Aim: To investigate the experience of Italian nurses during the first wave of the COVID-19 outbreak by analysing professional social media posts. Background: The COVID-19 outbreak has overwhelmed health care institutions; as a consequence, nurses' lives and psycho-physical health have been affected. Introduction: The COVID-19 pandemic forced nurses to work in physically and psychologically stressful conditions impacting on their life. Methods: A qualitative descriptive study. All narratives (texts and videos) posted by nurses from the 23 rd of February 2020 to the 3 rd of May (from the start of the outbreak to the end of the first lockdown) were analysed and published on the five most popular Italian professional social media platforms. The Consolidated Criteria for Reporting Qualitative research guidelines were followed. Results: Five themes emerged from the 380 narratives explored: 'Sharing what is happening within myself'; 'Experiencing unprecedented working conditions'; 'Experiencing a deep change'; 'Failing to rehabilitate the image of nurses in society'; and 'Do not abandon us'. Even though nurses appreciated the recognition of their communities, they still felt devalued and not recognized as professionals. Discussion: Several psychological, physical, social and professional implications emerged from nurses working during the COVID-19 pandemic. Despite being highly praised, nurses perceived they had failed in rehabilitating the image of nurses in society. Conclusion:The experience of working during the COVID-19 pandemic represented a traumatic event for nurses but it offered them personal and professional growth opportunities. Implications for nursing practice, nursing policy and health policy: Supporting nurses' mental health is highly recommended, together with a cultural investment on nurses' role recognition, and a zero-tolerance policy towards violence and aggression towards nurses.

Background Unfinished Nursing Care (UNC) concept, that express the condition when nurses are forced to delay or omit required nursing care, has been largely investigated as tasks left undone, missed care, and implicit rationing of nursing care. However, no summary of the available evidence regarding UNC antecedents has been published. The aim of this study is to identify and summarise antecedents of UNC as documented in primary studies to date. Methods A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. MEDLINE, CINAHL, SCOPUS, and PROSPERO databases were searched for quantitative studies reporting the relationships between antecedents and UNC published after 2004 up to 21 January 2020. The reference lists of secondary studies have been scrutinised to identify additional studies. Two reviewers independently identified studies and evaluated them for their eligibility and disagreements were resolved by the research team. The quality appraisal was based on the Joanna Briggs Institute Critical Appraisal tools, according to the study designs. A data extraction grid was piloted and then used to extract data. The antecedents that emerged were thematically categorised with an inductive approach. Results Fifty-eight studies were included; among them, 54 were cross-sectional, three were cohort studies, and one was a quasi-experimental study. They were conducted mainly in the United States and in hospital settings. The UNC antecedents have been investigated to date at the (a) unit (e.g., workloads, non-nursing tasks), (b) nurse (e.g., age, gender), and (c) patient levels (clinical instability). Conclusions At the unit level, it is highly recommended to provide an adequate staff level, strategies to deal with unpredictable workloads, and to promote good practice environments to reduce or minimise UNC. By contrast, at the nurse and patient levels, there were no clear trends regarding modifiable factors that could decrease the occurrence of UNC. The map of antecedents that emerged can be used to design interventional studies aimed at changing research from merely descriptive to that which evaluates the effectiveness of interventions.

Background 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. Objective This review aims to summarize digital health competencies investigated to date and the tools used to assess them among health care professionals. Methods 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. Results 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. Conclusions 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. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42021282775; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282775

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Aim: To map the main characteristics of massive open online courses, and their effectiveness, facilitators and barriers in continuing education among nurses and other healthcare professionals. Background: Online continuous education attracted new attention among educators and managers with regard to how to best design, implement it and evaluate its effectiveness. Introduction: No studies to date have mapped the state of research on massive open online courses and the facilitators promoting their effectiveness in continuing education. Methods: A scoping review performed in 2020 by following the Preferred Reporting Items for Systematic reviews and Meta-analysis extension-Scoping Reviews. Electronic databases were searched for primary and secondary studies, written in English. Identified barriers/facilitators were categorized using a content analysis. Results: Of the 1149 studies, 31 were included, and the majority had an explorative research design. Massive open online courses documented to date are characterized by their (a) developers' countries and providers, mainly the United Stated and universities, respectively; (b) variety of teaching methods and contents, including infectious diseases; (c) using both qualitative and quantitative assessment methods; and (d) multidisciplinary target audience ranging from 40 to 83 000 participants, including nurses. Facilitators of and barriers to effectiveness depend on their pedagogical background, appropriate course design, delivery and implementation as well as on the learners' profile. Discussion: Studies available to date are mainly based on experiential projects. A variety of strategies promoting massive online courses' effectiveness have emerged. Conclusion: Some public health issues may benefit from massive education, as a unique system promoting a quick and effective continuous education. Implications for Nursing/Health/Social Policy: Clinical nurses, nurse managers and educators should consider available evidence on massive online courses' when making decisions on which strategy to use to maintain competencies. Moreover, as a public health tool, massive online courses should be derived from a strong cooperation between political, scientific and professional bodies.

Aim To identify the strategies to prevent missed nursing care (MNC) that can be implemented by nurse managers/directors on a daily basis. Background Only few recommendations have been established to date aiming at supporting nurse managers/ directors in preventing MNC. However, several strategies are implemented on a daily basis, suggesting that a body of tacit, practical and wise knowledge is already in place. Method(s) An international qualitative descriptive study based on the positive deviance approach conducted in 2019−2020 and reported according to the Consolidated Criteria for Reporting Qualitative Research. A purposeful sample of 35 nurse managers/directors working in hospitals in Cyprus, Italy, Germany and Switzerland was involved. Codes were extracted from each country, and a thematic analysis was performed at the transnational level to identify strategies and interventions preformed to prevent MNC. Results Eight strategies and 22 interventions, mainly with preventive intent and designed at the hospital level, affecting both the processes and the structural dimensions, have been reported as effective in preventing MNC. Conclusion Nurse leaders are involved daily in implementing strategies to minimise MNC at the nursing and at the hospital system levels, integrated with each other. Implications for Nursing Management Preventing MNC should be a core value of the entire hospital, and not merely a nursing issue. Therefore, complex interventions at the system level are required.

Background The nursing role significantly changed following reforms in the nurse training process. Nowadays, nurses are increasingly trained to promote and improve the quality of clinical practice and to provide support in the assistance of patients and communities. Opportunities and threats are emerging as a consequence of the introduction of new disruptive technologies in public health, which requires the health care staff to develop new digital skills. Objective The aim of this paper is to review and define the role of nurses and the skills they are asked to master in terms of new methodological approaches and digital knowledge in a continuously evolving health care scenario that relies increasingly more on technology and digital solutions. Methods This scoping review was conducted using a thematic summary of previous studies. Authors collected publications through a cross-database search (PubMed, Web of Science, Google Scholar) related to new telemedicine approaches impacting the nurses’ role, considering the time span of 2011-2021 and therefore including experiences and publications related to the first phase of the COVID-19 pandemic. Results The assessment was completed between April and July 2021. After a cross-database search, authors reviewed a selection of 60 studies. The results obtained were organized into 5 emerging macro areas: (1) leadership (nurses are expected to show leadership capabilities when introducing new technologies in health care practices, considering their pivotal role in coordinating various professional figures and the patient), (2) soft skills (new communication skills, adaptiveness, and problem solving are needed to adapt the interaction to the level of digital skills and digital knowledge of the patient), (3) training (specific subjects need to be added to nursing training to boost the adoption of new communication and technological skills, enabling health care professionals to largely and effectively use new digital tools), (4) remote management of COVID-19 or chronic patients during the pandemic (a role that has proved to be fundamental is the community and family nurse and health care systems are adopting novel assistance models to support patients at home and to enable decentralization of services from hospitals to the territory), and (5) management of interpersonal relationships with patients through telemedicine (a person-centered approach with an open and sensitive attitude seems to be even more important in the framework of telemedicine where a face-to-face session is not possible and therefore nonverbal indicators are more problematic to be noticed). Conclusions Further advancing nurses’ readiness in adopting telemedicine requires an integrated approach, including combination of technical knowledge, management abilities, soft skills, and communication skills. This scoping review provides a wide-ranging and general—albeit valuable—starting point to identify these core competences and better understand their implications in terms of present and future health care professionals’ roles.

Aims and objectives To establish whether, and to what extent, tools measuring Unfinished Nursing Care (UNC) that have been validated to date have the ability to detect the discrete elements of the ‘Integration of care’ dimension of The Fundamentals of Care Framework (The Framework). Background UNC and The Framework have been established as two separate research lines, focused on (a) omitted care and related tools, and (b) on how to improve patient care, respectively. However, no attempts have been made to date to establish whether, and to what extent, tools measuring UNC have the ability to represent the discrete elements of The Framework. Design A two‐step study: (a) a secondary analysis of a systematic review up to June 2018 later updated in May 2020, followed by (b) a comparative analysis. Methods A systematic review of studies on validated tools measuring UNC was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guideline. Then, researchers independently performed a comparative analysis between the extracted (a) discrete elements of The Framework and (b) items of the UNC tools retrieved. Results A total of 14 tools were analysed. The physical dimension of The Framework was the one mostly covered by UNC tools (up to 87.5% with the Perceived Implicit Rationing of Nursing Care). The Norwegian Basel Extent of Rationing of Nursing Care showed the highest level of representation (41.6%) for the psychosocial dimension. Only the Perceived Implicit Rationing of Nursing Care and the Unfinished Care tool measure the relational dimension (22.2%, respectively). By considering all elements of the ‘Integration of care’ dimension, the Perceived Implicit Rationing of Care had the highest percentage of convergence (41%). Conclusion Not all UNC tools have the same ability to represent the discrete elements of The Framework. Moreover, physical needs are more often detected in UNC tools compared to the relational and psychological ones. Relevance to clinical practice Unfinished care tools validated to date can represent a body of knowledge on which to build The Framework metrics, especially for the physical dimensions.