Communication in NICUs.

In a Neonatal Intensive Care Unit (NICU) counseling should be a shared culture for all the care givers: it should be developed by all the professionals, to face up to parents' needs of information, explanations, facility of decisions, finding of resources, agreement, help, reassurance, attention. The first essential aspect is the training in counseling skills, by periodic courses for all professionals of the department (physicians, nurses, and physiotherapists). In our department, a professional counselor is present, assisting the medical staff in direct counseling. The counselor's intervention allows a better parent orientation in the situation. A more effective sharing of these rules also facilitates the communication among parents and medical staff. Periodic meetings are established among the medical staff, in which the professional counselor discusses difficult situations to share possible communicative strategies. We wanted to have not only a common communicative style, but also common subjects, independent from the characteristics of each of us. Individuals are often faced with different situations. For every setting that we more frequently face in communication (for example the first interview with a parent of a very preterm infant) we have built an 'algorithm' that follows a pattern: (1) information always given; (2) frequent questions from parents; and (3) frequent difficulties in the communication. Counselling is also a tool to face some critical issue, such as the decision to open the department to parents 24 h on 24, or the promotion of mother's milk use in Very Low Birth Weight Infants (VLBWI).

Counselling in neonatal intensive care unit.

Counselling is a professional intervention based on skills to communicate and to build relationships. The project "Not alone", related to counselling at our Neonatal Intensive Care Unit, is aimed to let counselling become a "shared culture" for all the care givers. The first essential aspect is to form the ability of counselling through periodic courses for all professionals of the department (physicians, nurses, physiotherapists). In our department a professional counsellor is present assisting the medical staff in direct counselling. The counsellor's intervention allows a better parent orientation in the situation. A more effective sharing of these rules also facilitates the communication among parents and medical staff. Periodic meetings are established among the medical staff, in which the professional counsellor discusses difficult situations in order to share possible communicative strategies. We wanted to have not only a common communicative style, but also common subjects, independent from the characteristics of each of us. Individuals are often faced with diverse situations. For every setting that we more frequently face in communication (for example the first interview with a parent of a very preterm infant) we have built an "algorithm" that follows a pattern: (1) information always given; (2) frequent questions from parents, (3) frequent difficulties in the communication. We also need to record important moments, for instance the "case history of the communication": in fact it would be desirable to have the case history, a sheet dedicated to important communications that are absolutely to be shared with other professionals.

Communicative strategies in a neonatal intensive care unit.

Counseling is a professional intervention based on skills to communicate and to build relationships. The project 'Not alone', related to counseling at our Neonatal Intensive Care Unit, is aimed to let counseling become a 'shared culture' for all the care givers. The first essential aspect is to form the ability of counseling through periodic courses for all professionals of the department (physicians, nurses, and physiotherapists). In our department, a professional counselor is present assisting the medical staff in direct counseling. The counselor's intervention allows a better parent orientation in the situation. A more effective sharing of these rules also facilitates the communication among parents and medical staff. Periodic meetings are established among the medical staff, in which the professional counselor discusses difficult situations to share possible communicative strategies. We wanted to have not only a common communicative style, but also common subjects, independent from the characteristics of each of us. Individuals are often faced with diverse situations. For every setting that we more frequently face in communication (for example the first interview with a parent of a very preterm infant) we have built an 'algorithm' that follows a pattern: (1) information always given; (2) frequent questions from parents; and (3) frequent difficulties in the communication. We also need to record important moments, for instance the 'case history of the communication': in fact it would be desirable to have the case history, a sheet dedicated to important communications that are absolutely to be shared with other professionals.

Counselling in Neonatal Intensive Care Unit (NICU).

Counselling is a professional intervention based on skills to communicate and to build relationships. The project "Not alone", related to counselling at our Neonatal Intensive Care Unit, is aimed to let counselling become a "shared culture" for all the care givers.

Who does Pap-test? The effect of one call program on coverage and determinants of compliance.

A pilot phase of a population-based organized screening programme for cervical cancer was run in Turin, Italy, in May-June 1991. Based on the city population lists, 1181 women 25 to 64 years old were invited in two family clinics. Overall compliance to invitation was 41.7%. In order to study the determinants of compliance, a random sample of 372 compliers and 398 non-compliers was interviewed. Interval since last Pap-test was strongly associated with compliance (ORs of complying were 2.52, 1.53, 1.41, 0.50 and 0.16 for intervals longer than 3 years, 1-3 years, 6 months-1 year, 3-6 months and less than 3 months respectively vs. never having had a Pap-test, p < 0.001). Estimated compliance was 39% among never screened women and 65% among those tested since more than 3 years, leading to an over 70% overall estimated coverage (women who complied or had a spontaneous test within 3 years). On the other hand, the effect of a number of sociodemographic variables (age, education, place of birth, marital status) was very weak or opposite (lower compliance among younger and more educated women) to what we found in a previous study on spontaneous Pap-testing. The clinic allocated to pre-fixed appointments had a higher compliance than the clinic with appointments to be arranged (OR = 2.36 95% c.i. 1.66-3.36). Anxiety caused by periodic controls for early diagnosis of cancer was an important negative determinant of compliance (ORs of complying were 0.85, 0.49, and 0.16 for those with mild, moderate and severe levels of anxiety vs. those reassured by the test). We concluded that personal invitations were actually able to reach those women who have a poor level of spontaneous practice and could reduce the selection in access to this preventive practice.