Professioni Infermieristiche (Consociazione Nazionale Delle Associazioni Infermiere/i)
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La consapevolezza di un Infermiere di malattie infiammatorie croniche intestinali tra i pazienti di un centro italiano
No full textBackground: Inflammatory Bowel Disease (IBD) is a chronic condition characterized by acute relapses which have an important impact on the quality of life of patients, both physically and psychologically. In the personalized care of IBD patients, a key role is covered by the IBD nurse, who provides psychological and educational support, as well as a source of contact for all patients.
Aim: Aim of the present study was to assess the perception of IBD patients about roles, competences and abilities of the IBD nurses in a specialized center. This is the base for further programs aiming to improve quality of care.
Methods: A questionnaire composed of 15 statements regarding the role of the IBD nurse in their treatment was offered to all patients attending this IBD center over a 3-month period. Results were showed comparing those of patients currently receiving treatment with a biologic therapy to those receiving non-biologic therapy.
Results: Patients in this center have a poor awareness of the IBD nurse role, particularly those not receiving biologic treatment. Although most patients are aware that they can use the IBD nurse as a point of contact, the majority are not aware of the qualifications of the IBD nurse to discuss their treatment options and provide psychological support.
Conclusion: Our survey shows that the figure of the IBD nurse is still poorly recognised by patients, with a likely resultant underutilisation of the services of a highly skilled and educated professional. Several key issues for improvement for the IBD nurse service have been raised by this study and warrant similar investigation in other centres.
Key words: Inflammatory bowel disease, IBD nurse, nurse specialist, patient perception, communication, education, psychological care, improved outcomes.Background: La malattia infiammatoria intestinale (IBD) è una condizione cronica caratterizzata da recidive acute che hanno un impatto importante sulla qualità della vita dei pazienti, sia fisicamente che psicologicamente. Nella cura personalizzata dei pazienti IBD, un ruolo chiave è ricoperto dall'infermiere IBD, che fornisce supporto psicologico ed educativo, nonché una fonte di contatto per tutti i pazienti.
Obiettivo: lo scopo del presente studio era valutare la percezione dei pazienti con IBD sui ruoli, le competenze e le abilità degli infermieri IBD in un centro specializzato. Questa è la base per ulteriori programmi volti a migliorare la qualità dell'assistenza.
Metodi: un questionario composto da 15 dichiarazioni riguardanti il ruolo dell'infermiere IBD nel loro trattamento è stato offerto a tutti i pazienti che frequentano questo centro IBD per un periodo di 3 mesi. I risultati sono stati mostrati confrontando quelli dei pazienti attualmente in trattamento con una terapia biologica con quelli che ricevono una terapia non biologica.
Risultati: i pazienti in questo centro hanno una scarsa consapevolezza del ruolo infermieristico IBD, in particolare quelli che non ricevono cure biologiche. Sebbene la maggior parte dei pazienti sia consapevole di poter utilizzare l'infermiere IBD come punto di contatto, la maggior parte non è a conoscenza delle qualifiche dell'infermiere IBD per discutere le proprie opzioni di trattamento e fornire supporto psicologico.
Conclusioni: l’indagine mostra che la figura dell'infermiere IBD è ancora poco riconosciuta dai pazienti, con una probabile conseguente sottoutilizzazione dei servizi di un professionista altamente qualificato e istruito. Diverse questioni chiave per il miglioramento del servizio infermieristico IBD sono state sollevate da questo studio e richiedono indagini simili in altri centri.
Parole chiave: malattie infiammatorie intestinali, infermiere IBD, infermiere specialista, percezione del paziente, comunicazione, educazione, assistenza psicologica, risultati miglior
SIAN e Professioni Infermieristiche. Collaborazioni scientifica ed editoriale tra Associazioni.
Full text linkCare Colleghe e Colleghi, con il 2019 il Direttivo SocietaÌ€ Infermieri Area Nefrologica(SIAN-Italia) ha proposto e intrapreso una collaborazione editoriale con la rivista "Professioni Infermieristiche".Come Presidente dell'Associazione, che in ambito italiano è anche l'unica realtaÌ€ associativa infer- mieristica del settore, ho accolto immediatamente questa opportunitaÌ€ di condivisione e divulgazione delle nostre competenze per metterla a disposizione di tutti i nostri soci SIAN. Il panorama della nefrologia italiana è ricco di storia, di attivitaÌ€ formative, di opportunitaÌ€ di appro- fondimento, l'idea è di condividere uno spazio per mostrare, divulgare eccellenze, ma anche ricerche, speri- mentazioni giaÌ€ presenti nei nostri servizi di dialisi e nefrologia. EÌ€ mia opinione che scrivere, leggere, condividere il nostro lavoro ci possa aiutare a capirlo, struttu- rarlo, codificarlo, arricchirlo delle azioni che svolgiamo ogni giorno, a volte caratterizzate dall'automatismo e dalla ripetitivitaÌ€. Il futuro della nostra professione dipende da quanto noi sappiamo cogliere le opportunitaÌ€ di crescita, di pensare, codificare, trasformare il nostro agire, finalizzato al miglioramento del servizio e al benessere che diamo al cittadino e di conseguenza a noi stessi. Invito tutti voi a proporvi, a inviare i vostri contributi che potranno provenire da varie fonti: lavori presentati a eventi formativi locali, congressi nazionali, internazionali, ricerche, sintesi di tesi di laurea, casi clinici. I lavori verranno presi in esame, letti, valutati in primis dal gruppo direttivo dell'Associazione e sottoposti al gruppo di ricerca che potraÌ€ aiutarvi ad apportare le giuste formulazioni. Potete trovare i miei contatti sul sito SIAN-Italia, oppure attraverso la segreteria editoriale. Seguiranno poi il percorso di double peer review anonima di Professioni Infermieristiche. Mi auguro questa collaborazione sia proficua per tutte le parti coinvolte, sono convinta che abbiamo grandi potenzialitaÌ€, dobbiamo solo incanalarle e saperle esprimere con la professionalitaÌ€ che ci contraddi- stingue. Cinzia Fabbri, Presidente SIAN - Itali
Men's experiences of deciding about treatment for localized prostate cancer: a meta-synthesis
No full textABSTRACT BACKGROUND. Prostate cancer is the most common cancer in men worldwide and nowadays several treatments are available, each presenting risks and benefits. Therefore, deciding on the most appropriate treatment is particularly challenging for men at the time of the diagnosis. AIM. This review was aimed at identifying, analyzing, and synthesizing the qualitative evidence on the experience of deciding about treatment after a diagnosis of localized Prostate cancer (LPC) METHODS. A meta-synthesis according to the meta-aggregation approach of the Joanna Briggs Institute (JBI) was used. The CINAHL, MEDLINE, and PsycINFO databases were searched for qualitative studies published from January 1998 to August 2018 in English and Italian. Qualita- tive Assessment and Review Instrument of JBI was used. RESULTS. From the identified sixteen studies two synthesized findings were derived that describe the decision-making as a complex process made in condition of emotional distress and influenced by internal and external factors; men evaluate differently the possible risks and benefits of cancer treatment, and after deciding they try to cope with their choice. CONCLUSION. The review provides evidence that men with LPC's need to receive emotional support and comprehensive information about the treatment options to facilitate their decision. The healthcare team should refer men to a multidisciplinary cancer service to permit access to all the treatment options. KEY WORDS: Prostate cancer; experience; decision-making; qualitative research; review L'esperienza di decidere sul miglior trattamento per un cancro prostatico localizzato: una meta-sintesi RIASSUNTO BACKGROUND. Il cancro della prostata è la neoplasia piuÌ€ comune negli uomini in tutto il mondo. Attualmente sono disponibili diversi trattamenti che presentano rischi e benefici. Ne consegue che scegliere il trattamento piuÌ€ opportuno è particolarmente difficile per gli uomini con una recente diagnosi di cancro prostatico. OBIETTIVI. La presente revisione ha lo scopo di identificare, analizzare e sintetizzare l'evidenza qualitativa sull'esperienza di decidere riguardo al trattamento dopo una diagnosi di cancro prosta- tico localizzato (LCP). METODI. E' stata condotta una meta-sintesi secondo l'approccio della meta-aggregazione racco- mandato dal Joanna Briggs Institute (JBI). Sono stati ricercati studi qualitativi pubblicati da gennaio 1998 ad agosto 2018 in lingua inglese e italiana sulle banche dati CINAHL, MEDLINE e PsycINFO. E' stata utilizzato lo strumento per le revisioni e la valutazione qualitativa del JBI. RISULTATI. Sono stati identificati 16 studi dai quali sono stati derivati due risultati sintetici che descrivono la presa di decisione come un processo complesso che avviene in condizioni di distress emozionale e che è influenzato da fattori interni ed esterni; gli uomini valutano differentemente i possibili rischi e benefici dei trattamenti del cancro e dopo aver preso la decisione, cercano di adat- tarsi alla decisione presa. CONCLUSIONI. La revisione evidenzia come gli uomini con un tumore prostatico localizzato hanno bisogno di ricevere supporto emozionale e informazioni complete sulle opzioni di tratta- mento al fine di facilitare la loro decisione. Il team sanitario dovrebbe indirizzare gli uomini con una diagnosi recente di cancro prostatico a centri multidisciplinari che permettano loro l'accesso a tutte le opzioni di trattamento. PAROLE CHIAVE: Cancro alla prostata, esperienza, processo decisionale, ricerca qualitativa, revision
Nursing Education: challenges and perspectives in a COVID-19 age
Full text linkThe COVID-19 outbreak deeply changed our lives on different levels. Social restrictions and distancing shaped in a different way our view of social relationships and behaviours. Like many aspects of daily life, also education has undergone radical changes. Nursing care was strongly affected by the outbreak, not only due to the risks in everyday practice, the heavy workload or the impact on nurses’ daily lives outside the healthcare settings, but also because nursing is caring profession and it embeds in its roots the close relationship with the patient, the touch, the patients’ body proximity as a way to communicate and to deliver an effective nursing care. All these issues, when brought in nursing education are also a learning opportunity for students and a way to develop their professional identity and to focusing on the nursing role. The COVID-19 outbreak heavily hit the clinical learning environments, as they are healthcare settings. The situation affected students’ learning opportunities, since clinical placements were suspended, Universities closed and in-person courses moved into online teaching. While lessons and courses rapidly switched into online teaching, in order to safeguard students’ education and faculty’s activity, it was not possible to manage the pre-clinical activities, such as simulations and labs, in order to support technical and relational competences. Most of all, it was not possible to arrange the clinical placements due to the uncertainty of the healthcare settings and the social and organizational restrictions to limiting unnecessary accesses to the services, as recommended by the American Association of Colleges of Nursing (2020). Recently, many authors have explored the issues related to the future of nursing education. In detail, an emerging issue is how it will be possible to educating nurses in a society facing isolation and social distance measures, but at the same time, in a society that needs more and more prepared clinical nurses (Dewart et al. 2020). Challenges connected to clinical learning environments Nursing curricula at the European level need to spend at least half of the overall education into clinical practice (European Directive 2013/55/EU). The COVID-19 outbreak affected the possibility to fulfil the criteria and it should be necessary to delay the graduation of undergraduate nursing students to achieve the formal standards for nursing education. Furthermore, it is not clear the impact of this situation in achieving and in maintaining the nursing students’ clinical competences. Competence development and maintenance both require a constant exposure to clinical practice, especially in the last year students, which need soon to face the professional role. Competence is considered as a setting- and time- specific concept where knowledge, skills and behaviours merge together. However, even in professional practice, there are no clear standards to certify competence maintenance over time (Casey et al., 2017). The effect of the break from clinical learning imposed by the outbreak is far to be measured, but we could reasonably suppose that students’ competences are not still stable over time in undergraduate education and they could be affected by a mastery loss. On the other side, the first year students need clinical practice to adjust into the nursing role and, often, to be aware of their choice in nursing, in order to possibly change their educational career. At the beginning of nursing education students experience uncertainty and the behavioural answer to these feeling depend on their motivation and their coping strategies with the academic and the nursing practice’s demands (Ha & Pepin, 2018). When the direct relationship with the academic and the clinical environment is lost or switched to a virtual one, students lose an opportunity to cope and to test their expectations with the choice they made. The first clinical internship experience represents, in a sense, an imprinting moment for the professional future. Due to COVID-19 pandemic, many students not only have lost meaningful chances of clinical learning, but they will also not be able to recover them, with important implications to their competencies acquisition and professional identity, that can be built only in the real clinical settings. Perspectives to push forward nursing education The COVID-19 outbreak also highlighted the relevance of nurses in facing the pandemic: nurses have been in the frontline in critical care, in supporting the community health, in preventing the contagion spread in the population. In this vein, the current pandemic represents an opportunity to drawing attention to the community-based nursing care, where nurses play a pivotal role in maintaining public health and to effectively manage further potential health emergencies. These all are relevant insights of the nursing role and they state the need to re-think nursing curricula and the education in facing infective diseases and in managing public health. Moreover, nurses demonstrated their readiness in facing public health issues on many levels, on broader levels than hospital care. This could have an impact on society’s perception of nurses and nursing and it could motivate the new generations to start a nursing career. The next year will tell us if this will be true or not, but for sure, now, nursing education has a chance to innovate both the study plan and the way to plan differently clinical learning. The study plans should implement more public health contents by educating students also in contact tracing activities and the inter-professional collaboration with public health assistants. Nurses could play a pivotal role in educating people at home in managing health at home, especially with chronically ill patients. Furthermore, nurses have a broader view on the community healthcare services to taking care of people at home when disability, chronic diseases, or social issues occur. COVID-19 outbreak deeply changed our healthcare systems’ view and so should change our nursing education view, in a way to highlight more the nursing role outside the hospital in integrating different views of care and healthcare professional collaboration. Nursing curricula should also focus more on patients’ empowerment and self-care. Healthcare communication has been crucial in promoting healthy and safe behaviours in the population during the outbreak. The roots of nursing are embedded into the proximity to patients’ needs and in finding the right way to improve people’s healthy behaviours. This pandemic brought us to disclose more these roots. The clinical nursing environments should also be re-though in order to enhance the healthcare settings’ integration and the transition of care. Nursing students should be more prepared to deepen patients’ biography, to conduct an in-depth interview useful to understand their habits, the contacts they had, in order to take in charge also the family members, especially when a contagion risk is a concrete possibility. The hospital-oriented education could had weakened a comprehensive view of patient’s history. This pandemic shifted also the focus on how hospital care is deeply linked with public health issues and on how public health issues affect nursing care. If holistic care was a statement and a value of nursing care and nursing education, now holistic care is an imperative need to deliver effective nursing care. Nursing education has to be set for at least 50% in clinical practice, but until now no further details have been stated about the distribution of this 50% in different clinical areas. Clinical competences should be coherent with the population needs and the priorities of the society; nursing education has the duty to provide nurses educated to face the worldwide priorities. It should be clear now that nursing education need to be specific to the area of nursing being practiced in the community and hospital environments. Clinical learning needs to consider how these times differently shaped the society’s needs. Further strategies should be also implemented to improve digitalization into clinical learning. In virtual education there are many factors, which contribute to effective and active learning and which should be considered in the implementation of the virtual learning environment. In detail it is important to consider technological barriers, student expectations and the students’ engagement in simulated environments. Moreover, the planning of virtual clinical educational programs should include effective student-to-teacher and student-to-student communication strategies and the design of specific activities to ensure students’ support (Jowsey et al. 2020). The idea to implement virtual clinical education is not new: both technical and relational skills can be exercised virtually and this was acknowledged as a useful way to test and to educate clinical competences in a safe and non-threatening environment. Although these technological resources are known and available, during the COVID-19 pandemic, heterogeneity has emerged within the nursing faculties. Not all academic institutions have effectively implemented technology to support students’ learning, perhaps because of the sudden and unexpected changes in the education system, which have imposed the use of technological resources not always recognized as regulatory requirements within the faculties. Indeed, the rapid transition from face to face education to virtual education has highlighted several problems related to virtual learning. Following the pandemic, many universities were able to offer education in an emergency distance learning programs but not a structured online education based on “well-considered, durable learning plans” (Morin, 2020). However, COVID-19 is an ongoing crisis but it could be the catalyst that drives nursing education towards innovations and a flexible but effective use of online learning. In spite of the potential of a well-planned online education, we should also consider the risk of inequality issues affecting students’ capability to achieve their learning outcomes; especially when they live in disadvantaged social contexts, with any access to Internet or Wi-Fi or obsolete computer. To encourage a more inclusive distance education some strategies should be implemented, as: to create small classes; to promote new teaching methods as inter-professional education; to create a structured mentoring program in supporting the relationship with students; to provide immediate and constructive feedback; to re-learn how to manage time, while supporting participative learning. On the other hand, distance learning might curb the burden of tuition fees, which could make higher education inaccessible for many individuals. In this vein, virtual teaching could allow more flexibility and a wider access to education (Murphy, 2020). For these reasons, it is possible that the future of undergraduate nursing education will strongly consider distance learning, and it will improve a blended approach to teaching clinical competences. This could represent an opportunity, as long as more efforts are made to improve transparency, accountability, service orientation and inclusion to education but also associated with some fears in respect to surveillance and control, privacy issues, power relations, and inequalities (Murphy, 2020). Conclusions The COVID-19 outbreak deeply affected nursing education, anyway together with the challenges, many new perspectives have been disclosed to reform nursing curricula or to implement new strategies in clinical learning. Those challenges and perspectives should push nursing education forward to innovate and they could shape new approaches to implement contents and competences in tune with the evolution of the societal needs. The new generations of graduate nurses will face a new normality. As the way of thinking nursing care changed, nursing education and clinical learning are the first drivers to shape this new normality in nursing. This historical period shapes a new educational environment deeply embedded in strong roots, and ready to face new perspectives to developing nursing care. The COVID-19 outbreak deeply changed our lives on different levels. Social restrictions and distancing shaped in a different way our view of social relationships and behaviours. Like many aspects of daily life, also education has undergone radical changes. Nursing care was strongly affected by the outbreak, not only due to the risks in everyday practice, the heavy workload or the impact on nurses’ daily lives outside the healthcare settings, but also because nursing is caring profession and it embeds in its roots the close relationship with the patient, the touch, the patients’ body proximity as a way to communicate and to deliver an effective nursing care. All these issues, when brought in nursing education are also a learning opportunity for students and a way to develop their professional identity and to focusing on the nursing role. The COVID-19 outbreak heavily hit the clinical learning environments, as they are healthcare settings. The situation affected students’ learning opportunities, since clinical placements were suspended, Universities closed and in-person courses moved into online teaching. While lessons and courses rapidly switched into online teaching, in order to safeguard students’ education and faculty’s activity, it was not possible to manage the pre-clinical activities, such as simulations and labs, in order to support technical and relational competences. Most of all, it was not possible to arrange the clinical placements due to the uncertainty of the healthcare settings and the social and organizational restrictions to limiting unnecessary accesses to the services, as recommended by the American Association of Colleges of Nursing (2020). Recently, many authors have explored the issues related to the future of nursing education. In detail, an emerging issue is how it will be possible to educating nurses in a society facing isolation and social distance measures, but at the same time, in a society that needs more and more prepared clinical nurses (Dewart et al. 2020). Challenges connected to clinical learning environments Nursing curricula at the European level need to spend at least half of the overall education into clinical practice (European Directive 2013/55/EU). The COVID-19 outbreak affected the possibility to fulfil the criteria and it should be necessary to delay the graduation of undergraduate nursing students to achieve the formal standards for nursing education. Furthermore, it is not clear the impact of this situation in achieving and in maintaining the nursing students’ clinical competences. Competence development and maintenance both require a constant exposure to clinical practice, especially in the last year students, which need soon to face the professional role. Competence is considered as a setting- and time- specific concept where knowledge, skills and behaviours merge together. However, even in professional practice, there are no clear standards to certify competence maintenance over time (Casey et al., 2017). The effect of the break from clinical learning imposed by the outbreak is far to be measured, but we could reasonably suppose that students’ competences are not still stable over time in undergraduate education and they could be affected by a mastery loss. On the other side, the first year students need clinical practice to adjust into the nursing role and, often, to be aware of their choice in nursing, in order to possibly change their educational career. At the beginning of nursing education students experience uncertainty and the behavioural answer to these feeling depend on their motivation and their coping strategies with the academic and the nursing practice’s demands (Ha & Pepin, 2018). When the direct relationship with the academic and the clinical environment is lost or switched to a virtual one, students lose an opportunity to cope and to test their expectations with the choice they made. The first clinical internship experience represents, in a sense, an imprinting moment for the professional future. Due to COVID-19 pandemic, many students not only have lost meaningful chances of clinical learning, but they will also not be able to recover them, with important implications to their competencies acquisition and professional identity, that can be built only in the real clinical settings. Perspectives to push forward nursing education The COVID-19 outbreak also highlighted the relevance of nurses in facing the pandemic: nurses have been in the frontline in critical care, in supporting the community health, in preventing the contagion spread in the population. In this vein, the current pandemic represents an opportunity to drawing attention to the community-based nursing care, where nurses play a pivotal role in maintaining public health and to effectively manage further potential health emergencies. These all are relevant insights of the nursing role and they state the need to re-think nursing curricula and the education in facing infective diseases and in managing public health. Moreover, nurses demonstrated their readiness in facing public health issues on many levels, on broader levels than hospital care. This could have an impact on society’s perception of nurses and nursing and it could motivate the new generations to start a nursing career. The next year will tell us if this will be true or not, but for sure, now, nursing education has a chance to innovate both the study plan and the way to plan differently clinical learning. The study plans should implement more public health contents by educating students also in contact tracing activities and the inter-professional collaboration with public health assistants. Nurses could play a pivotal role in educating people at home in managing health at home, especially with chronically ill patients. Furthermore, nurses have a broader view on the community healthcare services to taking care of people at home when disability, chronic diseases, or social issues occur. COVID-19 outbreak deeply changed our healthcare systems’ view and so should change our nursing education view, in a way to highlight more the nursing role outside the hospital in integrating different views of care and healthcare professional collaboration. Nursing curricula should also focus more on patients’ empowerment and self-care. Healthcare communication has been crucial in promoting healthy and safe behaviours in the population during the outbreak. The roots of nursing are embedded into the proximity to patients’ needs and in finding the right way to improve people’s healthy behaviours. This pandemic brought us to disclose more these roots. The clinical nursing environments should also be re-though in order to enhance the healthcare settings’ integration and the transition of care. Nursing students should be more prepared to deepen patients’ biography, to conduct an in-depth interview useful to understand their habits, the contacts they had, in order to take in charge also the family members, especially when a contagion risk is a concrete possibility. The hospital-oriented education could had weakened a comprehensive view of patient’s history. This pandemic shifted also the focus on how hospital care is deeply linked with public health issues and on how public health issues affect nursing care. If holistic care was a statement and a value of nursing care and nursing education, now holistic care is an imperative need to deliver effective nursing care. Nursing education has to be set for at least 50% in clinical practice, but until now no further details have been stated about the distribution of this 50% in different clinical areas. Clinical competences should be coherent with the population needs and the priorities of the society; nursing education has the duty to provide nurses educated to face the worldwide priorities. It should be clear now that nursing education need to be specific to the area of nursing being practiced in the community and hospital environments. Clinical learning needs to consider how these times differently shaped the society’s needs. Further strategies should be also implemented to improve digitalization into clinical learning. In virtual education there are many factors, which contribute to effective and active learning and which should be considered in the implementation of the virtual learning environment. In detail it is important to consider technological barriers, student expectations and the students’ engagement in simulated environments. Moreover, the planning of virtual clinical educational programs should include effective student-to-teacher and student-to-student communication strategies and the design of specific activities to ensure students’ support (Jowsey et al. 2020). The idea to implement virtual clinical education is not new: both technical and relational skills can be exercised virtually and this was acknowledged as a useful way to test and to educate clinical competences in a safe and non-threatening environment. Although these technological resources are known and available, during the COVID-19 pandemic, heterogeneity has emerged within the nursing faculties. Not all academic institutions have effectively implemented technology to support students’ learning, perhaps because of the sudden and unexpected changes in the education system, which have imposed the use of technological resources not always recognized as regulatory requirements within the faculties. Indeed, the rapid transition from face to face education to virtual education has highlighted several problems related to virtual learning. Fo
Integrated Procurement Model: A new approach to Tissue and Organ Procurement
No full textABSTRACT Introduction: Literature has shown that the process of procurement of organs and tissues is fundamental in determining the number of donations. Starting from these assumptions, an integrated procurement model of organs and tissues has been designed and tested, where nurse specialists in organ donation coordinate the team and the entire process. Aim: To evaluate the effectiveness of the Integrated Procurement Models in terms of identifying potential donors and the number of donations. Methods: A retrospective observational study was conducted before and after the introduction of the new procurement model in a large University Hospital in Rome. The data of potential donors identified, the number of donations made and the efficiency indicators of the donation process were compared. Results: 692 potential donors were identified. The introduction of the integrated model increased the number of actual donors (from 31 to 51), brain death assessments (from 69 to 99), and the efficiency indicators of the donation process (from 0.25 to 0.29). From the comparison between the activities before and after the introduction of the integrated procurement model, statistically significant differences emerged regarding the number of donors (X2 = 9.85; p <0.002) and the amount of corneal tissue extracted (X2 = 34, 01; p <0.001). Conclusion: The adoption of the standardized Integrated Procurement Model would increase the number of potential donors and actual donations, thanks also to the key role assumed by the nurse specializing in organ donation as team and process coordinator. Keywords: Specialist nurse, tissue organ and procurement, tissue donors, transplant RIASSUNTO Introduzione: La letteratura ha evidenziato che il processo di Procurement di organi e tessuti è fondamentale per determinare il numero di donazioni. Partendo da questi presupposti è stato ideato implementato e testato un modello integrato di Procurement di organi e tessuti, in cui infermieri specialisti della donazione di organi coordinano l'equipe e l'intero processo. Scopo: Valutare l'efficacia del Modelli integrato di Procurement in termini di individuazione di potenziali donatori e numero di donazioni. Materiali e metodi: EÌ€ stato condotto uno studio osservazionale retrospettivo prima e dopo l'introduzione del nuovo modello di Procurement in un grande Policlinico Universitario Romano. Sono stati confrontati i dati dei potenziali donatori individuati, il numero di donazioni effettuate e gli indicatori di efficienza del processo di donazione. Risultati: Sono stati identificati 692 potenziali donatori. L'introduzione del PIM ha aumentato il numero di donatori effettivi (da 31 a 51), gli accertamenti di morte encefali (da 69 a 99), gli indicatori di efficienza del processo di donazione (da 0,25 a 0,29). Dal confronto fra le attivitaÌ€ prima e dopo l'introduzione del modello integrato di Procurement, sono emerse differenze statisticamente significative relativamente al numero di donatori (X2=9,85; p<0,002) e alla quantitaÌ€ di tessuto corneale prelevato (X2=34,01; p<0,001). Conclusioni: L'adozione del modello integrato e standardizzato di Procurement permetterebbe di aumentare i possibili donatori e le reali donazioni, grazie anche al ruolo chiave assunto dall'infermiere specialista della donazione di organi come coordinatore dell'equipe e del processo. Parole chiave: Infermiere specialista, procurement, donazione di organi e tessuto, trapianto
La migrazione di infermieri e professionisti sanitari durante la pandemia da COVID-19
Full text linkRoughly one year after the momentous United Nations Global Compact for Migration (United Nations 2019; Shaffer, et al., 2019) heralded hope for a better global regime to support migrants and enable them to leverage their skills worldwide, the ominous COVID-19 pandemic has caused dramatic shifts and setbacks in efforts to make migration ‘safe’ and ‘regular.’ In fact, the world has witnessed an array of border shutdowns in attempt to curb the spread of the virus, limiting the flow and labor migration of tech workers, engineers, and even, in some cases, health professionals. Simultaneously, healthcare migrants have experienced a slightly different policy response. As countries experience continued pressures on their health systems, they have largely exempted health workers from their bans. In fact, while migration globally has been decimated, nurses and health professionals have been carved out from restrictions and prohibitions. Despite these policies, the migration of the health professionals has severely di-minished as the pandemic has brutally affected their mobility through unprecedented country barriers and travel restrictions. The COVID-19 pandemic has exposed the vulnerabilities of nursing supply flows, domestically and internationally. Its impact at the country-level has further highlighted preexisting nurse supply gaps and the effect of staffing shortages. Internationally, the pandemic has disrupted global supply chains. The world has witnessed the closing of borders, the interruption of travel, and, in some countries, the restriction of outflows. The State of the World’s Nursing Report (SOWN) (WHO, 2020) noted a shortfall of almost six million nurses immediately pre-COVID-19, a shortage suffered particularly by low- and middle-income countries. This is of major concern given that increased international outflows of nurses in the new post-COVID era could undermine, even more than before, the readiness of those countries to meet healthcare demands (ICN, 2020). In this default scenario, some, but not all, high-income destination countries will continue to rely on international inflow of nurses to a significant extent, as they did pre-COVID 19, further exacerbating the suffering of poor countries. Put simply, without country-level policy changes related to the nursing workforce and backed by international organisations, pre-COVID-19 trends of increased nurse flows from low- to high-income countries will likely continue. In this scenario, the iniquitous maldistribution of nurses may become more pronounced. This “do nothing” option risks undermining both country-level progress towards the attainment of Universal Health Coverage (UHC), and the overall global response to any future pandemic wave. Furthermore, key post-COVID-19 policies must prioritize bilateral and regional agreements to allow easier mobility for health professionals. The nursing workforce has been central to COVID-19 response effectiveness in all countries and its steady implementation constitutes a powerful response to the immediate and longer lasting effects of the pandemic on nurse supply. To improve longer-term nurse workforce sustainability, there is a need, as both the WHO (WHO, 2019) and OECD (2019) have noted, for a coor-dinated policy response with respect to the international supply of nurses. At the country-level, this will require implementing policy bundles with two interrelated objectives: to improve retention of domestically-trained nurses; and, to ensure adequate domestic trai-ning capacity. This requires a strong commitment to supporting regular and systematic national nurse labour market analysis via a set of data and workforce projections, particularly in resource-constrained countries, by the provision of technical advice and assi-stance, data improvement, independent analysis, and multi-stakeholder policy dialogues to agree on priority policy actions regarding domestic nurse supply and retention. The commitment to investing in nurse workforce sustainability in small states is essential, particularly in lower-income countries and fragile states. If these country-level and international nurse workforce policy responses are implemented effectively and in atimely manner, there can be hope for the future sustainability of the profession’s nursing supply. Strategic policy directions should endorse major investments in countries affected by shortages to educate, employ, and retain nurses and other health professionals through domestic funding as well as appropriately-aligned development assistance (Buchan, et al., 2019). Commitment to effective monitoring of international flows of nurses, based on complete national datasets using standard measures, rapid analysis, and timely publication, with global coverage, and including country level reporting on nurse “self-sufficiency” are mandatory if the world is to adequately cope with the pandemic. Ad oltre un anno dalla firma del trattato United Nations Global Compact for Migration (United Nations 2019; Shaffer, et al., 2019) che ha avviato una stagione di speranza di costruizione di una rete globale migliore per supportare i migranti e consentire loro di sfruttare le loro capacità in tutto il mondo, la minacciosa pandemia COVID-19 ha causato drammatici cambiamenti ed importanti battute d'arresto negli sforzi tesi a rendere la migrazione “sicura” e “regolare”. In effetti, il mondo ha assistito a una serie di chiusure alle frontiere nel tentativo di frenare la diffusione del virus, che hanno limitato il flusso e la migrazione di lavoratori tecnologici, come gli ingegneri e, in alcuni casi, anche professionisti sanitari. Allo stesso tempo, i migranti sanitari hanno sperimentato una risposta politica leggermente diversa. Poiché i Governi subiscono continue pressioni sui loro sistemi sanitari, hanno ampiamente esentato gli operatori sanitari dai loro divieti. Infatti, mentre la migrazione a livello globale è stata decimata, gli infermieri e gli operatori sanitari sono stati tagliati fuori da restrizioni e divieti. Nonostante queste politiche, la migrazione degli operatori sanitari è in ogni caso gravemente diminuita poiché la pandemia ha brutalmente colpito la loro mobilità attraverso barriere nazionali e restrizioni di viaggio senza precedenti. La pandemia COVID-19 ha esposto le vulnerabilità dei flussi di fornitura di personale infermieristico, a livello nazionale e internazionale. Il suo impatto a livello nazionale ha ulteriormente evidenziato le lacune preesistenti nelle modalità di impiego di infermieri e l'effetto della carenza di personale. A livello internazionale, la pandemia ha interrotto le catene di approvvigionamento globali. Il mondo ha assistito alla chiusura delle frontiere, all'interruzione dei viaggi e, in alcuni paesi, alla limitazione dei flussi in uscita. Il recente Report State of the World's Nursing (SOWN) (WHO, 2020) ha rilevato un deficit di quasi sei milioni di infermieri immediatamente prima del COVID-19, carenza sofferta in particolare dai paesi a basso e medio reddito. Ciò è motivo di grande preoccupazione dato che l'aumento dei flussi internazionali di infermieri nella nuova era post-COVID potrebbe minare, anche più di prima, la prontezza di quei paesi a soddisfare le richieste di assistenza sanitaria (ICN, 2020). In questo scenario, alcuni, ma non tutti, dei paesi di destinazione ad alto reddito continueranno a fare affidamento sull'afflusso internazionale di infermieri in misura significativa, come hanno fatto prima del COVID-19, esacerbando ulteriormente la sofferenza dei paesi poveri. In sintesi, senza cambiamenti politici a livello nazionale relativi alla gestione della forza lavoro infermieristica sostenuti da Organizzazioni Internazionali, le tendenze pre-COVID-19 di aumento dei flussi di infermieri dai Paesi a basso e alto reddito probabilmente continueranno. In questo scenario, l'iniqua distribuzione degli infermieri può diventare ancora più pronunciata. Questa opzione “non fare nulla” rischia di minare sia i progressi a livello nazionale verso il raggiungimento della copertura sanitaria universale (UHC), sia la risposta globale a qualsiasi futura ondata di pandemia. In questa ottica, le principali politiche post-COVID-19 devono dare la priorità agli accordi bilaterali e regionali per consentire una mobilità più facile per gli operatori sanitari. La forza lavoro infermieristica è stata fondamentale per l'efficacia della risposta COVID-19 in tutti i paesi e la sua costante implementazione costituisce una potente risposta agli effetti immediati e più duraturi della pandemia sul personale infermieristico. Per migliorare la sostenibilità della forza lavoro infermieristica a lungo termine, c'è bisogno, come hanno notato sia l'OMS (WHO, 2019) che l'OCSE (2019), di una risposta politica coordinata rispetto all'offerta internazionale di infermieri. A livello nazionale, ciò richiederà l'implementazione di pacchetti di politiche attive con due obiettivi correlati: migliorare la fidelizzazione degli infermieri formati a livello nazionale; e, garantire un'adeguata capacità di formazione in ambito locale. Ciò richiede un forte impegno nel supportare la conduzioni di analisi nazionali regolari e sistematiche del mercato del lavoro infermieristico attraverso una serie di dati e proiezioni sulla forza lavoro, in particolare nei Paesi con risorse limitate, fornendo consulenza e assistenza tecnica, valorizzazione dei dati, analisi indipendenti e multi-stakeholder, policy dialogues, per concordare azioni politiche prioritarie riguardanti gli organici infermieristici ed il mantenimento in attività degli infermieri. L'impegno a investire nella sostenibilità della forza lavoro infermieristica nelle diverse Nazioni è essenziale, in particolare nei Paesi a basso reddito e negli Stati cosidetti fragili. Se queste risposte politiche sulla forza lavoro infermieristica a livello nazionale e internazionale vengono attuate in modo efficace e tempestivo, ci potrà essere speranza per la futura sostenibilità dell'offerta infermieristica. Le direzioni politiche strategiche dovrebbero sostenere importanti investimenti nei paesi colpiti da carenze per formare, assumere e trattenere infermieri e altri professionisti sanitari attraverso finanziamenti nazionali e assistenza allo sviluppo delle professioni (Buchan, et al., 2019). L'impegno per un monitoraggio efficace dei flussi internazionali di infermieri, sulla base di set di dati nazionali completi, analisi rapide e pubblicazioni tempestive, con copertura globale, e includendo rapporti a livello nazionale sull’autosufficienza infermieristica diventano quanto mai obbligatori quando ci si trova di fronte ad una pandemia
Over-Under Triage nell’attivazione del Trauma Team: un’analisi retrospettiva nella ASST Monza
No full textIntroduction: Meeting the literature standards during the triage process of trauma victims, allows to make optimal use of the resources available in Trauma Centers and defines their level of quality and efficiency. Otherwise, it may occur over or under-triage. Up to now, in the reality under study and in the national literature, there wasn’t any available data about efficiency and effectiveness in the triage of traumatic patients, therefore the primary objective of this study is to evaluate the over and under-triage rate in activating Trauma Team (TT) in the ASST of Monza-San Gerardo Hospital. Method: The study design is retrospective monocentric observational. Results: During the analysis, the TT-activation in ASST of Monza-San Gerardo Hospital produced an over-triage of 62,9% and an under-triage of 1,7% for the same year. Discussion: The use of TT-activation algorithm is the first step of the entire care process of the trauma victim. This tool should guarantee the right balance between high sensitivity (under-triage → 0, accepting the risk of high over-triage rate) and high specificity (minimum over-triage rate with the possibility of higher under-triage). However, there is no sharing of these algorithms as they are inhomogeneous in the different realities; for example, the definition of major trauma, of TT and of its composition is still uneven. Conclusion: This study measured the over and under-triage rate related to the TT activation in the ASST of Monza. It is therefore advisable to monitor those rates periodically, as possible indicators of quality of assistance and to pursue the mission of increasing efficiency as well as effectiveness.Introduzione: Il rispetto degli standard presenti in letteratura durante il triage di persone vittima di trauma, permette di sfruttare in modo ottimale le risorse di cui dispongono i Trauma Center e ne definisce il livello di qualità ed efficienza. In caso contrario si può assistere ad over o under-triage. Fino a questo momento, nella realtà oggetto di studio e nella letteratura nazionale, non era disponibile alcuna misurazione di efficienza ed efficacia circa il relativo triage del paziente traumatico; pertanto l’obiettivo primario è ottenere dati relativi alle percentuali di over-triage e under-triage circa l’attivazione del Trauma Team (TT) nell’ASST di Monza-Ospedale San Gerardo. Metodo: Il disegno di studio è osservazionale retrospettivo monocentrico. Risultati: Nell’Ospedale San Gerardo, nel periodo esaminato, si è prodotto un over-triage del 62,9% ed un under-triage, relativo al medesimo anno, dell’1,7%. Discussione: Utilizzare un algoritmo decisionale di attivazione del TT è alla base dell’intero processo assistenziale della persona vittima di trauma. Questo strumento dovrebbe riportare il giusto compromesso tra sensibilità elevata (under-triage → 0, accettando il rischio di avere un over-triage elevato) e specificità elevata (over-triage minimo ma con possibilità di creare un più elevato under-triage). Non vi è tuttavia condivisione di tali algoritmi che risultano disomogenei nelle diverse realtà come è ancora disomogenea la definizione di trauma maggiore, del TT e della sua composizione. Conclusioni: Abbiamo misurato le percentuali di over e under triage relative all’attivazione del TT dell’ASST di Monza. Ci si aspetta di poterle monitorarle periodicamente, quali possibili indicatori di qualità d’assistenza al cittadino, ponendosi come mission, al pari dell’efficacia, di incrementare l’efficienza. 
Leadership infermieristica nella ricerca sanitaria qualitativa
Full text linkEsistono prove empiriche solide ed indiscutibili che supportano la conclusione che la vaccinazione di neonati e bambini contro morbillo, parotite, rosolia (MPR) non sia causa di autismo. In Europa, le prove più recenti provengono da uno studio di coorte effettuato su 657.461 bambini nati in Danimarca tra il 1999 e il 2010 che ha concluso che la vaccinazione MPR non è associata a nuovi casi di autismo post vaccinazione né aumenta il rischio di bambini di sviluppare l'autismo (Hviid, Hansen, Frish & Melbye, 2019). Sempre più spesso, tuttavia in svariati contesti sanitari di assistenza primaria, acuta, di comunití e a lungo termine, gli infermieri incontrano individui che appaiono molto scettici rispetto alle vaccinazioni, nonostante le robuste prove dell'efficacia dei vaccini e l'implementazione di piani internazionali ed nazionali di prevenzione vaccinale. Lo scetticismo nei confronti delle vaccinazioni cosí¬ come i bassi tassi di copertura vaccinale, sono ben documentati in tutta Europa, sia tra le donne alle quali è consigliato di vaccinarsi contro l'influenza e la pertosse durante la gravidanza (Wilson, Paterson, Larson, 2019), come anche negli adolescenti che possono essere vaccinati contro il Papillomavirus Umano (Vaccino HPV) (Karafillakis et al., 2019), ed infine tra gli operatori sanitari rispetto alla vaccinazione contro l'influenza stagionale (Gilardi et al., 2018). Di recente, l'Organizzazione Mondiale della Sanití (2019) ha identificato proprio nello scetticismo rispetto ai vaccini, una delle dieci minacce principali alla salute globale. Questa minaccia globale rende evidente che oltre agli studi quantitativi che forniscono informazioni sull'efficacia dei vaccini e sulle misure di copertura vaccinale, gli infermieri e gli altri operatori sanitari hanno bisogno di risposte a domande altrettanto importanti, quali: "Quali fattori del sistema organizzativo o sanitario influenzano l'adozione di successo dei programmi di vaccinazioni? "Quali sono i valori e le credenze delle persone nei confronti delle vaccinazioni? "o" In che modo le persone prendono la decisione di vaccinare (o meno)?". Le risposte a queste domande possono essere trovate attraverso la conduzione di studi di ricerca sanitaria qualitativa
L'infermieristica in Italia attraverso l'esperienza di pazienti e caregivers: scoping review
No full textIntroduzione: Il confronto con le realtí infermieristiche di altri paesi ha messo in luce che in Italia è ancora poco sviluppata la fase di teorizzazione, in particolare per quanto concerne la ricerca e lo sviluppo di aspetti teorici dell'infermieristica. I bisogni e le esperienze di salute della popolazione e gli approcci infermieristici in risposta a questi debbono necessariamente considerare gli aspetti culturali e professionali legati al contesto. Da qui la necessití di valutare la possibilití di sviluppare teorie fortemente radicate nel contesto dell'infermieristica italiana. Scopo dello studio è stato di mappare le conoscenze relative all'infermieristica in Italia, attraverso le esperienze di pazienti, famiglie e comunití , per fornire una base su cui sviluppare teorie infermieristiche.Metodo: La Scoping Review è stata selezionata come metodologia ottimale per la mappatura. Il metaparadigma infermieristico di Fawcett è stato scelto come guida e mezzo tramite il quale realizzare l'analisi della letteratura.Risultati: Sono stati inclusi 22 studi comprendenti contesti relativi ai pazienti acuti, con cronicití , all'area emergenza urgenza e ai servizi domiciliari. L'analisi ha consentito di definire i concetti ed i temi del Metaparadigma Infermieristico. Sebbene queste definizioni siano parziali, riferite soltanto ad alcuni contesti specifici ad alcune funzioni dell'assistenza infermieristica, l'originalití dello studio può stabilire il punto di partenza per la creazione di un modello.Conclusioni: Solo attraverso un'attenta valutazione del punto di vista di tutti gli attori coinvolti nel processo di assistenza è possibile rendere concreto e credibile un modello per il trasferimento nella pratica di concetti e temi finora spesso relegati ad una forma di intento.Parole chiave: Esperienza dei pazienti, metaparadigma dell'infermieristica, Italia, scoping review, teorie dell'infermieristica..Patients and caregivers experience on Nursing in Italy: scoping review Introduction:"ˆComparison of the state of nursing in Italy with other countries has shown that theory development in Italian nursing remains quite undeveloped. Theory development in Italian nursing will need to consider local cultural and professional aspects, specific to the Italian practice context, by drawing on known health needs, experiences and nursing approaches. The aim of this investigation was to map current knowledge related to nursing in Italy, based on the experiences of patients, families and communities, to provide a basis on which nursing theories could be developed.Methods: Scoping Review was selected as the best method for this knowledge mapping. Fawcett's nursing metaparadigm was chosen as a broad guide and means by which the literature analysis could be structured.Results:"ˆTwenty-two studies were retained and examined in this analysis, including contexts relating to acute care, chronic conditions, as well as emergency and home care services. We defined themes in line with the nursing metaparadigm. Although these definitions are partial, referring only to certain contexts specific to some aspects of nursing care, the original contributions of this investigation provides an important starting point for theory development in Italian nursing, based on the Italian context.Conclusion: Strong and credible theory development, that can be readily adapted to practice, requires a rigorous analysis of the points of view of all actors involved in the nursing care process.Key words: Italy, nursing metaparadigm, nursing theories, patient experience, scoping review
Il tempo dedicato alle cure palliative nella formazione di base degli infermieri in una sede di Corso di laurea italiana
Full text linkLa European Association of Palliative Care (EACP) nel documento Guida per lo sviluppo della formazione infermieristica in cure palliative in Europa, pone l'attenzione sulla necessití di un percorso specifico in cure palliative all'interno della formazione sanitaria di base. L'apertura nel 2010 dell'Unití Operativa (UO) di cure palliative all'interno dell'azienda socio-sanitaria di Varese (ASST Sette Laghi), nella quale gli studenti appartenenti all'Universití degli Studi dell'Insubria svolgono attivití di tirocinio clinico, ha fatto emergere l'utilití di applicare queste raccomandazioni. I Tutor del corso di laurea e gli infermieri che seguono gli studenti nell'UO (assistenti di tirocinio) hanno creato un percorso mirato, con l'obiettivo di fornire ai futuri colleghi conoscenze e competenze da applicare in situazioni che richiedano un approccio palliativo non solo in UO specialistiche, ma in tutti gli ambiti ove sia richiesto. L'approfondimento di queste tematiche ha fatto nascere negli studenti un interesse sempre maggiore tanto da essere scelto da molti di loro come argomento per la tesi per il conseguimento della laurea. Con questo articolo si intende illustrare il percorso teorico-pratico che gli studenti affrontano nell'arco dei tre anni del Corso di laurea in infermieristica nella sezione di Corso di laurea di Varese dell'Universití degli Studi dell'Insubria, che si sviluppa attraverso seminari, lezioni frontali e tirocini clinici. Ad oggi la consapevolezza dell'importanza delle cure palliative è in continua crescita nella sanití italiana; ciò ha messo in evidenza la necessití di sviluppare un linguaggio comune di conoscenze basate su programmi formativi coordinati e condivisi. In quest'ottica desideriamo condividere l'esperienza di Varese al fine di contribuire all'auspicabile confronto tra le diverse sedi formative.Parole chiave:"ˆcure palliative, studente infermiere, programma formativaThe time spended for palliative care in the nursing degree program at an italian UniversityThe European Association of Palliative Care (EAPC) with the document Guide for the Development of Palliative Nurse Education in Europe, focuses on the need for a specific curriculum in palliative care area within the basic health professionals' training. In 2010 opened the palliative care unit of Varese's Hospital (ASST Sette Laghi), where students, belonging to the University of Insubria, perform clinical training activities; this event stressed the importance of implementing the application of EAPC's recommendations. Tutors and trainee assistants, created a targeted way in order to provide to the future colleagues knowledge and skills that can be applied in situations requiring a palliative approach not only in palliative settings but in general care also. The deepening of these issues has given rise to an increasing interest in students so to be chosen by many of them as a dissertation topic. The aim of this work is to illustrate the theoretical and practical courses that students face over the three years nursing degree program, which is developed through seminars, lectures and internships. Actually, awareness of the importance of palliative care is constantly growing in Italian healthcare; this has highlighted the need to develop a common knowledge base on coordinated and shared programmes of training. With this goal, we would like to share the experience of Varese, in order to contribute to the comparison between the various training venues. Key words: palliative care, nursing students, curriculu