La Salute organizzativa degli infermieri

Background. La salute organizzativa, il benessere e la qualità della vita nei luoghi di cura, sono temi di sempre maggiore interesse e centralità per i manager sanitari. E’ importante in ambito sanitario valutare il livello di “salute organizzativa” degli infermieri con una metodologia di ascolto attivo che faccia emergere la “percezione” che gli stessi hanno del proprio vissuto organizzativo. Attraverso l’indagine sulla salute organizzativa, i manager possono dar vita ad un percorso di analisi organizzativa che consente di definire strategie di azione che tengano conto delle indicazioni e dei suggerimenti giunti dai propri collaboratori. -- Obiettivi. Nel corso del triennio dottorale è stato progettato e realizzato uno studio ricerca, con lo scopo di valutare la Salute Organizzativa degli Infermieri. Sono stati prefissati i seguenti obiettivi di ricerca: A. individuare in letteratura ed eventualmente sviluppare o modificare, uno strumento specifico per valutare la Salute Organizzativa degli infermieri; B. valutare quanto la salute organizzativa sia correlata con “qualità di vita” degli infermieri; C. individuare eventuali correlazioni tra Salute Organizzativa e ambito clinico-assistenziale di appartenenza; D. condurre un’indagine su un cospicuo numero di infermieri, diversificando il campione per tipologia organizzativa (Aziende, Policlinici, Strutture Private, etc) al fine di elaborare un manuale rivolto agli Infermieri Dirigenti per svolgere, in modo autonomo, un’indagine sullo stato di Salute Organizzativa nel proprio contesto lavorativo. -- Metodo. Per quanto concerne lo strumento per misurare la Salute Organizzativa, è stato elaborato e validato il Questionario Infermieristico sulla Salute Organizzaiva (QISO), uno strumento derivato dal Multidimensional Health Questionnaire (MOHQ). Il QISO, sottoposto a validità di contenuto da parte di un gruppo di esperti, è stato somministrato ad un campione di 1279 infermieri. Con l’analisi fattoriale sono state individuate 18 dimensioni (scale), tutte con buone caratteristiche psicometriche di validità e affidabilità. Per quanto riguarda il secondo obiettivo della ricerca, è stata condotta un’indagine su un campione di 411 infermieri dell’Emergenza Territoriale ai quali è stato somministrato il QISO e l’SF-12 (per misurare la qualità di vita). Complessivamente tra gli uomini sono stati rilevati: migliore salute mentale, migliore percezione dei propri coordinatori e una più alto apprezzamento (in termini di efficacia ed efficienza organizzativa) verso la propria organizzazione. Tra le donne, invece, si è riscontrata una maggior presenza di disturbi psicofisici e di indicatori negativi di salute organizzativa. In merito al terzo studio sono stati invece reclutati 542 infermieri che prestavano servizio presso diversi Policlinici Universitari Italiani: 337 provenienti dalle Unità Operative di Medicina e 205 dalle Camere Operatorie. Con lo studio è stato dimostrato che gli infermieri di Camera Operatoria hanno livelli significativamente più bassi di salute e soddisfazione organizzativa rispetto ai colleghi che lavorano nelle Unità Operative di Medicina. L’analisi statistica ha inoltre permesso di constatare che la salute organizzativa non differisce in rapporto all’età e al genere. Per ciò che concerne il manuale (obiettivo D) che affronta le tematiche inerenti la salute organizzativa, lo stesso, che risulta essere uno strumento di semplice applicazione nei diversi contesti sanitari, è stato realizzato con il reclutamento di 4334 infermieri. Grazie alla meticolosa spiegazione delle diverse fasi che compongono l’intero processo di indagine, permette inoltre, di valutare lo stato di salute del proprio contesto organizzativo, circostanziando il corretto utilizzo del QISO per l’elaborazione e l’interpretazione dei dati. -- Conclusioni. Le diverse ricerche condotte nel corso del triennio, hanno principalmente permesso di validare un nuovo strumento per rilevare la Salute organizzativa degli Infermieri. E’ stato quindi possibile dimostrare come la Qualità di Vita degli Infermieri sia strettamente correlata al proprio vissuto organizzativo e quanto alcune specifiche circostanze organizzative possano influenzare la salute mentale e la salute fisica diversificatamente per gli uomini e per le donne nonché per i giovani infermieri e per i più anziani. Inoltre, di fondamentale importanza, è risultato essere lo specifico contesto lavorativo. Ambienti di lavoro come le Unità Operative di Medicina, a differenza di particolari contesti come le Camere Operatorie, inducono gli infermieri ad avere una più positiva percezione della propria organizzazione, probabilmente dovuta all’aspetto relazionale e comunicativo che viene ad istaurarsi in questi contesti. Il manuale, infine, darà la possibilità di approfondire le tematiche inerenti la “buona” gestione del personale, di condurre le varie fasi dell’indagine volta alla valutazione dello stato di salute del proprio contesto organizzativo, di usare correttamente il QISO, di elaborare i dati nonché di interpretarne i risultati ottenuti.Background Organizational health, well-being and quality of life in health care settings are issues of increasing interest for nurse managers. It is important in health care setting to evaluate organizational health of nurses with a method of active listening that will bring out the perception they have about their own organization. Researching in their field of organizational health, managers can analyze their context and define actions that take into account the suggestions of their staff. Objectives During the three-year of the doctoral program it has been designed and implemented a research study with the aim of assessing the organizational health of nurses. The following research objectives have been identified: A. to identify in the literature and eventually to develop or modify a specific instrument for assessing the organizational health of nurses; B. to correlate the organizational health with the quality of life in nurses; C. to identify correlations between organizational health and clinical care contexts; D. to carry out an investigation on a large number of nurses in order to develop a manual for nurse managers. This manual will allow nurse managers to easily assess the organizational health on their working environment. Methods The Nursing Organizational Health Questionnaire (NOHQ), that has been derived from the Multidimensional Organizational Health Questionnaire (MOHQ) has been developed in the present study. The NOHQ underwent to content validity ad was administered to a sample of 1279 nurses. Eighteen dimensions (scales) have been identified by factor analysis each of one showed good psychometric properties of validity and reliability. To reach the second objective of the research, a survey was conducted on a sample of 411 nurses working in the territorial emergency. In this study the NOHQ and the SF-12 (to measure quality of life) were administered. Overall, male nurses had better mental health, better perception of their coordinators and higher appreciation (in terms of effectiveness and organizational efficiency) for their organization. Female nurses complained more psychophysical symptoms and showed more negative indicators of organizational health. For the third objective, 542 nurses were recruited in several university hospital in Italy: 337 nurses were enrolled from Medical Units and 205 from the Operating theaters. In this study it was demonstrated that operating room nurses had lower levels of organizational health and satisfaction than their colleagues working in the Medical Units. Statistical analysis also revealed that the organizational health did not differ among age and gender. With regard to the manual (objective D) a study with 4334 nurses was carried out in several health settings. This manual meticulously explains the different steps to investigate the organizational health in one’s own health context. It also gives procedures to administer the NOHQ, elaborate the data and understand the results. Conclusions The various studies conducted over three years allowed the validation of a new tool to measure the organizational health of nurses. It was possible to demonstrate how the quality of life of nurses is closely related to their organization and how some specific organizational circumstances can affect the mental and physical health in male and female nurses as well as in younger and older nurses. It was also demonstrated how the working context can affect the organizational health in nurses. In the medical units nurses have better organizational health than in the operating theaters; this means that in the first context nurses have a more positive perception of their organization, probably due to the relational and communicational aspects with patients. Finally, the manual will give the opportunity to nurse managers to better manage the personnel, carrying out surveys in their contexts, to properly use the NOHQ, to elaborate the data and to interpret the results

Dinamica stagionale e distribuzione orizzontale di fitoplancton, carbonio organico e batterioplancton. Struttura dei popolamenti fitoplanctonici

No abstract availabl

What is Behind Counterproductive Work Behaviors in the Nursing Profession? A Systematic Review

LETTURA CONSIGLIAT

Violare le norme organizzative e sociali nei luoghi di lavoro: Studio correlazionale nel contesto infermieristico

Obiettivi: L’obiettivo principale di questo studio è stato di valutare le relazioni esistenti tra le variabili del contesto organizzativo (per esempio, carichi di lavoro, conflitti interpersonali, vincoli organizzativi), il burnout, il disimpegno morale e i comportamenti controproduttivi (CWB) degli infermieri, negli specifici ambiti clinici in cui lavorano. Metodo: Uno studio descrittivo correlazionale è stato condotto su un campione di 347 infermieri di diverse realtà operative di una grande struttura ospedaliera universitaria del centro Italia. Per l’indagine è stato utilizzato un questionario composto da scale per la misurazione delle variabili di contesto organizzativo, delle dimensioni del burnout, del sovraccarico relazionale, del disimpegno morale e dei comportamenti contro produttivi. Risultati: Gli ambiti clinici influenzavano il benessere organizzativo vissuto dagli infermieri che, a loro volta, influenzavano l’attuazione di CWB. Le aree ambulatoriali e di day hospital risultavano quelle in cui gli infermieri mettevano meno in pratica i CWB, diversamente da quelle di pronto soccorso e di medicina generale in cui i CWB venivano attuati più frequentemente. Conclusioni: I risultati di questo studio sono importanti per chi si occupa del benessere dei lavoratori e per i dirigenti delle professioni infermieristiche perché mettono in luce quanto gli ambiti clinici e le variabili di contesto organizzativo possano spingere gli infermieri ai CWB. Le variabili di contesto organizzativo devono essere tenute in seria considerazione perché si riflettono sulla qualità delle cure offerte ai malati

Modified Moral Distress Scale (MDS-11): Validation Study Among Italian Nurses

Background: Moral distress (MD) has significant implications on individual and organizational health. However there is a lack of an instrument to assess it among Italian nurses. aim: The main aim of this study was to validate a brief instrument to assess MD, developed from the Corley's Moral Distress Scale (MDS).Methods: The modified MDS scale was subjected to content and cultural validity. The scale was administered to 347 nurses. Psychometric analysis were performed to assess construct validity.Results: The scale consists of 11 items, investigating MD in nursing practice in different clinical settings. The dimensionality of the scale was investigated through exploratory factor analysis (EFA), which showed a two-dimensional structure labeled futility and potential damage. The futility refers to feelings of powerlessness and ineffectiveness in some clinical situations; the potential damage dimension captures feelings of powerlessness when nurses are forced to tolerate or perform perceived abusive clinical proceedings. Nurses who experienced higher MD, were more lilely to experience burnout.Conclusions: The modified MDS showed good psychometric properties, and it is valid and reliable for assessing moral distress among Italian nurses. Hence, the modified MDS allows to monitor the distress experienced by nurses and it is an important contribution to the scientific community and all those dealing with well-being of health workers.Keywords: moral distress, professional burnout, medical futility, nursing ethics, clinical ethicsScala sullo Stress Morale Modificata (MDS-11): Studio di Validazione tra gli Infermieri ItalianiIntroduzione: Lo stress morale (DM) ha implicazioni significative sul benessere individuale e sull'organizzazione lavorativa. Tuttavia allo stato attuale non disponiamo di uno strumento per valutare il DM tra gli infermieri italiani. Obiettivo: Lo scopo principale del presente studio è stato quello di validare uno strumento sintetico per la valutazione del MD, sviluppato dalla Scala dello Stress Morale di Corley (MDS).Metodo: La MDS modificata è stata sottoposta a validití  di contenuto e culturale. La scala è stata quindi somministrata a 347 infermieri. Si è eseguita l'analisi psicometrica per valutare la validití  di costrutto.Risultati: La scala consta di 11 items che studiano il moral distress nell'assistenza infermieristica in diversi setting clinici. Le dimensioni della Scala sono state studiate con l'analisi fattoriale esplorativa (EFA), che ha evidenziato che essa consta di due dimensioni chiamate futilití  e danno potenziale. La futilití  si riferisce a sentimenti di impotenza e di inefficacia in alcune situazioni cliniche; a dimensione del danno potenziale cattura invece i sentimenti di impotenza quando si è costretti a tollerare o ad eseguire procedure cliniche ritenute abusive. Gli infermieri che maggiormente sperimentavano MD, erano più probabilmente esposti al burnout.Conclusioni: La MDS modificata ha buone proprietí  psicometriche, ed è uno strumento valido e affidabile per la misurazione dello stress morale tra gli infermieri italiani. Quindi la MDS modificata permette di monitorare lo stress morale vissuto dagli infermieri, e fornisce un importante contributo alla comunití  scientifica e a tutti coloro che si occupano di benessere e salute dei lavoratori.Parole chiave: stress morale, burnout, futilití  medica, etica infermieristica, etica clinic

[Integrated Procurement Model: A new approach to Tissue and Organ Procurement]

Introduction: Literature has shown that the process of procurement of organs and tissues is fundamental in determining the number of donations. Starting from these assumptions, an integrated procurement model of organs and tissues has been designed and tested, where nurse specialists in organ donation coordinate the team and the entire process. Aim: To evaluate the effectiveness of the Integrated Procurement Models in terms of identifying potential donors and the number of donations. Methods: A retrospective observational study was conducted before and after the introduction of the new procurement model in a large University Hospital in Rome. The data of potential donors identified, the number of donations made and the efficiency indicators of the donation process were compared. Results: 692 potential donors were identified. The introduction of the integrated model increased the number of actual donors (from 31 to 51), brain death assessments (from 69 to 99), and the efficiency indicators of the donation process (from 0.25 to 0.29). From the comparison between the activities before and after the introduction of the integrated procurement model, statistically significant differences emerged regarding the number of donors and the amount of corneal tissue extracted. Conclusions: The adoption of the standardized Integrated Procurement Model would increase the number of potential donors and actual donations, thanks also to the key role assumed by the nurse specializing in organ donation as team and process coordinator

Nurse moral disengagement

Background: Ethics is a founding component of the nursing profession; however, nurses sometimes find it difficult to constantly adhere to the required ethical standards. There is limited knowledge about the factors that cause a committed nurse to violate standards; moral disengagement, originally developed by Bandura, is an essential variable to consider. Research objectives: This study aimed at developing and validating a nursing moral disengagement scale and investigated how moral disengagement is associated with counterproductive and citizenship behaviour at work. Research design: The research comprised a qualitative study and a quantitative study, combining a crossvalidation approach and a structural equation model. Participants and research context: A total of 60 Italian nurses (63% female) involved in clinical work and enrolled as students in a postgraduate master’s programme took part in the qualitative study. In 2012, the researchers recruited 434 nurses (76% female) from different Italian hospitals using a convenience sampling method to take part in the quantitative study. Ethical considerations: All the organisations involved and the university gave ethical approval; all respondents participated on a voluntary basis and did not receive any form of compensation. Findings: The nursing moral disengagement scale comprised a total of 22 items. Results attested the mono-dimensionality of the scale and its good psychometric properties. In addition, results highlighted a significant association between moral disengagement and both counterproductive and citizenship behaviours

COVID-19 infection in adult patients with hematological malignancies:a European Hematology Association Survey (EPICOVIDEHA)

Background: Patients with hematological malignancies (HM) are at high risk of mortality from SARS-CoV-2 disease 2019 (COVID-19). A better understanding of risk factors for adverse outcomes may improve clinical management in these patients. We therefore studied baseline characteristics of HM patients developing COVID-19 and analyzed predictors of mortality. Methods: The survey was supported by the Scientific Working Group Infection in Hematology of the European Hematology Association (EHA). Eligible for the analysis were adult patients with HM and laboratory-confirmed COVID-19 observed between March and December 2020. Results: The study sample includes 3801 cases, represented by lymphoproliferative (mainly non-Hodgkin lymphoma n = 1084, myeloma n = 684 and chronic lymphoid leukemia n = 474) and myeloproliferative malignancies (mainly acute myeloid leukemia n = 497 and myelodysplastic syndromes n = 279). Severe/critical COVID-19 was observed in 63.8% of patients (n = 2425). Overall, 2778 (73.1%) of the patients were hospitalized, 689 (18.1%) of whom were admitted to intensive care units (ICUs). Overall, 1185 patients (31.2%) died. The primary cause of death was COVID-19 in 688 patients (58.1%), HM in 173 patients (14.6%), and a combination of both COVID-19 and progressing HM in 155 patients (13.1%). Highest mortality was observed in acute myeloid leukemia (199/497, 40%) and myelodysplastic syndromes (118/279, 42.3%). The mortality rate significantly decreased between the first COVID-19 wave (March–May 2020) and the second wave (October–December 2020) (581/1427, 40.7% vs. 439/1773, 24.8%, p value < 0.0001). In the multivariable analysis, age, active malignancy, chronic cardiac disease, liver disease, renal impairment, smoking history, and ICU stay correlated with mortality. Acute myeloid leukemia was a higher mortality risk than lymphoproliferative diseases. Conclusions: This survey confirms that COVID-19 patients with HM are at high risk of lethal complications. However, improved COVID-19 prevention has reduced mortality despite an increase in the number of reported cases

MOLNUPIRAVIR COMPARED TO NIRMATRELVIR/RITONAVIR FOR COVID-19 IN HIGH-RISK PATIENTS WITH HAEMATOLOGICAL MALIGNANCY IN EUROPE. A MATCHED-PAIRED ANALYSIS FROM THE EPICOVIDEHA REGISTRY

Introduction: Molnupiravir and nirmatrelvir/ritonavir are antivirals used to prevent progression to severe SARS-CoV-2 infections, which reduce both hospitalization and mortality rates. Nirmatrelvir/ritonavir was authorised in Europe in December 2021, while molnupiravir is not yet licensed in Europe as of February 2022. Molnupiravir may be an alternative to nirmatrelvir/ritonavir, because it displays less frequent drug-drug interactions and contraindications. A caveat connected to molnupiravir derives from the mode of action inducing viral mutations. In clinical trials on patients without haematological malignancy, mortality rate reduction of molnupiravir appeared less pronounced than that of nirmatrelvir/ritonavir. Little is known about the comparative efficacy of the two drugs in patients with haematological malignancy at high-risk of severe COVID-19. Thus, we here assess the effectiveness of molnupiravir compared to nirmatrelvir/ritonavir in our cohort of patients with haematological malignancies. Methods: Clinical data of patients treated either with molnupiravir or nirmatrelvir/ritonavir monotherapy for COVID-19 were retrieved from the EPICOVIDEHA registry. Patients treated with molnupiravir were matched by sex, age (±10 years), and baseline haematological malignancy severity to controls treated with nirmatrelvir/ritonavir. Results: A total of 116 patients receiving molnupiravir for the clinical management of COVID-19 were matched to an equal number of controls receiving nirmatrelvir/ritonavir. In each of the groups, 68 (59%) patients were male; with a median age of 64 years (IQR 53-74) for molnupiravir recipients and 64 years (IQR 54-73) for nirmatrelvir/ritonavir recipients; 57% (n=66) of the patients had controlled baseline haematological malignancy, 13% (n=15) stable, and 30% (n=35) had active disease at COVID-19 onset in each of the groups. During COVID-19 infection, one third of patients from each group were admitted to hospital. Although a similar proportion of vaccinated patients was observed in both groups (molnupiravir n=77, 66% vs nirmatrelvir/ritonavir n=87, 75%), those treated with nirmatrelvir/ritonavir had more often received four doses (n=27, 23%) as compared to patients treated with molnupiravir (n=5, 4%, p&lt;0.001). No differences were detected in COVID-19 severity (p=0.39) or hospitalization (p=1.0). No statistically significant differences were identified in overall mortality rate (p=0.78) or in survival probability (d30 p=0.19, d60 p=0.67, d90 p=0.68, last day of follow up p=0.68). In all patients, deaths were either attributed to COVID-19 or the infection contributed to death as per treating physician's judgement. Conclusions: In high-risk patients with haematological malignancies and COVID-19, molnupiravir showed rates of hospitalization and mortality comparable to those of nirmatrelvir/ritonavir in this matched-pair analysis. Molnupiravir appears to be a plausible alternative to nirmatrelvir/ritonavir for COVID-19 treatment in patients with haematological malignancy

Age, Successive Waves, Immunization, and Mortality in Elderly COVID-19 Haematological Patients: EPICOVIDEHA Findings

Introduction: elderly patients with haematologic malignancies face the highest risk of severe COVID-19 outcomes. The infection impact in different age groups remains unstudied in detail. Methods: We analysed elderly patients (age groups: 65-70, 71-75, 76-80 and &gt;80 years old) with hematologic malignancies included in the EPICOVIDEHA registry between January 2020 and July 2022. Univariable and multivariable Cox regression models were conducted to identify factors influencing death in COVID-19 patients with haematological malignancy. results: the study included data from 3,603 elderly patients (aged 65 or older) with haematological malignancy, with a majority being male (58.1%) and a significant proportion having comorbidities. The patients were divided into four age groups, and the analysis assessed COVID-19 outcomes, vaccination status, and other variables in relation to age and pandemic waves.tThe 90-day survival rate for patients with COVID-19 was 71.2%, with significant differences between groups. The pandemic waves had varying impacts, with the first wave affecting patients over 80 years old, the second being more severe in 65-70, and the third being the least severe in all age groups. factors contributing to 90-day mortality included age, comorbidities, lymphopenia, active malignancy, acute leukaemia, less than three vaccine doses, severe COVID-19, and using only corticosteroids as treatment. Conclusions: These data underscore the heterogeneity of elderly haematological patients, highlight the different impact of COVID waves and the pivotal importance of vaccination, and may help in planning future healthcare efforts