Experiential training course on spirituality for multidisciplinary palliative care teams in a hospital setting: a feasibility study.

BACKGROUND: There is widespread agreement about the importance of spiritual training programs (STPs) for healthcare professionals caring for cancer patients, and that reflecting on one's spirituality is the first step. Health professionals (HPs) working in hospitals must develop this dimension to guarantee the quality of life as well as spiritual and emotional support. In this paper, we propose a possible training format for hospital professionals and assess its implementation. METHODS: This is a phase 0-I study that follows the Medical Research Council (MRC) framework. The program was implemented for hospital palliative care specialists. The program included one theory lesson, three spiritual interactions, four pieces of reflective writing, and two individual follow-up sessions for each participant. The evaluation was performed quantitatively according to the MRC framework and qualitatively according to Moore's framework with data triangulation from interviews, reflective writings, and indicators. RESULTS: The program was implemented for palliative care physicians, nurses, psychologists, and bioethicists according to the plan, and the program components were highly appreciated by the participants. The results suggest the feasibility of a training course with some corrections, regarding both the components of the training and organizational issues. The qualitative analysis confirmed a shift in the meaning of the themes we identified. The trainees went from intrapersonal spirituality to interpersonal spirituality (engagement with the other person's spirituality, acknowledging their unique spiritual and cultural worldviews, beliefs, and practices), with colleagues, patients, and people close to them. The training had an impact on Moore's Level 3b. CONCLUSIONS: Spiritual training for hospital professionals working in palliative care is feasible. Having time dedicated to spirituality and the ongoing mentorship of spiritual care professionals were suggested as key elements. The next step is increasing awareness of spirituality from our hospital reality and creating a stable competent group (with nurses, chaplains, nuns, counselors, etc.) with the support of the management.

Taking care. Nursing towards Covid-19 patients during the pandemic emergency in Italy: a qualitative study.

BACKGROUND AND AIM OF THE STUDY: The Covid-19 pandemic has clearly impacted the Italian healthcare system. The growing number of patients in critical conditions has required a reorganization of the hospitals wards and of other healthcare structures, by changing the working routines of health professionals. The aim of the study is to explore if and how the nursing care towards Covid-19 positive patients have changed during the pandemic. METHOD: Qualitative study with a phenomenological approach conducted through semi-structured interviews. Interviews have been carried out during the months of October and November 2020. Our research involved 21 nursing professionals attending post-graduate courses at the Department of Medicine and Surgery of the University of Parma (academic year 2019/2020) and who have worked during the pandemic period in health services structures and organizations. RESULTS: The interviews showed how, during the period of the pandemic emergency, the care relationship between nurses and patients has changed because of the priority given to clinical and technical practices, in some cases, "life-saving". This happened due to different factors such as the nurses' fear of being infected by the virus and the lack of a sufficient time to ensure an holistic and integrated approach towards an increasing number of patients in highly complex conditions. Thus, the dimension of caring has been consciously overshadowed. CONCLUSIONS: The health emergency that has hit Italy since the first months of 2020 has shown structural limits and gaps of public health policies, hospital settings and national health services organization that already existed in the pre-pandemic period. It also highlighted how, even before Covid-19, nursing was already in part denoted by a loss of caring, a missed nursing care.

Nurse's knowledge and perceptions on communicative hypnosis: an observational study.

Background Much evidence shows that hypnotic communication can have a pain-relieving effect and reduce complications such as anxiety, insomnia and depression. Whenever this technique was applied, the use of pharmaceuticals was reduced, there were less side effects, shorter hospitalization timesframes and lower treatment costs. Aim of the study Evaluate the knowledge and perceptions of nurses about hypnotic communication and the causes for which this technique is not frequently used. A secondary objective pointed to measuring the effectiveness of an educational event on hypnosis. Method The evaluation was done by administering an anonymous and voluntary survey, in a pre-test and post-test modality to nurses subscribed to a formative event on hypnotic communication organized by the Nursing Order, Province of Ravenna. Results 78 nurses participated in the study. The analysis of the pre-test results show a gap of knowledge regarding hypnotic communication. The main causes were found regarding the lack of use for hypnotic communication: stereotypes and prejudices related to this technique and insufficient university education. Conclusions The implementation of this technique, effective and efficient under various aspects, requires a preliminary creation of culture regarding this theme, capable of surpassing the stereotypes and resistances brought by a lack of theoretical elements.

Nursing spiritual assessment instruments in adult patients: a narrative literature review.

BACKGROUND AND AIM OF THE WORK: Spiritual care in nursing is a critical part of providing holistic care. Whilst patients might desire spiritual care and value the opportunities that nurses take to engage with them to meet their spiritual needs, research suggests that nurses do not consistently engage in spiritual care with their patients. To identify instruments available to nurses to assess spirituality in different patient groups and highlight the characteristics and psychometric properties of these instruments. METHOD: A narrative literature review of the relevant literature published after 2008 was carried out in CINAHL, PsycINFO, MEDLINE and Google scholar databases in October 2020. Narrative review synthesized key findings and grouped instruments into macro areas by content. RESULTS: After the screening, based on inclusion criteria, 31 articles were identified. 17 instruments were identified and divided into 4 macro areas: wellbeing (N = 4), attitude (N = 5) needs (N =6) and multiple domains (N = 2). CONCLUSIONS: This review enables an increased awareness of the variety of instruments available to aid spiritual care and therefore increase their use within nurse clinical practice. The widening of the patient group to be considered (i.e., non-oncological) may have a significant impact on the practice, causing professionals to reflect on the necessity to investigate spiritual needs even at an early stage of a disease process. Future studies should aim to test reliability and validity of existing instruments rather than develop further ones.

Evaluation of midwifery students' satisfaction with regards to clinical internship.

BACKGROUND AND AIM OF THE WORK: The clinical internship is fundamental for the training of the future socio-health professional. Through the practical activity, the student develops professional skills, critical thinking and decision-making ability, internalizing the complexity of the professional role. While in the nursing field there are several tools for assessing the clinical experience of students, in the obstetric field there is a lack of validated tools. Therefore, the purpose of this work was to investigate the perception of the students of the Degree Course in Midwifery regarding the internship experience. METHOD: The study was conducted at the obstetric clinical internship where students carry out practical activities and involved all the students of the Degree Course in Midwifery at the University of Modena and Reggio Emilia. The data were collected through an anonymous online questionnaire (Google Model), which was inspired by the nursing CLES + T, simplified and adapted to the obstetric field. RESULTS: In total, 54 students took part in the research (81.8% of all students enrolled in the degree program examined). They were mainly of Italian nationality (98.1%), women (94.4%), aged between 18-22 years (85.2%). In general, the third-year students were more satisfied with the internship experience than the second- and first-year students, most likely for having achieved a degree of autonomy of care, awareness and greater professional motivation.  Conclusions. The results indicate the need to periodically investigate the quality and satisfaction of the clinical internships to ensure increasingly effective obstetric training.

The Patient's Narrative Agenda as an assessment tool: the story of Robert, suffering from osteosarcoma.

BACKGROUND AND AIM OF THE WORK: To activate the participation of the person in his/her care path, the literature highlight the impact of the professional's ability to show a genuine interest in the problems brought by the patient and to recognize him/her as 'competent'. In these sense the narrative patient's agenda could be a useful relational tool, because is focused on the perception of patient experiences of his/her illness. Thus this study aims to analyze the usefulness of patient's narrative agenda during the assessment phase. METHOD: A semi-structured interview has been adopted to explore the agenda of Robert, 21 years old, suffering from osteosarcoma. A first level analysis identified the four functional areas of the agenda: ideas and beliefs; expectations and desires and context in which he lives and interacts. A second level analysis assessed the main Robert's problems. RESULTS: The narrative agenda has highlighted many central problems of Robert (e.g. therapeutic adherence, quality of life, mood, body image, existential problems related to experiences, hopes and expectations). Of course these results could be integrated with other tools: qualitative, to understanding difficulties and to formulate hypotheses, and quantitative, to measure the level of severity of problems reported. DISCUSSION AND CONCLUSION: The narrative agenda has not only proved to be a valid instrument of assessment, allowing an adequate insight on the patient's problems, as we exemplified, but it can be also used for monitoring the dynamic situation of the person's history, lending itself to the re-exploration of its functional areas over time.

Self-efficacy in breastfeeding support: a research on Italian midwifery students.

BACKGROUND AND AIM OF THE STUDY: Maternal breastmilk represents the best nourishment for the newborn baby during its first six months, as it offers several benefits for the health and well-being of babies and mothers. In order to promote, protect and support effectively mother and child during breastfeeding, it is essential for midwives to be properly educated and to acquire highly professionalizing skills. This study aimed to evaluate the level of self-efficacy of the students attending the Degree Course of Midwifery, regarding the support of mother and child in breastfeeding. METHOD: A questionnaire of 37 items (Blackmanet al, 2015) validated in Italian by Mazzeo Melchionda (2019), was sent on-line to students of ten different Midwifery Degree Courses to assess their level of self-efficacy regarding the management of breastfeeding. Statistical analysis was carried out using statistic software R3.4.3 (The Foundation for Statistical Computing). RESULTS: 158 questionnaires were collected from ten Italian Midwifery Degree Courses. The areas in which students showed a high level of self-efficacy in managing breastfeeding include: the benefits of breastfeeding; the child's tendency to take the breast within an hour from childbirth and the relevance of skin to skin contact and rooming-in. Low levels of self-efficacy concerned the comfortably breastfeeding in public places and avoiding giving formula to the baby in its first six weeks of life. CONCLUSIONS: Generally the students attending Midwifery Degree Courses show a high level of self-efficacy in assisting mothers during breastfeeding and they prove to have a good knowledge of the benefits of breastfeeding to improve the health of mothers and their children. (www.actabiomedica.it).

Myanmar health professionals' educational needs: a pilot study.

BACKGROUND AND AIM OF THE WORK: The main factor hindering the development of the Myanmar health system lies in the scarcity of financial and human resources attributed to the health system. This paper presents the preliminary results of a pilot study on the educational needs of Myanmar health professionals, addressing the empowerment of human resources as a strategic pillar for delivering the essential packages of health services. METHODS: An explorative study following a qualitative approach has been conducted through semi-structured interviews to a convenience sample of 15 persons, selected as authoritative key-informants. RESULTS: In addition to the lack of infrastructures, medicines, ambulances and health instruments, and the health disparities between the urban and rural areas, some widespread problems are reported as requiring health professionals' training empowerment: traumas due to road accidents, management of childbirth, non-communicable diseases' management and poor health education of the population. DISCUSSION: Some areas can be evidenced for an improvement of professionals, training: ​​maternal, neonatal and child health; communication between professionals and laypeople; Myanmar population's health education; inter-professional training between doctors and nurses, but also between health personnel and non-health personnel. CONCLUSIONS: The educational needs of Myanmar health professionals emerge as closely related to the social and health needs of the Myanmar population, to the available resources and missing resources of the country's health system and to the role of professionals within professionals/patients' relationship. (www.actabiomedica.it).

Palliative care training addressed to hospital healthcare professionals by palliative care specialists: a mixed-method evaluation.

BACKGROUND: Despite the great advances in the concept of palliative care (PC) and its benefits, its application seems to be delayed, leaving unfulfilled the many needs of patients and family members. One way to overcome this difficulty could be to develop a new training programme by palliative care specialists to improve PC primary skills in healthcare professionals. The aim of this study was to evaluate the training's impact on trainees within a hospital setting using Kirkpatrick's and Moore's models. METHODS: We adopted a mixed-method evaluation with concurrent triangulation. The evaluation followed the first three steps of Kirkpatrick's and Moore's models and included a pre- and post-training evaluation through self-administered questionnaires and focus groups. We used the McNemar statistical test. RESULTS: The results highlighted the significant amount of knowledge acquired by the hospital professionals after training, in terms of increasing their knowledge of palliative care and in terms of the change in meaning that they attributed to phenomena related to chronicity and incurability, which they encounter daily in their professional practice. In both quantitative and qualitative research, the results, in synthesis, highlight: (i) the development of a new concept of palliative care, centred on the response to the holistic needs of people; (ii) that palliative care can also be extended to non-oncological patients in advanced illness stages (our training was directed to Geriatrics and Nephrology/Dialysis professionals); (iii) the empowerment and the increase in self-esteem that healthcare professionals gained, from learning about the logistical and structural organization of palliative care, to activate and implement PC; (iv) the need to share personal aspects of their professional life (this result emerges only in qualitative research); (v) the appreciation of cooperation and the joining of multiple competences towards a synergistic approach and enhanced outcomes. CONCLUSION: It is necessary to further develop rigorous research on training evaluation, at the most complex orders of the Kirkpatrick and Moore models, to measure primary PC skills in health care professionals. This will develop the effectiveness of the integration of I- and II-level palliative care competencies in hospitals and improve outcomes of patients' and families' quality of life.

The midwifery-led care model: a continuity of care model in the birth path.

BACKGROUND AND AIM OF THE STUDY: The birth path is affected by a fragmentation in the patient care process, creating a discontinuity of this last one. The pregnant woman has to interface with many professionals, both during the pregnancy, the childbirth and the puerperium. However, during the last ten years, there has been an increasing of the pregnancy care operated by the midwife, who is considered to be the operator with the right competences, who can take care of every pregnancy and may avail herself of other professionals' contributions in order to improve the outcomes of maternal and neonatal health. AIM: To verify whether there are proofs of effectiveness that support the caseload midwifery care model, and if it is possible to apply this model in the birth path in Italy. METHODS: A revision of literature has been done using some search engine (Google, Bing) and specific databases (MEDLINE, CINAHL, Embase, Home - ClinicalTrials.gov). There has also been a consultation of the Italian regulations, the national guidelines and the recommendations of WHO. RESULTS: The search string, properly adapted to the three databases, has given the following results: MEDLINE 64 articles, CINAHL 94 articles, Embase 88 articles. From this selection, 14 articles have been extracted: 1 systematic review, 3 controlled random trial, 7 observational studies, 3 qualitative studies. CONCLUSIONS: The caseload midwifery care seems to be an effective and reliable organisational/caring method. It responds to the criterions of quality and security, to the needs of women not only during the pregnancy but also during the post-partum phase. For these reasons, it seems very useful also for the birth path in the Italian reality.

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.

Clinical pathway for patients with Chronic Myeloid Leukaemia: The Euriclea Project.

BACKGROUND AND AIMS: The use of Tirosine Kinase Ihnibitors (TKIs) for the treatment of Chronic Myeloid Leukemia (CML) has definitely represented a turning point in the treatment of the onco-hematological diseases. Over the years, the interest of physicians, nurses, patients and caregivers has increasingly focused on the aspects of the humanization of care, the management of side effects and on the full and constant therapeutic adherence. The aim of the project was to define patient-oriented care processes, based on a proactive approach that can fully respond to the new health needs of CML patients. METHODS: A nursing expert Working Group (WG) was established. WG reviewed literature about CML patients assistance and then it was conducted a survey on organizational models for the treatment of CML patients, adopted by Italian haematologic and transplant centers.  Finally, the main issues regarding CML patients care were identified and discussed on a multiprofessional basis. RESULTS: Euriclea Project for care of CML patients with the description of a new and expanded nurse role was defined. The Nurse Case Manager or Nursing Clinical Experts were identified as key people for the management of the side effects of treatment, the promotion of the therapeutic adherence and the evaluation of efficacy and effectiveness of the process through the identification of specific indicators for structure, process and outcome. DISCUSSION: The focal areas of the care process were identified so as to define a different approach to the CML patient, through a holistic view of care and the multidisciplinary interventions.

Integrated narrative nursing: a new perspective for an advanced assessment.

The assessment is the first of the fundamental nursing processes: it includes data collection, problem identification, and setting of priorities, which all facilitates the process of making a nursing diagnosis. The assessment helps to identify a goal, which, through a decision-making process, orientates the planning as well as the nursing intervention, which will be evaluated at a later stage. It seems that the proposed multidimensional and integrated assessment has a good potential to significantly influence the nursing care. This model is multidimensional since it covers biophysical, psychological, socio-relational, but also the spiritual dimensions of each person, and is integrated since it's reinforced by the inter-professional dialogue between nurses, physicians, sociologists, psychologists, and other health professionals. To come up with a diagnosis, nurses integrate the "cases" (the set of data/information collected through a "traditional" assessment), with the "stories" (which are directly narrated from the people themselves). Thus the proposed model combines quantitative instruments, typical of natural sciences (questionnaires, scales, tests and surveys), with qualitative ones, deriving from human sciences (interviews, the patient's agenda and narratives). The complementary use of objective and subjective methods leads to valid, consistent and standardized results, and, at the same time, makes it possible to investigate unique and subjective perceptions. Several strategies are outlined in this paper, with methods, phases and instruments related to the advanced assessment model, in order to better determine the most suitable based on the person's individual needs.

Pet therapy: an effective strategy to care for the elderly? An experimental study in a nursing home.

BACKGROUND AND AIM: There has recently been a growing interest towards patients' affective and emotional needs, especially in relational therapies, which are considered vital as to increase the understanding of those needs and patients' well-being. In particular, we paid attention to those patients who are forced to spend the last phase of their existence in residential facilities, namely elderly people in nursing homes, who often feel marginalized, useless, depressed, unstimulated or unable to communicate. The aim of this study is to verify the effectiveness of pet therapy in improving well-being in the elderly living in a nursing home. METHODS: This is a longitudinal study with before and after intervention variables measurement in two groups of patients of a nursing home for elderly people. One group followed an AAI intervention (experimental group) the other one did not (control group). As to perform an assessment of well-being we measured the following dimensions in patients: anxiety (HAM-A), depression (GDS), apathy (AES), loneliness (UCLA), and quality of life (QUALID). Both groups filled the questionnaires as to measure the target variables (time 0). Once finished the scheduled meetings (time 1), all the participants, including the control group, filled the same questionnaires. RESULTS: In accordance with scientific evidence the results confirmed a significant reduction of the measured variables. Especially for the quality of life, which showed a greater reduction than the other. CONCLUSIONS: The implementation and success of the Pet Therapy could have a great emotional and social impact, bringing relief to patients and their family members, but also to health professionals.

An integrated narrative nursing model: towards a new healthcare paradigm.

In the traditional biomedical model of clinical practice, which assumes a medicine focused on disease, diseases are considered as biological or psycho-physiological universal entities. This explanation, although necessary, is not enough. Several authors have recently become interested in the use of narrative practices in the medical care setting, underlining the increasing importance of "a patient-centered approach", a "relationship -centered care" and "narrative medicine". Even in Nursing, the challenge was to combine two models that seemed incompatible: the Evidence-Based Nursing Model and the Narrative-Based Nursing Model. The first one is based on the disease and is capable of reaching measurable objectives. It is marked by rationality, objectivity, determinism, unilateralism and linearity, and its methods emphasize logic, control, measurement and deduction. The second model is based on a global approach, resulting in a psycho-social perspective which stresses the importance of individuality, interpersonal relationship, and the illness and sickness as significant parts of healthcare. Through a short examination of different narrative models in medicine, we underlined some principles which can be used in nursing practice and we suggested a new healthcare paradigm based on integrated narrative nursing. It represents a groundbreaking new normative approach, deriving from different epistemological (positivist paradigm and interpretive paradigm) and methodological approaches that integrate quantitative data already normally detected on the patient, with subjective information obtained from the person and his family, and by the social impact that the disease causes. The integrated narrative nursing makes use of quantitative (e.g. scales and scientific evidence) and qualitative tools (e.g. narratives, autobiographies, therapeutic emplotment and patient's agenda). This approach, based on holistic comprehension, hermeneutic dialogue and a high degree of narrative skill, produces different ways of understanding and offering cure, care and assistance. This could allow a targeted assessment, a precise diagnosis and a personalized education. The benefits coming from the use of this paradigm are several, as for example, to disseminate a personal experience in a perspective of humanization, to improves quality of life and to create a positive effects on patient care outcomes.

Efficacy of video-music therapy on quality of life improvement in a group of patients with Alzheimer's disease: a pre-post study.

BACKGROUND AND AIM OF THE STUDY: Alzheimer's disease is the most common degenerative dementia with a predominantly senile onset. The difficult management of altered behaviour related to this disorder, poorly responsive to pharmacological treatments, has stimulated growth in non-pharmacological interventions, such as music therapy, whose effectiveness has not been supported by the literature up to now. The aim of this study was to evaluate the efficacy of video-music therapy on quality of life improvement in Patients affected by Alzheimer's Disease (AD). METHODS: A pre-post study was conducted in a residential facility. 32 AD Patients, who attended this facility daily to participate in supportive and rehabilitative programs, were treated with 2 cycles of 6 video-music-therapy sessions, which consisted of folk music and video, recalling local traditions. In order to investigate their cognitive status, Mini Mental State Examination (MMSE) was administered and Patients were divided into stages according to MMSE scores. After each session of video-music-therapy, Quality of Life in Alzheimer's Disease Scale (QOL-AD) was administered to our Patients. RESULTS: 21 AD Patients completed the 2 cycles of video-music therapy. Among them, only the Patients with questionable, mild and moderate neurocognitive impairment (MMSE Stages 1, 2, 3) reported an improvement in their quality of life, whereas the Patients with severe deterioration (MMSE stage 4) did not report any change. Many items of QOL-AD improved, showing a statistically significantly correlation to each other. CONCLUSIONS: Video-music therapy was a valuable tool for improving the quality of life only in Patients affected by less severe neurocognitive impairment.

The complementary medicine (CAM) for the treatment of chronic pain: scientific evidence regarding the effects of healing touch massage.

BACKGROUND AND AIM: Evidence-based medicine offers effective pathways of pharmacological treatment for chronic pain that may compromise the quality of life of patients; this is one of the main reasons why more and more people resort to traditional and complementary approaches, to try to maintain or regain their health. The effectiveness of the various forms of complementary treatments often cannot be proven objectively, which is why, given the need to find more concrete evidence of the effectiveness of complementary therapies with particular reference to the method of healing touch massage, a review of the literature was conducted in order to gather evidence of the efficacy of the specific method regarding pain and other health outcomes of patients with malignant disease to support a proposal for improvement, based on the practice of healing touch massage conducted by nurses. METHOD: Systematic review. RESULTS: There are several examples (in some cases specifically regarding patients with tumors) of the positive effects of healing touch massage on pain, anxiety and fatigue, and also on biochemical parameters. CONCLUSIONS: The way to full recognition by both the institutional and the scientific community seems to promise fairly well, although it should be noted that the achievement of this goal will require further research avoiding the limitations of previous studies.

Meeting the needs of cancer patients: is there a need for an organizational change?

As stated in the literature the most important needs of cancer patients are not adequately meet. Improving information, communication and education provided have not led to incisive changes in the organizational model of the oncology departments. The study contributes to this direction, by planning an "Integrated Operating Point" (I.O.P.) dedicated to cancer patients and their relatives in Italy. 42 Some professionals, patients and relatives were involved and 42 of them participated in focus group/or interviews. Results of thematic content analysis allow us to sketch out some key elements that I.O.P. should have in order to support cancer patients and their families. Integration of services, continuity of care, and cooperation between professionals involved are key elements that might qualify such organizational development.