Piergiorgio Argentero

The utility of the Necessity—Concerns Framework in explaining treatment non-adherence in four chronic illness groups in Italy

Objective: To translate the Beliefs about Medicines Questionnaire (BMQ) into Italian and explore the utility of the Necessity—Concerns Framework in explaining treatment non-adherence in four chronic illness groups in Italy. Methods: 449 patients with chronic illness (depression, asthma, diabetes and cardiac disease) were approached at outpatient clinics in Turin and asked to complete Italian translations of the BMQ and the Medication Adherence Report Scale. Results: 427 patients consented to participate in the study. The BMQ demonstrated good internal consistency, with Cronbachs alphas of 0.78 (Necessity subscale) and 0.72 (Concerns subscale). Participants were divided into four attitudinal groups based on their responses to the BMQ: 59% Accepting (high Necessity, low Concerns), 29% ambivalent (high Necessity, high Concerns), 8% Indifferent (low Necessity, low Concerns) and 4% Skeptical (low Necessity, high Concerns). Those in the Accepting group reported the highest adherence to medication and those in the Skeptical group the lowest (p50.01). Discussion: The BMQ has been successfully translated and validated in Italian. This study provides support for the Necessity—Concerns Framework in explaining medication non-adherence in chronic illness. Interventions that address low perceived need for treatment and concerns about potential adverse effects of treatment are likely to facilitate optimal use of medicines.

When healthcare professionals cannot do the right thing: A systematic review of moral distress and its correlates

Moral distress occurs when professionals cannot carry out what they believe to be ethically appropriate actions. This review describes the publication trend on moral distress and explores its relationships with other constructs. A bibliometric analysis revealed that since 1984, 239 articles were published, with an increase after 2011. Most of them (71%) focused on nursing. Of the 239 articles, 17 empirical studies were systematically analyzed. Moral distress correlated with organizational environment (poor ethical climate and collaboration), professional attitudes (low work satisfaction and engagement), and psychological characteristics (low psychological empowerment and autonomy). Findings revealed that moral distress negatively affects clinicians’ wellbeing and job retention. Further studies should investigate protective psychological factors to develop preventive interventions.

Engagement and Vicarious Traumatization in rescue workers

PurposeThe aims of this study are (1) to investigate the incidence of the symptoms of Vicarious Traumatization in a group of rescue workers; (2) to explore some of the main predictors of Engagement and Vicarious Traumatization; and (3) to identify the individual and organizational factors able to improve the state of well-being of those working in the helping professions.MethodsA total of 782 rescue workers, involved in critical operations of various kinds in constant contact with traumatized subjects, were investigated applying the Maslach Burnout Inventory-General Scale (MBI-GS) and the Secondary Traumatic Stress Scale (STSS).ResultsThe post-traumatic symptoms most frequently reported were those of an intrusive nature. A partial overlap emerged between the predictors of Vicarious Traumatization and Engagement: if compared with social and demographic characteristics and with the degree of commitment required by the work, organizational variables would appear to have the greatest influence over the two constructs. A supportive working environment in particular favors Engagement, reducing the probability of developing Burnout.ConclusionsThe results confirm the hypotheses that Engagement and Vicarious Traumatization are primarily determined by organizational variables, and, particularly, by the level of job support.

Public Beliefs and Attitudes towards Depression in Italy: A National Survey

Background Previous studies have shown that attitudes towards depression may be influenced by country-specific social and cultural factors. A survey was carried out to collect beliefs on and attitudes toward depression in Italy, which has an established community-based mental health system. Methods A telephone survey was carried out in a probabilistic sample aged ≥15 years. A 20-item questionnaire was administered to explore knowledge of depression, stigma, causal beliefs, treatment preference, and help-seeking attitudes. Results Of the 1001 participants, 98% were aware of depression, and 62% had experienced it, either directly or indirectly. A widespread belief (75%) was that people suffering from depression should avoid talking about their problem. A minority of the sample viewed depression as a condition that should be managed without recourse to external help or a “socially dangerous” illness. Among perceived causes of depression, most respondents mentioned life stressors or physical strains. Psychologists were often indicated as an adequate source of professional help. Half of the sample believed that depression should be pharmacologically treated, but drugs were often seen as addictive. Referring to a primary care physician (PCP) was considered embarrassing; furthermore, many people thought that PCPs are too busy to treat patients suffering from depression. Conclusions Our findings indicate that depression is seen as a reaction to significant life events that should be overcome with the support of significant others or the help of health professionals (mainly psychologists). However, there are still barriers to the disclosure of depressive symptoms to PCPs, and concerns about the addictive effect of antidepressants. In the presence of a gap between people’s beliefs and what health professionals consider appropriate for the treatment of depression, a “shared decision making” approach to treatment selection should be adopted taking into account the patients’ preference for psychological interventions to ensure active compliance with effective treatments.

Organizational features of workplace and job engagement among Swiss healthcare workers.

The aim of this study was to determine the engagement level among healthcare workers in a Swiss hospital, identifying organizational predictors that could affect it. A four-part survey (a demographic questionnaire, Maslach Burnout Inventory-General Survey, Areas of Worklife Scale, and the General Health Questionnaire) was completed by 206 nurses and physicians. With regards to organizational predictors of job engagement, energy was primarily influenced by workload, involvement by values, and efficacy by reward. Moreover, we found that engagement might affect psychophysical health conditions: better health generally corresponds to higher levels of engagement. These results confirm that engagement is influenced by organizational variables and that engaged employees are generally more healthy and efficient. Therefore, interventions to minimize the impact of work stressors and to improve engagement are needed. Effective management of excessive workload, higher levels of autonomy, and greater job support are vital to limit psychological problems of healthcare workers.

Measuring Moral Distress Among Critical Care Clinicians : Validation and Psychometric Properties of the Italian Moral Distress Scale-Revised

Objectives: Moral distress is a common experience among critical care professionals, leading to frustration, withdrawal from patient care, and job abandonment. Most of the studies on moral distress have used the Moral Distress Scale or its revised version (Moral Distress Scale-Revised). However, these scales have never been validated through factor analysis. This article aims to explore the factorial structure of the Moral Distress Scale-Revised and develop a valid and reliable scale through factor analysis. Design: Validation study using a survey design. Setting: Eight medical-surgical ICUs in the north of Italy. Subjects: A total of 184 clinicians (64 physicians, 94 nurses, and 14 residents). Interventions: The Moral Distress Scale-Revised was translated into Italian and administered along with a measure of depression (Beck Depression Inventory-Second Edition) to establish convergent validity. Exploratory factor analysis was conducted to explore the Moral Distress Scale-Revised factorial structure. Items with low (less than or equal to 0.350) or multiple saturations were removed. The resulting model was tested through confirmatory factor analysis. Measurements and Main Results: The Italian Moral Distress Scale-Revised is composed of 14 items referring to four factors: futile care, poor teamwork, deceptive communication, and ethical misconduct. This model accounts for 59% of the total variance and presents a good fit with the data (root mean square error of approximation = 0.06; comparative fit index = 0.95; Tucker-Lewis index = 0.94; weighted root mean square residual = 0.65). The Italian Moral Distress Scale-Revised evinces good reliability (&agr; = 0.81) and moderately correlates with Beck Depression Inventory-Second Edition (r = 0.293; p < 0.001). No significant differences were found in the moral distress total score between physicians and nurses. However, nurses scored higher on futile care than physicians (t = 2.051; p = 0.042), whereas physicians scored higher on deceptive communication than nurses (t = 3.617; p < 0.001). Moral distress was higher for those clinicians considering to give up their position (t = 2.778; p = 0.006). Conclusions: The Italian Moral Distress Scale-Revised is a valid and reliable instrument to assess moral distress among critical care clinicians and develop tailored interventions addressing its different components. Further research could test the generalizability of its factorial structure in other cultures.

Proactive personality and training motivation among older workers: a mediational model of goal orientation

Purpose – This paper aims at examining the relationship between proactive personality and training motivation among older workers (aged over 55 years) in a context characterized by the growing ageing of the global population. First, the authors hypothesized that proactive personality predicts the motivation to learn among older workers and that this relationship is mediated by goal orientation. In particular, the authors hypothesized that learning goal orientation may mediate the relationship between proactive personality and learning motivation. Design/methodology/approach – The employees of an Italian bank completed an online questionnaire. AMOS 17 was used to carry out confirmatory factor analysis, and the SPSS macro was used to test the meditational model. Findings – The results confirmed both the hypotheses, demonstrating the influence of proactive personality on training motivation of older workers, as mediated by goal orientation and, in particular, by learning goal orientation. Practical implications – From an applicative point of view, this study may have implications for organizations that aim to increase the employability of older people by encouraging them to undertake more training. In particular, interventions aimed at increasing learning goal orientation could contribute in strengthening proactive personality that, in turn, may affect levels of training motivation. Originality/value – Even if proactive personality has already been found as a predictor of learning motivation, to the best of the authors’ knowledge, the present study demonstrates that the relationship between proactive personality and training motivation is mediated by goal orientation among older workers.

Return to work after coronary revascularization procedures and a patient’s job satisfaction: A prospective study

ObjectivesResearch into work reintegration following invasive cardiac procedures is limited. The aim of this prospective study was to explore predictors of job satisfaction among cardiac patients who have returned to work after cardiac rehabilitation (CR).Material and MethodsThe study population consisted of 90 cardiac patients who have recently been treated with coronary angioplasty or heart surgery. They were evaluated during their CR and 12 months after the discharge using validated self-report questionnaires measuring job satisfaction, work stress-related factors, emotional distress and illness perception. Information on socio-demographic, medical and occupational factors has also been collected.ResultsAfter adjusting for demographic, occupational and medical variables, baseline job satisfaction (p < 0.001), depression (p < 0.01) and ambition (p < 0.05) turned out to be independent, significant predictors of job satisfaction following return to work (RTW). Patients who had a partial RTW were more satisfied with their job than those who had a full RTW, controlling for baseline job satisfaction.ConclusionsThese findings recommend an early assessment of patients’ psychosocial work environment and emotional distress, with particular emphasis on job satisfaction and depressive symptoms, in order to promote satisfying and healthy RTW after cardiac interventions.

Il benessere nei vigili del fuoco volontari: la mindfulness come risorsa psicologica

Il principale obiettivo del presente studio e quello di indagare le condizioni di benessere occupazionale in un campione di vigili del fuoco volontari (N=99). In particolare, e stato verificato il ruolo di due specifiche risorse psicologiche, engagement e mindfulness, come fattori di protezione nei confronti del rischio di sviluppare esiti negativi di salute, in termini di sintomi post-traumatici e psicosomatici. Sono stati somministrati i seguenti questionari self-report: la Utrecht Work Engagement Scale-9; la Mindful Awareness Attention Scale; la Secondary Traumatic Stress Scale; il General Health Questionnaire-12. I risultati, ottenuti tramite modelli di regressione, evidenziano come la mindfulness possa essere considerata, tra quelli esaminati, l’unico significativo fattore protettivo nei confronti del rischio di sviluppare traumatizzazione vicaria e sintomi psicosomatici. Da un punto di vista applicativo, emerge l’importanza di progettare interventi finalizzati all’incremento della mindfulness, al fine di supportare i vigili del fuoco volontari nell’affrontare stressor lavorativi sia acuti sia cronici.

The Influence of Job Insecurity on Task and Contextual Performance: The Mediational Role of Overall Job Attitude

Job insecurity, that is the perceived threat of losing the current job, has become an increasing concern for organizations in the last decade mainly due to uncertain economic conditions and global competition. In this study, we intend to examine in particular the mechanisms through which job insecurity affects work performance, a criterion of central interest to management scholars. Drawing on the compatibility principle in attitude theory, we proposed that overall job attitude (job satisfaction and affective commitment) predicts behavioural criteria in response to job insecurity. In particular, relying on social exchange theory and rational choice theory two predictions were compared: job insecurity can be an harmful stressor with negative strain reactions (behavioural withdrawal, low performance) or a challenge stressor that motivates employees to engage actively in actions coping with the threat (higher performance). A sample of 570 Italian employees were used to test the hypotheses derived from our framework. Results from structural equations provided support for the social exchange model, showing the negative influence of job insecurity (as hindrance stressor) on task and contextual performance, i.e., in-role and extra-role behaviours.