Il moral distress nell'assistenza infermieristica

RIASSUNTONella pratica infermieristica, prendere decisioni ed intraprendere azioni nei confronti dei pazienti è considerata espressione del proprio ruolo professionale. Il problema può sorgere nel momento in cui gli infermieri, in base alle proprie convinzioni morali, vorrebbero intraprendere azioni che risultano essere in contrasto con le consuetudini e/o l'organizzazione o le politiche istituzionali del struttura sanitaria in cui prestano servizio. Questo non può che creare inevitabilmente una sofferenza morale negli infermieri, che si sentono impotenti ad agire come vorrebbero e dovrebbero. Anche se un certo grado di moral distress è connaturato alla professione infermieristica e in una certa misura inevitabile, quando il suo livello è troppo elevato oppure prolungato nel tempo, può diventare insopportabile ed essere un segno predittivo di un malessere che se non governato può sfociare nel burn- out con tutte le conseguenze ad esso correlate. Lo scopo dello studio è stato di comparare il livello di moral distress tra infermieri che operano in Unití  Operative diverse; identificare le situazioni cliniche associate in modo significativo con il moral distress. Lo studio di tipo trasversale-osservazionale , è stato realizzato nel novembre 2008 su un campione di 111 infermieri, per il quale è stata utilizzata una scala (MDS) formulata e validata in strutture sanitarie statunitensi da M.C. Corley e adattata al contesto italiano. In accordo con precedenti studi statunitensi il livello di moral di stress percepito dagli infermieri nei tre contesti indagati sembra essere di livello moderato, esistono tuttavia associazioni significative tra alcune situazioni cliniche e grado di moral distress.Parole chiave: Infermiere, Moral Distress, Moral Distress Scale, Organizzazione ,Burn OutABSTRACTIn nursing practice, the ability to make decisions regarding patients and to act on them is considered to be an espression of the professional nursing role. Problems may arise when a nurses would like to perform an action they believe morally correct but which are conflictual with the habits, organization or politics of the health structure in which they work. This unevitably produces moral distress in nurses who feel impotent to act as they feel they should. Although a certain amount of moral distress is part and parcel of the nursing profession , when it is excessive or prolonged it may become unacceptable and culminate in burn-out and the relative consequences. The aim of the study was to compare the level of moral stress in 111 Italian nurses working in different Operative Units to identify those clinical situations significantly associated with moral stress using the MDS scale. Similarly to studies performed in the USA, the level of moral stress in the 3 different work contexts was moderate, although some clinical situations were related to significant stress levels.Key words: Nurse, Moral Distress, Moral Distress Scale, Organization, Burn Ou

Survey on Sternal Wound Management in the Italian Pediatric Cardiac Intensive Care Units

(1) Background: a review of the literature found a lack of standardized pediatric guidelines regarding wound management after cardiac surgery. (2) Objective: the aim of the study is to investigate the cardiac surgical wound management in Italian pediatric cardiac intensive care units. (3) Methods: we sent an online questionnaire to the 13 Italian pediatric cardiac intensive care units. (4) Results: ten pediatric cardiac intensive care units (77%) have a protocol for the management of the cardiac surgical wound. The staff members that mainly have the responsibility for the wound management after cardiac surgery are registered nurses and physicians together both in the pediatric cardiac intensive care units (69%), and when a patient is transferred to another ward (62%). Thirty-eight percent of the pediatric cardiac intensive care units have a protocol used to monitor wound infection, and the staff mostly uses a written shift report (54%) to monitor the infection. (5) Discussion: this is the first survey to investigate the management of the wound after cardiac surgery in Italian pediatric cardiac intensive care units. The small sample size and the fact that the centers involved are only Italian cardiac intensive care units are the limits of this study. (6) Conclusions: in the Italian pediatric cardiac intensive care units it emerged that there is a diversity in the treatments adopted and a lack of specific protocols in the management of the pediatric cardiac surgical wound

Sistemi APR per la valutazione e la mappatura di terrazzamenti agricoli abbandonati: il caso di Rio Freddo

I sistemi agricoli terrazzati ricoprono un ruolo rilevante nell\u2019ambito del territorio collinare e montano, tuttavia in caso di abbandono possono contribuire all\u2019aumento del rischio idrogeologico. Grazie alle pi\uf9 recenti tecnologie di telerilevamento e all\u2019estrazione di dati topografici ad alta risoluzione \ue8 possibile valutare l\u2019estensione delle aree terrazzate anche in zone remote ed impervie. Il presente studio presenta l\u2019elaborazione GIS utile ad identificare le geometrie dei terrazzamenti nell\u2019area di Rio Freddo (VI). L\u2019elaborazione \ue8 stata realizzata a partire dal DTM (Digital Terrain Model) proveniente da un rilievo effettuato tramite volo SAPR. L\u2019estrazione dei profili dei terrazzamenti \ue8 avvenuta attraverso il calcolo della derivata seconda del DTM lungo la direzione di massima pendenza del versante, con l\u2019utilizzo del tool GIS di Profile Curvature, ed una successiva vettorializzazione. Accanto al processo di elaborazione, descritto passo-passo, risulta d\u2019interesse la sua applicazione tramite due diversi software GIS, ArcMap\u2122 e QGIS. A partire dallo scarto tra i due processi di calcolo \ue8 stato possibile trarre una serie di considerazioni, sulle differenti competenze richieste agli utenti dei due software e sui diversi ambiti di ricerca indicati per il loro utilizzo

Diagnostic and prognostic value of low percentage of glycosylated ferritin in acquired hemophagocytic lymphohistiocytosis: A single-center study

INTRODUCTION: Hemophagocytic lymphohistiocytosis (HLH) is an aggressive and life-threatening syndrome characterized by an excessive immune activation. Glycosylated ferritin (GF) level has been proposed as highly specific of HLH. METHODS: We have studied 12 subjects with HLH according to the HLH-04 trial criteria and 11 patients with a clinical and laboratoristic suspicion of HLH. The percentage of GF was measured by an in-house assay. RESULTS: The only biomarkers that were significantly different in the two groups were fraction of GF (P<.001) and the presence of hemophagocytosis in bone marrow (P=.006). Subjects with HLH had significantly lower percentage of GF than patients with other inflammatory conditions mimicking HLH. A fraction of GF 6420% was strongly consistent with a diagnosis of HLH. CONCLUSIONS: Fraction of GF is useful to identify subjects at high risk for early death and therefore in need of early treatment

Occurrence and reasons for unfinished nursing care between COVID-19 and non-COVID-19 patients

Aim: To compare the occurrence and the reasons for unfinished care among coronavirus disease (COVID-19) and non-COVID-19 patients as perceived by nurses. Background: The recent pandemic has imposed tremendous changes in hospitals in all countries. Introduction: Investigating the occurrence of and the reasons for unfinished care as perceived by nurses working in COVID-19 and non-COVID-19 units might help to gain insights and to address future pandemics. Methods: A comparative cross-sectional study based on the STROBE guideline has been conducted during November 2020-January 2021. The Unfinished Nursing Care Survey, comprising part A (elements) and part B (reasons), was administered online to all 479 nurses working in medical and surgical units converted progressively into COVID-19 and non-COVID-19 units. A total of 90 and 200 nurses participated, respectively. Results: No differences in the unfinished care occurrence have emerged at the overall level between nurses caring for COVID (2.10 out of 5; 95% confidence interval [CI], 1.94-2.27) and non-COVID-19 patients (2.16; 95% CI, 2.06-2.26). Reasons for unfinished care reported significant higher averages among nurses caring for COVID (2.21; 95% CI, 2.10-2.31) as compared with those caring for non-COVID-19 patients (2.07; 95% CI, 2.01-2.14; p = 0.030). Discussion: The overall occurrence of unfinished care was slightly higher compared with pre-pandemic data in all patients. Conclusions: Reasons triggering unfinished care were slightly different and were due to priority setting and human resources issues, which were perceived at higher significance among nurses working in COVID-19 compared with non-COVID-19 units. Implication for nursing and health policies: A clear map of action has emerged that might be valid in the post-COVID-19 era as well as in the case of future pandemics

Biopsy-Proven Myocarditis: Gender Differences and Serum Autoantibody Markers of Dismal Prognosis

Prognostic features in endomyocardial biopsy (EMB)-proven myocarditis remain poorly defined. Purpose: We assessed role of gender and of serum anti-heart (AHA), anti-intercalated disk (AIDA), anti-endothelial (AECA) and anti-nuclear autoantibodies (ANA) at diagnosis as possible predictors of death or heart transplantation (HTx). Methods: Our prospective cohort studied 250 consecutive myocarditis patients (117 with active, 102 borderline lymphocytic, 10 giant cell, 21 other histology types), 87 female, aged 37 ± 24 years, follow-up 57 ± 49 months. Polymerase chain reaction (PCR) was used to detect viral genomes on EMB. AHA (organ-specific, partially organ-specific or cross-reactive types) and AECA, AIDA, ANA were detected by indirect immunofluorescence on human heart and skeletal muscle. Univariate and multivariable Cox regression analyses for death or HTx status were used. Results: At last follow-up in May 2012, 179 patients were alive, 38 were dead or transplanted, 33 were lost to follow-up. In 20% of patients viral PCR was positive. Frequencies of positive antibody tests were as follows: AHA 55%, AIDA 17%, ANA 17%, AECA 10%. Actuarial survival at 6 years was lower in females (72% vs 87%, P=0.02). Females compared to males had higher frequency of family history of heart disease (45% vs 26%, p=0.003), extra-cardiac autoimmune disease (p=0.008), presentation with heart failure (p=0.01), higher NYHA class (p=0.03), higher frequency (p=0.009) and higher titer ANA (p=0.03). Univariate predictors of death/HTx in the whole cohort were: longer symptom duration, giant cell myocarditis, NYHA II-IV, presentation with ventricular dysfunction/symptomatic heart failure, echocardiographic and hemodynamic indexes of biventricular dysfunction, AECA, ANA. Independent predictors were female gender (p=0.01), young age (p=0.04), high titre ANA (p=0.001), high titre organ-specific AHA (p=0.02), lower echocardiographic LV ejection fraction at diagnosis (p=0.000). Conclusions: In EMB-proven myocarditis, an autoimmune pathogenesis, identified by high titer organ-specific AHA and ANA, is associated with a dismal prognosis, particularly in young females. This may reflect the well-known predilection of autoimmune disease for the female gender

Estimating minimum adult HIV prevalence: A cross-sectional study to assess the characteristics of people living with HIV in Italy

In 2012, we conducted a retrospective cross-sectional study to assess the number of people living with HIV linked to care and, among these, the number of people on antiretroviral therapy. The health authority in each of the 20 Italian Regions provided the list of Public Infectious Diseases Clinics providing antiretroviral therapy and monitoring people with HIV infection. We asked every Public Infectious Diseases Clinic to report the number of HIV-positive people diagnosed and linked to care and the number of those on antiretroviral therapy during 2012. In 2012, 94,146 people diagnosed with HIV and linked to care were reported. The majority were males (70.1%), Italians (84.4%), and aged between 25 and 49 years (63.4%); the probable route of transmission was heterosexual contact in 37.5% of cases, injecting drug use in 28.1%, and male-to-male contact in 27.9%. Among people in care, 20.1% had less than 350 CD4 cells/μl, 87.6% received antiretroviral therapy, and among these, 62.4% had a CD4 cell count higher than 350 cells/μl. The overall estimated prevalence of individuals diagnosed and linked to care in 2012 in Italy was 0.16 per 100 residents (all ages). Adding the estimated proportion of undiagnosed people, the estimated HIV prevalence would range between 0.19 and 0.26 per 100 residents. In Italy, the majority of people diagnosed and linked to care receive antiretroviral therapy. A higher prevalence of individuals diagnosed and linked to care was observed in Northern Italy and among males. More information for developing the HIV care continuum is necessary to improve the entire engagement in care, focusing on test-and-treat strategies to substantially reduce the proportion of people still undiagnosed or with a detectable viral load