One of the difficulties nurses experience in clinical practice in relation to ethical issues in connection with young oncology patients is moral distress. In this descriptive correlational study, the Moral Distress Scale-Paediatric Version (MDS-PV) was translated from the original language and tested on a conventional sample of nurses working in paediatric oncology and haematology wards, in six north paediatric hospitals of Italy. 13.7% of the total respondents claimed that they had changed unit or hospital due to moral distress. The items with the highest mean intensity in the sample were almost all connected with medical and nursing competence and have considerably higher values than frequency. The instrument was found to be reliable. The results confirmed the validity of the MDS-PV (Cronbach’s alpha = 0.959). This study represents the first small-scale attempt to validate MDS-PV for use in paediatric oncology-ematology nurses in Italy.

BackgroundSelf-care is essential for patients with diabetes mellitus. Both clinicians and researchers must be able to assess the quality of that self-care. Available tools have various limitations and none are theoretically based. The aims of this study were to develop and to test the psychometric properties of a new instrument based on the middle range-theory of self-care of chronic illness: the Self-Care of Diabetes Inventory (SCODI).MethodsForty SCODI items (5 point Likert type scale) were developed based on clinical recommendations and grouped into 4 dimensions: self-care maintenance, self-care monitoring, self-care management and self-care confidence based on the theory. Content validity was assessed by a multidisciplinary panel of experts. A multi-centre cross-sectional study was conducted in a consecutive sample of 200 type 1 and type 2 diabetes patients. Dimensionality was evaluated by exploratory factor analyses. Multidimensional model based reliability was estimated for each scale. Multiple regression models estimating associations between SCODI scores and glycated haemoglobin (HbA1c), body mass index, and diabetes complications, were used for construct validity.ResultsContent validity ratio was 100%. A multidimensional structure emerged for the 4 scales. Multidimensional model-based reliabilities were between 0.81 (maintenance) and 0.89 (confidence). Significant associations were found between self-care maintenance and HbA1c (p = 0.02) and between self-care monitoring and diabetes complications (p = 0.04). Self-care management was associated with BMI (p = 0.004) and diabetes complications (p = 0.03). Self-care confidence was a significant predictor of self-care maintenance, monitoring and management (all p < 0.0001).ConclusionThe SCODI is a valid and reliable theoretically-grounded tool to measure self-care in type 1 and type 2 DM patients.Electronic supplementary materialThe online version of this article (doi: 10.1186/s12902-017-0218-y) contains supplementary material, which is available to authorized users.

Aim To verify the role of dispositional mindfulness, difficulties in emotion regulation and empathy in explaining burnout levels of emergency room (ER) nurses. Background Many studies have examined the variables that can affect burnout amongst ER nurses, but little is known about factors that can protect ER nurses against work‐related stress. Method A multi‐centre cross‐sectional design was used. Burnout level intensity, dispositional mindfulness facets, difficulties in emotion regulation and empathy dimensions were assessed using valid and reliable self‐report questionnaires in a sample of ER nurses (N = 97) from three different hospitals. Results Higher dispositional mindfulness and cognitive empathy levels and lower difficulties in emotion regulation, were negatively associated with emotional exhaustion levels. Conclusion ER nurses with more mindful, emotion regulation and empathy skills are more able to manage work‐related distress. Implications for Nursing Management Experiential interventions to promote mindfulness skills, emotion regulation variability and flexibility in a clinical context and the cognitive side of empathy are recommended for ER nurses to reduce professional distress, and to enhance personal and work satisfaction. Future research should assess the effectiveness of new multi‐factorial interventions which combine the development of mindfulness, emotion regulation and empathy skills in ER nurses.

Self-care was poor in heart failure patients with diabetes mellitus. This population needs more intensive interventions to improve self-care. Determinants of self-care in heart failure patients with diabetes mellitus should be systematically assessed by clinicians to identify patients at risk of inadequate self-care.

Self-care influences both clinical outcomes and quality of life of T2DM patients. Although exercise is more frequently associated with positive outcomes, it is particularly poor in T2DM population. Blood testing and foot care should be performed to prevent complications and not only when a health problem is already occurred. Interventions aimed to improve exercise are recommended. Further research is needed to explore barriers to exercise.

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.

AimThe purpose of the this study was to test the factorial structure, internal consistency reliability and concurrent validity of the Caregiver Contribution to Self‐Care Chronic Illness Inventory.BackgroundExisting measures of caregiver contribution to self‐care are disease‐specific or behaviour‐specific; no generic measures exist.DesignA cross‐sectional study.MethodBetween April 2017 ‐ December 2018, we enrolled a convenience sample of 358 patients with chronic illnesses and their caregivers. Patients completed the Self‐Care of Chronic Illness Inventory while caregivers completed the Caregiver Contribution to Self‐Care of Chronic Illness Inventory, a modification of the Self‐Care of Chronic Illness Inventory, which includes three scales as follows: the Caregiver Contribution to Self‐Care Maintenance, the Caregiver Contribution to Self‐Care Monitoring and the Caregiver Contribution to Self‐Care Management. Of each scale, we tested the factorial structure with confirmatory factor analysis and reliability with the factor score determinacy coefficient, the global reliability index for multidimensional scale and Cronbach's alpha. Also, we used Pearson's correlations for concurrent validity purposes.ResultsConfirmatory factor analysis supported the two‐factor structure of the Caregiver Contribution to Self‐Care Maintenance and Management scales and the one‐factor structure of the Caregiver Contribution to Self‐Care Monitoring scale. A simultaneous confirmatory factor analysis on the combined set of items supported the more general model (Comparative Fit Index = 0.933). Reliability estimates ranged between 0.701 and 0.961 across the three scales. Concurrent validity of Caregiver Contribution to Self‐Care of Chronic Illness Inventory with the Self‐Care of Chronic Illness Inventory was not sufficiently supported since weak correlations were found.ConclusionThe Caregiver Contribution to Self‐Care of Chronic Illness Inventory is valid and reliable and can be used in clinical practice and research.ImpactThe Caregiver Contribution to Self‐Care of Chronic Illness Inventory is an useful instrument to evaluate the extent to which caregivers contribute to patient self‐care in chronic illnesses.

Further research is needed to test Nu-DESC on a larger sample. However, based on our results, Nu-DESC can be used in research and clinical practice in Italian settings because of its very good and similar performances to previous validation studies. The value of 3 appears to be the optimal cut-off in the Italian context.