Moral Distress in the Pediatric Intensive Care Unit : an Italian Study

Introduction: There is paucity of data within the Italian context regarding moral distress in intensive pediatric settings. The aim of the present study was to assess the frequency, intensity, and level of moral distress experienced by nurses working in a sample of pediatric intensive care units (PICUs). Materials and Methods: A cross-sectional questionnaire survey was conducted in eight PICUs from five northern Italian regions in a convenience sample of 136 nurses. Moral distress was evaluated using the modified Italian version of the Moral Distress Scale Neonatal-Pediatric Version (MDSNPV). Each item was scored in terms of frequency and intensity on a five-point Likert scale, ranging from 0 to 4. The total frequency and intensity scores for all the 21 clinical items were comprised between 0 and 84. For each item, the level of moral distress was derived by multiplying the frequency score by the intensity score and quantified with a score ranging from 0 to 16. The total score of the moral distress level for the 21 items ranged from 0 to 336. Results: The mean total scores for the frequency, intensity and level of moral distress were 24.1 \ub1 10.4, 36.2 \ub1 18.6, and 57.7 \ub1 37.1, respectively. The clinical situations identified as the major causes of moral distress among nurses in the present study involved end-of-life care and resuscitation. At multivariate logistic regression analysis, number of deaths occurring in PICUs, having children and intention to leave work due to moral distress resulted to be independently associated with a higher total moral distress level. Conclusions: The results of the present study contribute to the understanding of moral distress experience in acute pediatric care settings, including the clinical situations associated with a higher moral distress level, and highlight the importance of sharing thoughts, feelings and information within the multidisciplinary health care professional team for effective shared decision making, particularly in situations involving end-of-life care and resuscitation

Exploring the gap between needs and practice in facilitating breastfeeding within the neonatal intensive care setting : An Italian survey on organizational factors

Introduction: The system-level factors of the neonatal intensive care unit work environment contribute to breastfeeding promotion in the preterm population. The aim of this study was to investigate the operative policies related to breastfeeding support in a sample of Italian Neonatal Intensive Care Units. Materials and Methods: A multicenter cross-sectional survey was conducted, including a sample of 17 head nurses. The items of the questionnaire investigated the following areas: breastfeeding policies, staff education, family centered care, and breastfeeding promotion and support both in the neonatal intensive care units and after discharge. Results: Written breastfeeding policies were available for staff in all the neonatal intensive care units, most commonly addressing procedures related to skin-to-skin contact, human milk expression, and preterm infant breastfeeding. Most of the neonatal intensive care units correctly advised the mothers to initiate milk expression within 6 h from delivery and to pump milk at least 6 times/days. Breastfeeding training for the nursing staff was planned in the majority of the neonatal intensive care units although according to different schedules. With regard to the family centered care implementation, time restrictions were present in seven neonatal intensive care units, mostly occurring during the night shift, and the morning hours concomitantly with medical rounds. Moreover, in the majority of the investigated neonatal intensive care units, the parents were asked to leave the ward when their infant underwent a major invasive procedure or during the nurse/physician shift change report. With regard to breastfeeding promotion and support, eight neonatal care units had a multidisciplinary team with several health care professionals and 10 provided information about community-based support services. Most of the units assessed breastfeeding after discharge. Conclusion: Based on the present findings, enrolled Neonatal Intensive Care Units appear to provide breastfeeding-supportive environments with special regard to breastfeeding policies, milk expression practices, interprofessional collaboration, and continuity of care. Health care professionals should exert efforts to ensure continuous and updated breastfeeding staff education and promote parent-infant closeness and family centered care

Overcoming Rooming-In Barriers : a Survey on Mothers' Perspectives

Background: The importance of rooming-in in promoting breastfeeding initiation and continuation within the 10 Steps for Successful Breastfeeding is widely acknowledged. However, adherence to this practice by healthcare facilities is lower than that of other Steps. A deeper knowledge of maternal rooming-in experience has been advocated to identify the most effective rooming-in policies, thus enabling mothers to have a positive experience when practicing it in the postpartum period. Aim: To investigate maternal knowledge of rooming-in and the most frequently encountered barriers and possible facilitators of adherence to the practice, according to their experience. Study Design and Methods: We enrolled mothers who delivered healthy term or late preterm infants during the month of January 2019 in a tertiary referral center for neonatal care in Milan, Italy. At discharge, a structured interview about mothers' rooming-in experience was administered by healthcare professionals. Basic subjects' characteristics and mode of feeding were recorded. Results: The enrolled population included 328 mothers and 333 neonates. The great majority of mothers knew of rooming-in and 48.2% practiced it continuously. The 86.3% of mothers was aware of the beneficial effects of rooming-in; promotion of mother-infant bonding, increased confidence in taking care of the baby and ability to recognize baby's feeding cues were the most frequently cited, whereas improving breastfeeding was reported by a limited number of mothers, unless they were asked a specific question about it. The main reported obstacles were fatigue (40.5%) and cesarean section related difficulties (15.5%); night was the most critical time of the day for rooming-in. Strategies suggested by mothers for improving rooming-in were increased assistance to the dyad, organizational and structural changes and the possibility to have a family member during the night. Additionally, mothers who adhered to rooming-in practice continuously during hospital stay had a higher exclusive breastfeeding rate at discharge compared to mothers who did not. Conclusions: Our study contributes to a deeper knowledge of maternal rooming-in experience in an Italian tertiary maternity. We underline the importance of providing a tailored support to the mother-infant dyad in order to overcome rooming-in barriers perceived by mothers and promote a positive rooming-in experience

Maternal views on facilitators of and barriers to breastfeeding preterm infants

Background: The supply of breast milk to preterm infants tends to occur at a lower rate than that recorded among term infants. We aimed to investigate the facilitators of and barriers to breastfeeding during hospital stay according to the experiences of mothers that gave birth to premature infants requiring admission to neonatal intensive care unit. Methods: A cross-sectional questionnaire survey was conducted. Mothers who had delivered a newborn with a gestational age 6433 weeks requiring intensive care, entered the study. Basic subjects' characteristics and infant feeding practices were also recorded. Results: A total of 64 mothers were enrolled, leading to a total of 81 infants. At discharge, any breastfeeding was recorded in 66% of infants, with 27% of those infants being exclusively breastfed. Any infant was exclusively fed directly at the breast. Most mothers experienced adequate support during their infant's hospitalization and reported satisfaction with breastfeeding. Almost all mothers felt that feeding their infant human milk was beneficial for the infant's health. Thirty percent of the mothers reported that they had experienced some obstacles to breastfeeding. Specifically, infants born to mothers who experienced difficulties in pumping breast milk (OR = 4.6; CI 1.5-13.9) or in providing an adequate amount of milk to the infant (OR = 3.57; CI 1.1-11.5) were at higher risk of being fed with formula at discharge. Conclusions: On the basis of the present results, health care professionals should target their efforts to optimize breastfeeding support for mothers of premature infants admitted to level III care, especially by improving breast milk production and endorsing direct breastfeeding

Exploring the Emotional Breastfeeding Experience of First-Time Mothers : Implications for Healthcare Support

Background: Among breastfeeding determinants, the unique emotional breastfeeding experience has been poorly explored. The present study aimed to investigate the emotional breastfeeding experience in a cohort of first-time mothers. Materials and methods: We conducted a prospective observational study that enrolled primiparas having delivered singleton healthy term newborns, and exclusively breastfeeding at hospital discharge. At 3 months post-delivery mothers accessed an online questionnaire investigating their emotional breastfeeding experience. The chi-squared test was used to assess the association between the feelings experienced during breastfeeding and feeding outcomes at 3 months. Results: Out of the 421 enrolled mothers, 273 (65%) completed the questionnaire. At 3 months post-delivery exclusive breastfeeding was reported by a 66% of mothers, a 19% reported complementary feeding, and a 15% of mothers reported exclusive formula feeding. Breastfeeding experience was described as positive by 62% of mothers although breastfeeding difficulties were reported by 80% of the mothers. The mothers that had experienced fear, sadness, anger or concern during breastfeeding showed a significant higher exclusive formula feeding rate at 3 months post-delivery than those who did not (25.5 vs. 12.8%, p = 0.021; 28.6 vs. 13.4%, p = 0.02; 40 vs. 13.4%, p = 0.005; 20.5 vs. 11.8%, p = 0.049, respectively). An 85% of mothers stated that their breastfeeding experience was different from what they would have expected, blaming for this discrepancy the occurrence of difficulties during breastfeeding and the complexity of breastfeeding itself (50%), pain experience (8%), being dependent from the baby (6%), and breastfeeding failure (11%). A total of 25% of mothers, however, reported they found breastfeeding to be a much more positive experience than what they had expected. Conclusion: Breastfeeding care should include a tailored emotional support of first time-mothers in addition to the implementation of their breastfeeding knowledge and skills

Crescere: Studio longitudinale per il benessere dell´infanzia

La transizione dall’infanzia all’adolescenza è un momento chiave nella vita di una persona. Si affrontano numerose sfide e compiti di sviluppo, che aiutano la persona a potenziare le capacità e a formare la propria identità. Quali fattori favoriscono la crescita positiva e proteggono dai rischi? È la domanda principale dello studio CRESCERE. I risultati mettono in luce i circoli virtuosi che si possono sviluppare nella vita dei ragazzi. Emerge l’importanza dei legami familiari, del dialogo con i genitori, del supporto che percepiscono dalla famiglia e di quanto sia importante per promuovere la fiducia nelle proprie capacità, il sentirsi bene con se stessi e con gli altri. Il benessere scolastico è un altro aspetto fondamentale per la crescita, per lo sviluppo psicologico e sociale dei ragazzi.Fil: Barbero Vignola, G. Fondazione Emanuela Zancan; ItaliaFil: Bezze, Maria. Fondazione Emanuela Zancan; ItaliaFil: Canali, Cinzia. Fondazione Emanuela Zancan; ItaliaFil: Crocetti, Elisabetta. Università di Bologna; ItaliaFil: De Leo, Diego. Griffith University; AustraliaFil: Eynard, Martin. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Centro de Investigaciones y Estudios sobre Cultura y Sociedad. Universidad Nacional de Córdoba. Centro de Investigaciones y Estudios sobre Cultura y Sociedad; ArgentinaFil: Maurizio, Roberto. Fondazione Emanuela Zancan; ItaliaFil: Milan, Giuseppe. Università di Padova; ItaliaFil: Ongaro, Fausta. Università di Padova; ItaliaFil: Schiavon, Maurizio. Centro di Medicina dello Sport ; ItaliaFil: Vecchiato, Tiziano. Fondazione Emanuela Zancan; Itali

A polar diagram for comprehensive geriatric assessment

Comprehensive geriatric assessment has become synonymous with geriatric practice. This includes evaluation of the older person's physical and mental health, and the functional and social status. We propose a new way of representing a person's condition, called the "polar diagram". This shows the subject's scores on the evaluation scales that are arranged in radial positions inside a circle. The outer part of the circle corresponds to the best condition. Gaps between the best condition and the actual scores are easily identified. The diagram can be employed to monitor the subject's condition and to assess any changes in outcomes

Pruritus,prurigo and allergic contact sensitivity

Aim. The aim of this study was to make a new contribution to the subject of prurigo and pruritus sine materia with or with-out scratching-related lesions, and to assess any correlation with allergic contact sensitivity. Methods. The study was conducted on 104 patients with symp-toms of pruritus, excluding cases of definite dermatosis. After making a detailed anamnesis, the patients were administered a battery of biohumoral tests designed to establish their general state of health. Skin tests were performed if the patient\u2019s medical history. Patients who were positive on the allergic contact lf sensitivity test were informed about methods of avoiding contact with the haptens concerned and were followed-up for at least 3 months. No medication was administered. Results. Thirty-seven of the S3 patients tested positive for allergic contact sensitivity. At the final check-up, 15 of the above 37 patients presented complete objective and subjective remission. Conclusion. Our study concludes with the finding that latent contact sensitivity dissociated from clinically overt allergic contact dermatitis was present in 70% of surveyed patients. We do not believe that this is a random association; rather, it is our opinion that subliminal or minimal, exogenous or endogenous exposure may elicit pruritus without actually triggering contact eczematous dermatitis. Hence, screening by the patch test for contact sensitivity may be helpful in correctly assessing some forms of pruritus and prurigo

Applicazione della family-centered care in pediatria : studio descrittivo

Introduzione. Recenti studi evidenziano una realt\ue0 ospedaliera in cui le attivit\ue0 sono incentrate pi\uf9 sullo staff che sul nucleo familiare. Questo studio ha voluto misurare l\u2019applicazione della Family-centered care (FCC) in pediatria, utilizzando come indicatore la percezione di famiglie e infermieri, verificandone la corrispondenza attraverso appropriate analisi statistiche. Metodi e strumenti. La raccolta dati \ue8 stata condotta utilizzando i questionari MPOC-20 e MPOC-SP in 5 reparti di un IRCCS milanese. E\u2019 stato utilizzato un campionamento di convenienza nelle famiglie mentre tutte le testimonianze degli infermieri sono state raccolte. Risultati. Per le famiglie la FCC risulta applicata nei contesti per cronici, mentre i contesti \u201cmisti\u201d hanno totalizzato punteggi inferiori. Il tipo di ricovero influenza la soddisfazione percepita, con i punteggi pi\uf9 bassi segnalati dalle famiglie di bambini in ricovero programmato in contesti \u201cmisti\u201d. Per gli infermieri, sesso, anzianit\ue0 di servizio, genitorialit\ue0 e formazione di base sono risultate variabili influenti. Discussione e conclusioni. Nei contesti misti e per acuti la maggior adesione al modello biomedico, la specializzazione inferiore, un follow-up inferiore, meno risorse umane e la tendenza a privilegiare competenze tecniche, sfavoriscono la realizzazione di FCC. A famiglie pi\uf9 istruite sembrerebbero corrispondere maggiori aspettative educative e relazionali. La genitorialit\ue0 sembrerebbe influire positivamente sugli infermieri

Dall'ideale al meglio possibile nell'insegnamento/apprendimento clinico

Obiettivi, metodi e strumenti per l\u2019insegnamento/apprendimento clinico e la valutazione. Presentazione degli obiettivi della giornata: presentare i processi che guidano al raggiungimento degli obiettivi professionalizzanti dei tre anni di corso, invitare i partecipanti al corso ad identificare gli obiettivi considerati prioritari, invitare i partecipanti a dividersi a gruppi di cui ciascun gruppo analizzer\ue0 uno degli obiettivi precedentemente identificato elaborando le strategie per raggiungerlo in qualit\ue0 di Assistente di Tirocinio, invitare i partecipanti a riconoscere il modello di riferimento (tecnocratico o umanistico), invitare i partecipanti a ricondurre l\u2019assistenza dell\u2019ostetrica alla personalizzazione secondo i principi dimostrati dalle Prove di Evidenza (EB). inoltre si analizzeranno gli strumenti e metodi di valutazione dell\u2019insegnamento/ apprendimento clinico: cosa valutare, come valutare