[Self-compassion and secondary traumatization: results of an observational study carried out in Covid hospital ordinary units]. / Self-compassion e traumatizzazione secondaria: risultati di uno studio osservazionale condotto in reparti ordinari COVID.

SUMMARY: Introduction. The relationship between Self-compassion and Post-Traumatic Stress Disorder does not appear to be investigated among health professionals, in the period of the ongoing COVID-19 pandemic. This study intends to examine it in a hospital unit, where ordinary units have been converted into units for those infected with the virus. Materials and Methods. The cross-sectional observational study was carried out at a hospital in Central Italy, proposing the self-administration of the IES-R Impact Event Stress-Revised and SCS Self-Compassion Scale to nurses. The data were collected, from 10 January to 10 February 2021, on paper; the forms were handed over to the nursing coordinators, who distributed them to the operators. Results. The convenience sample includes 60 nurses, mainly female (76.7%), with an average age of 43 years (sd = 11.9) and with a presence in service of 14.6 years (sd = 11.7). The average level on the total scale Self-compassion 3.02 (ds = 1.26); the average level of Post-Traumatic Stress Disorder is 2.4 (sd = 0.64); there is a direct correlation between the common Humanity dimension and the intrusive symptoms and the mean total level of PTSD and between the Self-Criticism dimension and the avoidance symptoms. Discussion and Conclusion. The sample shows a good level in the positive dimensions of Self-compassion and low secondary Post-Traumatic Stress Disorder. Further studies, transversal, on specific more representative samples of nurses, and longitudinal, are required to evaluate the relationship between the two variables, even in the period of COVID-19. The acquisition of a personal attitude is recommended, which increases the positive dimension of Self-compassion, for one's personal well-being in the helping profession.

Factors that condition the spontaneous reporting of adverse drug reactions among nurses: an integrative review.

AIM: To describe and synthesise previous research on factors conditioning the spontaneous reporting of adverse drug reactions among nurses. BACKGROUND: Spontaneous reports of adverse drug reactions by health-care providers, are a main instrument for the continuous evaluation of the risk-benefit ratio of every drug. Under-reporting of adverse drug reactions by all health-care providers, in particular by nurses, is a major limitation to this system. EVALUATION: An integrated review of the literature was conducted using MEDLINE, CINAHL, Embase, Scopus databases and Google Scholar. After evaluation for appropriateness related to inclusion/exclusion criteria, 16 studies were included in the final analysis and synthesis. KEY ISSUES: Two factors emerged from the study: (1) intrinsic factors related to nurses' knowledge and attitudes; (2) extrinsic factors related to nurses' interaction with health-care organisations and to the relationship between nurses and physicians. Nurses' attitudes that hinder reporting include ignorance, insecurity, fear and lethargy. CONCLUSIONS: Nurses are not fully aware of their role in adverse drug reaction reporting. Nurses must acquire greater knowledge to implement specific skills into their daily clinical practice. IMPLICATIONS FOR NURSING MANAGEMENT: To improve nurses' reporting of adverse drug reactions, it is necessary to develop management approaches that modify both intrinsic and extrinsic factors.

Long-Term Effectiveness of an E-Learning Program in Improving Health Care Professionals' Attitudes and Practices on Breastfeeding: A 1-Year Follow-Up Study.

Introduction: In-service continuing education offers a unique opportunity to improve knowledge, skills, attitudes, and practices regarding breastfeeding. It has been shown that an online approach to in-service education is effective at improving practices and attitudes toward breastfeeding among health care professionals (HCPs) in the short term. Aim: To evaluate the long-term effectiveness of an online national program on infant nutrition for HCPs. Materials and Methods: We carried out a follow-up study using data from three time points: T0 (pretraining), T1 (immediately post-training), and T2 (1 year after training). The differences between T0, T1, and T2 were tested using repeated-measures ANOVA. Statistical analysis was performed using SPSS version 22.0. Results: The final sample was comprised of 4,582 participants, mainly women (87.4%). At T2, we observed a worsening of attitudes and practices (APs) as compared with T1, though those APs almost never reached the low levels observed at T0. The greatest changes over time concerned the use of drugs during breastfeeding (T0: 3.00 ± 1.33 versus T1: 1.74 ± 1.03 versus T2: 2.64 ± 1.35) and dietary restriction (T0: 2.77 ± 1.35 versus T1: 1.76 ± 1.12 versus T2: 2.57 ± 1.35). The differences between the means of APs at T0, T1, and T2 were significant (p < 0.01). Conclusion: This e-learning program was effective in improving APs regarding the protection, promotion, and support of breastfeeding. The improvement, higher immediately after training, decreased over time. E-learning project managers should propose strategies to facilitate the retention of knowledge related to the main training objectives.

E-learning to Improve Healthcare Professionals' Attitudes and Practices on Breastfeeding.

INTRODUCTION: Breastfeeding training has a crucial role in increasing healthcare professionals' attitudes and in improving professional support for breastfeeding. The collaboration between the Italian National Institute of Health, UNICEF, and the Local Health Authority of Milan has led to the development of an online course on lactation and infant feeding practices. AIM: To assess if the course was effective in improving healthcare professionals' attitudes and practices (APs). METHODS: We conducted a prestudy-poststudy, comparing users' APs before (T0) and after (T1) the course through a 20-item questionnaire. Changes in APs were analyzed using paired t-test. Lower mean differences indicated more positive attitudes and more frequent professional practices favoring breastfeeding. Statistical analysis was carried out using SPSS version 15.0. RESULTS: The course had 26,009 registrants and was successfully completed by 91.3% of users. The dropout rate was 8.7%. The final cohort was composed of 15,004 participants. The course improved attitudes, while minor changes were observed on practices (p < 0.05). Mean total attitude scores were 2.4 at T0 and 1.9 at T1, while mean total practice scores were 2.2 and 2.1, respectively. The main effects regarded the use of medications during breastfeeding (3.02 ± 1.29 at T0 and 1.88 ± 1.08 at T1) and the self-reported compliance with the International Code of Marketing of Breast Milk Substitutes (2.29 ± 1.24 at T0, 2.03 ± 1.21 at T1). CONCLUSION: The noninteractive, high-coverage e-learning approach seems to be a useful tool for improving awareness and positive attitudes toward breastfeeding among healthcare professionals.

Medications, "Natural" Products, and Pharmacovigilance during Breastfeeding: A Mixed-Methods Study on Women's Opinions.

BACKGROUND: In cases of pharmacotherapy, mothers are confronted with the dilemma of breastfeeding and giving up the medication or discontinuing breastfeeding in order to take the drug, thus avoiding any potential risk for the infants. OBJECTIVE: This study aimed to describe women's opinions on the use of medications and "natural" products during breastfeeding, pharmacovigilance and phytosurveillance, and the management of breastfeeding. METHODS: This was a mixed-methods study with a sequential exploratory design. In the first qualitative phase, we conducted focus groups and in-depth interviews with 25 mothers attending community services. Coding and content analysis were carried out using NVivo9. We identified 4 main categories, and on this basis, we built a questionnaire administered to 248 pregnant women and new mothers attending 2 third-level hospitals. We conducted a descriptive and bivariate analysis (P ≤ .05) using Epi-Info v.7. RESULTS: Women show 3 main attitudes: (1) to discontinue breastfeeding in order to take the medication, (2) to "endure the pain," or (3) to use so-called natural products, perceived safer than drugs. Women expressing an "endure the pain" opinion and women who considered natural products to be safer than medications had a higher probability of knowing that babies should be exclusively breastfed for the first 6 months (respectively, odds ratio [OR] = 2.24; 95% confidence interval [CI], 1.26-3.97; OR = 4.77; 95% CI, 2.56-8.88). CONCLUSION: In the dilemma of the mothers needing drug treatment, health professionals play a crucial role. They should convey evidence-based information on the compatibility of drugs with breastfeeding and provide individualized treatments, tailored to the single mother-baby case.

Nurses' reporting of suspect adverse drug reactions: a mixed-methods study.

OBJECTIVE: To assess nurses' knowledge, attitudes and practices (KAP) towards spontaneous adverse drug reactions (ADRs) reporting. METHODS: The mixed-method study was conducted following a quanti-qualitative sequential approach: a survey (using a KAP questionnaire) followed by a focus group was performed. RESULTS: In the quantitative findings, responders (570 hospital nurses) declared that they were unaware of the pharmacovigilance system (58.1%, n = 331); where to find the reporting form (63.5%, n = 362); how fill it in (71.6%, n = 408); to whom and how to send it (65.8%, n = 375). Only 11.1% (n = 63) reported ADRs. The qualitative phase supported the quantitative findings and provided new information about other factors that condition ADR reporting: misinterpretation of the meaning of "reporting", unawareness of nurses' autonomy in ADR reporting and fear of consequences after ADR reporting. CONCLUSION: Nurses are not fully aware of their role in ADR reporting. We recommend educational interventions and management changes.

The Difficulties in Antihypertensive Drug Prescription During Lactation: Is the Information Consistent?

INTRODUCTION: The lack of consistent official information on the use of medications during lactation is probably one of the main reasons leading to an excess of prudence, based on presumption of risk rather than on evidence. The objective of this study was to compare the level of agreement between different official sources available to doctors and women on the use of medications during lactation. MATERIALS AND METHODS: Sources of information included governmental regulatory agencies (RAs) and scientific sources (SS). The package leaflets (PLs) and summaries of product characteristics (SPCs) were retrieved from online databases of the European Union and U.S. RAs. Among the SS, the latest edition of the book Medications and Mothers' Milk by Hale and Rowe and the LactMed database were selected. Information about the use of 11 antihypertensive medications during breastfeeding was analyzed. RESULTS: The PLs and SPCs report a higher risk profile than the one expressed by SS, and they often suggest the interruption of lactation even for compatible medications. CONCLUSIONS: Health professionals should be supported by official, accurate, comprehensive, and consistent information about maternally ingested medication and breastfeeding management to facilitate proper decision-making.