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ROSARIA DI LORENZO
Docente in convenzione
Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze sede Arcispedale Santa Maria Nuova
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Pubblicazioni
2023
- Clinical Judgment Skills Assessment in High Fidelity Simulation: A Comparison Study in Nursing Education
[Capitolo/Saggio]
Bertozzi, Sarah; Ferri, Paola; Cortini, Carla; Mentasti, Riccardo; Scalorbi, Sandra; DI LORENZO, Rosaria; Rovesti, Sergio; Alberti, Sara; Rubbi, Ivan
abstract
Background: In nursing education, self-assessment associated with effective feedback promotes reflective learning, which is crucial for the acquisition of complex skills such as clinical judgment. The Lasater Clinical Judgment Rubric (LCJR) is one of the most frequently used scales for the evaluation of self-assessment among nursing students and it can be used by students and instructors for providing shared clinical judgment feedback. However, too few studies have evaluated its applicability. Objective of the study was to compare the LCJR scores assigned by the instructors with those self-reported by the nursing students to evaluate the students’ self-assessment skills. Methods: A comparative study was conducted in a probabilistic sample of 80 students enrolled in the 3rd year of the Nursing Programme in an Italian University. At the end of the high-fidelity simulation, the students and two instructors completed the LCJR scale. Results: The mean scores reported by instructors and students in the 4 subscales of LCJR were similar. In the 3 subscales, “Interpreting”, “Responding” and “Reflecting”, no significant differences were observed; only in the cognitive domain “Noticing” was a difference at the limit of statistical significance (p = 0.049) observed, with a slightly higher scores reported by instructors. Finally, the mean score of Overall Clinical Judgment of the LCJR scale reported by the instructors was slightly higher than that of the students (p = 0.044). Conclusions: Our results suggest that LCJR provides a common language between students and teachers and increases the training effectiveness of high-fidelity simulation through self-directed and reflective learning.
2023
- Evaluation of an interprofessional education intervention in partnership with patient educators
[Articolo su rivista]
Ferri, Paola; Vivarelli, Chiara; Lui, Fausta; Alberti, Sara; Rovesti, Sergio; Serafini, Alice; DI LORENZO, Rosaria; Amati, Gabriele; Padula, MARIA STELLA
abstract
Background and aim of the work: Patient involvement in interprofessional education is a novel approach to building collaborative and empathic skills in students. However, this area of teaching is lacking in
rigorous studies. The project aimed to evaluate whether an interprofessional education intervention in partnership with patient educators (IPE-PE) would increase readiness for interprofessional learning and empathy
in health sciences students. Methods: This is the report of a didactic innovation project. Participants included
310 undergraduate health sciences students who took part in an IPE-PE intervention. Data were collected
before and after the training, using the Readiness for Interprofessional Learning Scale (RIPLS) and the
Jefferson Scale of Empathy-Health Professions Student version ( JSE-HPS). Only at the end of the intervention, a data collection form was administered to explore the value of the patient educator in the training and
to investigate the socio-demographic variables. Results: The mean age of participants was 21±3.2 SD years and
76% were female. The Wilcoxon signed-rank test showed significant changes from before to after the IPE-PE
in the RIPLS total score (m=42.7±5.8 SD vs 44.62±5.9 SD, z=-4.168, P<0.001) and in the JSE-HPS total
score (m=112.7±12.5 SD vs 116.03±12.8 SD, z=-4.052, P<0.001). Conclusions: Our students reported that
IPE-PE had helped them to become more effective healthcare team members, to think positively about other
professionals, and to gain an empathic understanding of the perspective of the person being cared for. The
results of the project confirm that the intervention promoted the development of empathy, fostering a better
understanding of the patient-centred perspective.
2023
- Fluoride Exposure and ADHD: A Systematic Review of Epidemiological Studies
[Articolo su rivista]
Fiore, Gianluca; Veneri, Federica; Di Lorenzo, Rosaria; Generali, Luigi; Vinceti, Marco; Filippini, Tommaso
abstract
Background and objectives: Attention deficit hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental disorder characterized by two dimensions: inattentiveness and hyperactivity/impulsivity. ADHD may be the result of complex interactions between genetic, biological and environmental factors possibly including fluoride exposure. Materials and methods: A literature search was performed on 31 March 2023 in the following databases: PubMed, Embase and Web of Science. We defined the following inclusion criteria according to the PECOS statement: a healthy child and adolescent population (P), fluoride exposure of any type (E), comparison with low or null exposure (C), ADHD spectrum disorder (O), and ecological, cross-sectional, case-control and cohort studies (S). Results: We found eight eligible records corresponding to seven different studies investigating the effect of fluoride exposure on children and adolescents. One study had a cohort design and one a case-control one, while five were cross-sectional. Only three studies applied validated questionnaires for the purpose of ADHD diagnosis. As regards exposure assessment, levels of fluoride in urine and tap water were, respectively used in three and two studies, while two used both. Three studies reported a positive association with ADHD risk, all assessing exposure through fluoride levels. By using urinary fluoride, conversely, a positive correlation with inattention, internalizing symptoms, cognitive and psychosomatic problems was found in three studies, but no relation was found in the other one. Conclusions: The present review suggests that early exposure to fluoride may have neurotoxic effects on neurodevelopment affecting behavioral, cognitive and psychosomatic symptoms related to ADHD diagnosis. However, due to the heterogeneity of the studies included, current evidence does not allow to conclusively confirm that fluoride exposure is specifically linked to ADHD development.
2023
- Group therapy with peer support provider participation in an acute psychiatric ward: 1-year analysis
[Articolo su rivista]
DI LORENZO, Rosaria; Dʼamore, Jessica; Amoretti, Sara; Bonisoli, Jessica; Gualtieri, Federica; Ragazzini, Ilaria; Rovesti, Sergio; Ferri, Paola
abstract
Background: Group psychotherapy improves therapeutic process, fosters identification
with others, and increases illness awareness; (2) Methods: In 40 weekly group sessions held in an
acute psychiatric ward during one year, we retrospectively evaluated the inpatients’ participation
and the demographic and clinical variables of the individuals hospitalized in the ward, the group
type according to Bion’s assumptions, the main narrative themes expressed, and the mentalization
processes by using the Mentalization-Based Therapy-Group Adherence and Quality Scale (MBT-GAQS); (3) Results: The “working” group was the prevailing one, and the most represented narrative
theme was “treatment programs”; statistically significant correlations were found between the group
types according to Bion’s assumptions and the main narrative themes (Fisher’s exact, p = 0.007); at
our multivariate linear regression, the MBT-G-AQS overall occurrence score (dependent variable) was
positively correlated with the number of group participants (coef. = 14.87; p = 0.011) and negatively
with the number of participants speaking in groups (coef. = −16.87, p = 0.025); (4) Conclusion: our
study suggests that the group shows consistent defense mechanisms, relationships, mentalization,
and narrative themes, which can also maintain a therapeutic function in an acute ward.
2023
- Involuntary Hospitalizations in an Italian Acute Psychiatric Ward: A 6-Year Retrospective Analysis
[Articolo su rivista]
Di Lorenzo, Rosaria; Reami, Matteo; Dragone, Diego; Morgante, Martina; Panini, Giulia; Rovesti, Sergio; Filippini, Tommaso; Ferrari, Silvia; Ferri, Paola
abstract
Purpose: We evaluated the differences between demographic (age, sex, nationality, employment, housing, schooling, support administrator), clinical (hospitalization reason, aggressive behaviour, length of hospitalization, psychiatric diagnosis and comorbidities, psychiatric medications, discharge destination, “revolving door” hospitalizations) and environmental (pre-and pandemic period) variables in voluntary (VHs) and involuntary hospitalizations (IHs) in an acute psychiatric ward during a 6-year period.
Patients and Methods: We retrospectively collected the selected variables concerning the hospitalizations of subjects over 18 years of age in the Service for Psychiatric Diagnosis and Care of Mental Health and Drug Abuse Department in Modena from 01/01/2017 to 31/12/2022.
Results: We observed a progressive and sharp reduction in the number of VHs (n = 1800; 61.41%) during the pandemic and a stability of IHs (n = 1131; 38.59%), which in 2022 became prevalent. We highlighted the following differences between VHs and IHs: an increase in hospitalization length in IHs (14.25 mean days ± 15.89 SD) in comparison with VHs (8.78 mean days ± 13.88 SD), which increased more during the pandemic; an increase in aggressive behavior in IHs, especially during the pandemic (Pearson Chi2 = 90.80; p = 0.000); a prevalence of schizophrenia and bipolar disorders (Pearson Chi2 = 283.63; p = 0.000) and more frequent maladaptive social conditions among subjects in IHs.
Conclusion: During the 6-year observation period, we underscored a trend of increasingly reduced recourse to VHs, whereas IHs increased even in the pandemic. Our results suggest that IHs in Psychiatry represented an extreme measure for treating the most severe psychopathological situations such as schizophrenia and bipolar disorders, characterized by aggressive behaviour and precarious social conditions, which needed longer stay than VHs, especially during the pandemic.
2023
- Nursing students’ evaluation of clinical learning environment and supervision models before and during the COVID-19 pandemic: a comparative study
[Articolo su rivista]
Ferri, Paola; Stifani, Serena; Morotti, Elena; Alberti, Sara; Vannini, Valeria; DI LORENZO, Rosaria; Rovesti, Sergio; Palese, Alvisa
abstract
Background and aim: The COVID-19 pandemic has required a rapid reorganization of clinical
training and supervision models for nursing education. The aim of this study was to compare students’ levels
of perception of the quality of the Clinical Learning Environment (CLE) using two different clinical su pervision models. Methods: A comparative design was implemented. A convenience sample of second and
third-year undergraduate nursing students (n=127) in clinical training in the 2018/2019 Academic Year (AY)
received the usual nursing staff supervision model, while during the COVID-19 pandemic in the following
year, they (n=72) received an individualized supervision model. Data were collected using three instruments:
the Clinical Learning Environmental Quality Evaluation Index (CLEQI); the Clinical Learning Environ ment, Supervision and Nurse Teacher Scale (CLES+T); and a socio-demographic tool. Results: The mean
total scores of both scales had increased in the second survey (CLEQI: M=57.88±11.8 vs. M=60.88±9.3,
p=0.035; CLES+T: M=148.4±23.3 vs. M=154.5±21.9, p=0.037). The nursing students reported high levels
of CLE quality with both supervision models, even though the individualized supervision model was rated
significantly higher by the students than the staff supervision model. Conclusions: Students supported by a
personal supervisor during clinical training had a more positive experience and rated the quality of the tutorial
strategies, learning opportunities, safety and nursing care, leadership style of the ward manager and overall
CLE more highly
2022
- Effectiveness and Quality of Life with Paliperidone Palmitate 3-Monthly in Comparison with Other Long-Acting Drugs
[Articolo su rivista]
DI LORENZO, Rosaria; Iorio, Anita; Pinelli, Margherita; Magarini, Federica; Marchi, Mattia; Sacchetti, Andrea; Calogero, Chiara; Galeazzi, Gian Maria; Ferri, Paola; Rovesti, Sergio; Minarini, Alessandro
abstract
Purpose: Antipsychotic long-acting injections (AP-LAIs) are indicated for patients affected by schizophrenia especially those with
poor treatment adherence.
Patients and Methods: To compare paliperidone palmitate 3-monthly (PP3M), paliperidone palmitate one-monthly (PP1M) and
haloperidol decanoate (HAL-D) treatment, we enrolled 90 patients with schizophrenia treated in Mental Health Center with one of the
three AP-LAIs for at least six months and followed them for another 6 months. At 6 and 12 months of treatment we administered
Clinical Global Impression-Severity, Global Assessment of Functioning and World Health Organization Quality of Life-26 items
(WHOQOL-BREF). At 1-year treatment, we evaluated relapses (psychiatric hospitalizations and urgent consultations), side effects and
drop-outs.
Results: We did not highlight any statistically significant difference among the three treatments in relapses and scale scores. Weight
increase was significantly higher in PP1M and PP3M groups. Twelve patients (13.3%) discontinued AP-LAI. At 1-year AP-LAI
treatment, 69% of patients rated quality of life as “good” or “very good” and 71% declared themselves to be “satisfied” or “very
satisfied”.
Conclusion: HAL-D, PP1M and PP3M 1-year treatments were similarly effective in preventing relapses and improving quality of life and
health satisfaction. All discontinuations in the new 3-monthly antipsychotic treatment were caused by patient refusal to continue it.
2022
- Effects of lockdown on emergency room admissions for psychiatric evaluation: an observational study from 4 centres in Italy
[Articolo su rivista]
Beghi, M.; Ferrari, S.; Brandolini, R.; Casolaro, I.; Balestrieri, M.; Colli, C.; Fraticelli, C.; Di Lorenzo, R.; De Paoli, G.; Nicotra, A.; Pischiutta, L.; Tedeschini, E.; Castelpietra, G.
abstract
Objectives: An observation of the Emergency Room (ER) admissions during the lockdown. Methods: We monitored admissions to the ER requiring psychiatric evaluation during the 2020 lockdown (March 9th-May 3rd, 2020) compared to the same period of 2019, in four sites of Northern Italy (ASST Lariana, AUSL Modena, ASU Friuli Centrale and AUSL Romagna). Number of admissions, baseline demographic and clinical variables were extracted from the clinical databases. Results: A 20.0% reduction of psychiatric referrals was observed across the sites (24.2% in ASST Lariana, 30.5% in AUSL Modena, 12.0% in ASU Friuli Centrale and 14.5% in AUSL Romagna). This reduction peaked at 41.5% in the first month of the lockdown. Being homeless as well as with a dual diagnosis (OR 1,67, CI: 1.02–2.74), while living in a residential facility and admission for a depressive episode Being homeless (OR 2.50, CI: 1.36–4.61) and having a dual diagnosis (OR 1,67, CI: 1.02–2.74) were significantly associated with an increase in ER admission, while living in a residential facility (OR 0.48, CI: 0.31–0.74), having a depressive episode (OR 0.36, CI: 0.18–0.73) and a diagnosis of anxiety disorder (OR 0.60, CI: 0.36–0.99) were significantly associated with a decrease. Conclusions: During lockdown, a decrease in psychiatric referrals was observed.
2022
- Pain Management in a Prehospital Emergency Setting: A Retrospective Observational Study
[Articolo su rivista]
Ferri, Paola; Gambaretto, Carlo; Alberti, Sara; Parogni, Pierpaolo; Rovesti, Sergio; DI LORENZO, Rosaria; Sollami, Alfonso; Bargellini, Annalisa
abstract
Purpose: Acute pain is a prevalent symptomatology in prehospital emergency care. Although inadequate assessment and treatment of
acute pain are associated with various complications, about 43% of adults suffering from pain are undertreated. This phenomenon is
poorly studied, and limited data are available in the literature. The objective was to investigate the pain management in a prehospital
emergency health-care setting, verifying pain assessment, pharmacological treatment adherence and the effectiveness of pain relief
therapy.
Patients and Methods: A retrospective observational study was conducted in a sample including all adults treated by the
professionals of nurse-staffed ambulances and medical cars in an Italian Emergency Medical Services (EMS) from 1 January 2019
to 31 May 2019. We collected both demographic information and Numeric Rating Scale scores, which evaluated presence and
intensity of pain, from the EMS paper forms. All analyses were performed using SPSS, version 27.
Results: The study sample was composed of 629 people: 310 males (49%) and 319 females (51%), with an average age of 64.2±22
years (range 18–108). Pain information was collected in 75.5% (n = 475) of our sample; among them 222 patients (46.7%) suffered
from pain. We recorded that 79.7% (n = 177) of the subjects with pain received no pharmacological treatment, and in almost all of the
treated cases they did not adhere to the analgesia algorithm in use. Among those who were pharmacologically treated, pain statistically
significantly decreased in intensity, from before to after, in both emergency vehicles (nurse-staffed ambulances pre m = 8.36±0.9 vs
post m = 4.18±2.2, p<0.001; medical cars pre m = 7.25±1.7 vs post m = 3.50±2.6, p<0.001). Subsequently, pain was only reascertained in 24.3% of subjects.
Conclusion: Our findings confirm that pain is a prevalent symptom in prehospital patients, especially in the younger age range, but
that it remains an underrecognized, underestimated, and undertreated symptom with the risk of causing worse health outcomes.
2022
- The Collaboration Among Pediatric Residents, Nursing and Midwifery Students for Newborn Health: A Quasi-experimental Study on Interprofessional High-Fidelity Patient Simulation
[Relazione in Atti di Convegno]
Ferri, Paola; Rovesti, Sergio; Vivarelli, Chiara; Volpi, Paola; Cavani, Daniela; Masoni, Barbara; Morotti, Elena; DI LORENZO, Rosaria
abstract
Background: Pediatricians, midwives and nurses are the health professionals who provide treatment and care to newborns in life-threatening clinical conditions. Their professional training also consists of the development of communicative and collaborative capacities. Interprofessional simulation is effective training for improving students’ collaborative attitudes, although many questions remain about its feasibility and acceptability. Study design and participants: with the aim of investigating if interprofessional high-fidelity patient simulation (IHFPS) increases interprofessional collaboration, we implemented a pre and posttest design study in a Northern Italian University. The sample was composed of 126 nursing students and 20 midwifery students attending the last year of Nursing and Midwifery programs respectively and 20 residents attending the last two years of the Pediatric Residency Program. Methods: participants, who were grouped into small interprofessional teams, participated in an experimental intervention based on an IHFPS. To measure interprofessional collaboration attitude, the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration was administered to all participants in pre- and post-test of IHFPS. Results and conclusions: at the pre-test, nursing and midwifery students presented greater attitude of interprofessional collaboration than pediatric residents. At the post-test, only nursing students presented a statistically significant increase in their attitude of interprofessional collaboration, although midwifery students and pediatric residents also presented an improvement in interprofessional collaborative attitude. The results indicated that all three professional groups presented a more positive attitude toward collaboration following the interprofessional simulation event compared to the pre-training, suggesting that IHFPS is beneficial for increasing collaborative attitudes in different professional groups.
2022
- The Follow-Up of Eating Disorders from Adolescence to Early Adulthood: A Systematic Review
[Articolo su rivista]
Filipponi, Caterina; Visentini, Chiara; Filippini, Tommaso; Cutino, Anna; Ferri, Paola; Rovesti, Sergio; Latella, Emanuela; Di Lorenzo, Rosaria
abstract
Eating disorders (EDs) are common among children and adolescents and are characterized by excessive concerns for physical appearance, distorted body image, and fear of gaining weight. The purpose of this review is to evaluate the follow-up of EDs from adolescence to adulthood, analyzing persistence, relapses, and associated comorbidities. We searched scientific articles in PubMed, PsycInfo, Scopus, and Embase through two research strings, one for quantitative outcomes (recovery/persistence, relapse, and remission) and one for the other outcomes (psychiatric and medical comorbidities, substance use, and social-relational complications). From a total of 8043 retrieved articles, we selected 503 papers after exclusion of duplicates and title/abstract screening. After a full-text evaluation, we included 16 studies eligible for this review. We performed a meta-analysis describing the quantitative results, and we created a narrative synthesis for the qualitative outcomes. Results: Our results confirm that EDs can persist in early adulthood in 40.7% of cases with a relapse percentage of 24.5%. Individuals with an ED more frequently present with an empathy deficit and comorbid anxiety and depressive disorders. EDs are chronic and complex disorders, more frequent in females. In most cases, EDs reduce the autonomy of individuals who present many difficulties in affirming their independence from parental family.
2022
- The Impact of COVID-19 Pandemic on Psychiatric Emergencies in Two Different Settings: Emergency Room and Community Mental Health Service
[Articolo su rivista]
Di Lorenzo, Rosaria; Pinelli, Margherita; Bertani, Davide; Cutino, Anna; Dragone, Diego; Elia, Claudia; Farina, Riccardo; Fiore, Gianluca; Luisi, Filippa; Panico, Sofia; Valeo, Laura; Rovesti, Sergio; Ferri, Paola
abstract
Background: The SARS-CoV-2 pandemic caused a public health emergency with profound consequences on the physical and mental health of individuals. Emergency Rooms (ER) and Community Mental Health Services (CMHS) played a key role in the management of psychiatric emergencies during the pandemic. The purpose of the study was to evaluate urgent psychiatric consultations (UPCs) in the ERs of the General Hospitals and in the CMHS of a Northern Italian town during the pandemic period.
Methods: This monocentric observational study collected UPCs carried out in ER from 01/03/2020 to 28/02/2021 (the so-called “COVID-19 period”) and the demographic and clinical characteristics of patients who required UPCs in the 12-months period, comparing these data with those collected from 01/03/2019 to 29/02/2020 (the so-called “pre-COVID-19 period”). The same variables were collected for UPCs carried out in CMHS from 01/03/2020 to 31/01/2021 and compared with those collected from 01/03/2019 to 31/01/2020. The data were statistically analyzed through STATA 12-2011.
Results: In ER, we reported a 24% reduction in UPCs during the COVID-19 period (n = 909) in comparison with the pre-COVID-19 period (n = 1,194). Differently, we observed an increase of 4% in UPCs carried out in CMHS during the COVID-19 period (n = 1,214) in comparison with the previous period (n = 1,162). We observed an increase of UPCs in ER required by people who lived in psychiatric facilities or with disability pension whereas more UPCs in CMHS were required by older people or those living in other institutions compared to the previous period. In the COVID-19 period, the most frequent reasons for UPCs in ER were aggressiveness, socio-environmental maladjustment and psychiatric symptoms in organic disorders whereas in CMHS we reported an increase of UPCs for control of psychopharmacology therapy and mixed state/mania.
Conclusion: In light of our findings, we conclude that the most vulnerable people required more frequent attention and care in both ER and CMHS during pandemic, which disrupted individuals’ ability to adapt and induced many stressful reactive symptoms. In order to reduce the impact of the COVID-19 pandemic on mental health, psychological support interventions for the general population should be implemented, having particular regard for more psychologically fragile people.
2021
- Children and adolescents with ADHD followed up to adulthood: A systematic review of long-term outcomes
[Articolo su rivista]
Di Lorenzo, R.; Balducci, J.; Poppi, C.; Arcolin, E.; Cutino, A.; Ferri, P.; D'Amico, R.; Filippini, T.
abstract
Objective: To highlight the clinical and social outcomes among adults who suffered from ADHD in their childhood/adolescence. Method: PubMed, PsycINFO, Scopus databases were searched for prospective studies published during the last 5 years addressing patients with ADHD in childhood/adolescence followed up to adulthood. We also included studies published before 2015 reported in other reviews with similar outcomes. Results: 1485 studies were identified but only 39 were included for qualitative and 27 for quantitative analysis. Overall, we found that ADHD persisted into adulthood with a mean rate of 43% and was mainly associated with both substance/alcohol use disorders and antisocial behavior and, less frequently, with anxiety and depressive disorders. The prevalence of persistent ADHD in adulthood reported by studies published after 2011 (55%) was higher than that reported by studies published previously from 1985 to 2011 (34%), suggesting a greater focus on ADHD. Conclusion: Our results highlight that ADHD can be considered not only a neurodevelopmental disorder but a persistent and complex condition, with detrimental consequences for quality of life in adulthood.
2021
- Emotional impact of clinical practice in Burns Unit among nursing students: a qualitative study
[Articolo su rivista]
Caminati, Gloria; Cappelli, Lucia; Ferri, Paola; Artioli, Giovanna; Spadola, Milena; Vecchiatini, Moira; Melotto, Martina; DI LORENZO, Rosaria; Rubbi, Ivan
abstract
Background and aim of the work. In Burns Units, the long professional relationship with patients suffering from intense physical pain and psychological distress, which cannot be completely resolved or minimized, exposes nurses to very intense emotions and stressful experiences. Learning to care for patients with such medical conditions can arouse many emotions also in nursing students, that can be both positive and negative.The goal of this study was to describe the emotional impact experienced by nursing students in a Italian Burns Unit.
Methods. A qualitative research was implemented among 16 undergraduate nursing students, before and after clinical practice in a Burns Unit, through a semi-structured interview. Results. Strong and conflicting emotions from nursing students were reported in the preliminary stage of the internship. Their enthusiasm and curiosity for a new opportunity countered their fear and anxiety of not feeling able to deal with the clinical situation. The internship experience ranged from emotions of joy at the healing of patients to impotence and frustration at not being able to alleviate intense and lasting suffering. All students reported that the internship was experienced as an important opportunity for personal and professional growth.
Conclusions. In light of the results, we highlight that nurse trainers should support students to take full advantage of this training, helping them to express their emotions and, in the same time, to learn to manage them profitably.
2021
- Empathy and perceived burden in caregivers of patients with schizophrenia spectrum disorders
[Articolo su rivista]
DI LORENZO, Rosaria; Girone, Anna; Panzera, Nunzio; Fiore, Gianluca; Pinelli, Margherita; Venturi, Giulia; Magarini, Federica; Ferri, Paola
abstract
Background
Caregivers of patients load different kinds of burdens, including emotional distress. Aims of this study were to evaluate both burden and empathy of caregivers who assist patients with schizophrenia spectrum disorders.
Methods
We selected a sample of 60 caregivers (34 women and 26 men), who assisted patients with schizophrenia spectrum disorders treated in our local Community Mental Health Center for a 1-year minimum period. We administered two scales to our sample, Zarit Burden Interview (ZBI) and Balanced Emotional Empathy Scale (BEES), and collected data of caregivers and their assisted patients in a 3-month period. Data were statistically analyzed.
Results
We reported a mean ZBI score of 49.68 (±15.03 SD) and a mean BEES score of 14.35 (±9.05 SD), indicating the perception of moderate-severe burden and low level of empathy, respectively. The analysis of internal consistency confirmed the good reliability of both ZBI (Cronbach’s alpha = 0.90) and BEES (Cronbach’s alpha = 0.77). The correlation between the two scales was not statistically significant at Spearman test. At our multiple linear regression, many variables of both caregiver and patient showed a significant correlation with the ZBI score. In particular, not living with the assisted patient and female gender of caregiver potentially decreased the burden, whereas clinical severity of assisted patient and two caregiver conditions, middle school education and spouse relationship with patient, could worsen the burden. We highlighted two positive statistically significant correlations between the total score of BEES and caregiver characteristics: being spouse and not living with assisted patient.
Conclusions
Our study highlights that the caregiver burden of patients with severe psychiatric disorders is high and is associated with low emotional empathy experienced by caregivers, probably due to a defensive psychological mechanism. The conditions of spouse and cohabitation can concomitantly increase both empathy and burden in caregivers.
2021
- Interprofessional high-fidelity simulation on nursing students’ collaborative attitudes: A quasi-experimental study using a mixed-methods approach
[Relazione in Atti di Convegno]
Ferri, P.; Rovesti, S.; Barbieri, A.; Giuliani, E.; Vivarelli, C.; Panzera, N.; Volpi, P.; Di Lorenzo, R.
abstract
Background: interprofessional simulation appears to be effective training for nursing students, yet many questions remain about its feasibility, acceptability and efficacy in improving students’ collaborative attitudes. Study design and participants: the aim of this quasi-experimental study, with a mixed-methods approach, was to evaluate changes in interprofessional collaborative attitudes after a training session based on an interprofessional high-fidelity patient simulation (IHFPS). The sample was composed of students attending the 2nd and 3rd year of the Nursing Degree Program and residents of the Anaesthesia Residency Program at University of Modena and Reggio Emilia in 2019. Methods: nursing students and residents were grouped into small interprofessional teams and participated in an IHFPS focused on acute care. To measure interprofessional collaboration attitude, the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (JSAPNC) and the Readiness for Interprofessional Learning Scale (RIPLS) were administered to nursing students. They completed a post-test to investigate their satisfaction with IHFPS and they replied to open-ended statements. Results and conclusions: 204 nursing students completed both the pre- and post-test surveys. Our results suggested that an IHFPS, with small teams of nursing students and residents, improved interprofessional collaborative attitudes of nursing students. We reported a statistically significant improvement in three factors of JSAPNC and in the RIPLS, which showed the positive effects of this experience on many collaborative skills. The students expressed high satisfaction with the training conducted in a realistic and safe setting, which improved their awareness of working in an effective multidisciplinary team.
2021
- Nursing student attitudes toward dying patient care: A European multicenter cross-sectional study
[Articolo su rivista]
Ferri, Paola; DI LORENZO, Rosaria; Vagnini, Matilde; Morotti, Elena; Stifani, Serena; Jiménez Herrera María, Francisca; Bonacaro, Antonio; Artioli, Giovanna; Rubbi, Ivan; Palese, Alvisa
abstract
Background and aim of the work: Nursing education plays a key role in preparing future nurses to deal with dying patients, which represents one of the most emotionally involving aspect of nursing. The aims of the study were to explore nursing students’ attitudes towards care of dying patients in three different European contexts and to analyze the variables that can influence them.
Methods: We conducted an international multicenter cross-sectional study. We administered the Frommelt Attitude Toward Care of the Dying Scale form B (FATCOD-B) and a demographic form to 569 students, enrolled in three Nursing Programmes in different countries (Italy, Spain and United Kingdom), who accepted to participate in the study. The data were analyzed
using SPSS software version 26.0.
Results: Median total FATCOD-B scores indicated intermediate levels of students’ attitudes towards care for dying patients, with a statistically significant difference among the three student groups. The median total FATCOD-B scores did not statistically significantly change in students with different age, gender, year of study, religious beliefs, nursing education on palliative care, previous experiences of dying patient care and personal grieving.
Conclusions: In our study, nursing students feel partially prepared in caring for dying patients and their attitudes do not change as the course of study progresses. No selected variables had an impact on students’ attitudes towards palliative care. Since nurses play a vital role in ensuring the quality of care, education on end-of-life care should be offered as a core part of undergraduate nursing programs.
2021
- Psychiatric Emergencies During the Covid-19 Pandemic: A 6-Month Observational Study
[Articolo su rivista]
Di Lorenzo, R; Frattini, N; Dragone, D; Farina, Riccardo; Luisi, Filippa; Ferrari, Silvia; Bandiera, G; Rovesti, Sergio; Ferri, Paola
abstract
Background: The new SARS-CoV-2 has caused an ongoing pandemic. Health prevention measures to contain the outbreak are profoundly affecting the physical and mental health as
well as personal freedom of the population. Aim: To evaluate psychiatric emergencies in a 6-month period during the COVID-19 pandemic in 2020 compared to those of the corresponding period of the previous year.
Methods: This monocentric observational study preliminarily collected variables of the urgent psychiatric consultations (UPCs) carried out in emergency room (ER) from 1-3-2020 to 31-8-2020 and the socio-demographic and clinical characteristics of patients who required UPCs in the 6-month period, comparing these data with those collected from 1-3-2019 to 31-8-2019. The data, collected in alpha-numeric code, were statistically analyzed through STATA 12-2011.
Results: This research reported a reduction of both UPCs and hospital psychiatric admissions.
Concomitantly, we observed an increase of UPCs required by people already being treated by psychiatric and other health services, residents in psychiatric facilities and non-Italians. In 2020, differently from 2019, the most frequent reasons for urgent psychiatric consultations were aggressive behavior and adjustment disorders with anxiety and depressive mood.
Conclusion: This preliminary study suggests that, during the COVID-19 epidemic, urgent psychiatric consultations in ER were reduced, except for the most vulnerable people due to
their clinical and/or social conditions.
2021
- Therapeutic Factors in a Psychiatric Group Therapy: a Preliminary Validation of Therapeutic Factors Inventory-8, Italian Version
[Articolo su rivista]
Landi, Giulia; Simoni, Elena; Isotta, Landi; Galeazzi, Gian Maria; Moscara, Maria; Pighi, Marcella; Ferri, Paola; DI LORENZO, Rosaria
abstract
Several studies support group therapy effectiveness due to the activation in patients of unique psychological mechanisms defined as non-specific therapeutic factors (Therapeutic Factors-TFs), which shape the setting and, at the same time, enhance the specific group therapeutic factors. The objectives of this study were to preliminarly validate Therapeutic Factors Inventory-8 (TFI-8) Italian version and identify group therapeutic factors. In a psychiatric residential facility, a weekly psychotherapeutic group was evaluated during 1 year. One scale on group process (TFI-8, Ferrara-Group Experience Scale) and three clinical scales (Brief Symptom Inventory-53, Sheehan Disability Scale, WHO Quality of Life-Bref) were administered to participating patients. Internal consistency, Exploratory Factor Analysis (EFA), convergent validity of TFI-8 were assessed. Correlations between TFI-8 and other scale scores and selected variables were pwerformed. Our sample consisted of 64 participants. TFI-8 showed good internal consistency (Chronbach’s alpha = 0.84), concurrent validity with Fe-GES (Rho = 0.42, p = 0.0008). EFA highlighted a single Factor, accounting for 92% of variance. TFI-8 was not significantly related to clinical scale scores. TFI-8 Italian version proved to be a valid and reliable tool which allowed us to identify one therapeutic factor indicating relational attraction in group therapy, composed of three dimensions: infusion of hope, cohesion and social learning.
2021
- Urgent Psychiatric Consultations at Mental Health Center during COVID‑19 Pandemic: Retrospective Observational Study
[Articolo su rivista]
DI LORENZO, Rosaria; Fiore, Gianluca; Bruno, Alessandra; Pinelli, Margherita; Bertani, Davide; Falcone, Patrizia; Marrama, Donatella; Starace, Fabrizio; Ferri, Paola
abstract
The coronavirus pandemic and related social distancing measures have brought about dramatic changes in people’s lives. In particular, health workers have been forced to
change their activities both for the different needs of patients and for preventive measures against the spread of the virus. This study is aimed at comparing the urgent psychiatric
consultations (UPC) performed at the outpatient Mental Health Center (MHC) of Modena during the coronavirus outbreak period, from 1 March to 31 August 2020, with
the same period in 2019. We retrospectively collected in a database the demographic and clinical characteristics of patients who required UPC in the MHC during the
6-month observation periods in both 2019 and 2020. Data were statistically analyzed.
We analyzed 656 urgent psychiatric consultations in 2019 and 811 in 2020, requested by 425 patients in 2019 and 488 in 2020, respectively. In the pandemic period, we
observed an increase in the total and daily number of UPC which were more frequently required by patients in care at local outpatient services in comparison with the previous
period. During 2020, an increased number of UPC was carried out remotely and the outcome was more frequently represented by discharge at home, avoiding hospitalization
as much as possible. In the course of the coronavirus pandemic, MHC had to face an increased demand for clinical activity especially from the most clinically and
socially vulnerable patients, who more frequently required UPC in outpatient psychiatric services.
2020
- Attitude towards drug therapy in a Community Mental Health Center evaluated by the Drug Attitude Inventory
[Articolo su rivista]
Di Lorenzo, R; Perrone, D; Montorsi, Anushree; Balducci, J; Rovesti, Sergio; Ferri, Paola
abstract
Introduction: Negative attitude towards drug therapy can foster limited adherence to
treatment, which remains one of the biggest obstacles for implementing effective treatments,
especially long term.
Purposes: The purposes of the study were 1) to evaluate the attitude towards drug therapy
among a representative sample of patients treated in a community psychiatric service using
30-item Drug Attitude Inventory (DAI-30); 2) to evaluate the DAI-30 dimensions, applying
factorial analysis; and 3) to highlight the socio-demographic and clinical variables correlated
to DAI-30 score and factors.
Methods: The DAI was administered, over a 7-month period, to all patients treated in our
psychiatric outpatient services who agreed to participate in this study and provided their
informed consent. Data were statistically analyzed.
Results: With a response rate of 63.3%, 164 females and 136 males completed the DAI-30
with an average score of 14.24 (±10.46 SD), indicating moderately positive attitude towards
drug therapy. The analysis of DAI-30 internal consistency confirmed its reliability
(Cronbach’s alpha=0.84). Our factorial analysis highlighted three factors: Factor 1
(Cronbach’s alpha=0.81), composed of 7 items which indicate positive, trustful attitude;
Factor 2 (Cronbach’s alpha=0.78), composed of 5 items indicating negative attitude of
suspiciousness; and Factor 3 (Cronbach’s alpha=0.66), composed of 4 items suggesting
defensive and control attitude towards drug therapy.
Discussion: Among the selected variables, “monotherapy” and “total number of hospitalizations”
were negatively correlated to the final score of DAI-30, whereas being “married”
was positively correlated to it, in a statistically significant way, using the multiple linear
regression model. These correlations suggest that positive attitude towards drug therapy
could be reinforced by the condition of being married and reduced by relapses with
hospitalization, as literature highlighted, and, paradoxically, by a monotherapy, which
could suggest a sort of psychological dependence on therapy and, indirectly, on psychiatric
service, potentially correlated to the long-term treatments of our patients.
2020
- Perceptions of Caring Behavior Among Undergraduate Nursing Students: A Three-Cohort Observational Study
[Articolo su rivista]
Ferri, Paola; Stifani, Serena; Morotti, Elena; Nuvoletta, Maria; Bonetti, Loris; Rovesti, Sergio; Cutino, Anna; DI LORENZO, Rosaria
abstract
Introduction: Increase in the knowledge of “caring science” among nurses plays a key role in ensuring a correct caring behavior towards patients. Caring training for students is
a priority in nursing education, but unfortunately there are limited and conflicting studies which explore this outcome. The purpose of this observational study was to explore the
perceptions of caring behaviors by nursing students during their clinical practice training in order to highlight if the level of caring behaviors changes as the nursing course progresses.
Materials and Methods: The Caring Behaviors Inventory-24 (CBI-24) was administered to 331 students, enrolled in the three years of an Italian Nursing Course, who accepted to
participate in the study (89.2% response rate). The data were analyzed using SPSS software version 26.0 (SPSS Inc., Chicago, IL).
Results: The total mean score of CBI-24 was 4.82 in the first, 5.12 in the second and 5.26 in the third-year students. The CBI-24 dimensions “Responding to individual needs” and
“Being with” obtained the highest scores among the students of the first year. At the end of the first year, our students were already able to perform expressive caring, whereas
instrumental caring developed at a high level in the second and third years. We did not highlight any statistically significant difference between the two gender CBI-24 item scores.
Conclusion: In light of our results, we put in evidence that Nursing Degree Programme favours the development in students of both relational and technical components of caring
behaviors. We hope that in future students’ self-assessment of caring behaviors could be considered an educational outcome for Nursing Programme.
2020
- Retrospective Analysis of Factors Associated with Long-Stay Hospitalizations in an Acute Psychiatric Ward
[Articolo su rivista]
DI LORENZO, Rosaria; Montardi, Giulia; Panza, Leda; DEL GIOVANE, Cinzia; Saraceni, Serena; Rovesti, Sergio; Ferri, Paola
abstract
Purpose: To evaluate the longest hospitalizations in an acute psychiatric ward [Service of Psychiatric Diagnosis and Treatment (SPDT)] and the related demographic, clinical and
organizational variables to understand the factors that contribute to long-stay (LOS) phenomenon. The term “long stay” indicates clinical, social and organizational problems
responsible for delayed discharges. In psychiatry, clinical severity, social dysfunction and/or health-care system organization appear relevant factors in prolonging stays.
Patients and Methods: We divided all the SPDT hospitalizations from 1 January 2010 to 31 December 2015 into two groups based on the 97.5th percentile of duration: ≤36 day (n=3254)
and >36 day (n=81) stays, in order to compare the two groups for the selected variables. Comparisons were made using Pearson’s chi-square for categorical data and t-test for continuous
variables, the correlation between the LOS, as a dependent variable, and the selected variables was analyzed in stepwise multiple linear regression and in multiple logistic regression models.
Results: The longest hospitalizations were significantly related to the diagnosis of “schizophrenia and other psychosis” (Pearson Chi2=17.24; p=0.045), the presence of moderate and severe aggressiveness (Pearson chi2=29; p=0.000), compulsory treatment (Pearson Chi2=8.05; p=0.005), parenteral or other route administration of psycho-pharmacotherapy (Pearson Chi2=12.91; p=0.007), poli-therapy (Pearson Chi2=6.40; p=0.041), complex psychiatric activities (Pearson Chi2=12.26; p=0.002) and rehabilitative programs (Pearson Chi2=37.05; p=0.000) during the hospitalization and at discharge (Pearson Chi2=29.89; p=0.000). Many demographic and clinical variables were statistically significantly correlated to the LOS at our
multiple linear and logistic regression model.
Conclusion: In our sample, clinical illness severity and need for complex therapeutic and rehabilitative treatments were associated with prolonged psychiatric hospitalizations.
Understanding this phenomenon can have not only economic but also clinical, ethical and social relevance.
2020
- Violence against nurses in the triage area: a mixed-methods study
[Articolo su rivista]
Ferri, Paola; Stifani, Serena; Accoto, Angela; Bonetti, Loris; Rubbi, Ivan; DI LORENZO, ROSARIA
abstract
Introduction
Workplace violence is a serious occupational problem among nurses in emergency departments. The aim of this study was to better understand workplace violence experienced by triage nurses.
Methods
A mixed-methods study was carried out with 27 Italian nurses involved in the triage area of an emergency department. Quantitative data were collected using the Violent Incident Form and qualitative data were obtained from 3 focus groups.
Results
Ninety-six percent of triage nurses had suffered an episode of violence during the previous year. Participants reported that perpetrators of violence were primarily patients' relatives or friends (62%), usually male and in a lucid state of consciousness. The aggressor was a male patient in 31% of violent episodes. Male nurses reported only verbal abuse, unlike female nurses who suffered both physical and verbal episodes. Females received assistance from other staff during the aggression event more frequently than males, and females more frequently suffered from physical injury. Only physical and verbal aggressions were associated with physical injury. Four main themes emerged from the focus groups.
Discussion
Nurses reported that high exposure to workplace violence in triaging had significant consequences on their psychological well-being and on their behavior at work and at home. Violence, perceived as a personal and/or professional injury owing to insufficient organizational support, led professionals to experience feelings of resignation and to believe that abuse was an inevitable part of the job. Nevertheless, in our study, the precipitating factors were investigated, suggesting several possible solutions to limit this phenomenon.
2019
- Early death in Munchausen Syndrome: a case report
[Articolo su rivista]
DI LORENZO, ROSARIA; Lannocca, Ludovica; Burattini, Maritea; VASTA, Andrea; GALLETTI, MARTINA; MINARINI, ALESSANDRO; Mongelli, Francesca; Sportiello, Salvatore; Rovesti, Sergio; Ferri, Paola
abstract
This case contributes to raising awareness and understanding of the complex clinical presentations of Munchausen syndrome (MS). Education of staff to the seriousness and genuineness of this disorder should be implemented, especially in hospital units, in order to detect such complex clinical situations quickly and accurately, preventing iatrogenic risks.
2019
- Effect of expert-patient teaching on empathy in nursing students: a randomized controlled trial
[Articolo su rivista]
Ferri, P; Rovesti, S; Padula, Ms; D’Amico, R; Di Lorenzo, R
abstract
Background: Empathy is a relevant clinical competence for nursing students. Involvement of expert patients in nursing education could help students develop their innate capacity to empathize.
Objective: To evaluate the effect of expert-patient teaching on empathy development in nursing students.
Methods: This randomized controlled trial was conducted among 144 first-year undergraduate nursing students divided into two equal groups. In the experimental group, the educational intervention consisted of a seminar focused on empathy, followed by a presentation on expert-patient function. Subsequently, each student participated in two interactive meetings with nursing teacher and expert patient. At the end, the nursing teacher encouraged students to reflect on this experience. In the control group, students only attended a similar seminar focused on empathy and afterward participated in two interactive meetings with a nursing teacher to reflect on this topic without expert-patient involvement. Before (T0) and after (T1) the training intervention, the Balanced Emotional Empathy Scale, Jefferson Scale of Empathy — Health Professions Student (JSE-HPS), and a short demographic questionnaire were administered to the two student groups to measure their empathy levels. The study was approved by the Local Ethics Committee of Area Vasta Emilia Nord (protocol 1763, May 11, 2017). Data were statistically analyzed.
Results: We found a statistically significant difference between mean scores at T0 and T1 in both scales in the experimental group. Male students, who presented significantly lower levels of empathy at baseline in comparison with females, showed increased in empathy after training on the the Balanced Emotional Empathy Scale in both the experimental and control groups.
Conclusion: The present study highlights that involvement of expert patients in teaching is effective in improving empathy levels in both male and female nursing students. Expert-patient teaching can be a promising nursing-education modality for developing empathy.
2019
- Effectiveness of 1-year treatment with long-acting formulation of aripiprazole, haloperidol, or paliperidone in patients with schizophrenia: retrospective study in a real-world clinical setting
[Articolo su rivista]
DI LORENZO, Rosaria; Ferri, Paola; Cameli, Michela; Rovesti, Sergio; Piemonte, Chiara
abstract
Background: Schizophrenia is a chronic mental illness that requires lifelong antipsychotic treatment. Therapy discontinuation, often due to poor adherence, increases the risk of relapses
after both first and subsequent psychotic episodes. Long-acting injectable (LAI) antipsychotic drugs (APDs) have been introduced to increase therapeutic adherence, reducing blood-level
variability compared to corresponding oral preparations.
Purpose: To compare the effectiveness of three LAI-APDs: aripiprazole (Apr) prolonged release once monthly (OM) haloperidol decanoate (Hal-D) and paliperidone palmitate
(PP-OM).
Methods: We retrospectively collected data for all patients with schizophrenia or other psychoses (n=217) treated with the three LAI-APDs for the first time from January 1, 2012
to October 31, 2016: n=48 with Apr-OM, n=55 with Hal-D, and n=114 with PP-OM. After 6 and 12 months of LAI treatments, we assessed clinical and functioning improvement, urgent
consultations, psychiatric hospitalizations, adverse effects, and dropout. We compared urgent consultations and psychiatric hospitalizations required by the same patient 6 and 12 months
before and after LAI implementation. Data were statistically analyzed.
Results: The three LAI groups differed significantly only for “need for economic support from social service” (more frequent in the Hal-D group) and “schizoaffective disorder” (prevalent
in the Apr-OM group). Apr-OM was prescribed at the maximum dose required by the official guidelines, whereas the other two LAIs were prescribed at lower doses. After 6 and 12 months’
treatment with the three LAI-APDs, we registered similar and significant reductions in both urgent consultations and psychiatric hospitalizations (P,0.001) and overlapping clinical and
functioning improvement-scale scores (P,0.001), and 14.28% of patients dropped out, with no difference among the three LAI-APDs. Different kinds of adverse effects, though similar
for number and severity, were reported in the three LAI groups.
Conclusion: Our results suggest that both first- and second-generation LAI-APDs represent important therapeutic options, useful for improving schizophrenia’s clinical course and its
economic burden. Our study, which offers a wide and comprehensive observation of real-world clinical settings, combined an effectiveness evaluation through mirror analysis performed for
each individual patient to a subsequent comparison among the three LAI-APDs, allowing us a more complete evaluation of clinical efficacy.
2019
- Emotional intelligence, empathy and alexithymia: a cross-sectional survey on emotional competence in a group of nursing students
[Articolo su rivista]
DI LORENZO, Rosaria; Giulia, Venturelli; Spiga, Giulia; Ferri, Paola
abstract
Background: Emotional intelligence (EI) is the ability to recognize and manage one’s own and
others’ emotions, empathy is the ability to understand how others feel, whereas alexithymia represents the
difficulty in feeling and verbally expressing emotions. Emotional competences are important requirements
for positive outcomes in nursing profession. The aim of the study: To analyze EI, empathy and alexithymia in
nursing students. Methods: We conducted a cross-sectional survey in a sample of 237 students (53 males, 184
females), attending both the 1st and 3rd year of the University Nursing Course in Modena. We administered
three Italian validated scales: Schutte Self-Report Emotional Intelligence Test (SSEIT), Jefferson Scale of
Empathy - Health Professions Student ( JSE-HPS), Toronto Alexithymia Scale (TAS-20). Data were statistically
analyzed. Results: Statistically significant differences were found between the 1st and 3rd year students
at SSEIT (t=-0.6, p=0.52), JSE-HPS (t=-3.2, p=0.0016) and TAS-20 scores (t=-3.54, p=0.0005). Among
3rd- year students, females obtained significantly different scores from those of males at SSEIT (t=2.8,
p=0.006). All three scales reported a Cronbach’s alpha >0.80. SSEIT correlated positively with JSE-HPS
(Spearman’s rho=0.15, p=0.02) and negatively with TAS-20 (Spearman’s rho=-0.18, p=0.006). Conclusions:
Our study highlighted a good level of emotional skills among students at the beginning of nursing training,
further increased by the last year of the course, suggesting that emotional competences can be learned, and
confirmed that empathy, but not alexithymia, is a dimension of EI.
2019
- Evaluation of empathy among undergraduate nursing students: a three-year longitudinal study
[Articolo su rivista]
Ferri, Paola; Rovesti, Sergio; Bonetti, Loris; Stifani, Serena; Panzera, Nunzio; DI LORENZO, Rosaria
abstract
Background and aim: An empathic approach is considered fundamental in order to ensure the identification of patient needs and to provide the appropriate care, although the studies on the development of empathic attitude during nursing course reported conflicting results. Different empathic tendencies have been observed in the two genders: many studies showed greater empathy in females. Methods: To assess empathy level of students enrolled in the academic year 2015/16 at an Italian University nursing course, the Balanced Emotional Empathy Scale (BEES) was administered at the start of Year 1 (n=118), at the mid-point of Year 2 (n=99) and at the end of Year 3 (n=67). Data were statistically analyzed. Results: Cronbach’s values were satisfactory (0.87 at Year 1, 0.89 at Year 2, 0.79 at Year 3), confirming the good internal reliability of BEES. The nursing students obtained a total BEES mean ± SD score of 37.0 ± 19.5 at Year 1, 33.5 ± 22.6 at Year 2 and 35.4 ± 16 at Year 3, without any statistically significant difference among the three years. The BEES mean scores reported by males were lower in comparison with females during the three years of the course, although, at the end of the third year, males showed a significant increase at the “Emotional spread responsiveness” dimension of the scale. Conclusions: The study suggests that empathy can be maintained at good levels during the nursing education especially if nursing teaching and internship are focused on this topic, acting up the innate aptitude of each student.
2019
- Factors Associated with Long-Stays in an Italian Psychiatric Intensive Treatment Facility: 1-Year Retrospective Observational Analysis
[Articolo su rivista]
Di Lorenzo, Rosaria; Teresa, Olmi; Rioli, Giulia; Galeazzi, Gian Maria; Ferri, Paola
abstract
Psychiatric Intensive Treatment Facilities (PITF) are health inpatient settings for patients affected by sub-acute psychiatric disorders with impaired personal and social functioning. The aim of this study is to analyse the demographic and clinical variables related to long-stays in an Italian PITF in order to highlight the risk factors for stay lengthening. We retrospectively collected the selected variables from all patients and their stays in a PITF from 1 to 11-2016 to 31-10-2017.We divided the stays according to the median of duration, ≤29 and > 29 days, to compare selected variables in the two groups of stay length. Patients hospitalized for >29 days more frequently presented “Self-neglect”, nursing diagnosis NANDA-I, and needed economic social service support.Multiple linear regression revealed that the presence of some variables as “many medical consultations”, “economic social service support”, “clinical interviews extended to institutional figures” were statistically significantly associated with an increased stay duration, suggesting that both clinical severity and difficult economic conditions were associated with the lengthening of stay. The knowledge of these factors can contribute to improve psychiatric treatments, reducing potential risk conditions for patient institutional dependence.
2018
- A randomized comparison trial of two and four-step approaches to teaching Cardio-Pulmonary Reanimation
[Articolo su rivista]
Lapucci, Giorgio; Bondi, Barbara; Rubbi, Ivan; Cremonini, Valeria; Moretti, Erica; DI LORENZO, Rosaria; Magnani, Daniela; Ferri, Paola
abstract
Background and aim of the work: The treatment of cardiac arrest in an extra-hospital environment improves with the increase in the number of people able to establish an early Cardio-Pulmonary Reanimation (CPR). The main aim of the study was to assess the validity of the two-step method in case of prolonged CPR. Methods: A randomized comparison study was conducted in the University Nursing School of a Northern Italian town, during the 2015/16 academic year, among 60 students, to teach them CPR techniques, through two different teaching methods (4-step and the 2-step of CPR training). The effectiveness of the maneuvers performed on mannequins equipped with skill-meter was verified. Results: Our study did not highlight any significant difference between the two methods of CPR training. The comparison between the two methods regarding their efficacy in practical teaching of CPR, highlighted by this study, proved the validity of both the 4-minute continuous method (1st method) and the 30:2 method (2nd method). Conclusions: The results of the study showed no differences between the 2-step and the 4-step methods, in the effectiveness of cardiac massage. The correct execution of chest compressions during a CPR is the key to increase the patient’s chances of rescue. Research has shown that any interruption in the execution of chest compressions, leads to a progressive reduction of the effectiveness of cardiac massage, with negative consequences on the prognosis of the patient undergoing at CPR.
2018
- Clinical improvement, relapse and treatment adherence with paliperidone palmitate 1-month formulation: 1-year treatment in a naturalistic outpatient setting
[Articolo su rivista]
DI LORENZO, Rosaria; Cameli, Michela; Piemonte, Chiara; Bolondi, Marisa; Landi, Giulia; Pollutri, Gabriella; Moretti, Valentina; Ferri, Paola
abstract
Purpose: To evaluate paliperidone palmitate 1-month formulation (PP1M) effectiveness in a naturalistic outpatient psychiatric setting. Materials and methods: We collected data from 50 outpatients affected by schizophrenia disorders treated with PP1M for 12 months in an Italian Mental Health Department. After analyzing selected demographic, clinical and pharmacological variables, we performed mirror analysis to compare psychiatric hospitalizations and urgent consultations required by the same patient 6 and 12 months before and after PP1M implementation (primary outcome). We analyzed clinical improvement in symptom (Clinical Global Impression-severity and improvement) and functioning (Global Assessment of Functioning) scales and drop-out rate during the 12-month PP1M treatment (secondary outcome). Data were statistically analyzed. Results: The mean PP1M dose was 93.5 mg (±27.7 SD) with a mean interval between each injection of 27.1 d (±4.5 SD). Twenty-three patients (46%) reported adverse effects (sexual dysfunctions, weight gain and extrapyramidal symptoms).Fifteen patients (30%) dropped out after 137.2 d (±103.1 SD) on average: six due to the lack of therapeutic adherence, six due to inefficacy and three due to adverse events. The drop-out patients presented more severe clinical profile in CGI-S and GAF scores at T0 in comparison with others. At mirror analysis, 12-month but not 6-month PP1M treatment statistically significantly reduced psychiatric hospitalizations (t = 2.3, p < .05) and urgent consultations (t = 2.1, p < .05). Both scale scores showed statistically significant improvement at T12 in comparison to T0. Conclusions: This naturalistic study indicates that long-term PP1M treatment was safe and effective in preventing hospitalizations and urgent consultations as well as in improving clinical course.
2018
- Demographic and clinical characteristics of patients involuntarily hospitalized in an Italian psychiatric ward: a 1-year retrospective analysis
[Articolo su rivista]
DI LORENZO, Rosaria; Laura, Vecchi; Artoni, Cecilia; Mongelli, Francesca; Ferri, Paola
abstract
Background: In Italy, psychiatric compulsory treatments are regulated by Law 180 of 13-5-1978 that establishes three criteria: 1) acute psychiatric conditions requiring urgent treatment, 2) patient’s refusal of treatment, 3) inpatient treatment is necessary and cannot be postponed. Aim: To highlight demographic and clinical risk factors for involuntary treatments. Methods: We retrospectively collected all hospitalizations in the Service of Psychiatric Diagnosis and Treatment of a northern Italian town from 1-1-2015 to 31-12-2015. We statistically compared demographic and clinical variables related to voluntarily and involuntarily admitted patients and their hospitalizations. Results: We divided our sample into patients voluntarily hospitalized (PVH=236) and involuntarily (PIH=160) according to their voluntary (VH= 304) and involuntary (IH=197) hospitalizations. PIH were older than PVH and, more frequently, lived alone and were unemployed (p<0.001). “Acute worsening of psychopathology” for IH and “Suicidality” for VH were the prevalent reasons (p<0.001). IH was longer than VH (p<0.001). Among PIH, the most frequent diagnoses were
“Schizophrenia and Other Psychosis” (ICD-9-CM) and “Ineffective Impulse Control + Disturbed Personal Identity” (NANDA-I) (p<0.001). During hospitalizations, PIH more often than PVH presented aggressive behavior (p<0.001). At discharge, PIH were more frequently sent to another psychiatric ward or protected facility with long-acting injectable antipsychotics (p<0.001). Conclusions: Our involuntarily admitted patients were affected by severe psychiatric disorders with social maladjustment and required complex therapeutic and rehabilitative programs to counteract aggressive behaviour, poor therapeutic compliance and prolonged hospitalizations. The assessment of patients’ characteristics can help clinicians recognize who are at risk for compulsory treatment and prevent it.
2018
- Evaluation of fatigue in patients with pancreatic cancer receiving chemotherapy treatment: a cross-sectional observational study
[Articolo su rivista]
DI MARCO, Mariacristina; Ivan, Rubbi; Agnese, Baldi; DI LORENZO, Rosaria; Magnani, Daniela; Valeria, Cremonini; Leopoldo, Sarli; Artioli, Giovanna; Ferri, Paola
abstract
Background and aim of the work: Cancer-related fatigue (CRF) is one of the most common symptoms experienced by cancer patients (CPs) and negatively affects quality of life. Although CRF is frequently experienced, it is often underreported, underdiagnosed and undertreated. The objectives of this study were to evaluate the level of fatigue in patients with pancreatic cancer undergoing chemotherapy and to analyse its correlation with patients’ demographic and clinical variables. Methods: A cross-sectional observational study was implemented in the Oncology Day Hospital of a Northern Italian hospital. A sample of 48 patients receiving chemotherapy were evaluated through the Brief Fatigue Inventory Italian version (BFI-I) between 1 May and 12 October 2016. Data were statistically analysed. Results: Most of our patients (94%) experienced fatigue. Women as well as patients with an age ≥65 years reported more fatigue. Anemia, pain and a weight loss of over 16 kg in the last 6 months were significantly related to the perception of fatigue. Regarding life habits, smoking was related to high global score of BFI-I. Conclusions: In accordance with literature, our study suggests that fatigue is a frequent symptom influenced by many constitutional, clinical and environmental factors. Our results highlight the need for an early and regular evaluation of fatigue among cancer patients, in order to implement all those pharmacological and non-pharmacological interventions with proven efficacy in attenuating this symptom.
2018
- Psychometric properties of the Patient Dignity Inventory in an acute psychiatric ward: an extension study of the preliminary validation
[Articolo su rivista]
DI LORENZO, Rosaria; Ferri, Paola; Biffarella, Carlotta; Cabri, Giulio; Carretti, Eleonora; Pollutri, Gabriella; Spattini, Ludovica; DEL GIOVANE, Cinzia; Chochinov Harvey, Max
abstract
Background: During the last decades, dignity has been an emerging issue in mental health since its ethical and therapeutic implications became known. This study is an extension of the preliminary validation of the Patient Dignity Inventory (PDI) in a psychiatric setting, originally designed for assessing perceived dignity in terminal cancer patients.
Methods: From October 21, 2015 to December 31, 2016, we administered the Italian PDI to all patients hospitalized in an acute psychiatric ward, who provided their consent and completed it at discharge (n=165). We performed Cronbach’s alpha coefficient and principal factor analysis. We administered other scales concomitantly to analyze the concurrent validity of PDI. We applied stepwise multiple linear regression to identify the patients’ demographic and clinical variables related to the PDI score.
Results: Our response rate was 93%, with excellent internal consistency (Cronbach’s alpha coefficient=0.94). The factorial analysis showed three factors with eigenvalue .1, which explained .80% of total variance: 1) “loss of self-identity and anxiety for the future”, 2) “concerns for social dignity and spiritual life”, and 3) “loss of personal autonomy”. The PDI and the three factor scores were positively and significantly correlated with the Hamilton Scales for Depression and Anxiety but not with other scale scores. Among patients’ variables, “suicide risk” and “insufficient social and economic condition” were positively and significantly correlated with the PDI total score.
Conclusion: The PDI can be a reliable tool to assess patients’ dignity perception in a psychiatric setting, which suggests that both social and clinical severe conditions are closely related to dignity loss.
2018
- The association of Mediterranean diet and exercise modifications with anthropometric parameters in a psychiatric community population: A pilot study
[Articolo su rivista]
DI LORENZO, Rosaria; Pedretti, Jessica; Grossi, Letizia; Cuoghi, Benedetta; Varni, Cinzia; Landi, Giulia; Spattini, Ludovica; Visentini, Chiara; Ferri, Paola; Carubbi, Francesca
abstract
Weight gain and related metabolic syndrome (MS) are major current issues in public health. MS consists of
abdominal fat, atherogenic dyslipidemia, hypertension, hyperglycemia, insulin resistance, pro-inflammatory and
pro-thrombotic state, and accounts for both cardiovascular diseases and type II diabetes mellitus risk factors.
Patients affected by psychiatric illness present a prevalence of 35–40% of MS. Many studies have shown that
Mediterranean diet is associated with the reduction of mortality due to cardiovascular and malignant diseases,
potentially preventing both obesity and type II diabetes mellitus. Our pilot study explores the effects of a 12-
month healthy lifestyle program (Mediterranean diet and mild physical activity) on metabolic and anthropometric
parameters of patients affected by chronic psychiatric disorders who live in a psychiatric community
facility. A Mediterranean diet was provided by a senior nutritional clinician and adapted by two dieticians,
according to the needs and preferences of the community population. Concomitantly, a program of moderate
physical activity, consisting in 30-min walks on level ground 4 days a week, and psycho-educational group
sessions with educational and therapeutic purposes were implemented. The metabolic and anthropometric
parameters of our patients improved after both 6 (T6) and 12 (T12) months. Body Max Index was statistically
significantly reduced at T6 and T12, with patients perceiving good quality of life. These positive outcomes
suggest that a low-cost healthy lifestyle program can produce good adherence and feasibility even among patients
with chronic psychiatric diseases, reducing their risk for MS, cardiovascular diseases and other complications.
2018
- The efficacy of interprofessional simulation in improving collaborative attitude between nursing students and residents in medicine. A study protocol for a randomised controlled trial
[Articolo su rivista]
Ferri, Paola; Rovesti, Sergio; Magnani, Daniela; Barbieri, Alberto; Bargellini, Annalisa; Mongelli, Francesca; Bonetti, Loris; Vestri, Annarita; Alunni Fegatelli, Danilo; DI LORENZO, Rosaria
abstract
Background: Effective collaboration among health professionals is an essential component to ensure quality of care. Many adverse events experienced by patients are attributed to misunderstanding or poor communication among members of the interprofessional team. Interprofessional simulation is a learning strategy used to improve collaboration and facilitate communication between medical and nursing students. Aim of the work: To determine the efficacy of educational program based on high-fidelity interprofessional simulation aimed at improving collaborative attitude. Method: For this purpose, a protocol for a planned single-center,
non-blinded and Randomized Controlled Trial (RCT) was chosen. The present has been approved by the Ethics Committee of Area Vasta Emilia Nord (Italy) (n° 479/2018). All students attending the second and third year of nursing and all resident physicians in anesthesia, reanimation, intensive care and pain management of University of Modena and Reggio Emilia, will be recruited and randomly assigned to two groups. The Experimental Group (EG) will receive an educational intervention based on high-fidelity simulation and the Control Group (CG) will attend a traditional classroom lesson. Jefferson Scale of Attitudes toward
Physician-Nurse Collaboration (JSAPNC) and Readiness for Interprofessional Learning Scale (RIPLS) will be administered before and after the educational program in both the EG and CG. Conclusion: Expected outcomes is that, at the end of the study, nursing students and resident physicians who participated in the interprofessional simulation show significantly higher levels of interprofessional collaboration compared to the CG, evaluated through the JSAPNC.
2016
- A 5-year retrospective study of demographic, anamnestic, and clinical factors related to psychiatric hospitalizations of adolescent patients
[Articolo su rivista]
DI LORENZO, Rosaria; Cimino, Nina; Di Pietro, Elena; Pollutri, Gabriella; Neviani, Vittoria; Ferri, Paola
abstract
Background: Psychiatric emergencies of children and adolescents have greatly increased during the last years, but this phenomenon has not been studied in detail. The aim of this study was to analyze the correlation between acute psychiatric hospitalizations of adolescents and selected variables to highlight risk factors for psychiatric emergencies.
Methods: This retrospective research was conducted in the acute psychiatric public ward, Service of Psychiatric Diagnosis and Treatment (SPDT), and in the residential facility for adolescents, “The Medlar”, located in Modena. The sample was constituted by all adolescent patients (n=101, age range 14–18) who had acute hospitalizations (n=140) in SPDT and had been successively transferred to “The Medlar” (n=83), from February 2, 2010 to January 31, 2015. From clinical charts, we extracted demographic and anamnestic characteristics of patients and clinical variables related to hospitalizations. Data were statistically analyzed.
Results: Sixty-one percent of our patients lived with one divorced parent, with adoptive or immigrant family, or in institutions; 51% had experienced stressful events during childhood; 81% had a normal intellective level, but only 6% presented regular school performance. Parental psychiatric illness was negatively related, in a statistically significantly way, with onset age of adolescent mental disorders (coefficient -2.28, 95% confidence interval [CI]: -3.53 to 1.01, P<0.001, single linear regression; odds ratio: 4.39, 95% CI: 1.43–13.47, P<0.010, single logistic regression). The most frequent reasons for admission were aggressive behavior in males and suicide risk in females (P=0.002). The most frequent psychiatric diagnosis at SPDT discharge was “conduct disorder”, more frequent in males, followed by “adjustment disorder”, more frequent in females (P=0.001). In SPDT, the adolescent hospitalizations progressively increased fivefold at the end of the observation period.
Conclusion: Our results overlap the worldwide trend of increasing adolescent psychiatric hospitalizations, suggest risk factors like parental psychiatric illness and early life stressful events, and highlight the different prevalence of aggressiveness and suicide in males and females.
2016
- The Revolving Door Phenomenon in an Italian Acute Psychiatric Ward: A 5-Year Retrospective Analysis of the Potential Risk Factors
[Articolo su rivista]
Di Lorenzo, R.; Sagona, M.; Landi, G.; Martire, L.; Piemonte, C.; Del Giovane, C.
abstract
To highlight the revolving door (RD) phenomenon in an acute psychiatric ward, we retrospectively identified the patients hospitalized three or more times in a calendar year from 1/1/2009 to 31/12/2013 as RD patients (RDP). We collected sociodemographic and clinical variables of RDP and statistically analyzed the potential RD risk factors. We divided RDP into "high" and "extremely high" utilizers and evaluated the variables related to more frequent readmissions. RDP represented 5.68% of all patients and their hospitalizations (RDH) 25% of all admissions. The statistically significant risk factors for all RDH were "disability pension," "substance abuse/dependence," "mild/severe aggressiveness," and "psychiatric and social rehabilitative programs". The comparison between "high" and "extremely high" utilizers showed that "manic episodes" and "personality disorders," among the diagnoses, "familial relational conflicts" and "violence/suicidality", among the hospitalization reasons, were statistically significant risk factors for more frequent readmissions. RD phenomenon was greatly affected by severe clinical conditions with social disability.
2015
- Unidades de Cuidados Intensivos (UCI) abiertas: las opiniones de los profesionales sanitarios. Un estudio cualitativo
[Articolo su rivista]
Magnani, Daniela; Lionte, Giovanni; DI LORENZO, Rosaria; Pisani, Maria; Palazzolo, Cristian; Ferri, Paola
abstract
Many studies have highlighted that “open” Intensive Care Unit (ICU) can bring multiple benefits for patients: reduced cardiovascular complications, mortality and length of stay. However, professionals are still reluctant to accept open units because of many concerns: risk of infection, interference with patient care, increased workload for team, reduced efficacy of intensive care, increased level of stress for patients and their families, violation of patient privacy. The aim of this study was to analyze the positive and negative aspects of an open ICU. After 18 months from the reorganization into open modality of the ICU located in an Hospital in Modena, we performed a qualitative research. We applied focus groups technique and semi-structured interviews to 70 nurses and 4 physicians of the open ICU, in order to appraise their evaluation of this organizational change. Our results evidenced many organizational issues, concerning the difficulty to guarantee the privacy of patients, the necessity of clear, well-defined and shared rules of work and the need of psychological support for the staff due to the higher emotional involvement with patients and their families. Nevertheless, professionals expressed the intention to maintain open ICU, in the belief that it can induce many advantages not only to patients and their families, but also to professionals themselves.
2014
- The undergraduate nursing student evaluation of clinical learning environment: an Italian survey [La valutazione dell'ambiente di apprendimento clinico da parte degli studenti del Corso di Laurea in Infermieristica: una indagine italiana]
[Articolo su rivista]
Magnani, Daniela; DI LORENZO, Rosaria; Bari, Alessia; Pozzi, Samantha; DEL GIOVANE, Cinzia; Ferri, Paola
abstract
BACKGROUND: Nursing students have to deal with many different clinical and practical aspects of knowledge to become skilled professionals. Student perception may be considered an indicator of teaching quality, since positive perception of students is strictly related to their effective professional learning. The Clinical Learning Environment and Supervision plus Nurse Teacher (CLES+T) scale is considered the gold standard psychometric instrument to evaluate both the quality and the climate of clinical learning environment.
AIMS: To evaluate the quality of nurse teaching by means of CLES+T scale and to highlight significant correlations between CLES+T scale and selected characteristics of both students and clinical environments.
METHODS: On 4 March 2013, a cross-sectional survey was conducted at University of Modena: CLES+T scale was administered during a plenary convocation to 242 nursing students who attended the second and third years of Nursing Degree. All 34 items of the scale were statistically analysed using the median test.
RESULTS: The median values were uniformly represented by "4" level (on the Likert scale). The final marks of clinical learning experience were the only variable statistically significantly related to the scale scores. The paediatrics and emergency areas obtained the highest scale scores.
CONCLUSIONS: The nursing student evaluations were uniformly positive and related to their positive final marks. A positive ward atmosphere was identified as especially important in this study. These data indicate that a non-hostile and hospitable environment can favour the best clinical learning. We conclude that CLES+T scale can be a useful instrument to explore the clinical climate in all hospital areas and to highlight critical clinical situations.