title: Nursing care received by older patients in Italian medical units: findings from an explorative study.
abstract: BACKGROUND
  According to available evidence, when the nurse-to-patient ratio is insufficient the occurrence of accidental falls, pressure sores, malnutrition, hospital-acquired dependency in activities of daily living, infections associated with nursing practice and errors in administration of medication as well as mortality all increase. However, while several countries have established a body of evidence and policies concerning the minimum nurse-to-patient ratio, the amount of nursing care offered in Italian medical units remains under-studied.
  
  
  METHODS
  Evaluating variability in the nurse-to-patient ratio and in the skill-mix offered, 12 medical units willing to participate were evaluated with a face-to-face interview performed by a researcher to the nurse manager of the unit. The role of the unit at the hospital level, the nurse-to-patient ratio available on a daily basis, the skill-mix and the strategies enacted in the case of patient overcrowding or understaffing were collected.
  
  
  RESULTS
  The mission of the medical units is devoted mainly towards elderly people. The bed occupancy is high and the strategies adopted in case of patient overcrowding determine unstable environments both for medical units (extra beds) and other units (patients temporarily hosted). In the medical units, nurses attend to 5-13 patients in the morning, 7.6-14.6 in the afternoon, and 12.3-30.5 during the night. The skill-mix ranges from 43.5 % (more nursing aides than nurses are available on the ward) to 81.2 % (more nurses than nursing aides are available).
  
  
  CONCLUSIONS
  This assessment exercise indicates that nursing care in medical units faces high workloads. Establishing national minimum standards of nursing care to be delivered towards older people admitted in Italian medical units is recommended.
authors.affiliation: School of Nursing, Udine University, Viale Ungheria 20, 33100, Udine, Italy, alvisa.palese@uniud.it.
authors.forename: Alvisa
authors.initials: A
authors.lastname: Palese
authors.forename: Marina
authors.initials: M
authors.lastname: Cuel
authors.forename: Paolo
authors.initials: P
authors.lastname: Zanella
authors.forename: Paola
authors.initials: P
authors.lastname: Zambiasi
authors.forename: Annamaria
authors.initials: A
authors.lastname: Guarnier
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Allegrini
authors.forename: Luisa
authors.initials: L
authors.lastname: Saiani
mesh_terms: D000367:Age Factors; D000368:Aged; D006757:Hospital Units; D006801:Humans; D007558:Italy; D009732:Nursing Care; D009741:Nursing Staff, Hospital; D005791:Patient Care; D016526:Workload