Lucia Zannini

The experience of patients undergoing awake craniotomy: in the patients' own words. A qualitative study.

Intraoperative mapping is a well-established and safe technique to maximize the excision of tumors involving the eloquent cortex while minimizing neurological damage. Although different techniques are used, very little has been documented about how the patients feel, what they think about, or how they approach this type of surgery without an anesthetic. Considering the inconsistency of literature, a phenomenology study was conducted with the purpose to describe the human experience of patients before, during, and immediately after awake craniotomy. Twenty-one patients were interviewed at length, both the evening before and the evening after surgery. Awake craniotomy is a complex and subjective experience, the behavioral patterns of the subjects interviewed can be attributed to the instinct of self-preservation, the ability to participate during the procedure helping the surgeon in avoiding brain damage; to be in control of the situation; and to reassure themselves and others. It is most important for a healthcare team to understand the patients experiences. Immediately before and after surgery, the patients seem to concentrate more on keeping their emotions in check and focus on the risk of subsequent defect or disability, rather than on the brain cancer and what it may imply on life. During the surgery, they become particularly involved in the task: they feel directly responsible for the results of surgery relating this to the effectiveness of collaboration with the neurosurgeons.

Giving bad news : a GPs’ narrative perspective

Abstract The purpose of this study was to explore GPs perspectives on giving bad news during consultations. To this end, 168 GPs were asked to recall, and record on the first page of a questionnaire, an occasion when they had given medically related bad news to a patient. The stories were analysed with a qualitative and interpretative approach. Two axes, each with a semantic polarity, were identified: a relational axis (semantic polarity: escape vs accompanying) and an ethical axis (semantic polarity: the doctors choice vs the patients choice). Furthermore, two main topics appeared to be common to almost all the narratives: the need to reassure the patient and the account of the doctors emotions. Two different relational patterns appear to be described by doctors. A substantial number of GPs implicitly describe a disease- or doctor-centred consultation: in these cases the physicians refer to signs and symptoms, diagnosis and treatments; they decide for themselves whether to tell the truth or not. On the other hand, a smaller number describe consultations that could be defined as patient centred: these doctors consider that their duty of care for the individual ill person is paramount and try to respect the patients right to decide. In both these relational patterns, GPs feel it is a fundamental professional duty to reassure the patient; furthermore, they feel the most difficult aspect is managing their own emotional responses.

How do healthcare professionals perceive themselves after a mentoring programme? A qualitative study based on the reflective exercise of ‘writing a letter to yourself’

AIMSnThis article is a report of a study of participants responses to a reflective practice exercise about a mentoring programme.nnnBACKGROUNDnParticipants opinions on mentoring programmes are considered a fundamental component of their evaluation. These opinions are commonly gathered through questionnaires, interviews and focus groups.nnnMETHODnAn 18-month, multi-professional, mentoring programme was started in 2000. About thirty participants (60% nurses) were involved each time in three consecutive classes. Participants learning achievements were assessed by short essays. Participants perception of themselves was evaluated during the last course (ended in 2008) by a reflective writing exercise: write a letter to yourself. A phenomenological-hermeneutic analysis was conducted on the 27 returned letters. The letters were inductively analysed, the resulting core concepts were labelled and then grouped into categories to identify the main themes.nnnFINDINGSnSix themes were identified: (1) the mentoring programme can be a strategy for career advancement and professional development, but (2) it was also a challenging experience that put participants to the test; (3) the mentoring programme taught not only how to mentor students, but also how to be a mentor; (4) mentoring is an in progress experience; (5) the mentoring programme was very positive for group processes and it created a web of professionals and (6) after the mentoring programme, many participants felt profoundly changed both professionally and personally.nnnCONCLUSIONSnMentoring is a profound relationship that can deeply change the mentee, and training to mentorship can affect the identity of the future mentor, as well.

Exploring the mother's perception of latching difficulty in the first days after birth: An interview study in an Italian hospital

OBJECTIVESnto explore Italian mothers perception of latching difficulty in the first days postpartum. Latching difficulty is the only qualitative item included in the Breastfeeding Assessment Score (BAS) that has proven to be a valid instrument to identify women at risk of early breast-feeding cessation.nnnDESIGN AND SETTINGna phenomenologic-hermeneutic study was conducted at the Mangiagalli Clinic, Milan, Italy.nnnPARTICIPANTSnfifteen women who received a BAS <8 (indicating an early breast-feeding cessation risk) were interviewed before discharge, and later by phone, for member checking.nnnFINDINGSnsix main themes emerged from the interviews: (1) Breast feeding can be difficult due to both the mother and newborn, and encountered problems are mainly physical. (2) Women have developed different strategies to overcome latching difficulties. (3) Early breast feeding, even if difficult, is mostly related to positive feelings. (4) Breast-feeding sustains the child-mother relationship. (5) Mothers have already developed constructive theories about human colostrum, breast milk and artificial milk. (6) Receiving integrated health-care support and education is fundamental to overcome early breast-feeding problems.nnnCONCLUSIONSnthe interviews suggest that although mothers experience difficulties during early breast feeding, positive feelings seem to prevail over the negative ones, and mothers have already developed strategies to overcome their latching problems. Receiving support is fundamental, but this must be consistent among health-care professionals.nnnIMPLICATIONS FOR PRACTICEnwhen evaluating the BAS item latching difficulty, midwives should consider that difficulties are primarily related to physical problems. Furthermore, to sustain lactation, mothers should be helped to elicit their experience of early breast feeding, as it can be extremely satisfying, even when difficulties in latching the babies occur.

[Validation of the Italian Clinical Learning Environment Instrument (SVIAT): study protocol].

UNLABELLEDn. Validation of the Italian Clinical Learning Environment Instrument (SVIAT): study protocol.nnnINTRODUCTIONnNursing students obtain most of their university credits in internship environments whose quality can affect their clinical learning. Several tools are available to measure the quality of the clinical learning environment (CLE) as perceived by students: these instruments developed in other countries, were validated in Italian but do not discriminate those CLEs capable (or not) to promote significant clinical learning.nnnAIMnTo validate an instrument to measure the capability of the CLE to generate clinical learning; the secondary aim is to describe the learning environments as perceived by nursing students according to individual course site and tutorial models adopted.nnnMETHODSnThe study will be developed in three phases: a) instrument development and pilot phase, b) validation of the psychometric properties of the instrument and c) description of the CLEs as perceived by the students including factors/item confirmed in the validation process. Expected outcomes. A large validation, with more than 8,000 participating students is expected; the construct under lying will be confirmed through exploratory and confirmatory factor analysis and will report high internal consistency; the instrument will report also a high test-retest and inter-rater reliability; in addition, the instrument will demonstrate predictive ability by discriminating those units able (or not) to activate effective learning processes.

Narratives, memorable cases and metaphors of night nursing: findings from an interpretative phenomenological study.

The aim of the study was to explore the experiences of night nurses. An interpretative phenomenological study was undertaken, and 35 nurses working in Italian medical, surgical and intensive care units were purposely recruited. Data were gathered in 2010 by semi-structured interviews, collecting nurses narratives, memorable cases and metaphors, aimed at summarising the essence of work as a nurse during the night. The experience of night nursing is based on four interconnected themes: (i) working in a state of alert, (ii) growing by expanding autonomy and responsibility, (iii) assuring sensitive surveillance and (iv) experiencing deep intimacy. Memorable episodes were polarised along (i) expected/unexpected events; (ii) positive/negative epilogues; and (iii) life/death issues. Many of the emergent metaphors described working during the night as being in the middle of a space where an apparent calm scene takes place, but unpredictable factors may suddenly change the order of events and the outcomes, creating chaos. Working during the night alerts nurses, who increase autonomy, expanding their role and assuming more responsibility with respect to that assumed during daily shifts. The nurses clinical reasoning is based on data they carefully listen to, and on the meaning that nurses give time by time to different noises and silence. While in the past a sense of companionships was reported, a loneliness or a neutral experience concerning the relationships with colleagues seems to prevail during night nursing. Working night shifts is a complex task, and specific training must be assured to students/novices.

The role of observational research in improving faculty lecturing skills: A qualitative study in an Italian dental school

Background: This pilot study is based on observational research of lecturing skills during the annual Oral Medicine course at the Milan Dentistry School. Aims: Our goals were to explore how teachers exhibited desirable lecturing skills, to observe how their attitudes and lecturing skills affected students’ attention and thereby learning, and to provide feedback. Method: We prepared a structured observational grid divided into four categories: explaining, questioning, visual aids, and lecturer attitude. The grid was filled in by a participant, nonactive researcher. Results: Two main types of lecture were observed: “traditional” and “interactive”. Both of these can result in a high level of attention among students. Among the categories, only “lecturer attitude” appeared to affect student attention. In particular, the skills of “speaking aloud” and “sustaining verbal communication with vocal inflection” appeared to have the greatest impact on lecturer attitude. The data were then presented blindly to the five lecturers, who were able to identify their own lesson. Conclusions: Our grid proved to be a valid instrument although it was very expensive. When integrated with other strategies for improving lecturing, such as student scoring, peer evaluation, and microteaching, observational research can be a cost-effective method to stimulate guided reflection and to improve the lecturing skills of faculty members.

Surviving Childhood Leukemia in a Latin Culture: An Explorative Study Based on Young Adults’ Written Narratives

This study investigated memories of childhood leukemia conveyed by survivors belonging to a Latin culture, exploring whether benefit findings was spontaneously reported, as by non-Latin survivors. Three hundred patients previously treated for leukemia were contacted by post/e-mail and asked to write freely about their illness experience. The 106 letters received were analyzed for narrative structure and content, according to a grounded theory approach. Participants expressed most of the themes conveyed by childhood cancer survivors in non-Latin countries, and benefit finding was spontaneously reported. To the latter, the usefulness of creating and maintaining personal narratives on cancer experience, sustained by health care professionals, is discussed.

L’assistenza infermieristica durante la notte : revisione narrativa della letteratura

Anche se il turno notturno copre ncirca un terzo dellassistenza ai pazienti ricoverati, e stata ndedicata sinora poca attenzione alle attivita eseguite ed ai nproblemi degli infermieri che lavorano di notte. Metodi. Sono nstate consultate le banche dati e riviste elettroniche (MEDLINE, nCINAHL) utilizzando le seguenti parole chiave: shift nworkers, nurses, night, nursing, assessment, night duty, per nesplorare le attivita eseguite di notte ed i vissuti di infermieri ne pazienti. Sono stati inclusi 23 studi. Risultati. Durante nla notte gli infermieri eseguono attivita pianificate e nnon pianificate. La funzione principale e la sorveglianza ed nil monitoraggio dei pazienti durante i giri notturni. Anche nse stressante dal punto di vista fisico, gli infermieri riconoscono nil valore del turno notturno perche hanno la completa nresponsabilita dei pazienti. La principale lamentela dei npazienti e sul rumore, che disturba il sonno. Conclusioni. nOccorre fare ricerca per studiare i turni notturni e definire nstandard per migliorare la qualita dellassistenza notturna

Enhanced Recovery After Surgery (ERAS®) multimodal programme as experienced by pancreatic surgery patients: Findings from an Italian qualitative study

BACKGROUNDnERAS has recently been implemented in pancreatic surgery settings, but there is little evidence regarding the effects as perceived by patients. Given the lack of the knowledge in the field, the aim of this study was to capture the experience of patients undergoing pancreatic surgery who received perioperative care based on the ERAS programme.nnnMETHODSnWe designed a qualitative study undertaken in the pancreatic surgery unit of San Raffaele Hospital in Milan, Italy. Twenty-two consecutive patients were invited to participate in the study and 13 patients were interviewed. Data was collected between March and December 2012 either through face-to-face or semi-structured telephone follow-up from three to six weeks after discharge. Data was analysed using the interpretative phenomenological approach.nnnRESULTSnPatients who underwent surgical pancreatic procedures and treated with ERAS programme reported experiences based on four themes: (1) Feeling prepared to face surgery, (2) Being actively inside or outside the programme, (3) Healing at home: the best setting, and (4) Perceiving the ordinary as extraordinary: reaching independence, once at home.nnnCONCLUSIONnAccording to the findings, uncomplicated pancreatic surgery patients may benefit from the ERAS programme. Preadmission counselling should help patients to assume an active role. Once the patient returns home, the availability of a caregiver should be thoroughly assessed to guarantee the support needed by patients to successfully complete the ERAS(programme. Surgery and nursing staff should carefully monitor patients and suggest whether they continue, interrupt, or individualise the scheduled ERAS interventions in accordance with a patients clinical condition and preferred personal timing.