Alessandro Stievano

Professional dignity in nursing in clinical and community workplaces

The purpose of this qualitative study was to analyse nurses’ professional dignity in their everyday working lives. We explored the factors that affect nursing professional dignity in practice that emerge in relationships with health professionals, among clinical nurses working in hospitals and in community settings in central Italy. The main themes identified were: (i) nursing professional dignity perceived as an achievement; (ii) recognition of dignity beyond professional roles. These two concepts are interconnected. This study provides insights into professional dignity in nursing being perceived as an achievement linked to the intrinsic dignity of every human being. The ‘nursing professional dignity perceived as an achievement’ was perceived as having declined in different social factors. Some factors of nursing professional dignity perceived as an achievement were attained more easily in community settings. ‘Recognition of dignity beyond professional roles’ underpins the intrinsic dignity as an expression of humanity, embedded in persons regardless of any profession, and values, such as: respect, moral integrity, humility, working conscientiously and kindness.

The dignity of the nursing profession: A meta-synthesis of qualitative research

Background: Nursing continues to gain legitimation epistemologically and ontologically as a scientific discipline throughout the world. If a profession gains respect as a true autonomous scientific profession, then this recognition has to be put in practice in all environments and geographical areas. Nursing professional dignity, as a self-regarding concept, does not have a clear definition in the literature, and it has only begun to be analyzed in the last 10 years. Objectives: The purpose of this meta-synthesis was to determine the various factors that constitute the notion of nursing professional dignity. The target was to create a tentative model of the concept. Research design: The research design was a meta-synthesis (N = 15 original articles) of nursing professional dignity described in the literature, based on the guidelines by Noblit and Hare. Method and findings: Original studies were sought out from electronic databases and manual searches. The selection of literature was conducted on stages based on titles (n = 2595), abstracts (n = 70), and full-texts (n = 15) according to the inclusion and exclusion criteria. From this analysis, a clear definition of nursing professional dignity emerged that underscored two main macro-dimensions constituting this intertwined, multidimensional, and complex notion: characteristics of the human beings and workplace elements. Conclusion: The recognition of nursing professional dignity could have a positive impact on patients because the results clearly showed that nurses are more prone to foster patients’ dignity, patients’ safety, and a better quality of care if their own dignity is respected. If nurses are uncomfortable, humiliated, or not seen in their professional role, it is difficult to give to others good care, good support, or good relationships.

Nurses’ perceptions of professional dignity in hospital settings

Background: The concept of dignity can be divided into two main attributes: absolute dignity that calls for recognition of an inner worth of persons and social dignity that can be changeable and can be lost as a result of different social factors and moral behaviours. In this light, the nursing profession has a professional dignity that is to be continually constructed and re-constructed and involves both main attributes of dignity. Objectives: The purpose of this study was to determine how nurses described nursing’s professional dignity in internal medicine and surgery departments in hospital settings. Research design: The research design was qualitative. Ethical considerations: This study was approved by the ethics committees of the healthcare organizations involved. All the participants were provided with information about the purpose and the nature of the study. Participants: A total of 124 nurses participated in this study. Method: The data were collected using 20 focus group sessions in different parts of Italy. The data were analysed by means of a conventional inductive content analysis starting from the information retrieved in order to extract meaning units and sorting the arising phenomena into conceptually meaningful categories and themes. Results: Nursing’s professional dignity was deeply embedded in the innermost part of individuals. Regarding the social part of dignity, a great importance was put on the values that compose nursing’s professional identity, the socio-historical background and the evolution of nursing in the area considered. The social part of dignity was also linked to collaboration with physicians and with healthcare assistants who were thought to have a central role in easing work strain. Equally important, though, was the relationship with peers and senior nurses. Conclusion: The organizational environments under scrutiny with their low staffing levels, overload of work and hierarchical interactions did not promote respect for the dignity of nurses. To understand these professional values, it is pivotal to comprehend the role of different health professions in their cultural milieu and the evolution of the nursing profession in diverse countries.

The Evolution of Professional Nursing Culture in Italy: Metaphors and Paradoxes

We explored the perceptions of Italian nurses regarding their developing culture as a health profession. We sought to understand the ongoing evolution of the nursing profession and the changes that were central to it becoming an intellectual discipline on par with the other health professions in Italy. In 2010, the Regulatory Board of Nursing established a center of excellence to build evidence-based practice, advocate for interdisciplinary health care, and champion health profession reforms for nursing. In this study, focus groups—involving 66 nurse participants from various educational, clinical, and administrative backgrounds—were utilized to better ascertain how the profession has changed. Six themes, three of them metaphors—“vortex,” “leopard spots,” and “deductive jungle”—explain nurses’ experiences of professional change in Italy between 2001 and 2011 and the multiple dimensions that characterize their professional identity and autonomy.

Nurses’ perceptions of their professional rights

The purpose of this study, which is part of a wider study of professional ethics, was to describe nurses’ perceptions of their rights in Italy. The data were collected by open-ended focus group interviews and analyzed with inductive content analysis. Based on the analysis, three main themes were identified. The first theme “Unfamiliarity with rights” described nurses’ perception that their rights mirrored historical roots, educational content, and nurses’ and patients’ position in the society. The second theme, “Rights reflected in legislation” highlighted that working and professional Italian legislation played a strong role. The third theme, “Managerial barriers for nurses’ rights” underlined the nurses’ perceptions that nursing management had the responsibility to create the conditions where nurses’ rights could flourish. This study intends to contribute to the debate on this underexplored topic.

ILISI® digital index of the Italian scientific literature of nursing

The IPASVI Rome Nursing Board-Centre of Excellence-began the project of building a free accessed database, Ilisi®, where the main Italian nursing and health-related journals could be consulted (including the few peer reviewed, at international level, Italian journals of nursing). Today, it includes the abstracts of more than 2700 articles from 2004 of about 25 Italian journals of nursing and/or related to nursing disciplines. The Ilisi® project has got with Thisi-Italian thesaurus of nursing science-a controlled vocabulary specifically built for nursing science, its tool of feasibility. This project was developed to foster nursing scholarship in Italy and to offer a free controlled database for all stakeholders (students, nurses, other health professionals, and scholars). The abstracts of the articles of these Italian journals are a tool for lifelong learning and constitute a patrimony for nursing science even at a wider level if this patrimony could be translated in English that will be a further step of the project. The project group who developed this database is going to value Italian nursing literature production and implement an electronic tool that, in the near future, might be used by all students and healthcare professionals in the world. Besides, with this project scientific productions by Italian students, nurses could be encouraged. More of them need to be trained in the use of the most frequently used databases, and Ilisi® could be a good training experience for them.

Nursing’s professional respect as experienced by hospital and community nurses

Background: There is growing awareness that patient care suffers when nurses are not respected. Therefore, to improve outcomes for patients, it is crucial that nurses operate in a moral work environment that involves both recognition respect, a form of respect that ought to be accorded to every single person, and appraisal respect, a recognition of the relative and contingent value of respect modulated by the relationships of the healthcare professionals in a determined context. Research question/aim: The purpose of this study was to develop better understandings of perceptions of nursing’s professional respect in community and hospital settings in England. Research design: The research design was qualitative. Focus groups were chosen as the most appropriate method for eliciting discussion about nursing’s professional respect. Participants and research context: A total of 62 nurses who had been qualified for at least a year and were working in two localities in England participated in this study. Methods: Data were collected using 11 focus group sessions. The data were analysed by means of an inductive content analysis, extracting meaning units from the information retrieved and classifying the arising phenomena into conceptually meaningful categories and themes. Ethical considerations: To conduct the research, permission was obtained from the selected universities. Results: Recognition respect of human beings was perceived as ingrained in the innermost part of nurses. Regarding appraisal respect, a great importance was placed on: the interactions among healthcare professionals, the time to build trust in these relationships, the influences of the workplace characteristics and nurses’ professional autonomy and decision-making. Conclusion: Recognition respect of persons was embedded in the inmost part of nurses as individuals. Concerning appraisal respect, it was thought to be deeply enshrined in the inter- and intra-healthcare professional interactions. The forging of trusting relationships over time was deemed to be strongly associated with good quality interactions with other healthcare professionals.

Center of Excellence to Build Nursing Scholarship and Improve Health Care in Italy

PURPOSE This article profiles the establishment and initial phase (2010-2014) of a Center of Excellence (CoE) as an instrument to strengthen nursing scholarship and improve health care in Italy. APPROACH This CoE is unique as a non-university-based center. The National Regulatory Board of Registered Nurses, Health Visitors, and Pediatric Nurses (IPASVI) designated substantial administrative and funding support to the CoE for advancing nursing education, clinical practice, research development, and research training. Boyers Model of Scholarship underpinned the CoEs conceptual framework, and its operational infrastructure was adapted from the U.S. National Institutes of Health P20 program award mechanism. Diverse methods included sponsoring research studies by nurse-led teams, research training courses, nursing education longitudinal studies, evidence-based practice training, and related pilot studies. FINDINGS Multiple collaborative projects were conducted via the CoE in conjunction with the successful launch of an expansive digital library and communication system accessible to nurses. The introduction of English proficiency courses was also a unique contribution. CONCLUSIONS The CoE concept is a potential instrument to strengthen nursing scholarship in Italy with potential scalability considerations to other global settings. CLINICAL RELEVANCE An overlapping focus on research, education, and practice under the umbrella of nursing scholarship within a CoE while engaging all levels of nursing is important to impact healthcare changes.

Tuning Nursing Educational in an Italian academic context.

BACKGROUND The European Union Bologna Process has laid the foundation for a common European competence-based educational framework. In many countries, nursing education is in transition from vocational to higher education, with many diverse systems. The competence-based approach provided by the project Tuning Educational Structures offers a common and coherent framework able to facilitate the implementation of the principles underpinning the Bologna Process reform. OBJECTIVES This study aimed to ascertain the relevance that Italian nursing university lecturers attributed to the 40 competences of the Italian version of the nursing Bachelors and Masters Degrees. These competences were developed through adoption of the Tuning Methodology in the nursing context. SETTING The study was conducted in the 4 universities of one region of Italy which offer nursing Bachelors and Masters Degrees. PARTICIPANTS A total of 164 Italian university nursing lecturers. METHODS Using a four point scale, a cross sectional survey was conducted from March 2011 to April 2012. Participants evaluated each competence according to its relevance for Bachelors or Masters Education. Frequency analysis was conducted. RESULTS The significance for each competence of Tuning was rated very high by Italian lecturers and appeared to overlap partially with the original European study. In Italy, the most relevant competences for Bachelors Degree were the skills associated with the use of appropriate interventions, activities and skills in nursing and the skills associated with nursing practice and clinical decision-making. For Masters Degree, leadership, management and team competences were the most important. CONCLUSIONS The Tuning Nursing Project was accepted by the Italian lecturers. The competence-based approach was considered by Italian lectures as a support enabling to reflect on the current Italian nursing education cycles of study and to ensure shared visions and common approaches between Italian and European lecturers.

Case Study: Perceived Cultural Discord and Possible Discrimination Involving a Moroccan Truck Driver in Italy

Ahmed is a 40-year-old Moroccan truck driver who has been working in Italy for the last 13 years. Ahmed has a basic level of education and a sufficient conversational skill in the Italian language. Ahmed lives alone, and although is married with two children, his wife and children were left behind in Morocco. He is also financially accountable for his visually disabled younger brother who lives in Morocco. Ahmed, being the sole breadwinner, relies on his truck driving job to support himself, his immediate family, and his brother’s family (Pfau-Effinger 2004).