Giovanna Artioli

The role of professional and team commitments in nurse–physician collaboration

AIM To analyse the effect of both professional and care unit commitments on attitudes towards interprofessional collaboration between nurses and physicians. BACKGROUND The effects of both professional and care unit commitment on inter-professional collaboration have not been taken into account together, and previous research has analysed only one profession at a time, neglecting the nurse-physician comparison. METHOD A cross-sectional survey of 138 physicians and 359 nurses was used. RESULTS For physicians, professional commitment decreased attitudes towards interprofessional collaboration whereas care unit commitment had a positive influence. Conversely, for nurses, the professional commitment had a significant positive effect on attitudes towards interprofessional collaboration whereas care unit commitment had no significant effect. CONCLUSION Intergroup relations affect the extent to which nurses and physicians are inclined to engage in interprofessional collaboration. Professional and care unit commitments had different effects on attitude toward the inter-professional collaboration of nurses and physicians. IMPLICATION FOR NURSING MANAGEMENT Inter-professional collaboration is affected by the relationship between physicians and nurse at the professional group level. Managers who want to change and improve inter-professional collaboration should pay close attention to the interplay between changes they are introducing and well-established identities and practices between professionals.

The public perception of nurses. An Italian cross-sectional study

Abstract Background and aim: The public opinion about the nursing profession can influence health service users, the work performance of nurses, health policies, and the choice to become a nurse. The aim of this study was to investigate the perception of nursing in modern society. Methods: A cross-sectional study was conducted with a sample of 398 participants belonging to four population groups: Very Important Persons (VIPs), general population, upper-school students, and nursing students. This phenomenon was assessed through the Nursing Attitude Questionnaire (NAQ) and several additional items. Results: The results highlighted that general population and nursing students showed a significantly better image of nurses than did VIPs and upper-school students. Conclusions: Overall, the sample acknowledged nurses fundamental connotations and functions, although secondary school students poorly recognized nurses’ professional autonomy, and VIPs’ judgements seemed to be more sensitive to the image of nurses given by mass media.

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.

The lived experience of parents whose children discharged to home after cardiac surgery for congenital heart disease

Background: Congenital Heart Diseases (CHDs) afflicting children are estimated in 8 per 1000 live births. Recent advances in surgery and medical treatments allowed an improvement in survival rates leading to changes in diseases management as chronic conditions. Parents involvement during clinical pathways is considered an essential component of care, but frequently they experience stress and anxiety conditions during the care path. These feelings are typical of the pre and peri-operative period, however they don’t disappear easily and sometimes they can increase after hospital discharge, affecting the family environment and its behaviors. Aim of the work: The purpose of this qualitative study is to examine the lived experience of parents during the time just after their children return home from hospital after undergoing surgery for CHD. Methods: Parents were enrolled and interviewed as a prepositive sampling until concept saturation using Cohen’s phenomenology approach. A quantitative approach was also applied using SF-12 questionnaire. The study was conducted in two Italian hospitals: the Pediatric Heart Surgery Center of the Fondazione Toscana G. Monasterio Institute in Massa and the Pediatric Cardiac Surgery Center of the Federico II University Hospital in Naples. Results: The main themes emerged after the analysis were “happiness and uncertainty”; “chronic psychophysical fatigue”; “the rediscovery of a strong link with health care professionals”. Conclusions: Fully understand the life experience of these families will allow the implementation of targeted health interventions through the implementation of shared strategies and tools to reduce families and children discomfort after hospital discharge.

“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.

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

Background and aim of the work: Cancer-related fatigue (CRF) is one of the most common symptoms experienced by cancer patients (CPs) and negatively affects quality of life. Although CRF is frequently experienced, it is often underreported, underdiagnosed and undertreated. The objectives of this study were to evaluate the level of fatigue in patients with pancreatic cancer undergoing chemotherapy and to analyse its correlation with patients’ demographic and clinical variables. Methods: A cross-sectional observational study was implemented in the Oncology Day Hospital of a Northern Italian hospital. A sample of 48 patients receiving chemotherapy were evaluated through the Brief Fatigue Inventory Italian version (BFI-I) between 1 May and 12 October 2016. Data were statistically analysed. Results: Most of our patients (94%) experienced fatigue. Women as well as patients with an age ≥65 years reported more fatigue. Anemia, pain and a weight loss of over 16 kg in the last 6 months were significantly related to the perception of fatigue. Regarding life habits, smoking was related to high global score of BFI-I. Conclusions: In accordance with literature, our study suggests that fatigue is a frequent symptom influenced by many constitutional, clinical and environmental factors. Our results highlight the need for an early and regular evaluation of fatigue among cancer patients, in order to implement all those pharmacological and non-pharmacological interventions with proven efficacy in attenuating this symptom.

Effectiveness of support groups to improve the quality of life of people with idiopathic pulmonary fibrosis a pre-post test pilot study

Background and aim of the work: Idiopathic Pulmonary Fibrosis (IPF) is an interstitial lung disease, which progressively leads to severe disability and death. The average survival expectancy, ranges from 3 to 5 years from diagnosis, and the available medicines do not lead to healing. The progression of IPF lead to a decline in forced vital capacity (FVC), dyspnea, cough, continuous sleep interruptions, resulting in increased fatigue and deteriorating quality of life (QOL), progressive limitation of daily life activities and social life, with repercussions on psychological and emotional well-being, aggravated by anxiety, loss of sense of self-confidence and depression. The aim of the study was to evaluate how the support groups influence the psychological well-being of people with IPF and their family members. Methods: A pre-post test pilot study with a single group was conducted in a university hospital in Northern Italy, a centre for diagnosis and treatment of IPF. A support group was conducted by a nurse and entirely dedicated to people with IPF and their family members. Eighteen participants were enrolled in the support group. To measure the changes in psychological well-being was chosen the Psychological General Well-Being Index (PGWBI), which was administered at the time of enrolment to the group and after six months of attendance. Results: Even if the effect is not statistically significant, the paired t-test showed that the participation in a support group conducted by a nurse, could increase psychological well-being in all of its dimensions: anxiety, depression, positivity, self-control, overall health, and vitality. Conclusions: Despite the null association, the increase of psychological well-being, closely related to the quality of life, indicates the need to further studies. In the absence of effective pharmacological treatments for healing, the support groups represent an opportunity for the wellbeing of the IPF patients and their caregivers.

Expressive writing. A tool to help health workers. Research project on the benefits of expressive writing

Abstract Background and Aims: Numerous studies in the international literature hold that expressive writing is a useful tool to take care of the person as a whole. It gives voice to emotions, moods and intimate thoughts of patients, as well as caregivers and family members. The reference model is based on Pennebaker’s theory (2004), which posits that expressing our deeper thoughts and feelings can result in significant health benefits in the short and long term. Studies over the past 25 years have shown that expressive writing, that is, simple writing on deeper thoughts and emotional sensations, is a useful tool to alleviate both physical and psychological symptoms. This research seeks to ascertain whether and how expressive writing has an impact on work satisfaction, coping strategies, and relational communication satisfaction of health practitioners. Methods: a comparison was made between the expressive writing and neutral writing of two randomized groups of health care professionals. A group of 66 healthcare professionals participated in this study. They were evaluated pre- and post-intervention using several scales and an ad hoc questionnaire, with one-month follow-up. Results: After analyzing the texts, as in Pennebaker’s studies, there was a reduction of words with negative emotion in the course of writing sessions. Discussion: Expressive writing has a positive impact on adaptive coping strategies and work relational communication satisfaction. It also can facilitate the clarification and solution of various problems, increase cognitive abilities, and promote social interactions.