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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, 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 and having to face Pain every day, there is an overexposure to human fragility and vulnerability.

• If fight against pain is a Human Right toward Dignity, to experience pain is in the Human condition.

Pain therapy

"The set of diagnostic and therapeutic interventions designed to identify and apply to chronical diseases suitable and appropriate drug therapies, surgical instruments, and psychological rehabilitation, variously integrated with each other 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

““ Palliative 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 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 from different specialities and different realities (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“

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

Our VEDUTA project: not only digits but also stories

• The quantitative variables are assessed by means of demographic data, a job description, the team organization and workload, the relationship with the patients, the 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 people 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, what is 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 associations

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 scientific societies involved in pain therapy

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

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 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 and 66 storiesAll 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 professionals72% Men, out of these, 28% filled in the story 28 % Women, out of these 54% filled in the

story

Professionals

doctors anesthesist

96%

nurse2%

physiotherapist2%

doctors anesthesist

nurse

physiotherapist

Once upon a time, there was a / an ............... that through a long journey ........................... came to the village of care for people suffering from ..........................................The country was on / in / near Th..........................................................................In that country there were not only the people who were suffering who came from .............. and were made of.......................................... but there were also their loved ones around and they were made of ............................................ And then, in that country, all the others lived who had settled there to take care of those who needed it and were made of ................................................... 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 an evil day it happened that…… But then it happened also that …Now that country is …That country will be happy on condition…that

Short conclusion while the study is running

• Strong committment by the scientific societies to endorse bith the quantitative and narrative part

• In a mainly male population (as up to now) there might be a gender effect on freeing oneselve using the narrative tool

• From a first reading from the stories there is full committment in terms of existential values against pain and suffering, however, between the lines there are complains about the difficulties of the law because paucity of resources… 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