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Progetto Veduta
 

Progetto Veduta

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Il Progetto Veduta presentato da Maria Giulia Marini al 3rd Societal Impact of Pain symposium di Copenhagen dal 29 al 31 Maggio 2012

Il Progetto Veduta presentato da Maria Giulia Marini al 3rd Societal Impact of Pain symposium di Copenhagen dal 29 al 31 Maggio 2012

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Progetto Veduta Progetto Veduta Presentation Transcript

  • Project V.E.D.U.T.A. (Valori Esistenziali contro il Dolore nelle Unità di Terapia e Assistenza) (Existential Values against pain in the Units of therapy and assistance)www.fondazioneistud.it Societal Impact of Pain, Copenhagen, May 30 2012, Maria Giulia Marini
  • Why climate analyses?• Climate analyses are conducted inside working organizations or teams, public and private, and often repeated with a scheduled frequency.• Issues are the evaluation of workers needs, their motivations, their work life balance, the dynamics of communication, the internal cohesion and collaboration, the strong and weak points of the organization, the quality of the leadership.• Goals consist in improving the satisfaction and quality of life of workers and defining a model – bottom up- of shared values.
  • Climate analyses in the fightagainst pain• In the health care sector, the exposure of personnel to burn is a crucial factor to be assessed : are physicians and other providers of care happy?• Having to face Pain every day, which belongs to Human condition, there is an overexposure to human fragility and vulnerability.
  • Pain therapy"The set of diagnostic and therapeuticinterventions designed to identify and apply tochronic diseases suitable and appropriate drugtherapies, surgical instruments, and psychologicalrehabilitation, variously integrated , in order todevelop appropriate diagnostic and therapeuticpathways for suppression and pain management “
  • Another Italian and Mediterranean PainTheEconomist,March 2012
  • In Italy; despite the crisis aprofound change is warrantedthrough the Italian law 38/2010alliative care and pain management are priority objectivesof the National Health Plan. [...] in order to ensure respectfor the dignity and autonomy of the human person, healthneeds, equity in access, quality of care and theirappropriateness regarding specific requirements.The Minister of Health [...] defines the minimumrequirements [...] to the terminally ill and palliative careunits and pain therapy home care in each region, in order todefine the network palliative care for pain management,[...], at a staffing plan of care appropriate to the needs ofthe resident population and an adequate supply ofprofessionals with specific skills and experience inthe field of palliative care and pain therapy, evenwith regard to family support.
  • The competence requested forbeing a pain therapist "[...] the professionals with specific skills and experience in the field of palliative care and pain therapy, for the pediatric age too, with particular reference to general practitioners and medical specialists in anesthesia and intensive care, geriatrics, neurology, oncology, radiotherapy, pediatrics, physicians with at least three years experience in the field of palliative care and pain management, nurses, psychologists and social workers and other professionals deemed critical. "
  • The issue of professional identityPain therapists originates mainly from anesthesists andthey are organized in different care setting (workinggroups, hospitals...)Their function is to “serve” accross the hospital and otherhealth care department: there are few centers which dealspecifically with the treatment of painDifficulties in developing collective professional identity and building a network
  • The importance of the paintherapist network• Feeling of belonging: recognition and support of professionals who are working• Information sharing, and resource saving, moving from a competitive approach to a cooperative behaviour, able to better negotiate with regional and central institutions• Better management of patients who are seen "as a whole“ and not as splitted fragments
  • Objectives of VEDUTA• Framing of the professional identity of pain therapists• Understanding individual and organizational needs• Creation of a situation fostering the network among pain therapist (such as of “inter-est group” and within the structures) in a context of very limited resources
  • VEDUTA project: stories cancatch what questionnaires don’tcatch• The quantitative variables are means of demographic data, job description, team organization and workload, relationship with the patients, personal motivations and expectations and the evaluation of the quality of their professional life.• Narrative method thinking enrich the quantitative figures, probing the meaning of the choice of this profession: humans by nature are storyteller and stories compel attention and promote reactions and retention. The qualitative analysis in VEDUTA is based on narrative free descriptions, which includes” a semi-structured “fairy tales”-
  • Zoom on narrativeThe goal of Project V.E.D.U.T.A. is understanding, throughstories, who are pain therapists, the level of committment,the living in their organization and what are the majorprofessional and personal issues they have to faceThanks to the stories, we can discover the deepestexperience, values ​and needs of the healthcareprofessionalsBy analyzing the stories, it will be also possible to findsome guidance for the organization of pain careservices.
  • Federdolore- Health Ministry SICD professionals of Health Pain SIAARTI Therapy ISALCittadinazAttiva ESRA
  • Project steps December 2011 Establishment of steering committeeSTEP 1 January 2012 Involvement of the scientific societiesSTEP January 2012 Definition of the sample 2-3 February 2012 Tools development March 2012STEP 4 Conducting the survey June 2012 Data analysis:STEP 5 June 2012 - writing reports July 2012 - share with steering committee Communication and disseminationSTEP 6 August 2012 October 2012 of the results
  • 340 pain therapist are still in areaching process all over ItalyThe data are collected in different ways:•Dissemination through mailing to 350 centersinvolved in pain therapy• Web Sites of Fondazione ISTUD, Federdolore-SICD,ESRA and SIAARTI•Local health care management of the centres wereinformed about the project.
  • The results which will originatefrom the study• a national map of the distribution of active centers that deal with pain therapy• a “climate test” of quality of life, and personal and organizational needs of the professional• a starting point for action planning which can support the professional and his/her health care organization
  • 43% of compliance on the italianterritory: 152 inyerviews and 66stories All regions have completed the online interviews Territorial answers 20,0% Answers 15,0% 10,0% 5,0% 0,0% piemonte veneto marche trentino abruzzo umbria sardegna toscana molise lombardia campania puglia valle friuli liguria lazio emilia calabria basilicata sicilia Regions
  • The 152 professionals72% Men, out of these, 28% filled in the story28 % Women, out of these 54% filled in the story57,51% with and 42% without coordination role
  • The village of caring of thepeople who sufferedOnce upon a time, there was a / an ............... that through a longjourney ........................... came to the village of care for peoplewho suffered ..........................................The country was on / in / nearThe..........................................................................In that country there were not only the people who weresuffering who came from .............. and were madeof.......................................... but there were also their belovedones around, and they were made of ............................................And then, in that country, all the others who had settled there totake care of those who needed, lived and were madeof ...................................................
  • The village of caring of thepeople who sufferedWhen .............. saw for the first time the faces ofpeople trying to care and thought that these faceswere .................................................................. .. Andthen looked at his hands and thought that those handswere ................. ...............................and thenlooked .................................. and listened to theirwords …………Then … decided /thought that he wouldbe staying in that country because it would ……..Buton an evil day it happened that…… But then ithappened also that …Now that country is …That country will be happy on condition…that
  • Short conclusion while the studyis running• Strong committment by the scientific societies to endorse both the quantitative and narrative part• In a mainly male population (as up to now) there might be a gender effect: women more able to free themselves through narrative• From a first reading from the stories there is full committment in terms of existential values against pain and suffering; “patientcentric” values and willing to achieve the bet possible therapy in patient management.• However, organizational complains about the difficulties of application of the law because paucity of resources… and culture not prepared yet: still a long journey to run
  • “Narrative Medicine fortifies clinical practice withthe narrative competence to recognize, absorb,metabolize, interpret, and be moved by the storiesof illness:… helps doctors, nurses, socialworkers, and therapists to improve theeffectiveness of care by developing thecapacity for attention, reflection, representation,and affiliation with patients and colleagues.” Rita Charon University of Columbia
  • A tribute to Hans ChristianAndersen: a genious of storytelling“When I tell a fairy tale or a story tochildren, I start to talk when adults arearound: the messages and the meaningsare not only for the children but muchmore for the grown up people”