bluuebunny/crossref_metadata_2025_split huggingface dataset:
COVID-19: knowledge and attitudes of hospital staff of a large Italian teaching hospital
Authors: Moro M , Vigezzi G P , Capraro M , Biancardi A , Nizzero P , Signorelli C , Odone A 
Published: October 2020

Abstract

Background
During infectious disease emergencies, fully aware healthcare workers (HCWs) and public services staff are unique resources to keep health systems active and tackle epidemics. Aim of the study was to assess concern, general and health-related knowledge (case management and Infection Prevention and Control [IPC] measures) among hospital staff on SARS-CoV-2 in Lombardy region (Italy).

Methods
One week after WHO declared COVID-19 a public health emergency we developed and online administered a 7-item questionnaire to all staff of San Raffaele Hospital, a referral and teaching hospital in Milan, exploring knowledge and attitudes on COVID-19. The survey remained accessible online for 72 hours.

Results
A total of 2,046, including HCWs and other staff, answered the survey (response rate 25%). Among the 2,027 responders included in the analysis, 1,102 were HCWs (54%), also in training, and 924 non-HCWs (46%). 60% of responders reported being worried or extremely worried about the epidemic. Concerning knowledge, the survey asked about modes of transmission, clinical forms, preventive measures in everyday life in Italy and cough etiquette. There were uniform trends in the two groups: HCWs were more aware and answered more properly (mean of correct answers 71,6%) than non-HCWs (mean 61,2%). HCWs were asked about IPC precautions, with only 41% providing correct answers, while over 74% knew only supportive therapy is currently available against COVID-19.

Conclusions
We were among the first to explore hospital staff knowledge on COVID-19 reporting data from a large study population. HCWs were slightly less concerned but more knowledgeable than general staff. Last questions showed that among HCWs there is generally good knowledge on the topic. However, most of the responders missed the recommendations to adopt simultaneously standard, contact and airborne precautions plus eye protection managing suspected and confirmed cases, as proposed by national and international authorities.

Key messages
During the ongoing emergency, it is of utmost importance that hospital staff is adequately trained to implement the best IPC measures and limit the spread of the infection. Our data can inform planning of these preventive measures.
Evaluating quality variation of emergency departments
Authors: Oschmann L , Geissler A , Nimptsch U 
Published: October 2020

Abstract

Background
Germany introduced a graduated system of emergency levels (0 non-participation; 1 for basic up to 3 for comprehensive infrastructure) to overcome various inefficiencies of hospital emergency care. For each level, detailed requirements must be met, however, the case volume of conditions treated in the levels is unclear. Moreover, the relationship between emergency level and outcomes needs evaluation to analyse if patients are directed to the most appropriate hospital.

Methods
We selected three major emergency conditions - Stroke, AMI and Hip fracture - and matched risk-adjusted outcome and process indicators on hospital level to the hospital respective emergency level. Descriptive statistics such as distribution and correlation are used to examine the allocation of cases to emergency levels and to analyse the effect of structural differences on health outcomes.

Results
We saw large variations in quality for all clinical conditions regardless of the emergency level. Hospitals with a small case number showed greater fragmentation; hospitals that did not meet the requirements nevertheless performed interventions for AMI and stroke. In detail, 30-day mortality of AMI shows high variation of quality results in level 1; for stroke it is underperformed with almost 10% in hospitals with level 0. Pre-operative LOS for hip fracture is above the acceptable average in any level (tolerance range ≤ 15%), and the ratio O/E in mortality is noticeable for 40% of hospitals with level 0.

Conclusions
Many cases are treated in low volume hospitals with wide quality variation and subpar results. Therefore, the definition of emergency levels should be integrated to emergency pathways which might help to direct patients to the most appropriate hospital. Moreover, many emergency symptoms are not captured by available quality metrics and current classification systems which shows that emergency service provision is to a large extent not covered by current measurement initiatives.

Key messages
Emergency service provision is fragmented and not related to emergency levels. Development of emergency quality indicators is needed.
Patient health engagement model: explaining citizens noncompliance and maladaptive behaviors
Authors: Graffigna G , Barello S , Palamenghi L , Savarese M , Castellini G 
Published: October 2020

Abstract

Background
At the end of February 2020 a new case was diagnosed with COVID-19 in north Italy, suddenly followed by new cases. Italian health authorities decided to enforce restrictive measures. Northern areas of Italy were identified as “red areas” to slow down the epidemic and its impact on the healthcare system. From this perspective, the COVID-19 epidemic in Italy constitutes a testing ground for the assessment of the ability of consumers to cope with this health risk.

Methods
A cross-sectional study on a representative sample of 1000 Italian citizens was conducted over the period 27 February- 5 March exploring the following hypotheses: 1) less engaged individuals are more concerned for the health emergency and feel more vulnerable; 2) less engaged have higher probability to develop negative attitudes and dysfunctional behaviors.

Results
only the 16% the interviewees presented a high level of engagement. Lower levels of engagement were measured in the southern parts of Italy (not yet touched by the epidemics at the time of data collection). People with lowers levels of engagement reported higher fears for the contagion and sense of vulnerability. Furthermore, they showed the lower levels of trust in the Public Health Authorities, in medical research and in vaccines. Finally, they appeared more dismissive in their preventive behaviors and more disorganized in the fruition of the healthcare services.

Conclusions
A psychological analysis of processes of attitudinal and role change in the direction of becoming more engaged in health prevention is worthy in order to forecast potential dysfunctional reactions to restrictive health prevention measures and to orient personalized education initiatives to consumers with different level of engagement.

Key messages
Profiling based on the levels of health engagement is important in order to plan more effective healthcare measures during epidemics. Targeted educational initiatives should take into account citizens' engagement profiles.
Evaluation of a project on Nursing education of refugees and other persons in need of support
Authors: Winkelmann C , Helmer-Denzel A 
Published: October 2020

Abstract
The European Social Fund, in cooperation with Baden-Württemberg, Germany, supports projects to attract people to care. Results of the project New paths in training occupations of the nursing assistant in Ulm (PfAU) (01.02.2017 to 31.03.2019) are presented. PfAU is divided into a) recruit interested persons, b) two-month preparatory course, c) one-year training in care for elderly or nursing with special support from school and care facilities. Focus is on individual participation in employment, non-discrimination and equality.
The evaluation was formative and summative. A milestone discussion and semi-structured interviews with participants, project team and leader in care facilities were used. Data of participants were provided for evaluation.
There were two rounds involving 40 people (f = 17, m = 23); shown following categories:
I_Refugees (mainly men under 30, for religious reasons resistances against care for elderly); II_Economic migrants (mainly women under 30, preparing for migration in their home country); III_Non-European migrants (mainly women from different countries of origin, Au-pair employment or partnership in Germany); IV_Persons with learning disabilities and/ or individual difficulties from Germany (women and men mostly under 33 years).
Reasons for leaving PfAU are motivational or language gaps, cognitive limitations, religious reasons, error expectations, health problems, child care, single parenting. Reasons for staying are financial support for the family, image, meaningful task, social network through chain migration.
PfAU works, but long-term perspective and financial resources are necessary. Future funding should be based on the identified categories, with special attention to their individual support needs. Important are motivation and the idea of nursing activity. Preparation course should be extended. There should be an individual selection for the training. Existing teams in the care facilities must be supported in the integration.

Key messages
PfAU is just a pilot project. In future, permanent implementation is necessary to close the gap due to demographic change and skill shortages. Existing teams in the care facilities must be supported in the integration.
Patient satisfaction with the quality of nursing care: A cross-sectional study
Authors: Skhvitaridze N , Lobjanidze T , Papidze A , Barjadze E , Landia N 
Published: October 2020

Abstract

Aim
To evaluate patients' satisfaction with the quality of nursing care and examine factors which affect their decision.

Design
A retrospective, cross-sectional, descriptive survey study.

Methods
Data were collected using a structured questionnaire in Georgian language was administered to the patients. The response rate was 93% and the final sample was composed of 173 patients who enrolled consequently after taking written informed consent. One hospital and one outpatient department in the capital city of Georgia were selected for the study setting. Data were collected during one month. Data on demography was collected. Descriptive and inferential statistics were applied accordingly using STATA version 17. Eligible criteria: Adults, capable of independent communication and who talk Georgian language, did not have any severe process or complications, were in the recovery stage, with no referral and discharging to home.

Results
Majority of respondents were aged between 56-65 years (50%), males (52.5%), residents of the capital city (70%), having higher education (80%) and employed (75%). Overall, 89% of patients described provided nursing care as an excellent. The most important factors, which affect patients' satisfaction are the waiting time before admission, safety of services, comfortable environment along with the proper level of care and attentiveness. These results can be generalized and may be useful in comparative studies of patient satisfaction.

Key messages
Permanent evaluation of nursing care is important to evaluate patients satisfaction. Factors as waiting time, safety of services, comfortable and friendly environment, and attentiveness are key for high level of satisfaction.
Why do nurses stay? A positive deviance study of nurse turnover
Authors: Hølge-Hazelton B , Berthelsen C B 
Published: October 2020

Abstract

Background
Nursing shortage is a global problem and high turnover of nurses has negative effects on health care organizations and patients. In Denmark, the highest nursing shortage is found in the Zealand region, where an effort to recruit and retain nurses is urgently needed. However, not all departments are equally challenged, despite covering the same clinical areas. The aim of this study was to investigate nurses' experiences and descriptions of practices in hospital departments with low nurse turnover compared to similar departments in the same region: 1) How do nurses experience and describe the culture and work environment in their department? 2) How do nurses experience and describe practical nursing in their department? 3) How do nurses experience and describe the meaning, importance, or significance of nurse management?

Methods
A constructivist design with a positive deviance theoretical approach was chosen. 21 nurses from four different departments (medical, surgical, acute and psychiatric) with the lowest turnover of nurses participated during focused observations (N = 8) and focus group conversations (N = 13).

Results
The results revealed a sense of community between nurses and department managers; nurses identified these close relations as the reason for not seeking 'greener pastures' elsewhere. The results were presented as four categories: collaborative fellowship, professional pride, embracing management, and 'as green as it gets'.

Conclusions
Even though the nurses' daily practice was exhausting, they did not consider leaving their jobs due to the special culture in the departments, which brought the nurses closer together

Key messages
Due to the centrality of nurse managers as a reason for nurses’ retention, future attention should focus on the cultural and strategic perspectives and actions of nurse leaders. Collaborative fellowship and professional pride can not be underestimated as means to retention and recruitment of nurses.
Medical certificate of disability: a descriptive analysis of Aveiro region, from 2010 to 2016
Authors: Sá R , Matos J 
Published: October 2020

Abstract

Background
In Portugal, Public Health Physicians attribute the medical certificate of disability (MCD). This document is mainly used for fiscal benefits or from other kind, as priority parking card and non-medical public services are increasing its requirement. The threshold to determine benefits is 60% of incapacity by law. Oncological, musculoskeletal and psychiatric diseases account for most of the cases. This activity is highly time-consuming and is not part of the Essential Public Health Operations or the competences of Public Health Physicians according to the Medical Professional Order. The aim of this study is to characterize the evolution of this procedure and the obtained incapacity values from 2010 to 2016 in the Public Health Unit of Baixo Vouga Primary Healthcare Cluster.

Methods
A descriptive analysis was made with the registers of production of MCD in four municipalities of the Aveiro Region from 2010 to 2016.

Results
An increase in the number of MCD was verified, going from 274 in 2010 to 550 in 2016, in a total of 3087. Two thousand and fifteen was the year with the greatest frequencies, with 632 certificates. The median value of incapacity was 60% (64% of total MCDs), with an interquartile amplitude of 12, varying from 6% to 99%. Incapacity values have an increasing tendency over the years, showing a cohort effect.

Conclusions
The increase of MCD reflects an enormous burden for the Public Health Services that consequently have fewer resources to deal with Essential Public Health Operations. Human resources or task distribution should be rethought in order to respond to population's needs. Cohort effects might be explained by the law-fixed re-evaluation, required every 5 years for oncological cases. In fact, this incapacity is the main cause of requirement of the MCD. Further studies should address this problematic in order to better organize the health services and understand the effectiveness of this procedure.

Key messages
The number of issued MCD is growing, overloading Health Services. The median incapacity is 60%, which is the threshold to attribute benefits. Further investigation is needed to address this issue.
Case simulations for permanent education in Primary Care – School of Patients DF
Authors: Cubas-Rolim E , Yung F R , Gripp M R , Oliveira C L A , Marques L A , Fagundes M C , Souza B V , Ribeiro L , Faria-Tostes E , Santana F 
Published: October 2020

Abstract

Background
In scenarios of vulnerability that include triple charge of diseases, permanent education in Primary Care and university is fundamental to allow greater access, efficiency and safety for users and health teams.

Objectives
The School of Patients DF was created as a tool for popular and technical health education, including case simulations for practice. It consists of standard technical content (Chapters), categorized by conditions and diseases, shared by Google Drive and used primarily in selected primary care units of Brazil's capital city.

Results
Technical simulations are performed in pairs, 1 participant acts as “patient” with script in hand (topics of the training) while the other acts as “health professional” as if in a regular visit. Simulations are timed for 10 minutes for consultation and 5 for feedback, boosting learning. Contents are based on guidelines and protocols from the Ministry of Health, Secretary of Health and Brazilian Community and Family Medicine Society. Since 2016 there have been realized over 1400 simulations, including weekly classes for last term medical students at the capital city federal university.

Conclusions
Simulations optimize the time necessary for permanent education (15 minutes blocks), avoiding limiting access for triage and consults, allowing smaller groups to train with greater focus and independent of computers or projectors.

Key messages
Standardizing training and practice bring benefit to patient care and safety. Simulations with structured physical examination are important both for professional as well as students.
Organizational well-being among healthcare workers of middle management: a pilot study
Authors: Piras I , Vivolo M , Portoghese I , Azara A , Piana A , Galletta M 
Published: October 2020

Abstract

Background
The organizational well-being assessment makes possible to identify risks for health in workers and organizations and to introduce health promotion actions in the workplace. The aim of the study is to analyze the organizational well-being among health professional managers who manage professional groups (e.g., nurses, midwives, physiotherapists) in hospital and identify potential main discomfort factors of these middle management workers.

Methods
A bicentric pilot study was performed in October 2019. A questionnaire with validated scales was administered to all the health professional managers of two Italian hospitals. The scales investigated variables such as distress, stress risk factors (e.g., physical and emotional workload, job control, job autonomy, role clarity, relationships, support), well-being, and job satisfaction.

Results
A self-reported questionnaire was administered to 38 out of 40 managers. They were male for 21% and female for 79%. The average age was 53.9 years. T-test analysis showed no significant difference between the two hospitals. The entire sample shows low general distress level, but 25% of the sample declares moderate distress and 8% high distress. The managers refer pace and workloads often (37%) or always (47%) excessive, they refer to not be able to 'detach' themselves from work issues when they get off work (60%) and to be too tired to live their lives (63%). They report that rarely (29%) or never (43%) have a say in how to do their job and refer that their direct supervisor is never available to listen their work problems (43%). The managers often or always perceive tension in working relationships (49%) and refer to do not have the needed support from colleagues (56%). Thirteen percent of managers applied for move into another ward.

Conclusions
This study shows that health professional managers experience general working discomfort and perceive problems with regard workload and poor support from colleagues and supervisors.

Key messages
Managers’ well-being can be compromised by both organizational and relationship factors. Middle management well-being should be improved to reduce distress risk and increase professional team efficacy.
The Italian validation of the revised Incivility in Nursing Education survey: preliminary results
Authors: Unim B , Santini M , Gambale G , Chiarini M , Nicoli M , De Vito C , Cattaruzza M S 
Published: October 2020

Abstract

Background
Incivility in nursing education is defined as rude or disruptive behaviors that can result into psychological or physiological distress for the people involved. Therefore, academic nursing incivility may seriously impact the nursing profession. The revised Incivility in Nursing Education (INE-R) is a validated instrument to measure academic incivility, but it is not available in Italian language. The aim of the study is to translate and validate the INE-R survey instrument with an Italian sample.

Methods
The Italian version of the INE-R survey was piloted for content and general linguistic clarity. It is currently administered online to nursing faculty (NF) and nursing students (NS) of Sapienza University of Rome. The survey explores uncivil behaviors and their frequency of occurrence among NF and NS. It also collects suggestions for improving the level of academic civility.

Results
To date, 33 responders (8 NF and 25 NS) have completed the survey, of which 45,5% consider incivility in their department a moderate problem. A common NF uncivil behavior was canceling class without warning (39%), while arriving late for class was common among NS (40%). The top strategies to improve the level of civility in nursing education are the adoption of codes of conduct that define acceptable and unacceptable behaviors (39%) and the provision of training for effective communication and conflict negotiation (33%). The main consequences of incivility in nursing education are inappropriate teaching practice and poor quality education (54,5%).

Conclusions
Incivility in nursing education negatively affects teaching-learning process and can lead to emotional, or physical distress for faculty staff and students. There is therefore a need for specific policies and continuous monitoring on academic incivility to guarantee a healthy work and study environment. It is important to raise awareness among students and faculty while adopting zero-tolerance policy regarding incivility.

Key messages
Incivility in nursing education negatively affects teaching-learning process and can lead to emotional, or physical distress for the individuals involved. There is a need for specific policies and continuous monitoring on academic incivility to guarantee a healthy work environment.