Lavoro sociale e pratiche di sconfinamento. Incontrare l'altro nella relazione di aiuto

A partire dalla considerazione che gli operatori di aiuto, per svolgere il proprio lavoro, necessariamente incontrano l’Altro, l’articolo propone una riflessione su come lo sconfinamento nella vita dell’Altro possa essere considerato fonte di un buon intervento di aiuto. I principi della relazionalità, del riconoscimento e della partecipazione sono alla base di buone pratiche di sconfinamento che promuovono l’incontro rispettoso con l’Altro e l’instaurarsi di relazioni di aiuto efficaci. L’incontro autentico tra operatori e persone in difficoltà produce uno sconfinamento reciproco e una contaminazione di competenze tra il sapere tecnico degli operatori e il sapere esperienziale delle persone. Promuovere prassi di lavoro all’insegna della partecipazione e della relazionalità non può rimanere responsabilità unicamente dei singoli operatori; deve interrogare anche le Organizzazioni di cui gli operatori fanno parte, chiamate a ridefinire i propri confini in conseguenza dell’apertura all’Altro, riconoscendo la contaminazione delle competenze come prassi per la costruzione di percorsi di aiuto capaci di rinnovarsi in sintonia le problematiche sociali.Starting from the consideration that social workers, in doing their work, necessarily meeting Other, the article proposes a reflection on how the trespass in the Other’s life can be considered a good way to help. The principles networking, recognition and participation are the basis of good practices of trespass that promote respectful encounter with the Other and the establishment of effective helping relationships. The authentic encounter among social workers and people in need produces a mutual trespass and contamination of powers between the social workers’ technical knowledge and the experiential knowledge of people. Promoting practices in the name of participation and relatedness can not remain the sole responsibility of the single social worker; Organizations are calling to redefine its boundaries as a result of the opening to the Other, recognizing the contamination of skills as practice for the construction of effective pathways capable of renewing aid in keeping social issues

La casa delle famiglie. Un progetto relazionale

L'articolo presenta un'analisi metodologica in ottica relazionale di un progetto di sviluppo di comunita' che ha visto la nascita di un centro per le famiglie grazie al lavoro in rete di alcuni operatori sociali con un gruppo di cittadini interessati a promuovere esperienze di mutualita' familiare

L'educatore come operatore "sociale". Dalla persona, alla famiglia, alla comunità.

Differently from other professional roles, social educators support people going through problems in their everyday trials and tribulations; they thus pick up on the peculiarities and singularities of the people involved and are at the same time seen by the latter as good people. it is in this concrete dimension that social educators and families can identify a common aim, and starting from this, together define concrete steps that need to be taken for their wellbeing. the social educator's task is therefore on the borderline and often provides them with the opportunity to see things differently form institution sending them into the field: thus, they can become part of the network and encourage empowerment processes, tighter with the child or youth, the parents, the surrounding family and any volunteers involved

Accogliere i genitori non solo i loro figli. La partecipazione della famiglia nella comunita' per minori

Promuovere un progetto di cambiamento che investa sul futuro ritorno del bambino nella propria famiglia di origine vuol dire attivare percorsi di sostegno alle famiglie, affinche' possano riprendersi quel ruolo di genitori accudenti a cui in passato sono venuti meno. Come promuovere il coinvolgimento e la partecipazione in quei genitori che hanno i loro figli in una comunita' di accoglienza? E' questa la domanda attorno a cui gli autori riflettono a partire da una esperienza concreta di una comunita' di accoglienza per minori e del lavoro degli operatori con le famiglie dei minori accolti

Physiological effects of awake prone position in acute hypoxemic respiratory failure

Abstract Background The effects of awake prone position on the breathing pattern of hypoxemic patients need to be better understood. We conducted a crossover trial to assess the physiological effects of awake prone position in patients with acute hypoxemic respiratory failure. Methods Fifteen patients with acute hypoxemic respiratory failure and PaO2/FiO2  0.99) and ΔP L (9 [7–11] cmH2O vs. 8 [5–9], p = 0.17). Airway resistance and time constant were higher in prone vs. supine position (9 cmH2O s arbitrary units−3 [4–11] vs. 6 [4–9], p = 0.05; 0.53 s [0.32–61] vs. 0.40 [0.37–0.44], p = 0.03). Prone position increased EELI (3887 arbitrary units [3414–8547] vs. 1456 [959–2420], p = 0.002) and promoted V T distribution towards dorsal lung regions without affecting V T size and lung compliance: this generated lower dynamic strain (0.21 [0.16–0.24] vs. 0.38 [0.30–0.49], p = 0.004). The magnitude of pendelluft phenomenon was not different between study phases (55% [7–57] of V T in prone vs. 31% [14–55] in supine position, p > 0.99). Conclusions Prone position improves oxygenation, increases EELI and promotes V T distribution towards dependent lung regions without affecting V T size, ΔP L, lung compliance and pendelluft magnitude. Prone position reduces respiratory rate and increases ΔP ES because of positional increases in airway resistance and prolonged expiratory time. Because high ΔP ES is the main mechanistic determinant of self-inflicted lung injury, caution may be needed in using awake prone position in patients exhibiting intense ΔP ES. Clinical trail registeration: The study was registered on clinicaltrials.gov (NCT03095300) on March 29, 2017

Microbiologic surveillance through subglottic secretion cultures during invasive mechanical ventilation: a prospective observational study

Purpose: Whether subglottic secretions (SS) culture during invasive mechanical ventilation may aid microbiological surveillance is unknown. We conducted a prospective study to assess SS cultures predictivity of endotracheal aspirate (ETA) and bronchoalveolar lavage (BAL) isolates. Materials and methods: 109 patients receiving mechanical ventilation for 6548 hours underwent SS and ETA surveillance cultures twice weekly; blind BAL was performed in case of clinically suspected pneumonia. Results: SS and ETA cultures were fully concordant in 170 (81%-overall accuracy) of 211 sample pairs. As compared to ETA, SS culture global sensitivity and specificity were 84% [95%CI: 77 to 91] and 74% [95%CI: 66 to 82]; negative and positive predictive values were 82% and 77%. Forty-four episodes of clinically suspected pneumonia were observed. Compared to BAL, SS culture global sensitivity and specificity were 68% [95%CI: 45 to 81] and 63% [95%CI: 44 to 82]; negative and positive predictive values were both 65%. SS sensitivity, specificity, positive and negative predictive values in anticipating BAL isolates were comparable to ETA (all p > 0.20). Conclusions: SS cultures show worthy accuracy in identifying ETA isolates, with excellent sensitivity and good negative predictivity. SS cultures may be not inferior to ETA in predicting BAL results in case of ventilator-associated pneumonia

Usefulness of differential time to positivity between catheter and peripheral blood cultures for diagnosing catheter-related bloodstream infection: Data analysis from routine clinical practice in the intensive care unit

Purpose: To assess the accuracy of differential time to positivity (DTP) method for the diagnosis of catheter-related bloodstream infections (CRBSI) in the routine practice of our intensive care unit (ICU). Materials and methods: Over a five-year study period, ICU patients with a central venous catheter in place for ≥48 h and undergoing DTP test with catheter tip culture were analyzed. We investigated: the accuracy of DTP test with the usual threshold of 120 min in confirming the clinical suspicion of CRBSI; the most accurate threshold value of DTP to detect CRBSI; the diagnostic accuracy of the ratio (rather than the difference) between times to positivity. Results: Among 278 episodes of paired blood cultures, 13% were CRBSIs. DTP value ≥120 min used for the diagnosis of CRBSI yielded 41% sensitivity and 74% specificity. Performance of DTP values in predicting CRBSI was low (AUC = 0.60 [95%CI: 0.48-0.72]). Cutoff value of the ratio between times to positivity was 0.80, with 46% sensitivity and 79% specificity. Conclusions: The routine use of the DTP method at any cutoff point has inadequate accuracy in detecting CRBSI in the real every day clinical practice. Not even the ratio between times to positivity seems to be clinically useful