Violenza domestica: quali competenze e conoscenze dell’infermiere in emergenza?

Il fenomeno della violenza domestica e le condotte di approccio a questo problema assumono una particolare rilevanza sia sociale che sanitaria. Lo scopo della ricerca è quello di misurare le conoscenze e le competenze degli infermieri che prestano servizio nelle realtà operative di ED (Emergenza Dipartimento) rispetto alla gestione in urgenza della donna che ha subito violenza domestica. E’ stato effettuato uno studio osservazionale trasversale che ha coinvolto gli infermieri del servizio di emergenza intraospedaliera (EDI) e Extraospedaliera (EDE) in tre ambiti territoriali afferenti ad una Azienda Sanitaria del nord Italia. Il campione è di tipo non probabilistico. Il questionario scelto è stato Help– Knowledge and Attitudes of Gender – Based Violence. Si evidenzia un risultato con un range di risposte corrette che vanno dal 72,6% al 99%. La comparazione fra gli infermieri dell’EDE e quelli dell’EDI ha evidenziato una maggiore comprensione del fenomeno dell’IPV (Intimate Partner Violence) da parte di questi ultimi; ciò con molta probabilità può essere dovuto, da un lato, al fatto che i secondi possiedono più strumenti e tempo per riconoscere i segni di maltrattamento, mentre la donna, dall’altro, ha la possibilità di ricercare maggiore empatia, un sostegno psicologico e una guida ai servizi che possano aiutare la propria famiglia. Le correlazioni provano, inoltre, una notevole sensibilità che il personale di ED ha sulle diverse tipologie di maltrattamenti, non solo fisiche, ma anche psicologiche, economiche e sessuali. Con molta probabilità tali conoscenze sono legate all’esperienza sul campo in quanto il 56,6% (n=56) del campione ha un’anzianità di servizio che va dagli 11 ai 30 anni. Le phénomène de la violence conjugale et les différentes approches à ce problème sont particulièrement importants sur les plans social et sanitaire. Le but de cette recherche est d’évaluer les compétences et les connaissances des infirmiers travaillant aux services d’urgence (ED) et qui assurent la prise en charge des femmes victimes de violence conjugale. Une étude par observation a été menée impliquant les infirmiers des services d’urgence intrahospitaliers (EDI) et extrahospitaliers (EDE) de trois territoires liés à une unité de soins du nord de l’Italie. Il s’agissait d’un échantillon non probabiliste et le questionnaire choisi était le Help–Knowledge and Attitudes of Gender–Based Violence. Le résultat a été globalement positif et les réponses correctes allait de 72,6 % à 99 % selon les questions. La comparaison entre infirmiers de l’EDE et de l’EDI a montré que ces derniers ont une meilleure connaissance du phénomène de la violence d’un partenaire intime (IPV – Intimate Partner Violence) par rapport aux premiers. Cela est peut-être dû au fait que, d’un côté, les infirmiers EDI ont davantage d’outils et de temps pour reconnaître les signes d’abus, tandis que la femme, de l’autre, a la possibilité de recevoir davantage d’empathie, un soutien psychologique et un guide aux services du territoire pour aider sa famille. En outre, les corrélations démontrent que le personnel ED est très conscient des différentes formes de maltraitance, qui ne concernent pas seulement le cadre physique, mais aussi les domaines psychologiques, économiques et sexuels. Il est fort probable que ces connaissances soient liées à leur expérience car 56,6 % des personnes interrogées travaillent dans ce secteur depuis au moins 11 ans. The phenomenon of domestic violence and the different approaches to this are especially important both from a social and health point of view. The aim of the survey is to measure the skills and knowledge of the nurses who work in Emergency Departments providing medical care to women who are victims of domestic violence. An observational study was implemented involving the nurses of the Intra-hospital Emergency Services (EDI) and of the Extra-hospital Emergency Services (EDE) of three territories linked to a Northern Italian healthcare unit. The sample is a non-probabilistic one. The title of the administered questionnaire is Help-Knowledge and Attitudes of Gender–Based Violence. There was a positive result overall with a range of correct answers ranging from 72.6% to 99% depending on the question. The comparison between EDE and EDI nurses showed a better understanding of the IPV phenomenon (Intimate Partner Violence) amongst the latter. This may be due to the fact, on the one hand, that EDI nurses have more tools and time in order to recognize the signs of abuse, while women, using the other services, have the possibility to get more empathy and psychological support along with information about assistance provided by territorial services available for families. Correlations demonstrate, moreover, that EDI staff have a strong awareness of the various kinds of abuse, not only physical but also psychological, economical and sexual ones. This particular knowledge is most likely linked to their experience because 56.6% of respondents have been working in this field for 11 to 30 years

L'apprendimento clinico in simulazione: studio osservazionale sulla soddisfazione percepita dagli studenti di infermieristica [Learning in clinical simulation: observational study on satisfaction perceived by students of nursing]

Introduzione: la simulazione nel contesto del laboratorio didattico sta divenendo un’importante metodologia di apprendimento, in quanto consente di riprodurre situazioni clinicoassistenziali realistiche. Tali attività formative professionalizzanti favoriscono lo sviluppo di abilità cognitive, affettive e psicomotorie in un contesto pedagogico sicuro e privo di rischi, ma richiedono di essere valutate con strumenti validi e affidabili. Obiettivo: indagare il grado di soddisfazione degli studenti di un Corso di Laurea in Infermieristica del nord Italia riguardo le esercitazioni con simulatori statici e ad alta fedeltà e i casi clinici. Metodo: è stato condotto uno studio osservazionale prospettico che ha coinvolto un campione non probabilistico di 51 studenti del terzo anno durante tutto l'a.a. 2013/14. Lo strumento di raccolta dati si compone dei 3 questionari Student Satisfaction and Self-confidence in Learning Scale, Educational Practices Questionnaire, Simulation Design Scale e di 3 domande sulla soddisfazione complessiva. L'analisi statistica è stata condotta con i programmi SPSS vers. demo. ed Excel di Office 2003. Risultati e Conclusioni: il tasso di risposta ottenuto è dell’89,5%. L’Alfa di Cronbach, ha evidenziato un’affidabilità interna ottima ( = .982). Gli studenti sono stati complessivamente soddisfatti delle attività svolte nel laboratorio didattico, dimostrando più entusiasmo per la simulazione con i manichini statici (71%) e con i simulatori ad alta fedeltà (60%), attività per le quali hanno avvertito un significativo coinvolgimento e apprendimento attivo. La didattica con i casi clinici ha ottenuto un grado di soddisfazione minore (38%) e per questo metodo si è riscontrato il maggior numero di elementi di debolezza. Parole chiave: studenti infermieri, simulazione, strategia di apprendimento attivo, simulatori ad alta fedeltà, soddisfazioneINTRODUCTION: Simulation in the context of the educational workshop is becoming an important learning method, as it allows to play realistic clinical-care situations. These vocational training activities promote the development of cognitive, affective and psychomotor skills in a pedagogical context safe and risk-free, but need to be accounted for using by valid and reliable instruments. AIM: To inspect the level of satisfaction of the students of a Degree in Nursing in northern Italy about static and high-fidelity exercises with simulators and clinical cases. METHODS: A prospective observational study has been conducted involving a non-probabili- stic sample of 51 third-year students throughout the academic year 2013/14. The data collection instrument consists of three questionnaires Student Satisfaction and Self-confidence in Learning Scale, Educational Practices Questionnaire, Simulation Design Scale and 3 questions on overall satisfaction. Statistical analysis was performed with SPSS 20.0 and Office 2003 Excel. RESULT AND CONCLUSION: The response rate of 89.5% is obtained. The Cronbach Alfa showed a good internal reliability (α = .982). The students were generally satisfied with the activities carried out in the teaching laboratory, showing more enthusiasm for the simulation with static mannequins (71%) and with high-fidelity simulators (60%), activities for which they have experienced a significant involvement and active learning. The teaching with clinical cases scored a lesser degree of satisfaction (38%) and for this method it was found the largest number of elements of weakness

Measuring nursing care workload in non-intensive cardiac surgery: an observational study

Background: An understanding of the time nurses spend assessing and meeting patients’ needs is key to improve nursing outcomes and support organizational well-being. Aims and objectives: The study was designed to determine whether the use of an assessment scale with some clinical parameters indicative of hemodynamic, neurological, respiratory and mobility functions could be able to estimate nursing care workload in non-intensive cardiac surgery patients. Methods: A correlational descriptive study was designed. Two types of inpatients were included in the study: those waiting for cardiac surgery and those who had already undergone cardiac surgery. Using specific indicators, patient’s clinical status was classified in 10 levels of complexity and nursing care interventions were divided into three categories: clinical activities, educational activities and organizational activities. For each of this categories the correlation coefficient between the nursing time and the level of patient’s complexity was measured. Results: Per hour of hospitalization, nurses spent an average of 11 minutes and 49 seconds providing care to each patient. A good correlation coefficient between the amount of the nursing time spent for clinical activities and the level of patient’s complexity was found. Educational activities were minimal compared with the clinical and organizational activities, but they were mostly conducted during the preoperative phase. Conclusions: The assessment scale tested in this study, including some information about the patient's clinical status, allowed to estimate clinical nursing workload in non-intensive cardiac surgery patients.Keywords: Nursing in cardiology setting; health status indicators; severity of illness index; nursing care complexity; non-intensive cardiac surgery unit. RIASSUNTO Background: la quantificazione del tempo impiegato dagli infermieri per valutare e trattare i bisogni dei pazienti rappresenta un fattore chiave per migliorare gli esiti assistenziali e favorire il benessere organizzativo delle strutture sanitarie. Obiettivi: lo studio è stato eseguito per verificare se l'uso di una scala di indicatori della funzione emodinamica, neurologica, respiratoria e motoria, possa consentire di stimare il carico di lavoro infermieristico richiesto dai pazienti cardiochirurgici ricoverati nelle unità di degenza non intensive. Metodi: per lo scopo del lavoro è stato disegnato uno studio descrittivo-correlazionale. Sono stati osservati pazienti in fase preoperatoria e postoperatoria. Utilizzando una scala di indicatori specifici, lo stato clinico del paziente è stato suddiviso in 10 livelli di complessità assistenziale; mentre le attività infermieristiche sono state classificate in 3 categorie: cliniche, educative e gestionali. Per ognuna di queste categorie è stato misurato il coefficiente di correlazione tra il tempo assistenziale erogato ed il livello di complessità rilevato. Risultati: per ogni ora di ricovero gli infermieri hanno erogato mediamente a ciascun paziente 11 minuti e 49 secondi di assistenza. Il tempo impiegato in attività assistenziali cliniche è risultato correlato al livello di complessità rilevato. Le attività educative sono risultate prevalenti nella fase preoperatoria, ma il tempo ad esse dedicato è risultato minimo rispetto a quello impiegato in attività cliniche e gestionali. Conclusioni: la scala di indicatori clinici testata ha consentito di stimare il carico di lavoro infermieristico di tipo clinico richiesto dai pazienti cardiochirurgici ricoverati nelle unità di degenza non intensive.Parole chiave: infermieristica in cardiologia, indicatori clinici, indice di gravità della malattia, complessità infermieristica, unità di cardiochirurgia non intensiv

Validation of the Italian version of Behavioral Pain Scale in sedated, intubated, and mechanically ventilated pediatric patients

Background and aim: Pain assessment in pediatric intensive care unit (PICU) is a demanding challenge. The COMFORT-B scale is recognized as the gold standard in such patients. However, the use of this instrument in PICU setting is disputed. The Behavioral Pain Scale (BPS), instead, is considered to be the gold standard for pain assessment in deeply sedated, mechanically ventilated adult patients. The BPS has been validated in Italian, requires a short observation time compared to the COMFORT-B and does not increase workloads. A first evaluation of BPS was made in PICU with good results regarding face validity and content validity, however suggesting further studies given the small sample on which it was tested. The aim of this study was the validation of the BPS in sedated, intubated, and mechanically ventilated pediatric patients. Methods: A descriptive, comparative design was used. A convenience sample of 84 non-verbal, sedated and mechanically ventilated critical care pediatric patients was included. Patient pain was assessed concurrently with three observational scales (BPS, COMFORT-B, NRS) before, during and after routine procedures that are considered painful and non-painful. Results: Internal consistency was α = .86. Correlations between BPS and the other instruments were high, demonstrating a good concurrent validity of the BPS. T test and assessment of ROC curves demonstrated a good discriminant validity of the BPS. Conclusions: The BPS proved to be valid and reliable for the assessment of pain also in the use with pediatric patients

Measuring nursing care workload in non-intensive cardiac surgery: an observational study

Background: An understanding of the time nurses spend assessing and meeting patients' needs is key to improve nursing outcomes and support organizational well-being. Aims and objectives: The study was designed to determine whether the use of an assessment scale with some clinical parameters indicative of hemodynamic, neurological, respiratory and mobility functions could be able to estimate nursing care workload in non-intensive cardiac surgery patients. Methods: A correlational descriptive study was designed. Two types of inpatients were included in the study: those waiting for cardiac surgery and those who had already undergone cardiac surgery. Using specific indicators, patient's clinical status was classified in 10 levels of complexity and nursing care interventions were divided into three categories: clinical activities, educational activities and organizational activities. For each of this categories the correlation coefficient between the nursing time and the level of patient's complexity was measured. Results: Per hour of hospitalization, nurses spent an average of 11 minutes and 49 seconds providing care to each patient. A good correlation coefficient between the amount of the nursing time spent for clinical activities and the level of patient's complexity was found. Educational activities were minimal compared with the clinical and organizational activities, but they were mostly conducted during the preoperative phase. Conclusions: The assessment scale tested in this study, including some information about the patient's clinical status, allowed to estimate clinical nursing workload in non-intensive cardiac surgery patients.Keywords:"ˆNursing in cardiology setting; health status indicators; severity of illness index; nursing care complexity; non-intensive cardiac surgery unit. RIASSUNTO Background: la quantificazione del tempo impiegato dagli infermieri per valutare e trattare i bisogni dei pazienti rappresenta un fattore chiave per migliorare gli esiti assistenziali e favorire il benessere organizzativo delle strutture sanitarie. Obiettivi: lo studio è stato eseguito per verificare se l'uso di una scala di indicatori della funzione emodinamica, neurologica, respiratoria e motoria, possa consentire di stimare il carico di lavoro infermieristico richiesto dai pazienti cardiochirurgici ricoverati nelle unití  di degenza non intensive. Metodi: per lo scopo del lavoro è stato disegnato uno studio descrittivo-correlazionale. Sono stati osservati pazienti in fase preoperatoria e postoperatoria. Utilizzando una scala di indicatori specifici, lo stato clinico del paziente è stato suddiviso in 10 livelli di complessití  assistenziale; mentre le attivití  infermieristiche sono state classificate in 3 categorie: cliniche, educative e gestionali. Per ognuna di queste categorie è stato misurato il coefficiente di correlazione tra il tempo assistenziale erogato ed il livello di complessití  rilevato. Risultati: per ogni ora di ricovero gli infermieri hanno erogato mediamente a ciascun paziente 11 minuti e 49 secondi di assistenza. Il tempo impiegato in attivití  assistenziali cliniche è risultato correlato al livello di complessití  rilevato. Le attivití  educative sono risultate prevalenti nella fase preoperatoria, ma il tempo ad esse dedicato è risultato minimo rispetto a quello impiegato in attivití  cliniche e gestionali. Conclusioni: la scala di indicatori clinici testata ha consentito di stimare il carico di lavoro infermieristico di tipo clinico richiesto dai pazienti cardiochirurgici ricoverati nelle unití  di degenza non intensive.Parole chiave: infermieristica in cardiologia, indicatori clinici, indice di gravití  della malattia, complessití  infermieristica, unití  di cardiochirurgia non intensiv

A randomized comparison trial of two and four-step approaches to teaching Cardio-Pulmonary Reanimation

Background and aim of the work: The treatment of cardiac arrest in an extra-hospital environment improves with the increase in the number of people able to establish an early Cardio-Pulmonary Reanimation (CPR). The main aim of the study was to assess the validity of the two-step method in case of prolonged CPR. Methods: A randomized comparison study was conducted in the University Nursing School of a Northern Italian town, during the 2015/16 academic year, among 60 students, to teach them CPR techniques, through two different teaching methods (4-step and the 2-step of CPR training). The effectiveness of the maneuvers performed on mannequins equipped with skill-meter was verified. Results: Our study did not highlight any significant difference between the two methods of CPR training. The comparison between the two methods regarding their efficacy in practical teaching of CPR, highlighted by this study, proved the validity of both the 4-minute continuous method (1st method) and the 30:2 method (2nd method). Conclusions: The results of the study showed no differences between the 2-step and the 4-step methods, in the effectiveness of cardiac massage. The correct execution of chest compressions during a CPR is the key to increase the patient’s chances of rescue. Research has shown that any interruption in the execution of chest compressions, leads to a progressive reduction of the effectiveness of cardiac massage, with negative consequences on the prognosis of the patient undergoing at CPR

Effectiveness of a video lesson for the correct use in an emergency of the automated external defibrillator (AED)

Background and aim of the work: Every year around 275 thousand people in Europe and 420 thousand in the United States are affected by sudden cardiac arrest. Early electrical defibrillation before the arrival of emergency services can improve survival. Training the population to use the AED is essential. The training method currently in use is the BLSD course, which limits training to a population cohort and may not be enough to meet the requirements of the proposed Law no. 1839/2019. This study aims to verify the effectiveness of an online course that illustrates the practical use of the AED to a population of laypeople. Methods: An observational study was conducted to compare a lay population undergoing the view of a video spot and a cohort of people who had participated in BLSD Category A courses. The performances of the two groups were measured immediately after the course and 6 months later. Results: Overall, the video lesson reported positive results. Six months later the skills were partially retained. The cohort that followed the video lesson showed significant deterioration in the ability to correctly position the pads and in safety. Conclusions: Although improved through significant reinforcements, the video spot represents a valid alternative training method for spreading defibrillation with public access and could facilitate the culture of defibrillation as required by the new Italian law proposal