ww

w.fo

nda

zio

ne

istu

d.it

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)

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 fight against 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 therapeutic interventions designed to identify and apply to chronic diseases suitable and appropriate drug therapies, surgical instruments, and psychological rehabilitation, variously integrated , in order to develop appropriate diagnostic and therapeutic pathways for suppression and pain management “

Another Italian and Mediterranean Pain

The Economist, March 2012

In Italy; despite the crisis a profound change is warranted through the Italian law 38/2010

alliative care and pain management are priority objectives of the National Health Plan. [...] in order to ensure respect for the dignity and autonomy of the human person, health needs, equity in access, quality of care and their appropriateness regarding specific requirements.

The Minister of Health [...] defines the minimum requirements [...] to the terminally ill and palliative care units and pain therapy home care in each region, in order to define the network palliative care for pain management, [...], at a staffing plan of care appropriate to the needs of the resident population and an adequate supply of professionals with specific skills and experience in the field of palliative care and pain therapy, even with regard to family support.

The competence requested for being 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 identity

Pain therapists originates mainly from anesthesists and they are organized in different care setting (working groups, hospitals...)

Their function is to “serve” accross the hospital and other health care department: there are few centers which deal specifically with the treatment of pain

Difficulties in developing collective professional identity and building a network

The importance of the pain therapist 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 organizationalneeds

• 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 can catch what questionnaires don’t catch• 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 narrative

The goal of Project V.E.D.U.T.A. is understanding, through stories, who are pain therapists, the level of committment, the living in their organization and what are the major professional and personal issues they have to face

Thanks to the stories, we can discover the deepest experience, values and needs of the healthcare professionals

By analyzing the stories, it will be also possible to find some guidance for the organization of pain care services.

Ministryof Health

CittadinazAttiva

Federdolore-SICDHealth

professionals

ESRA

Pain Therapy

ISAL

SIAARTI

Project steps

STEP 1 Establishment of steering committee

Involvement of the scientific societies

December 2011January 2012

Definition of the sample Tools development

STEP 2-3

STEP 4

STEP 5

STEP 6

January 2012February 2012

March 2012 June 2012

June 2012July 2012

August 2012October 2012

Conducting the survey

Data analysis:- writing reports- share with steering committee

Communication and dissemination

of the results

340 pain therapist are still in a reaching process all over Italy

The data are collected in different ways:

•Dissemination through mailing to 350 centers involved in pain therapy

• Web Sites of Fondazione ISTUD, Federdolore-SICD, ESRA and SIAARTI

•Local health care management of the centres were informed about the project.

The results which will originate from 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 italian territory: 152 inyerviews and 66 stories

All regions have completed the online interviews

Territorial answers

0,0%

5,0%

10,0%

15,0%

20,0%

abruzzo

basilicata

calabria

campania

emilia

lazio

liguria

lombardia

marche

molise

piem

onte

puglia

sardegna

trentin

o

valle

veneto

friuli

sicilia

umbria

toscana

Regions

Ans

wer

s

The 152 professionals

72% Men, out of these, 28% filled in the story

28 % Women, out of these 54% filled in the story

57,51% with and 42% without coordination role

Once upon a time, there was a / an ............... that through a long journey ........................... came to the village of care for people who suffered ..........................................The country was on / in / near The..........................................................................In that country there were not only the people who were suffering who came from .............. and were made of.......................................... but there were also their beloved ones around, and they were made of ............................................ And then, in that country, all the others who had settled there to take care of those who needed, lived and were made of ...................................................

The village of caring of the people who suffered

When .............. saw for the first time the faces of people trying to care and thought that these faces were .................................................................. .. And then looked at his hands and thought that those hands were ................. ...............................and then looked .................................. and listened to their words …………Then … decided /thought that he would be staying in that country because it would ……..But on an evil day it happened that…… But then it happened also that …Now that country is …That country will be happy on condition…that

The village of caring of the people who suffered

Short conclusion while the study is 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 with the narrative competence to recognize, absorb, metabolize, interpret, and be moved by the stories of illness:… helps doctors, nurses, social workers, and therapists to improve the effectiveness of care by developing the capacity for attention, reflection, representation, and affiliation with patients and colleagues.”

Rita CharonUniversity of Columbia

A tribute to Hans Christian Andersen: a genious of story telling

“When I tell a fairy tale or a story to children, I start to talk when adults are around: the messages and the meanings are not only for the children but much more for the grown up people”