Health coaching for undergraduate nursing students: a pilot study for an action research.

BACKGROUND AND AIM: The Nursing undergraduate degree educational program represents an intensive and complex course, and includes a number of professionalizing practical internships, and for these reasons it requires an action to support and improve. Coaching is based on the premise that people have personal strengths and abilities which, through a interview, can be directed to solving their problems. Several studies demonstrate the efficacy of Health Coaching in different University, but never have been measured benefits regard skills improving. The objective of the study is to assess the impact of a health coaching program on the nursing students. METHOD: A pre-post quasi-experimental study was conducted, involving the activation of a Health Coaching Program for 25 nursing students selected through convenience sampling, based on their fulfillment of the inclusion criteria. The Health Coaching Program was administered by the Health Coaching Academy. RESULT: This study also evaluated parameters such as: level of concentration in study, motivation, problem solving and reorganization skills, study organization skills, psycho-physical-emotional state comprehension, decision-making skills and self-esteem, noting a statistically significant increase post-HC program. A statistically significant improvement was also found in the students' perception of their own stress management skills after the course. CONCLUSION: This study strengthens the hypothesis that HC programs contribute to improving performance of nursing students. Those conclusions need to be corroborated by future studies on the topic to further support the hypothesis that programs of HC within the learning nursing contexts can lead to a tangible benefit for students of the health professions.

Taking care of dying patients through an 'interprofessional ecosystem': a grounded theory study on the experience of an interprofessional team in palliative care.

BACKGROUND: The interprofessional approach is part of the philosophy in palliative care, and its benefits are already documented. However, there are no evidence regarding the process through which the interprofessional team faces the process of the patient's end-of-life and how this experience might be of value for the team's development itself. The aim of this study was to analyse and understand the psychosocial processes that occurs when an interprofessional team accompanies patients and their families to death in palliative care, with the ultimate aim to develop a substantive theory to describe this phenomenon. METHODS: A Grounded Theory method, as theorized by Strauss and Corbin, was adopted for this study. Data were collected through semi-structured interviews and then independently analysed using constant comparison analysis. Fourteen healthcare professionals - belonging to different disciplines (doctor, nurse coordinator, nurse, nurse assistant, psychologist) - were interviewed in a Northern Italy palliative care facility. FINDINGS: The core category of this study was identified to be the process of accompaniment of the dying patient as an interprofessional ecosystem. Moreover, the results showed four main factors determining the development of the core psychosocial process: from professionals' 'Hidden Amazement' to 'Onerous Happiness' where 'Weaving of Professional Resources' and 'Work Meaning' are the underlying conditions to catalyse the process itself. CONCLUSION: Interprofessional care appears an essential value, which becomes the source of the team's strength when facing end-of-life experiences. Health policies and organisations should take the importance of the characteristics of the work environment more carefully. The meaning that professionals attribute to their work and to the team itself, indeed, it may have impact on the overall quality of care and contribute to sustain work engagement, even in stressful situations like end-of-life care.

The process of developing the professional identity of the Nurse Case Care Manager: A Grounded Theory Study.

BACKGROUND AND PURPOSE: The Nurse Case Care Manager (NCCM) is still an emerging figure in the Italian healthcare context. The knowledge of the dynamics inherent in the process of identity development shows how they can be decisive for the affirmation and recognition of this new role. The aim of the study was therefore to analyse the psychosocial processes of developing the identity of the NCCM for a better understanding of the variables that influence its development. METHODS: A qualitative study with Grounded Theory method was conducted. From December 2018 to January 2019, 20 semi-structured interviews were given to the NCCM of the Emilia Romagna Region and the Lombardy Region. The analysis of the material has led to a structuring of the theoretical model on the processes of development of professional identity. RESULTS: Two main conditions have been identified: that of the "LOST CASE MANAGER" and that of the "CASE MANAGER DIRECTOR". This process requires time, perseverance, courage and personal skills. Two transversal background concepts have been identified, namely "available space" and "relationship with the family". CONCLUSION: The process of developing the NCCM's professional identity encounters several obstacles. Among these, in particular a lack of recognition by operators highlighting the need for greater organizational clarity in the context in which the professional operates, in order to facilitate the inclusion of the NCCM clarifying skills and effectiveness profile.

A third mission at the Nursing Study course University of Parma. Intervention report.

BACKGROUND: The term Third Mission refers to the activities with which universities interact directly with the communities and the territory of reference, combining the objectives of the third mission with the two traditional missions: teaching and research.  These were the premises that guided the Nursing Studies Course of the University of Parma, with the goal of implementing a structured path of "Intercultural Nursing" on a demo-ethno-anthropological basis. METHODS: The path taken was divided into several phases: arrangement of moments of interaction with students; teaching activity aimed at students based on the relationship between ethno-anthropological knowledge, aspects of migration medicine and social legislation; direct meetings with representatives of some communities present in the Parma area. RESULTS: The interaction with students was achieved through meetings called "Cultural Coffee". The first meetings, in the measure of 4-5, took place in the period October-December 2013, subsequently, the same number of meetings was repeated in the following years. In 2019, two important results were achieved: the creation of an ADE (teaching chosen by the student) dedicated to multiculturality. Another activity of the "Intercultural Nursing" course involve the students with some communities in the Parma area. CONCLUSION: The results of this experience and the underlying idea that these aspects, if addressed in the basic training, can be for the professionals most expendable in the workplace, provide reasons to continue the path started. The international comparison on the intercultural skills of nurses, indicates collaboration and partnership with communities, as fundamental elements for a complete and effective assistance.

The Patient's Narrative Agenda as an assessment tool: the story of Robert, suffering from osteosarcoma.

BACKGROUND AND AIM OF THE WORK: To activate the participation of the person in his/her care path, the literature highlight the impact of the professional's ability to show a genuine interest in the problems brought by the patient and to recognize him/her as 'competent'. In these sense the narrative patient's agenda could be a useful relational tool, because is focused on the perception of patient experiences of his/her illness. Thus this study aims to analyze the usefulness of patient's narrative agenda during the assessment phase. METHOD: A semi-structured interview has been adopted to explore the agenda of Robert, 21 years old, suffering from osteosarcoma. A first level analysis identified the four functional areas of the agenda: ideas and beliefs; expectations and desires and context in which he lives and interacts. A second level analysis assessed the main Robert's problems. RESULTS: The narrative agenda has highlighted many central problems of Robert (e.g. therapeutic adherence, quality of life, mood, body image, existential problems related to experiences, hopes and expectations). Of course these results could be integrated with other tools: qualitative, to understanding difficulties and to formulate hypotheses, and quantitative, to measure the level of severity of problems reported. DISCUSSION AND CONCLUSION: The narrative agenda has not only proved to be a valid instrument of assessment, allowing an adequate insight on the patient's problems, as we exemplified, but it can be also used for monitoring the dynamic situation of the person's history, lending itself to the re-exploration of its functional areas over time.

The narrative interview for the assessment of the assisted person: structure, method and data analysis.

BACKGROUND AND AIM: If it is true that the impact of the symptoms of the disease is differently perceived by each person and that there is an incommunicability of the experiences of suffering, it is equally true that the narration provides an understandable representation, which derives from the network of representations that are part of a personal history.  The aim of this study was to offer an in-depth analysis of the "narrative interview" collected during the assessment of a 74 years old diabetic woman. METHODS: A case study was conducted by a nurse with advanced expertise in conducting narrative interview. Content analysis and Meaning analysis were performed using a Grounded theory approach and according with Gee's Poetic Method. RESULTS: The patient after the diagnosis felt disbelief, anger and confusion. The illness forces her to change her life, habits and social role, with high suffering. However she adjusted to this new condition and thanks to her strong and positive attitude and the social support she received, she has succeeded in activating her "post traumatic growth". CONCLUSIONS: A good narrative interview starts long before the interview itself and it requires: a specific training in the use of the instrument; the strengthening of specific skills (e.g. the active listening); the choice of optimal setting and timing for the patient; the ability to offer encouragement in the expression of the subjective experience and to conduct an analysis of the patient's words with a subjective lens, reflecting the uniqueness of each illness experience.

Health-Care-Associated Infections Management, sow the seed of good habits: a grounded theory study.

BACKGROUND AND AIM OF THE WORK: The reasons that condition and motivate adherence to good practices have a multifactorial nature. From the literature review, emerged different elements that interact within the operating context and represent a part of the variables that condition the "Best Practice". The aim of this research was to investigate the variables that influence adherence to operators' good practices. METHODS: A qualitative study with Grounded Theory (GT) methodology was carried out, which leads to the establishment of a theory about basic social processes. This theory is based on the observation and perception of the social scene and evolves during data collection. Data collection took place through interviews with the participants, through an ad hoc semi-structured interview grid. The initial sampling consisted of 12 health workers, while the theoretical sample was made up of 6 health workers. RESULTS: The analysis organization through the creation of schemes and diagrams has allowed to formulate different concepts including: false beliefs, knowledge and emotions experienced, that connect with the initial condition of Unconsciousness unaware; awareness of the consequences, team, welcome the new, which are connected to the intermediate phase of Revolution of the professional oneself; awareness of the limits, culture, responsibility, context, rigor and control that connects to the final state of Attentive Habit. CONCLUSIONS: The theoretical model develops through a path of growth and revolution that starts from the roots of an Unconsciousness unaware and brings with it the seed of a model.

"I would like to tatoo the illness on my arm". The Integrated Personalized Nursing Diagnosis (IPND).

BACKGROUND AND AIM: The nursing diagnosis can based on two different approaches: the standard diagnosis, searching for regularities that can fall within pre-existing categories identified by the nurse, as the expert of the disease; the narrative diagnosis, based on personal meaning attributed to the illness, of which only the patient is the expert. The aim of this work is to underline the usefulness of integration between standard diagnosis and narrative diagnosis, through the Integrated Personalized Nursing Diagnosis (IPND). METHODS: A 31 years old man, suffering from leukaemia, is welcomed at an Italian Oncological Day Hospital, by a nurse trained in the IPND approach. She used the Gordon functional models on objective data, and collected a narration about patient's experience, which has been analyzed with a Grounded Theory methodology. RESULTS: The narrative revealed critical issues and the priorities that patient assigns, which would not have been obtained from a standard diagnosis. From the standard diagnosis, however, emerge several aspects that the patient has neglected to narrate and that does not directly address in his story. The diagnostic integration allowed the nurse to define a conceptual map of problems and resources in a personalized manner. CONCLUSION: The IPND not only gives importance to the priorities of the patient, but also underlines the dynamic path, in which not only the static analysis of needs becomes significant, but also the changes that occur in attributing new meanings to the life experience, as well as the evolution of the person him/herself in this process.

"Could I return to my life?" Integrated Narrative Nursing Model in Education (INNE).

BACKGROUND AND AIM: The Integrated Narrative Nursing Model (INNM) is an approach that integrates the qualitative methodology typical of the human sciences, with the quantitative methodology more often associated with the natural sciences. This complex model, which combines a focus on narrative with quantitative measures, has recently been effectively applied to the assessment of chronic patients. In this study, the model is applied to the planning phase of education (Integrated Narrative Nursing Education, INNE), and proves to be a valid instrument for the promotion of the current educational paradigm that is centered on the engagement of both the patient and the caregiver in their own path of care. The aim of this study is therefore to describe the nurse's strategy in the planning of an educational intervention by using the INNE model. METHODS: The case of a 70-year-old woman with pulmonary neoplasm is described at her first admission to Hospice. Each step conducted by the reference nurse, who uses INNE to record the nurse-patient narrative and collect subsequent questionnaires in order to create a shared educational plan, is also described. RESULTS: The information collected was submitted, starting from a grounded methodology to the following four levels of analysis: I. Needs Assessment, II. Narrative Diagnosis, III. Quantitative Outcome, IV. Integrated Outcome. Step IV, which is derived from the integration of all levels of analysis, allows a nurse to define, even graphically, the conceptual map of a patient's needs, resources and perspectives, in a completely tailored manner. CONCLUSION: The INNE model offers a valid methodological support for the professional who intends to educate the patient through an inter-subjective and engaged pathway, between the professional, their patient and the socio-relational context. It is a matter of adopting a complex vision that combines processes and methods that require a steady scientific basis and advanced methodological expertise with active listening and empathy - skills which require emotional intelligence.

Integrated narrative assessment exemplification: a leukaemia case history.

BACKGROUND AND AIM: In the Integrated Narrative Nursing Assessment (INNA), the Evidence-Based Nursing Model is integrated with the Narrative-Based Nursing Model. The INNA makes use of quantitative instruments, arising from the natural sciences as well as of qualitative ones, arising from the human achieving results of standardization and reproducibility, as well as of customization and uniqueness. Accordingly, the purpose of this work is to exemplify the thinking process of and the method adopted by a nurse adopting an integrated narrative assessment in the evaluation of a patient. METHOD: The patient suffered from acute myeloid leukaemia, treated with chemotherapy. Her nurse worked in a haematology ward in a North Italy Hospital. The nurse had previous experience in conducting the assessment according to INNA. Based on patient's characteristics, the nurse chose to use the narration (to explore needs from their subjective perception) and the scales (to measure them objectively) among the various assessment instruments provided by the INNA. RESULTS: The resultant integrated outcomes helped the nurse to have a comprehensive overview of the person's health-care needs and their connections. These outcomes derive from the integration of narrative information with those obtained from the scales, which in this paper have shown consistent results. CONCLUSION: It is very difficult to reach this complexity by considering qualitative and quantitative assessment strategies as mutually foreclosing, given that both emerged as being very useful in identifying, understanding and measuring the needs of the assisted person. Then they both could be used to design a customized intervention, encouraging new connections between disease, illness, sickness and everyday life.

Healthcare associated infection: good practices, knowledge and the locus of control in heatlhcare professionals.

BACKGROUND AND AIM: The incidence of Healthcare Associated Infections (HAI) is an important indicator of the quality of care. The behaviors associated with the prevention of infections are not only supported by rational knowledge or motivation, but are mediated by social, emotional and often stereotyped behaviors. The awarness of the good practices related to HAI, may be a factor. Other studies, identify how the perception of the problem in healthcare professionals is often influenced by a tendency towards an external Locus of Control: the patient, the family, the other wards, other care settings. The aim of this study is to investigate the perception of healthcare professionals. In particular they have been measured their  awarness of the good practices, perceptions of the potential contamination level of some commonly used objects, knowledge about the management of invasive devices, Locus of Control. METHOD: A cross-sectional correlational design was utilized.  An ad hoc questionnaire was interviewed by 222 health professionals nurses and physicians in a northern hospital of Italy. RESULTS: The percentage of professionals who have attended training courses over the last 5 years was quite high, both for upgrades on HAI (78.7%) and Vascular Catheters (78.8%), while the percentage of professionals who updated on bladder catheterization (59.46%) was lower. The mean  score of good practice awareness towards HAI (5.06), is high. The perception of the potential level of contamination of some devices had a  mean ranging from 4.62 (for the drip) to 5.26 (for the door handle). The average value of the Locus of Control (43.54) indicates that participants demonstrated a value that is midway between External and Internal. The correlation test analysis revealed no significant relationships among professionals'age, knowledge about HAI, or infection related venus catheter. Also, results revealed that there were statistically significant positive relationships between professionals' Good Practices awareness about HAI , Knowledge, and Locus of Control. CONCLUSION: The study findings demonstrated that good practice awareness towards HAI among nurse and physician was good but not completely optimal. Findings revealed that knowledge toward HAI prevention and HAI related device prevention were not completely adequate. The educational courses, according to our correlational findings, should definitely take into account the psycho-social aspects of this phenomenon.

Advanced skills and research.

The health organisation has recently been placing emphasis on the importance of the fundamental rights of the individual, promoting an idea of health seen not only from the biological point of view but also and above all in its psychological, relational and social aspects. [...].

Integrated narrative nursing: a new perspective for an advanced assessment.

The assessment is the first of the fundamental nursing processes: it includes data collection, problem identification, and setting of priorities, which all facilitates the process of making a nursing diagnosis. The assessment helps to identify a goal, which, through a decision-making process, orientates the planning as well as the nursing intervention, which will be evaluated at a later stage. It seems that the proposed multidimensional and integrated assessment has a good potential to significantly influence the nursing care. This model is multidimensional since it covers biophysical, psychological, socio-relational, but also the spiritual dimensions of each person, and is integrated since it's reinforced by the inter-professional dialogue between nurses, physicians, sociologists, psychologists, and other health professionals. To come up with a diagnosis, nurses integrate the "cases" (the set of data/information collected through a "traditional" assessment), with the "stories" (which are directly narrated from the people themselves). Thus the proposed model combines quantitative instruments, typical of natural sciences (questionnaires, scales, tests and surveys), with qualitative ones, deriving from human sciences (interviews, the patient's agenda and narratives). The complementary use of objective and subjective methods leads to valid, consistent and standardized results, and, at the same time, makes it possible to investigate unique and subjective perceptions. Several strategies are outlined in this paper, with methods, phases and instruments related to the advanced assessment model, in order to better determine the most suitable based on the person's individual needs.

Pet therapy: an effective strategy to care for the elderly? An experimental study in a nursing home.

BACKGROUND AND AIM: There has recently been a growing interest towards patients' affective and emotional needs, especially in relational therapies, which are considered vital as to increase the understanding of those needs and patients' well-being. In particular, we paid attention to those patients who are forced to spend the last phase of their existence in residential facilities, namely elderly people in nursing homes, who often feel marginalized, useless, depressed, unstimulated or unable to communicate. The aim of this study is to verify the effectiveness of pet therapy in improving well-being in the elderly living in a nursing home. METHODS: This is a longitudinal study with before and after intervention variables measurement in two groups of patients of a nursing home for elderly people. One group followed an AAI intervention (experimental group) the other one did not (control group). As to perform an assessment of well-being we measured the following dimensions in patients: anxiety (HAM-A), depression (GDS), apathy (AES), loneliness (UCLA), and quality of life (QUALID). Both groups filled the questionnaires as to measure the target variables (time 0). Once finished the scheduled meetings (time 1), all the participants, including the control group, filled the same questionnaires. RESULTS: In accordance with scientific evidence the results confirmed a significant reduction of the measured variables. Especially for the quality of life, which showed a greater reduction than the other. CONCLUSIONS: The implementation and success of the Pet Therapy could have a great emotional and social impact, bringing relief to patients and their family members, but also to health professionals.

An integrated narrative nursing model: towards a new healthcare paradigm.

In the traditional biomedical model of clinical practice, which assumes a medicine focused on disease, diseases are considered as biological or psycho-physiological universal entities. This explanation, although necessary, is not enough. Several authors have recently become interested in the use of narrative practices in the medical care setting, underlining the increasing importance of "a patient-centered approach", a "relationship -centered care" and "narrative medicine". Even in Nursing, the challenge was to combine two models that seemed incompatible: the Evidence-Based Nursing Model and the Narrative-Based Nursing Model. The first one is based on the disease and is capable of reaching measurable objectives. It is marked by rationality, objectivity, determinism, unilateralism and linearity, and its methods emphasize logic, control, measurement and deduction. The second model is based on a global approach, resulting in a psycho-social perspective which stresses the importance of individuality, interpersonal relationship, and the illness and sickness as significant parts of healthcare. Through a short examination of different narrative models in medicine, we underlined some principles which can be used in nursing practice and we suggested a new healthcare paradigm based on integrated narrative nursing. It represents a groundbreaking new normative approach, deriving from different epistemological (positivist paradigm and interpretive paradigm) and methodological approaches that integrate quantitative data already normally detected on the patient, with subjective information obtained from the person and his family, and by the social impact that the disease causes. The integrated narrative nursing makes use of quantitative (e.g. scales and scientific evidence) and qualitative tools (e.g. narratives, autobiographies, therapeutic emplotment and patient's agenda). This approach, based on holistic comprehension, hermeneutic dialogue and a high degree of narrative skill, produces different ways of understanding and offering cure, care and assistance. This could allow a targeted assessment, a precise diagnosis and a personalized education. The benefits coming from the use of this paradigm are several, as for example, to disseminate a personal experience in a perspective of humanization, to improves quality of life and to create a positive effects on patient care outcomes.

The role of professional and team commitments in nurse-physician collaboration.

AIM: To analyse the effect of both professional and care unit commitments on attitudes towards interprofessional collaboration between nurses and physicians. BACKGROUND: The effects of both professional and care unit commitment on inter-professional collaboration have not been taken into account together, and previous research has analysed only one profession at a time, neglecting the nurse-physician comparison. METHOD: A cross-sectional survey of 138 physicians and 359 nurses was used. RESULTS: For physicians, professional commitment decreased attitudes towards interprofessional collaboration whereas care unit commitment had a positive influence. Conversely, for nurses, the professional commitment had a significant positive effect on attitudes towards interprofessional collaboration whereas care unit commitment had no significant effect. CONCLUSION: Intergroup relations affect the extent to which nurses and physicians are inclined to engage in interprofessional collaboration. Professional and care unit commitments had different effects on attitude toward the inter-professional collaboration of nurses and physicians. IMPLICATION FOR NURSING MANAGEMENT: Inter-professional collaboration is affected by the relationship between physicians and nurse at the professional group level. Managers who want to change and improve inter-professional collaboration should pay close attention to the interplay between changes they are introducing and well-established identities and practices between professionals.