Background and aim: Unplanned extubations (UE) are getting more and more relevant in Critical Care, becoming a quality and care safeness outcome. This happens because after an UE the patient can face some complications concerning the airway management, respiratory and hemodynamic problems, lengthen in the hospital stay and in the mechanical ventilation time. The aim of this review is identify and classify the factors that could increase UE risk. Methodology: A systematic review of scientific articles was performed consulting the databases PubMed, Cinahl, Medline, EBSCOhost and Google Scholar. Articles from 2006 to 2011 were included. Pediatric Care settings were excluded. Results: 21 articles were selected. From the results emerged that risk factors associated to the patient are widely controversial. Yet restlessness, a low level of sedation and a high level of consciousness seem to be highly related to UE. Organizational risk factors, as workload, nurse:patient ratio, and the use of interdisciplinary protocols seem to play an important role in UE. Conclusion: According the current literature, the research on UE still has to handle a wide uncertainty. There is the need for more studies developing conclusive evidences on the role of different risk factors. Anyway, literature highlights the importance of the nurse and of the healthcare system organization in reducing UE incidence.

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

Background and aim of the work: Palliative Care professionals are exposed to intense emotional environment. This puts them at risk for Compassion Fatigue and Burnout. The protective factors that can counter their onset are Compassion Satisfaction, Organizational Commitment and Resilience. Expressive Writing is a valid tool for adapting to traumatic events and enhancing psychological well-being. Aim of this study is to evaluate the effect of the Expressive Writing in Palliative Care professionals on Compassion Satisfaction, Organizational Commitment, Resilience, Compassion Fatigue and perceived distress. Methods: Prospective experimental study with experimental/control groups and pre/post measurements. 50 Palliative Care professionals were recruited in Northern and Central Italy. Participants filled: Organizational Commitment Questionnaire; ProQol - revision III; Resilience Scale for Adults; Impact of Event-Scale Revised; Emotion Thermometer; ad hoc questionnaire for the evaluation of protocol usefulness. Results: Wilcoxon test demonstrated change in Continuative Commitment (Z = -3.357, p = .001), anger (Z = -2.214, p = .027), sleep (Z = -2.268, p = .023), help (Z = -2.184, p = .029), intrusiveness (Z = -2.469, p = .014), hyperarousal (Z = -2.717, p = .007), and total IES (Z = -2.456 , p =, 014). Mann Whitney test showed a significantly lower score on post-test Intrusiveness in the experimental group (U = 202, p = .038). Conclusions: The Expressive Writing intervention was effective in improving organizational and emotional variables. Expressive Writing supports healthcare professionals in relieving the burden of traumatic episodes, ordering associated thoughts and emotions, and implementing a process of deep comprehension.

The roles of Case Managers, Care Managers and fledgling Case / Care Managers integrate clinical systems to achieve optimal patient outcomes through the coordinated use of the most appropriate clinical resources. Although the Case and Care Managers roles have been researched, there is still little evidence of the development of the Case / Care Manager in the Italian Healthcare System. Aim of this research is to investigate the perception of healthcare professionals of the implementation of the Case / Care Manager figure and how it operates . The study adopted a qualitative descriptive methodology with a phenomenological approach, using in-depth interviews. Participants (N = 21) were health professionals of multidisciplinary teams from several healthcare contexts in northern and central Italy, in which was activated a Case, Care, or Case / Care Manager role. The study was conducted in December 2020/ January 2021. Results. The themes showed a vision of the Case Manager, even a critical one, as a figure in transformation precisely from Case Management to Case / Care management. The themes underline how the Case / Care Manager represent a facilitator of clinical-therapeutic paths while acting as a reference figure, supporting the patient, his/her family and the multidisciplinary team. The results of the study confirm the Case / Care Manager as the health professional who deals with care pathways through an integrated, interdisciplinary and personalized approach, placing the person at the centre and thus overcoming a disease-centered approach.

The care of chronically ill and older adults affects families in terms of physical, emotional, relational, and social impact; the functioning of the family; and an alteration in family dynamics. This study aimed to evaluate the experiences of family caregivers of older patients in depth. A qualitative study was conducted, consisting of twenty-four narrative interviews with caregivers of chronically ill and older adults, consisting of twenty-three women and one man. The caregivers were all close relatives of the patients. The main results were as follows: (i) caregiving is predominantly performed by females; (ii) the caregiver experiences an ‘indirect’ illness; (iii) the family undergoes changes in roles, responsibilities, and relationships; (iv) support needs emerge, especially those of a social, family, work, and economic nature; and (v) resources are also activated, linked to the presence or absence of self-care. Illnesses directly impact the primary caregiver, but they also have repercussions on the entire family unit, which may activate coping strategies or lead to breakdown. It is crucial to accurately monitor the new family dynamics in order to find suitable solutions to support the family of chronically ill and older patients, underscoring the importance of work in this area.