Evaluation of the continuity of obstetric home care services (ADOC) between hospitals and local areas - ASL TO5-Piedmont. INTRODUCTION:Home visits by midwives during the postpartum period support physiological recovery, limit the chronicity of health problems and promote the timely diagnosis of maternal and neonatal problems. OBJECTIVE:To describe the midwifery postnatal home care service (ADOC) through the analysis of interventions, outcomes and satisfaction of the families involved. METHODS:Retrospective study conducted in a Piedmont District on 756 new mothers followed up at home after hospital discharge. Socio-demographic and clinical variables were investigated, including hospital follow-ups, re-admissions and links with the network. Family satisfaction was surveyed using a questionnaire. RESULTS:81% of eligible women joined the project and received 2 home visits (IQR 2-3): the first guaranteed the day after hospital discharge in 48% of cases and the second after 3 days (IQR 2-4). Re-admissions were necessary for 1 (0.1%) woman and 3 (0.4%) infants. At the end of ADOC 76,9% of infants were fed with breast milk; 12 cases (1.6%) were referred to the perinatal health network for mental distress; 93,5% of mother-son dyads were referred to the community center. The satisfaction rate was high, particularly for the perceived increased confidence and parental skills in dealing with care needs. CONCLUSIONS:ADOC fostered continuity of care and linkage with the network supporting parenthood and early interception of situations at risk. Activated during the Covid-19 pandemic, it was then structurally implemented in the care provision.
. Compassion and freedom: the example of Alex Pretti. In this issue we publish Giuseppe Gristina's moving remembrance of Alex Jeffrey Pretti, a US intensive care nurse who was killed in Minneapolis on January 24, 2026 during protests following a controversial police action. Pretti was also an engaged citizen, active in public life and committed to democratic values. His story reminds us that nursing (and health professionals) identity cannot be confined to hospital wards or clinical settings: nurses work at the intersection of health, social vulnerability, and inequality, and their professional responsibility often extends beyond the bedside into the civic sphere. Pretti's legacy therefore stands as a reminder that the ethics of care continues not only in clinical practice, but also in the way professionals choose to engage with the world around them.
Defining the scope of activity of family/community nurses: the experience of the Veneto Region. INTRODUCTION:The introduction of the family and community nurse (FCN) in Italy, established by Law 77/2020 and Ministerial Decree 77/2022, strengthened primary care but resulted in heterogeneous regional implementation. OBJECTIVE:To describe the Veneto Region's process to define an organizational model for Family and community nursing services (SIFoC) and to develop a standardized catalogue of core FCN activities, improving measurability and governance. METHODS:A regional multidisciplinary working group was established. Semiannual monitoring and benchmarking across Local Health Authorities assessed organizational models, activity volumes, and assessment tools. Initial catalogues (24, then 60 activities) were progressively revised through structured training and consensus meetings. RESULTS:Monitoring revealed variability in organizational structures, assessment tool use, and activity distribution. The final catalogue included 27 core activities organized by care processes, target units (individual, caregiver, family, community), settings, and delivery modes, thus balancing excessive generalization and over-fragmentation. It explicitly incorporated activities such as population stratification, proactive case finding, case management, therapeutic education, and community-level interventions. Integration into regional information systems has been initiated to enhance traceability. CONCLUSIONS:Defining FCN activities proved to be both a technical and cultural process. The described model enhances visibility, measurability, and governance of community nursing practice, providing a foundation for future evaluation of clinical and organizational outcomes.
. Telemedicine and drug adherence in mood disorders: a narrative review of the literature. INTRODUCTION:Mood disorders (ICD-10: F30-F39), including major depressive disorder and bipolar disorder, are chronic psychiatric conditions characterized by high prevalence and significant disability. Treatment adherence remains a critical challenge, influenced by a wide range of clinical and psychosocial factors. In recent years, telemedicine has emerged as a strategic tool to promote continuity of care and improve personalized access to mental health services. OBJECTIVE:To evaluate the effectiveness of telemedicine-based interventions in enhancing treatment adherence among individuals with mood disorders. METHODS:A narrative review of the literature was conducted, including both systematic reviews (SR) and randomized controlled trials (RCT), that investigated digital interventions such as text messaging (SMS), follow-up phone calls, and mobile health applications. A structured data extraction grid was employed for analysis. RESULTS:A total of four studies were included in the review (3 SR and 1 RCT). The interventions assessed ranged from SMS reminders and follow-up phone calls to mobile app-based notifications. The majority of studies reported a statistically significant improvement in treatment adherence compared to standard clinical care. CONCLUSIONS:Simple, low-intensity digital interventions show concrete potential for integration into treatment pathways for mood disorders, offering pragmatic and sustainable solutions to enhance medication adherence in routine care.
. The concept of overeducation and its implication for the nursing profession. Beyond salary-related issues, limited social recognition and the insufficient valorisation of competencies acquired through post-basic education or advanced professional experience also play a significant role in the attractiveness of the nursing profession. The concept of overeducation in this context refers to the mismatch between the level of education attained and the role actually performed. Despite its growing relevance, this concept still lacks a clear theoretical and operational framework, particularly within nursing.A narrative literature review was conducted using PubMed, Web of Science, and grey literature sources, including contributions from economic and sociological research to analyse definitions, measurement approaches, causes, and consequences of overeducation, as well as related concepts such as overskilling, skill mismatch, and overqualification.Published papers adopt different definitions making comparisons difficult. Overeducation may take individual or collective forms and can be either temporary or persistent, with economic, organisational, and professional determinants. It may impact on job dissatisfaction, turnover intentions, burnout, and the underutilisation of human capital, but it may also prompt proactive strategies for professional mobility. Measuring overeducation in nursing requires first clarifying how the concept can be operationalized within a profession where advanced education does not always correspond to formally differentiated roles. Studying overeducation becomes essential to understand the alignment between training, recognition of credentials, and the effective use of professional competencies. This involves defining appropriate indicators that capture the alignment between educational attainment, role requirements, and the actual use of competencies in practice.
. Striking nurses in New York brave the freezing cold. The text reflects on the symbolic image of freezing streets and bridges in New York as a backdrop to a deeper message about nursing and social responsibility. Although these winter scenes may feel distant when read in spring, the contrast highlights a broader tension between hardship and hope. At a time when the United States, long considered a reference point for health professions, appears marked by violence and social contradictions, the nursing profession embodies resistance and moral responsibility. In New York, nurses have taken a stand grounded not in partisan politics but in ethical commitment. Their mobilization serves as a reminder that healthcare must prioritize human life, especially the lives of the most vulnerable. Nurses affirm that care must be valued above weapons and that true security comes from investing in health and dignity. For care to be real, economic priorities must shift toward supporting adequate time, staffing, and resources. Professional dignity requires conditions that allow nurses to genuinely meet people's needs. The gesture described is less about political protest and more about reaffirming care as a social foundation. The deeper message is that knowledge only becomes meaningful when it translates into real, accessible care for those who need it most.
. From emergency derogation to normalization of the exception: implications for the nursing profession in Italy. The Italian emergency provision allowing foreign-trained nurses to practice without prior formal recognition, introduced during the Covid-19 pandemic under Decree-Law 18/2020, has progressively evolved from a temporary measure into a structural workforce strategy. Under the ordinary pathway, foreign qualifications must undergo ministerial recognition, verification of substantial equivalence, language certification, and registration with the Provincial Nursing Board (OPI). The derogation reverses this sequence, permitting professional practice before or even without formal recognition, thereby shifting from preventive evaluation to ex-post control. While the measure ensures rapid recruitment and staffing flexibility, it raises concerns regarding patient safety, professional standards, and regulatory coherence. Variability in international nursing education, absence of compensatory measures, and limited language assessment may produce heterogeneous competencies.Available data indicate a marked increase in foreign nurse recruitment, with estimates suggesting that nearly 10% of the Italian nursing workforce is foreign-trained. However, transparency gaps remain regarding numbers, distribution, and long-term integration. Ethical implications extend globally, as large-scale recruitment from countries with their own workforce shortages risks contributing to health-sector brain drain.A sustainable response requires transparent monitoring, structured integration pathways, mentoring programs, and renewed investment in domestic workforce planning. Balancing openness with quality assurance is essential to safeguard patient safety, professional identity, and long-term health system sustainability.
. When protocols meet reality. The JAMA narrative highlights the structural and ethical limits of clinical protocols. While protocols ensure standardization, safety, and accountability, their mechanical application may conflict with patient dignity and vulnerability. In advanced dementia, asking cognitively impossible questions can generate psychological and relational harm, raising concerns about unintended iatrogenic distress. Protocols are designed for typical cases and measurable outcomes, but rarely account for cognitive variability or emotional impact. When system coherence overrides lived experience, care risks losing its human dimension. The key principle emerging from this case is that relationship must precede procedure. Clinicians must be trained not only to apply protocols, but to adapt them responsibly. Without this competence, even evidence-based practice may produce avoidable harm.
. Peer-to-peer interventions in health promotion within the prison community: an integrative review of the literature. Introduction. The Italian prison system is confronted with significant health challenges, driven by an increasingly elderly and vulnerable inmate population. There is growing interest in peer interventions-internationally validated as a strategy to promote health and well-being. Objective. To explore the most recent evidence on peer-to-peer interventions within the prison population, describing their characteristics, areas of application, and the main outcomes regarding self-care, mental health, treatment adherence, and hospitalization. Methods. An integrative review was conducted. A systematic search was carried out in the Medline, PubMed, CINAHL, Embase, and PsycINFO databases, using the keywords prisoners, peer support, peer tutor, peer education, listeners group, and health trainers. Studies published from 2014 to February 2025 were included. Results. The findings indicate that peer support and peer mentoring represent the most comprehensive and effective approaches for improving mental health, reducing suicide risk, enhancing treatment adherence, and supporting social reintegration. Peer-to-peer interventions were particularly effective in promoting positive attitudes and behaviours toward the prevention of infectious and sexually transmitted diseases; improving emotional well-being-especially in the early stages of detention; ensuring adherence to outpatient services and correct medication intake, which in turn significantly reduced hospitalisations. Conclusions. Peer interventions have a positive impact on mental health, well-being, and reintegration outcomes, demonstrating both effectiveness and sustainability. Nevertheless, in Italy, structured programmes remain scarce, highlighting the urgency of strengthening and coordinating existing local initiatives.
. Obesity as a chronic disease: the key role of new therapies. The global prevalence of overweight and obesity has risen dramatically, with obesity now recognized as a chronic, progressive, and multifactorial disease linked to major health complications. Traditional lifestyle interventions and older pharmacologic treatments produce modest and often unsustained weight loss, with limited impact on cardiovascular outcomes. The introduction of GLP-1 receptor agonists-such as liraglutide and semaglutide-has transformed obesity management by producing substantial weight reduction and improving risks of diabetes, cardiovascular disease, and sleep apnea. Even more pronounced effects have been observed with tirzepatide, a dual GIP/GLP-1 agonist, which achieves weight loss approaching that of metabolic surgery and demonstrates promising cardiometabolic benefits. Despite their efficacy, these therapies require long-term use, as discontinuation leads to weight regain and potentially increased cardiovascular risk. Concerns also include reductions in lean mass, high treatment costs, and misuse driven by social media. Ensuring appropriate use requires medical supervision, preventive strategies, and public awareness efforts.
. The end of life as a test of a culture of care. The text examines the cultural and operational implications of framing end-of-life care through two parallel narratives: the official administrative statement of the Azienda USL Toscana Nord Ovest and the personal account written by a member of the clinical ethics committee. Both describe a recent case of medically assisted dying carried out under the 2025 Tuscan regional law, highlighting the tension between bureaucratic procedure and the profoundly human experience of a person choosing to end unbearable suffering. While the institutional version emphasizes compliance, safeguards, and organizational responsibilities, the internal narrative restores centrality to the patient's story, emotional journey, and need for relational support. The reflection argues that the term "assisted suicide" is culturally misleading and obscures the reality of a medically supported choice within a relationship of care. It stresses the crucial role of nurses and the broader need for a healthcare culture that protects dignity, relational time, and compassionate accompaniment at the end of life.
. What is the life expectancy for children in Gaza in the coming years? For two years, Gaza's population has endured a devastating war that has killed, injured, and displaced civilians-especially children. Homes, schools, and hospitals lie in ruins, and essential services have collapsed. Tens of thousands of children have been killed, maimed, or orphaned, while many suffer from acute malnutrition and preventable diseases. Even after a fragile ceasefire, violence and violations persist. Infant and child mortality has surged, life expectancy has collapsed, and education has nearly disappeared. Historical examples suggest that recovering pre-war child-health conditions may take more than a decade. Ensuring Gaza's children a future requires rapid restoration of their fundamental rights.
. Prevalence of pain and satisfaction with treatment in patients admitted to medical, surgical, trauma and oncology wards. INTRODUCTION:Chronic pain is a significant issue among European adults, with prevalence ranging from 12% to 43.5%; in Italy, 21.7% of hospitalized patients suffer from pain, often associated with sleep disturbances and emotional impact. AIMS:To describe the prevalence of pain and satisfaction with its treatment in adult patients hospitalized in medical, surgical, onco-hematological, and trauma units in an Italian hospital. METHOD:Cross-sectional study conducted at Niguarda Hospital in Milan on 391 patients hospitalized for at least 24 hours. Data on pain intensity and treatment satisfaction were collected through paper questionnaires. RESULTS:36% of patients reported pain at the time of data collection, with higher prevalence in trauma and surgical wards. Satisfaction with pain treatment was high, with 84% of patients finding the therapy effective. CONCLUSIONS:The results indicate an increase in pain prevalence compared to previous studies, but also very high levels of patient satisfaction with treatment, which remains a priority to improve patients' quality of life.
. Peer-to-peer interventions in health promotion within the prison community: an integrative review of the literature. INTRODUCTION:The Italian prison system is confronted with significant health challenges, driven by an increasingly elderly and vulnerable inmate population. There is growing interest in peer interventions-internationally validated as a strategy to promote health and well-being. OBJECTIVE:To explore the most recent evidence on peer-to-peer interventions within the prison population, describing their characteristics, areas of application, and the main outcomes regarding self-care, mental health, treatment adherence, and hospitalization. METHODS:An integrative review was conducted. A systematic search was carried out in the Medline, PubMed, CINAHL, Embase, and PsycINFO databases, using the keywords prisoners, peer support, peer tutor, peer education, listeners group, and health trainers. Studies published from 2014 to February 2025 were included. RESULTS:The findings indicate that peer support and peer mentoring represent the most comprehensive and effective approaches for improving mental health, reducing suicide risk, enhancing treatment adherence, and supporting social reintegration. Peer-to-peer interventions were particularly effective in promoting positive attitudes and behaviours toward the prevention of infectious and sexually transmitted diseases; improving emotional well-being-especially in the early stages of detention; ensuring adherence to outpatient services and correct medication intake, which in turn significantly reduced hospitalisations. CONCLUSIONS:Peer interventions have a positive impact on mental health, well-being, and reintegration outcomes, demonstrating both effectiveness and sustainability. Nevertheless, in Italy, structured programmes remain scarce, highlighting the urgency of strengthening and coordinating existing local initiatives.
. Malnutrition in older adults. Malnutrition in older adults is a multifactorial condition with serious health and social consequences. Physiological changes such as reduced appetite, impaired taste and smell, and slower gastrointestinal signaling contribute to the "anorexia of aging." Physical impairments, including poor oral health, chewing and swallowing difficulties, and mobility limitations, further reduce food intake. Cognitive decline, dementia, depression, and delirium also compromise nutrition, while chronic diseases, inflammation, and polypharmacy increase nutritional needs or interfere with absorption. Social isolation, poverty, and inadequate institutional care exacerbate the problem. Prevalence varies by setting: about 3% in community dwelling elders, 22% in hospitalized patients, and up to 50% in those with cancer, heart failure, or in long term care. Malnutrition leads to frailty, falls, infections, longer hospital stays, disability, and higher costs. Diagnosis relies on validated tools such as the Mini Nutritional Assessment and the GLIM criteria, which combine phenotypic markers (weight loss, low BMI, reduced muscle mass) with etiologic factors (low intake, malabsorption, inflammation). Prevention and treatment require routine screening, individualized nutrition plans, and multidisciplinary approaches. Strategies include enriched diets, oral supplements, assistance during meals, social support, and, when necessary, enteral or parenteral nutrition. Early, personalized, and comprehensive interventions improve outcomes, reduce mortality, and enhance quality of life in older adults.
Pilot study of a cluster randomized controlled trial to assess the efficacy of ultraviolet light in improving hand hygiene in hospital staff. Introduction. Hand hygiene is considered the most effective measure for reducing healthcare associated infections and achieving maximum adherence to this practice is essential for patient safety; however, it is difficult to verify its adequacy and quality. Aim. To assess how the visual feedback of an ultraviolet light can improve the percentage of sanitized areas with handwashing in nurses, nurse aides and physiotherapists. Methods. A pilot study was conducted for a cluster randomized controlled trial involving the detection of the quality of hand hygiene through the use of a fluorescent gel and a UV light, in 3 times, after 18 +/- 3 days each. The quality of hygiene was documented with direct observation. The subjects in the UV group received immediate visual feedback on the quality of hygiene; those in the control group only at the end of the study. Results. Out of 117 participants, 103 (50 'feedback' group-53 'no feedback' group) were included in the analysis. No significant differences were observed between groups at T0 and T1. The probability of having hands sanitized at T2 was higher and statistically significant in subjects with feedback compared to those without (p-value = 0.0395). Conclusions. The use of visual feedback with ultraviolet light seems to improve the percentage of hand sanitization of healthcare workers, and its quality over time.
The transition from the role of generalist nurse to advanced: a narrative review. BACKGROUND:While awaiting the interministerial decrees that will define the role of clinical specialist nurses with master's degree in Italy, the challenges and strategies documented in other countries regarding the transition from generalist to advanced/specialist roles have been described. OBJECTIVE:To analyze: 1. the experiences and perceptions of generalist nurses transitioning to an advanced/specialist/practitioner role (hereafter advanced), 2. the factors influencing this transition, and 3. facilitating strategies. METHODS:A narrative review in PubMed, CINAHL, and the COCHRANE Library was conducted. Eligible studies included primary and secondary research published in English or Italian in the last five years that reported experiences and/or documented barriers, facilitators, and strategies supporting the transition. RESULTS:Eleven studies were included. Nurses' experienced ambiguity in role identity, inadequacy, and stress, especially in the initial phase, which can lead to isolation, anxiety, and frustration. Facilitating factors included role clarity, educational and organizational support, availability of trained tutors, and positive feedback from patients and colleagues. Major barriers were the lack of regulations, limited recognition by doctor and nurses, and variability in organizational and legislative policies. Facilitating strategies were a solid and immersive university training, robust mentoring systems, professional support networks, a favorable organizational culture, and documentation of positive experiences. CONCLUSIONS:The individual efforts that each nurse undertakes to establish in the new role must be supported by systemic strategies at the organizational, professional, and educational levels, to facilitate recognition, legitimacy, and value of advanced practice.
