Sfide etiche nell'assistenza agli anziani in contesto acuto e residenziale: una revisione di scopo

Introduction: The discontinuity between the high ideals of nursing education and real-world practice is a major cause of frustration, moral distress and burnout among the youngest, and pushes up to half nurses to change career within two years. These conditions are accentuated in the care of elderly patients with multiple chronic needs. Method: A multidisciplinary team of nurses and philosophers investigated the chronic determinants of ethical issues in aged care nursing, building on insightful experiences from different institu­tional settings, in order to provide evidence for contextualized and patient-oriented professio­nal support. A scoping review protocol was employed at this purpose. Results: Most of the environmental and organizational deteminants of chronical ethical issues are out­side the control of nurses, and most of the relational ones follow as a result in both settings. Many of the them have been confirmed and further aggravated by the COVID-19 pandemic. Discussion: Although there are not universal solutions to the issues described, still it is possible to distin­guish which determinants fall within the control of nurses, to help them prevent or manage their occurrence; and what are beyond, to help them avoid self-blame and transfer constructive information to those who can intervene. Conclusion: Education can help exercise critical thinking and communicate properly. However, once maximized team cooperation, orga­nizational efficiency, and individual soft skills, diminishing room for improvement will be available at increasing human and financial costs. Improving the condition of nurses is an urgent political responsibility and requires a broader socio-cultural change. Keywords: burnout, COVID-19, elderly, moral distress, workplace health promotion.Introduzione: La frattura fra educazione infermieristica e realtà lavorativa quotidiana rappresenta una frequente causa di frustrazione ed esaurimento psicofisico, che spinge fino a metà degli infermieri a ritirarsi entro due anni dal conseguimento del titolo. Tali condizioni sono accentuate nell’assistenza alla persona anziana affetta da bisogni cronici e complessi. Metodo: Un gruppo multidisciplinare di infermieri e filosofi ha studiato i determinanti ambientali, organizzativi e relazionali alla base dei problemi etici che emergono con maggior frequenza nell’assistenza alla persona anziana, sia nelle strutture per acuti, sia nelle strutture di ricovero a lungo termine, alla ricerca di evidenze utili a migliorare le condizioni dei professionisti. A tal proposito è stata una condotta una revisione di scopo. Risultati: La maggior parte dei problemi ambientali e organizzativi risultano essere al di fuori del controllo dei singoli infermieri, e la maggior parte dei problemi relazionali ne rappresentano la conseguenza. Molti di questi problemi sono stati confermati e aggravati dalla pandemia di COVID-19. Discussione: Sebbene non vi siano soluzioni trasversali a tutti i contesti, resta possibile distinguere quali problemi rientrino nel dominio di azione degli infermieri, per aiutarli a prevenirne o gestirne l’occorrenza; e quali invece vadano oltre, onde evitare sentimenti di autoaccusa, e trasferire informazioni utili a coloro che invece possono di volta in volta intervenire. Conclusioni: La formazione può allenare il pensiero critico e la comunicazione fra operatori, pazienti e familiari. Una volta raggiunti i massimi livelli possibili di cooperazione ed efficienza, tuttavia, margini di miglioramento sempre più ridotti saranno acquisiti a costi umani ed economici sempre maggiori. Il miglioramento delle condizioni degli infermieri dipende sempre sempre più da investimenti allocativi e culturali urgenti. Keywords: anziani, COVID-19, esaurimento psicofisico, politiche allocative, salute sul luogo di lavoro

Nursing students’ experience of risk assessment, prevention and management: a systematic review

Introduction:  As a fundamental dimension of quality, the patient safety and healthcare workers safety in the healthcare environment depend on the ability of each healthcare workers (whether administrators or technicians) to reduce the probability of error. This review focused on nursing students. The aim was to assess level and determinants of knowledge about risk assessment, risk prevention and risk management of nursing students. Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Two reviewers searched the bibliographic databases Pubmed, Scopus and Cinahl to collect all the available articles in English and Italian issued between 2015 and August 2019. To obtain an exhaustive string search, the following keywords were combined through Boolean operators AND and OR: Clinical Risk Assessment, Nursing Education, Nursing Student*, Patient Safety. The authors assessed the quality of the evidence by using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method.  Results: Twelve papers are included. Although the literature on the nursing student's error is limited, their frequencies are worrying. Some authors have created a model of prevention of clinical error based on three level. However, the majority of nursing students don’t felt confident with a patient safety. Many authors shown that patient safety education was delivery by lecture, laboratory or simulation sessions. Conclusions: This review underlines the need to revise the nursing curriculum on patient safety and the need to think what educational methodology is the better for the student to create a safe care. &nbsp

Indagine conoscitiva sul concetto di competenza avanzata nella professione infermieristica

Introduzione: L’evoluzione della formazione infermieristica ha di fatto portato ad un accrescimento di conoscenze e competenze che hanno reso gli infermieri dei veri e propri professionisti. Con l’introduzione del comma 566 della Legge di stabilità del 2015 e della Legge 24 del 2017, è stata posta una maggiore attenzione sull’utilizzo delle Linee Guida e su come esse, insieme alla buona pratica, possano ridurre il ricorso ad una medicina difensiva. Obiettivo: Indagine sulle conoscenze del personale infermieristico riguardanti i concetti di competenza avanzata e responsabilità professionale, in relazione al loro agire quotidiano, e ai nuovi assetti normativi. Materiali e Metodi: Uno studio cross-sectional è stato eseguito su un campione di 60 soggetti fra Giugno 2019 e Settembre 2019, presso l’ospedale Policlinico Umberto I di Roma. È stata condotta una survey, rivolta agli infermieri operanti nel setting dell’area critica e chirurgica, mediante l’utilizzo di un questionario non validato, in forma anonima in cui vengono analizzati e saggiati: a) dati anagrafici; b) analisi dell’attività lavorativa; c) analisi delle conoscenze. Risultati: Sono stati convalidati per lo studio 60 questionari correttamente compilati, con un tasso di risposta del 63.8%. Il 68.3% degli infermieri era di sesso femminile ed il 31.6% di sesso maschile. L’età media del campione è di 35.2 anni. Il 16.7% degli infermieri utilizza sempre le linee guida aziendali/ministeriali nella pratica clinica; il 36.7% le usa raramente; il 41.7% le utilizza abbastanza, mentre il 5% non le utilizza mai. In relazione alla conoscenza della normativa vigente, emerge che il 48.3% non conosce il comma 566 della Legge di stabilità, con il 48.3% del campione che asserisce di conoscere la Legge Gelli. Conclusione: Dai risultati ottenuti emerge la necessità del personale infermieristico di una maggiore formazione circa gli aspetti legali della professione mediante una formazione dedicata. Inoltre emerge l’importanza dell’aggiornamento professionale come mezzo per non incorrere in atti di medicina difensiva.Introduction: The evolution of nursing education has in fact led to an increase in knowledge and skills that have made nurses real professionals. With the introduction of paragraph 566 of the 2015 Stability Law and Law 24 of 2017, greater attention has been paid to the use of the Guidelines and how they, together with good practice, can reduce the use of defensive medicine. Aim: The aim of this is to investigate the knowledge of nursing staff regarding the concepts of advanced competence and professional responsibility in relation to their daily actions, considering the new law framework. Materials and Methods: A cross-sectional study was performed on a sample of 60 responders between June 2019 and September 2019, at the Policlinico Umberto I hospital in Rome.A survey was conducted, aimed at nurses operating in the critical and surgical area setting, through the use of an anonymous, non-validated questionnaire in whic the following are analyzed and tested: a) personal data; b) analysis of work activity; c) knowledge analysis. Results: 60 correctly completed questionnaires with a response rate of 63.8% were validated for the study. 68.3% of the nurses were female and 31.6% male. The average age of the sample is 35.2 years. 16.7% of nurses always use company / ministerial guidelines in clinical practice; 36.7% rarely use them; 41.7% use them enough, while 5% never use them. In relation to the knowledge of current legislation, it emerges that 48.3% do not know paragraph 566 of the Stability Law, with 48.3% of the sample claiming to know the Gelli Law. Conclusion: The results obtained show that the nursing staff need more training on the legal aspects of the profession through dedicated training. Furthermore, the importance of professional updating emerges as a means of not incurring defensive medicine

L'infermiere e la percezione del Moral Distress nella cura del fine vita nel paziente dializzato

The phenomenon of Moral Distress in nursing practice is described as a situation of suffering that arises when the nurse recognizes the ethically appropriate action to be taken and yet institutional impediments make it impossible for him to follow the right course of action. Dialysis patients often have a complex disease trajectory that sometimes involves professional and emotional challenges for staff, especially at the end of life. The objective of this review is to identify which strategies are useful for preserving emotional integrity and awareness in operational settings, for the benefit of both operators and patients

Ethical Problems and Moral Distress in Primary Care: A Scoping Review

Background: Since 1997, nursing ethics research has focused on solving ethical dilemmas, enhancing decision-making strategies, and introducing professional education. Few studies describe the triggers of ethical dilemmas among primary care nurses. The aim of this study was to explore the moral distress and ethical dilemmas among primary care nurses. Methods: A scoping review was performed following Arskey and O’Malley’s framework. PubMed, CINAHL, PsycINFO, Embase, and Scopus were searched systematically to retrieve relevant titles and abstracts. A temporal filter was applied to focus on the most recent literature (years of 2010–2020). The research was completed on 17 November 2020. Results: Of 184 articles retrieved, 15 were included in the review. Some (n = 7) studies had a qualitative design, and the most productive country was Brazil (n = 7). The total number of nurses involved in quantitative studies was 1137 (range: 36–433); the total number of nurses involved in qualitative studies was 144 (range: 7–73). Three main focus areas were identified: (a) frequent ethical conflicts and moral distress episodes among nurses working in primary care settings; (b) frequent moral distress measures here employed; (c) coping strategies here adopted to prevent or manage moral distress. Conclusion: Further research is needed to examine the differences between moral distress triggers and sources of ethical dilemmas among the different care environments, such as primary care and acute care settings

Medication errors in homecare setting. An Italian validation study

Objective Medication errors are a concern in overall the world. Although there are studies that investigate what may be the main causes that lead to the genesis of the medication error in the home care setting, there is no tool that correlates knowledge, attitudes, and behavior to medication errors in the context of home care. This study aimed to psychometrically test to the questionnaire on knowledge, attitudes, and behaviors in the administration of medication in the new setting: home care setting. Design This observational study was reported according to the STROBE checklist. Sample Sixty two nurses working in home care setting responded to the online survey. Measurement The face and content validity of the items generated was assessed. An Exploratory Factorial Analysis descriptive statistical analysis was conducted. The final questionnaire is composed of 20 items. Results The results of the statistical analyses allowed to validate the questionnaire, ensuring good internal consistency and reliability. Most of the sample pointed out that the use of electronic health record, medication reconciliation and the pharmacist's figure are all useful strategies for reducing the risk of medication errors. Conclusion The questionnaire is reliable to measure knowledge, attitude, and behavior about medication errors prevention in home care settings

A worldwide bibliometric analysis of published literature on medication errors

Objectives: The aim of the study was to map the recent literature on medication error to monitor the state of research and explore emerging research fronts. Specifically, the co-occurrences analysis aimed to research the conceptual structure of the medication errors, whereas the coauthorship analysis aimed to research the "authorities" that influenced the academic and political discussion on medication errors. Methods: The search for relevant studies was carried out through the Scopus. To map and monitor the state of research on medication error, a preliminary analysis was conducted through the year of publication, type of article, and language. The count of citation shows the most relevant work among those included. Bibliometric analyses were conducted, such as coauthorship analysis and co-occurrences analysis. Results: The search strategy yielded 5393 articles. Of these, 1267 articles were included. Four main themes emerged from this bibliometric analysis: (a) the exploration of human factors related to health care professionals that increase the risk of medication error, (b) the investigation of behaviors and strategies that can prevent the error in the preparation and administration stage, (c) the analysis of the benefits related to the presence of the pharmacist in hospital settings, and (d) the exploration of the consequences of a medication error and/or adverse effects of drugs. Conclusions: For the first time, a bibliometric analysis of medication errors research in the world has been conducted and demonstrated that there is a wealth of contributions already being made that are well aligned to the World Health Organization challenge

Management of chronic musculoskeletal pain in veterans: a systematic review

Veterans are military with health problems due to military conditions. The improved body armor and operational conditions has reduced the number of deaths, but increased the number of veterans with severe injuries, affected by musculoskeletal pain and associated syndromes, such as post-traumatic stress disorder. Multimodal approaches are considered in USA the gold standard for the treatment of these problems, while in Europe and Italy the data are unknown. The aim of this review was to describe and summarize multimodal therapeutic approaches that apply to the veteran population for chronic musculoskeletal pain and relate syndromes management

Farmaci orfani. uno sguardo sulle politiche di produzione e ricerca in ambito europeo [Orphan drugs. An European production, research and development policies]

Se il percorso di approvazione e commercializzazione di un farmaco è di per sé macchinoso, passando per la sperimentazione clinica, la richiesta di rimborsabilità pubblica e la farmacovigilanza, il caso dei farmaci orfani è singolarmente complesso per una serie di ragioni: in primis, il processo di produzione delle prove scientifiche necessarie è lungo e dispendioso, così come oneroso è quindi il prezzo di rimborso. Tali considerazioni impongono a chi ha in capo la responsabilità della salute pubblica una riflessione sulle metodologie di incentivazione della ricerca scientifica nell’ambito dei farmaci orfani, le cui prospettive sono sempre più asfittiche. La presente revisione della letteratura ambisce a fornire una panoramica sulle metodologie di incentivazione dello sviluppo di farmaci orfani, con particolare attenzione agli Early Access Programs (EAPs) che mirano a velocizzare l’accessibilità ai medicinali orfani.Summary. The drug approval process consists of two stages: clinical trials (CT) and new drug application (NDA) approval. Orphan drugs are medicines or vaccines intended to treat, prevent or diagnose a rare disease. New programs in orphan drug development may offer valuable solutions to bring orphan treatments to the market more quickly in despite of hight prices. The aim of this study is to review the range and types of existing policies adopted by Europe to enable the availability and accessibility of orphan drugs

Gestione della comunicazione nel paziente tracheostomizzato

Communicating is one of the essential life needs, a requirement that becomes even more important for patients subjected to tracheostomy, often deprived of alternative suitable instruments for both expressing physiological needs and attenuating negative feelings connected with their condition. Through an analysis of literature, it is possible to outline different communication approaches that constitute an alternative to the verbal one that the nurse, following a customized care project, must select according to the assisted person’s experiences and learning skills. Main target is restoring the communication between patient and environment at a bi-directional osmosis level