Lorenza Garrino

Dealing with the patient’s body in nursing: nurses’ ambiguous experience in clinical practice

The core of nursing in western countries is interaction with the patient and with his/her body in particular. As all nursing practices revolve around caring for the patients body, nurses need to understand the frailty of the body, the intimacy surrounding it, the story it tells, as well as the discomfort and difficulties both illness and close contact can generate in the nurse-patient relationship. With this study, we wanted to explore the ward experiences of a small group of nurses in their day-to-day interaction with patients and their bodies, to highlight their perceptions and possible difficulties in providing care. We collected qualitative data from in-depth interviews with 14 nurses working in departments of general internal medicine, neurology, and geriatrics. The interviews were conducted between April and June 2006 and interpreted using an interpretive phenomenological approach. Analysis of the interview transcripts revealed that while the nurses recognize the centrality of the body in nursing, they also expressed a certain ambiguity toward it: being able to improve a patients well-being through attentive care to the body is a major source of job satisfaction, but various coping and defense strategies are deployed to overcome care-giving situations that elicit avoidance or refusal reactions to the patients body.

Biofield Therapies and Cancer-Related Symptoms: A Review

Patients with cancer can experience several treatment-related symptoms, and conventional care focuses primarily on cure and survival without a holistic approach to disease. Subsequently, an increasing number of patients are accustomed to complementary modalities to improve well-being. Biofield therapies (BTs) are complementary and alternative medicine (CAM) modalities based on the philosophy that humans have an energetic dimension. Physical and psychological symptoms may cause imbalance, and BTs are believed to balance disturbance in the energy field. This article provides a study review of the main BTs (i.e., therapeutic touch, healing touch, and Reiki) in the treatment of cancer-related symptoms. Although BTs are among the most ancient healing practices, data on their effectiveness are poor and additional multicenter research with larger samples are necessary. BTs may eventually become an autonomous field of nursing activity and allow professionals to build a relationship with the patient, thereby improving motivation. The idea that this method can be self-managed and may effectively reduce pain for patients with cancer can improve satisfaction challenges experienced by the current healthcare system.

Living With and Treating Rare Diseases Experiences of Patients and Professional Health Care Providers

We explored the experiences of illness of patients suffering from rare diseases and of the health professionals who care for them at the Center for the Interregional Coordination of Rare Diseases of Piedmont and Valle d’Aosta in Italy. The research was carried out between 2010 and 2011. We collected qualitative data from 22 patients and 12 health professional health care providers. The interviews were analyzed using the Colaizzi phenomenological approach. We identified five themes from the narratives of the patient participants—dealing with disease development, living with the disease, everyday living, relating to others, and relations with health care providers—and four themes from the professional health care participants—dealing with the disease, dealing with expectations, building relationships, and being operators in the context. The study has raised awareness about the issue of rare diseases and it provides some useful considerations for improving services.

Adherence to treatment in patient with severe cancer pain: A qualitative enquiry through illness narratives

PURPOSE Pain is a common symptom in cancer patients and often the most tangible sign of disease they and their families perceive. Despite currently available treatments, cancer pain frequently remains underrated and undertreated because of lack of adherence to the prescribed drug regimen. With this study we sought to identify elements that could facilitate pain management by exploring through narrative interviews the lived experiences of patients with severe chronic cancer pain in relation to their adherence to pain therapy. METHOD A purposive sample of 18 cancer patients, treated at the Centre for Oncology and Haematology (COES), City Hospital for Health and Science, Turin, were interviewed. The interview contents were analysed using a qualitative phenomenological methodology as described by Giorgi. RESULTS Three themes emerged from analysis of the interview transcripts: the significance of pain in subjective experience; the experience of being a patient pursuing a care pathway and the importance attributed to pain therapy. Factors facilitating adherence included the perception of the physical and psychological benefits of having and following a pain medications plan, subjective self-efficacy in pain control, and trust in the healthcare team. Barriers to adherence were negative attitudes toward opioid analgesic therapy, debilitating drug side effects, and denial of pain as a tangible sign of disease. CONCLUSION Probing into the significance of the pain experience and its treatment through these narrative interviews revealed several core constituents of adherence. Healthcare providers can use this better understanding to build a trusting relationship with patients and foster adherence to treatment throughout the care pathway.

The effectiveness of the quality program Pac-IficO to improve pain management in hospitalized cancer patients: a before-after cluster phase II trial

BackgroundCancer-related pain continues to be a major healthcare issue worldwide. Despite the availability of effective analgesic drugs, published guidelines and educational programs for Health Care Professionals (HCPs) the symptom is still under-diagnosed and its treatment is not appropriate in many patients. The objective of the study is to evaluate the efficacy of the Pac-IFicO programme in improving the quality of pain management in hospitalised cancer patients.Methods/designThis is a before-after cluster phase II study. After the before assessment, the experimental intervention – the Pac-IFicO programme – will be implemented in ten medicine, oncology and respiratory disease hospital wards. The same assessment will be repeated after the completion of the intervention. The Pac-IFicO programme is a complex intervention with multiple components. It includes focus group with ward professionals for identifying possible local obstacles to optimal pain control, informative material for the patients, an educational program performed through guides from the wards, and an organisational intervention to the ward. The primary end-point of the study is the proportion of cancer patients with severe pain. Secondary end-points include opioids administered in the wards, knowledge in pain management, and quality of pain management. We plan to recruit about 500 cancer patients. This sample size should be sufficient, after appropriate statistical adjustments for clustering, to detect an absolute decrease in the primary end-point from 20% to 9%.DiscussionThis trial is aimed at exploring with an experimental approach the efficacy of a new quality improvement educational intervention.Trial registrationClinicalTrials.gov: NCT02035098

Caring for Dying Patient and Their Families: The Lived Experiences of Nursing Students in Italy

Background: The literature from recent decades persistently suggests that nurses are not adequately trained in caring for the dying. Numerous studies call for enhanced education in end-of-life care. Objective: To explore student nurses’ experience of caring for dying persons and their families and how this experience was influenced by their undergraduate education, with a view to improving end-of-life training. Methods: Narrative interviews were administered to a purposive sample of 18 undergraduate students at Turin University’s School of Nursing and analyzed following Giorgi’s qualitative phenomenological methodology. Results: The students’ accounts featured 4 main themes: emotions and feelings, reactions and coping strategies, growth in personal and professional awareness, and the professional nursing model. Students reporting positive experience of end-of-life care in clinical settings displayed the expected learning outcomes for undergraduate nursing education. Conclusion: This study’s strength lies in the fact that it draws on student nurses’ lived experience to assess training in end-of-life care. It confirms the need to invest in targeted end-of-life education and support for nursing students.

Adaptation and validation of the Caregiver Burden Inventory in Spinal Cord Injuries (CBI-SCI)

DesignValidation cross-sectional study.ObjectivesEven though caregiver burden (CB) represents a well-recognised concern among caregivers of people with a spinal cord injury (SCI), there are no specific questionnaires designed for its evaluation. This study aimed to assess the psychometric properties of the Caregiver Burden Inventory in Spinal Cord Injury (CBI-SCI), which was modified from its original version, and specifically its construct and reliability.SettingMulticentre study in four urban spinal units across Italy. The CBI-SCI was administered to family caregivers in outpatient clinics.MethodsCBI-SCI was administered in a toolset composed of a sociodemographic questionnaire, the Family Strain Questionnaire-Short Form (FSQ-SF), the Short Form-36 (SF-36), and the Modified Barthel Index (MBI). The CBI-SCI construct validity was assessed through an exploratory factor analysis. The internal consistency of the questionnaire was examined using Cronbach’s alpha (α) coefficient for the total scale and its subscales. Concurrent validity was evaluated performing Pearson’s correlation coefficient with all instruments included in the toolset.ResultsThe CBI-SCI was administered to 176 participants from February 2016 to September 2017. Factor analysis highlighted the five-factored structure of the questionnaire. The total scale Cronbach’s α was 0.91 (p < 0.001). All the five subscales of CBI-SCI showed an acceptable internal consistency, ranging from 0.76 to 0.91 (p < 0.001). Pearson’s correlation coefficients of the CBI-SCI with all the administered instruments were statistically significant (p < 0.001), showing congruent relations.ConclusionThe CBI-SCI, due to its validity and reliability, may represent a valuable instrument to evaluate the CB longitudinally in SCI.

Descrizione del ruolo e delle competenze percepite dai tutor clinici del Corso di Laurea in Infermieristica di Torino: studio osservazionale

Diverse sono le strategie formative finalizzate al miglioramento delle competenze tutoriali proposte nella formazione infermieristica. In questo studio e stato indagato il percepito relativamente a ruolo e competenze esercitate dai tutor clinici, tramite un questionario. L’indagine mostra buoni livelli di competenza percepita, con alcune variabilita nell’utilizzo delle strategie e dei dispositivi formativi.

Raccontami una storia: memoria di un’azione educativa. La narrazione delle esperienze come strumento di riflessione e formazione

Aim: Telling himself and others is a natural way that man has always organize their thinking in order to give a structure and order to the events and experiences; explore the meanings that students attach to their educational actions triggered in the context of life and in professional situations, giving meaning and value and interpret them allows you to get in touch with the complexity of the training process personally and professionally. Objective: Explore the meanings that students attach to their educational actions triggered in the context of life and in professional situations, giving meaning and value in relation to the complexity of the training process personally and professionally. Methods: We conducted a qualitative study approach with bottom-up narrative that used the tool of storytelling. In the teaching of Tutorial Teaching at the Specialistic Degree of Science in Nursing and Midwifery of Turin has been used a narrative tool to invite participants to explore the experiences related to their work education and training. Results: The narratives written by the students were twenty-five. The main plot is kind of epic-romantic: after a difficult start in which subjects feel inadequate to convey the teachings and values, they manage to find the right communication channel to deal with the obstacle winning spirit; aware that the path will be marked by many challenges but with mutual support, acts of kindness, selflessness and sharing, will be able to recognize themselves within an organizational context, to keep their memory and to share their knowledge. Conclusions: The narrative tool, through the memories, promotes the connection on an emotional level among students; attributing meaning to events and linking them to their own experience, with its successes and failures, students reinforce the value of reciprocity and reshape the contours of his new life in the contexts in which they live.

Educazione terapeutica ai malati oncologici: esperienza degli infermieri italiani

Introduction. Therapeutic patient’ education is a complex process requiring a proper level of communication between the patient and the healthcare professional. Nurses play a key role in providing the patients and their families with educational activities. Objective: This paper is the report of a study which investigates the experiences of some Italian nurses with regards to their role in therapeutic education to cancer patients. Methods: Qualitative research. Semi-structured interviews were carried out with 52 nurses working in different Local Health Service Units of two northern Italy regions: Piedmont and Valle d’Aosta. To identify categories and items arising from the data, the researchers used a qualitative content analysis. Results: The interview format was classified into six main categories: a) Patient education as daily care activity; b) Relevance of communication and dialogue for educational purposes; c) Relative usefulness of written information; d) Therapeutic education recording; e) Patients’ feedbacks as a tool for assessing therapeutic education; and f) Difficult communication. Conclusions: The experience of nurses in terms of their professional role in therapeutic education for cancer patients shows the steady presence of educational activities carried out in a non-planned way. This research confirms the need to launch educational interventions for nurses. Implications for Practice: It is essential to implement an action plan to promote opportunities of professional training in the field since among the most frequent reasons for project failure in therapeutic education is the lack of expert human resources