Publications by authors named "Paola Ferri"

84 Publications

Emotional impact of clinical practice in Burns Unit among nursing students: a qualitative study.

Acta Biomed 2021 03 31;92(S2):e2021008. Epub 2021 Mar 31.

Corso di Laurea in Infermieristica Università di Bologna - Faenza.

Background And Aim Of The Work: In Burns Units, the long professional relationship with patients suffering from intense physical pain and psychological distress, which cannot be completely resolved or minimized, exposes nurses to very intense emotions and stressful experiences. Learning to care for patients with such medical conditions can arouse many emotions also in nursing students, that can be both positive and negative. The goal of this study was to describe the emotional impact experienced by nursing students in a Italian Burns Unit.

Methods: A qualitative research was implemented among 16 undergraduate nursing students, before and after clinical practice in a Burns Unit, through a semi-structured interview.

Results: Strong and conflicting emotions from nursing students were reported in the preliminary stage of the internship. Their enthusiasm and curiosity for a new opportunity countered their fear and anxiety of not feeling able to deal with the clinical situation. The internship experience ranged from emotions of joy at the healing of patients to impotence and frustration at not being able to alleviate intense and lasting suffering. All students reported that the internship was experienced as an important opportunity for personal and professional growth.

Conclusions: In light of the results, we highlight that nurse trainers should support students to take full advantage of this training, helping them to express their emotions and, in the same time, to learn to manage them profitably.
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http://dx.doi.org/10.23750/abm.v92iS2.11411DOI Listing
March 2021

Nursing student attitudes toward dying patient care: A European multicenter cross-sectional study.

Acta Biomed 2021 03 31;92(S2):e2021018. Epub 2021 Mar 31.

Department of Medical Science, Udine University.

Background and aim of the work Nursing education plays a key role in preparing future nurses to deal with dying patients, which represents one of the most emotionally involving aspect of nursing. The aims of the study were to explore nursing students' attitudes towards care of dying patients in three different European contexts and to analyze the variables that can influence them. Methods We conducted an international multicenter cross-sectional study. We administered the Frommelt Attitude Toward Care of the Dying Scale form B (FATCOD-B) and a demographic form to 569 students, enrolled in the Nursing Programmes in three different countries (Italy, Spain and the United Kingdom), who accepted to participate in the study. The data were analyzed using SPSS software version 26.0. Results Median total FATCOD-B scores indicated intermediate levels of students' attitudes towards care for dying patients, with a statistically significant difference among the three student groups. The median total FATCOD-B scores did not statistically significantly change in students with different age, gender, year of study, religious believes, nursing education on palliative care, previous experiences of dying patient care and personal grieving. Conclusions In our study, nursing students feel partially prepared in caring for dying patients and their attitudes do not change as the course of study progresses. No selected variables had an impact on students' attitudes towards palliative care. Since nurses play a vital role in ensuring the quality of care, education on end-of-life care should be offered as a core part of undergraduate nursing programs.
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http://dx.doi.org/10.23750/abm.v92iS2.11403DOI Listing
March 2021

Urgent Psychiatric Consultations at Mental Health Center during COVID-19 Pandemic: Retrospective Observational Study.

Psychiatr Q 2021 Mar 26. Epub 2021 Mar 26.

Department of Biomedical, Metabolic and Neural Sciences, Via G. Campi, 287, 41125, Modena, Italy.

The coronavirus pandemic and related social distancing measures have brought about dramatic changes in people's lives. In particular, health workers have been forced to change their activities both for the different needs of patients and for preventive measures against the spread of the virus. This study is aimed at comparing the urgent psychiatric consultations (UPC) performed at the outpatient Mental Health Center (MHC) of Modena during the coronavirus outbreak period, from 1 March to 31 August 2020, with the same period in 2019. We retrospectively collected in a database the demographic and clinical characteristics of patients who required UPC in the MHC during the 6-month observation periods in both 2019 and 2020. Data were statistically analyzed. We analyzed 656 urgent psychiatric consultations in 2019 and 811 in 2020, requested by 425 patients in 2019 and 488 in 2020, respectively. In the pandemic period, we observed an increase in the total and daily number of UPC which were more frequently required by patients in care at local outpatient services in comparison with the previous period. During 2020, an increased number of UPC was carried out remotely and the outcome was more frequently represented by discharge at home, avoiding hospitalization as much as possible. In the course of the coronavirus pandemic, MHC had to face an increased demand for clinical activity especially from the most clinically and socially vulnerable patients, who more frequently required UPC in outpatient psychiatric services.
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http://dx.doi.org/10.1007/s11126-021-09907-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997653PMC
March 2021

Empathy and perceived burden in caregivers of patients with schizophrenia spectrum disorders.

BMC Health Serv Res 2021 Mar 19;21(1):250. Epub 2021 Mar 19.

Department of Biomedical, Metabolic and Neural Sciences, via Campi, 287, 41125, Modena, Italy.

Background: Caregivers of patients load different kinds of burdens, including emotional distress. Aims of this study were to evaluate both burden and empathy of caregivers who assist patients with schizophrenia spectrum disorders.

Methods: We selected a sample of 60 caregivers (34 women and 26 men), who assisted patients with schizophrenia spectrum disorders treated in our local Community Mental Health Center for a 1-year minimum period. We administered two scales to our sample, Zarit Burden Interview (ZBI) and Balanced Emotional Empathy Scale (BEES), and collected data of caregivers and their assisted patients in a 3-month period. Data were statistically analyzed.

Results: We reported a mean ZBI score of 49.68 (±15.03 SD) and a mean BEES score of 14.35 (±9.05 SD), indicating the perception of moderate-severe burden and low level of empathy, respectively. The analysis of internal consistency confirmed the good reliability of both ZBI (Cronbach's alpha = 0.90) and BEES (Cronbach's alpha = 0.77). The correlation between the two scales was not statistically significant at Spearman test. At our multiple linear regression, many variables of both caregiver and patient showed a significant correlation with the ZBI score. In particular, not living with the assisted patient and female gender of caregiver potentially decreased the burden, whereas clinical severity of assisted patient and two caregiver conditions, middle school education and spouse relationship with patient, could worsen the burden. We highlighted two positive statistically significant correlations between the total score of BEES and caregiver characteristics: being spouse and not living with assisted patient.

Conclusions: Our study highlights that the caregiver burden of patients with severe psychiatric disorders is high and is associated with low emotional empathy experienced by caregivers, probably due to a defensive psychological mechanism. The conditions of spouse and cohabitation can concomitantly increase both empathy and burden in caregivers.
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http://dx.doi.org/10.1186/s12913-021-06258-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7980555PMC
March 2021

The effectiveness of team-based learning in nursing education: A systematic review.

Nurse Educ Today 2021 Feb 11;97:104721. Epub 2020 Dec 11.

Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern, Manno, Switzerland; Clinical Expert in Nursing Research, Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland. Electronic address:

Aim: Team-Based Learning (TBL) is an active teaching methodology, recently implemented also in the field of nursing education. The main objective of this study was to identify, appraise and summarize primary studies on the effectiveness of TBL in achieving learning outcomes in undergraduate nursing students. The secondary objective was to explore the generic competencies the students developed, and their reactions and attitudes.

Study Design: A systematic review of experimental and quasi-experimental studies.

Databases Sources: Cochrane Library, Pubmed/Medline, Cinahl, PsycINFO, and Eric; Google Scholar was used to search for grey literature and the reference lists of the retrieved papers.

Review Methods: A research protocol was developed according to the PRISMA-P guidelines. Two reviewers conducted the selection process. The "JBI Critical Appraisal Checklist" was used to check the quality of the selected studies.

Results: We included 12 studies: 2 monocentric randomized controlled trials and 10 quasi-experimental studies. Nine out of 12 studies produced significant results in favour of TBL in terms of academic performance and skills development, however results were divergent when TBL was compared with other teaching methods. The results of 7 studies highlighted the effectiveness of TBL in improving the development of communication skills, interprofessional learning, and self-directed learning. Divergent results were obtained with regard to problem solving and critical thinking skills. TBL promoted classroom engagement, however it did not seem to be associated with better learning outcomes.

Conclusions: Overall, TBL was found to be effective in achieving undergraduate nursing students' learning outcomes, but evidence was not sufficiently strong to warrant that it is more effective than other teaching methods. The results of this review are in favour of the implementation of TBL in nursing education, however studies with more rigorous methods and with a mixed method design are required to improve the transferability of results.
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http://dx.doi.org/10.1016/j.nedt.2020.104721DOI Listing
February 2021

Perceptions of Caring Behavior Among Undergraduate Nursing Students: A Three-Cohort Observational Study.

Psychol Res Behav Manag 2020 24;13:1311-1322. Epub 2020 Dec 24.

Psychiatric Intensive Treatment Facility, Mental Health and Drug Abuse Department of AUSL-Modena, Modena 41122, Italy.

Introduction: Increase in the knowledge of "caring science" among nurses plays a key role in ensuring a correct caring behavior towards patients. Caring training for students is a priority in nursing education, but unfortunately there are limited and conflicting studies which explore this outcome. The purpose of this observational study was to explore the perceptions of caring behaviors by nursing students during their clinical practice training in order to highlight if the level of caring behaviors changes as the nursing course progresses.

Materials And Methods: The Caring Behaviors Inventory-24 (CBI-24) was administered to 331 students, enrolled in the three years of an Italian Nursing Course, who accepted to participate in the study (89.2% response rate). The data were analyzed using SPSS software version 26.0 (SPSS Inc., Chicago, IL).

Results: The total mean score of CBI-24 was 4.82 in the first, 5.12 in the second and 5.26 in the third-year students. The CBI-24 dimensions "Responding to individual needs" and "Being with" obtained the highest scores among the students of the first year. At the end of the first year, our students were already able to perform expressive caring, whereas instrumental caring developed at a high level in the second and third years. We did not highlight any statistically significant difference between the two gender CBI-24 item scores.

Conclusion: In light of our results, we put in evidence that Nursing Degree Programme favours the development in students of both relational and technical components of caring behaviors. We hope that in future students' self-assessment of caring behaviors could be considered an educational outcome for Nursing Programme.
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http://dx.doi.org/10.2147/PRBM.S279063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769154PMC
December 2020

Therapeutic Factors in a Psychiatric Group Therapy: a Preliminary Validation of Therapeutic Factors Inventory-8, Italian Version.

Psychiatr Q 2020 Aug 20. Epub 2020 Aug 20.

Psychiatric Intensive Treatment Facility, Department of Mental Health and Drug Abuse, AUSL Modena, 41122, Modena, Italy.

Several studies support group therapy effectiveness due to the activation in patients of unique psychological mechanisms defined as non-specific therapeutic factors (Therapeutic Factors-TFs), which shape the setting and, at the same time, enhance the specific group therapeutic factors. The objectives of this study were to preliminarly validate Therapeutic Factors Inventory-8 (TFI-8) Italian version and identify group therapeutic factors. In a psychiatric residential facility, a weekly psychotherapeutic group was evaluated during 1 year. One scale on group process (TFI-8, Ferrara-Group Experience Scale) and three clinical scales (Brief Symptom Inventory-53, Sheehan Disability Scale, WHO Quality of Life-Bref) were administered to participating patients. Internal consistency, Exploratory Factor Analysis (EFA), convergent validity of TFI-8 were assessed. Correlations between TFI-8 and other scale scores and selected variables were pwerformed. Our sample consisted of 64 participants. TFI-8 showed good internal consistency (Chronbach's alpha = 0.84), concurrent validity with Fe-GES (Rho = 0.42, p = 0.0008). EFA highlighted a single Factor, accounting for 92% of variance. TFI-8 was not significantly related to clinical scale scores. TFI-8 Italian version proved to be a valid and reliable tool which allowed us to identify one therapeutic factor indicating relational attraction in group therapy, composed of three dimensions: infusion of hope, cohesion and social learning.
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http://dx.doi.org/10.1007/s11126-020-09834-2DOI Listing
August 2020

Predicting needlestick and sharps injuries in nursing students: Development of the SNNIP scale.

Nurs Open 2020 09 28;7(5):1578-1587. Epub 2020 Jun 28.

Department of Health Sciences University of Genoa Genoa Italy.

Aim: To develop an instrument to investigate knowledge and predictive factors of needlestick and sharps injuries (NSIs) in nursing students during clinical placements.

Design: Instrument development and cross-sectional study for psychometric testing.

Methods: A self-administered instrument including demographic data, injury epidemiology and predictive factors of NSIs was developed between October 2018-January 2019. Content validity was assessed by a panel of experts. The instrument's factor structure and discriminant validity were explored using principal components analysis. The STROBE guidelines were followed.

Results: Evidence of content validity was found (S-CVI 0.75; I-CVI 0.50-1.00). A three-factor structure was shown by exploratory factor analysis. Of the 238 participants, 39% had been injured at least once, of which 67.3% in the second year. Higher perceptions of "personal exposure" (4.06, 3.78) were reported by third-year students. Higher scores for "perceived benefits" of preventive behaviours (13.6, 1.46) were reported by second-year students.
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http://dx.doi.org/10.1002/nop2.540DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7424443PMC
September 2020

Attitude Towards Drug Therapy in a Community Mental Health Center Evaluated by the Drug Attitude Inventory.

Patient Prefer Adherence 2020 17;14:995-1010. Epub 2020 Jun 17.

Nursing, Department of Biomedical, Metabolic and Neural Sciences, Public Health Section, Modena, 41125, Italy.

Introduction: Negative attitude towards drug therapy can foster limited adherence to treatment, which remains one of the biggest obstacles for implementing effective treatments, especially long term.

Purposes: The purposes of the study were 1) to evaluate the attitude towards drug therapy among a representative sample of patients treated in a community psychiatric service using 30-item Drug Attitude Inventory (DAI-30); 2) to evaluate the DAI-30 dimensions, applying factorial analysis; and 3) to highlight the socio-demographic and clinical variables correlated to DAI-30 score and factors.

Methods: The DAI was administered, over a 7-month period, to all patients treated in our psychiatric outpatient services who agreed to participate in this study and provided their informed consent. Data were statistically analyzed.

Results: With a response rate of 63.3%, 164 females and 136 males completed the DAI-30 with an average score of 14.24 (±10.46 SD), indicating moderately positive attitude towards drug therapy. The analysis of DAI-30 internal consistency confirmed its reliability (Cronbach's alpha=0.84). Our factorial analysis highlighted three factors: Factor 1 (Cronbach's alpha=0.81), composed of 7 items which indicate positive, trustful attitude; Factor 2 (Cronbach's alpha=0.78), composed of 5 items indicating negative attitude of suspiciousness; and Factor 3 (Cronbach's alpha=0.66), composed of 4 items suggesting defensive and control attitude towards drug therapy.

Discussion: Among the selected variables, "monotherapy" and "total number of hospitalizations" were negatively correlated to the final score of DAI-30, whereas being "married" was positively correlated to it, in a statistically significant way, using the multiple linear regression model. These correlations suggest that positive attitude towards drug therapy could be reinforced by the condition of being married and reduced by relapses with hospitalization, as literature highlighted, and, paradoxically, by a monotherapy, which could suggest a sort of psychological dependence on therapy and, indirectly, on psychiatric service, potentially correlated to the long-term treatments of our patients.
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http://dx.doi.org/10.2147/PPA.S251993DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7307441PMC
June 2020

Online Education for Vaccination Competence Among Health Sciences Students.

Stud Health Technol Inform 2020 Jun;272:267-271

Department of Public and Community Health, Laboratory of Hygiene and Epidemiology, School of Public Health, University of West Attica, Athens, Greece.

The EDUVAC project aims to develop and implement a web-based course on educating vaccination competence among health sciences students. In the current study students' feedback and evaluation is assessed which guided the partners' efforts to improve the final course content and learning material that will be available for open access. After completing the web-based course, most of the students (N=103, 75.1%) perceived their vaccination knowledge was up to date and their overall participating experience was "above average or excellent (N=119, 86.9%). While, almost all of the students (N=127, 92.7%) found that the web-based course has benefitted them and their future career. Our findings support that the web-based courses can provide satisfactory learning experience to University students and offer flexibility when needed especially in times that remote education is the only option.
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http://dx.doi.org/10.3233/SHTI200546DOI Listing
June 2020

Effectiveness of a video lesson for the correct use in an emergency of the automated external defibrillator (AED).

Acta Biomed 2020 06 20;91(6-S):71-78. Epub 2020 Jun 20.

School of Nursing, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.

Background And Aim Of The Work: Every year around 275 thousand people in Europe and 420 thousand in the United States are affected by sudden cardiac arrest. Early electrical defibrillation before the arrival of emergency services can improve survival. Training the population to use the AED is essential. The training method currently in use is the BLSD course, which limits training to a population cohort and may not be enough to meet the requirements of the proposed Law no. 1839/2019. This study aims to verify the effectiveness of an online course that illustrates the practical use of the AED to a population of laypeople.

Methods: An observational study was conducted to compare a lay population undergoing the view of a video spot and a cohort of people who had participated in BLSD Category A courses. The performances of the two groups were measured immediately after the course and 6 months later.

Results: Overall, the video lesson reported positive results. Six months later the skills were partially retained. The cohort that followed the video lesson showed significant deterioration in the ability to correctly position the pads and in safety.

Conclusions: Although improved through significant reinforcements, the video spot represents a valid alternative training method for spreading defibrillation with public access and could facilitate the culture of defibrillation as required by the new Italian law proposal.
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http://dx.doi.org/10.23750/abm.v91i6-S.9589DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7975845PMC
June 2020

Nurses' interventions to promote cancer patient engagement and related outcomes: a systematic review and meta-analysis protocol.

Acta Biomed 2020 06 20;91(6-S):65-70. Epub 2020 Jun 20.

EngageMinds HUB - Consumer, Food and Health Engagement Research Center. Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy..

Background And Aim Of The Work: Due to the ageing of cancer patients, new approaches that require a more active participation in the self-management of cancer treatment at home are needed. Nurses are strategic in improving the patient's engagement capability in this regard. Knowing which interventions are more effective for the promotion of patient engagement could be useful to improve the effectiveness of the care provided. Therefore, this study aims to systematically review nursing interventions or programs that promote patient engagement in oncological nursing care and summarizing the main evidence related to their impact on relevant clinical and psychosocial outcomes.

Method: This is a systematic review and meta-analysis protocol based on Cochrane Handbook for the systematic review of interventions. We will search the most important electronic databases (PUBMED, CINAHL, EMBASE, SCOPUS, ISI Web of Science, Cochrane library) to find out which patient engagement interventions (active adult patient involvement) are implemented in oncological settings and understand what is the effectiveness of these interventions on the outcomes reported in the literature. The GRADE methodology will be used to synthetize the evidence. If possible, also a meta-analysis will be performed. We registered the study protocol on the PROSPERO database (N° CRD42020146189).

Discussion And Conclusion: To our knowledge, this is the first systematic review to address this clinical question in the field of oncology. This review will offer health professionals indications on the most frequently adopted patient engagement interventions and verify their clinical effectiveness. Furthermore, any gaps in the scientific literature will be highlighted.
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http://dx.doi.org/10.23750/abm.v91i6-S.9658DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7975835PMC
June 2020

Retrospective Analysis of Factors Associated with Long-Stay Hospitalizations in an Acute Psychiatric Ward.

Risk Manag Healthc Policy 2020 19;13:433-442. Epub 2020 May 19.

Nursing, Department of Biomedical, Metabolic and Neural Sciences, Modena 41125, Italy.

Purpose: To evaluate the longest hospitalizations in an acute psychiatric ward [Service of Psychiatric Diagnosis and Treatment (SPDT)] and the related demographic, clinical and organizational variables to understand the factors that contribute to long-stay (LOS) phenomenon. The term "long stay" indicates clinical, social and organizational problems responsible for delayed discharges. In psychiatry, clinical severity, social dysfunction and/or health-care system organization appear relevant factors in prolonging stays.

Patients And Methods: We divided all the SPDT hospitalizations from 1 January 2010 to 31 December 2015 into two groups based on the 97.5 percentile of duration: ≤36 day (n=3254) and >36 day (n=81) stays, in order to compare the two groups for the selected variables. Comparisons were made using Pearson's chi-square for categorical data and -test for continuous variables, the correlation between the LOS, as a dependent variable, and the selected variables was analyzed in stepwise multiple linear regression and in multiple logistic regression models.

Results: The longest hospitalizations were significantly related to the diagnosis of "schizophrenia and other psychosis" (Pearson Chi=17.24; p=0.045), the presence of moderate and severe aggressiveness (Pearson chi=29; p=0.000), compulsory treatment (Pearson Chi=8.05; p=0.005), parenteral or other route administration of psycho-pharmacotherapy (Pearson Chi=12.91; p=0.007), poli-therapy (Pearson Chi=6.40; p=0.041), complex psychiatric activities (Pearson Chi=12.26; p=0.002) and rehabilitative programs (Pearson Chi=37.05; p=0.000) during the hospitalization and at discharge (Pearson Chi=29.89; p=0.000). Many demographic and clinical variables were statistically significantly correlated to the LOS at our multiple linear and logistic regression model.

Conclusion: In our sample, clinical illness severity and need for complex therapeutic and rehabilitative treatments were associated with prolonged psychiatric hospitalizations. Understanding this phenomenon can have not only economic but also clinical, ethical and social relevance.
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http://dx.doi.org/10.2147/RMHP.S238741DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245472PMC
May 2020

Violence Against Nurses in the Triage Area: A Mixed-Methods Study.

J Emerg Nurs 2020 May;46(3):384-397

Introduction: Workplace violence is a serious occupational problem among nurses in emergency departments. The aim of this study was to better understand workplace violence experienced by triage nurses.

Methods: A mixed-methods study was carried out with 27 Italian nurses involved in the triage area of an emergency department. Quantitative data were collected using the Violent Incident Form and qualitative data were obtained from 3 focus groups.

Results: Ninety-six percent of triage nurses had suffered an episode of violence during the previous year. Participants reported that perpetrators of violence were primarily patients' relatives or friends (62%), usually male and in a lucid state of consciousness. The aggressor was a male patient in 31% of violent episodes. Male nurses reported only verbal abuse, unlike female nurses who suffered both physical and verbal episodes. Females received assistance from other staff during the aggression event more frequently than males, and females more frequently suffered from physical injury. Only physical and verbal aggressions were associated with physical injury. Four main themes emerged from the focus groups.

Discussion: Nurses reported that high exposure to workplace violence in triaging had significant consequences on their psychological well-being and on their behavior at work and at home. Violence, perceived as a personal and/or professional injury owing to insufficient organizational support, led professionals to experience feelings of resignation and to believe that abuse was an inevitable part of the job. Nevertheless, in our study, the precipitating factors were investigated, suggesting several possible solutions to limit this phenomenon.
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http://dx.doi.org/10.1016/j.jen.2020.02.013DOI Listing
May 2020

Evaluation of empathy among undergraduate nursing students: a three-year longitudinal study.

Acta Biomed 2019 11 11;90(11-S):98-107. Epub 2019 Nov 11.

.

Background And Aim: An empathic approach is considered fundamental in order to ensure the identification of patient needs and to provide the appropriate care, although the studies on the development of empathic attitude during nursing course reported conflicting results. Different empathic tendencies have been observed in the two genders: many studies showed greater empathy in females.

Methods: To assess empathy level of students enrolled in the academic year 2015/16 at an Italian University nursing course, the Balanced Emotional Empathy Scale (BEES) was administered at the start of Year 1 (n=118), at the mid-point of Year 2 (n=99) and at the end of Year 3 (n=67). Data were statistically analyzed.

Results: Cronbach's values were satisfactory (0.87 at Year 1, 0.89 at Year 2, 0.79 at Year 3), confirming the good internal reliability of BEES. The nursing students obtained a total BEES mean ± SD score of 37.0 ± 19.5 at Year 1, 33.5 ± 22.6 at Year 2 and 35.4 ± 16 at Year 3, without any statistically significant difference among the three years. The BEES mean scores reported by males were lower in comparison with females during the three years of the course, although, at the end of the third year, males showed a significant increase at the "Emotional spread responsiveness" dimension of the scale.

Conclusions: The study suggests that empathy can be maintained at good levels during the nursing education especially if nursing teaching and internship are focused on this topic, acting up the innate aptitude of each student.
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http://dx.doi.org/10.23750/abm.v90i11-S.8874DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233630PMC
November 2019

Early death in Munchausen syndrome: A case report.

Clin Case Rep 2019 Aug 20;7(8):1473-1477. Epub 2019 Jun 20.

Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia Modena Italy.

This case contributes to raising awareness and understanding of the complex clinical presentations of Munchausen syndrome (MS). Education of staff to the seriousness and genuineness of this disorder should be implemented, especially in hospital units, in order to detect such complex clinical situations quickly and accurately, preventing iatrogenic risks.
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http://dx.doi.org/10.1002/ccr3.2254DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6692973PMC
August 2019

Effect of expert-patient teaching on empathy in nursing students: a randomized controlled trial.

Psychol Res Behav Manag 2019 27;12:457-467. Epub 2019 Jun 27.

Psychiatric Intensive Treatment Facility, Department of Mental Health and Drug Abuse, AUSL Modena, Modena 41122, Italy.

Empathy is a relevant clinical competence for nursing students. Involvement of expert patients in nursing education could help students develop their innate capacity to empathize. To evaluate the effect of expert-patient teaching on empathy development in nursing students. This randomized controlled trial was conducted among 144 first-year undergraduate nursing students divided into two equal groups. In the experimental group, the educational intervention consisted of a seminar focused on empathy, followed by a presentation on expert-patient function. Subsequently, each student participated in two interactive meetings with nursing teacher and expert patient. At the end, the nursing teacher encouraged students to reflect on this experience. In the control group, students only attended a similar seminar focused on empathy and afterward participated in two interactive meetings with a nursing teacher to reflect on this topic without expert-patient involvement. Before (T0) and after (T1) the training intervention, the Balanced Emotional Empathy Scale, Jefferson Scale of Empathy - Health Professions Student (JSE-HPS), and a short demographic questionnaire were administered to the two student groups to measure their empathy levels. The study was approved by the Local Ethics Committee of Area Vasta Emilia Nord (protocol 1763, May 11, 2017). Data were statistically analyzed. We found a statistically significant difference between mean scores at T0 and T1 in both scales in the experimental group. Male students, who presented significantly lower levels of empathy at baseline in comparison with females, showed increased in empathy after training on the the Balanced Emotional Empathy Scale in both the experimental and control groups. The present study highlights that involvement of expert patients in teaching is effective in improving empathy levels in both male and female nursing students. Expert-patient teaching can be a promising nursing-education modality for developing empathy.
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http://dx.doi.org/10.2147/PRBM.S208427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602298PMC
June 2019

The narrative interview for the assessment of the assisted person: structure, method and data analysis.

Acta Biomed 2019 07 8;90(6-S):7-16. Epub 2019 Jul 8.

Azienda USL-IRCCS of Reggio Emilia, Italy.

Background And Aim: If it is true that the impact of the symptoms of the disease is differently perceived by each person and that there is an incommunicability of the experiences of suffering, it is equally true that the narration provides an understandable representation, which derives from the network of representations that are part of a personal history.  The aim of this study was to offer an in-depth analysis of the "narrative interview" collected during the assessment of a 74 years old diabetic woman.

Methods: A case study was conducted by a nurse with advanced expertise in conducting narrative interview. Content analysis and Meaning analysis were performed using a Grounded theory approach and according with Gee's Poetic Method.

Results: The patient after the diagnosis felt disbelief, anger and confusion. The illness forces her to change her life, habits and social role, with high suffering. However she adjusted to this new condition and thanks to her strong and positive attitude and the social support she received, she has succeeded in activating her "post traumatic growth".

Conclusions: A good narrative interview starts long before the interview itself and it requires: a specific training in the use of the instrument; the strengthening of specific skills (e.g. the active listening); the choice of optimal setting and timing for the patient; the ability to offer encouragement in the expression of the subjective experience and to conduct an analysis of the patient's words with a subjective lens, reflecting the uniqueness of each illness experience.
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http://dx.doi.org/10.23750/abm.v90i6-S.8640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6776180PMC
July 2019

Emotional intelligence, empathy and alexithymia: a cross-sectional survey on emotional competence in a group of nursing students.

Acta Biomed 2019 03 28;90(4-S):32-43. Epub 2019 Mar 28.

Az. USL Modena.

Background: Emotional intelligence (EI) is the ability to recognize and manage one's own and others' emotions, empathy is the ability to understand how others feel, whereas alexithymia represents the difficulty in feeling and verbally expressing emotions.  Emotional competences are important requirements for positive outcomes in nursing profession.

The Aim Of The Study: To analyze EI, empathy and alexithymia in nursing students.

Methods: We conducted a cross-sectional survey in a sample of 237 students (53 males, 184 females), attending both the 1st and 3rd year of the University Nursing Course in Modena. We administered three Italian validated scales: Schutte Self-Report Emotional Intelligence Test (SSEIT), Jefferson Scale of Empathy - Health Professions Student (JSE-HPS), Toronto Alexithymia Scale (TAS-20). Data were statistically analyzed.

Results: Statistically significant differences were found between the 1st and 3rd year students at SSEIT (t=-0.6, p=0.52), JSE-HPS (t=-3.2, p=0.0016) and TAS-20 scores (t=-3.54, p=0.0005). Among 3rd year students, females obtained significantly different scores from those of males at SSEIT (t=2.8, p=0.006). All three scales reported a Cronbach's alpha >0.80. SSEIT correlated positively with JSE-HPS (Spearman's rho=0.15, p=0.02) and negatively with TAS-20 (Spearman's rho=-0.18, p=0.006).

Conclusions: Our study highlighted a good level of emotional skills among students at the beginning of nursing training, further increased by the last year of the course, suggesting that emotional competences can be learned, and confirmed that empathy, but not alexithymia, is a dimension of EI.
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http://dx.doi.org/10.23750/abm.v90i4-S.8273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625563PMC
March 2019

Effectiveness of 1-year treatment with long-acting formulation of aripiprazole, haloperidol, or paliperidone in patients with schizophrenia: retrospective study in a real-world clinical setting.

Neuropsychiatr Dis Treat 2019 7;15:183-198. Epub 2019 Jan 7.

Private Accredited Psychiatric Hospital, Villa Igea, Modena, Italy.

Background: Schizophrenia is a chronic mental illness that requires lifelong antipsychotic treatment. Therapy discontinuation, often due to poor adherence, increases the risk of relapses after both first and subsequent psychotic episodes. Long-acting injectable (LAI) antipsychotic drugs (APDs) have been introduced to increase therapeutic adherence, reducing blood-level variability compared to corresponding oral preparations.

Purpose: To compare the effectiveness of three LAI-APDs: aripiprazole (Apr) prolonged release once monthly (OM) haloperidol decanoate (Hal-D) and paliperidone palmitate (PP-OM).

Methods: We retrospectively collected data for all patients with schizophrenia or other psychoses (n=217) treated with the three LAI-APDs for the first time from January 1, 2012 to October 31, 2016: n=48 with Apr-OM, n=55 with Hal-D, and n=114 with PP-OM. After 6 and 12 months of LAI treatments, we assessed clinical and functioning improvement, urgent consultations, psychiatric hospitalizations, adverse effects, and dropout. We compared urgent consultations and psychiatric hospitalizations required by the same patient 6 and 12 months before and after LAI implementation. Data were statistically analyzed.

Results: The three LAI groups differed significantly only for "need for economic support from social service" (more frequent in the Hal-D group) and "schizoaffective disorder" (prevalent in the Apr-OM group). Apr-OM was prescribed at the maximum dose required by the official guidelines, whereas the other two LAIs were prescribed at lower doses. After 6 and 12 months' treatment with the three LAI-APDs, we registered similar and significant reductions in both urgent consultations and psychiatric hospitalizations (<0.001) and overlapping clinical and functioning improvement-scale scores (<0.001), and 14.28% of patients dropped out, with no difference among the three LAI-APDs. Different kinds of adverse effects, though similar for number and severity, were reported in the three LAI groups.

Conclusion: Our results suggest that both first- and second-generation LAI-APDs represent important therapeutic options, useful for improving schizophrenia's clinical course and its economic burden. Our study, which offers a wide and comprehensive observation of real-world clinical settings, combined an effectiveness evaluation through mirror analysis performed for each individual patient to a subsequent comparison among the three LAI-APDs, allowing us a more complete evaluation of clinical efficacy.
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http://dx.doi.org/10.2147/NDT.S189245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6328290PMC
January 2019

Nursing activity measurement for intensive care unit patients with specific conditions - An area of further investigation.

Intensive Crit Care Nurs 2019 04 20;51:83-84. Epub 2018 Dec 20.

Anesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy.

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http://dx.doi.org/10.1016/j.iccn.2018.11.003DOI Listing
April 2019

The efficacy of interprofessional simulation in improving collaborative attitude between nursing students and residents in medicine. A study protocol for a randomised controlled trial.

Acta Biomed 2018 12 7;89(7-S):32-40. Epub 2018 Dec 7.

.

Background: Effective collaboration among health professionals is an essential component to ensure quality of care. Many adverse events experienced by patients are attributed to misunderstanding or poor communication among members of the interprofessional team. Interprofessional simulation is a learning strategy used to improve collaboration and facilitate communication between medical and nursing students.

Aim Of The Work: To determine the efficacy of educational program based on high-fidelity interprofessional simulation aimed at improving collaborative attitude.

Method: For this purpose, a protocol for a planned single-center, non-blinded and Randomized Controlled Trial (RCT) was chosen. The present has been approved by the Ethics Committee of Area Vasta Emilia Nord (Italy) (n° 479/2018). All students attending the second and third year of nursing and all resident physicians in anesthesia, reanimation, intensive care and pain management of University of Modena and Reggio Emilia, will be recruited and randomly assigned to two groups. The Experimental Group (EG) will receive an educational intervention based on high-fidelity simulation and the Control Group (CG) will attend a traditional classroom lesson. Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (JSAPNC) and Readiness for Interprofessional Learning Scale (RIPLS) will be administered before and after the educational program in both the EG and CG.

Conclusion: Expected outcomes is that, at the end of the study, nursing students and resident physicians who participated in the interprofessional simulation show significantly higher levels of interprofessional collaboration compared to the CG, evaluated through the JSAPNC.
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http://dx.doi.org/10.23750/abm.v89i7-S.7875DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502140PMC
December 2018

Factors Associated with Long-Stays in an Italian Psychiatric Intensive Treatment Facility: 1-Year Retrospective Observational Analysis.

Psychiatr Q 2019 03;90(1):185-196

Section of Clinical Neuroscience, Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124, Modena, Italy.

Psychiatric Intensive Treatment Facilities (PITF) are health inpatient settings for patients affected by sub-acute psychiatric disorders with impaired personal and social functioning. The aim of this study is to analyse the demographic and clinical variables related to long-stays in an Italian PITF in order to highlight the risk factors for stay lengthening. We retrospectively collected the selected variables from all patients and their stays in a PITF from 1 to 11-2016 to 31-10-2017. We divided the stays according to the median of duration, ≤29 and > 29 days, to compare selected variables in the two groups of stay length. Patients hospitalized for >29 days more frequently presented "Self-neglect", nursing diagnosis NANDA-I, and needed economic social service support. Multiple linear regression revealed that the presence of some variables as "many medical consultations", "economic social service support", "clinical interviews extended to institutional figures" were statistically significantly associated with an increased stay duration, suggesting that both clinical severity and difficult economic conditions were associated with the lengthening of stay. The knowledge of these factors can contribute to improve psychiatric treatments, reducing potential risk conditions for patient institutional dependence.
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http://dx.doi.org/10.1007/s11126-018-9616-1DOI Listing
March 2019

Demographic and clinical characteristics of patients involuntarily hospitalized in an Italian psychiatric ward: a 1-year retrospective analysis.

Acta Biomed 2018 07 18;89(6-S):17-28. Epub 2018 Jul 18.

Az. USL Modena.

Background: In Italy, psychiatric compulsory treatments are regulated by Law 180 of 13-5-1978 that establishes three criteria: 1) acute psychiatric conditions requiring urgent treatment, 2) patient's refusal of treatment, 3) inpatient treatment is necessary and cannot be postponed.

Aim: To highlight demographic and clinical risk factors for involuntary treatments.

Methods: We retrospectively collected all hospitalizations in the Service of Psychiatric Diagnosis and Treatment of a northern Italian town from 1-1-2015 to 31-12-2015. We statistically compared demographic and clinical variables related to voluntarily and involuntarily admitted patients and their hospitalizations.

Results: We divided our sample into patients voluntarily hospitalized (PVH=236) and involuntarily (PIH=160) according to their voluntary (VH= 304) and involuntary (IH=197) hospitalizations. PIH were older than PVH and, more frequently, lived alone and were unemployed (p<0.001). "Acute worsening of psychopathology" for IH and "Suicidality" for VH were the prevalent reasons (p<0.001). IH was longer than VH (p<0.001). Among PIH, the most frequent diagnoses were "Schizophrenia and Other Psychosis" (ICD-9-CM) and "Ineffective Impulse Control + Disturbed Personal Identity" (NANDA-I) (p<0.001). During hospitalizations, PIH more often than PVH presented aggressive behavior (p<0.001). At discharge, PIH were more frequently sent to another psychiatric ward or protected facility with long-acting injectable antipsychotics (p<0.001).

Conclusions: Our involuntarily admitted patients were affected by severe psychiatric disorders with social maladjustment and required complex therapeutic and rehabilitative programs to counteract aggressive behaviour, poor therapeutic compliance and prolonged hospitalizations. The assessment of patients' characteristics can help clinicians recognize who are at risk for compulsory treatment and prevent it.
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http://dx.doi.org/10.23750/abm.v89i6-S.7392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357598PMC
July 2018

Efficacy of the Buzzy System for pain relief during venipuncture in children: a randomized controlled trial.

Acta Biomed 2018 07 18;89(6-S):6-16. Epub 2018 Jul 18.

General Medical Ward, ASST Monza-San Gerardo, San Gerardo Hospital, Italy..

Background And Aim Of The Work: procedural pain is a significant issue for paediatric patients. In particular, needle pain is amongst the most stressful for children. Studies revealed that a large number of children do not receive adequate pain prevention during the procedures. Neglecting the prevention of needle pain can cause several psychological effects such as anxiety and phobias, and increase perceptions of pain in the future. We aimed to verify the efficacy of Buzzy System in reducing pain during venipuncture.

Methods: A randomized control trial was conducted among 72 children aged 3 to 10 years undergoing venipuncture. Children were randomly assigned to The Buzzy with distraction cards group (experimental group) or to "magic gloves" group (control group). Perception of pain was measured through the Visual Analogue Scale (VAS), the Wong-Baker Scale (WBS) and the Numeric Rating Scale (NRS).

Results: Sixty-four children participated in the study, 34 in the experimental group and 30 in the control group. The experimental group showed significantly lower levels of pain (p=.039; 95% CI: -2,11; -0,06) in terms of the mean=3.65±2.011; median=3, compared to the control group (mean: 4.67±2.14, median=4). Caregivers were satisfied with the Buzzy System.

Conclusion: The Buzzy System combined to distraction cards showed a greater reduction of perceived pain than "magic glove" technique. This study underlines the importance of active involvement of caregivers during procedural pain in children. Pediatric nurses have an important role in empowering children and caregivers to be interactive during venipunctures.
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http://dx.doi.org/10.23750/abm.v89i6-S.7378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357594PMC
July 2018

Distraction Technique for pain reduction in Peripheral Venous Catheterization: randomized, controlled trial.

Acta Biomed 2018 02 21;89(4-S):55-63. Epub 2018 Feb 21.

Oncology Institute of Southern Switzerland, Nursing research and development unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland..

Background And Aim Of The Work: Procedural pain during Peripheral Venous Catheterization (PVC) is a significant issue for patients. Reducing procedure-induced pain improves the quality of care and reduces patient discomfort. We aimed to compare a non-pharmacological technique (distraction) to anaesthetic cream (EMLA) for the reduction of procedural pain during PVC, in patients undergoing Computerized Tomography (CT) or Nuclear Magnetic Resonance (NMR) with contrast.

Methods: This is a Prospective, Randomized Controlled Trial. The study was carried out during the month of October 2015. A total of 72 patients undergoing PVC were randomly assigned to the experimental group (distraction technique, n=36) or control group (EMLA, n=36). After PVC, pain was evaluated by means of the numeric pain-rating scale (NRS). Pain perception was compared by means of Mann-Whitney Test.

Results: The average pain in the distraction group was 0.69 (SD±1.26), with a median value of 0. The average pain in the EMLA group was 1.86 (SD±1.73), with a median value of 2. The study showed a significant improvement from the distraction technique (U=347, p<.001, r=.42) with respect to the local anaesthetic in reducing pain perception. Conclusions/Implication for practice: Distraction is more effective than local anaesthetic in reducing of pain-perception during PVC insertion. This study is one of few comparing the distraction technique to an anaesthetic. It confirms that the practitioner-patient relationship is an important point in nursing assistance, allowing the establishment of trust with the patient and increasing compliance during the treatment process.
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http://dx.doi.org/10.23750/abm.v89i4-S.7115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357630PMC
February 2018

A randomized comparison trial of two and four-step approaches to teaching Cardio-Pulmonary Reanimation.

Acta Biomed 2018 02 23;89(4-S):37-44. Epub 2018 Feb 23.

School of Nursing, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.

Background And Aim Of The Work: The treatment of cardiac arrest in an extra-hospital environment improves with the increase in the number of people able to establish an early Cardio-Pulmonary Reanimation (CPR). The main aim of the study was to assess the validity of the two-step method in case of prolonged CPR.

Methods: A randomized comparison study was conducted in the University Nursing School of a Northern Italian town, during the 2015/16 academic year, among 60 students, to teach them CPR techniques, through two different teaching methods (4-step and the 2-step of CPR training). The effectiveness of the maneuvers performed on mannequins equipped with skill-meter was verified.

Results: Our study did not highlight any significant difference between the two methods of CPR training. The comparison between the two methods regarding their efficacy in practical teaching of CPR, highlighted by this study, proved the validity of both the 4-minute continuous method (1st method) and the 30:2 method (2nd method).

Conclusions: The results of the study showed no differences between the 2-step and the 4-step methods, in the effectiveness of cardiac massage. The correct execution of chest compressions during a CPR is the key to increase the patient's chances of rescue. Research has shown that any interruption in the execution of chest compressions, leads to a progressive reduction of the effectiveness of cardiac massage, with negative consequences on the prognosis of the patient undergoing at CPR.
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http://dx.doi.org/10.23750/abm.v89i4-S.7129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357629PMC
February 2018

Evaluation of fatigue in patients with pancreatic cancer receiving chemotherapy treatment: a cross-sectional observational study.

Acta Biomed 2018 02 27;89(4-S):18-27. Epub 2018 Feb 27.

University of Modena and Reggio Emilia.

Background And Aim Of The Work: Cancer-related fatigue (CRF) is one of the most common symptoms experienced by cancer patients (CPs) and negatively affects quality of life. Although CRF is frequently experienced, it is often underreported, underdiagnosed and undertreated. The objectives of this study were to evaluate the level of fatigue in patients with pancreatic cancer undergoing chemotherapy and to analyse its correlation with patients' demographic and clinical variables.

Methods: A cross-sectional observational study was implemented in the Oncology Day Hospital of a Northern Italian hospital. A sample of 48 patients receiving chemotherapy were evaluated through the Brief Fatigue Inventory Italian version (BFI-I) between 1 May and 12 October 2016. Data were statistically analysed.

Results: Most of our patients (94%) experienced fatigue. Women as well as patients with an age ≥65 years reported more fatigue. Anemia, pain and a weight loss of over 16 kg in the last 6 months were significantly related to the perception of fatigue. Regarding life habits, smoking was related to high global score of BFI-I.

Conclusions: In accordance with literature, our study suggests that fatigue is a frequent symptom influenced by many constitutional, clinical and environmental factors. Our results highlight the need for an early and regular evaluation of fatigue among cancer patients, in order to implement all those pharmacological and non-pharmacological interventions with proven efficacy in attenuating this symptom.
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http://dx.doi.org/10.23750/abm.v89i4-S.7063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357627PMC
February 2018

Psychometric properties of the Patient Dignity Inventory in an acute psychiatric ward: an extension study of the preliminary validation.

Neuropsychiatr Dis Treat 2018 29;14:903-913. Epub 2018 Mar 29.

Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada.

Background: During the last decades, dignity has been an emerging issue in mental health since its ethical and therapeutic implications became known. This study is an extension of the preliminary validation of the Patient Dignity Inventory (PDI) in a psychiatric setting, originally designed for assessing perceived dignity in terminal cancer patients.

Methods: From October 21, 2015 to December 31, 2016, we administered the Italian PDI to all patients hospitalized in an acute psychiatric ward, who provided their consent and completed it at discharge (n=165). We performed Cronbach's alpha coefficient and principal factor analysis. We administered other scales concomitantly to analyze the concurrent validity of PDI. We applied stepwise multiple linear regression to identify the patients' demographic and clinical variables related to the PDI score.

Results: Our response rate was 93%, with excellent internal consistency (Cronbach's alpha coefficient=0.94). The factorial analysis showed three factors with eigenvalue >1, which explained >80% of total variance: 1) "loss of self-identity and anxiety for the future", 2) "concerns for social dignity and spiritual life", and 3) "loss of personal autonomy". The PDI and the three factor scores were positively and significantly correlated with the Hamilton Scales for Depression and Anxiety but not with other scale scores. Among patients' variables, "suicide risk" and "insufficient social and economic condition" were positively and significantly correlated with the PDI total score.

Conclusion: The PDI can be a reliable tool to assess patients' dignity perception in a psychiatric setting, which suggests that both social and clinical severe conditions are closely related to dignity loss.
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http://dx.doi.org/10.2147/NDT.S153902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5880412PMC
March 2018

The burden of not-weighted factors - Nursing workload in a medical Intensive Care Unit.

Intensive Crit Care Nurs 2018 Aug 2;47:98-101. Epub 2018 Apr 2.

Anesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy. Electronic address:

Objectives: Body weight and infection status affect nursing workload and are not accounted for in the Therapeutic Intervention Scoring System 28 (TISS-28) and Nine Equivalents of Nursing Manpower Use Score (NEMS). The objective of this study was to analyse the correlation between weight and infection status with TISS 28 and NEMS in a cohort of medical Intensive Care Unit patients.

Research Methodology: A retrospective observational trial was conducted on the nursing records of 26 randomly selected patients over a 12-month period. TISS-28 and NEMS were calculated for each day of ICU stay. Infectious status was determined based on positive cultures to multi-resistant organisms while overweight and obesity were based on Body Mass Index.

Results: A total of 809 nursing shifts' activity records were analysed. There were 12 infected patients that required isolation, 14 overweight patients and 3 obese: 9 patients presented both conditions. Only the presence of both conditions was statistically associated with an increase in workload (TISS-28p-value = 0.041 and NEMS p-value = 0.011).

Conclusions: Although TISS-28 and NEMS do not specifically consider body weight and infection status, their integration into nursing workload scores may improve the accuracy as management tools, increasing the quality of the cares provided.
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http://dx.doi.org/10.1016/j.iccn.2018.02.009DOI Listing
August 2018