Esplorando il distress morale tra gli infermieri clinici

RIASSUNTOIl fenomeno del distress morale nella pratica infermieristica è descritto come una situazione di sofferenza che sorge quando l'infermiere riconosce l'azione eticamente appropriata da adottare e tuttavia impedimenti istituzionali gli rendono impossibile seguire il giusto corso d'azione. L'obiettivo è descrivere situazioni di pratica infermieristica che generano distress morale a causa dell'impossibilití  di intraprendere l'azione riconosciuta come eticamente appropriata; descrivere come gli infermieri gestiscono tali situazioni e le strategie identificate per affrontarle. È stato svolto un focus group in tre reparti di un grande ospedale del nord Italia. In un quarto reparto agli infermieri è stato chiesto di scrivere un'esperienza di distress morale. Sono stati coinvolti 40 infermieri e raccolte 50 esperienze. Dall'analisi delle esperienze sono emersi 5 ambiti fonte di distress morale: 1) decisione clinica; 2) competenze infermieristiche; 3) collaborazione infermiere-medico; 4) organizzazione dell'assistenza; 5) cure sicure. Per ogni ambito sono stati individuati i temi più frequentemente ricorrenti nelle narrazioni. Gli ambiti della collaborazione infermiere-medico, delle competenze infermieristiche e dell'organizzazione dell'assistenza impegnano i nurse leader nella identificazione e attuazione di strategie di intervento per la gestione del distress morale. Parole chiave: distress etico, distress morale, infermiere clinico ospedaliero, pratica infermieristica, eticaABSTRACTMoral distress in nursing practice is described as a suffering situation that arises when the nurse is unable to act her/his ethical choices, when institutional constraints interfere with acting in the way she/he believes to be right. The aim is to describe nursing practice situations causing moral distress resulting from the recognition of the ethical appropriate actions combined with the impossibility to pursue it; to describe how nurses manage moral distress situations and the strategies to cope with them. A focus group was conducted in three wards of a large teaching-hospital in the north of Italy. In another ward the nurses were asked to write a moral distress experience. A total of 40 nurses were involved and 50 experiences collected. The experiences' analysis has shown 5 source areas of moral distress: 1) clinical decision; 2) nursing competences; 3) nurse-physician collaboration; 4) organization of care; 5) safe care. For each area the most frequent themes were highlighted.Areas of clinical decision, nursing competences, nurse-physician collaboration involve nurse leaders in identification and implementation of strategies for managing moral distress.Key words: Moral/ethical distress, hospital nursing staff, nursing practice, ethic

Empathy and burnout: an analytic cross-sectional study among nurses and nursing students

Background and aim: Empathy is an essential element of good nursing care associated with increased patient satisfaction. Burnout represents chronic occupational stress which diminishes interest in work and reduces patient safety and satisfaction. The purpose of this study was to evaluate the correlation between empathy and burnout in nursing students and nurses. Method: This cross-sectional research was conducted in a sample of 298 nurses and 115 nursing students. Socio-demographic and career information was collected. Balanced Emotional Empathy Scale (BEES) and Maslach Burnout Inventory (MBI) were administered. Data were statistically analysed. Results: 63% of our sample answered questionnaires (54% of nurses and 84% of students). The BEES global mean score was slightly inferior to empathy cut-off of 32. In the student group, two BEES dimension scores were statistically significantly higher than nurses (p=0.011 and p=0.007 respectively, t-test). Empathy was negatively related to age (p=0.001, ANOVA). Emotional exhaustion (EE) scores of MBI reported statistically significantly lower levels for students (p<0.0001, t-test). EE was negatively related to BEES mean total score in students (r=-0.307, p<0.002) and nurses (r=-0.245, p<0.002), personal accomplishment of MBI presented positive correlation with BEES mean total scores in students (r=0.319, p<0.002) and nurses (r=0.266, p<0.001, Pearson’s correlation). Female students showed superior empathy capacity in comparison to male students in all 5 dimensions of BEES (p<0.001), whereas females nurses in only one dimension (p<0.001). Conclusions: Our data suggest empathy declines with age and career. High levels of empathy can be protective against burnout development, which, when presents, reduces empathy

Una aplicación de lógica difusa en el modelado de una cadena de suministro con incertidumbre en el abastecimiento de materiales

El problema que se aborda en este artículo tiene como objetivo la optimización de la compra de materiales y entrega de productos en la cadena de suministros, considerando fallas en la provisión de materias primas por parte de los proveedores. El modelo matemático que se formula es mixto entero nolineal (MINLP) y abarca un horizonte de tiempo dividido en varios períodos. Para fortalecer la relación con los proveedores se les ofrece contratos de compra, por material adquirido, en cada uno de los períodos propuestos. Para el modelado se recurre a la utilización de conjuntos difusos (fuzzy sets) que permiten asignar grados de confiabilidad a cada proveedor a partir del comportamiento histórico registrado por los mismos. El modelo determina los proveedores y las cantidades comprar y cuáles son los contratos a ofrecer de modo tal de minimizar los costos de compra y almacenamiento de materias primas. El modelo se emplea para realizar un análisis de sensibilidad del proceso de compra y la relación con sus proveedores. Para ello se realiza se proponen varios escenarios fijando la periodicidad de falla de cada proveedor, con estos valores fijos, el modelo MINLP se transforma en uno lineal MILP (Mixed Integer Linear Program) en cada uno de los escenario propuesto. El objetivo principal del artículo radica entonces en exponer una perspectiva distinta a la existente en la literatura cuando la provisión incierta de materiales no presenta una distribución de falla conocida o cuando un enfoque probabilístico no refleja eficientemente el comportamiento de cada proveedor. La resolución de los escenarios propuestos permite visualizar la dependencia del proceso de compra con los proveedores de materias primas.Sociedad Argentina de Informática e Investigación Operativ

Knowledge and attitudes of hospital nurses in italy related to near-death experiences.

ABSTRACT: I distributed Nina Thornburg&apos;s Near-Death Phenomena Knowledge and Attitudes Questionnaire to 750 nurses in three Verona hospitals, and received 476 completed questionnaires. Questionnaire respondents had a modest knowledge of near-death experiences (NDEs). Nevertheless, respondents expressed a positive attitude towards NDEs in general, and towards patients who had had NDEs. Thirty-four percent of the nurses had personally encountered NDErs, and those nurses reported a higher level of knowledge than their colleagues who had not had that opportunity. Furthermore, in relation to the global sample, nurses who had encountered an NDEr showed attitudes that were more positive regarding both the NDE itself and the type of assistance they offered NDErs

Modelo para el planeamiento de una cadena de suministro bajo demanda incierta

El problema que se aborda en este artículo tiene como objetivo la asignación óptima de los recursos de producción de una cadena de suministro, para satisfacer, a costo mínimo, las demandas inciertas en un horizonte de tiempo dividido en diversos períodos. Se apunta a brindar un plan de acción que responda eficientemente ante los distintos escenarios que supone el intervalo de incertidumbre, mediante el cual se modelan las especulaciones realizadas sobre las variaciones del mercado consumidor. Para ello, se implementa una metodología de resolución que transforma el modelo FMILP (Fuzzy Mixed Integer Linear Programming) en un MILP del que se desprende una solución óptima úni-ca. De este modo, se exhibe un enfoque distinto al existente en la literatura, que permite evitar subjetividades o inconsistencias en la elección de una solución promisoria, requerida en procedimientos de análisis de sensibilidad o escenarios.Sociedad Argentina de Informática e Investigación Operativa (SADIO

Una aplicación de lógica difusa en el modelado de una cadena de suministro con incertidumbre en el abastecimiento de materiales

El problema que se aborda en este artículo tiene como objetivo la optimización de la compra de materiales y entrega de productos en la cadena de suministros, considerando fallas en la provisión de materias primas por parte de los proveedores. El modelo matemático que se formula es mixto entero nolineal (MINLP) y abarca un horizonte de tiempo dividido en varios períodos. Para fortalecer la relación con los proveedores se les ofrece contratos de compra, por material adquirido, en cada uno de los períodos propuestos. Para el modelado se recurre a la utilización de conjuntos difusos (fuzzy sets) que permiten asignar grados de confiabilidad a cada proveedor a partir del comportamiento histórico registrado por los mismos. El modelo determina los proveedores y las cantidades comprar y cuáles son los contratos a ofrecer de modo tal de minimizar los costos de compra y almacenamiento de materias primas. El modelo se emplea para realizar un análisis de sensibilidad del proceso de compra y la relación con sus proveedores. Para ello se realiza se proponen varios escenarios fijando la periodicidad de falla de cada proveedor, con estos valores fijos, el modelo MINLP se transforma en uno lineal MILP (Mixed Integer Linear Program) en cada uno de los escenario propuesto. El objetivo principal del artículo radica entonces en exponer una perspectiva distinta a la existente en la literatura cuando la provisión incierta de materiales no presenta una distribución de falla conocida o cuando un enfoque probabilístico no refleja eficientemente el comportamiento de cada proveedor. La resolución de los escenarios propuestos permite visualizar la dependencia del proceso de compra con los proveedores de materias primas.Sociedad Argentina de Informática e Investigación Operativ

Una aplicación de lógica difusa en el modelado de una cadena de suministro con incertidumbre en el abastecimiento de materiales

El problema que se aborda en este artículo tiene como objetivo la optimización de la compra de materiales y entrega de productos en la cadena de suministros, considerando fallas en la provisión de materias primas por parte de los proveedores. El modelo matemático que se formula es mixto entero nolineal (MINLP) y abarca un horizonte de tiempo dividido en varios períodos. Para fortalecer la relación con los proveedores se les ofrece contratos de compra, por material adquirido, en cada uno de los períodos propuestos. Para el modelado se recurre a la utilización de conjuntos difusos (fuzzy sets) que permiten asignar grados de confiabilidad a cada proveedor a partir del comportamiento histórico registrado por los mismos. El modelo determina los proveedores y las cantidades comprar y cuáles son los contratos a ofrecer de modo tal de minimizar los costos de compra y almacenamiento de materias primas. El modelo se emplea para realizar un análisis de sensibilidad del proceso de compra y la relación con sus proveedores. Para ello se realiza se proponen varios escenarios fijando la periodicidad de falla de cada proveedor, con estos valores fijos, el modelo MINLP se transforma en uno lineal MILP (Mixed Integer Linear Program) en cada uno de los escenario propuesto. El objetivo principal del artículo radica entonces en exponer una perspectiva distinta a la existente en la literatura cuando la provisión incierta de materiales no presenta una distribución de falla conocida o cuando un enfoque probabilístico no refleja eficientemente el comportamiento de cada proveedor. La resolución de los escenarios propuestos permite visualizar la dependencia del proceso de compra con los proveedores de materias primas.Sociedad Argentina de Informática e Investigación Operativ

Parole e gesti di gratitudine dei pazienti. Le esperienze degli studenti in infermieristica nel tirocinio clinico

ABSTRACT Introduzione: La ricerca sugli effetti della gratitudine ricevuta dalle figure che operano nei contesti della salute è poco rappresentata. Gli studi quantitativi hanno utilizzato questionari self-report per misurare la percezione e gli effetti della gratitudine sui professionisti sanitari (Martini &amp; Converso, 2014; Mc Cullough et al., 2002). Altri studi esplorano con metodi qualitativi la gratitudine ricevuta dagli assistiti (Jung e Han, 2017; Aparicio et al., 2018; Berger et al., 2019). L’obiettivo dello studio è descrivere parole e gesti di gratitudine espressi dai pazienti o familiari nei confronti degli studenti di Infermieristica durante il tirocinio ed esplorare come il sentimento di gratitudine influenzi il percorso di studi.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Metodi: È stata condotta una ricerca qualitativa su narrazioni scritte da studenti del primo anno di Laurea in Infermieristica dell’Università di Verona, in cui vengono narrati episodi di gratitudine ricevuta durante il tirocinio, su di un format con 3 domande guida.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;Risultati: Le 18 narrazioni di gratitudine appartenevano a 15 studentesse e a 3 studenti. Dall’analisi dei racconti sono emersi 4 temi e relativi sottotemi: “Diventare un buon infermiere”, “Essere sulla strada giusta”, “Essere ripagati per la fatica e l’impegno del tirocinio”, “Provare emozioni positive”.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Discussione: Gli apprezzamenti dei pazienti e familiari giocano un ruolo rilevante per gli studenti durante il primo anno. La gratitudine funge da rinforzo sul proseguimento degli studi e sull’esperienza del tirocinio: i grazie diventano feedback riguardo alle loro alle capacità relazionali ed empatiche e sembrano affievolire la fatica fisica e l’impegno cognitivo. I tutor possono invitare gli studenti a riportare le esperienze di gratitudine e attuare su di esse una riflessione “on action”, per guadagnare benessere emozionale e apprendimento. Parole chiave: gratitudine, studenti infermieri, tirocinio clinico, assistenza &nbsp; TAKE HOME MESSAGE Ricevere gratitudine dagli assistiti durante le prime esperienze di tirocinio clinico gioca un ruolo di rinforzo nel proseguire il percorso di studi per gli studenti di Infermieristica. 2. Il ricevere un “grazie” e/o un sorriso di riconoscenza dagli assistiti supporta e ripaga gli studenti degli sforzi e della stanchezza, sia fisica che emozionale, che il tirocinio richiede.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;3. Gli studenti sono sorpresi dalla gratitudine e che i loro piccoli gesti siano considerati importanti dai pazienti e tali da meritare un grazie. Il gesto più apprezzato è quello fatto di persona dal paziente o familiare che li cerca, li chiama per nome o li aspetta per ringraziarli. &nbsp; ABSTRACT Introduction: Research on the effects of gratitude received by people operating in health setting is not much. Some studies, use self-report questionnaires for the perception and effects of gratitude on healthcare professionals (Martini &amp;Converso, 2014; Mc Cullough et al., 2002), other studies recommend to explore the gratitude received by patients more thoroughly and with qualitative methods (Jung and Han, 2017; Aparicio et al., 2018; Berger et al., 2019). The objective of this study is to describe words and gestures of gratitude expressed by patients or family members towards nursing students.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Method: A qualitative research was conducted on written narratives from the first year nursing students of Verona University, asking them to report one or more episodes of gratitude received during clinical practice. A format for the written narration with 3 guiding questions was sent them.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Result: The 18 gratitude narratives belonged to15 female students and 3 male students. From the analysis of the testis emerged four themes and related sub-themes. &nbsp;"Becoming a good nurse", "Being on the right path", "Being repaid for the effort and commitment of the clinical internship", "Feeling positive emotions".&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Discussion: The appreciations of patients and family members play a relevant role for students during the first year. Gratitude acts as a reinforcement on the continuation of the studies and on the overall experience of the internship: thanks, smiles become feedback regarding their relational and empathic skills and seem to ease physical fatigue and cognitive difficulties. Tutors can invite students to write the experiences of gratitude and carry out an “on action” reflection on them, to gain emotional well-being and at the same time learning. Key words: Gratitude, nursing education, clinical placement, caring TAKE HOME MESSAGE For nursing students, receiving gratitude from patients during their first clinical internship experience plays a reinforcing role in continuing their studies. 2. Receiving a “thank you” and/or a smile from the patient they are caring repays the students for the effort and the physical and emotional tiredness that the practical training requires.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;3. The students are surprised by the gratitude they receive and by the fact that their small gestures are considered important by the patients and worthy of tanks. The most appreciate gesture is when the patient or a family member personally thanks them, or call them by name or waits to talk with them

Marketing digital: um estudo de caso baseado na validação de ferramentas de venda para um infoproduto musical

The objective of this article is to validate, based on an empirical case, which digital tools produce better results in the sales of online courses for distance music education. It is still common for companies not to know how to take advantage of digital tools to increase sales, even if they present opportunities to have results in less time (DAY, 2011). The research uses a single case study, carried out in an Individual Microenterprise in the field of educational infoproducts, with data collection carried out through a triangulation of documentary data, interview and questionnaire. From the analyzes carried out and observed, it was found that the launch model proposed by Érico Rocha resulted in more conversions and an ROI of R$3.26, higher than the previously used model. It is concluded that Paid Traffic, Email Marketing, Reminders, Online Event and Warm Up Lives were the most effective strategies that made the Classic Launch obtain a positive result.O objetivo deste artigo consiste em validar, a partir de um caso empírico, quais ferramentas digitais produzem melhores resultados nas vendas de cursos online para ensino musical a distância. Ainda é comum as empresas não saberem aproveitar ferramentas digitais para aumento de vendas, mesmo que estas apresentem oportunidades de ter resultados em menos tempo (DAY, 2011). A pesquisa se utiliza do estudo de caso único, realizado em uma Microempresa Individual do ramo de infoprodutos educacionais, tendo a coleta de dados realizada por meio de uma triangulação de dados documentais, entrevista e questionário. Das análises realizadas e observadas, constatou-se que o modelo de lançamento proposto por Érico Rocha resultou em mais conversões e um ROI de R$3,26, superior ao modelo anteriormente utilizado. Conclui-se que o Tráfego Pago, o Email Marketing, os Lembretes, o Evento Online e as Lives de Aquecimento, foram as estratégias mais efetivas que fez com que o Lançamento Clássico obtivesse o resultado positivo

Planificación de la infraestructura energética considerando la incertidumbre en los precios de los recursos fósiles

El presente trabajo propone un modelo de programación matemática cuyo objetivo se centra en la planificación de inversiones, destinadas a la gestión y empleo eficiente de las fuentes de energías convencionales y renovables en la Argentina. La problemática sobre la actual composición de la matriz energética nacional, notablemente sesgada hacia la utilización de recursos fósiles, puede ser abordada desde distintos puntos claves; todos ellos reunidos bajo el concepto de sustentabilidad. En este caso, el enfoque adoptado se acopla a un análisis socio-económico; el modelo orientado por la maximización del valor presente neto (VPN) es sujeto a variaciones en los precios del petróleo y del gas natural. La incertidumbre, en los precios de las fuentes fósiles, es representada e introducida a partir de números triangulares dando origen a un modelo difuso; la solución exhibida se desprende de un modelo lineal convencional equivalente al que se arriba a partir de una serie de reformulaciones descritas.Sociedad Argentina de Informática e Investigación Operativa (SADIO