurrence of, reasons for, and consequences of unfinished nursing care among patients in healthcare settings during the COVID-19 pandemic.
Systematic review registered in PROSPERO (CRD42023422871). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guideline and the Joanna Briggs Institute Critical Appraisal tool for cross-sectional studies were used. MEDLINE-PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Scopus were searched from March 2020 up to May 2023, using keywords established in the field as missed care, unfinished nursing care, or implicit rationing.
Twenty-five studies conducted mainly in European and Asiatic countries were included and assessed as possessing good methodological quality. The following tools were used: the MISSCARE Survey (= 14); the Basel Extent of Rationing of Nursing Care (= 1), also in its revised form (= 2) and regarding nursing homes (= 2); the Perceived Implicit Rationing of Nursing Care (= 4); the Intensive Care Unit-Omitted Nursing Care (= 1); and the Unfinished Nursing Care Survey (= 1). The order of unfinished nursing care interventions that emerged across studies for some countries is substantially in line with pre-pandemic data (e.g., oral care, ambulation). However, some interesting variations emerged at the country and inter-country levels. Conversely, labour resources and reasons close to the emotional state and well-being of nurses were mentioned homogeneously as most affecting unfinished nursing care during the pandemic. None of the studies investigated the consequences of unfinished nursing care.
Two continents led the research in this field during the pandemic: Europe, where this research was already well established, and Asia, where this research is substantially new. While unfinished care occurrence seems to be based on pre-established patterns across Europe (e.g., regarding fundamentals needs), new patterns emerged across Asiatic countries. Among the reasons, homogeneity in the findings emerged all in line with those documented in the pre-pandemic era.
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CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Aims
To measure and model Australian, Cypriot and Italian nurses’ beliefs about what care is missed and how frequently it occurs within their settings.
Background
This study expands on previous ...MISSCARE research but now applies and predicts missed care within three countries.
Methods
Multivariate analysis was performed to estimate 1,896 nurses’ consensus scores about missed care activities based on Alfaro‐Lefevre's conceptual framework of care priorities.
Results
Five latent variables have direct predictor effects on missed care frequencies. Another four variables including the nurses’ age, highest qualifications, absenteeism rate and workplace type, contributed to explaining the overall variance of missed care scores. The nurses’ gender had no influence on missed care.
Conclusion
Cross country comparisons of missed nursing care allow for a more refined identification of strategies for remediation for both managers and clinicians.
Implications for Nursing Management
Reliable consensus estimates about the types and frequencies of missed care can be scaled with variables identified to predict missed care across three different countries. Comparative international studies build on the foundations for understanding missed care in terms of nursing practices, policies and related social policies.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Aim
To describe the experiences of Italian nurses who have been urgently and compulsorily allocated to a newly established COVID‐19 sub‐intensive care unit.
Background
In the context of the COVID‐19 ...pandemic, no studies have documented the experience of nurses urgently reallocated to a newly created unit.
Method
A qualitative descriptive study. Twenty‐four nurses working in a sub‐intensive care unit created for COVID‐19 patients participated in four focus groups. Audio‐recorded interviews were verbatim‐transcribed; then, a thematic analysis was performed.
Results
The experience of nurses was summarized along three lines: (a) ‘becoming a frontline nurse’, (b) ‘living a double‐faced professional experience’ and (c) ‘advancing in nursing practice’.
Conclusions
Nurses who experienced being mandatorily recruited and urgently reallocated to a COVID‐19 unit lived through a mix of negative feelings in the early stages, a double‐faced situation during the episode and, at the end, the perception of global growth as a person, as a team and as a professional.
Implication for nursing management
Nurse managers could play a key role in identifying and preparing nurses in advance to mitigate their concerns and their sense of unpreparedness. The value attributed to nursing care should be promoted both during and after the current COVID‐19 pandemic.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Introduction
Unfinished nursing care (UNC), as the care required by patients that delayed or not delivered, has been investigated mainly from the perspective of nurses, while little is still known ...from the side of patients. Some studies have involved patients to measure which elements of care are mostly unfinished (e.g., mouth care), whereas a few studies have investigated the reasons for UNC as perceived by them. Their involvement in understanding the reasons for UNC is crucial to advance the knowledge and co‐develop possible strategies to prevent or minimize UNC.
Methods
This is a descriptive qualitative study performed according to COnsolidated criteria for REporting Qualitative research guidelines in 2022. A purposeful sample of Italian hospitalized patients in two medical and two surgical units was involved. A face‐to‐face semistructured interview was used to merge reasons for UNC. Qualitative content analysis was conducted to merge subthemes and themes as factors leading to UNC according to the experience of patients.
Results
A total of 23 patients (12 surgical and 11 medical) were involved (12/23 male) with an age average of 66.2 years, educated mainly at secondary school, and with previous hospitalizations (20/23), and dependent on nursing care in daily activities (14/23). Reasons for UNC have been identified at four levels: (1) ‘New health‐care system priorities’ and ‘Pre‐existing frailty of health‐care facilities’ were reasons identified at the health‐care system level; (2) ‘Lack of resources attributed to wards’, ‘Ineffective ward organization’ and ‘Leadership’ were identified at the unit level; (3) ‘Nurses' attitudes and behaviour’ were reported at the nurses' level and (4) ‘Increased nursing care expectations’ were pinpointed at the patient level.
Conclusion
Patients can be involved in identifying UNC, but also in recognizing the underlying reasons. Engaging them in such investigations might broaden our understanding of the phenomenon and the possibility of identifying strategies to minimize and prevent UNC.
Patient or Public Contribution
Patients from four hospital units (two medical and two surgical) were involved in face‐to‐face interviews to merge the reasons perceived by them as triggering UNC. All factors (as themes and subthemes) have derived from their words, thus enhancing the evidence available from the side of the patients.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Patients with acute stroke are particularly vulnerable to delirium episodes. Although delirium detection is important, no evidence-based recommendations have been established to date on how these ...patients should be routinely screened for delirium or which tool should be used for this purpose in this population. Therefore, the aim of this study was to identify delirium screening tools for patients with acute stroke and to summarise their accuracy.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of Medline, CINAHL and Scopus databases was performed to include: (a) diagnostic test accuracy studies; (b) evaluating tools detecting delirium among patients with acute stroke; (c) written in English; (d) published up to September 2018. The included studies were assessed in their quality by using the Quality Assessment of Diagnostic Accuracy Studies-2.
A total of four studies have been performed to date in the field with a variable quality for the methodology used and documentation of the accuracy of mainly two tools, as (1) the 4-Assessment Test for delirium (4AT), reporting a range of sensitivity from 90.2 to 100% and a specificity from 64.5 to 86%; and (2) the Confusion Assessment Method-Intensive Care Unit (CAM-ICU) showing a sensitivity of 76% (95% Confidence of Interval CI 55-91) and a specificity of 98% (95%CI 93-100). Other tools have been studied as: The Abbreviated Mental Test-10, the Abbreviated Mental Test short form, the Clock Drawing Test, the Cognitive Examination derived from the National Institutes of Health Stroke Scale and the Glasgow Coma Scale. Moreover, the use of a single question-namely, 'Does this patient have cognitive issues?' as answered by the multidisciplinary team-has been subjected to a validation process.
To date a few primary studies have been published to test the accuracy of tools in their ability to detect post-stroke delirium; among those available, the 4AT and the CAM-ICU tools have been mostly studied. Research has just started to add evidence to the challenge of detecting and usefully assessing newly-acquired delirium among stroke patients: therefore, more studies are needed to improve the knowledge and allow a robust selection of the most useful tool to use in this population.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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