SIMED-New Doc course, a matter of reflection.

BACKGROUND AND AIM: Obtaining a degree in medicine in Italy qualifies for the medical profession; this fact has entailed a newly qualified doctor's remarkable involvement on the medical activities of the National Health Service, especially during the Covid-19 pandemic. It is important to understand the knowledge of the newly qualified doctors and to create specific courses oriented to them. The aim of the study is to evaluate the impact of a peer learning course for the students who attend the last year of medicine school, with the purpose of defining the formal requests to integrate on the course. METHODS: A pre and post qualitative research has been carried out on SIMED-NEWDOC course. The course consisted on peer teaching lectures, as lecturers were resident doctors part of SIMED board. At the end of the course it has been submitted a survey to the participants, and data has been analyzed. RESULTS: The students enrolled were 139, the average of the participants was 27% of the registered. A qualitative evaluation questionnaire was submitted, the responses were 32 (86%). Average age was 25. Participants attending the last year of medicine school were 30 (95%). 40% of them declared to have attended at least 5 lessons. Among the course participants, 96% judged the course as very useful. CONCLUSIONS: All questionnaire results are useful to reflect on future projects. It is necessary to implement further educational projects to better understand the phenomenon, considering the positive impact that participants declared.

Role and challenges to digital technologies in community health promotion programs in Italy during the COVID-19 pandemic: a multiple embedded case study protocol.

BACKGROUND AND AIM: Due to the COVID-19 pandemics, The Italian League Against Cancer (LILT), a national federation of local associations promoting cancer prevention, had to face the challenge to find new ways and technologies to promote health in their territories. This study aims to explore how LILT associations led their health promotion interventions during the COVID-19 pandemic and to understand which interventions had a greater impact, for which population group, and why. METHODS: In this descriptive multiple embedded case study, each case will focus on the activities of a local LILT association and their collaborators on the perception and experience of the use of digital technology for health promotion and prevention, through interviews, observations, and a study of products and artifacts. A general overview of each case study will be provided, along with an introduction of the unit(s) of more in-depth analysis. The logical models that emerge from the analysis of each case will be described by using realist analysis, producing a list of possible CMO configurations (Context; Mechanisms; Outcomes). The final report will consist of a cross-case analysis (a comparison between the different case studies). DISCUSSION: This multiple case study will help generate a first "theory of the use of digital technology in health promotion in local LILT communities. The observation of what local LILT associations in Italy have done during COVID-19 will help identify new and useful health promotion strategies based on these technologies.

Dealing with uncertainty. A qualitative study on the illness' experience in patients with Long-COVID in Italy.

BACKGROUND AND GOALS: An unknown proportion of people who had COVID-19 infection continue to experience symptoms such as fatigue, breathlessness, joint or muscle pain, difficulty sleeping, and brain fog. These symptoms have a significant impact on the quality of life. Long-COVID is a new multisystem disease still under investigation. This research aims to explore the illness experienced by patients suffering from Long-COVID in Italy. RESEARCH DESIGN AND METHODS: Qualitative methodology with semi-structured interviews. Participants were recruited on the Facebook patient group between October 2021 and January 2022. Participants had been experiencing symptoms for at least three months following confirmed COVID-19 infection. Interviews were conducted by video call, recorded and transcribed with consent. The thematic analysis method has been chosen to infer data from textual material. RESULTS: 17 interviews with women with Long-COVID have been analysed. The main themes include: a total change of life due to the symptomatology, loss of autonomy that affects social, family and professional life; social isolation, a sense of abandonment often increased by stigma, the difficulty of being believed and achieving diagnosis; difficulty in managing symptoms and accessing to care services; living with uncertainty caused by the lack of institutional, social, professional, familial and medical support.  Conclusions: Intervention programs, both institutional and social-health policies should be developed for patients with Long-COVID. The impact of symptoms could be reduced by developing standards and protocols, and by ensuring access to care and to multi-disciplinary rehabilitation. Further development of knowledge on Long-COVID is essential.

Re-evaluation of the interprofessional collaboration scale validation between nurses towards other health care professionals occupied in Italian emergency medical services.

BACKGROUND AND AIM: Interprofessional collaboration (IPC) between health professionals is fundamental for the provision of an efficient and effective medical care service. This is especially so in states of emergency, as highlighted by the ongoing coronavirus disease 2019 pandemic. This study aimed to obtain further evidence regarding the validity and reliability of the Italian language IPC scale -an instrument for measuring interprofessional collaboration- in a setting that has yet to be investigated at an in-depth level: the emergency departments in Italian hospitals. METHODS: The survey tool was a structured questionnaire in the Italian language. It comprised the validated Italian version of the IPC scale plus a question concerning the frequency of collaborations between the nurses interviewed and other health professionals. Confirmatory factor analysis was applied to rate the three factors ("communication", "accommodation" and "isolation") that compose the scale. RESULTS: Four hundred thirty-six nurses working in an emergency department for at least one year completed the questionnaire, which assessed collaboration with other health professionals working in the same department. The model fit statistics are satisfactory for all the nurse-target group combinations analysed. Regarding the Cronbach's alpha statistic used to compute the reliability of the scale, acceptable values were obtained for all items, except for those related to the isolation factor for each case of interprofessional collaboration considered. CONCLUSIONS: The results confirm the validity of the IPC scale as an instrument for the assessment of interprofessional collaboration involving nurses and other workers occupied in the provision of healthcare in Italian emergency departments.

Interprofessional Training and Commitment to Research increasingly useful for the Health Professions.

Editorial.

A realist synthesis of staff-based primary health care interventions addressing universal health coverage.

Background: Universal Health Coverage (UHC) can be achieved by universal access to a solid and resilient people-centred health care system, with Primary Health Care (PHC) as its foundation and strategy. Increased access to PHC occurs when health care services are available, affordable, accessible, acceptable, and perceived appropriate by users. Many studies highlight that health care workers are critical in helping people access, navigate, and interact with PHC services. How the interventions involving health care staff work and under what circumstance remains unclear. Methods: Through a systematic review and a realist synthesis, we identified and described staff-based interventions impacting UHC through PHC. We conducted the systematic review from inception to June 2021, searching for peer-reviewed studies published in English, using quantitative methods for evaluating interventions. Results: We identified three Context-Mechanism-Outcome (CMO) configurations: inserting culturally sensitive ad hoc bridge figures, tailoring staff practices to the needs of specified populations, and training as a means for staff reskilling. Inserting ad hoc bridge figures in health care services was successful when they were familiar with the contextual culture and the users' needs. The second configuration entails interventions where the staff was asked to consider the needs of targeted populations and differentiate strategies by the detected conditions. Finally, the third one consists of specific, ad hoc, and context-based training targeting several stakeholders. Central to this intervention was training for health care bridge figures, since they were explicitly trained before performing their duties to cope with the health care and social needs of the specific groups they intended to serve. Conclusions: The review highlights that the context and contextual factors should be considered for an intervention to be successful. Hence, it provides policymakers with practical indications for designing staff-based interventions for reaching UHC within PHC services in a given context. Healthcare bridge figures, an umbrella term embracing a variety of selected community health workers, often trained and working in the communities from which they come, increase access to PHC services as they respond to local societal and cultural norms and customs, ensuring community acceptance and ownership.

From classroom training to e-learning: a journey through the quality of learning life of nurse students in post-graduate education - A longitudinal qualitative study.

BACKGROUND AND AIM: recent studies regarding COVID-19 experiences of nursing students highlighted the effect of the transition from face-to-face to online education, rather than the complexity of the overall quality of educational life. This study aim investigating of how the students perceive the quality of educational life in the forced online training, searching for any shift of meanings concerning the students learning experience, from the first phase of the sudden transition to online and the online stabilization phase. METHODS: a longitudinal qualitative study, carried during two moments of the online teaching activity forced by COVID-19, the first one in May-June 2020 and the second six months later in January -February 2021. A convenience sample of 24 students attending post-graduate courses for health professions recruited at University of Parma, answered in-depth interviews, videotaped, verbatim transcribed and analyzed using the Braun and Clarke model. RESULTS: five themes emerged from meaning shift of data collection: reactions to change in educational life; factors favoring a new quality of educational life; factors hindering the perception of the quality of educational life; adaptation strategies to the new educational life; tools and strategies to facilitate communication and the absence of the classroom. CONCLUSIONS: participants perceive advantages of online teaching, on quality of their educational life. The issue of how to create opportunities for internship period remains open. Further research to understand online internship and exploring what extent it is essential to propose it in face-to-face modality.

The impact of the alterations in caring for COVID-19 patients on Compassion Satisfaction and Compassion Fatigue in Italian nurses: a multi method study.

BACKGROUND AND AIM OF THE WORK: During COVID-19 first wave,  healthcare professionals were exposed to a major psychological pressure related to uncertainty, a lack of therapies or a vaccine and shortages of healthcare resources. They developed higher levels of Burnout and  Compassion Fatigue, and similar levels of Compassion Satisfaction. Aim is evaluating in Italian nurses Compassion Satisfaction and Compassion Fatigue and impacting individual and relational variables. METHODS: A multi-methods approach was used. Qualitative data were collected through 2 focus group. Quantitative data were collected through a web survey composed by an ad hoc questionnaire developed from the focus group results, the Professional Quality of Life Scale-5 and the Resilience Scale (RS-14). RESULTS: In the qualitative phase 6 categories emerged. From the quantitative analysis the sample reported a moderate level of Compassion Satisfaction, a low level of Burnout  and a moderate level of Secondary Traumatic Stress. Compassion Satisfaction had as predictors resilience (ß = .501), followed by feeling part of the team (ß = .406) and collaboration with colleagues (ß = .386). Secondary Traumatic Stress had as predictors the impact of PPE (ß = .269), and feeling Covid-related individual sufferance (ß = .212). The only predictor of Burnout was resilience (ß = -2195). Conclusions: During COVID-19 first wave Italian nurses were exposed to a higher risk of Secondary Traumatic Stress, mainly impacted by frustration, loss of control, loss of possibility to properly care for patients, and personal threat. Relational and team support had a crucial role in sustaining Compassion Satisfaction.

Does open data tell us everything?

The community of the entire planet is still grappling with the management of the Sars-CoV-19 pandemic and in some countries the spread of the infection is as serious as it was in Italy in the first months of 2020. In this issue of the magazine Kalli M et al. describe the situation in Chad.[...].

The experience of the emergency psychologist during the Covid-19 pandemic.

BACKGROUND AND AIM OF THE WORK: the new coronavirus pandemic COVID-19 has had a strong psy- chological impact on the world population. Volunteer psychologists, and psychologists that work in the emer- gencies have also been exposed to the consequences of the impact of the pandemic. The purpose of this study was to explore the experiences of the psychologist during the Covid-19 emergency intervention. METHODS: an exploratory study, following a qualitative design using Focus Group method was adopted. A total of 24 psychologists was recruited from volunteers of the "Pronto Pșy - Covid-19" service, organized by the Ital- ian Society of Emergency Psychology Social Support, Emilia Romagna. Focus Group Discussions (FGDs) was held about: their experiences during the online psychological support; needs detected by users; training needs that emerged during the intervention and professional skills applied. RESULTS: five themes were identi- fied: psychological distress of rescuers; online emergency setting; support of colleagues and gratitude as stress management strategies; need of skill and tools in pandemic emergency intervention; integrated psychological intervention. DISCUSSION: the stress reaction of the emergency psychologists was due in particular to the type of emergency and lack of standardized approach. The group meetings represented an important resource to face traumatic stress. CONCLUSIONS: this study showed the role the need for specific tools for pandemic intervention to protect the well-being of the professional from impact of stress. Further research is needed. (www.actabiomedica.it).

SARS-CoV-2 docet.

One year has passed since the Sars-CoV-2 infection diagnosis was made in a patient hospitalized in Codogno unveiling the outbreak of coronavirus in Italy and the start of one of the worst pandemics in history. Today, we know a lot more about Covid-19 infection than we did a year ago. We know that the fight against the spread of the virus, when not correctly done, favours the development of variants of the original covid-19 strain and, we also know that these variants especially the one defined as the "English" variant, has the ability to spread much more and more quickly than the original strain. We know that people, even at lethal risk of complications, are especially old aged, but we also know that those who are oligosymptomatic or asymptomatic patients can spread the infection. Grossi E. et al. report in the following pages the results of a research conducted on pregnant women which shows how the risk of contracting the infection is higher in pregnancy although in an asymptomatic form and that the risk is also transmitted to the unborn child. This data makes the report here provided by Intraccolo U. et al. even more interesting according to which the Italian female population tends to excessively medicalise low-risk pregnancies. [...].

Nurse's identity role during Covid-19.

BACKGROUND AND AIM OF THE WORK: The main purpose of the study is to investigate the experience of nurses who worked in the Covid-19 area focusing on the perception of their role. In particular, has been explored the nurses' perception of job satisfaction in relation to the images sent back by public opinion through the mass media and social communication channels. During the first wave of Covid-19 nurses have acquired media visibility , but their feeling is represented more by the discomfort of finding themselves suddenly glorified in the face of a lack of professional, social, and economic recognition. MATERIALS AND METHODS: A Mix-Method methodology and convenience sampling was adopted, on the population of professionals and students in post-graduate specializations, belonging to the Department of Medicine and Surgery of the University of Parma, and by nurses from the ASST-Bergamo Asst Bergamo Est, Lombardia Italy, who worked in the Covid emergency during the first wave of the pandemic, from February 2020 to May 2020.  In the quantitative phase Stamm's Professional Quality of Life Scale -  ProQOL was administered to 89 respondents through a Google Form, In the qualitative phase, 3 Focus Groups were conducted  on a total of 17 students . RESULTS: At the ProQol questionnaire, a moderate score was found in the Compassion Satisfaction scale (CF = 38.28) and in the Secondary Traumatic Stress subscale (STS-24.33), while low values emerged in the Burnout subscale (BO = 16.02). From the focus groups emerged five specific thematic: Professional collaboration, Job satisfaction, Nurse's personal skills, Failure to protect the public image and the nursing profession. CONCLUSIONS: The professional collaboration, union with the work team, sense of solidarity, job satisfaction, professional growth and awareness of one's role seem to have worked favorably on Compassion Satisfaction, while keeping Compassion Fatigue levels under control.

The qualitative method for a humanisation of research.

Huge progress in scientific research, added to vast investments, have allowed to develop vaccines against the virus responsible for Sars-Cov-2 in times unimaginable, until recently (1). The use of these vaccines has documented their high efficacy and very low risk of adverse events. Undergoing vaccination campaigns around the world are changing the history of the COVID-19 pandemic. Never before has scientific research been a topic of widespread interest as in this period. [...].

Taking care. Nursing towards Covid-19 patients during the pandemic emergency in Italy: a qualitative study.

BACKGROUND AND AIM OF THE STUDY: The Covid-19 pandemic has clearly impacted the Italian healthcare system. The growing number of patients in critical conditions has required a reorganization of the hospitals wards and of other healthcare structures, by changing the working routines of health professionals. The aim of the study is to explore if and how the nursing care towards Covid-19 positive patients have changed during the pandemic. METHOD: Qualitative study with a phenomenological approach conducted through semi-structured interviews. Interviews have been carried out during the months of October and November 2020. Our research involved 21 nursing professionals attending post-graduate courses at the Department of Medicine and Surgery of the University of Parma (academic year 2019/2020) and who have worked during the pandemic period in health services structures and organizations. RESULTS: The interviews showed how, during the period of the pandemic emergency, the care relationship between nurses and patients has changed because of the priority given to clinical and technical practices, in some cases, "life-saving". This happened due to different factors such as the nurses' fear of being infected by the virus and the lack of a sufficient time to ensure an holistic and integrated approach towards an increasing number of patients in highly complex conditions. Thus, the dimension of caring has been consciously overshadowed. CONCLUSIONS: The health emergency that has hit Italy since the first months of 2020 has shown structural limits and gaps of public health policies, hospital settings and national health services organization that already existed in the pre-pandemic period. It also highlighted how, even before Covid-19, nursing was already in part denoted by a loss of caring, a missed nursing care.

The intervention of the emergency psychologist: the SIPEM SoS Emilia Romagna during the first lockdown from COVID-19.

Background and purpose of this work: WHO 11 March 2020 declares that Sars-Cov-2 infection is not only a health emergency but must be considered a pandemic. Covid-19 required the urgency of a new psychological intervention model to better address the crisis and ensure a direct support response to the people involved in the pandemic. The present study aimed to detect the symptoms and reactions of the population with respect to the event. The survey was carried out by describing the clinical symptoms that emerged from the triage card used by SIPEM SoS Emilia Romagna (Italy), connoting the criteria of emergency psychology. METHODS: A retrospective quantitative study was conducted on 288 psychological triage cards. RESULTS: only 11% of users who ask for support say they are positive while 85% report not having contracted the virus. Of the total, 40.9% call for psychological support in the management of anxiety symptoms, a need also reported by 55% of the subsample who declared previous psychological problems. In reaction to the pandemic event, 51.1% of the total refers to coping resources and availability for help. DISCUSSIONS: the need for support of the population to manage symptoms highlights the need for early interventions, also to facilitate that slice of the population that does not have effective individual coping strategies and resources available to help. CONCLUSIONS: it can be deduced that interventions during these types of emergencies must be timely and aimed not only at those affected but also at the general population.

Before, during and after the COVID-19 pandemic.

The social disruption that had characterized the rapid progression of CoVid-19 infection in Italy in the first months of 2020 appeared again in the days in which this journal issue is being published. Due to what is defined as the second wave of the SARS-CoV-2 pandemic, measures to contain the contagion were still necessary, such as social distancing, isolation, the suspension of some production activities, closure of the majority of educational activities in presence in schools and universities. [...].

The Pandemic from COVID 19: a Lesson that we must not forget.

This issue of the Acta Biomedica for Health Professions magazine was prepared during the lockdown, imposed by the Italian government, for the contain- ment of COVID 19. This acute syndrome was initially thought to concern only the respiratory system and for this reason it has been defined as SARS CoV-2. To date, however, we know that COVID 19 affects numerous areas of the body (1,2). In Italy, the first western country where the infection manifested itself in the form of an epidemic, we listened to health bulletins that resembled war bulletins, which reported on thousands of people affected by the virus and hundreds of dead people. [...].