L’infermiere e la percezione del Moral Distress nella cura del fine vita nel paziente dializzato

The phenomenon of Moral Distress in nursing practice is described as a situation of suffering that arises when the nurse recognizes the ethically appropriate action to be taken and yet institutional impediments make it impossible for him to follow the right course of action. Dialysis patients often have a complex disease trajectory that sometimes involves professional and emotional challenges for staff, especially at the end of life. The objective of this review is to identify which strategies are useful for preserving emotional integrity and awareness in operational settings, for the benefit of both operators and patients.

È possibile una gestione “ideale” della pandemia da malattia renale cronica?

Chronic Kidney Disease (CKD) is recognized as one of the major categories of noncommunicable epidemic diseases and in the last decades it has been largely growing in incidence and prevalence all over the world. Ideal management of CKD pandemic should be comprehensive of measures of tertiary, secondary, primary and primordial prevention. So, it should include prompt diagnosis and treatment of traditional and non-traditional risk factors for CKD, optimal conservative treatment for non-dialysis dependent CKD patients and appropriated dialysis therapy or renal transplantation for patients with end-stage renal disease. However, these goals are not easy to obtain on a global scale. It would be possible only by a broad and holistic approach, ranging from good governance to achievement of the sustainable development goals (SDGs).

Erratum in ”Medicazione a base d’argento nella gestione dell’emergenza cutanea”

In the article "Silver dressing in cutaneous emergency management” published in Vol. 33, n. 1 of Giornale di Clinica Nefrologica e Dialisi, the number of patients included in the study, as well as the number of patients with positve outcome, were incorrectly reported respectively in the "Methods" and "Results" section of the abstract. These data have been corrected in the final version available online. We apologize with our readers for this inconvenience, which does not affect the results presented in the study.

Le nuove abitudini e il paradosso evolutivo

Human evolution lasting millennia has allowed us to develop mechanisms in physiology capable of defending ourselves from the main difficulties. We can accumulate fat as a reserve, and we have acute inflammation as a response to pathogens and platelets to defend us from bleeding, but precisely the main defenses are now transformed due to the changed living conditions of part of humanity into potential enemies, creating a very dangerous paradox.

Metodologia e produzione delle Linee Guida

This article has the aim of informing the reader about methodology and production of Clinical Practice Guidelines (CPG) and the instruments in order to be able to approach the whole process, from the production to the publication and distribution, but also to updated CPG. The importance of the issue is given by: 1) the need to avoid the CPG duplication, which is the reason of waste of resources and that raises confusion among users; 2) the need to ensure the independence of the experts involved and without conflict of interests; 3) the use of methodologies that respect the best quality standards; 4) the inhomogeneity of healthcare processes in the Italian territory and practices not based on scientific evidences; 5) the consultation and the commentary of stakeholders on the recommendations produced.

Il Chronic Care Model

In recent years, the incidence rate of chronic diseases shows a steady increase in every industrialized Country. The almost logarithmic trend of the number of people living with chronic diseases is constantly on the rise. Each predictive statistical model indicates a strong impact for national health systems at the level of the organization of care and management costs. It is urgent to systematically introduce an evidence-based care model in chronic care management such as the Chronic Care Model. The Chronic Care Model is the reference model for WHO. The Chronic Care Model allows for personalized, holistic, multi-professional assistance, characterized by a strong humanization of care, by preventive interventions and relationships between healthcare professionals, patients and caregivers as a system of care and assistance. The fundamental roles are social integration and the improvement of the quality of life of patients. The Chronic Care Model involves the use of a computerized system of information flow and telemedicine and trained healthcare professionals. The Chronic Care Model showed an improvement in the quality of life, a reduction in the number of hospitalizations, a better adherence to therapies, and a reduction in costs.

Presa in carico infermieristica nella Malattia Renale Cronica

n 2017, thanks to an initiative of IPASVI College (the Order of Nursing Professionals of the province of Bologna) in response to 2014 legislations referring to the Guidelines about Chronic Kidney Disease (CKD), nephrology professionals and members of EDTNA/ERCA Italian Branch Association (which in 2018 became Società Infermieri Area Nefrologica, SIAN) in 2021 were requested to contribute to define the role and skills performed by nurses on a daily basis. The management of the CKD patient has been structured into 7 phases: the model for each phase takes into consideration the professionals involved, the care settings and the tools used. To support this approach, we decided to introduce two elements which broaden the clinical and care approach to the patient and at the same time highlight the contribution of nursing professionals, with a referring workflow for the CKD patient, the nurses’ role and skills required throughout the patient’s journey. Furthermore, to ensure the best continuity of care, we believe that it is necessary to apply a logical model based on the principles of early recognition of health and welfare needs; guarantee the most appropriate healthcare response; ensure early care; standardize the procedures of professionals to improve the quality of life of the patient and manage the social and economic impact.