Foreword

.

Validation of the Italian version of the Critical Pain Observation Tool in brain-injured critically ill adults

Background and aim: Pain in intensive care units (ICUs) is a frequent and often undermanaged problem. Brain-injured patients are often unable to reliably self-report their pain, calling forth the need to use behavioural scales such as the Critical-Care Pain Observation Tool (CPOT). This study aimed to test the reliability and validity of the Italian CPOT use with brain-injured ICU adults. Method: A sample of 50 adults critical care patients was included. Each patient was assessed by two independent observers at three predefined times – at rest; during mobilization for hygiene; 20 minutes later – using the CPOT, PAINAD, and NRS. Results: A good correlation was found between independent observers scores during painful procedure, establishing interrater reliability of CPOT. Criterion validation was supported by a strong correlation between CPOT and PAINAD scores, and a moderate relation between CPOT and NRS scores. The CPOT was able to discriminate between patients undergoing painful versus non-painful procedures. However, PAINAD performed better in this sample, as revealed by the comparison between the two AUC of ROC curves. Conclusions: The Italian CPOT use was found reliable and valid in this patient group.

Unplanned Extubations in Intensive Care Unit: evidences for risk factors. A literature review

Background and aim: Unplanned extubations (UE) are getting more and more relevant in Critical Care, becoming a quality and care safeness outcome. This happens because after an UE the patient can face some complications concerning the airway management, respiratory and hemodynamic problems, lengthen in the hospital stay and in the mechanical ventilation time. The aim of this review is identify and classify the factors that could increase UE risk. Methodology: A systematic review of scientific articles was performed consulting the databases PubMed, Cinahl, Medline, EBSCOhost and Google Scholar. Articles from 2006 to 2011 were included. Pediatric Care settings were excluded. Results: 21 articles were selected. From the results emerged that risk factors associated to the patient are widely controversial. Yet restlessness, a low level of sedation and a high level of consciousness seem to be highly related to UE. Organizational risk factors, as workload, nurse:patient ratio, and the use of interdisciplinary protocols seem to play an important role in UE. Conclusion: According the current literature, the research on UE still has to handle a wide uncertainty. There is the need for more studies developing conclusive evidences on the role of different risk factors. Anyway, literature highlights the importance of the nurse and of the healthcare system organization in reducing UE incidence.

Healthcare associated infection: good practices, knowledge and the locus of control in heatlhcare professionals

BACKGROUND AND AIM

The incidence of Healthcare Associated Infections (HAI) is an important indicator of the quality of care. The behaviors associated with the prevention of infections are not only supported by rational knowledge or motivation, but are mediated by social, emotional and often stereotyped behaviors. The awarness of the good practices related to HAI, may be a factor. Other studies, identify how the perception of the problem in healthcare professionals is often influenced by a tendency towards an external Locus of Control: the patient, the family, the other wards, other care settings. The aim of this study is to investigate the perception of healthcare professionals. In particular they have been measured their  awarness of the good practices, perceptions of the potential contamination level of some commonly used objects, knowledge about the management of invasive devices, Locus of Control.

METHOD

A cross-sectional correlational design was utilized.  An ad hoc questionnaire was interviewed by 222 health professionals nurses and physicians in a northern hospital of Italy.

RESULTS

The percentage of professionals who have attended training courses over the last 5 years was quite high, both for upgrades on HAI (78.7%) and Vascular Catheters (78.8%), while the percentage of professionals who updated on bladder catheterization (59.46%) was lower. The mean  score of good practice awareness towards HAI (5.06), is high. The perception of the potential level of contamination of some devices had a  mean ranging from 4.62 (for the drip) to 5.26 (for the door handle). The average value of the Locus of Control (43.54) indicates that participants demonstrated a value that is midway between External and Internal. The correlation test analysis revealed no significant relationships among professionals'age, knowledge about HAI, or infection related venus catheter. Also, results revealed that there were statistically significant positive relationships between professionals' Good Practices awareness about HAI , Knowledge, and Locus of Control.

CONCLUSION

The study findings demonstrated that good practice awareness towards HAI among nurse and physician was good but not completely optimal. Findings revealed that knowledge toward HAI prevention and HAI related device prevention were not completely adequate. The educational courses, according to our correlational findings, should definitely take into account the psycho-social aspects of this phenomenon.

Advanced competencies mapping of critical care nursing: a qualitative research in two Intensive Care Units

BACKGROUND AND AIM

Nowadays, in Italy, the nursing profession has suffered important changes in response to the needs of citizens' health and to improve the quality of the health service in the country.  At the basis of this development there is an increase of the nurses' knowledge, competencies and responsibilities. Currently, the presence of nurses who have followed post-basic training paths, and the subsequent acquisition of advanced clinical knowledge and specializations, has made it essential for the presence of competencies mappings for each specialty, also to differentiate them from general care nurses. The objective is to get a mapping of nurse's individual competencies working in critical care, to analyze the context of the Parma Hospital and comparing it with the Lebanon Heart Hospital in Lebanon.

METHOD

The survey has been done through a series of interviews involving some of the hospital staff, in order to collect opinions about the ICU nurses' competencies.

RESULTS

What emerged from the data allowed us to get a list of important abilities, competencies, character traits and  intensive care nurse activities. Italians and Lebanese nurses appear to be prepared from a technical point of view, with a desire for improvement through specializations, masters and enabling courses in advanced health maneuvers. By respondents nurses can seize a strong desire for professional improvement.

CONCLUSIONS

At the end of our research we were able to draw a list of different individual competencies, behavioral and moral characteristics. The nurse figure has a high potential and large professional improvement prospects, if more taken into account by the health system.

Intergroup contact and team functioning among nursing students: the mediation role of intergroup anxiety

BACKGROUND AND AIM

BACKGROUND AND AIM OF THE WORK

The improvement of team effectivity is one of the main concerns for healthcare organizations. Moreover, healthcare organizations must cope with increasing multicultural composition of both workforce and patients. The intergroup contact theory suggests that frequent and positive face-to-face contact among professionals or students with different cultural heritage can help to reach both increasing team effectiveness and adequate care in a multicultural setting. The aim was then to verify whether intergroup contact during practical training would decrease intergroup anxiety and then increase team functioning.

METHODS

A cross-sectional design was used in which a questionnaire was delivered to 83 nursing students.

RESULTS

According to the intergroup contact theory, frequent and positive contact with non-native professionals decreased the intergroup anxiety which, in turn, increased prejudice and, more importantly, decreased team functioning. Moreover, intergroup anxiety showed a complete mediation effect on the relations between intergroup contact during practical training and both negative attitude toward immigrants and team functioning.

CONCLUSIONS

Intergroup contact with non-native professionals or students during practical training is able to indirectly decrease prejudice and improve team functioning by lowering the anxiety that is aroused by encounter with non-native individuals.

The mapping competences of the nurse Case/Care Manager in the context of Intensive Care

BACKGROUND AND AIMS

Since the recent introduction of the Case/Care Manager's professional figure, it is quite difficult to identify properly his/her own particular features, which could be mainly be found revising mainly in American studies. Therefore, the present study intended to identify the Case/Care Manager's skills and professional profile in an Intensive Care Unit experience, taking into consideration the staff's activities, perception and expectations towards the Case/Care Manager. In particular, it has been compared the experience of an Intensive Care Units where the Case/Care Manager's profile is operational to a different Unit where a Case/Care Manager is not yet in force.

METHOD

a Levati's model was used to map the Case/Care Manager's skills, involving each unit whole working staff, executives and caregivers through semi-structured interviews. It has been taken into consideration the Anaesthesia Unit and Emergency Unit of Cesena's healthcare organisation (AUSL of Romagna) and a Cardiology Intensive Care Unit of Piacenza's healthcare organisation, where the Case/Care Manager's profile has not been experimented yet. Firstly, it a data collection in each healthcare organization has been organised. Subsequently, semi-structured interviews to doctors, unit nurses, caregivers, nurses' coordinators and medical staff have been used to compare each healthcare system. The interviewees' described their expectations in relation to the Case/Care Manager working in a critical area. Then, every data collected during interviews has been organised to map a Case/Care Manager's essential professional profile to work in a critical area together with medical staff.

RESULTS

Piacenza's O.U. critical area experience reported a major demand for patients' and patient's families' assistance. On the other hand, the very same aspects seem to have been better achieved in Cesena's O.U., where a Case/Care Manager's recent introduction has actually helped to overcome the void in organising systems.

CONCLUSIONS

a Case/Care Manager's profile has been drafted on the basis of the comparative analysis conducted. It has been noted how the Case/Care Manager's professional profile can really improve relationships and communications between medical staff and patients, promoting a major unity among the working team. According to the present research, the Case/Care Manager's profile has been proved helpful in positively influencing the team activity and to elicit major satisfaction both in patients and their family.

Advanced skills and research

The health organisation has recently been placing emphasis on the importance of the fundamental rights of the individual, promoting an idea of health seen not only from the biological point of view but also and above all in its psychological, relational and social aspects. [...].

Hand hygiene in health care settings: the citizens' point of view

BACKGROUND AND AIM

The infection risk prevention is one of the main objectives of all health and sanitary systems, since the reduction of the healthcare associated infections is attainable goals through appropriate prevention strategies. Among these, proper hand hygiene of health care professionals and citizens (visitors/outpatients/caregivers, volunteers) is fundamental to reduce the spreading of micro organisms and prevent infections. The purpose of the study is indeed to explore the self-reported hand washing behavior of citizens who access to health facilities and the variables involved in it, using in particular the Theory of Planned Behaviour.

METHOD

A quantitative research was lead using an anonymous questionnaire, filled out online by 195 citizens (53.6% Female). In the survey were included all the associations of volunteers, relatives and caregivers who cooperate in health care settings of Emilia Romagna Region (Italy).

RESULTS

This study has shown that hand hygiene is influenced by different socio-demographic (e.g. gender, age, education) and socio-cognitive variables (intention, attitude, subjective norms, control beliefs). In particular, citizens have a favorable attitude toward hands hygiene in healthcare settings, but they wash their hands more frequently in other contexts or in case of global infectious diseases.

CONCLUSION

The study confirms that the Theory of Planned Behavior adequately explains the hand hygiene behavior in health care settings. Furthermore the threat of infection has a significant impact both on the intention and on the behavior. The results mostly interested those are involved in infectious risk giving the opportunity to intervene with targeted programs for the citizenship.

Healthcare associated infection: good practices, knowledge and the locus of control in heatlhcare professionals

BACKGROUND AND AIM

The incidence of Healthcare Associated Infections (HAI) is an important indicator of the quality of care. The behaviors associated with the prevention of infections are not only supported by rational knowledge or motivation, but are mediated by social, emotional and often stereotyped behaviors. The awarness of the good practices related to HAI, may be a factor. Other studies, identify how the perception of the problem in healthcare professionals is often influenced by a tendency towards an external Locus of Control: the patient, the family, the other wards, other care settings. The aim of this study is to investigate the perception of healthcare professionals. In particular they have been measured their  awarness of the good practices, perceptions of the potential contamination level of some commonly used objects, knowledge about the management of invasive devices, Locus of Control.

METHOD

A cross-sectional correlational design was utilized.  An ad hoc questionnaire was interviewed by 222 health professionals nurses and physicians in a northern hospital of Italy.

RESULTS

The percentage of professionals who have attended training courses over the last 5 years was quite high, both for upgrades on HAI (78.7%) and Vascular Catheters (78.8%), while the percentage of professionals who updated on bladder catheterization (59.46%) was lower. The mean  score of good practice awareness towards HAI (5.06), is high. The perception of the potential level of contamination of some devices had a  mean ranging from 4.62 (for the drip) to 5.26 (for the door handle). The average value of the Locus of Control (43.54) indicates that participants demonstrated a value that is midway between External and Internal. The correlation test analysis revealed no significant relationships among professionals'age, knowledge about HAI, or infection related venus catheter. Also, results revealed that there were statistically significant positive relationships between professionals' Good Practices awareness about HAI , Knowledge, and Locus of Control.

CONCLUSION

The study findings demonstrated that good practice awareness towards HAI among nurse and physician was good but not completely optimal. Findings revealed that knowledge toward HAI prevention and HAI related device prevention were not completely adequate. The educational courses, according to our correlational findings, should definitely take into account the psycho-social aspects of this phenomenon.

Intergroup contact and team functioning among nursing students: the mediation role of intergroup anxiety

BACKGROUND AND AIM

BACKGROUND AND AIM OF THE WORK

The improvement of team effectivity is one of the main concerns for healthcare organizations. Moreover, healthcare organizations must cope with increasing multicultural composition of both workforce and patients. The intergroup contact theory suggests that frequent and positive face-to-face contact among professionals or students with different cultural heritage can help to reach both increasing team effectiveness and adequate care in a multicultural setting. The aim was then to verify whether intergroup contact during practical training would decrease intergroup anxiety and then increase team functioning.

METHODS

A cross-sectional design was used in which a questionnaire was delivered to 83 nursing students.

RESULTS

According to the intergroup contact theory, frequent and positive contact with non-native professionals decreased the intergroup anxiety which, in turn, increased prejudice and, more importantly, decreased team functioning. Moreover, intergroup anxiety showed a complete mediation effect on the relations between intergroup contact during practical training and both negative attitude toward immigrants and team functioning.

CONCLUSIONS

Intergroup contact with non-native professionals or students during practical training is able to indirectly decrease prejudice and improve team functioning by lowering the anxiety that is aroused by encounter with non-native individuals.

Advanced competencies mapping of critical care nursing: a qualitative research in two Intensive Care Units

BACKGROUND AND AIM

Nowadays, in Italy, the nursing profession has suffered important changes in response to the needs of citizens' health and to improve the quality of the health service in the country.  At the basis of this development there is an increase of the nurses' knowledge, competencies and responsibilities. Currently, the presence of nurses who have followed post-basic training paths, and the subsequent acquisition of advanced clinical knowledge and specializations, has made it essential for the presence of competencies mappings for each specialty, also to differentiate them from general care nurses. The objective is to get a mapping of nurse's individual competencies working in critical care, to analyze the context of the Parma Hospital and comparing it with the Lebanon Heart Hospital in Lebanon.

METHOD

The survey has been done through a series of interviews involving some of the hospital staff, in order to collect opinions about the ICU nurses' competencies.

RESULTS

What emerged from the data allowed us to get a list of important abilities, competencies, character traits and  intensive care nurse activities. Italians and Lebanese nurses appear to be prepared from a technical point of view, with a desire for improvement through specializations, masters and enabling courses in advanced health maneuvers. By respondents nurses can seize a strong desire for professional improvement.

CONCLUSIONS

At the end of our research we were able to draw a list of different individual competencies, behavioral and moral characteristics. The nurse figure has a high potential and large professional improvement prospects, if more taken into account by the health system.

Online access and motivation of tutors of health professions higher education

The case study of PUNTOZERO as an open web lab for activities, research and support to 5 Master's courses for the health professions is described. A virtual learning environment integrated in a much wider network including social networks and open resources was experimented on for five Master's Courses for the health professions at the University of Parma. A social learning approach might be applied by the engagement of motivated and skilled tutors. This is not only needed for the improvement and integration of the digital and collaborative dimension in higher education, but it aims to introduce issues and biases of emerging e-health and online networking dimensions for future healthcare professionals. Elements of e-readiness to train tutors and improve their digital skills and e-moderation approaches are evident. This emerged during an online and asynchronous interview with two tutors out of the four that were involved, by the use of a wiki where interviewer and informants could both read and add contents and comments.

Care Case Managers' Job Satisfaction: a first contribution to the Italian validation of the Job Satisfaction Scale

Background and aims of the work: From the analysis of the Italian literature emerges a lack of studies both about the work satisfaction of Case Care Manager Nurses (CCMN) and on their role in the sanitary context. This research aims to fill this gap through a first Italian validation of the Job Satisfaction Scale (JSS).

METHOD

An Italian translation of JSS was provided by three independent judges. To verify the convergent validity of the scale the McCloskey Mueller Satisfaction Scale were used. A measure of the Organizational Wellbeing in the Operating Unit was used in order to verify the concurrent validity. A Professional Self-Efficacy evaluation allowed to verify the discriminant validity. Two open questions examined the role description and the difficulties met at work by the CCMN. The questionnaire was published on the Italian Association of Case Manager and in several Italian Professional Associations of Nurses, Sanitary Assistants and Pediatric nurses (IPASVI).

RESULTS

86 people (70 women) answered the questionnaire; 34 of which were Nurses and 52 CCMN. The convergent, the discriminant and the concurrent validity of the scale were proved. The participants were more satisfied with the quality and the kind of their job, and with the supervision and the colleagues, and less satisfied with the contingent recognitions, the marginal benefits, the promotions and with working and salary conditions. No relevant differences were found between Nurses and CCMN, but in authonomy, responsibility and professional opportunities the CCMN were more satisfied.

CONCLUSIONS

This study aimed to offer a first validation contribution of the JSS Scale. Unfortunately the number of participants did not allow to testify a confirmatory factor analysis of the scale. Thus this work should be further improved. Finally, the data highlighted the need to investigate on the recognition of CCMN, since its absence is often the cause of a job dissatisfaction.

Anastomotic recurrence of colon cancer: Genetic analysis challenges the widely held theories of cancerous cells' intraluminal implantation and metachronous carcinogenesis

BACKGROUND AND OBJECTIVES

Anastomotic recurrence (AR), whose etiopathogenesis is attributed to intraluminal implantation of cancerous cells or metachronous carcinogenesis, is a major issue for patients undergoing colon cancer (CC) resection. The objective of the study is to throw some light on AR etiopathogenesis and to identify risk factors of AR in selecting patients to undergo early endoscopy.

METHODS

An analysis of clinical and histopathological parameters, including MSI and LOH of seven sites (Myc-L, BAT26, BAT40, D5S346, D18S452, D18S64, D16S402) was performed in primary CC and AR of 18 patients. They were then compared to 36 controls not developing AR.

RESULTS

A genetic instability was present in 16/18 patients, with distinct genetic patterns between primaries and ARs. LOH at 5q21 and/or 18p11.23 were found in both primary and AR in >50% of cases, but this rate was no different from control population. CEA resulted as associated with AR (P = 0.03), whereas N status presented a borderline result (P = 0.08).

CONCLUSIONS

Our findings challenge present theories about AR development. No "genetic marker" has been found. CEA and, to a lesser extent, N status, appear associated with AR. Rectal washout is seemingly meaningless. Iterative resection should be recommended since a long survival may be expected. J. Surg. Oncol. 2016;114:228-236. © 2016 Wiley Periodicals, Inc.

Late surgical complications of subtotal colectomy with antiperistaltic caeco-rectal anastomosis for slow transit constipation A critical analysis

PURPOSE

Despite a good percentage of success, mainly related to the amelioration of patient selection, surgery for slow transit constipation still presents failures and late complications, often unpredictable, and sometimes related to technical variants. The aim of the study is to critically analyze late surgical complications of subtotal colectomy with caeco-rectal anastomosis (SCCRA), examining the peculiar risks of the procedure and possible prevention measures.

METHODS

Follow-up data of 43 compliant patients submitted to SCCRA at our Institution were reviewed. Patients undergoing further surgery for a complication clearly related to SCCRA at our centre were included.

RESULTS

We identified three late surgical complications (7%): a caecal distension, an ileo-caecal volvulus and an ileal volvulus. all patients were successfully treated. an evident predisposing condition was found only in the first case.

CONCLUSIONS

Peculiar long term complications related to the presence of a dysfunctional or mobile caecal stump may be prevented by careful patient selection and surgical technique.

KEY WORDS

Constipation, Complication, Caecal distension, Ileo-caecal volvulus, Subtotal colectomy.

The complementary medicine (CAM) for the treatment of chronic pain: scientific evidence regarding the effects of healing touch massage

BACKGROUND AND AIM

Evidence-based medicine offers effective pathways of pharmacological treatment for chronic pain that may compromise the quality of life of patients; this is one of the main reasons why more and more people resort to traditional and complementary approaches, to try to maintain or regain their health. The effectiveness of the various forms of complementary treatments often cannot be proven objectively, which is why, given the need to find more concrete evidence of the effectiveness of complementary therapies with particular reference to the method of healing touch massage, a review of the literature was conducted in order to gather evidence of the efficacy of the specific method regarding pain and other health outcomes of patients with malignant disease to support a proposal for improvement, based on the practice of healing touch massage conducted by nurses.

METHOD

Systematic review.

RESULTS

There are several examples (in some cases specifically regarding patients with tumors) of the positive effects of healing touch massage on pain, anxiety and fatigue, and also on biochemical parameters.

CONCLUSIONS

The way to full recognition by both the institutional and the scientific community seems to promise fairly well, although it should be noted that the achievement of this goal will require further research avoiding the limitations of previous studies.

Bio-clinical and psycho-social nursing practice. An experimental research in an Intensive Coronary Care Unit

BACKGROUND AND AIM

The literature on patients with cardiovascular disease emphasizes the importance of providing a bio-medical and a psycho-social nursing care during the three phases of the nursing process (acceptance, assistance, education). How is his multidimensional nursing approach actually used during nursing practice? The present study aimed to evaluate the effects of a nursing educational training and it was finalized to implement a multidimensional care practice of nurses working in Intensive Coronary Care Unit (I.C.C.U.).

METHOD

The entire nursing staff of the I.C.C.U of Parma Hospital (N = 17) took part in the research and it has been randomized in two subgroups. A group of 9 nurses participated as experimental group. They filled up a semi-structured questionnaire investigating the bio-clinical and psycho-social nursing activities, before (pre-test, time 1) and after (post-test, time 2) a professional training. 8 nurses participated as control group. They filled out the same questionnaire (at the time 1 and 2), but they did not participate at the professional training.

RESULTS

Results indicated how the nursing practice was more related to the bio-clinical (e.g. blood pressure) than to the psycho-social (e.g. mood) activities at the time 1. After the professional training (time 2), only the experimental group changed its professional practice, by integrating the bio-medical with the psycho-social nursing.

CONCLUSIONS

The data showed the importance to promote a multidimensional educational path for nurses that assess the impact of the professional training on the professional practice, in order to improve the quality of care delivered to patients affected by cardiovascular disease.

The hypothesis of contact in nursing: a narrative review of the literature

BACKGROUND AND AIM

In Social Psychology, in relation to the effects of contact, there are two theoretical strands apparently fighting against each other: to one side, the contact hypothesis of Allport according to which, the meeting between members of different groups can, if managed in favorable conditions, reduce prejudice, on the other side, the Social Identity Theory of Tajfel and Turner, according to which the comparison between people belonging to different groups may actually generate an attitude of ingroup favoritism and outgroup discrimination. The aim of this review was to analyze how the literature has dealt with the problem of contact with people from different cultures in relation to its outcomes taking into account the environment of nursing.

METHOD

Systematic review.

RESULTS

There is sufficient evidence that contacts by race / ethnicity, present in nursing-education settings, in the relationship among nurse practitioners, and between nurses and patients, they produce discriminations and prejudices. The contact in the workplace shows however, also favorable outcomes, highlighting then contradictory results.

CONCLUSIONS

The scarcity of material available in the literature and the inconsistency of results, both as regards to the effects of the contact in the training nursing, and as regards to the effects of the contact in relation to the quality of care provided, does not allow definitive conclusions to support the usefulness of the contact in nursing in terms of reducing prejudices and discriminations. It would therefore be advisable to investigate more deeply the effects of contact in the nursing environment.

The journey continues

Here is the second special issue of the journal Acta BioMedica, dedicated to the health professions.The publication of the first issue gave rise to diverse reactions - all positive - in the relevant circles.

Being an overseas student at the Faculty of Medicine and Surgery of the University of Parma: the perceptions of students from Cameroon

There is a steady rise in the number of overseas students taking degree courses at the Medicine and Surgery faculties of Italian Universities. Numerous scholars, mainly from the English speaking world, have testified to the fact that a university teaching organisation aimed at attaining good levels of integration among students of differing cultural appurtenance is a prerequisite for success in the acquisition of good treatment practices.

AIM

To explore the experience of students from Cameroon studying on the degree courses in Medicine and Surgery and in Nursing at the University of Parma, in order to discover the strong and weak points of the organisation of the courses so as to achieve a good process of integration.

MATERIALS AND METHODS

An ethnographic study plan was adopted. In-depth interviews were conducted with 20 students from Cameroon enrolled in the Faculty of Medicine of Parma University: 10 in the Degree Course in Medicine and Surgery and 10 in the Degree Course in Nursing. The interviews were recorded and analysed independently by two researchers, who then pooled their results. The age of the interviewed ranges from 24 to 31, the average age is 26,5.

RESULTS

Independently from the attended degree course, most of the students interviewed claim that the process of integration has not been very successful: despite attempts to open up a dialogue with their Italian counterparts in order to get to know them, the latter showed no signs of willingness to integrate. Some students develop a self-critical attitude, maintaining that it would be a good idea to strengthen their awareness of their own cultural identity so as to start from a firm base in the attempt to open up to the host society without defensive attitudes that lead to ostracism. The difficulties of socialisation are compounded by those of learning, which many attribute to the language difficulties and some to the differing academic organisation between country of origin and host country.

DISCUSSION

The problem of the difficulties of integration of overseas students is not new. In other geographical locations, changes to syllabuses designed to solve the problem, at least in part, have been proposed and successfully implemented. The Italian situation is a particular one, and this preliminary study yields some ideas for the implementation of changes to the syllabuses of the Italian universities.

Nursing students' experiences of and satisfaction with the clinical learning environment: the role of educational models in the simulation laboratory and in clinical practice

BACKGROUND AND AIM OF THE WORK

Student satisfaction is an important element of the effectiveness of clinical placement, but there is little consensus in the literature as to the preferred model of clinical experience for undergraduate nursing students. The aim of this study was assess, for each academic year, students' perception of the roles of nurse teachers (NT) and clinical nurse supervisors (CNS) who perform tutoring in both apprenticeship and laboratories and to identify and evaluate students' satisfaction with the environment of clinical learning.

METHOD

This analytic cross-sectional study was conducted in a sample of 173 nursing students in the Northern Italy. The research instrument used is the Clinical learning environment, supervision and nurse teacher (CLES+T) evaluation scale. Data were statistically analysed.

RESULTS

94% of our sample answered questionnaires. Students expressed a higher level of satisfaction with their training experiences. The highest mean value was in the sub-dimension "Pedagogical atmosphere on the ward". Third year students expressed higher satisfaction levels in their relationship with the CNS and lower satisfaction levels in their relationship with the NT. This result may be due to the educational model that is adopted in the course, in which the simulation laboratory didactic activities of the third year are conducted by CNS, who also supervises experiences of clinical learning in the clinical practice.

CONCLUSIONS

The main finding in this study was that the students' satisfaction with the supervisory relationship and the role of NT depend on how supervision in the clinical practice and in the simulation laboratory is organized.

A cross selectional survey in a critical care: the job satisfaction and functioning team of the health professionals

BACKGROUND AND AIM OF THE WORK

Health care workers, especially those who are part of the OS core, are essential in the delivery of services, as they represent the institution at the time of the contact with the user and they represent also the image of the organization. Health administrations, therefore, are called to improve the performance through a better motivation and satisfaction of the staff, in view of two strategic aspects: job satisfaction of professionals and team collaboration.

METHOD

Between January and September 2014, a survey at the OU (UUOO) intensive care and sub intensive has been made inside three hospitals in Emilia Romagna. It' s been a multicentre cross-sectional quantitative study by administering a self-report questionnaire designed to investigate the different constructs. On 742 questionnaires were spread 454 professionals gave it back  (response rate = 73%). Of those, 273 (60.1%) were nurses, 119 (26.2%) were physicians and 62 (13.7%) were healthcare operators. 62 (13.7%) Job Satisfaction was measured with the McCloskey Mueller Satisfaction Scale. Team Functioning was measured with the Index of Interprofessional Team Collaboration.

RESULTS

Results from MANOVA indicated that physicians were less satisfied of scheduling than both nurses and healthcare operators. For professional opportunities, instead, healthcare operators showed the lower level of satisfaction. The participants seem to perceive a high level of team effectiveness and therefore the professionals involved in the care of critically ill patients than the two dimensions analysed, (reflection between the processes and interdependent roles), also state a greater tendency to respect the roles interdisciplinary, maintaining their professional autonomy and a lower tendency to use critical thinking to act professionally in order to improve the effectiveness of care provided.

CONCLUSION

The study results oriented healthcare administrators, to take paths that feed the job satisfaction and the collaboration of professionals by developing the aspects investigated. Considering the shared perception among the professions studied, compared to the constructs under investigation, it seems to be clear how the routes should be designed in a systematic order to involve, in an integrated way the best professionals (nurses, doctors and OSS) involved in taking managing critical patients. No statistically significant difference have been found between these three professions considered, on most dimensions of job satisfaction investigated (relations between colleagues, 'social interactions, work-family balance, time work organization and working professional opportunity). There is a difference between two specific factors: the work time planning organization and wich is seen less by the nurses, while the job opportunities that are perceived less from the OOS.