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J Nurs Manag. 2013 Mar;21(2):251-62. doi: 10.1111/j.1365-2834.2012.01392.x. Epub 2012 Jun 28.

Nursing effectiveness in Italy: findings from a grounded theory study.

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School of Nursing, Udine University, Udine, Italy.



The aim of the present study was to conceptualize the basic social process by which nursing intervention affects patient outcomes in Italian daily practice.


Different frameworks explain the relationship between nursing care and patient outcomes. However, several authors have suggested the need to develop further theory in order to understand this relationship.


A qualitative study based on a grounded theory approach was undertaken to generate a conceptual description of nursing care in Italy and its relationship to patient outcomes. Data collection and analysis processes were conducted simultaneously in an Italian Teaching Hospital from 2007 to 2009.


Nursing effectiveness (the core variable) expresses the positive effects of the nursing system on patient outcomes, on patient safety and on the multi-disciplinary outcomes. The two interdependent social processes that assure nursing effectiveness are: creating a supportive environment for potentially effective nursing (causative factors); and performing organizational, clinical and collaborative intervention (nursing strategies and consequences).


The factors determining a potentially supportive environment for nursing effectiveness are similar to those documented in the literature but the need for clinical nurses to compensate systematically when this support is not available seems to be unique.


Understanding the basic processes involved in the determination of nursing effectiveness in one country has implications for nursing leaders' decision-making, on National Health Service policy recommendations and on professional development both at national and international levels.

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