Igiene e Sanità Pubblica 2025; 99 (2): 78-93
Chiara Gatti*, Stefano Marcelli**, Gloria D’Angelo**, Cinzia Borgognoni*, Elena Torresi***
*AOU delle Marche(MSN)
** UNIVPM CDL Infermieristica AST Ascoli Piceno (MSN)
***UNIVPM CDL Infermieristica AST Macerata (RN)
ABSTRACT
Background
Schools are key environments for children’s daily lives, where urgent events such as syncope, hypoglycemia, seizures, and minor trauma can occur. In Italy, the absence of school nurses and the lack of mandatory first aid training for all teachers place initial emergency management largely on educational staff, whose preparation is variable. Enhancing first aid culture and readiness is therefore essential for prevention, early recognition, and timely response.
Aim
To assess the training level and preparedness of teachers—from nursery to lower secondary school—in managing pediatric urgent and emergency situations within school settings.
Material and Methods
A multicenter, descriptive, cross sectional observational study was conducted (April–October 2025) using a structured questionnaire integrating two validated instruments. Participants were recruited from nursery, kindergarten, primary, and lower secondary schools in the Marche region (Italy). Data were summarized as proportions with 95% CIs (Clopper–Pearson). Associations were tested with chi square (exact tests as needed), with effect size via Cramér’s V. Significance α=0.05. Correct CPR sequence knowledge was estimated as prevalence.
Results
The sample included nursery (n=8), kindergarten (n=12), primary (n=23), and lower secondary (n=24) teachers, mostly aged 26–50 years; 64.2% held a university degree. While 91% reported first aid knowledge and 88% had attended at least one course, only 7.5% felt genuinely prepared; 64.2% felt insecure and 28.4% unprepared, and ~90% requested further practical training. Scenario items revealed procedural gaps: only 55.2% prioritized assessing consciousness in an injured/unconscious student; 71.6% would avoid manipulating a sprained ankle; responses on bleeding were split (direct pressure 52.2% vs gentle tamponing 46.3%). Diabetes knowledge was stronger (e.g., insulin via injection 95.5%; insulin does not raise glucose 92.5%), yet uncertainty remained for managing acute episodes on site. On epilepsy, misconceptions were largely rejected, but causal attributions mixed genetics (47.8%) and emotional factors (41.8%). Practical first aid sequencing showed fragmentation; only ~33% (95% CI 22–45%) knew the correct CPR sequence. Training was strongly associated with perceived preparedness (χ²(2)=22.95; p<0.001; V=0.59), age and seniority with lower confidence (V=0.66 and 0.61, respectively), and perception moderately with correct CPR sequence (p=0.003; V≈0.42). Training alone did not correlate with correct CPR sequencing (p=0.366).
Discussion
Current training reduces outright unpreparedness but often leaves teachers in a state of operational insecurity. Confidence and competence—especially CPR sequencing—appear to require hands on practice, realistic simulations, and regular refreshers rather than single-course exposure.
Conclusions
Teachers show acceptable theoretical awareness in selected areas but significant practical uncertainties in first aid, especially CPR and initial assessment. Structured, periodic, skills based programs and competency verification are priorities. Integrating the school nurse as a health educator could provide sustainable, on site support for training and emergency readiness.
Keyword MeSH Term: First Aid, Schools, Emergency Medical Services, Cardiopulmonary Resuscitation, Nurse
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Affiliations:
¹ Emergency Department, Department of Emergency, AOU delle Marche, Ancona, Italy
² Cardiac Surgery Operating Unit, Medical Directorate, AOU delle Marche, Ancona, Italy
³ Pediatric and Congenital Cardiac Surgery and Cardiology Unit, Pediatric Intensive Care Unit, Department of Cardiovascular Sciences, AOU delle Marche, Ancona, Italy
⁴ Università Politecnica delle Marche, School of Medicine and Surgery, Ancona, Italy
⁵ Cardiac Surgery Intensive Care Unit, Macerata Hospital, AST Macerata, Italy
⁶ Anesthesia and Intensive Care Unit, San Benedetto del Tronto Hospital, AST Ascoli Piceno, Italy
ABSTRACT
Background. The increasing clinical complexity of pediatric patients, combined with global nursing workforce shortages, requires reliable tools to measure nursing care complexity and support evidence-based staffing decisions. In highly specialized settings such as pediatric cardiovascular units, patient acuity and cognitive nursing workload are particularly demanding. However, data on validated tools for assessing care complexity in pediatric contexts remain limited. Objective. To measure nursing care complexity in pediatric cardiovascular patients and to identify clinical and organizational factors associated with higher complexity levels using validated pediatric acuity tools. Material and Methods. A retrospective cross-sectional observational study was conducted on 313 patient records from the Pediatric and Congenital Cardiac Surgery and Cardiology Unit and the Pediatric Intensive Care Unit of a tertiary university hospital in Italy (January–December 2022). Nursing care complexity was assessed using the CAMEO II tool for intensive care and the Inpatient CAMEO tool for ward settings. Descriptive statistics were performed. Associations between complexity and categorical variables were analyzed using chi-square tests. Simple and multiple linear regression analyses were conducted to identify predictors of baseline complexity (T0).
Statistical significance was set at p < 0.05. Results. All patients admitted to the intensive care unit showed medium nursing care complexity. In the inpatient cardiac unit, 27% of patients had low complexity and 73% had medium complexity; no high-complexity cases were observed. Younger age was significantly associated with higher complexity (B = −0.29, p < 0.001). Urgent admission (B = 6.73, p < 0.001) and longer hospital stay (B = 0.37, p < 0.001) were also significant predictors. Organizational variables, including day of the week and work shift, were not significantly associated with complexity. The regression model explained 46% of the variance in baseline complexity scores (adjusted R² = 0.451). Discussion and Conclusions. In pediatric cardiovascular settings, nursing care complexity is primarily driven by patient-related clinical factors rather than organizational variables. Younger and urgently admitted patients with longer hospital stays require higher cognitive nursing workload.
The systematic implementation of validated acuity tools such as CAMEO II and Inpatient CAMEO may support evidence-based workforce planning, optimize nurse-to-patient ratios according to patient acuity, and enhance quality and safety of care. These findings are particularly relevant in the context of healthcare resource constraints and contribute to improving organizational decision-making in specialized pediatric settings.
Keywords: Pediatric Nursing, Workload, Patient Acuity , Health Workforce, Intensive Care Units, Pediatric
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