[The Educational Aspect in Promoting a Low-Sodium Diet, Physical Activity and Therapy Adherence among Patients with Autosomal Dominant Polycystic Disease: A Literature Review].

Background. Polycystic kidney disease (ADPKD) is the most common monogenic cause of End Stage Renal Disease (ESRD), and, thus, of kidney transplantation and dialysis. Educational interventions aimed to improve adherence to therapy, physical performance, and adequate food intake in patients can slow down disease progression by developing self-care skills, which are useful to promote their autonomy while aligning their life plans and required treatments. The aim of this review is to analyze the adherence of patients with polycystic kidney to pharmacological therapy, low-sodium diet, and physical activity, as evidenced in the clinical literature to guide structured educational interventions. Methods. We conducted a literature review from 01/09/2021 to 30/12/2022 through the combination of free keywords and MeSH terms on the databases: PubMed, CINAHL and Cochrane. Results. Findings in medical literature show that physical activity can improve blood pressure control and a low-sodium diet can slow down the progression towards ESRD. Furthermore, although patients may adhere to the complex drug therapy, unresolved educational demands concern choices and behaviors of daily life that, involving the sphere of feelings and emotions, can evolve into manifestations of anxiety and stress. Conclusion. Among ADPKD patients a personalized educational support, considering disease stage and psychological factors, may enable them to acquire knowledge, skills, and behaviors that can improve clinical outcomes.

Experiences of healthcare providers from a working week during the first wave of the COVID-19 outbreak.

BACKGROUND AND AIM OF THE WORK: The delivery of care to patients with COVID-19 enhanced many psychological issues among healthcare workers (HCWs), exacerbating the risk of burnout and compromising the efficacy and quality of services provided to patients. In this context, the peculiarities regarding professional roles in delivering care to patients with COVID-19 might reflect daily lived experiences that could impact psychological outcomes in specific professional groups. However, daily lived experiences considering different groups of HCWs have been poorly investigated, especially with a longitudinal qualitative study. Accordingly, our study aims firstly to longitudinally explore perceptions and experiences of HCWs about their daily working life during the initial COVID-19 outbreak, highlighting the specific lived experiences of physicians, nurses, radiology technicians, and healthcare assistants. METHODS: A longitudinal qualitative content analysis was conducted to analyse the comments and quotations made on a daily diary lasting seven days by physicians, nurses, radiology technicians, and healthcare assistants during the first wave of the COVID-19 outbreak. According to Elo and Kyngäs recommendation, the data analysis process was developed in three main phases: preparation, organising, and reporting. RESULTS: Four main generic categories emerged by data analysis: 'Clinical practice in COVID-19 patients'; 'The importance of relationship'; 'Navigating by sight'; and 'Good always pays off'. Several differences emerged from the sentences of the HCWs, which require further investigation. CONCLUSIONS: Understanding the profession-specific experiences of the involved HCWs in facing the challenges of the COVID-19 pandemic is key for boosting reflections, research, and actions to adequately support each professional group.

Nurses' moral distress in end-of-life care: A qualitative study.

BACKGROUND: Moral distress is a neglected issue in most palliative education programmes, and research has largely focused on this phenomenon as an occupational problem for nursing staff. RESEARCH QUESTION: The primary outcome of this study was to explore the causes of morally distressing events, feelings experienced by nurses and coping strategies utilised by a nursing population at an Italian teaching hospital. A secondary outcome of this qualitative study was to analyse whether palliative care or end-of-life care education may reduce morally distressing events. RESEARCH DESIGN: A hermeneutic-phenomenological qualitative study was performed. PARTICIPANTS AND RESEARCH CONTEXT: Participants were recruited through snowball sampling. The interviews were conducted and recorded by one interviewer and transcribed verbatim. ETHICAL CONSIDERATIONS: Ethical approval was obtained from the Institutional Review Hospital Board. FINDINGS: Six main themes emerged from the interview analyses: (1) the causes of moral distress; (2) feelings and emotions experienced during morally distressing events; (3) factors that affect the experience of moral distress; (4) strategies for coping with moral distress; (5) recovering from morally distressing events; and (6) end-of-life accompaniment. Varying opinions regarding the usefulness of palliative care education existed. Some nurses stated that participation in end-of-life courses did not help them cope with morally distressing events in the ward, and they believe that existing courses should be strengthened and better structured. DISCUSSION: In this study, moral distress was often associated with poor communication or a lack of communication between healthcare professionals and the patients and/or their relatives and with the inability to satisfy the patients' last requests. According to our findings, the concept of 'good' end-of-life accompaniment was extremely important to our sample for the prevention of morally distressing events. CONCLUSION: Nurses who work in the onco-haematological setting frequently experience moral distress. Determining the causes of moral distress at early stages is of paramount importance for finding a solution.

In search of salience: phenomenological analysis of moral distress.

The nurse's moral competences in the management of situations which present ethical implications are less investigated in literature than other ethical problems related to clinical nursing. Phenomenology affirms that emotional warmth is the first fundamental attitude as well as the premise of any ethical reasoning. Nevertheless, it is not clear how and when this could be confirmed in situations where the effect of emotions on the nurse's decisional process is undiscovered. To explore the processes through which situations of moral distress are determined for the nurses involved in nursing situations, a phenomenological-hermeneutic analysis of a nurse's report of an experience lived by her as a moral distress situation has been conducted. Nursing emerges as a relational doctrine that requires the nurse to have different degrees of personal involvement, the integration between logical-formal thinking and narrative thinking, the perception of the salience of the given situation also through the interpretation and management of one's own emotions, and the capacity to undergo a process of co-construction of shared meanings that the others might consider adequate for the resolution of her problem. Moral action requires the nurse to think constantly about the important things that are happening in a nursing situation. Commitment towards practical situations is directed to training in order to promote the nurse's reflective ability towards finding salience in nursing situations, but it is also directed to the management of nursing assistance and human resources for the initial impact that this reflexive ability has on patients' and their families' lives and on their need to be heard and assisted. The only case analysed does not allow generalizations. Further research is needed to investigate how feelings generated by emotional acceptance influence ethical decision making and moral distress in nursing situations.

[The implementation of nurse case manager's in wards for acute and post-acute patients: the perception of health care workers and patients and the impact an clinical outcomes]. / Studio per documentare l'esperienza dell'inserimento degli infermieri case manager in reparti per acuti e post acuti: il punto di vista degli operatori, dei pazienti ed i risultati clinico-organizzativi.

UNLABELLED: Nurses case managers were implemented since 2000 in several wards of S. Orsola hospital in Bologna. AIM: The aim of this study is to assess the association of ICM to clinical outcomes and patients and nurses satisfaction. MATERIALS AND METHODS: The mean hospital length of stay, the number of planned discharges and of falls were assessed the year before and after the implementation of case managers in 14 wards. Nurses satisfaction was assessed exploring in 13 wards the nurses, doctors and nurses aids' perception of positive changes and benefits after the implementation of case-managers and patients satisfaction (8 wards) with the Newcastle satisfaction with nursing scale. RESULTS: No differences were observed in mean length of stay, only a small increase of planned discharges (+8.2%) and a decrease (-24%) of patients falls. The questionnaire on perception of positive changes showed an higher satisfaction of nurse managers but an overall appreciation (agreement > 2.8 on a 4 points likert scale) for improvement on organization and patients management. The unaffected elements were perception of workload and stress. The patients' satisfaction with nursing care supported the nurses perception. CONCLUSION: The choice of indicators to document organizative changes is not simple. Positive effects were observed only on health care workers perception and on the decreased number of falls. Future studies are needed to confirm the positive trends observed.