Uncovering doctors' perceived barriers and facilitators of antibiotic prescribing behaviours: a qualitative study using the theoretical domains framework

BACKGROUND AND AIM OF THE WORK

Uncovering the barriers and facilitators of antibiotic prescribing is crucial in order to develop effective strategies for promoting responsible and evidence-based antibiotic use, thereby combating antibiotic resistance and enhancing patient care. This qualitative study, informed by the Theoretical Domains Framework (TDF) - specifically designed to understand and analyze the factors that influence human behavior, with a focus on identifying barriers and facilitators to behavior change, was aimed to explore the determinants (barriers and facilitators) of antibiotic prescribing behaviors from the perspective of doctors.

RESEARCH DESIGN AND METHODS

Semi-structured interviews were conducted with healthcare professionals, and data analysis followed a theory-driven approach guided by the TDF.

RESULTS

The analysis identified eight TDF domains influencing antibiotic prescribing, including memory, attention, and decision processes; knowledge; skills; belief about capabilities; goals; belief about consequences; emotions; and environmental context and resources. These domains were clustered into three overarching themes according to a bottom-up logic: the decision-making prescribing process itself, intrinsic factors related to the physician, and extrinsic factors influencing the decision.

CONCLUSIONS

This research provides a comprehensive understanding of the complex interactions between these determinants in antibiotic prescribing. The evidence gained from the study valuable information for developing targeted interventions to improve antibiotic prescribing practices and combat antimicrobial resistance considering psychosocial and environmental variables impacting on antibiotic prescription decision making.

The impact of ACLS training in theoretical knowledge

BACKGROUND AND AIM

Italy has a public health system where also young physicians hold various jobs, including Emergency Services. Advanced Cardiovascular Life Support (ACLS) course is developed for the management of cardiovascular emergencies. This study evaluates the preparation of Italian physicians on ACLS and their perceived need to be trained on it.

METHODS

surveys had been administered to 4698 Medical Doctors. They consisted of questions on sociodemographic characteristics, knowledge of ACLS protocol, and willingness to attend an ACLS course.

RESULTS

Online survey reached 4698 physicians, 137 of them had been excluded for invalid answering. People who had attended an ACLS course scored significantly higher on the test (M=5.68 SD=1.89) than those who had not (M=4.71 SD=1.91). Experienced physicians scored significantly higher (M=5.25 SD=1.96) than recently licensed ones (M=4.84 SD=1.94). Multiple regression was used to predict the ACLS test score.

CONCLUSIONS

ACLS training has a stronger effect on Cardiovascular Emergency management knowledge (d=-.510) than general working experience (d=-.212). The median score in ACLS knowledge is low (5/10), despite its importance. Multiple linear regression reveals that ACLS has the greatest impact on the score. A small portion of doctors have attended an ACLS course (22%), but the majority of them would participate (89%).

Gender and sex bias in prevention and clinical treatment of women's chronic pain: hypotheses of a curriculum development

This discursive paper focuses on undergraduate medical education's role in tackling gender bias in clinical practice, specifically preventing and managing from a non-biomedical perspective chronic pain in women. A preliminary web search of medical schools' curricula was performed to identify programs content related to gender bias in pain management. The web search included 10 universities' websites selected from the top 10 rankings QS Universities Rankings 2022 for medical schools. Additionally, a questionnaire was sent to all deans of the selected academic institutions to explore the curriculum content further. The web search, and the lack of response from the deans, highlighted that relevant curriculum components on gender bias and chronic pain needed to be implemented. Therefore, this paper introduces an innovative curriculum development approach designed by the multi-professional research team to be implemented in medical school programs. This novel educational strategy could also cross-contaminate other healthcare practitioners' university programs and, thus, stimulate an interprofessional debate into fostering inclusiveness and equal opportunities in health.

The use of skin traction in the adult patients with proximal femur fracture. What are the effects, advantages and disadvantages? A scoping review

BACKGROUND

Hip surgery is normally the chosen therapy for proximal femur fractures. Surgery within 24-48 h after hip fracture is recommended, but surgery may not always be performed promptly. Consequently, skin-traction is applied to reduce complications. The purpose of this review is to assess both advantages and disadvantages of skin traction.

METHODS

A scoping review was conducted. The research question was: which are the effects of skin traction, its advantages and disadvantages in adult patients with proximal femur fractures hospitalised in orthopaedic wards? The search was done in the databases PubMed, CINAHL, Cochrane, Embase, DOAJ, ClinicalTrials.gov and OpenDissertation.

RESULTS

9 records were included, skin traction effects were summarised in 7 categories: pain, pressure sores, comfort and relaxation, thromboembolism, damage from adhesive, complications and quality of care. The possible advantage is pain reduction between 24 and 60 h, the possible disadvantage is skin damage.

DISCUSSION AND CONCLUSION

The routine use of skin traction does not appear recommended, but more consistent evidence is necessary to make clinic decisions. Future RCTs could focus on the effects of skin traction 24-60 h after hospitalisation and before surgery.

Leadership styles' influence on ICU nurses' quality of professional life: A cross-sectional study

BACKGROUND

Intensive Care Units are emotionally intense environments where professional autonomy and interprofessional collaboration are essential. Nurses are at high risk of burnout, and the level of compassion satisfaction has a deep impact on the quality of their professional life. Although leadership styles and burnout have been the subject of an extensive body of research, there is an existing gap regarding the relationship between leadership strategies and intensive care nurses' quality of working life and the impact on their compassion satisfaction. Specifically, there is a lack of literature in southern European countries concerning the influence of organizational and cultural contexts.

AIM

To evaluate the impact of nurse managers' leadership styles on Intensive Care Unit nurses' job satisfaction and compassion satisfaction.

DESIGN

A cross-sectional study.

METHODS

An online set of validated tests was sent to a non-probabilistic sample of nurses, recruited via the Italian association of intensive care and emergency nursing website. The set of tests consisted of the Empowering Leadership Questionnaire, Compassion Satisfaction Scale, and McCloskey Mueller Satisfaction Scale. Nurses actively working in intensive care and critical care settings were included in this study. ICU managers and leaders were excluded.

RESULTS

308 nurses (response rate 63,2%) completed the questionnaires. Statistical analysis showed that the Leadership dimension of "Showing concern towards the team" had a significant effect on Compassion Satisfaction. In addition, this dimension had an effect on nurses' overall job satisfaction on five out of eight subscales.

CONCLUSIONS

Leaders' authentic listening, communication, and participation capabilities have a positive impact on nurses' job and compassion satisfaction. The interest for team well-being, taking time to discuss team concerns, and working closely with the team affects unpredicted factors like working hours, flexibility in shift scheduling, satisfaction about recognition, and career advancement.

RELEVANCE TO CLINICAL PRACTICE

Results suggest that nurse managers can draw on/adopt leadership strategies oriented to authentic listening and interaction with the team in order to manage organizational issues, increase nurses' professional quality of life and prevent burnout.

Evaluation of pain in the paediatric patient admitted to sub-intensive care: a scoping review protocol

BACKGROUND AND AIM

pain is considered as the 5th vital sign thus it's paramount that healthcare professionals are equipped with validated tools for his correct assessment. There are different paediatric pain assessment scales that take into account patients' age. Actually, the "Face, Legs, Activity, Cry, Consolability" (FLACC), Wong-Baker and NRS scales are regarded as the gold standard in low intensity clinical areas, while the COMFORT-Behavior (COMFORT-B) and Behavioral Pain Scale (BPS) ones are used for high intensity clinical areas where paediatric patients are sedated/intubated. It's unclear which pain assessment scale should be used in sub-intensive areas such as Sub-Paediatric Intensive Care Unit (Sub-PICU) e Sub-Neonatal Intensive Care Unit (Sub-NICU). The aim of this protocol is to map the literature in order to identify what evidences are available regarding the assessment of pain in the paediatric sub-intensive clinical areas.

RESEARCH QUESTION

"What is the literature available on pain assessment in paediatric patients in sub-intensive clinical areas such as Sub-PICU and sub-NICU?".

SOURCE OF EVIDENCE

literature search will be performed through the following databases: PubMed, Scopus, CINAHL, Cochrane Library, Open Dissertations (EBSCO) and DOAJ. Furthermore, Cochrane CENTRAL and ClinicalTrials.gov will also be included.

METHODS

this scoping review will be conducted in accordance to the Joanna Briggs Institute guidelines and the results presented through a PRISMA flowchart.

REVIEW REGISTRATION

Open Science Framework https://doi.org/10.17605/OSF.IO/8KBRQ.

SIMED-New Doc course, a matter of reflection

BACKGROUND AND AIM

Obtaining a degree in medicine in Italy qualifies for the medical profession; this fact has entailed a newly qualified doctor's remarkable involvement on the medical activities of the National Health Service, especially during the Covid-19 pandemic. It is important to understand the knowledge of the newly qualified doctors and to create specific courses oriented to them. The aim of the study is to evaluate the impact of a peer learning course for the students who attend the last year of medicine school, with the purpose of defining the formal requests to integrate on the course.

METHODS

A pre and post qualitative research has been carried out on SIMED-NEWDOC course. The course consisted on peer teaching lectures, as lecturers were resident doctors part of SIMED board. At the end of the course it has been submitted a survey to the participants, and data has been analyzed.

RESULTS

The students enrolled were 139, the average of the participants was 27% of the registered. A qualitative evaluation questionnaire was submitted, the responses were 32 (86%). Average age was 25. Participants attending the last year of medicine school were 30 (95%). 40% of them declared to have attended at least 5 lessons. Among the course participants, 96% judged the course as very useful.

CONCLUSIONS

All questionnaire results are useful to reflect on future projects. It is necessary to implement further educational projects to better understand the phenomenon, considering the positive impact that participants declared.

Role and challenges to digital technologies in community health promotion programs in Italy during the COVID-19 pandemic: a multiple embedded case study protocol

BACKGROUND AND AIM

Due to the COVID-19 pandemics, The Italian League Against Cancer (LILT), a national federation of local associations promoting cancer prevention, had to face the challenge to find new ways and technologies to promote health in their territories. This study aims to explore how LILT associations led their health promotion interventions during the COVID-19 pandemic and to understand which interventions had a greater impact, for which population group, and why.

METHODS

In this descriptive multiple embedded case study, each case will focus on the activities of a local LILT association and their collaborators on the perception and experience of the use of digital technology for health promotion and prevention, through interviews, observations, and a study of products and artifacts. A general overview of each case study will be provided, along with an introduction of the unit(s) of more in-depth analysis. The logical models that emerge from the analysis of each case will be described by using realist analysis, producing a list of possible CMO configurations (Context; Mechanisms; Outcomes). The final report will consist of a cross-case analysis (a comparison between the different case studies).

DISCUSSION

This multiple case study will help generate a first "theory of the use of digital technology in health promotion in local LILT communities. The observation of what local LILT associations in Italy have done during COVID-19 will help identify new and useful health promotion strategies based on these technologies.

A realist synthesis of staff-based primary health care interventions addressing universal health coverage

Background

Methods

Results

Conclusions

The impact of the alterations in caring for COVID-19 patients on Compassion Satisfaction and Compassion Fatigue in Italian nurses: a multi method study

Background and aim of the work:

During COVID-19 first wave, healthcare professionals were exposed to a major psychological pressure related to uncertainty, a lack of therapies or a vaccine and shortages of healthcare resources. They developed higher levels of Burnout and Compassion Fatigue, and similar levels of Compassion Satisfaction. Aim is evaluating in Italian nurses Compassion Satisfaction and Compassion Fatigue and impacting individual and relational variables.

Methods:

A multi-methods approach was used. Qualitative data were collected through 2 focus group. Quantitative data were collected through a web survey composed by an ad hoc questionnaire developed from the focus group results, the Professional Quality of Life Scale-5 and the Resilience Scale .

Results:

In the qualitative phase 6 categories emerged. From the quantitative analysis the sample reported a moderate level of Compassion Satisfaction, a low level of Burnout and a moderate level of Secondary Traumatic Stress. Compassion Satisfaction had as predictors resilience (β = .501), followed by feeling part of the team (β = .406) and collaboration with colleagues (β = .386). Secondary Traumatic Stress had as predictors the impact of PPE (β = .269), and feeling Covid-related individual sufferance (β = .212). The only predictor of Burnout was resilience (β = -2195).

Conclusions:

During COVID-19 first wave Italian nurses were exposed to a higher risk of Secondary Traumatic Stress, mainly impacted by frustration, loss of control, loss of possibility to properly care for patients, and personal threat. Relational and team support had a crucial role in sustaining Compassion Satisfaction. (www.actabiomedica.it)

Advanced competence in intensive care unit: expectations, role ambiguity between physicians and nurses in intensive care units. Multi - method survey

BACKGROUND AND AIM

The roles of physicians and nurses have undergone profound changes in recent years, becoming more complex and creating, at times, overlapping competencies with consequent negative repercussions in terms of problems related to autonomy and inter-professional collaboration. The study aims to detect the opinions of intensive care physicians and nurses with respect to their skills and role expectations.

METHOD

The study was conducted in two phases. In the first phase, with a qualitative design, data were collected through the focus group. In the second phase, with quantitative design, an ad hoc questionnaire was constructed from the results of the previous phase.   Results: 3 main themes emerged from the focus groups: the need to increase the system of inter-professional collaboration; autonomy and professional role; and the need for a shared advanced training system for physicians and nurses. The results of the questionnaire show that both professionals believe that the development of advanced skills does not lead to conflicting situations and role ambiguity unless the skills are recognized and respected. Both professionals agree that it is useful and necessary to implement a shared educational pathway.   Conclusion: Inter-professional collaboration, specialist skills and specific training are a key element of the ICU teamwork.

Satisfaction evaluation for ACLS training

BACKGROUND AND AIM

simulation became gradually pivotal in training of health professionals: indeed, it showed an improvement in practical skill of the trainees compared to theoretical lectures. Among others, ACLS (advance cardiovascular life support) courses are now one of the standard learning practices most spread around the world. The primary aim of this study is to evaluate both the level of satisfaction and the clinical thinking that the trainees perceived during an ACLS course. This was performed via the SSE validated scale (Satisfaction with simulation experience scale). The secondary aim was to evaluate if demographics affect the aforementioned perceived satisfaction.

METHODS

a SSE questionnaire was distributed after the ACLS section of practical scenarios, just before the end of the course and of the practical test.

RESULTS

72 questionnaires have been collected. The sample was constituted by 68.1% of females, 44,4% by nurses without a master's degree, and 52,8% personnel that works outside of a critical care setting. QTOT Median score was 89 (IQR=86-90), DTOT Median's 45 (IQR= 44.25-45), RTOT Median's 25 (IQR=22-25), LTOT Median was 20 (IQR=19-20).  Conclusions: The ACLS course attains a high grade of satisfaction on all of the three aspects evaluated by the questionnaire. The perception was not influenced by the demographics.

The unmet needs of women with breast cancer: a qualitative research

BACKGROUND AND AIM OF THE WORK

Breast cancer (CM) is the most commonly diagnosed form of cancer in Italy and the most common malignancy in women (25%) with 53,000 new cases. This disease affects all age groups (1 in 40 women <49 years, 1 in 20 between 50 and 69 years, 1 in 25 between 70 and 84 years). The percentage of patients diagnosed with cancer within 5 years of diagnosis is higher than for other cancers, and this conviction rate in these cancer patients has increased, leading to an ever-improving level of attention. The research aims to understand the main needs of women with breast cancer, compare them with those reported in the literature and in particular to identify which of these are still unsatisfied. Method The study is based on the use of the narrative interview conducted by the Case Manager, in the Breast Unit of Melegnano (Milan), selected with a sampling of convenience.The participants who joined the research project were 12 women with breast cancer, aged between 40 and 60, who are in the active treatment phase of the disease.

RESULTS

As highlighted by literature, various unmet needs have emerged, afferent to well-defined areas: emotional health, continuity of care, information, adverse effects, educational strategies, economics, information and social support. The study showed that, the needs that are most unsatisfied relate to the information area and the psychological area.

CONCLUSION

The interviews conducted underlined the importance of the role of the Case Care Manager as a facilitator of the disease path that patients are experiencing both in terms of the clinical and psychological aspects but also as a support in managing daily life. future research should investigate the role of the Case Vare manager in meeting these needs.

Interprofessional Training and Commitment to Research increasingly useful for the Health Professions

Editorial.

From classroom training to e-learning: a journey through the quality of learning life of nurse students in post-graduate education - A longitudinal qualitative study

Background and aim:

recent studies regarding COVID-19 experiences of nursing students highlighted the effect of the transition from face-to-face to online education, rather than the complexity of the overall quality of educational life. This study aim investigating of how the students perceive the quality of educational life in the forced online training, searching for any shift of meanings concerning the students learning experience, from the first phase of the sudden transition to online and the online stabilization phase.

Methods:

a longitudinal qualitative study, carried during two moments of the online teaching activity forced by COVID-19, the first one in May-June 2020 and the second six months later in January -February 2021. A convenience sample of 24 students attending post-graduate courses for health professions recruited at University of Parma, answered in-depth interviews, videotaped, verbatim transcribed and analyzed using the Braun and Clarke model.

Results:

five themes emerged from meaning shift of data collection: reactions to change in educational life; factors hindering the perception of the quality of educational life; strategies to facilitate communication and lack of the classroom; factors favoring a new quality of educational life; adaptation strategies to the new educational life.

Conclusions:

participants perceive advantages of online teaching, on quality of their educational life. The issue of how to create opportunities for internship period remains open. Further research to understand online internship and exploring what extent it is essential to propose it in face-to-face modality. (www.actabiomedica.it)

Relational dynamics involved in therapeutic discordance among prescribers and patients: A Grounded Theory study

OBJECTIVE

No studies have explored the negative process of concordance: discordance in prescribing-medication-taking. This study provides a deeper understanding of discordance as a co-constructed process among patients and prescribers.

METHODS

To explore the question "what psychological and relational processes are involved when therapeutic discordance among prescribers and receivers occurs?" a constructivist Grounded Theory study was carried out through semi-structured interviews with patients and their medical doctors.

RESULTS

The final sample of our study was composed of 29 participants: 16 receivers and 13 prescribers. "Neglecting the relationship", the core category, shapes the therapeutic discordance and connects three main conceptual phases: signing a non-negotiating contract, acting alone, and establishing a superficial relationship.

CONCLUSION

Our grounded theory conceptualization contributes to the concordance-related debate by evidencing the processes among prescribers and receivers in interwoven actions. It offers another dimension to how notions of compliance, adherence and concordance have been theorized to date.

PRACTICE IMPLICATIONS

More than one interaction with receivers is recommended. If there are hints that conflict potentially is compromising the relationship, prescribers should involve intermediaries. Setting aside for a moment, evidence-based justification for treatments and trying to understand prescribers' motivations may boost a positive change.

Medication administration and anxiety: an observational study with nursing students

BACKGROUND AND AIM

Medication administration errors represent a topic of great scientific interest. Medication administration is considered by nursing students a complex process during which it is easy to make mistakes; therefore, institutional measures have been adopted in order to reduce medication errors. However, it remains a critical issue in nursing practice for which several causes have been identified, including environmental factors and individual knowledge. Mistakes can be made by nurses and especially by students who must cope with additional causal factors including anxiety management. The aim was to investigate state anxiety levels among nursing students when it comes to medication administration.

RESEARCH DESIGN AND METHODS

An observational study involving a convenience sample of 150 nursing students from a Northern Italy University has been conducted; they were asked to complete a questionnaire to measure the levels of state anxiety in relation to medication administration.   Results. There were no particularly high levels of state anxiety among students associated with medication administration; however, state anxiety levels were slightly higher in third-year students than in second-year students, and this is most likely due to the growing complexity of the medication administration process compared to the lack of experience.   Conclusions. Although the results don't show statistically significant data, the effectiveness of nursing education plays a crucial role in reducing medication errors, which is why it is essential to provide suitable tools for the professionals of the future and invest in clinical simulations.

Italian validation of the DEMQOL-PROXY: Exploratory Factor Analysis, Convergent and Divergent Validity

BACKGROUND AND AIM OF THE WORK

we present in this paper a complete Italian validation version. We show some psychometric properties of the Italian version of the DEMQOL-PROXY: Structural validity (by use Exploratory Factor Analysis), convergent validity and divergent validity in Italian language Method.We enrolled a sample of 182 caregivers of people with mild to moderate Dementia. In particular, we collected 90 questionnaires of professional caregivers and 92 questionnaires of family caregivers. We used Exploratory Factor Analysis (Varimax rotation), to identify the saturation of items on the relevant factors.The internal consistency of the instrument was evaluated by using the Cronbach Alpha coefficient. Finally, referring to the Validity of convergent and Divergent validity, we used Spearman's correlation coefficient by comparing the various instruments of the study.

RESULTS

Our result shows that the variance explained by 4 factors corresponds to almost 51% of the total variance. Factors extracted in our Italian version are: Cognition;Negative and Positive emotion; Daily activity and Membership.

CONCLUSION

The Italian version of the DEMQOL-PROXY point out very good psychometric properties: factors extracted are similar to the original version and convergent and divergent validity show good proprieties. We consider this paper as a complete Italian Validation.

Re-evaluation of the interprofessional collaboration scale validation between nurses towards other health care professionals occupied in Italian emergency medical services

BACKGROUND AND AIM

Interprofessional collaboration (IPC) between health professionals is fundamental for the provision of an efficient and effective medical care service. This is especially so in states of emergency, as highlighted by the ongoing coronavirus disease 2019 pandemic. This study aimed to obtain further evidence regarding the validity and reliability of the Italian language IPC scale -an instrument for measuring interprofessional collaboration- in a setting that has yet to be investigated at an in-depth level: the emergency departments in Italian hospitals.

METHODS

The survey tool was a structured questionnaire in the Italian language. It comprised the validated Italian version of the IPC scale plus a question concerning the frequency of collaborations between the nurses interviewed and other health professionals. Confirmatory factor analysis was applied to rate the three factors ("communication", "accommodation" and "isolation") that compose the scale.

RESULTS

Four hundred thirty-six nurses working in an emergency department for at least one year completed the questionnaire, which assessed collaboration with other health professionals working in the same department. The model fit statistics are satisfactory for all the nurse-target group combinations analysed. Regarding the Cronbach's alpha statistic used to compute the reliability of the scale, acceptable values were obtained for all items, except for those related to the isolation factor for each case of interprofessional collaboration considered.

CONCLUSIONS

The results confirm the validity of the IPC scale as an instrument for the assessment of interprofessional collaboration involving nurses and other workers occupied in the provision of healthcare in Italian emergency departments.

Dealing with uncertainty. A qualitative study on the illness' experience in patients with Long-COVID in Italy

BACKGROUND AND GOALS

An unknown proportion of people who had COVID-19 infection continue to experience symptoms such as fatigue, breathlessness, joint or muscle pain, difficulty sleeping, and brain fog. These symptoms have a significant impact on the quality of life. Long-COVID is a new multisystem disease still under investigation. This research aims to explore the illness experienced by patients suffering from Long-COVID in Italy.

RESEARCH DESIGN AND METHODS

Qualitative methodology with semi-structured interviews. Participants were recruited on the Facebook patient group between October 2021 and January 2022. Participants had been experiencing symptoms for at least three months following confirmed COVID-19 infection. Interviews were conducted by video call, recorded and transcribed with consent. The thematic analysis method has been chosen to infer data from textual material.

RESULTS

17 interviews with women with Long-COVID have been analysed. The main themes include: a total change of life due to the symptomatology, loss of autonomy that affects social, family and professional life; social isolation, a sense of abandonment often increased by stigma, the difficulty of being believed and achieving diagnosis; difficulty in managing symptoms and accessing to care services; living with uncertainty caused by the lack of institutional, social, professional, familial and medical support.  Conclusions: Intervention programs, both institutional and social-health policies should be developed for patients with Long-COVID. The impact of symptoms could be reduced by developing standards and protocols, and by ensuring access to care and to multi-disciplinary rehabilitation. Further development of knowledge on Long-COVID is essential.

The Nursing Management of Tourniquet: the infective risk related to its use

BACKGROUND AND AIM OF THE WORK

Reusable tourniquets should be considered and used in clinical practice as semi-critical devices, as they are colonized by potentially pathogenic agents, a possible cause of care-related infections. The aim of the study was to analyse the management of tourniquets in the clinical reality of wards, investigating the aspects related to their use in venepuncture procedures, the cleaning process after their use and storage.

METHODS

It has been conducted an observational study with a questionnaire on a sample of nurses (N = 73) and nursing students (N = 60) recruited in a hospital and in an University of northern Italy.

RESULTS

Data revealed a very positive attitude regarding the high standards of hand hygiene among nurses and nursing students sampled; the critical issues concern the lack of shared protocols or guidelines for the management of tourniquets that lead to discussion both on their use in clinical practice and on the disinfection process after use as well as tourniquets disposal.

CONCLUSIONS

Tourniquets can represent a serious potential danger in terms of infections transmission, especially in the pandemic period we are experiencing; their use is practically transversal in all healthcare settings and it is therefore necessary to implement the use of shared management and disposal guidelines / protocols. From this research it appears that in the setting explored, although much attention is paid to hand hygiene, this aspect still seems to be a critical point of nursing care.

Validation of the Italian version of Behavioral Pain Scale in sedated, intubated, and mechanically ventilated pediatric patients

BACKGROUND AND AIM

Pain assessment in pediatric intensive care unit (PICU) is a demanding challenge. The COMFORT-B scale is recognized as the gold standard in such patients. However, the use of this instrument in PICU setting is disputed. The Behavioral Pain Scale (BPS), instead, is considered to be the gold standard for pain assessment in deeply sedated, mechanically ventilated adult patients. The BPS has been validated in Italian, requires a short observation time compared to the COMFORT-B and does not increase workloads. A first evaluation of BPS was made in PICU with good results regarding face validity and content validity, however suggesting further studies given the small sample on which it was tested. The aim of this study was the validation of the BPS in sedated, intubated, and mechanically ventilated pediatric patients.

METHODS

A descriptive, comparative design was used. A convenience sample of 84 non-verbal, sedated and mechanically ventilated critical care pediatric patients was included. Patient pain was assessed concurrently with three observational scales (BPS, COMFORT-B, NRS) before, during and after routine procedures that are considered painful and non-painful.

RESULTS

Internal consistency was α = .86. Correlations between BPS and the other instruments were high, demonstrating a good concurrent validity of the BPS. T test and assessment of ROC curves demonstrated a good discriminant validity of the BPS.

CONCLUSIONS

The BPS proved to be valid and reliable for the assessment of pain also in the use with pediatric patients.

Does open data tell us everything?

The community of the entire planet is still grappling with the management of the Sars-CoV-19 pandemic and in some countries the spread of the infection is as serious as it was in Italy in the first months of 2020. In this issue of the magazine Kalli M et al. describe the situation in Chad.[...].

The experience of the emergency psychologist during the Covid-19 pandemic

BACKGROUND AND AIM OF THE WORK

the new coronavirus pandemic COVID-19 has had a strong psy- chological impact on the world population. Volunteer psychologists, and psychologists that work in the emer- gencies have also been exposed to the consequences of the impact of the pandemic. The purpose of this study was to explore the experiences of the psychologist during the Covid-19 emergency intervention.

METHODS

an exploratory study, following a qualitative design using Focus Group method was adopted. A total of 24 psychologists was recruited from volunteers of the "Pronto Pșy - Covid-19" service, organized by the Ital- ian Society of Emergency Psychology Social Support, Emilia Romagna. Focus Group Discussions (FGDs) was held about: their experiences during the online psychological support; needs detected by users; training needs that emerged during the intervention and professional skills applied.

RESULTS

five themes were identi- fied: psychological distress of rescuers; online emergency setting; support of colleagues and gratitude as stress management strategies; need of skill and tools in pandemic emergency intervention; integrated psychological intervention.

DISCUSSION

the stress reaction of the emergency psychologists was due in particular to the type of emergency and lack of standardized approach. The group meetings represented an important resource to face traumatic stress.

CONCLUSIONS

this study showed the role the need for specific tools for pandemic intervention to protect the well-being of the professional from impact of stress. Further research is needed. (www.actabiomedica.it).

Intraosseus access vs ecoguided peripherical venous access in emergency and urgency: a systematic review

BACKGROUND AND AIM OF THE WORK

Ensuring vascular access in emergency conditions is critical. Peripheral venous catheters (CVP) are the most used devices in clinical practice, even though their positioning can result difficult, causing delay in life-support treatments with possible critical results. Ultrasounds allow you to view blood vessel in real time, for this reason they could result helpful during use. Another option for the vascular access can be intraosseous access (I.O.), by introducing a needle directly in the bone marrow cavity. This review aim is to examine what typology of vascular access is best for the drug delivery in emergency/urgency in international and national literature.

METHODS

Bibliographical research was conducted by consulting the main biomedical databases through keywords and MESH terminology. In this review 21 articles published in the last 7 years have been included. They were published in English, Italian and French.

RESULTS

Contraindications and complications of I.O and of ultrasound-guided CVP positioning are limited. I.O access finding attempts are as fast as CVP positioning attempts but with a higher chance of success. Furthermore, ultrasound-guided CVP insertion is more comfortable for patients, it minimizes delays in medical treatment and it guarantees a better healthcare, with high percentage of right venous catheter placement.

CONCLUSIONS

Intraosseous access is recommended for severely compromised patients; the ultrasound guide is a very useful tool when peripheral vascular areas are difficult to detect with only the palpation, it would be more appropriate in situations of urgency than that of emergency.

Interprofessional collaboration between different health care professions in Emilia Romagna

BACKGROUND

Interprofessional collaboration in the healthcare sector contributes to the delivery of high quality and safe services to patients across different subdivisions of the healthcare system which is faced with constant challenges. The international literature offers a plethora of tools for assessing the collaboration between health workers, but only a few of these have been validated in the Italian language. One that has undergone such validation is the interprofessional collaboration (IPC) scale, which measures the perception of collaboration among health professionals. An advantage of this scale is that is addresses all workers within the system, and is not limited to specific professions. The aim of the present study was to apply the validated Italian version of the IPC scale, to a context different to the one used for its validation, to measure the level of collaboration between different health care workers.

METHOD

A questionnaire-based study was conducted on a sample consisting of 329 health professionals working at Azienda USL-IRCCS in Reggio Emilia. The categorical and continuous variables were analysed using descriptive statistics (frequencies, percentages and SD).

RESULTS

The IPC scale showed physicians to express the highest level of collaboration with other professionals, in line with the results of other studies in the literature. The values calculated for the factors "accommodation" and "communication" were higher than for "isolation", depicting a good level collaboration. The only case in which the isolation factor, which describes an absence of collaboration, was equal to the other two factors was in relation to the evaluation of midwives by nursing aides/orderlies.

CONCLUSIONS

In conclusion, the Italian version of the IPC scale provides a useful instrument for measuring interprofessional collaboration between workers in the healthcare sector. In the present study, it revealed a satisfactory level of collaboration between health professionals in an organization located in Emilia Romagna, Italy.

"Growing through relationship" - the Engagement of the Health Professional Students in the Internship Experience: a Grounded Theory Research

BACKGROUND AND AIM

Little is known about the students' engagement in the training experience and how it is lived by the health professional students. We aim at building a theoretical model of the engagement process starting from their lived experiences with Grounded Theory approach.

METHODS

In-depth qualitative interviews are conducted with 12 students from the Master Degree Courses in Nursing, Physiotherapy and Prevention Techniques in the environment and in the workplace, who had carried out and/or were doing internships in the same territory (2nd and 3rd year). Results The health professions' student engagement in the training program is developed in three main phases: initial phase, central phase and final phase, where emotions, behaviours, awareness contribute to the development of the entire engagement process with different relevance. The intertwining of these different components that develop along the stages of the experience gives life to the core category: growing through relationship, which expressed the crucial role of the relational network built during the internship experience in shaping students' engagement.

CONCLUSIONS

The results of this study underline the crucial role of students' engagement in the internship experience in favouring both better learning outcomes and perspective professional success and wellbeing. (www.actabiomedica.it).

The safety of care focused on patient identity: an observational study

Background and aim:

Healthcare organizations, to reduce errors and extend the number of safe practices, are looking for possible solutions to enhance the clients’ health quality care and trying to spread the culture of safety healthcare. Although in the literature the field of research “patient safety” is very debated, there are few empirical studies that investigate about the strategies undertaken by nursing students for the patients’ identification process during their care pathway. The aim of this study is to investigate the knowledge of the Ministerial Recommendation No. 3/2008 among nursing students, a specific Italian directive that aims to guarantee the safety of cares.

Methods:

A four-weeks single-centered observational study was conducted, involving a convenient sample of 112 students of the 2^nd and 3^rd year of the Nursing Course Degree of the University of Parma. The survey was conducted using an ad-hoc questionnaire.

Results:

The use of the identification wristband is considered one of the most important strategy to make sure the patient identification; unfortunately, it is in practice used just on few occasions and only when performed specific procedures; it is furthermore noted that patients are not enough informed about the use and finalities of the identification wristband.

Conclusions:

Considering the importance of the patient identification process to guarantee the safety of cares, the results produced, suggest that this investigation field deserves further insights in order to collect more substantial data and expand knowledge on the specific subject, so as to fill knowledge gaps and sensitize nursing students to the correct use of the identification wristband.

A protocol for Italian validation of DEMQoL-Proxy Scale: assessing the Quality of Life of people with moderate or mild dementia

In this paper, we propose an adaptation of a protocol for a tool's validation. We have utilized this phases-theory to validate in Italian language an instrument to assess Quality of Life for people with moderate or mild dementia. We will explain the example of our Italian validation of DEMQoL-Proxy considering each De Vellis's phase. We will explain our application of De Vellis's model to Italian example described. For the first three phases, we reproduced the original validating study in which authors (Smith et al., 2005) defined what to measure, how generate a set of items and the structure of the scale. Indeed, for the last five phases we explained the adaptation of De Vellis's model to Italian validation. We hope that this model could be effective to validating goals, for researchers and in particular for all professionals who deal with caregivers and patients with moderate and mild dementia. Furthermore, the measurement of the Quality of Life makes the scale widely useful within the various professional specialties and setting. Finally, thanks to the methodological assumptions adopted following the De Vellis's eight-phase model, we can affirm that this first Italian pre-validation of the DEMQoL-Proxy seems to be an excellent forerunner for its effective validation in the Italian context.

Nurse's identity role during Covid-19

Background and aim of the work:

The main purpose of this study is to investigate on the experience of nurses working in the Covid-19 area focusing on their role’s perception. In particular, we explored the nurses’ perception of job satisfaction in relation to the images sent back by public opinion through the mass media and social communication channels. During the first wave of Covid-19 nurses have acquired media visibility, but their feeling is represented more by the discomfort of finding themselves suddenly glorified in the face of a lack of professional, social, and economic recognition.

Materials and methods:

A Mix-Method methodology and convenience sampling was adopted, on the population of professionals and students in post-graduate specializations, belonging to the Department of Medicine and Surgery of the University of Parma, and by nurses from the ASST-Bergamo Est, Lombardia Italy, who worked in the Covid emergency during the first

wave

of the pandemic, from February 2020 to May 2020. In the quantitative phase Stamm’s Professional Quality of Life Scale - ProQOL was administered to 89 respondents through a Google Form, In the qualitative phase, 3 Focus Groups were conducted on a total of 17 students.

Results:

At the ProQOL questionnaire, a moderate score was found in the Compassion Satisfaction scale (CF = 38.28) and in the Secondary Traumatic Stress subscale (STS-24.33), while low values emerged in the Burnout subscale (BO = 16.02). Five specific topics emerged from the focus groups: Professional collaboration, Job satisfaction, Nurse’s personal skills, Failure to protect the public image and the nursing profession.

Conclusions:

The professional collaboration, union with the work team, sense of solidarity, job satisfaction, professional growth, and awareness of one’s role seem to have worked favorably on Compassion Satisfaction, while keeping Compassion Fatigue levels under control.

Nomophobia in healthcare: an observational study between nurses and students

BACKGROUND AND AIM

The abuse of technical devices can be considered a form of addiction that is defined in current literature as Nomophobia. The phenomenon appears to be quite widespread among nurses and nursing students, and nomophobic behaviours of professionals can lead to a reduction in the quality of the care provided. The aim of this study is to investigate the situation in a University and in a hospital in northern Italy and evaluate the levels of nomophobia among nurses and students.

METHODS

An observational study was conducted with a questionnaire using a sample of nursing students and nurses.  Both of the studies had the common goal of investigating the levels of nomophobia and   evaluate the comparison between the two groups.

RESULTS

In general, neither nurses nor students seem to demonstrate nomophobia's critical levels. The comparison of the daily use of the smartphone between nurses and students shows that the frequent use of students is balanced by the nurses' daily trend line that progressively decreases. Both nurses and students affirm to use their smartphones at work with a certain frequency although, especially among the students, it is usually for appropriate and justified reasons.

CONCLUSIONS

It is necessary to consider the development of an educational project that regulates the use of smartphones, explaining the meaning of nomophobia, right from the first year of the University experience so as to correctly address the students'  (and future professionals') behaviours  to make them aware of the misuse of mobile phones, especially in the clinical setting that can easily cause distractions and consequently irreversible  errors.

The global health community must stand for health and democracy in Myanmar

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The qualitative method for a humanisation of research

Huge progress in scientific research, added to vast investments, have allowed to develop vaccines against the virus responsible for Sars-Cov-2 in times unimaginable, until recently (1). The use of these vaccines has documented their high efficacy and very low risk of adverse events. Undergoing vaccination campaigns around the world are changing the history of the COVID-19 pandemic. Never before has scientific research been a topic of widespread interest as in this period. [...].

Taking care. Nursing towards Covid-19 patients during the pandemic emergency in Italy: a qualitative study

BACKGROUND AND AIM OF THE STUDY

The Covid-19 pandemic has clearly impacted the Italian healthcare system. The growing number of patients in critical conditions has required a reorganization of the hospitals wards and of other healthcare structures, by changing the working routines of health professionals. The aim of the study is to explore if and how the nursing care towards Covid-19 positive patients have changed during the pandemic.

METHOD

Qualitative study with a phenomenological approach conducted through semi-structured interviews. Interviews have been carried out during the months of October and November 2020. Our research involved 21 nursing professionals attending post-graduate courses at the Department of Medicine and Surgery of the University of Parma (academic year 2019/2020) and who have worked during the pandemic period in health services structures and organizations.

RESULTS

The interviews showed how, during the period of the pandemic emergency, the care relationship between nurses and patients has changed because of the priority given to clinical and technical practices, in some cases, "life-saving". This happened due to different factors such as the nurses' fear of being infected by the virus and the lack of a sufficient time to ensure an holistic and integrated approach towards an increasing number of patients in highly complex conditions. Thus, the dimension of caring has been consciously overshadowed.

CONCLUSIONS

The health emergency that has hit Italy since the first months of 2020 has shown structural limits and gaps of public health policies, hospital settings and national health services organization that already existed in the pre-pandemic period. It also highlighted how, even before Covid-19, nursing was already in part denoted by a loss of caring, a missed nursing care.

Take a picture! The role of visual methods in understanding psychiatric patient's everyday life

Background and aim:

Understanding the patient’s experience of mental illness can foster better support for this population and greater partnership with healthcare professionals. This study aims to explore the application of visual methods in the psychiatric field and, in particular, the experience of people suffering from psychotic disorders, because it is still an open question that has not been only partially empirically examined.

Methods:

This qualitative study was conducted using two visual methods (auto-photography and photo-elicitation) associated with the narrative that emerged from an unstructured interview, in a clinical setting of adult Mental Health in Italy, between October 2019 and February 2020. A total of 5 patients and 5 corresponding referring healthcare professionals were identified and enrolled. Patients were asked to produce photographs following 4 thematic areas: “Fun”, “Time”, “Something indispensable”, “Place where I feel good”.

Results:

A total of 85 photographs were produced. Visual methods have proved to be a useful technique in qualitative research in the area of adult psychiatry. From the interviews it emerged that visual methods have allowed psychotic patients to use a new language to be able to communicate their emotions.

Conclusions:

The healthcare professionals involved also confirm the potential of this tool which, when combined with the traditional interview, is able to deepen the patient’s knowledge by overcoming the verbal barriers that often make it difficult to reconstruct the individual experience of illness.

The intervention of the emergency psychologist: the SIPEM SoS Emilia Romagna during the first lockdown from COVID-19

Background and purpose of this work: WHO 11 March 2020 declares that Sars-Cov-2 infection is not only a health emergency but must be considered a pandemic. Covid-19 required the urgency of a new psychological intervention model to better address the crisis and ensure a direct support response to the people involved in the pandemic. The present study aimed to detect the symptoms and reactions of the population with respect to the event. The survey was carried out by describing the clinical symptoms that emerged from the triage card used by SIPEM SoS Emilia Romagna (Italy), connoting the criteria of emergency psychology.

METHODS

A retrospective quantitative study was conducted on 288 psychological triage cards.

RESULTS

only 11% of users who ask for support say they are positive while 85% report not having contracted the virus. Of the total, 40.9% call for psychological support in the management of anxiety symptoms, a need also reported by 55% of the subsample who declared previous psychological problems. In reaction to the pandemic event, 51.1% of the total refers to coping resources and availability for help.

DISCUSSIONS

the need for support of the population to manage symptoms highlights the need for early interventions, also to facilitate that slice of the population that does not have effective individual coping strategies and resources available to help.

CONCLUSIONS

it can be deduced that interventions during these types of emergencies must be timely and aimed not only at those affected but also at the general population.

Effectiveness of Expressive Writing protocol in Palliative Care Healthworkers: a quantitative study

BACKGROUND AND AIM OF THE WORK

Palliative Care professionals are exposed to intense emotional environment. This puts them at risk for Compassion Fatigue and Burnout. The protective factors that can counter their onset are Compassion Satisfaction, Organizational Commitment and Resilience. Expressive Writing is a valid tool for adapting to traumatic events and enhancing psychological well-being. Aim of this study is to evaluate the effect of the Expressive Writing in Palliative Care professionals on Compassion Satisfaction, Organizational Commitment, Resilience, Compassion Fatigue and perceived distress.

METHODS

Prospective experimental study with experimental/control groups and pre/post measurements. 50 Palliative Care professionals were recruited in Northern and Central Italy. Participants filled: Organizational Commitment Questionnaire; ProQol - revision III; Resilience Scale for Adults; Impact of Event-Scale Revised; Emotion Thermometer; ad hoc questionnaire for the evaluation of protocol usefulness.

RESULTS

Wilcoxon test demonstrated change in Continuative Commitment (Z = -3.357, p = .001), anger (Z = -2.214, p = .027), sleep (Z = -2.268, p = .023), help (Z = -2.184, p = .029), intrusiveness (Z = -2.469, p = .014), hyperarousal (Z = -2.717, p = .007), and total IES (Z = -2.456 , p =, 014). Mann Whitney test showed a significantly lower score on post-test Intrusiveness in the experimental group (U = 202, p = .038).

CONCLUSIONS

The Expressive Writing intervention was effective in improving organizational and emotional variables. Expressive Writing supports healthcare professionals in relieving the burden of traumatic episodes, ordering associated thoughts and emotions, and implementing a process of deep comprehension.

First Italian validation of the "Satisfaction with simulation experience" scale (SSE) for the evaluation of the learning experience through simulation

BACKGROUND AND AIM OF THE WORK

Training in simulation through "mannequins" is increasingly widespread among nursing students. In the Italian context, however, there are no tools that measure the degree of student satisfaction after clinical training through simulation. The aim of the study is to provide a first validation in Italian of the Satisfaction with simulation experience" (SSE) scale, a tool already validated in several languages.

METHODS

After obtaining the author's consent, the SSE was subjected to forward and backward translation. The content validity was assessed by 5 training experts by calculating the Content Validity Index by Item and by Scale (I-CVI and S-CVI); the face validity was tested on 4 nursing students who had participated in a simulation experience. Subsequently, the SSE was administered to 10 nursing students with test-retest after 7 days in order to evaluate the reliability by calculating the reliability coefficient (r) and Cronbach's α.

RESULTS

The author approved the final version of the SSE translated into Italian: I-CVI values>0.80 and S-CVI was 0.94. r is 0.88 and the α of the scale is 0.713.

CONCLUSIONS

The detected values of I-CVI and S-CVI are satisfactory, demonstrating the validity of the content of the SSE-ITA. The test-retest showed "optimal" reliability and the α was considered acceptable given the little deviation from the original (0.776). Although the results demonstrate satisfactory values, this is a first validation and other studies with larger samples are needed.

Nursing spiritual assessment instruments in adult patients: a narrative literature review

Background and aim of the work:

Spiritual care in nursing is a critical part of providing holistic care. Whilst patients might desire spiritual care and value the opportunities that nurses take to engage with them to meet their spiritual needs, research suggests that nurses do not consistently engage in spiritual care with their patients. To identify instruments available to nurses to assess spirituality in different patient groups and highlight the characteristics and psychometric properties of these instruments.

Method:

A narrative literature review of the relevant literature published after 2008 was carried out in CINAHL, PsycINFO, MEDLINE and Google scholar databases in October 2020. Narrative review synthesized key findings and grouped instruments into macro areas by content.

Results:

After the screening, based on inclusion criteria, 31 articles were identified. 17 instruments were identified and divided into 4 macro areas: wellbeing (N = 4), attitude (N = 5) needs (N =6) and multiple domains (N = 2).

Conclusions:

This review enables an increased awareness of the variety of instruments available to aid spiritual care and therefore increase their use within nurse clinical practice. The widening of the patient group to be considered (i.e., non-oncological) may have a significant impact on the practice, causing professionals to reflect on the necessity to investigate spiritual needs even at an early stage of a disease process. Future studies should aim to test reliability and validity of existing instruments rather than develop further ones. (www.actabiomedica.it)

Health professionals' perception of appropriateness of care: a qualitative study in Italian pediatric hospices

Background:

Appropriateness is particularly relevant in palliative care, an area in which it is essential to question the real need for treatments. Few studies explored the perception of appropriateness by professionals in pediatric palliative care, revealing the conflict sometimes faced when confronted with the uncertainty of prognosis and end-of-life decisions.

Aims:

The objective of this study is firstly to investigate the perception that doctors, nurses and psychologists, operating in Italian pediatric hospices, have of the appropriateness of the care they provide. Secondly, to understand what repercussions the perception of non-appropriateness has at individual and team level.

Methods:

A qualitative study was conducted between 2019 and 2020 through semi-structured interviews with a convenience sample of 17 professionals working it Italian pediatric hospices.

Results:

The interviewees do not refer to a common concept of appropriateness, but compare the latter to: the quality of life, the global care of the assisted person, the proportionality of care, the early recognition of the need for palliative care. The discussion within the team emerges as a privileged place to manage the discomfort of individual professionals in the face of treatment choices in conflict with their own values.

Conclusion:

the non-referring to a univocal conception of appropriateness deprives professionals of an objective criterion to resolve the most difficult decisions. However, it allows them to establish what from time to time seems to be the most appropriate care pathway for a given patient, at a given time and context, preserving the goal of personalized care. (www.actabiomedica.it)

Psychosocial precursors of the correct sanitation and sanitization of the patient unit in the hospital setting

BACKGROUND AND AIM OF THE WORK

Worrying data indicate the urgency of strongly limiting Healthcare-Associated Infections (HAI). Therefore, according to the Theory of Planned Behavior, the psychosocial precursors of correct sanitation and sanitization were assessed.

METHODS

An Italian sample of hospital health workers (nurses, healthcare assistants, cleaners; N=250), replied to a validated questionnaire measuring: a) knowledge of HAI; b) favorable attitude towards the correct sanitation and sanitization procedure; c) perception that the management and colleagues give importance to the government of infectious risk; d) perception of being able to implement risk management behaviors; e) perception of having received proper training for the prevention of HAI.

RESULTS

The results show many mistakes about knowledge, the perception of insufficient specific training, and not always favorable attitude towards sanitation and sanitization practices. Workers also perceive that they can act the required behaviors and that the management of infectious risk represents a value in the group they belong to, but they believe that the management does not offer sufficient support.

CONCLUSIONS

The improvement of the factors considered (knowledge, personal attitudes, actions of management and colleagues, perception of being able to implement the required behaviors) is affected by proper training. This is one of the aspects on which management should invest more.

Job satisfaction, work engagement and stress/burnout of elderly care staff: a qualitative research

BACKGROUND AND AIM OF THE WORK

Faced with the widespread use of services and facilities for the care and assistance of the elderly, the aim of this study was to explore the factors that can affect job satisfaction, work engagement and stress / burnout of the professionals who work there.

METHOD

32 semi-structured interviews were administered to a not probabilistic sample of the different professional roles (coordinators, nurses, healthcare assistants, physiotherapists, community animators) of a Human Services Company in Reggio Emilia (Italy). This includes day-care and residential care facilities for the elderly.

RESULTS

The thematic content analysis showed that inter-professional collaboration and positive relationships with superiors, colleagues and elderly people favour the job satisfaction, while workload, high responsibilities, reduction of rest periods and contributory inequity create dissatisfaction. The work engagement is favoured by professional autonomy, a sense of belonging, professional growth, specific training, while it is disadvantaged by scarce career opportunities, job insecurity and low recognition of one's contribution. Finally, inadequate pay, work load, high turnover and strong emotional experiences related to elderly people increase work-related stress/burnout, while working autonomy, psychological support and good relationships with the elderly reduce it. Some specificities were found according to the different professional roles and the type of services offered.

DISCUSSION AND CONCLUSIONS

The results suggest organizational improvement strategies that take these factors into account. Among the improvement proposals we highlight, for example, the promotion of training events, a greater involvement of personnel in corporate decisions and an adequate psychological support for professionals.

The Pandemic from COVID 19: a Lesson that we must not forget

This issue of the Acta Biomedica for Health Professions magazine was prepared during the lockdown, imposed by the Italian government, for the contain- ment of COVID 19. This acute syndrome was initially thought to concern only the respiratory system and for this reason it has been defined as SARS CoV-2. To date, however, we know that COVID 19 affects numerous areas of the body (1,2). In Italy, the first western country where the infection manifested itself in the form of an epidemic, we listened to health bulletins that resembled war bulletins, which reported on thousands of people affected by the virus and hundreds of dead people. [...].

The VaRP Project: qualitative evaluation of the training effectiveness of Post Graduate Specializations for health professionals

INTRODUCTION

The healthcare professionals' specialized training has a positive impact on professional values, patient's outcome, and promotion of evidence-based practices. To raise the educational standard, the University of Parma has created Post Graduate Specializations which, in addition to learning sector-specific techniques and skills, include the acquisition of soft skills. Aim of the study is investigating the perception of the tutors dedicated to the organization, management, and teaching of the Post Graduate Specializations on the skills gained and the changes achieved in clinical practice, training, and research.

MATERIALS AND METHODS

Qualitative research was carried out through a semi-structured interview to 11 tutors who have been coordinating the Post Graduate Specializations.

RESULTS

The Qualitative analysis developed "thick" descriptions characterized by analytical density and interpretative richness. The emerging thematic nuclei were: General/unpredicted aspects, Professional empowerment, Satisfaction, Professional outcomes, Limits of the Post Graduate Specializations, and Development areas.

CONCLUSIONS

We identified the most effective areas of the Post Graduate Specializations that emerged consistently from the interviews. We hypothesized that the values and mission the Scientific Board, are effectively lived and championed in the everyday activities of the Post Graduate Specializations. Some domains still need to be furtherly developed, as the professional record, the absence of a "follow up" relationship with former students, and the effective management of workload both for students and tutors. The rise of these limits, can be particularly fruitful, as it gives the chance to identify the development trajectory the post-graduate trainings should pursue to raise the standard of excellence.

The impact of a "narrative interview" intervention in oncology. A study protocol for a feasibility study

BACKGROUND AND AIM OF THE WORK

Oncological diagnosis determines a biographical breakdown and requires the person to adapt to the disease. If patients, after diagnosis, ask professionals for 'compassionate care', research on these issues is still underdeveloped. There are currently no studies that use the narrative interview as an intervention tool. The objectives of the study are to evaluate: (1) the feasibility of the narrative interview intervention on cancer patients in the first diagnosis; (2) the impact of the narrative medicine intervention on the patient's self-perception, his psychological distress and adaptation to the disease.

METHODS

It is a mixed-method study, with an intervention (narrative interview) and quantitative evaluation before/after intervention and qualitative evaluation post-intervention (reflective writing). The analysis will use the Psychological Distress Inventory scale for the assessment of psychological distress and the Mini-Mental Adjustment to Cancer Scale for the assessment of disease adaptation. Adult patients, with oncological pathology will be recruited one month after the communication of the diagnosis, regardless of the type of tumor. The Wilcoxon test for paired data will be used to verify pre-post-intervention differences. The 'reflective writings' will be subjected to thematic analysis.

DISCUSSION AND CONCLUSION

The study evaluates the feasibility of the narrative interview intervention as a primary outcome. Secondly, the impact of the intervention is assessed in relation to: a) identification of risk or protective factors on psychological distress and adaptation to the disease; b) re-elaboration of the patient's experiences and experiences related to his/her own illness.

The process of developing the professional identity of the Nurse Case Care Manager: A Grounded Theory Study

Background and purpose.

The Nurse Case Care Manager (NCCM) is still an emerging figure in the Italian healthcare context. The knowledge of the dynamics inherent in the process of identity development shows how they can be decisive for the affirmation and recognition of this new role. The aim of the study was therefore to analyse the psychosocial processes of developing the identity of the NCCM for a better understanding of the variables that influence its development.

Methods.

A qualitative study with Grounded Theory method was conducted. From December 2018 to January 2019, 20 semi-structured interviews were given to the NCCM of the Emilia Romagna Region and the Lombardy Region. The analysis of the material has led to a structuring of the theoretical model on the processes of development of professional identity.

Results.

Two main conditions have been identified: that of the “LOST CASE CARE MANAGER” and that of the “CASE CARE MANAGER DIRECTOR”. This process requires time, perseverance, courage and personal skills. Two transversal background concepts have been identified, namely “available space” and “relationship with the family”.

Conclusion.

The process of developing the NCCM’s professional identity encounters several obstacles. Among these, in particular a lack of recognition by operators highlighting the need for greater organizational clarity in the context in which the professional operates, in order to facilitate the inclusion of the NCCM clarifying skills and effectiveness profile. (www.actabiomedica.it)

Use of traffic crash as a risk assessment scale in hospitalized seniors: a perspective observational study

Background and aim:

According to the World Health Organization (WHO), falls represent the second main cause of accidental and involuntary deaths worldwide, which led to define them as one of the “four giants of the geriatrician” that particularly affect the elderly aged ≥ 65 years. The study’s aim is to evaluate whether the Traffic Crash scale is valid in identifying patients at risk of falling by comparing it to the Conley scale currently used.

Methods:

Prospective observational study evaluating the fall risk using TC on a sample of patients aged ≥ 65 years, hospitalized in General Medicine Ward and Gastroenterology, after informed consent and favorable opinion of the AVEN Ethics Committee. The results are compared with those obtained from the Conley scale, and with those obtained from the indications of the Business Operating Instruction. The method of administration occurred concurrently and distinctly on the same patient by two researchers in order to demonstrate the scale inter-rater reliability.

Results:

The final sample was made up of 88 patients. Data shows that 46 out of 55 patients (84%) are medium / high risk for both scales. According to the indications of the Company Operating Instruction, the entire sample is at risk. The inter-rater reliability was confirmed with Cohen’s K which is equal to p = 1.

Conclusions:

The TC scale is comparable to Conley scale, for the fall risk identification but specifically the stratification is low-medium-high. Therefore, in future, this will make it possible to implement personalized prevention interventions in care planning. (www.actabiomedica.it)