Chiara Foà

School moral atmosphere and normative orientation to explain aggressive and transgressive behaviours at secondary school

The school moral atmosphere refers to informal norms and values that regulate the relationships in school and their degree of sharing among students. We tested whether the school moral atmosphere is a mediating variable between adolescents’ normative orientation and their self-reported aggressive and transgressive behaviours. A total of 664 Italian students (age range 15–21, M = 17.06, SD = 1.15) filled out a questionnaire to measure their perception of: (1) school moral atmosphere, (2) normative orientation and (3) frequency of aggressive and transgressive behaviours at school. Normative orientation and school moral atmosphere were good predictors of both aggressive and transgressive behaviours. Normative orientation was proved as a direct explicative variable with transgressive behaviours as dependent variable, but an indirect variable with aggressive behaviours as dependent. In this case the relation was mediated by the school moral atmosphere, confirming previous results. Educational implications are discussed.

Unplanned Extubations in Intensive Care Unit: evidences for risk factors. A literature review.

Abstract Background and aim: Unplanned extubations (UE) are getting more and more relevant in Critical Care, becoming a quality and care safeness outcome. This happens because after an UE the patient can face some complications concerning the airway management, respiratory and hemodynamic problems, lengthen in the hospital stay and in the mechanical ventilation time. The aim of this review is identify and classify the factors that could increase UE risk. Methodology: A systematic review of scientific articles was performed consulting the databases PubMed, Cinahl, Medline, EBSCOhost and Google Scholar. Articles from 2006 to 2011 were included. Pediatric Care settings were excluded. Results: 21 articles were selected. From the results emerged that risk factors associated to the patient are widely controversial. Yet restlessness, a low level of sedation and a high level of consciousness seem to be highly related to UE. Organizational risk factors, as workload, nurse:patient ratio, and the use of interdisciplinary protocols seem to play an important role in UE. Conclusion: According the current literature, the research on UE still has to handle a wide uncertainty. There is the need for more studies developing conclusive evidences on the role of different risk factors. Anyway, literature highlights the importance of the nurse and of the healthcare system organization in reducing UE incidence.

COPE-NVI-25: validazione italiana della versione ridotta della Coping Orientation to the Problems Experienced (COPE-NVI)

Lo scopo del presente lavoro e la validazione di una versione ridotta a 25 item del COPE- NVI, uno strumento largamente utilizzato in ambito italiano per la misurazione degli stili di coping. Lo strumento e stato somministrato a 824 partecipanti adulti suddivisi in due gruppi: persone che hanno avuto un infarto del miocardio (N = 371) e persone che non hanno, e non hanno avuto, gravi problemi di salute (N = 453). L’analisi fattoriale confermativa mostra che la struttura fattoriale del COPE-NVI-25 ricalca quella dello strumento originario e che le dimensioni misurate presentano una buona validita di costrutto e una buona attendibilita. L’analisi multi-gruppo evidenzia che la scala e metricamente invariante fra i due campioni considerati. L’analisi delle differenze nei punteggi medi fra persone infartuate e non infartuate mostra una buona validita discriminante della scala. In sintesi, il COPE-NVI- 25 si dimostra uno strumento altrettanto valido, ma di piu agevole somministrazione, rispetto allo strumento originale. In virtu della ridotta estensione, il COPE-NVI-25 puo essere somministrato facilmente anche a persone che presentano gravi problemi di salute.

ALLiance for sEcondary PREvention after an acute coronary syndrome. The ALLEPRE trial: A multicenter fully nurse-coordinated intensive intervention program

Abstract The main objective of cardiovascular disease prevention is to reduce morbidity and mortality by promoting a healthy lifestyle, reducing risk factors, and improving adherence to medications. Secondary prevention after an acute coronary syndrome has proved to be effective in reducing new cardiovascular events, but its limited use in everyday clinical practice suggests that there is considerable room for improvement. The short-term results of evidence-based studies of nurse-coordinated secondary prevention programs have been positive, but there is a lack of long-term outcome data. The Alliance for the Secondary Prevention of Cardiovascular Disease in the Emilia-Romagna region (ALLEPRE) is a multicenter, randomized, controlled trial designed to compare the effects of a structured nurse-coordinated intensive intervention on long-term outcomes and risk profiles after an acute coronary syndrome with those of the standard of care. All of the patients randomized to the intervention group take part in 9 one-to-one sessions with an experienced nurse from the participating centers with the aim at promoting healthy lifestyles, reducing risk factors, and increasing adherence to medication over a mean period of 5 years. The primary clinical end point is the reduction in the risk of the 5-year occurrence of major adverse events (a composite of cardiovascular mortality, nonfatal reinfarction, and nonfatal stroke). The primary surrogate end point is the achievement of prespecified targets relating to classical risk factors, lifestyle modifications, and adherence to pharmacological therapy after 2 years of follow-up.

“Could I return to my life?” Integrated Narrative Nursing Model in Education (INNE)

Background and aim: The Integrated Narrative Nursing Model (INNM) is an approach that integrates the qualitative methodology typical of the human sciences, with the quantitative methodology more often associated with the natural sciences. This complex model, which combines a focus on narrative with quantitative measures, has recently been effectively applied to the assessment of chronic patients. In this study, the model is applied to the planning phase of education (Integrated Narrative Nursing Education, INNE), and proves to be a valid instrument for the promotion of the current educational paradigm that is centered on the engagement of both the patient and the caregiver in their own path of care. The aim of this study is therefore to describe the nurse’s strategy in the planning of an educational intervention by using the INNE model. Methods: The case of a 70-year-old woman with pulmonary neoplasm is described at her first admission to Hospice. Each step conducted by the reference nurse, who uses INNE to record the nurse-patient narrative and collect subsequent questionnaires in order to create a shared educational plan, is also described. Results: The information collected was submitted, starting from a grounded methodology to the following four levels of analysis: I. Needs Assessment, II. Narrative Diagnosis, III. Quantitative Outcome, IV. Integrated Outcome. Step IV, which is derived from the integration of all levels of analysis, allows a nurse to define, even graphically, the conceptual map of a patient’s needs, resources and perspectives, in a completely tailored manner. Conclusion: The INNE model offers a valid methodological support for the professional who intends to educate the patient through an inter-subjective and engaged pathway, between the professional, their patient and the socio-relational context. It is a matter of adopting a complex vision that combines processes and methods that require a steady scientific basis and advanced methodological expertise with active listening and empathy – skills which require emotional intelligence.

The palliative care in dementia context: health professionals point of view about advantages and resistances

Background and aim: The 38/2010 law has expanded the provision of palliative care to patients with chronic-degenerative diseases. The ISTAT data show that 60% of the dying population is suffering from these diseases and could, according to the literature review, benefit particularly from such treatments. This study investigates the point of view of healthcare professionals, working in the context of dementia, regarding the knowledge and application of palliative care in the field of dementia. The focus is on the analysis of the resistance that may prevent the spread of palliative care, slowing the application of such care in different settings of terminality. Methods: The method is a qualitative phenomenological approach. A grid of semi-structured interviews was created and was proposed to 33 health workers (18 women) who work in Health Centres or in the Alzheimer Nucleus of Northern Italy. Results: Most operators think they understand palliative care, they believe it to be useful and necessary, but often only connect it with terminal illness. Others have a broader vision based on a more abstract and theoretical level than on real practical knowledge. A majority of respondents think that the spread of palliative care is slow and difficult because of the prevalence of the biomedical model that holistically and prejudicially hinders the introduction of new models. Conclusion: Appropriate training is the fundamental key to overcoming resistance. The professionals interviewed showed that they were aware of their lack of knowledge and declared that they had little competence in managing the complexity of long-term pathologies.

L’AIDS, una malattia come le altre? Rappresentazioni sociali dell’HIV/AIDS in un campione di soggetti adulti

Lo studio e parte di un progetto finanziato nel 2007 dall’ISS finalizzato a cogliere i motivi che possono favorire o ostacolare l’accesso al test per l’HIV. L’obiettivo dello studio presentato era quello di cogliere alcuni aspetti descrittivi delle rappresentazioni sociali dell’HIV e dell’AIDS attivando due piani della conoscenza: quello evocativo-emotivo e quello razionale- cognitivo. Un questionario semi-strutturato e stato somministrato a 307 partecipanti. I risultati mostrano come, da un punto di vista evocativo-emotivo, sia possibile cogliere una sostanziale equivalenza fra l’immagine dell’AIDS e quella dell’HIV. Queste rappresentazioni enfatizzano, da un lato, una concezione di AIDS/HIV basata prevalentemente su contenuti propri delle conoscenze scientifiche, dall’altro concezioni in cui prevale la dimensione valutativo-morale. E solo a seguito di un’attivazione mediata cognitivamente che i partecipanti riconoscono piu chiaramente la differenza fra HIV e AIDS. In questo caso, essi sono consapevoli che l’HIV non sia la stessa cosa dell’AIDS e che essere sieropositivi non equivalga ad essere malati di AIDS. Vengono discusse le implicazioni di tali risultati per le campagne preventive.