1,721,282 research outputs found
[Notes of method to imagine an education tailored to the future]
No full text. Notes of method to imagine an education tailored to the future. Health and social inequalities represent a problem not only from an ethical point of view but also from the point of view of public and social health. Unfortunately, this issue remains confined to conferences and debates and is not yet the subject of a serious reflection on how to constructively and permanently incorporate it in the education of health professionals, to provide the skill to read and interpret data, and to make research. This contribution, in addition to providing some reflections, launches an initiative that aims at incorporating these contents in the basic education, to make the message of Florence Nightingale real: wounds, suffering, dying and the absurdity of disability can be taken care of, be part of the care, only if you learn to recognize the causes, which are not only in the medical domain
Epidemiologia dei problemi assistenziali e legati a farmaci e presidi in RSA e distretto.
No full textNegli ultimi anni sono stati prodotti pochi dati, e frammentati, sull’epidemiologia clinica e sull’assistenza di una delle popolazioni- (grandi) anziani assistiti in RSA e distretti, che sono, e diventeranno sempre più, il centro dell’attenzione e delle preoccupazioni delle società e dei loro sistemi sanitari. Vale la pena sottolineare che in questo scenario di scarsità di informazioni, la ricerca infermieristica non ha prodotto un contributo particolarmente originale,
anche se le caratteristiche dei problemi da affrontare in questi contesti, potrebbero e dovrebbero rappresentare una stimolante opportunità per esprimere la specificità dei ruoli e dei saperi infermieristici.
Obiettivi. 1. Testare la fattibilità e i risultati dell’attivazione di una grossa rete di contesti assistenziali per anziani, sia residenziali che di distretto, per produrre un monitoraggio epidemiologico.
2. Produrre un profilo epidemiologico quanti-qualitativo della percezione di situazioni ed eventi gestiti dagli infermieri, che richiedono attenzione specifica o interventi.
3. Esplorare e documentare la capacità di una rete indipendente di infermieri nell’assumere un ruolo di vigilanza epidemiologica anche su farmaci e presidi, con una metodologia che combina criteri oggettivi e soggettivi nell’osservazione, raccolta e qualificazione dei dati.
Metodologia. È stata creata una rete di ricerca (senza fondi, eccetto che quelli necessari per il coordinamento centrale) su base volontaria, cui hanno partecipato 427 infermieri di 36 distretti e 62 RSA di 7 regioni. Il protocollo e le schede di raccolta dati sono stati sviluppati nell’arco di 6 mesi, con la partecipazione intensiva di rappresentanti di componenti della rete, che hanno ricevuto una formazione sulla logica e le implicazioni pratiche della metodologia della ricerca, con particolare attenzione sul significato dei criteri di percezione dei problemi, della loro rilevanza, evitabilità, che costituivano i punti chiave della metodologia quali-quantitativa adottata. Per ciascun contesto è stato identificato un monitor e garantito un contatto telefonico
per risolvere eventuali dubbi o problemi a livello locale. Tutte le schede raccolte sono state inviate al centro di coordinamento, controllate, e le informazioni dubbie sono state chiarite con i rilevatori. L’analisi dei dati è stata fatta in collaborazione e sotto la responsabilità del Centro Studi della Società Italiana di Farmacologia Clinica (SIFO).
Risultati e implicazioni. In base al protocollo di studio, i dati sono stati raccolti in 6 giorni indice, (distribuiti su un periodo di tre mesi) in modo da rappresentare le condizioni assistenziali di routine dei 98 centri partecipanti. Quattrocento ventisette infermiere/i hanno fatto sorveglianza attiva dei pazienti di cui erano responsabili. Sono stati identificati 2224 problemi ed il 25% è stato attribuito a farmaci o presidi. Non è possibile fare una sintesi compatibile con la lunghezza di un abstract: è stato descritto il profilo e la qualificazione (in termini di frequenza, percezione dell’evitabilità) dei problemi segnalati, e l’esposizione ai farmaci della popolazione osservata, per avere un quadro di riferimento per i problemi associati ai farmaci.
Rispetto agli obiettivi:
a. È stato dimostrato che una strategia infermieristica di sorveglianza quanti-qualitativa, dello spettro di problemi che frequentemente complicano l’assistenza in RSA e Distretti, può essere integrata nell’assistenza di routine.
b. Le informazioni cliniche ed epidemiologiche prodotte rappresentano non solo un contributo originale alle conoscenze ma si sono rivelate un metodo molto efficace per l’aggiornamento e la formazione delle centinaia di infermieri che hanno raccolto i dati per il progetto.
c. L’analisi e la discussione delle caratteristiche, delle cause, della percezione di inevitabilità dei principali problemi clinici ed organizzativi riportati ha consentito di formulare una nuova agenda di ricerca che è diventata il programma di lavoro di quella che, ci si augura, rimanga una rete permanente di ricerca
A qualitative study on family carers views on how end-of-life communication contributes to palliative oriented care in nursing home.
Full text linkBackground. Although family-centered communication about end-of-life care has been recognized to promote palliative-oriented care in nursing home (NH), how this communication may work is still unknown. Therefore, we explored the mechanisms by which end-of-life communication may contribute to palliative-oriented care in NH from the perspective of bereaved family carers.Methods. A descriptive qualitative design was performed. Interviews were conducted with 32 bereaved family carers whose relative had died between 45 days to 9 months prior from 13 different NHs. A two-steps analysis process firstly with deductive and then with inductive content analysis was adopted.Results. Four mechanisms by which end-of-life communication contributed to palliative-oriented care were identified: a) promoting family carers understanding about their relative's health conditions, prognosis, and treatments available; b) fostering shared decision-making between healthcare professionals and residents/family carers; c) improving knowledge of residents' preferences; and d) improving knowledge of family carers' preferences.Conclusion. Clear and in-depth communication provides insight into residents' and family carers' preferences for care and treatment at the end-of-life, and increases understanding and shared decision-making
The changing pattern of cohabitation: A sequence analysis approach
Full text linkBackground: During the last decades, nonmarital cohabitation has diffused throughout the industrialised world, although not uniformly. The Second Demographic Transition (SDT) predicts a convergence of cohabitation patterns towards a final stage in which cohabitation and marriage will be almost indistinguishable. Objective: This paper contributes to the literature on the convergence of cohabitation patterns across countries by testing whether countries are becoming more similar over time, as suggested by the SDT. Methods: We use sequence analysis and cluster analysis techniques to classify different patterns of cohabitation in France, Italy, Norway, Bulgaria, and the United States. Using data mainly stemming from the Gender and Generations Surveys (GGS), we analyse women's patterns of behaviour during the five years following the start of their first cohabitation, over a time span of three decades (1970s-2000s). Results: On the basis of sequencing the events of childbirth, marriage, and separation we are able to identify five different clusters corresponding to different ways of going through the cohabitation experience. Conclusions: Our results suggest that there is a general decreasing trend of cohabitation as a pre-marital experience and an increasing trend of cohabitation as an alternative to marriage or as a free union. However, within this homogeneous trend, persistent peculiarities at the country level suggest that the selected countries are not simply at different stages of the same trajectory. Contribution: The classification that emerges from the data-driven approach combines several features of already existing typologies of cohabitation experience. Analysis of the data highlights country peculiarities in the development of the cohabitation experience, rather than the existence of a common path as predicted by the SDT
Missed Nursing Care in a Sample of High-Dependency Italian Nursing Home Residents: Description of Nursing Care in Action
No full textOBJECTIVE:
The aim of the study was to describe omitted or delayed nursing care (i.e., missed nursing care [MNC]) in a sample of Italian nursing homes (NHs).
METHODS:
Nurses from 50 NHs located in Northern Italy selected the 20 most dependent residents in their care and reported instances of MNC for three to five consecutive shifts. They described the type of MNC, its cause(s), management, recurrence, and severity of possible consequences for the resident. Information on the residents and the NH was also collected. The instances of MNC were classified as potentially avoidable/preventable or not.
RESULTS:
Overall, 266 (85.3%) of 312 nurses participated and 1000 residents were observed during 381 shifts (164 mornings, 164 afternoons, and 53 nights); 101 (38%) nurses reported 223 instances of MNC among 175 residents (17.5%). Ninety-seven omissions and 109 delays occurred during the day shift (56 omissions were delegated to the next shift). The most frequent MNC was drug administration (n = 71, 34.5%). In 24 (44.4%) of 54 instances of delayed drug administration, the delay was less than 30 minutes. Nurses rated approximately 20% of MNC (n = 41) as highly severe because of the discomfort caused to the resident, the clinical impact, or the repetitiveness of the situation. Nurses ascribed almost half of MNC (n = 100, 48.5%) to inadequate staffing, and they categorized 26 (11.6%) instances of MNC as unavoidable.
CONCLUSIONS:
The number of nurse-reported instances of MNC we reported was much lower than that previously collected with available instruments. Most MNC did not impact the comfort and safety of residents. A certain proportion of MNC was unavoidable
Association Between End-of-Life Conversations in Nursing Homes and End-of-Life Care Outcomes: A Systematic Review and Meta-analysis
Full text linkObjective: Less aggressive end-of-life (EOL) care has been observed when health care professionals discuss approaching EOL and preferences about life-sustaining treatments with nursing home (NH) residents or their families. We performed a comprehensive systematic review to evaluate the association between health care professionals-residents and health care professionals-family EOL conversations and EOL care outcomes.Design: Systematic review with meta-analysis.Setting and Participants: Seven databases were searched in December 2017 to find studies that focused on health care professionals-residents (without oncologic disease) and health care professionals-family EOL conversations and aimed to explore the impact of EOL conversations on resident's or family's EOL care outcomes.Measures: Random effects meta-analyses with subsequent quality sensitivity analysis and meta-regression were performed to assess the effects of EOL conversations on the decision to limit or withdraw life-sustaining treatments. A funnel plot and Eagger test were used to assess publication bias.Results: 16 studies were included in the qualitative and 7 in the quantitative synthesis. Health care professionals-family EOL conversations were positively associated with the family's decision to limit or withdraw life-sustaining treatments (odds ratio = 2.23, 95% confidence interval: 1.58-3.14). The overall effect of health care professionals-family EOL conversations on the family's decision to limit or withdraw life-sustaining treatments remained stable in the quality sensitivity analysis. In the meta-regression, family members with a higher level of education were less influenced by EOL conversations with health care professionals when making decisions about limiting or withdrawing life-sustaining treatments. No publication bias was detected (P = .4483).Conclusions/Implications: This systematic review shows that EOL conversations promote palliative care. Structured conversations aimed at exploring NH resident preferences about EOL treatment should become routine. NH administrators should offer health care professionals regular training on EOL conversations, and resident-centered care that involves residents and their families in a shared decision-making process at EOL needs to be promoted. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine
Mechanisms by which end-of-life communication influences palliative-oriented care in nursing homes: A scoping review
Full text linkObjective: End-of-life communication has been largely recognized to promote quality end-of-life care in nursing home (NHs) by increasing residents' likelihood of receiving comfort-oriented care. This scoping review summarizes what is known about the potential mechanisms by which end-of-life communication may contribute to palliative-oriented care in NHs.Methods: Using the framework proposed by Arksey and O'Malley and refined by the Joanna Briggs Institute methodology, five literature databases were searched. We extracted 2159 articles, 11 of which met the inclusion criteria: seven quantitative, three qualitative, and one mixed-methods study.Results: Three mechanisms were identified: a) promotion of family carers' understanding about their family member's health condition, prognosis, and treatments available; b) fostering of shared decision-making between health care professionals (HCPs) and residents/family carers; and c) using and improving knowledge about residents' preferences.Conclusion: Family carers' understanding, shared decision-making, and knowledge of residents' preferences contribute to palliative-oriented care in NHs.Practice implications: Discussions about end-of-life should take place early in a resident's disease trajectory to allow time for family carers to understand the condition and participate in subsequent, mindful, shared decision-making. HCPs should conduct systematic and thorough discussions about end-of-life treatment options with all cognitively competent residents to promote informed advance directives. (c) 2019 Elsevier B.V. All rights reserved
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