Publications by authors named "Leopoldo Sarli"

115 Publications

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

Acta Biomed 2020 11 30;91(12-S):e2020015. Epub 2020 Nov 30.

Azienda USL -IRCCS, Reggio Emilia.

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.
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http://dx.doi.org/10.23750/abm.v91i12-S.10998DOI Listing
November 2020

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

Acta Biomed 2020 11 30;91(12-S):e2020010. Epub 2020 Nov 30.

Department of Medicine and Surgery, University of Parma, Italy.

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.
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http://dx.doi.org/10.23750/abm.v91i12-S.10756DOI Listing
November 2020

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

Acta Biomed 2020 11 30;91(12-S):e2020013. Epub 2020 Nov 30.

Casa Sollievo Bimbi, Pediatric Hospice, VIDAS Association, Milan.

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.
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http://dx.doi.org/10.23750/abm.v91i12-S.10859DOI Listing
November 2020

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

Acta Biomed 2020 11 30;91(12-S):e2020014. Epub 2020 Nov 30.

Azienda USL-IRCCS di Reggio Emilia, Italy.

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.
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http://dx.doi.org/10.23750/abm.v91i12-S.10918DOI Listing
November 2020

Before, during and after the COVID-19 pandemic.

Acta Biomed 2020 11 30;91(12-S):e2020017. Epub 2020 Nov 30.

Azienda USL-IRCCS di Reggio Emilia, Italy.

The social disruption that had characterized the rapid progression of CoVid-19 infection in Italy in the first months of 2020 appeared again in the days in which this journal issue is being published. Due to what is defined as the second wave of the SARS-CoV-2 pandemic, measures to contain the contagion were still necessary, such as social distancing, isolation, the suspension of some production activities, closure of the majority of educational activities in presence in schools and universities. [...].
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http://dx.doi.org/10.23750/abm.v91i12-S.10993DOI Listing
November 2020

Untangling Species-Level Composition of Complex Bacterial Communities through a Novel Metagenomic Approach.

mSystems 2020 Jul 28;5(4). Epub 2020 Jul 28.

Laboratory of Probiogenomics, Department of Chemistry, Life Sciences, and Environmental Sustainability, University of Parma, Parma, Italy

16S small-subunit (SSU) rRNA gene-based bacterial profiling is the gold standard for cost-effective taxonomic reconstruction of complex bacterial populations down to the genus level. However, it has been proven ineffective in clinical and research settings requiring higher taxonomic resolution. We therefore developed a bacterial profiling method based on the internal transcribed spacer (ITS) region employing optimized primers and a comprehensive ITS database for accurate cataloguing of bacterial communities at (sub)species resolution. Performance of the microbial ITS profiling pipeline was tested through analysis of host-associated, food, and environmental matrices, while its efficacy in clinical settings was assessed through analysis of mucosal biopsy specimens of colorectal cancer, leading to the identification of putative novel biomarkers. The data collected indicate that the proposed pipeline represents a major step forward in cost-effective identification and screening of microbial biomarkers at (sub)species level, with relevant impact in research, industrial, and clinical settings. We developed a novel method for accurate cataloguing of bacterial communities at (sub)species level involving amplification of the internal transcribed spacer (ITS) region through optimized primers, followed by next-generation sequencing and taxonomic classification of amplicons by means of a comprehensive database of bacterial ITS sequences. Host-associated, food, and environmental matrices were employed to test the performance of the microbial ITS profiling pipeline. Moreover, mucosal biopsy samples from colorectal cancer patients were analyzed to demonstrate the scientific relevance of this profiling approach in a clinical setting through identification of putative novel biomarkers. The results indicate that the ITS-based profiling pipeline proposed here represents a key metagenomic tool with major relevance for research, industrial, and clinical settings.
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http://dx.doi.org/10.1128/mSystems.00404-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394355PMC
July 2020

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

Acta Biomed 2020 06 20;91(6-S):106-117. Epub 2020 Jun 20.

Department of Medicine and Surgery, University of Parma, Italy.

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.
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http://dx.doi.org/10.23750/abm.v91i6-S.10027DOI Listing
June 2020

Italian pilot version of DEMOQL-PROXY: Content and Face validity: a methodological bridge for a future Italian validation.

Acta Biomed 2020 06 20;91(6-S):100-105. Epub 2020 Jun 20.

Azienda USL -IRCCS, Reggio Emilia, Italy.

Background And Aim Of The Work: The assessment of Quality of Life through validated tools allow to improve level of assistance for people suffering from Dementia. To our Knowledge in Italian language seem to be absent a tool to evaluate mild and moderate dementia, consequently underestimating and underrating needs of this specific target. We show an Italian pilot version of the DEMQOL-PROXY (specific for mild and moderate Dementia) testing some psychometric properties as: back-translation, content validity and face validity in Italian language.

Method: A back-translation by two bilingual authors was presented. Was enrolled an expert panel to test Content Validity composed by eight Medical Doctor and a panel of six participants was recruited to assess Face Validity (three professional caregivers and three family caregivers) related to patients with moderate Dementia (with 10 to 20 MMSE, mild and moderate Dementia).

Results: Each item has a degree of agreement between experts of more than 70% and the Total CVI score is .90 (90% of agreement). So, in line with these results we can accept the version of items proposed. As regard Face Validity, the items of the instrument seem to be clear, without difficulty and there are no questions consiedered offensive or irritating.

Conclusion: The Italian version of the DEMQOL-PROXY showed good psychometric properties: its structure and the results it leads to are similar to the original version and to the other translations produced so far. For this reason, we consider this paper as a methodological bridge for a future complete Italian Validation.
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http://dx.doi.org/10.23750/abm.v91i6-S.10011DOI Listing
June 2020

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

Acta Biomed 2020 06 20;91(6-S):92-99. Epub 2020 Jun 20.

Azienda USL -IRCCS, Reggio Emilia, Italy .

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.
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http://dx.doi.org/10.23750/abm.v91i6-S.9673DOI Listing
June 2020

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

Acta Biomed 2020 06 20;91(6-S):38-47. Epub 2020 Jun 20.

Department of Medicine and Surgery, University of Parma, Italy.

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.
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http://dx.doi.org/10.23750/abm.v91i6-S.10016DOI Listing
June 2020

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

Acta Biomed 2020 06 20;91(6-S):19-27. Epub 2020 Jun 20.

Azienda USL-IRCCS di Reggio Emilia, Italy.

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 MANAGER" and that of the "CASE 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.
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http://dx.doi.org/10.23750/abm.v91i6-S.10019DOI Listing
June 2020

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

Authors:
Leopoldo Sarli

Acta Biomed 2020 06 20;91(6-S):5-8. Epub 2020 Jun 20.

Department of Medicine and Surgery, University of Parma, Italy.

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. [...].
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http://dx.doi.org/10.23750/abm.v91i6-S.10047DOI Listing
June 2020

Italian Validation of the Chiba Interprofessional Competency Scale (CICS29).

Acta Biomed 2020 03 13;91(2-S):58-66. Epub 2020 Mar 13.

Department of Medicine and Surgery, University of Parma, Italy.

Background And Aim Of The Work: The Chiba Inter-professional Competency Scale (CICS29) validated in several languages, it is a self-report instrument that investigates the degree of interprofessional collaboration in six areas: attitudes and beliefs of the professional; ability to manage a work group; actions to achieve goals; providing assistance that respects the patient; attitudes and behaviours that improve the cohesion of the working group; fulfilling or performing the own professional role. In addition to being recent, the scale investigates collaboration among all health professionals, and is not limited to specific professionals. The aim of the study was to validate the Italian version of CICS29.

Method: A questionnaire-based study was conducted with an Italian sample consisting of 530 health professionals (419 women¸ mean age = 40 years, SD = 10.7; range 23- 58 years). The internal validity was measured using factor analysis. To verify the convergent validity, the Italian Version of Interprofessional Collaborative Competency Attainment Survey (ICCAS) was correlated with the CICS29; Results: The reliability and the internal validity of the CICS29 revealed 6 factors corresponding to the original subscales. The analysis presents an excellent sample adequacy measure (KMO = .933) with the scores ranging from 0.62 to 0.78 for the interclass correlation coefficients of the 6 domains. A significant level of correlation was found between the subscales of the CICS29 and the ICCAS.

Conclusions: In conclusion, the Italian version of CICS29 has a satisfactory level of reliability and validity and it is recommended for measuring interprofessional collaboration of the health professionals. (www.actabiomedica.it).
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http://dx.doi.org/10.23750/abm.v91i2-S.9172DOI Listing
March 2020

Myanmar health professionals' educational needs: a pilot study.

Acta Biomed 2020 03 13;91(2-S):35-44. Epub 2020 Mar 13.

University of Parma.

Background And Aim Of The Work: The main factor hindering the development of the Myanmar health system lies in the scarcity of financial and human resources attributed to the health system. This paper presents the preliminary results of a pilot study on the educational needs of Myanmar health professionals, addressing the empowerment of human resources as a strategic pillar for delivering the essential packages of health services.

Methods: An explorative study following a qualitative approach has been conducted through semi-structured interviews to a convenience sample of 15 persons, selected as authoritative key-informants.

Results: In addition to the lack of infrastructures, medicines, ambulances and health instruments, and the health disparities between the urban and rural areas, some widespread problems are reported as requiring health professionals' training empowerment: traumas due to road accidents, management of childbirth, non-communicable diseases' management and poor health education of the population.

Discussion: Some areas can be evidenced for an improvement of professionals, training: ​​maternal, neonatal and child health; communication between professionals and laypeople; Myanmar population's health education; inter-professional training between doctors and nurses, but also between health personnel and non-health personnel.

Conclusions: The educational needs of Myanmar health professionals emerge as closely related to the social and health needs of the Myanmar population, to the available resources and missing resources of the country's health system and to the role of professionals within professionals/patients' relationship. (www.actabiomedica.it).
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http://dx.doi.org/10.23750/abm.v91i2-S.9344DOI Listing
March 2020

The Patient's Narrative Agenda as an assessment tool: the story of Robert, suffering from osteosarcoma.

Acta Biomed 2020 03 13;91(2-S):7-15. Epub 2020 Mar 13.

Department of Medicine and Surgery, University of Parma, Italy.

Background And Aim Of The Work: To activate the participation of the person in his/her care path, the literature highlight the impact of the professional's ability to show a genuine interest in the problems brought by the patient and to recognize him/her as 'competent'. In these sense the narrative patient's agenda could be a useful relational tool, because is focused on the perception of patient experiences of his/her illness. Thus this study aims to analyze the usefulness of patient's narrative agenda during the assessment phase.

Method: A semi-structured interview has been adopted to explore the agenda of Robert, 21 years old, suffering from osteosarcoma. A first level analysis identified the four functional areas of the agenda: ideas and beliefs; expectations and desires and context in which he lives and interacts. A second level analysis assessed the main Robert's problems.

Results: The narrative agenda has highlighted many central problems of Robert (e.g. therapeutic adherence, quality of life, mood, body image, existential problems related to experiences, hopes and expectations). Of course these results could be integrated with other tools: qualitative, to understanding difficulties and to formulate hypotheses, and quantitative, to measure the level of severity of problems reported.

Discussion And Conclusion: The narrative agenda has not only proved to be a valid instrument of assessment, allowing an adequate insight on the patient's problems, as we exemplified, but it can be also used for monitoring the dynamic situation of the person's history, lending itself to the re-exploration of its functional areas over time.
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http://dx.doi.org/10.23750/abm.v91i2-S.9371DOI Listing
March 2020

Editorial.

Acta Biomed 2020 03 13;91(2-S):5-6. Epub 2020 Mar 13.

Department of Medicine and Surgery, University of Parma, Italy.

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http://dx.doi.org/10.23750/abm.v91i2-S.9380DOI Listing
March 2020

Infectious risk in ostomy patient: the role of nursing competence.

Acta Biomed 2019 11 11;90(11-S):53-64. Epub 2019 Nov 11.

Department of Medicine and Surgery, University of Parma, Italy.

Background And Aim Of The Work: The risk of peristomal infections in ostomy patients is well documented in the literature. The nurse and the stoma therapist play a fundamental role in the management and prevention of ostomy-related infections. The present research aims to investigate, across the different phases of the nursing process, the level and characteristics of nursing expertise and highlight their impact on reducing infectious risk in ostomy patients.

Methods: 40 nurses (31 women; mean age = 47.7; SD= 7.68) working with ostomy patients were interviewed, in three Italian Local Healthcare Company (LHC) of Northern Italy, Central Italy, and Southern Italy. Nurses compiled a semi-structured ad-hoc interview concerning the level of skills, training, and experience with ostomy patients. The declared expertise has been compared to the retrospective archive data related to the peristomal skin infections of the three LHC.

Results: Several differences have emerged in terms of nurses' expertise and care settings: for instance, ostomy complications in Southern Italy being managed with specific checklists, whereas in the Northern Italy complications being managed by stoma therapists and in Central Italy by hospital ward general nurses. Moreover, the level of professional training was very important for all respondents. The incidence rates of infections after training are lower than a pre-training period.

Conclusions: The expertise resulting from specific training for nurses and stoma therapists are crucial for the management of the ostomy and the prevention of complications, in particular of infections. If the training reduces the peristomal complications, therefore, it is necessary to provide and preserve nurses' expertise, to guarantee patients an optimal treatment path.
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http://dx.doi.org/10.23750/abm.v90i11-S.8909DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233622PMC
November 2019

The Case/Care Manager in Eating Disorders: the nurse's role and responsibilities.

Acta Biomed 2019 11 11;90(11-S):17-28. Epub 2019 Nov 11.

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Background And Aim Of The Work: Despite its incidence, the Eating Disorder (ED) is underdiagnosed and, for its complexity, it requires multidisciplinary interventions. The Nurse and Case/Care Manager (CCM) have a central role in taking care of the patients with ED, even if the research concerning their role are lacking. Thus, the aim of the study was to investigate roles, activities and expectations of the nurse and the CCM in taking care of patients with ED.

Method: 25 Italian different professionals were interviewed (16 women, average age 43.4; SD = 9.23). The semi-structured interview has investigated: nurses' roles and activities; perceptions of nurses' evaluation; expectations on nurses' and CCM's roles; the interprofessional collaboration.

Results: The nurses analyse patients' care needs and coordinate the multi-professional care with empathic attitude. Their "professionalism, skills, sensitivity, ability to relate to the patient-family unit" are expectations shared by various professionals. About the interprofessional collaboration, the action of professionals is not always well coordinated, the decisions are often not shared and hospital-territory connection is not always realised. The CCM would be the reference in this process for all interviewees.

Conclusions: In the three examined contexts the figure of the CCM was not present, but his/her importance was acknowledged in the management of the patient's care path and as a point of reference for health professionals. It seems important that CCM is institutionally recognized, because the CCM would ensure an efficient management of the clinical pathway and would guarantee the continuity and appropriateness of care.
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http://dx.doi.org/10.23750/abm.v90i11-S.8989DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233626PMC
November 2019

Opening the horizons of clinical reasoning to qualitative research.

Acta Biomed 2019 11 11;90(11-S):8-16. Epub 2019 Nov 11.

Array.

Clinical Reasoning (CR) is an important aspect of health professional education and effective practice. It is a complex series of factors and cognitive functions, involving higher-level thinking to define problems, examine the evidence and then making decisions and choices to improve the patient's physiological and psycho-social state.CR consists of 3 interconnected and interdependent sub-processes: clinical experience and clinical context and Evidence-Based Practice. This essay focuses on the opportunities that Qualitative Research offers during the CR process when the doctor finds the evidence to address a patient's health problem. Clinicians are often faced with questions that randomized clinical trials or systematic reviews of efficacy studies cannot answer. For this reason, we considered it necessary to offer an expanded view of the process of interpretation of the scientific literature used in daily clinical practice through the complex process of Clinical Reasoning, through the use of studies conducted with qualitative methods, which are able to respond to a different range of clinical questions, and to support studies based on the effectiveness of treatments.
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http://dx.doi.org/10.23750/abm.v90i11-S.8916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233629PMC
November 2019

Interprofessionalism and interprofessional research: a challenge still to be won in Italy.

Acta Biomed 2019 11 11;90(11-S):5-7. Epub 2019 Nov 11.

University of Parma.

Public health and pedagogical institutions have long been calling for collaborative models of assistance and training that provide inter-professional synergy and there is a broad international consensus on the importance of inter-professionalism in the field of assessment and healthcare provision (1-10). [...].
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http://dx.doi.org/10.23750/abm.v90i11-S.8947DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233633PMC
November 2019

Health-Care-Associated Infections Management, sow the seed of good habits: a grounded theory study.

Acta Biomed 2019 07 8;90(6-S):26-33. Epub 2019 Jul 8.

University Teaching Hospital, Parma. Italy.

Background And Aim Of The Work: The reasons that condition and motivate adherence to good practices have a multifactorial nature. From the literature review, emerged different elements that interact within the operating context and represent a part of the variables that condition the "Best Practice". The aim of this research was to investigate the variables that influence adherence to operators' good practices.

Methods: A qualitative study with Grounded Theory (GT) methodology was carried out, which leads to the establishment of a theory about basic social processes. This theory is based on the observation and perception of the social scene and evolves during data collection. Data collection took place through interviews with the participants, through an ad hoc semi-structured interview grid. The initial sampling consisted of 12 health workers, while the theoretical sample was made up of 6 health workers.

Results: The analysis organization through the creation of schemes and diagrams has allowed to formulate different concepts including: false beliefs, knowledge and emotions experienced, that connect with the initial condition of Unconsciousness unaware; awareness of the consequences, team, welcome the new, which are connected to the intermediate phase of Revolution of the professional oneself; awareness of the limits, culture, responsibility, context, rigor and control that connects to the final state of Attentive Habit.

Conclusions: The theoretical model develops through a path of growth and revolution that starts from the roots of an Unconsciousness unaware and brings with it the seed of a model.
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http://dx.doi.org/10.23750/abm.v90i6-S.8642DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6776175PMC
July 2019

Editorial.

Acta Biomed 2019 07 8;90(6-S):5-6. Epub 2019 Jul 8.

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This editorial focuses on qualitative research, often mistakenly considered less scientific than quantitative research, in that it is "research without statistics". [...].
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http://dx.doi.org/10.23750/abm.v90i6-S.8643DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6776183PMC
July 2019

The use of blended learning to improve health professionals' communication skills: a literature review.

Acta Biomed 2019 03 28;90(4-S):17-24. Epub 2019 Mar 28.

University of Bologna.

Background And Aim Of The Work: In recent years, health professionals' education has moved towards the increasing use of blended learning. One of the most widespread blended formulas is the mix of face-to-face and online learning, which combines the advantages of distance learning, both in training provision and in training fruition, with the maintenance of socialization goals and application to practice activities. This literature review aims to find out whether blended-learning is employed for improving health professionals' communication skills and which are its outcomes.

Methods: Literature review of publications released from January 2000 to January 2019 was conducted across the academic databases Cinahl (EBSCO), Cochrane and Pubmed using relevant keywords.

Results: Research has shown that blended learning is used in the education of different health professionals (students, nurses, physicians, etc.) at various stages of the educational path. The enhancement of communication skills appears to be a secondary learning objective in many studies, but it is shown to be nevertheless central to the proper acquisition and application of more clinical skills addressed by the blended courses. The blended modules here examined achieved their goals. However, the evaluation of the learning outcomes is still based on self-assessment, and thus needs to be implemented.

Conclusions: Blended learning providers would need to pay more attention in the design and implementation phases of blended modules, assessing participants' needs and offering more tailored and targeted programs, and should provide a more rigorous evaluation of learning outcomes.
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http://dx.doi.org/10.23750/abm.v90i4-S.8330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625558PMC
March 2019

Inter-Professionalism in Health Care Post-graduate specialization: an innovative Laboratory.

Acta Biomed 2019 03 28;90(4-S):8-16. Epub 2019 Mar 28.

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Background And Aim: Inter- professional Collaboration (IPC) is an important component of a well-functioning healthcare system. It is linked to improvements in patient safety and case management, optimal use of the skills of each healthcare team member and provision of better health services. Inter- professional Education (IPE), is one key factor in the development of positive behaviors useful for IPC: the basic and post-basic training are key moments to raise awareness, train and help implement the IPC. Aim of this paper is to present and evaluate the use of an innovative laboratory of Consensus Conference implemented in the Nursing Post-graduate specialization at the University of Parma to train students to IPC.

Methods: An Innovative Laboratory inspired by of the Consensus Conference (CC) methodology on the "Integrated Narrative Nursing Assessment" was designed. Three Post-graduate specialization courses were involved and assigned to different tasks in the CC, according to the characteristics of the specializations.

Results: Strengths and weaknesses of the methodology were analyzed. Strengths: students' engagement in their competencies building, and the acquisition inter-professional collaboration skills. Weaknesses: the lack of time to develop the whole process, and the need of a deeper guidance in the scientific production.

Conclusions: Although the methodology have to be continuously improved through practice, this experimental Laboratory reached the aim of offering a real experience of IPC to the students. They really collaborated with different professionals to reach a common goal and being already considered an expert.
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http://dx.doi.org/10.23750/abm.v90i4-S.8306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625561PMC
March 2019

Editorial: a focus on Post-Graduate specializations.

Acta Biomed 2019 03 28;90(4-S):5-7. Epub 2019 Mar 28.

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http://dx.doi.org/10.23750/abm.v90i4-S.8308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625564PMC
March 2019

A first contribution to the validation of the Italian version of the Behavioral Pain Scale in sedated, intubated, and mechanically ventilated paediatric patients.

Acta Biomed 2018 12 7;89(7-S):19-24. Epub 2018 Dec 7.

Department of Medicine and Surgery, Parma University, Italy.

Background And Aim Of The Work: Numerous negative outcomes of inadequate pain management among children have been cited in the literature. Inadequate pain management may be particularly detrimental to children and adolescents facing life-threatening injury or illness on a Paediatric Intensive Care Unit (PICU). It is therefore absolutely necessary that professionals utilize effective and efficient tools in order to evaluate a person's sensations of pain in the most objective way possible. The COMFORT-B scale is recognised as the gold standard in such patients. However, the use of this instrument in the clinical PICU setting is disputed. It requires long periods of observation to ensure an adequate utilization. Boerlage et al. noted that nurses are often impatient and do not always observe the patient for the recommended 2 minutes period. The Behavioral Pain Scale (BPS), instead, is considered to be the gold standard for pain assessment in deeply sedated, mechanically ventilated adult patients. This observational pain scale requires shorter observation time compared to the COMFORT-B. Moreover, BPS three subscales are included in other observational pain scales for paediatric patients. Therefore, the objective of this study was to assess the applicability of the BPS for use with paediatric patients.

Methods: Firstly, a questionnaire was administered to physicians and nursing staff that work in the units where the study was conducted in order to investigate the actual use of observational pain scales in their units. A second questionnaire was administered to a group of experts regarding the BPS, to assess both face validity and content validity, and to gain opinions on the relative appropriateness of each item. A descriptive, comparative design was used. A convenience sample of non-verbal, sedated and mechanically ventilated critical care paediatric patients was included. 39 observations were collected from 9 patients, all in their first year of age. Patient pain was assessed concurrently with the three observational scales, before, during and after routine procedures that are considered painful and non-painful.

Results: The data collected through questionnaires for professionals gave a useful insight into pain assessment in the investigated units: only 46% of respondents stated that they assessed patients' pain levels, with an average of 2.8 times per shift; 60% of respondents declared to be unhappy with the observational scales that they utilise. Regarding the observations, internal consistency was α = .865. Correlations between BPS and the other instruments were high, demonstrating a good concurrent validity of the test. T test and ROC curves demonstrated a good discriminant validity as well.

Conclusions: Although the current study is based on a small sample of participants, these first results encourage us to continue working in the validation of the BPS in paediatric patients.
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http://dx.doi.org/10.23750/abm.v89i7-S.7945DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502142PMC
December 2018

Application of palliative care in demented patients: the caregivers' point of view.

Acta Biomed 2018 12 7;89(7-S):78-88. Epub 2018 Dec 7.

Università di Parma.

Background: The 38/2010 law has widened the supply of palliative care for patients with chronic and degenerative illness. Dementia is a chronic and debilitating illness and it requires specific, complex and constant assistance, involving the health professionals' community and family, and should also benefit from palliative care. But what do the caregivers of these patients think about it?

Aim: To explore the point of view of caregivers accompanying dementia patients regarding palliative care and the accompaniment of the medical team.

Method: A qualitative method with phenomenological approach: 29 semi-structured interviews have been submitted to caregivers of patients suffering from dementia. The interviews were submitted to analysis of thematic content.

Result: In the majority of cases the caregiver is a member of the family and holds this position because of the affective relationship he/she shares with the patient. They too live the illness of the relative as if it were theirs. The caregiver doesn't know about palliative care or has only heard of it, but is resistant to the application of this care, especially when its correct meaning and use are explained. At the same time, the health professionals'' role is important when it comes to taking decisions: caregivers rely completely on the team's competence and on their judgement.

Conclusion: A correct sharing of knowledge is fundamental. The healthcare professionals must be trained in palliative care in order to correctly inform caregivers and to avoid false beliefs about or resistance to the application of these useful pathways.
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http://dx.doi.org/10.23750/abm.v89i7-S.7895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502135PMC
December 2018

Foreword.

Acta Biomed 2018 12 7;89(7-S). Epub 2018 Dec 7.

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Foreword.
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http://dx.doi.org/10.23750/abm.v89i7-S.7959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502137PMC
December 2018

Expressive writing. A tool to help health workers of palliative care.

Acta Biomed 2018 07 18;89(6-S):35-42. Epub 2018 Jul 18.

Department of Medicine and Surgery, University of Parma, Italy.

Background And Aims: From a previous study (1) was highlighted that Expressive writing is an important strategy for preventing and managing the effects of compassion fatigue (2). It helps educate caregivers in recognising these feelings and providing them with a "space" and a time for their reflection. This, in turn, results in significant positive repercussions on the quality of service, reducing burnout risk, implementing coping strategies, and increasing perceived work satisfaction. Reflecting occasionally in writing about ambiguous and emotionally charged situations helps in many ways: it facilitates clarification and problem-solving, and makes one more spontaneous and present in social situations, more in tune with others and available to interact. People begin to interact differently with others and see themselves in a new light after writing about an emotional subject. The objective of thi study is ascertain and confirm the results of the previous study using a reduced methodological approach. Infact, the difference from the previous research is the use of only two expressive writing sessions.

Methods: A comparison was made between the expressive writing and neutral writing of two randomized groups of health care professionals of palliative care. They were evaluated pre- and post-intervention using several scales and an ad hoc questionnaire.

Results: After analyzing the texts, this study confirm  previous results, using only two sessions.
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http://dx.doi.org/10.23750/abm.v89i6-S.7452DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357597PMC
July 2018

Foreword.

Acta Biomed 2018 07 18;89(6-S). Epub 2018 Jul 18.

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http://dx.doi.org/10.23750/abm.v89i6-S.7486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357601PMC
July 2018