Aim To summarize, critically review, and interpret the evidence related to the systematic reviews on health literacy (HL) amongst type 2 diabetes mellitus (T2DM). Methods The methodology for this study consisted of a systematic review of systematic reviews, using the PRISMA statement and flowchart to select studies, and searching on PubMed, CINAHL, Scopus, and Cochrane. The search covered the period between January 2006 and June 2016. Results From the 115 identified record by the queries, only six systematic reviews were included, following a quality evaluation using AMSTAR. The included systematic reviews content was analyzed by the independent work of two authors, using a narrative synthesis approach. The findings of this study (i.e., main themes) are areas of consensus and gaps in knowledge. Areas of consensus are HL definition, HL measurement tools, and the relationship between T2DM patient knowledge (or literacy) and his/her HL. The gaps in knowledge were the assessment of the relations between HL and health outcomes and self-efficacy, the gender differences, the effectiveness of interventions to improve HL, the cost-effectiveness study of interventions to improve HL, and the understanding of the influence of organizational environment on HL. Conclusion This review provides a current state of knowledge to address clinical practice and research proposals. HL could be useful to personalize patients' follow-up and it should be routinely assessed in its three dimensions (i.e. functional, interactive and critical) to enhance patients' ability to cope with clinical recommendations. Future research should be mainly aimed to test the effectiveness of evidence-based interventions to improve HL amongst T2DM patients.

Aim: This study describes the development and validation of the Nursing Profession Self-Efficacy Scale.Background: Self-efficacy can be useful in predicting performance, job satisfaction or well-being.In the nursing field, there is a shortage of studies on self-efficacy in regard to a nurses' global confidence in coping ability across a range of everyday challenging work situations. Methods:To define the theoretical framework of nursing professional self-efficacy, two focus groups and a literature review were performed. An empirical study was then conducted to test validity and reliability. Face and content validity, construct validity, concurrent validity, internal consistency and test-retest reliability were examined. The content validity index was evaluated by 12 experts who suggested deleting eleven redundant items. The final developed tool was tested for construct analysis using a cross-validation approach, randomly splitting the overall sample of 917 nurses in two subgroups. Findings:The construct validity indicated two dimensions. The face and content validity were adequate. Test-retest reliability displayed a good stability, and internal consistency (Cronbach's α) was acceptable. Moreover, concurrent validity using the Generalized Self-Efficacy Scale was in line with the theoretical framework. Conclusion:The scale showed evidence of validity and reliability. The major limitation is the strong influence of the Italian context in the tool development. Implications for Nursing and Health Policy:The Nursing Profession Self-Efficacy Scale could be a fruitful tool that facilitates the application of theories (i.e. social cognitive theory) in the nursing field and even development of interventions. Furthermore, a measurement of self-efficacy could be used to predict nursing clinical performance.

AimThe aim of this study was to critically analyse and describe gender differences related to self-care among patients with chronic heart failure (HF).Methods and resultsA monocentric real-world cohort of 346 patients with chronic HF in follow-up was used for this cross-sectional study. We report data related to the cohort’s demographic and clinical characteristics. Self-care was assessed using the Self-Care of Heart Failure Index before patients’ discharge. After bivariate analysis, logistical regression models were used to describe the relationship between gender, self-care behaviours and self-care confidence. While men were found to have more than quadruple the risk of poor self-care than women (OR 4.596; 95% CI 1.075 to 19.650), men were also found to be approximately 60% more likely to have adequate self-care confidence than women (OR 0.412; 95% CI 0.104 to 0.962). Considering that self-care confidence is described as a positive predictor of behaviours, our results suggest a paradox. It is possible that the patient–caregiver relationship mediates the effect of confidence on behaviours. Overall, adequate levels of self-care behaviours are a current issue, ranging 7.6%–18.0%.ConclusionThis study sets the stage for future research where elements of the patient–caregiver relationship ought to be considered to inform the planning of appropriate educational interventions. We recommend routinely measuring patients’ self-care behaviours to guide their follow-up and as a basis for any changes in their daily life behaviours.

Aim: To systematically and critically summarize the state of the evidence about the Synergy Model and its utilization in nursing practice. Background: The Synergy Model emphasizes the importance of alignment between patient needs and nurse competencies in achieving adequate patient-and nurse-related outcomes. It is a relatively new patient-centred care model developed at the end of the 1990s. Introduction: Despite the Synergy Model's potential to support patient-centred care, its practical application is still mainly limited. Thus far, literature about the Synergy Model has not yet been synthesized, undermining its broader utilization globally. Methods: A systematic search was performed on the following databases: PubMed, CINAHL and Scopus. The authors used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement and checklist to guide the systematic search; 26 papers were included in this study. A critical interpretative synthesis was adopted to summarize the data extracted from the included papers. Results: Five interpretative themes emerged: conceptualization, experiences from the field, nursing education, patient-related outcomes and system-related outcomes. Synergy Model shows a precise theoretical definition, and it was implemented in multiple clinical settings, mainly in critical care contexts. It seems to have a positive influence on patient-related, nurse-related and system-related outcomes. Discussion: Synergy Model seems to be positively associated with specific susceptible outcomes, such as patient satisfaction, reduction of patient's complications, staff satisfaction, empowerment, and engagement of patients and healthcare providers. However, the level of evidence is still limited. Conclusion: Future international research should demonstrate the feasibility of implementing the Synergy Model at an international level. More empirical research is needed to demonstrate the effectiveness of the model on susceptible outcomes. Implications for nursing and health policy: This systematic review could support further development of international programmes based on the Synergy Model. The Synergy Model's implementation has the potential to optimize nursing competencies, patient-and nurse-related outcomes.

Understanding factors that socially, legislatively and politically have influenced the development of regulatory bodies over time helps to mould local, national and international policies that have a stronger impact on health worldwide. To achieve this, there must be effective cooperation among systems of nursing regulations globally.

Prejudices on psychiatric disorders frequently turn into stigmatizating attitudes, also among health care providers. The Opening Minds Stigma Scale for Health Care Providers (OMS-HC) was introduced in 2012 to measure stigma. No Italian versions of this tool exist so far. We wanted to investigate stigma among healthcare students in Italy, and to prepare an Italian version of the scale. A multicentric, cross-sectional study was conducted on a sample of Nursing, Physiotherapy, Occupational therapy, and Dietistics students. The Italian version of the scale was obtained through back-translation.
561 students were enrolled, median age 21 years, IQR [20;23], 62.22% females (n = 349). 262 students declared having met subjetcs affected by psychiatric disorders during their training; 50 had one or more psychiatric disorders in their lives. The Italian version proved valid and reliable. Older students had lower stigma scores. No differences existed between stigma scores according to gender and personal experience of mental illness.

Background: Pressure ulcers (PUs) represent a current issue for healthcare delivery.Nurse self-efficacy in managing PUs could predict patients' outcome, being a proxy assessment of their overall competency to managing PUs. However, a valid and reliable scale of this task-specific self-efficacy has not yet been developed.Objectives: To develop a valid and reliable scale to assess nurses' self-efficacy in managing PUs, that is, the pressure ulcer management self-efficacy scale for nurses (PUM-SES). Methods:This study had a multi-method and multi-phase design, where study reporting was supported by the STROBE checklist (File S1). Phase 1 referred to the scale development, consisting in the items' generation, mainly based on themes emerged from the literature and discussed within a panel of experts. Phase 2 focused on a three-step validation process: the first step aimed to assess face and content validity of the pool of items previously generated (initial version of the PUM-SES); the second aimed to assess psychometrics properties through exploratory factorial analysis; the third step assessed construct validity through confirmative factorial analysis, while concurrent validity was evaluated describing the relationships between PUM-SES and an established general self-efficacy measurement. Reliability was assessed through the evaluation of stability and internal consistency.Results: PUM-SES showed evidence of face and content validity, adequate construct and concurrent validity, internal consistency and stability. Specifically, PUM-SES had four domains, labelled as follows: assessment, planning, supervision and decisionmaking. These domains were predicted by the same second-order factor, labelled as PU management self-efficacy.Conclusion: PUM-SES is a 10-item scale to measure nurses' self-efficacy in PU management. A standardised 0-100 scoring is suggested for computing each domain and the overall scale. PUM-SES might be used in clinical and educational research.

Education 1 | Cristina Arrigoni RN, MSN, Researcher 2 | Irene Baroni RN, MSN, Clinical Research Nurse 1 | Gianluca Conte RN, Clinical Research Nurse 3 | Cristina Di Pasquale RN, Stoma-therapist Nurse Specialist 4 | Lorenzo Casole RN, Clinical Nurse 1 | Giulia Villa PhD, RN, Head Nurse 5 | Abstract Aim: To develop and psychometrically test a self-efficacy scale for ostomy care nursing management.Design: This study adopted a multi-method and multi-phase design. Method: Phase 1 of the study was comprised of the developmental tasks, where items were generated based on the emergent themes from literature. The items were then discussed with a panel of experts. Phase 2 focused on the validation process of the scale, where its content validity, construct and concurrent validity, and its internal consistency were assessed. The validation process was conducted Results: The final version of the self-efficacy scale in ostomy care nursing management encompasses 24 items in three domains, namely the clinical assessment domain, the education and relationship domain, and the teamwork domain. The scale showed the evidence of face and content validity, adequate construct and concurrent validity, and adequate internal consistency. Conclusion: The developed scale can be used in clinical and educational research.Impact: This study presents the development and validation of the first valid and reliable self-reporting measurement for nurses' self-efficacy in ostomy care nursing management. Self-efficacy ostomy care nursing management encompasses 24 items and three domains, which are clinical assessment, education and relationship, and teamwork. This research will have an impact on nursing education, as it addresses the need for a specific self-efficacy assessment of ostomy care nursing management. Self-efficacy ostomy care nursing management will have an impact on nurses and patients, as it can be used to improve nurses' self-efficacy and clinical outcomes for patients in ostomy care.