Deaf-Blindness through the Voices and Experiences of Parents and Educators

This qualitative study used the experiences of parents and educators to explore the developmental processes and behaviors of deafblind people of different ages and with different etiologies. It also explored which strategies of intervention and care employed by parents and educators best promote and stimulate the abilities and the autonomy of deafblind people. Eligible parents and educators were identified and recruited from the New York Parents Association for Deafblind and the Helen Keller National Center on Long Island using purposeful sampling. Seven mothers, one father, and two educators were interviewed using a narrative method. Data analysis was performed using Heideggerian hermeneutic phenomenology. The themes that emerged concern communication, expression of emotions, sense of self and external reality, autonomy, and the sphere of educational intervention. This research goes beyond existing knowledge on the syndromes/disabilities related to deafblindness, focusing instead on the combinations of varying degrees of hearing and sight deprivation.

Nursing students' perspectives of dance movement therapy to learn relational skills: A qualitative description study

BACKGROUND

Nursing students are expected to develop communication and relational skills during their undergraduate education, and the literature on art-based methods for teaching these skills is growing. Art-based education seems to be a promising method for teaching relational skills, especially embodied and performing arts. Dance Movement Therapy has been used previously to learn relational skills, but never in undergraduate nursing students.

AIM

To describe how first-year undergraduate nursing students experienced the learning of communication and relational skills through a Dance Movement Therapy workshop.

SETTINGS & PARTICIPANTS

First-year undergraduate nursing students who completed a two-session Dance Movement Therapy workshop.

DESIGN & METHODS

This study utilised a Qualitative Description design. Data were gathered from students' reflective journals (n = 226 journals, 113 students) and analysed with a thematic analysis approach.

RESULTS

Three themes were identified: learning happens through the experience of competences, learning happens through corporeality, and learning takes time. The first theme describes how students experienced theoretical concepts through workshop games. "Learning happens through corporeality" focuses on the role of the body during Dance Movement Therapy games as a medium for learning. "Learning takes time" describes students' evolution during the workshop, both within and between sessions, and the graduality of comprehension and learning.

CONCLUSIONS

The findings of this study suggest that Dance Movement Therapy can be an applicable methodology for nursing students to learn communication and relational skills. Most of the relational skills and non-verbal communication components were explored and strengthened during the workshop. Students were also able to create links between theoretical concepts and nursing practice. Nurse educators may want to consider using Dance Movement Therapy to teach communication and relational skills.

The hidden curriculum in nursing education: a scoping study

CONTEXT

The hidden curriculum is a learning dimension made up of culturally acquired, unintended lessons. Although nurse educators are not fully aware of it, through the hidden curriculum students are prepared for adult professional roles, internalising professional values and developing a professional identity. However, academic nursing education has paid relatively scarce attention to it. The objective was to map the nursing education literature about the hidden curriculum and to identify and verify to which of the four areas suggested by Hafferty (institutional policies, resource allocation decisions, institutional slang and evaluation) it refers.

METHODS

A scoping study was conducted. In July 2018, a search was performed in MEDLINE/PubMed, Scopus, EBSCO/ Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Library databases, without time or language restrictions. Two authors independently performed the selection of studies, which followed the preferred reporting items for systematic reviews and meta-analysis (PRISMA) flowchart. Data charting was conducted with both an analytical and a narrative approach.

RESULTS

The study included 18 articles, 13 of which were published during the last 5 years. A total of 12 were research articles, 10 of which used qualitative methodology. Regarding the area of analysis, all four areas could be identified within nursing education literature. The most widely explored area proved to be institutional policies, mentioned by 15 articles, predominantly to highlight the negative effect of the hidden curriculum. Some relational aspects, attributed to the hidden curriculum within nursing literature, belong to the informal curriculum.

CONCLUSIONS

The hidden curriculum in nursing education remains a largely overlooked topic. It appears to be a broader concept than that theorised by Hafferty, often also encompassing the informal curriculum. Furthermore, the literature reviewed mostly highlights the negative consequences of the hidden curriculum, such as the difficulty of transmitting professional values and ethics. Conversely, future researchers should concentrate on its positive consequences as a way to limit the loss of professional values.

Teaching resilience and vulnerability to nursing students using films: A qualitative study

BACKGROUND

There is a limited tradition of using films in healthcare education, although it is constantly developing. Further, to understand complex concepts, such as vulnerability and resilience, is fundamental to improving nursing education.

OBJECTIVE

This study aims to explore how a combined approach, using films and expert patients, could influence nursing education on the topics of vulnerability and resilience.

METHODS

A qualitative descriptive study was carried out. Reflective writings of eight bache- lor's degree students during the first semester of the second year were analysed through a con- tent analysis methodology.

RESULTS

Two main themes emerged: 1) To face up to vulnerability through resilience expe- riences, with three sub-themes: active behaviours to cope with disability; carrying the heavy load of vulnerability; using resilience as a new beginning; 2) Students' difficulties and perspectives on caring vulnerable people, with two sub-themes: awkwardness of facing vulnerability; and walk together to overcome disability CONCLUSIONS: The use of films, enhanced by the lived experiences of expert patients, would improve the learning in the new generation of nursing students that are actually more involved in the use of innovative learning strategies. The adoption of new ways to teach complex con- cepts to bachelor degree nursing students is pivotal to simplify theories and to establish a posi- tive connection between nursing students and educators. The education system should consider that, only through emotionally strong educational strategies, is possible to foster an endu- ring emotional knowledge in students.

Nursing profession and nurses' contribution to nursing education as seen through students' eyes: A qualitative study

The behavior of clinical instructors, as observed by students, deeply influences their professional development. When instructors behave unprofessionally, they risk undermining the professional growth students gain from their clinical placement experience. Clinical instructors need to be aware of how their behavior can affect the students' learning process and the contributions they make to clinical nursing education. A qualitative study was performed to describe the nursing profession as perceived by students who observed their clinical instructors' behaviors during the clinical experience. In-depth interviews of nursing students were conducted until data saturation was attained. Sixteen interviews were analyzed using an inductive content analysis methodology. The nursing profession was described by the participants through five themes as follows: the helping relationship, technical role, professional growth, working group, and contradictions and conflicts. Several examples of unprofessional behaviors on the part of the clinical instructors were reported by the respondents. The nursing profession, as perceived by nursing students, does not always reflect their expectations and their ideas related to professionalism. Universities and schools of nursing should ascertain that clinical instructors are prepared to educate students. Faculty should clearly state to students what they can expect from the clinical experience, namely, preparing students to face real working environments that do not always reflect educational philosophies.

Caring for Dying Patient and Their Families

Background:

The literature from recent decades persistently suggests that nurses are not adequately trained in caring for the dying. Numerous studies call for enhanced education in end-of-life care.

Objective:

To explore student nurses’ experience of caring for dying persons and their families and how this experience was influenced by their undergraduate education, with a view to improving end-of-life training.

Methods:

Narrative interviews were administered to a purposive sample of 18 undergraduate students at Turin University’s School of Nursing and analyzed following Giorgi’s qualitative phenomenological methodology.

Results:

The students’ accounts featured 4 main themes: emotions and feelings, reactions and coping strategies, growth in personal and professional awareness, and the professional nursing model. Students reporting positive experience of end-of-life care in clinical settings displayed the expected learning outcomes for undergraduate nursing education.

Conclusion:

This study’s strength lies in the fact that it draws on student nurses’ lived experience to assess training in end-of-life care. It confirms the need to invest in targeted end-of-life education and support for nursing students.

[Organizational features influencing health worker's fulfillment in an Alzheimer center and in a nursing home]

OBJECTIVES

The pursuit of the best working conditions and of a rewarding job are pivotal elements in care process cause working satisfaction plays a main role to further the positive treatments outcome.

METHODS

Anonymous questionnaires were administered to 59 subjects (10 nurses and 49 health workers) operating in two different institutions, an Alzheimer centre and a nursing home, in order to describe their personal sensation about work's gratification.

RESULTS

Our research shows up, in both institutions, a satisfying perception about working conditions, learning and educational opportunities, teamwork and individual skills recognition.

CONCLUSIONS

Patients' behavioural disorders and hard relationship with families are source of strain and stress for both groups. The rest home staff complain about the unsuitable environmental conditions which make difficult the managing of particular minor behavioural disorders like wonderings, escapes and falls. Elements as salary and balance between work and free time are relevant for both groups but not adequate to fulfill their expectations if work recognition and individual daily efforts appreciation are lacking.

Barriers in the management of cancer-related pain and strategies to overcome them: findings of a qualitative research involving physicians and nurses in Italy

INTRODUCTION AND AIMS

There are many barriers and obstacles that even today lead to an inadequate treatment of cancer-related pain. The aim is to describe the experiences of a group of Italian physicians and nurses as far as the nature of these barriers is concerned and the possible tools to be used to overcome them.

MATERIAL AND METHOD

We run 5 focus groups with 42 healthcare professionals (11 physicians, 31 nurses) working in 5 hospitals in Italy. The findings of the focus groups were analysed according to the "Content Analysis" method.

RESULTS

Five main items emerged: the importance of communication, the need for education regarding pain therapy, the ethnic/cultural/religious differences, the mutual trust and support within the working group, the daily challenges.

CONCLUSION

In harmony with the most recent literature, physicians and nurses voice above all their need for an education more directly aimed at overcoming the prevailing barriers rooted in ignorance, prejudice and fears.

[The use of expressive writing in the course of care for cancer patients to reduce emotional distress: analysis of the literature]

AIM

The emotional distress represents one of the symptoms most frequently reported in the cancer patient in therapy, increasing the risk of developing a disease depressive. Through the analysis of the literature we want to assess whether the use of expressive writing on cancer patients in their care pathway compared to the use of writing neutral reduces emotional distress.

METHOD

The bibliographic search was conducted using the databases CINAHL, PubMed, Cochrane Library and PsycInfo.

RESULTS

The results of research conducted on 7 randomized controlled trials, including 3 pilot studies have shown after expressive writing sessions (experimental group) versus neutral writing (control group) a significant reduction in distress in the experimental group early stages of cancer (p = 0,0183); in patients with a diagnosis of metastatic assigned to the group expressive writing there was a statistically significant relevance in the reduction of mood disorders (p = 0,03).Were determined statistically significant group differences also with respect to some measure on the quality of sleep (p = 0,04). The expressive writing did not produce significant reductions in psychological distress and improvements in physical health (p > 0,20) in patients diagnosed with metastatic disease of long duration and, in the palliative care there have been results of feasibility for poor adherence at follow-up.

CONCLUSION

From the results it is evident that the strategies of expressive writing improves the management of the disease, reduce the physical and psychological symptoms related to the tumor while reducing the emotional distress in patients at an early stage of the disease.

Living with and treating rare diseases: experiences of patients and professional health care providers

We explored the experiences of illness of patients suffering from rare diseases and of the health professionals who care for them at the Center for the Interregional Coordination of Rare Diseases of Piedmont and Valle d'Aosta in Italy. The research was carried out between 2010 and 2011. We collected qualitative data from 22 patients and 12 health professional health care providers. The interviews were analyzed using the Colaizzi phenomenological approach. We identified five themes from the narratives of the patient participants--dealing with disease development, living with the disease, everyday living, relating to others, and relations with health care providers--and four themes from the professional health care participants--dealing with the disease, dealing with expectations, building relationships, and being operators in the context. The study has raised awareness about the issue of rare diseases and it provides some useful considerations for improving services.

[Taking care of foreign users: what training is needed for the healthcare workers at the Municipal Health and Science Agency of Torino?]

INTRODUTION

Immigration is growing and immigrants' presence is important also in the health care system, thereby services reorientation and a multicultural approach are needed.

OBJECTIVE

To explore health care professionals' training needs of Turin Azienda Città della Salute e della Scienza in taking care of foreign users.

METHODS

An ad hoc 4-sections questionnaire was built: (1) Knowledge, attitudes and perceptions; (2) Lived and Training; (3) Improvement in cultural competence; (4) Socio-demographic data. Questions were dichotomous (yes/no), closed and short open. Doctors, nurses, speech therapists and support staff of the "Head and Neck" Department were involved.

RESULTS

One hundred seventy-six operators answered (75%). Less than 20% (n=34) knew the normative concerning immigrants' health services use; tubercolosis, venereal diseases and AIDS were believed to be the most frequent diseases in foreign users. Female sex (p=0.008) and allied health care profile (trend p=0051) were significantly associated to consider clients' values important, while a previous training was associated to the need of improving their knowledge (p=0.0002). The most important training needs were: meaning of illness and care, perception of prevention, hygiene and self-care practices and perception of care. Among the most effective strategies: lecture and discussion, group work and filmography.

CONCLUSION

The analysis shows the main needing education areas and the training strategies which operators considered more effective.

Adherence to treatment in patient with severe cancer pain: A qualitative enquiry through illness narratives

PURPOSE

Pain is a common symptom in cancer patients and often the most tangible sign of disease they and their families perceive. Despite currently available treatments, cancer pain frequently remains underrated and undertreated because of lack of adherence to the prescribed drug regimen. With this study we sought to identify elements that could facilitate pain management by exploring through narrative interviews the lived experiences of patients with severe chronic cancer pain in relation to their adherence to pain therapy.

METHOD

A purposive sample of 18 cancer patients, treated at the Centre for Oncology and Haematology (COES), City Hospital for Health and Science, Turin, were interviewed. The interview contents were analysed using a qualitative phenomenological methodology as described by Giorgi.

RESULTS

Three themes emerged from analysis of the interview transcripts: the significance of pain in subjective experience; the experience of being a patient pursuing a care pathway and the importance attributed to pain therapy. Factors facilitating adherence included the perception of the physical and psychological benefits of having and following a pain medications plan, subjective self-efficacy in pain control, and trust in the healthcare team. Barriers to adherence were negative attitudes toward opioid analgesic therapy, debilitating drug side effects, and denial of pain as a tangible sign of disease.

CONCLUSION

Probing into the significance of the pain experience and its treatment through these narrative interviews revealed several core constituents of adherence. Healthcare providers can use this better understanding to build a trusting relationship with patients and foster adherence to treatment throughout the care pathway.

Biofield therapies and cancer-related symptoms: a review

Patients with cancer can experience several treatment-related symptoms, and conventional care focuses primarily on cure and survival without a holistic approach to disease. Subsequently, an increasing number of patients are accustomed to complementary modalities to improve well-being. Biofield therapies (BTs) are complementary and alternative medicine (CAM) modalities based on the philosophy that humans have an energetic dimension. Physical and psychological symptoms may cause imbalance, and BTs are believed to balance disturbance in the energy field. This article provides a study review of the main BTs (i.e., therapeutic touch, healing touch, and Reiki) in the treatment of cancer-related symptoms. Although BTs are among the most ancient healing practices, data on their effectiveness are poor and additional multicenter research with larger samples are necessary. BTs may eventually become an autonomous field of nursing activity and allow professionals to build a relationship with the patient, thereby improving motivation. The idea that this method can be self-managed and may effectively reduce pain for patients with cancer can improve satisfaction challenges experienced by the current healthcare system.

[Profiles and evaluation process: what integration? Experience of the Local Health Agency TO2 of Turin]

INTRODUCTION

The Service of Health Professions of this facility (TO2 of Turin) aimed during the 2010 to devise/develop a new evaluation tool for the new employees , trying to fit them with the profiles set up the previous year.

METHODS

The conceptual model of reference for the construction of working drafts of the grids was inspired by the special insert edition of "L'infermiere" in 2007, a literature review was carried out and a number of internal meeting within 6 of the Service of health Professions were set up. A working group were set up - 93 people - as well as indicators were developed to monitor and implementation of the instruments. Once the drafts of the standard tools were made, working groups started to improve the tools provided under the supervision of a tutor. Finally half way through an evaluation was carried out using a questionnaire.

CONCLUSION

The new template leads a number of problems which were later sorted out also with the support of tutors.

The effectiveness of the quality program Pac-IficO to improve pain management in hospitalized cancer patients: a before-after cluster phase II trial

Background

Cancer-related pain continues to be a major healthcare issue worldwide. Despite the availability of effective analgesic drugs, published guidelines and educational programs for Health Care Professionals (HCPs) the symptom is still under-diagnosed and its treatment is not appropriate in many patients. The objective of the study is to evaluate the efficacy of the Pac-IFicO programme in improving the quality of pain management in hospitalised cancer patients.

Methods/design

This is a before-after cluster phase II study. After the before assessment, the experimental intervention – the Pac-IFicO programme – will be implemented in ten medicine, oncology and respiratory disease hospital wards. The same assessment will be repeated after the completion of the intervention. The Pac-IFicO programme is a complex intervention with multiple components. It includes focus group with ward professionals for identifying possible local obstacles to optimal pain control, informative material for the patients, an educational program performed through guides from the wards, and an organisational intervention to the ward. The primary end-point of the study is the proportion of cancer patients with severe pain. Secondary end-points include opioids administered in the wards, knowledge in pain management, and quality of pain management. We plan to recruit about 500 cancer patients. This sample size should be sufficient, after appropriate statistical adjustments for clustering, to detect an absolute decrease in the primary end-point from 20% to 9%.

Discussion

This trial is aimed at exploring with an experimental approach the efficacy of a new quality improvement educational intervention.

Trial registration

ClinicalTrials.gov: NCT02035098

Effectiveness of an educational video as an instrument to refresh and reinforce the learning of a nursing technique: a randomized controlled trial

The Undergraduate Nursing Course has been using videos for the past year or so. Videos are used for many different purposes such as during lessons, nurse refresher courses, reinforcement, and sharing and comparison of knowledge with the professional and scientific community. The purpose of this study was to estimate the efficacy of the video (moving an uncooperative patient from the supine to the lateral position) as an instrument to refresh and reinforce nursing techniques. A two-arm randomized controlled trial (RCT) design was chosen: both groups attended lessons in the classroom as well as in the laboratory; a month later while one group received written information as a refresher, the other group watched the video. Both groups were evaluated in a blinded fashion. A total of 223 students agreed to take part in the study. The difference observed between those who had seen the video and those who had read up on the technique turned out to be an average of 6.19 points in favour of the first (P < 0.05). The results of the RCT demonstrated that students who had seen the video were better able to apply the technique, resulting in a better performance. The video, therefore, represents an important tool to refresh and reinforce previous learning.

[Nursing managers: study to assess the expectations of nursing coordinators in a Northern Italian Hospital]

In modern health-care , nursing managers play a strategic role in improving the quality of care and the skills of carers, since management and leadership strategies are known to be decisive in the deployment of resources and professional development. The aim of this study is to present the opinions and expectations of nursing coordinators regarding their managerial role. During the creation of a nursing service unifying the management of 3 local health authorities in Northern Italy, with different organizational and professional features, nursing coordinators were asked to fill in a questionnaire. Results showed that a priority aspect of the managerial role is to assess the appropriateness of care and the use of resources Their answers showed that they hoped for a style of management founded on aspects related to clinical government. For the style of leadership, they emphasized dedication to work, participation of staff in decision-making, group information and providing support in areas needing improvement. Although the study was territorial , it confirmed international guide-lines regarding the policies which give value to investments in the quality of organization and can be considered a point of reference for planning and creating future nursing services.

Towards personalized care for persons with spinal cord injury: a study on patients' perceptions

OBJECTIVE/BACKGROUND

A newly designed Spinal Cord Unit (SCU) was set up at the Orthopedic Traumatology Center (OTC), Turin, Italy, in July 2007. With the relocation of the SCU came the need to reorganize and improve the delivery of its services. The study reported here is a preliminary part of a project entitled 'Experimentation and evaluation of personalized healthcare for patients with spinal cord injury', which is a component of an overarching program of targeted research into healthcare funded by the Piedmont Region in 2006. The aim of this study was to assess the perception of care by patients with spinal cord injury (SCI) by collecting important data in order to determine whether an integrated and personalized care pathway could be effective both in hospital and in a rehabilitation setting.

DESIGN

Qualitative research study. The interview format was based on a narrative approach.

METHODS

Qualitative in-depth semi-structured interviews were conducted with 21 patients with SCI. Qualitative content analysis was used to identify categories and themes arising from the data.

RESULTS

Six main categories emerged from the perspectives of patients: expectations of rehabilitation care, impact and welcome, relationship with nurses and their involvement in treatment, relationship with physical therapists and participation in rehabilitation programs, relationship with physicians and their availability and attendance, and imparting of information on injury and rehabilitation outcomes. Care was the aspect new patients admitted to the SCU found most important. When closer relationships with staff formed, the healthcare professionals became an essential support. Patients with SCI commonly stated that receiving explicit information was necessary for accepting their condition.

CONCLUSIONS

Analysis of the patients' perceptions revealed a wealth of details on their experience in the SCU and the need for flexible planning of care time in particular. Incorporating the patients' perceptions into a new care model could increase professionals' awareness of patients' needs and provide a useful basis for constructing a personalized care plan.

Dealing with the patient's body in nursing: nurses' ambiguous experience in clinical practice

The core of nursing in western countries is interaction with the patient and with his/her body in particular. As all nursing practices revolve around caring for the patient's body, nurses need to understand the frailty of the body, the intimacy surrounding it, the story it tells, as well as the discomfort and difficulties both illness and close contact can generate in the nurse-patient relationship. With this study, we wanted to explore the ward experiences of a small group of nurses in their day-to-day interaction with patients and their bodies, to highlight their perceptions and possible difficulties in providing care. We collected qualitative data from in-depth interviews with 14 nurses working in departments of general internal medicine, neurology, and geriatrics. The interviews were conducted between April and June 2006 and interpreted using an interpretive phenomenological approach. Analysis of the interview transcripts revealed that while the nurses recognize the centrality of the body in nursing, they also expressed a certain ambiguity toward it: being able to improve a patient's well-being through attentive care to the body is a major source of job satisfaction, but various coping and defense strategies are deployed to overcome care-giving situations that elicit avoidance or refusal reactions to the patient's body.

[Organizational analysis of hospital work: identification of constraint elements and hypothesis of their relationship with nurses' wellbeing]

The paper reports the results of a research project on hospital work in which the analysis of organized work situations in different contexts was made using a method based on a valid organizational theory, with the objective of an ergonomic study on the relationships between organized work and well-being. From the analysis of these different situations, via the application of the Method of Organizational Congruencies, the greatest individual level of danger for well-being was constantly observed in nurses, not only as regards the traditional risks of exposure to physical or biological agents, but also the psychophysical aspecific discomfort related, particularly, both to imposition and to uncertainty in the coordination and control of technical actions and in the coordination and control of individuals. The use of an instrument of organizational analysis and the contribution of specific disciplinary approaches (the theory on stress by H. Selye and the theory on communication by G. Bateson), satisfied the needs of suggesting and understanding the relationships between organization choices and well-being of nurses, with the aim of reducing the conditions of danger for well-being related to organization choices.