La migrazione di infermieri e professionisti sanitari durante la pandemia da COVID-19

Roughly one year after the momentous United Nations Global Compact for Migration (United Nations 2019; Shaffer, et al., 2019) heralded hope for a better global regime to support migrants and enable them to leverage their skills worldwide, the ominous COVID-19 pandemic has caused dramatic shifts and setbacks in efforts to make migration ‘safe’ and ‘regular.’ In fact, the world has witnessed an array of border shutdowns in attempt to curb the spread of the virus, limiting the flow and labor migration of tech workers, engineers, and even, in some cases, health professionals. Simultaneously, healthcare migrants have experienced a slightly different policy response. As countries experience continued pressures on their health systems, they have largely exempted health workers from their bans. In fact, while migration globally has been decimated, nurses and health professionals have been carved out from restrictions and prohibitions. Despite these policies, the migration of the health professionals has severely di-minished as the pandemic has brutally affected their mobility through unprecedented country barriers and travel restrictions. The COVID-19 pandemic has exposed the vulnerabilities of nursing supply flows, domestically and internationally. Its impact at the country-level has further highlighted preexisting nurse supply gaps and the effect of staffing shortages. Internationally, the pandemic has disrupted global supply chains. The world has witnessed the closing of borders, the interruption of travel, and, in some countries, the restriction of outflows. The State of the World’s Nursing Report (SOWN) (WHO, 2020) noted a shortfall of almost six million nurses immediately pre-COVID-19, a shortage suffered particularly by low- and middle-income countries. This is of major concern given that increased international outflows of nurses in the new post-COVID era could undermine, even more than before, the readiness of those countries to meet healthcare demands (ICN, 2020). In this default scenario, some, but not all, high-income destination countries will continue to rely on international inflow of nurses to a significant extent, as they did pre-COVID 19, further exacerbating the suffering of poor countries. Put simply, without country-level policy changes related to the nursing workforce and backed by international organisations, pre-COVID-19 trends of increased nurse flows from low- to high-income countries will likely continue. In this scenario, the iniquitous maldistribution of nurses may become more pronounced. This “do nothing” option risks undermining both country-level progress towards the attainment of Universal Health Coverage (UHC), and the overall global response to any future pandemic wave. Furthermore, key post-COVID-19 policies must prioritize bilateral and regional agreements to allow easier mobility for health professionals. The nursing workforce has been central to COVID-19 response effectiveness in all countries and its steady implementation constitutes a powerful response to the immediate and longer lasting effects of the pandemic on nurse supply. To improve longer-term nurse workforce sustainability, there is a need, as both the WHO (WHO, 2019) and OECD (2019) have noted, for a coor-dinated policy response with respect to the international supply of nurses. At the country-level, this will require implementing policy bundles with two interrelated objectives: to improve retention of domestically-trained nurses; and, to ensure adequate domestic trai-ning capacity. This requires a strong commitment to supporting regular and systematic national nurse labour market analysis via a set of data and workforce projections, particularly in resource-constrained countries, by the provision of technical advice and assi-stance, data improvement, independent analysis, and multi-stakeholder policy dialogues to agree on priority policy actions regarding domestic nurse supply and retention. The commitment to investing in nurse workforce sustainability in small states is essential, particularly in lower-income countries and fragile states. If these country-level and international nurse workforce policy responses are implemented effectively and in atimely manner, there can be hope for the future sustainability of the profession’s nursing supply. Strategic policy directions should endorse major investments in countries affected by shortages to educate, employ, and retain nurses and other health professionals through domestic funding as well as appropriately-aligned development assistance (Buchan, et al., 2019). Commitment to effective monitoring of international flows of nurses, based on complete national datasets using standard measures, rapid analysis, and timely publication, with global coverage, and including country level reporting on nurse “self-sufficiency” are mandatory if the world is to adequately cope with the pandemic. Ad oltre un anno dalla firma del trattato United Nations Global Compact for Migration (United Nations 2019; Shaffer, et al., 2019) che ha avviato una stagione di speranza di costruizione di una rete globale migliore per supportare i migranti e consentire loro di sfruttare le loro capacità in tutto il mondo, la minacciosa pandemia COVID-19 ha causato drammatici cambiamenti ed importanti battute d'arresto negli sforzi tesi a rendere la migrazione “sicura” e “regolare”. In effetti, il mondo ha assistito a una serie di chiusure alle frontiere nel tentativo di frenare la diffusione del virus, che hanno limitato il flusso e la migrazione di lavoratori tecnologici, come gli ingegneri e, in alcuni casi, anche professionisti sanitari. Allo stesso tempo, i migranti sanitari hanno sperimentato una risposta politica leggermente diversa. Poiché i Governi subiscono continue pressioni sui loro sistemi sanitari, hanno ampiamente esentato gli operatori sanitari dai loro divieti. Infatti, mentre la migrazione a livello globale è stata decimata, gli infermieri e gli operatori sanitari sono stati tagliati fuori da restrizioni e divieti. Nonostante queste politiche, la migrazione degli operatori sanitari è in ogni caso gravemente diminuita poiché la pandemia ha brutalmente colpito la loro mobilità attraverso barriere nazionali e restrizioni di viaggio senza precedenti. La pandemia COVID-19 ha esposto le vulnerabilità dei flussi di fornitura di personale infermieristico, a livello nazionale e internazionale. Il suo impatto a livello nazionale ha ulteriormente evidenziato le lacune preesistenti nelle modalità di impiego di infermieri e l'effetto della carenza di personale. A livello internazionale, la pandemia ha interrotto le catene di approvvigionamento globali. Il mondo ha assistito alla chiusura delle frontiere, all'interruzione dei viaggi e, in alcuni paesi, alla limitazione dei flussi in uscita. Il recente Report State of the World's Nursing (SOWN) (WHO, 2020) ha rilevato un deficit di quasi sei milioni di infermieri immediatamente prima del COVID-19, carenza sofferta in particolare dai paesi a basso e medio reddito. Ciò è motivo di grande preoccupazione dato che l'aumento dei flussi internazionali di infermieri nella nuova era post-COVID potrebbe minare, anche più di prima, la prontezza di quei paesi a soddisfare le richieste di assistenza sanitaria (ICN, 2020). In questo scenario, alcuni, ma non tutti, dei paesi di destinazione ad alto reddito continueranno a fare affidamento sull'afflusso internazionale di infermieri in misura significativa, come hanno fatto prima del COVID-19, esacerbando ulteriormente la sofferenza dei paesi poveri. In sintesi, senza cambiamenti politici a livello nazionale relativi alla gestione della forza lavoro infermieristica sostenuti da Organizzazioni Internazionali, le tendenze pre-COVID-19 di aumento dei flussi di infermieri dai Paesi a basso e alto reddito probabilmente continueranno. In questo scenario, l'iniqua distribuzione degli infermieri può diventare ancora più pronunciata. Questa opzione “non fare nulla” rischia di minare sia i progressi a livello nazionale verso il raggiungimento della copertura sanitaria universale (UHC), sia la risposta globale a qualsiasi futura ondata di pandemia. In questa ottica, le principali politiche post-COVID-19 devono dare la priorità agli accordi bilaterali e regionali per consentire una mobilità più facile per gli operatori sanitari. La forza lavoro infermieristica è stata fondamentale per l'efficacia della risposta COVID-19 in tutti i paesi e la sua costante implementazione costituisce una potente risposta agli effetti immediati e più duraturi della pandemia sul personale infermieristico. Per migliorare la sostenibilità della forza lavoro infermieristica a lungo termine, c'è bisogno, come hanno notato sia l'OMS (WHO, 2019) che l'OCSE (2019), di una risposta politica coordinata rispetto all'offerta internazionale di infermieri. A livello nazionale, ciò richiederà l'implementazione di pacchetti di politiche attive con due obiettivi correlati: migliorare la fidelizzazione degli infermieri formati a livello nazionale; e, garantire un'adeguata capacità di formazione in ambito locale. Ciò richiede un forte impegno nel supportare la conduzioni di analisi nazionali regolari e sistematiche del mercato del lavoro infermieristico attraverso una serie di dati e proiezioni sulla forza lavoro, in particolare nei Paesi con risorse limitate, fornendo consulenza e assistenza tecnica, valorizzazione dei dati, analisi indipendenti e multi-stakeholder, policy dialogues, per concordare azioni politiche prioritarie riguardanti gli organici infermieristici ed il mantenimento in attività degli infermieri. L'impegno a investire nella sostenibilità della forza lavoro infermieristica nelle diverse Nazioni è essenziale, in particolare nei Paesi a basso reddito e negli Stati cosidetti fragili. Se queste risposte politiche sulla forza lavoro infermieristica a livello nazionale e internazionale vengono attuate in modo efficace e tempestivo, ci potrà essere speranza per la futura sostenibilità dell'offerta infermieristica. Le direzioni politiche strategiche dovrebbero sostenere importanti investimenti nei paesi colpiti da carenze per formare, assumere e trattenere infermieri e altri professionisti sanitari attraverso finanziamenti nazionali e assistenza allo sviluppo delle professioni (Buchan, et al., 2019). L'impegno per un monitoraggio efficace dei flussi internazionali di infermieri, sulla base di set di dati nazionali completi, analisi rapide e pubblicazioni tempestive, con copertura globale, e includendo rapporti a livello nazionale sull’autosufficienza infermieristica diventano quanto mai obbligatori quando ci si trova di fronte ad una pandemia

Trends in foreign-educated nurse mobility beyond the COVID-19 pandemic

While the COVID-19 pandemic initially halted the mobility of health professionals, global migration has since returned to pre-pandemic levels and will likely explode in the years beyond the pandemic. Simultaneously, the situation surrounding global health workforce staffing and sustainability is dire; the current global shortage of nurses is estimated at seven million, while the WHO calls for 13 million new nurses by 2030. In response, countries, particularly in high-income regions, seek to fill workforce vacancies with foreign-educated health workers. To both meet the demands of high-income countries’ strained health systems and to ensure ethical and sustainable recruitment practices for equally strained low- to middle-income regions, governments, health systems, and other stakeholders should strive for workforce sustainability via effective and coordinated policy responses, both at the national and international level. If correctly endorsed and implemented, the WHO Global Code of Practice on the International Recruitment of Health Personnel can be an effective tool in helping “destination” countries and regions meet the needs of their strained health workforces while also ensuring sustainability and ethical recruitment from “source” regions that are equally at risk

Modified Research Utilization Questionnaire: Development and Validation Study among Italian Nurses

Purpose: The purpose of this study was to develop the modified research utilization questionnaire (M-RUQ) and to establish its content and face validity, construct validity, and reliability. Methods: This study has a multiphase (three phases), methodological, and cross-sectional design. First, research utilization questionnaire (RUQ) was translated into Italian, which is the target language to develop the M-RUQ. Second, the RUQ psychometric proprieties were assessed using exploratory factorial analysis to identify ambiguous or problematic items (e.g., cross-loadings) (cross-sectional sampling A). The RUQ modification (i.e., item deleting, wording modification, and scoring procedure) represented the development of the M-RUQ among Italian nurses. The third phase was aimed to confirm the construct validity of the M-RUQ and to test its stability and internal consistency (cross-sectional sampling B). Results: This study's findings show that M-RUQ has a three-dimensional structure and a total of 22 items. The M-RUQ shows evidence of validity and reliability. Precisely, the factorial structure coming from an exploratory factorial analysis on the first sample (n = 504) was confirmed by a final model of confirmatory factorial analysis (CFA) on a second sample (n = 362). The final CFA model showed adequate goodness of fit, where all the factor loadings showed values higher than .40. Cronbach's α was satisfactory for each domain and for the overall scale. Furthermore, the M-RUQ showed good stability described by the test–retest. Conclusion: The M-RUQ should be used to assess research utilization among nurses for educational or research purposes to address the practice. Further research about its validity and reliability is suggested. Keywords: evidence-based nursing, nursing, psychometric

Admission to the Long-Term Care Facilities and Institutionalization Rate in Community-Dwelling Frail Adults: An Observational Longitudinal Cohort Study

The worldwide aging and the increase of chronic disease impacted the Health System by generating an increased risk of admission to Long-Term Care (LTC) facilities for older adults. The study aimed to evaluate the admission rate to LTC facilities for community-dwelling older adults and investigate factors associated with these admissions. A secondary data analysis stemming from an observational longitudinal cohort study (from 2014 to 2017) was performed. The sample was made up by 1246 older adults (664 females and 582 males, mean age 76.3, SD ± 7.1). The LTC facilities access rate was 12.5 per 1000 observations/ year. Multivariable Linear Regression identified frailty, cardiovascular disease, and incapacity to take medicine and manage money as predictors of the LTC facilities' access rate. The Multiple Correspondence Analysis identified three clusters: those living at home with comorbidities; those living in LTC facilities who are pre-frail or frail; those very frail but not linked to residential LTC. The results indicate that access to LTC facilities is not determined by severe disability, severe comorbidity, and higher frailty levels. Instead, it is related to moderate disability associated with a lack of social support. Therefore, the care policies need to enhance social interventions to integrate medical, nursing, and rehabilitative care

Psychometric Characteristics of the Self-Care of Chronic Illness Inventory in Older Adults Living in a Middle-Income Country

: Chronic illness requires numerous treatments and self-care is essential in the care process. Evaluation of self-care behaviors facilitates the identification of patients' needs and optimizes education and care processes. This study aimed to test the psychometric characteristics (validity, reliability, and measurement error) of the Albanian version of the Self-Care of Chronic Illness Inventory (SC-CII). Patients with multiple chronic conditions and caregivers were recruited in outpatient clinics in Albania. The patients completed the SC-CII, which includes three scales: self-care maintenance, self-care monitoring, and self-care management. Factorial validity was tested for each scale, with confirmatory factor analysis. Reliability was evaluated with the composite coefficient, Cronbach's alpha, and the global reliability index for multidimensional scales. The construct validity was tested using hypothesis testing and known differences between groups. The measurement error was tested to assess responsiveness to changes. The self-care maintenance and self-care monitoring scales showed a unidimensional factorial structure, while the self-care management scale showed a bidimensional structure. Reliability estimates were adequate for all reliability coefficients. Construct validity was supported. The measurement error was adequate. The Albanian version of the SC-CII shows good psychometric properties in the Albanian sample

A Single-Center, Randomized Controlled Trial to Test the Efficacy of Nurse-Led Motivational Interviewing for Enhancing Self-Care in Adults with Heart Failure

Background: The role of nurse-led motivational interviewing (MI) in improving self-care among patients with heart failure (HF) is promising, even if it still requires further empirical evidence to determine its efficacy. For this reason, this study tested its efficacy in enhancing self-care maintenance (primary endpoint), self-care management, and self-care confidence after three months from enrollment in adults with HF compared to usual care, and assessed changes in self-care over follow-up times (3, 6, 9, and 12 months). Methods: A single-center, randomized, controlled, parallel-group, superiority study with two experimental arms and a control group was performed. Allocation was in a 1:1:1 ratio between intervention groups and control. Results: MI was effective in improving self-care maintenance after three months when it was performed only for patients (arm 1) and for the patients-caregivers dyad (arm 2) (respectively, Cohen's d = 0.92, p-value < 0.001; Cohen's d = 0.68, p-value < 0.001). These effects were stable over the one-year follow-up. No effects were observed concerning self-care management, while MI moderately influenced self-care confidence. Conclusions: This study supported the adoption of nurse-led MI in the clinical management of adults with HF

Il ruolo degli stili di coping e dei fattori di stress sulla qualita di vita professionale tra gli operatori di una centrale operativa delle emergenze sanitarie: uno studio preliminare cross-sectional

INTRODUCTION: The professional quality of life (ProQOL) is a fundamental aspect of the care providers’ working life and plays an important role in monitoring their mental health status and wellbeing. The objective of this study is to explore the level of ProQOL among the Emergency Operating Center workers in the Italian context and to examine the role of both stressors and coping strategies. Health workers from an Italian 118 Emergency Operating Center participated into the research. METHODS: A preliminar y cross-sectional study has been performed RESULTS:. The survey’s response rate was 72.04% (n = 67). Results found that Stressors arepositively correlated with Burnout and Compassion Fatigue whereas Compassion Satisfaction has a positive correlation with the Task-oriented coping strategy and with the Emotion-oriented strategy. CONCLUSIONS: In conclusion, it is pivotal to implement strategies and solutions that can enhance the levels of satisfaction of Emergency Operating Center workers in order to improve patients care and organizational outcomes. Key words: Quality of life, Coping, Stressor, Emergency, Nurse.INTRODUZIONE: La qualità della vita professionale (ProQOL) è un aspetto fondamentale della vita lavorativa del personale che eroga assistenza sanitaria e gioca un ruolo importante nel monitorare il loro stato di salute mentale e fisico. L’obiettivo di questo studio è esplorare il livello di ProQOL tra gli operatori della salute di una Centrale operativa delle emergenze sanitarie nel contesto italiano ed esaminare il ruolo dei fattori di stress e delle strategie di Coping. I partecipanti alla ricerca sono operatori sanitari appartenenti alla Centrale Operativa delle emergenze sanitarie del 118. METODO: E’ stato effettuato uno studio preliminare di prevalenza. RISULTATI: Il tasso di risposta ai questionari è stato del 72,04% (n = 67). I risultati indicano che il Burnout e la Compassion Fatigue hanno un correlazione positiva con i fattori di stress mentre la Compassion Satisfaction ha mostrato un’associazione positiva con gli stili di coping Task-oriented ed Emotion-oriented. CONCLUSIONI: In conclusione è importante implementare strategie e soluzioni che possono innalzare i livelli di soddisfazione lavorativa degli operatori delle Centrali Operative di Emergenza per migliorare l’assistenza ai pazienti e i risultati manageriali. Parole chiave: Qualità della vita, Coping, Stressor, Emergenza, Infermiere.   © 202

Crystal-chemistry and reactivity of fibrous amphiboles of environmental and health interest

This work concerns the physico-chemical and structural characterisation of mineral fibres (asbestos) and the comprehension of the chemical and molecular mechanisms which are responsible of the development of human pathologies specific to their inhalation. In particular, in this work we performed a crystallochemical and surface reactivity study of floro-edenite, a natural amphibole of volcanic origin recently discovered in Biancavilla (Sicily, Italy). The properties of this mineral were compared to those of other natural mineral fibres, such as tremolite and chrysotile, also present in ophiolitic formations of the Italian peninsula. This work consists of several different parts, which are proof of its multidisciplinary and applied character. In the first part, we studied the mineralogical, chemical and morphological analysis of previously purified natural fibres of fluoro-edenite. The main goal of this part was to determine precisely the crystallographic structure and the composition of this material. This information has been of fundamental importance in the second part of this study, which concerned the toxicochemical properties and the surface reactivity of this mineral. In order to underline the possible pathogenic effect of the inhalation of these fibres, these properties were compared to those of other mineral fibres, such as tremolite and chrysotile, the toxicological properties of which are already known.The second part of this study was finally validated by parallel in vitro and in vivo tests of these materials, in collaboration with a biomedical research group.Ce travail de thèse concerne la caractérisation physico-chimique et structurale de fibres minérales et la compréhension de mécanismes chimiques et moléculaires qui peuvent amorcer des pathologies spécifiques relatives à leur inhalation. En particulier, dans ce travail on s'est concentrés sur la fluoro-édénite, une amphibole naturelle d origine volcanique découverte récemment à Biancavilla (Sicile), en comparaison avec d autres fibres minérales, comme les trémolites et le chrysotile. La première partie de cette thèse concerne l étude minéralogique, chimique et morphologique des fibres naturelles de fluoro-édénite préalablement purifiées. Ces informations ont été fondamentales pour la deuxième partie de cette étude, qui a concerné l étude des propriétés toxicochimiques et la réactivité de surface de ce minéral. Cette approche a été enfin validée à travers des tests in vitro et in vivo de la toxicité de ces matériaux, en collaboration avec une équipe de médecins et biologistes.PARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF