La caverna nel bosco

The book is part of an action-research project (MinViTI) dedicated to the accompaniment and support of youngsters who have a family member hospitalized in ICU. The book is designed for children aged 6 to 10 and their parents, so that, through the story of the Leo bear and his mother - cared for by the animals in the cave in the forest - they can find a way to recognize and share their emotions, activate resources and prepare for a possible visit to the Intensive Care Unit. The book is promoted in collaboration with the Intensive project, it, a scientific initiative supported by SIAARTI, ANIARTI, AAROI-EMAC, dedicated to the humanization of ICU care.illustratorIl libro fa parte di un più ampio progetto di ricerca-azione (MinViTI) dedicato all’accompagnamento e al supporto dei minori che hanno un familiare ricoverato in Terapia Intensiva. Il libro è pensato per i bambini da 6 ai 10 anni e per i loro genitori, affinché, attraverso la storia dell’orsetto Leo e della sua mamma- curata dagli animali nella caverna del bosco- possano trovare un modo per riconoscere e condividere le loro emozioni, attivare risorse e prepararsi ad un eventuale visita presso il reparto di Terapia Intensiva. Questo volume è promosso in collaborazione con il progetto Intensiva,it, un’iniziativa scientifica supportata da SIAARTI, ANIARTI, AAROI-EMAC, dedicata all’umanizzazione delle cure in Terapia Intensiva

The impact of visiting the Intensive Care Unit (ICU) on children's and adolescents' psychological well-being: A systematic review

Abstract Objectives The visits of children/adolescents in adult intensive care units are increasingly more common. However, few studies examine the psychological impact of visiting. This systematic review aims to summarise the psychological effects that visiting family members has on children/adolescents. Research methodology A systematic review of research articles published from 1990 to January 2021 was conducted using PsycInfo, PubMed, and CINAHL. Inclusion/exclusion criteria were applied. Those studies included were evaluated using the Joanna Briggs Institute Critical Appraisal tools. A narrative synthesis of the results was conducted. Setting Adult intensive care unit. Results The review identified five studies (three of which qualitative), involving 141 children/adolescents. Although the experience of visiting was potentially traumatic, it enabled children/adolescents to better understand the reality and to preserve their relationships with family members. The impact of visiting was influenced by individual characteristics (e.g., age, past traumatic experiences) and by organisational characteristics (e.g., facilitated visit or not). Regardless of visitation, most children/adolescents presented anxiety and depression symptoms that need to be addressed. Conclusions Child/adolescent visitation seems to have positive effects, provided there is preparation and facilitation. Clinicians should pay attention to individual characteristics and optimise organisational factors (e.g., environment) in order to minimise potentially trauma-inducing aspects

How to communicate with families living in complete isolation

The global emergency caused by the SARS-CoV-2 pandemic has suddenly changed how we communicate with families in all the CoViD19 care settings, on account of the need to maintain complete social isolation. Far-reaching mental suffering manifests itself in widespread anxiety. Health workers are isolated from their families, and must manage the consequences of this isolation just like the patients under their care. Patients and their families perceive not only the clinical results but also the personal attitudes, closeness and psychological support from the care teams. This perception of genuine participation by the health worker in the course of the treatment is especially important when a patient dies, and may influence the whole process of grief

Moral Distress Trajectories of Physicians 1 Year after the COVID-19 Outbreak: A Grounded Theory Study

The COVID-19 pandemic has confronted emergency and critical care physicians with unprecedented ethically challenging situations. The aim of this paper was to explore physicians’ experience of moral distress during the pandemic. A qualitative multicenter study was conducted using grounded theory. We recruited 15 emergency and critical care physicians who worked in six hospitals from the Lombardy region of Italy. Semi-structured interviews about their professional experience of moral distress were conducted from November 2020–February 2021 (1 year after the pandemic outbreak). The transcripts were qualitatively analyzed following open, axial, and selective coding. A model of moral distress was generated around the core category of Being a Good Doctor. Several Pandemic Stressors threatened the sense of Being a Good Doctor, causing moral distress. Pandemic Stressors included limited healthcare resources, intensified patient triage, changeable selection criteria, limited therapeutic/clinical knowledge, and patient isolation. Emotions of Moral Distress included powerlessness, frustration/anger, and sadness. Physicians presented different Individual Responses to cope with moral distress, such as avoidance, acquiescence, reinterpretation, and resistance. These Individual Responses generated different Moral Outcomes, such as moral residue, disengagement, or moral integrity. The Working Environment, especially the team and organizational culture, was instrumental in restoring or disrupting moral integrity. In order for physicians to manage moral distress successfully, it was important to use reinterpretation, that is, to find new ways of enacting their own values by reframing morally distressing situations, and to perceive a cooperative and supportive Working Environment

Moral distress among critical care clinicians: Protective factors and consequences on clinicians’ well-being and quality of care

Introduction. Psychological well-being of people working in the helping professions has received increased attention in the last decade. Working in critical care settings, such as Intensive Care Units (ICUs), is especially stressful as it exposes clinicians to high patient morbidity and mortality, challenging work routines, and regular encounters with traumatic and ethical issues. Growing literature highlights that the experience of moral distress, that means not acting accordingly to what one perceives to be ethically right, is relevant among clinicians working in critical care. However, there is a lack of quantitative studies aimed to identify the protective factors and the consequences of moral distress on clinicians and patients. This thesis aimed to fill this gap by exploring: 1) the dimensionality of the construct of moral distress, through the validation of a scale to measure moral distress in Italy; 2) the protective factors of moral distress and its effect on clinicians’ psychological well-being; and 3) the relationship between clinicians’ moral distress and the perception of care quality by family members of ICU patients. Methods. A cross-sectional study was conducted involving physicians, nurses, and residents working in ICU, and the family members of their patients. Clinicians working in 8 ICUs (n=184) were administered the Moral Distress Scale-Revised (MDS-R; Hamric et al., 2012) and the Beck Depression Inventory-II (BDI-II; Beck, Steer & Brown, 2006) for validation. In addition, a subsample of clinicians of 7 ICUs (n=170) were administered two further subscales (Value and Control) of the Areas of Worklife Scale (AWS; Leiter & Maslach, 2005) in order to assess the relationships between moral distress, value congruence, control and depression. Family members (n=59) of the patients hospitalized in a subsample of 5 ICUSs were administered the Family Satisfaction with care in the ICU survey (FS-ICU; Wall et al., 2007) in order to assess the relationship between clinicians’ moral distress and family satisfaction with care. Results. The Italian MDS-R showed a 4-factor structure composed of: Futile care, Poor teamwork, Deceptive communication, and Ethical Misconduct. This model accounted for 59% of the total variance and presented a good fit with the data (RMSEA=.06; CFI=.95; TLI=.94; WRMR=.65). For what concerns the protective factors of moral distress and its effect on clinicians’ well-being, a mediation path from value congruence and control to depression through moral distress was tested, yielding a significant total indirect effect of value congruence on depression through moral distress (β= -.12; p= .02). Regarding the effect of moral distress on the quality of care, moral distress of clinicians correlated with the family satisfaction as to the inclusion in the decision making process (ρ=-.900; p=.037). Moral distress of physicians and nurses correlated with different aspects of family members’ satisfaction. Conclusions. Findings of this thesis contributed to the refinement of the construct of moral distress and provided evidence of its multidimensionality. Congruence between individual and organizational value was found to influence moral distress. As moral distress was related to depression and family perception of care quality, interventions should be implemented to reduce it. The findings of this thesis offer a preliminary base for the development of tailored interventions for clinicians

Il viaggio

The book, for kids between the ages of 11 and 13, is part of an action research project (MinViTI) dedicated to the accompaniment and support of youngsters who have a family member hospitalized in Intensive Care Unit. Through the journey of a kid, led by a wise man in the world where his father is battling his illness, the reader will find a way to recognize and share his emotions, activate resources and prepare for a possible visit to the Intensive Care Unit. The book is promoted in collaboration with the Intensive project, it, a scientific initiative supported by SIAARTI, Aniarti, AAROI-EMAC, and dedicated to the humanization of ICU care.PublishedIl fumetto, per ragazzi dagli 11 ai 13 anni, fa parte di un più ampio progetto di ricerca-azione (MinViTI) dedicato all’accompagnamento e al supporto dei minori che hanno un familiare ricoverato in Terapia Intensiva. Attraverso il viaggio di un ragazzo guidato da un saggio nel mondo dove il padre lotta contro il suo male, il lettore potrà trovare un modo per riconoscere e condividere le sue emozioni, attivare risorse e prepararsi ad un eventuale visita presso il reparto di Terapia Intensiva. Il libro è promosso in collaborazione con il progetto Intensiva,it, un’iniziativa scientifica supportata da SIAARTI, Aniarti, AAROI-EMAC, dedicata all’umanizzazione delle cure in Terapia Intensiva

Communication and relationship at time of COVID-19: a possible heritage

Not applicabl

The impact of visiting the Intensive Care Unit on children's and adolescents' psychological well-being: A systematic review

Objectives: The visits of children/adolescents in adult intensive care units are increasingly more common.However, few studies examine the psychological impact of visiting. This systematic review aims to summarise the psychological effects that visiting family members has on children/adolescents.Research methodology: A systematic review of research articles published from 1990 to January 2021 was conducted using PsycInfo, PubMed, and CINAHL. Inclusion/exclusion criteria were applied. Those studies included were evaluated using the Joanna Briggs Institute Critical Appraisal tools. A narrative synthesis of the results was conducted.Setting: Adult intensive care unit.Results: The review identified five studies (three of which qualitative), involving 141 children/adolescents. Although the experience of visiting was potentially traumatic, it enabled children/adolescents to better understand the reality and to preserve their relationships with family members. The impact of visiting was influenced by individual characteristics (e.g., age, past traumatic experiences) and by organisational characteristics (e.g., facilitated visit or not). Regardless of visitation, most children/adolescents presented anxiety and depression symptoms that need to be addressed.Conclusions: Child/adolescent visitation seems to have positive effects, provided there is preparation and facilitation. Clinicians should pay attention to individual characteristics and optimise organisational factors (e.g., environment) in order to minimise potentially trauma-inducing aspects.(c) 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

The Power of Words: Deliberation dialogue as a model to favor patient engagement in chronic care

The concept of patient engagement is attracting growing attention from scholars working on doctor-patient interactions. It refers to the condition in which patients are fully aware of their medical condition and willing to be active both in the relationship with their caregivers and towards the health care institutions. However, the operative steps necessary to achieve patient engagement have not yet been fully described. This chapter focuses on the communicative dimension of engagement. Communication is shown to be a pivotal means to improve patient self-efficacy and commitment, both fundamental components of engagement. In particular, the authors take a closer look at the process of decision making in chronic care settings, and propose a normative model to analyze and evaluate the quality of decision making in consultations. It is argued that the model can also be used as a blueprint to create training materials for clinicians

Employees' well-being six months after the COVID-19 outbreak: results from a psychological screening program in Italy

The COVID-19 outbreak has taken a heavy toll on the mental well-being of healthcare workers. This study aims to describe a psychological screening program developed at a large University Hospital in Milan, Italy, and assess the psychological outcomes of employees and associated factors. A survey was electronically conducted among hospital employees between July and October 2020. Sociodemographic data, information about COVID-19 experience and three scales assessing anxiety (STAI-Y1), depression (HAM-D) and post-traumatic stress disorder (PCL-5) were collected. A total of 308 employees (80% women; mean age 45.1 years) responded: 16% physicians, 68% other healthcare professionals, and 16% administrative staff. Employees reported moderate/severe symptoms of anxiety (23%), depression (53%), and post-traumatic stress disorder (40%). At multivariate logistic regression analysis, having suffered a loss for COVID-19 in the personal context was independently associated with higher risk of moderate/severe anxiety (OR = 2.40; 95% CI 1.16-4.98), being female was associated with higher risk of moderate/severe depression (OR = 2.82; 95% CI 1.43-5.59), and having had a family member affected by COVID-19 was associated with higher risk of moderate/severe post-traumatic stress disorder (OR = 2.75; 95% CI 1.01-7.48). COVID-19 personal experience may have a profound impact on hospital workers' mental health and should be considered in supportive interventions