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.

Gambling and internet addiction: a pilot study among a Population of Italian Healthcare : Gambling and Internet Addition in a Healthcare Group.

AIM: Measuring the phenomenon of gambling and Internet addiction, with analysis of attitudes and psychophysical consequences among nurses working in different care settings. METHODS: An observational, cross sectional, multicenter study was conducted from April to September 2020. Participants' socio-demographic information, the "Internet Addiction Test" (IAT) scale, and the "South Oaks Gambling Screen" (SOGS) were collected in order to assess the overuse of and whether an individual has a problematic relationship with gambling, respectively. RESULTS: 502 nurses were enrolled in the study. Significant correlations were found (p < .001) between the IAT score and gender, number of years of work experience, job role, educational qualification; and between the SOGS and gender, number of years of work experience, job role and regions of Italy. CONCLUSIONS: The study highlighted an emerging social problem, and the results may be just the tip of the iceberg. Given the lack of knowledge of these phenomena and a high percentage of people who suffer from them but are afraid to admit it and get help, this study could also be useful in expanding knowledge and allow more professionals to get help and learn about possible treatments and cures for the resolution of these addictions.

Leadership styles' influence on ICU nurses' quality of professional life: A cross-sectional study.

BACKGROUND: Intensive Care Units are emotionally intense environments where professional autonomy and interprofessional collaboration are essential. Nurses are at high risk of burnout, and the level of compassion satisfaction has a deep impact on the quality of their professional life. Although leadership styles and burnout have been the subject of an extensive body of research, there is an existing gap regarding the relationship between leadership strategies and intensive care nurses' quality of working life and the impact on their compassion satisfaction. Specifically, there is a lack of literature in southern European countries concerning the influence of organizational and cultural contexts. AIM: To evaluate the impact of nurse managers' leadership styles on Intensive Care Unit nurses' job satisfaction and compassion satisfaction. DESIGN: A cross-sectional study. METHODS: An online set of validated tests was sent to a non-probabilistic sample of nurses, recruited via the Italian association of intensive care and emergency nursing website. The set of tests consisted of the Empowering Leadership Questionnaire, Compassion Satisfaction Scale, and McCloskey Mueller Satisfaction Scale. Nurses actively working in intensive care and critical care settings were included in this study. ICU managers and leaders were excluded. RESULTS: 308 nurses (response rate 63,2%) completed the questionnaires. Statistical analysis showed that the Leadership dimension of "Showing concern towards the team" had a significant effect on Compassion Satisfaction. In addition, this dimension had an effect on nurses' overall job satisfaction on five out of eight subscales. CONCLUSIONS: Leaders' authentic listening, communication, and participation capabilities have a positive impact on nurses' job and compassion satisfaction. The interest for team well-being, taking time to discuss team concerns, and working closely with the team affects unpredicted factors like working hours, flexibility in shift scheduling, satisfaction about recognition, and career advancement. RELEVANCE TO CLINICAL PRACTICE: Results suggest that nurse managers can draw on/adopt leadership strategies oriented to authentic listening and interaction with the team in order to manage organizational issues, increase nurses' professional quality of life and prevent burnout.

Consultations' demand for a hospital palliative care unit: how to increase appropriateness? Implementing and evaluating a multicomponent educational intervention aimed at increase palliative care complexity perception skill.

BACKGROUND: Planned, multidisciplinary teams' discussions of cases are common in cancer care, but their impact on patients' outcome is not always clear. Palliative care (PC) needs might emerge long before the last weeks of life. Many palliative care patients could be managed from the usual care staff, if appropriately trained; specialist palliative care should be provided to patients with more complex needs. Staff needs adequate training, so that only patients presenting a higher complexity are properly referred to the second level ("specialized") PC services. In the considered hospital setting, "tumour boards" (multidisciplinary discussions) refer often to a low number of patients. Overall complexity of patients' needs is hardly considered. METHODS: A mixed method pilot study with data triangulation of professionals' interviews and an independently structured evaluation of complexity of referred patients, before and after the intervention, using the PALCOM instrument. We trained four teams of professionals to deliver first-level palliation and to refer patients with complex needs detected in multidisciplinary discussions. A multicomponent, first level PC educational intervention, including information technology's adaptation, a training course, and bedside training was offered from the specialized PC Services, to all the HPs involved in multidisciplinary pancreas, lung, ovarian, and liver tumour boards. RESULTS: While the level of complexity of referred patients did not increase, trainees seemed to develop a better understanding of palliative care and a higher sensitivity to palliative needs. The number of referred patients increased, but patients' complexity did not. Qualitative data showed that professionals seemed to be more aware of the complexity of PC needs. A "meaning shift" was perceived, specifically on the referral process (e.g., "when" and "for what" referring to specialist PC) and on the teams' increased focus on patients' needs. The training, positively received, was adapted to trainees' needs and observations that led also to organizational modifications. CONCLUSIONS: Our multicomponent intervention positively impacted the number of referrals but not the patients' complexity (measured with the PALCOM instrument). Hospital staff does not easily recognize that patients may have PC needs significantly earlier than at the end of life.

Research, education, ethics consultation: evaluating a Bioethics Unit in an Oncological Research Hospital.

BACKGROUND: This study aims to quantitatively and qualitatively evaluate the activities of a Bioethics Unit (BU) 5 years since its implementation (2016-2020). The BU is a research unit providing empirical research on ethical issues related to clinical practice, clinical ethics consultation, and ethical education for health care professionals (HPS). METHODS: We performed an explanatory, sequential, mixed-method, observational study, using the subsequent qualitative data to explain the initial quantitative findings. Quantitative data were collected from an internal database and analyzed by descriptive analysis. Qualitative evaluation was performed by semi-structured interviews with 18 HPs who were differently involved in the BU's activities and analyzed by framework analysis. RESULTS: Quantitative results showed an extensive increment of the number of BU research projects over the years and the number of work collaborations with other units and wards. Qualitative findings revealed four main themes, concerning: 1. the reasons for contacting the BU and the type of collaboration; 2. the role of the bioethicist; 3. the impact of BU activities on HPs, in terms of developing deeper and more mature thinking; 4. the need to extend ethics support to other settings. Overall, our results showed that performing both empirical bioethics research and more traditional clinical ethics activities at the same unit would produce an impetus to increase collaboration and spread an 'ethical culture' among local HPs. CONCLUSIONS: Our findings contribute to a growing body of literature on the models of clinical ethics support services and the role of empirical research in bioethics internationally. They also prepare the ground for the implementation of a multidisciplinary Clinical Ethics Committee (CEC) that aims to support the BU's ethics consultation service within the local context.

"Challenging Professional Boundaries": A Grounded Theory Study of Health Professionals' First Experiences of End-of-Life Care in Hospital.

Little is known about health professionals first experiences of End-of-Life care in hospital. This study aims to understand the psycho-social process that occurs when hospital-based health professionals engage in caring for a dying patient for the first time. We conducted a Grounded Theory study, with 19 health professionals. Challenging professional boundaries is the core category which explains the overall process. The theoretical model we conceptualized evidenced three phases: 1) building a relationship between patient/family and professionals, 2) the disrupting impact and 3) the reaction phase. Our analysis highlighted the initial strong impact of this experience, which brought professionals to perceive emotional suffering and feelings of inadequacy. The new aspect our grounded theory revealed is that all the categories are pertinent to all the professionals involved, therefore they explain important aspects of interprofessional collaboration in End-of-Life care.

Health professionals and students' experiences of reflective writing in learning: A qualitative meta-synthesis.

BACKGROUND: Reflective writing provides an opportunity for health professionals and students to learn from their mistakes, successes, anxieties, and worries that otherwise would remain disjointed and worthless. This systematic review addresses the following question: "What are the experiences of health professionals and students in applying reflective writing during their education and training?" METHODS: We performed a systematic review and meta-synthesis of qualitative studies. Our search comprised six electronic databases: MedLine, Embase, Cinahl, PsycINFO, Eric, and Scopus. Our initial search produced 1237 titles, excluding duplicates that we removed. After title and abstract screening, 17 articles met the inclusion criteria. We identified descriptive themes and the conceptual elements explaining the health professionals' and students' experience using reflective writing during their academic and in-service training by performing a meta-synthesis. RESULTS: We identified four main categories (and related sub-categories) through the meta-synthesis: reflection and reflexivity, accomplishing learning potential, building a philosophical and empathic approach, and identifying reflective writing feasibility. We placed the main categories into an interpretative model which explains the users' experiences of reflective writing during their education and training. Reflective writing triggered reflection and reflexivity that allows, on the one hand, skills development, professional growth, and the ability to act on change; on the other hand, the acquisition of empathic attitudes and sensitivity towards one's own and others' emotions. Perceived barriers and impeding factors and facilitating ones, like timing and strategies for using reflective writing, were also identified. CONCLUSIONS: The use of this learning methodology is crucial today because of the recognition of the increasing complexity of healthcare contexts requiring professionals to learn advanced skills beyond their clinical ones. Implementing reflective writing-based courses and training in university curricula and clinical contexts can benefit human and professional development.

Taking care of dying patients through an 'interprofessional ecosystem': a grounded theory study on the experience of an interprofessional team in palliative care.

BACKGROUND: The interprofessional approach is part of the philosophy in palliative care, and its benefits are already documented. However, there are no evidence regarding the process through which the interprofessional team faces the process of the patient's end-of-life and how this experience might be of value for the team's development itself. The aim of this study was to analyse and understand the psychosocial processes that occurs when an interprofessional team accompanies patients and their families to death in palliative care, with the ultimate aim to develop a substantive theory to describe this phenomenon. METHODS: A Grounded Theory method, as theorized by Strauss and Corbin, was adopted for this study. Data were collected through semi-structured interviews and then independently analysed using constant comparison analysis. Fourteen healthcare professionals - belonging to different disciplines (doctor, nurse coordinator, nurse, nurse assistant, psychologist) - were interviewed in a Northern Italy palliative care facility. FINDINGS: The core category of this study was identified to be the process of accompaniment of the dying patient as an interprofessional ecosystem. Moreover, the results showed four main factors determining the development of the core psychosocial process: from professionals' 'Hidden Amazement' to 'Onerous Happiness' where 'Weaving of Professional Resources' and 'Work Meaning' are the underlying conditions to catalyse the process itself. CONCLUSION: Interprofessional care appears an essential value, which becomes the source of the team's strength when facing end-of-life experiences. Health policies and organisations should take the importance of the characteristics of the work environment more carefully. The meaning that professionals attribute to their work and to the team itself, indeed, it may have impact on the overall quality of care and contribute to sustain work engagement, even in stressful situations like end-of-life care.

"Teach for ethics in palliative care": a mixed-method evaluation of a medical ethics training programme.

BACKGROUND: Training in medical ethics aims to educate health care professionals in dealing with daily care ethical issues. To guarantee quality of life and spiritual and emotional support, palliative care professionals have to develop ethical and relational skills. We propose the implementation and evaluation of a specialized training programme in medical ethics dedicated to a hospital-based Palliative Care Unit. METHODS: This study is a mixed-method before-after evaluation with data triangulation. RESULTS: The results highlight that participants developed their ethical knowledge, and a deeper ethical awareness. They also felt more confident and motivated to widely apply ethical reflections and reasonings in their daily practice. CONCLUSION: The participants appreciated the innovative structure of the training, especially regarding the integration of the theoretical-interactive and practical parts. However, they recommended increasing the number of concrete occasions for ethical supervision and practical application of what they learned during the programme. The training programme also has some potential practical implications: the development of advanced ethical skills within a hospital-based PC team may improve the quality of life of the patients and their families. In addition, health care professionals with advanced ethical competencies are able to educate patients and their families towards more active participation in the decision-making process.

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.

Researching children's perspectives in pediatric palliative care: A systematic review and meta-summary of qualitative research.

OBJECTIVE: Qualitative research is pivotal in gaining understanding of individuals' experiences in pediatric palliative care. In the past few decades, the number of qualitative studies on pediatric palliative care has increased slightly, as has interest in qualitative research in this area. Nonetheless, a limited number of such studies have included the first-person perspective of children. The aim of this article is to understand the contribution of previous qualitative research on pediatric palliative care that included the voices of children. METHOD: A systematic review of qualitative studies and a meta-summary were conducted. MEDLINE, CINAHL, PsycINFO, PsycARTICLES, and ERIC were searched without limitations on publication date or language. Eligible articles were qualitative research articles in which the participants were children ranging in age from 3 to 18 years.ResultWe retrieved 16 qualitative research articles reporting on 12 unique studies, and we selected two mixed-method articles. The meta-summary shows eight themes: the relationship with professional caregivers, pain and its management, "living beyond pain," the relationship between pediatric patients and their families, children's view on their treatment and service provision, meanings children give to their end-of-life situation, consequences of clinical decisions, and the relationships among children in pediatric palliative care and their peers.Significance of resultsThis meta-summary presents the "state of the art" of pediatric palliative care qualitative research on children and highlights additional research areas that warrant qualitative study.

ALLiance for sEcondary PREvention after an acute coronary syndrome. The ALLEPRE trial: A multicenter fully nurse-coordinated intensive intervention program.

The main objective of cardiovascular disease prevention is to reduce morbidity and mortality by promoting a healthy lifestyle, reducing risk factors, and improving adherence to medications. Secondary prevention after an acute coronary syndrome has proved to be effective in reducing new cardiovascular events, but its limited use in everyday clinical practice suggests that there is considerable room for improvement. The short-term results of evidence-based studies of nurse-coordinated secondary prevention programs have been positive, but there is a lack of long-term outcome data. The Alliance for the Secondary Prevention of Cardiovascular Disease in the Emilia-Romagna region (ALLEPRE) is a multicenter, randomized, controlled trial designed to compare the effects of a structured nurse-coordinated intensive intervention on long-term outcomes and risk profiles after an acute coronary syndrome with those of the standard of care. All of the patients randomized to the intervention group take part in 9 one-to-one sessions with an experienced nurse from the participating centers with the aim at promoting healthy lifestyles, reducing risk factors, and increasing adherence to medication over a mean period of 5 years. The primary clinical end point is the reduction in the risk of the 5-year occurrence of major adverse events (a composite of cardiovascular mortality, nonfatal reinfarction, and nonfatal stroke). The primary surrogate end point is the achievement of prespecified targets relating to classical risk factors, lifestyle modifications, and adherence to pharmacological therapy after 2 years of follow-up. Coronary heart disease is a chronic degenerative disease, and patients who recover from an acute coronary syndrome (ACS) are at high risk of developing recurrent events.1 Although secondary prevention measures have proved to be effective and are strongly recommended by all of the international guidelines,2., 3. the 4 EUROASPIRE surveys4., 5., 6., 7., 8. showed that there was still a high prevalence of conventional risk factors, that secondary prevention measures were inadequately implemented, and that their main goals were often not reached. In addition, there were considerable discrepancy in secondary prevention practices between centers and countries, and a widespread underuse of cardiac prevention and rehabilitation programs despite their demonstrated effectiveness in reducing cardiovascular risk over time.9., 10. Over the last 10 years, nurses have been increasingly involved in successful cardiovascular risk management,11., 12., 13. but although this has improved levels of cardiovascular risk, no clear reduction in hard end points such as major cardiovascular adverse events and mortality has been demonstrated.10 The aim of the ALLEPRE trial is to evaluate the benefit of a homogeneous, structured, secondary prevention intervention program, fully coordinated by nurses from in- and outpatient clinics, in terms of cardiovascular risk profiles and major clinical events in ACS patients living in the large Emilia-Romagna region of Italy.

The role of professional and team commitments in nurse-physician collaboration.

AIM: To analyse the effect of both professional and care unit commitments on attitudes towards interprofessional collaboration between nurses and physicians. BACKGROUND: The effects of both professional and care unit commitment on inter-professional collaboration have not been taken into account together, and previous research has analysed only one profession at a time, neglecting the nurse-physician comparison. METHOD: A cross-sectional survey of 138 physicians and 359 nurses was used. RESULTS: For physicians, professional commitment decreased attitudes towards interprofessional collaboration whereas care unit commitment had a positive influence. Conversely, for nurses, the professional commitment had a significant positive effect on attitudes towards interprofessional collaboration whereas care unit commitment had no significant effect. CONCLUSION: Intergroup relations affect the extent to which nurses and physicians are inclined to engage in interprofessional collaboration. Professional and care unit commitments had different effects on attitude toward the inter-professional collaboration of nurses and physicians. IMPLICATION FOR NURSING MANAGEMENT: Inter-professional collaboration is affected by the relationship between physicians and nurse at the professional group level. Managers who want to change and improve inter-professional collaboration should pay close attention to the interplay between changes they are introducing and well-established identities and practices between professionals.

Therapeutic adherence and health outcomes in acute coronary syndrome (SCA) patient: the role of nursing.

BACKGROUND AND AIM: The literature on cardiovascular disease has highlighted that therapeutic adherence is often inadequate. What are the reasons for this poor adherence to medication? The goal has been to measure the different factors related to therapeutic adherence,  differentiating the SCA patients on three levels of self-referred therapeutic adherence and delving the relations between self-reported therapeutic adherence and socio-demographic, clinical, emotive, cognitive and socio-relational variables. METHOD: A total of 84 Italian patients (66.7% males) with (SCA) took part in the study and completed a semi-structured questionnaire investigating the variables described above. RESULTS: RESULTS indicate the influence of clinical variables, showing that patients suffer more of dyspnea and angina symptoms than those that state to follow prescriptions. But the emotive aspects seem able to interfere more with the adherence: the subjects scarcely adherent have felt more threatened by their illness, and experimented more symptoms of anxiety and sadness than highly adherent patients. At a cognitive level the adherent patients have chosen coping strategies not centred on emotions, but headed to the solution of the problem. At socio-relational level is confirmed the importance of the social support in favouring the adherence. CONCLUSIONS: Among the different factors here considered, are those psychological and relational that tend to be associated to level of adherence for prescriptions. The outcomes have shown that the demo-graphical and clinical variables result are not tightly associated to the adherence, confirning instead the importance of psycho-social factors, as already notable in the literature in heart studies. The implications have been discussed.

Psychosocial predictors of collaborative practice between nurses and physicians working in hospitals.

BACKGROUND AND AIM OF THE WORK: Works from healthcare management and organizational psychology prove that psychosocial variables linked to professional identity are strongly associated with nurse-physician collaborative practice. However, literature pays little attention to the role of these variables. Moreover, evidence for the relation between collaborative practice on psychosocial variables for physicians is rather sparse. The purpose of this study was to investigate the relationship among self-efficacy, team commitment, professional commitment, and collaborative practice in both nurses and physicians. METHODS: A cross-sectional survey was adopted and questionnaire was distributed to 269 nurses and 124 physicians working in different hospitals. RESULTS: The perception of collaborative practice enhanced the self-efficacy and team commitment of both professionals. For nurses, professional commitment and self-efficacy positively predicted a willingness to collaborate; for physicians, professional commitment hindered a willingness to collaborate, while self-efficacy had no effect. CONCLUSIONS: The study indicates that collaborative practice is an important contextual resource bolstering self-efficacy and team commitment in both professional groups. However, strong professional commitment hinders the willingness of physicians to collaborate with nurses in a way that recognizes the autonomy of nurses

Meeting the needs of cancer patients: identifying patients', relatives' and professionals' representations.

BACKGROUND AND AIM: The literature on cancer patients agrees that most of the cancer patients' needs often remain unmet. How are these different needs perceived by patients, relatives and professionals? The present research has tried to make a contribution by analysing evidences of the needs, especially unmet, that different actors attribute to a cancer patient. METHOD: A total of 42 Italian participants (76.2% women) took part in the study. Patients, relatives, physicians, nurses, social care assistants and volunteers participated separately in six focus groups. Three face-to-face interviews were conducted with psychologist, general practitioner and social worker. All focus groups/interviews were processed through an analysis of thematic content. RESULTS: The results showed a priority given to the need for information, and also the importance of psychological and social support needs, confirming that they remain unmet. Differences between participants are visible by looking at the needs cited more frequently. For example, the oncologists are more sensitive to information needs related to the illness and its treatment, while the social worker cited the need for social, economic and legal assistance more frequently. The nurses highlighted the need for continuity of care, and the psychologists underlined the importance of psychological support, while the relatives cited the need of support both from and for families. CONCLUSIONS: RESULTS suggested that a comprehensive approach that addresses medical and psychosocial factors is needed. Cancer patients must be provided with a multidisciplinary survivorship care plan that addresses information related to their long-term care and identifies available psychological and social services.

Work climate, work values and professional commitment as predictors of job satisfaction in nurses.

AIM: To investigate the effect of some psychosocial variables on nurses' job satisfaction. BACKGROUND: Nurses' job satisfaction is one of the most important factors in determining individuals' intention to stay or leave a health-care organisation. Literature shows a predictive role of work climate, professional commitment and work values on job satisfaction, but their conjoint effect has rarely been considered. METHODS: A cross-sectional questionnaire survey was adopted. Participants were hospital nurses and data were collected in 2011. RESULTS: Professional commitment and work climate positively predicted nurses' job satisfaction. The effect of intrinsic vs. extrinsic work value orientation on job satisfaction was completely mediated by professional commitment. CONCLUSIONS: Nurses' job satisfaction is influenced by both contextual and personal variables, in particular work climate and professional commitment. According to a more recent theoretical framework, work climate, work values and professional commitment interact with each other in determining nurses' job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing management must be careful to keep the context of work tuned to individuals' attitude and vice versa. Improving the work climate can have a positive effect on job satisfaction, but its effect may be enhanced by favouring strong professional commitment and by promoting intrinsic more than extrinsic work values.

Training an infectious disease unit in palliative care during and post COVID-19: a qualitative longitudinal study.

Background: To understand palliative care needs and their changes perceived by health professionals (HPs) of the Infectious Diseases Unit who participated in palliative care (PC) intensive training during the pandemic and behind/during the pandemic and one year after the outbreak. Methods: A longitudinal qualitative study. Thematic analysis and meaning shift were two months after training to one year. This specific thematic approach enabled the researchers to fully understand the experiences of the HPs after they participated in the intensive PC training program during the pandemic. Participant validation meeting with the ward's staff one year after the end of the course was performed. The two last validation meetings were used as a triangulation source to plan the new education projects. Results: From March 9 to 28, 2020, the Palliative Care Services (PCS) developed intensive experiential training. Thirty-one HPs of the Infectious Diseases Unit (physicians and nurses) who were facing the COVID-19 emergency participated in the training. We conducted eight semi-structured interviews with HPs who participated in intensive training during the first wave of the pandemic (T0), two months (T1) after training and after one year (T2), during the second wave. Two validation meetings were performed as suggested by the best practices in medical education. Twenty-two infectious disease staff members participated, 8 physicians and 14 nurses. Our data show a meaning shift on five overarching themes (defined within the sub-themes): (1) Recognizing patients' palliative care needs; (2) Responses to palliative care needs; (3) Increasing attention to intervention and care choices; (4) The suffering of health professionals; (5) Training evaluations and future expectations. At the end of Pandemic period, new training needs and acquisition have emerged. Palliative care needs changed over time: the COVID-19 themes are now far from their perception, and somehow the skills acquired during the intensive training are less present. Conclusion: The pandemic led to a rapid acquisition of competencies and changes in the professionals' behaviors, maintenance of professionals' knowledge and competencies at two months and one year. COVID has improved relationships and increased interactions with the infectious world but that it has not been enough. The integration between PC and Infectious world needs models of integration to implement.