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Purpose: A routine preoperative assessment is considered both ineffective and inefficient. Despite the widespread application of lean thinking in healthcare, there is little evidence of successful experiences in preoperative admissions in order to reduce "No value added" activities. A conceptual framework reporting the drivers (clinic, tools, innovation, organization, and governance) and impacts (patient, efficiency, sustainability, time, learning and growth) was developed. Methodology: Drawing on the experience of an Italian high complexity hospital, this paper analyzes the case study by reporting evidence on how to implement lean in preoperative assessment and how to evaluate the positive results obtained. Results: Applying lean principles, the identification of value improved the appropriateness of care by creating 40 personalized pathways; the value stream resulted in a reduction of "No Value Added Time" from 37% to 28%, chest X-rays from 41% to 14% and cardiac visits from 49% to 37%; the pursuit of continuous flow through innovation contributed to increase the use of digitalization; the new pull organization helped to reduce the average time spent per year by 1.5 h; the continuous improvement was ensured through the governance of results. Conclusion: The proposed framework should be used to improve the quality of care in preoperative admissions by adopting the lean drivers for successful implementation and reporting the impacts. [ABSTRACT FROM AUTHOR]

This paper draws on two experiences of undertaking comparative research in England, Sweden and Italy, and offers a discussion of the kinds of dilemmas raised in relation to language and meaning surfaced by these. Its primary focus is to examine the reflexive construction of meaning, both in relation generally to the workings of an international research team and, more specifically, how such construction of meaning impacts on the process of qualitative interviewing across linguistic and cultural boundaries. The article argues that a culture of reflexive research practice is helpful for approaching national differences, to facilitate understanding in internationally mixed research teams and to support and empower participants in research, in second languages and differing cultures. Overall, the paper attempts to advance some tentative ideas that other international researchers may be able to consider and deploy in relation to their own research ambitions. [ABSTRACT FROM AUTHOR]

This article uses a life-course approach to investigate how and why migrants' feelings of belonging change between childhood and young adulthood. Drawing on 24 in-depth retrospective interviews with young Romanian migrants who moved to Italy as children, the paper shows how young migrants' belonging is shaped by the nature of social relations and by the level of acceptance or exclusion expressed by others in the receiving and origin countries, under specific institutional and socioeconomic contexts. Overall, the study demonstrates how life-course methodologies are an essential tool to capture the dynamic, changing nature of belonging. [ABSTRACT FROM AUTHOR]

Within the past several years, a considerable body of research on adherence to diabetes regimen has emerged in public health. However, the focus of the vast majority of these studies has been on the individual traits and attitudes affecting adherence. Still little is known on the role of the social and physical context in supporting or hindering diabetes self-management, particularly from a qualitative standpoint. To address these limitations, this paper presents the findings of a Photovoice study on a sample of 10 type 2 diabetic older adults living in a deprived neighbourhood of an Italian city. The findings reveal that the possibility to engage in diet, exercise and blood sugar monitoring seems to be more affected by physical and social elements of the respondents' environment than by the interviewees' beliefs and attitudes. Both environmental barriers and social isolation emerge as barriers to lifestyle changes and self-care activities related to blood sugar monitoring. The predominance of bonding social capital, the scant level of trust and the negative perception of local health services result in a low level of social cohesion, a limited circulation of health information on diabetes management and, consequently, in poor health outcomes. [ABSTRACT FROM AUTHOR]

Geography and the graphic image have a long, intertwined history of exchange. In recent scholarship, the graphic image plays an important role in geography's creative (re)turn and geographers are experimenting with new visual languages and creative practices to carry out research and communicate with wider audiences. This paper explores geography as a 'graphic' discipline that represents and produces spatial knowledge by experimenting with scribing, a verbo-visual technique. In the first part of the article, we propose an auto-ethnographic account of a residential seminar with students in Local and Sustainable Territorial Development, held in 2017 at the Po Delta (Italy), where we experimented with scribing as a tool for geographical fieldwork and spatial storytelling, understanding it as a practice for seeing beyond representing territories. The second more theoretical part of the paper presents scribing as a means to respond to the increasing need for more creative visualisation tools in qualitative research and highlights the performative potential of scribing as a practice/product for thinking about space. The graphic product of scribing results from an intersubjective dialogue and is used to develop spatial analyses and disseminate geographical research beyond academic boundaries, engaging non-expert audiences and local communities. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to advance a model to assess the overall level of well-being within healthcare organizations. Design/methodology/approach: The paper employs a job demands-resources approach by considering the multilevel model of employee well-being as theoretical framework, integrated with personal resources and health indicators. A specific case is built in the Italian context, with empirical data gathered from three Italian paediatric hospitals belonging to the same healthcare organizations. Findings: Results show that the job demand-resource model may well explain differences in the work environment, and that personality enables coping with negative effects of work environment settings. Originality/value. The paper contributes to extending the literature on well-being and the management of healthcare organizations, by providing interesting insights on the multilevel model of employee well-being. It also has interesting academic and practical implications, since it tries to put forward a model to assess employee well-being and provides an empirical application of a well-known theoretical model. [ABSTRACT FROM AUTHOR]

Actions to counter violence against women are a fully fledged policy field with significant differences across countries. Through a comparative analysis of Spain and Italy, this article maps the interplay between women's movements and national governments in launching violence against women (VAW) policies. In Spain, policy formation was the outcome of dual feminist–socialist activism, leading to dialogue between movements and the government. In Italy, movements opposed the government from the outside. In both countries, the critical factor inciting responsiveness on VAW was not one single variable but a combination of political opportunity, movement identity, dedicated women's policy agencies, and the soft power of international institutions. [ABSTRACT FROM AUTHOR]

Healthcare organizations worldwide face challenges in retaining their healthcare workforce, with individual and organizational factors influencing their intentions to leave. This study conducted eight online co-creation workshops and four Delphi sessions to gain qualitative and in-depth insights into job retention interventions, involving healthcare workers, hospital managers, and policymakers. A thematic analysis was conducted, resulting in multiple interventions that were clustered in four pre-defined themes: professional and personal support, education, financial incentives, and regulatory measures. Professional and personal support interventions included regular interprofessional team meetings, leadership training programs, self-scheduling and sabbaticals, support for administrative and non-clinical work, and the provision of psychological counselling. Educational interventions encompassed facilitating development opportunities, periodic evaluations, onboarding, mentorship programs, and peer support groups. Financial incentives included the provision of competitive salaries, adequate infrastructure, extra benefits, transport possibilities, and permanent employment contracts. Regulatory measures addressed the need for complementary legislation across various levels, fixed healthcare worker-to-patient ratio, and instruments to monitor workload. To optimize retention strategies, healthcare organizations should tailor these interventions to address the unique factors influencing their workforce's intentions to leave within their specific context. The study concludes that combining personal and professional support, educational opportunities, financial incentives, and regulatory measures is necessary because there is no one-size-fits-all solution. [ABSTRACT FROM AUTHOR]

This article analyses the implications of qualitative research on migration in terms of reflexivity and positionality. In particular, it presents research as care, revolved around three main critical nodes of reflection: the epistemological importance of emotions, intersectional positionality and the ethics of care. Drawing upon the insights concerning a qualitative research on migration in Italian shrinking areas, the contribution underlines the importance of conceiving research as a process of negotiation. Moreover, it shows how positionality in qualitative migration research is not static but flexible, and is conditioned by different emotionalities emerging during the fieldwork. In this sense, the continuous negotiation that exists between researchers and participants can imply affectivities and kinship that valorises the relationships created during the research. [ABSTRACT FROM AUTHOR]

Summary: Although the literature is rich in contributions analyzing the role of social workers in sports, there remains a lack of empirical research with respect to how these workers can be determinant in the development of inclusion outcomes in sports-driven interventions targeting socially vulnerable youth. The investigation analyzes the case of a sports-based program run by an Italian non-profit organization (NGO) from an ecological system perspective. Data from interviews and focus groups with youth involved in the program (21), parents (15), sport coaches (9), and the social workers of the NGO (15) were triangulated with the aim of exploring how social workers promoted inclusion through sport. Data were analyzed in a top–down thematic analysis. Findings: Social workers promoted many social inclusion outcomes: (1) they linked sport clubs with the youth excluded from the sport system, thus sustaining access to sport; (2) they emotionally supported youth and their families in the program, fostering the relational dimension of social inclusion; (3) they formed alliances between the diverse systems of youth life, enhancing youth capacity to overcome their personal challenges in sports; and (4) they encouraged the integration of people coming from different socio-economic backgrounds within the sport context. Applications: The case informs the practice of social workers in sport-driven interventions providing insights around the tasks they should achieve to promote social inclusion, including (1) recruitment of youth excluded from the sport system and linkage with sport clubs, (2) sport bureaucracy support, and (3) dialogue with diverse youth life systems. [ABSTRACT FROM AUTHOR]

Background: Italy was the first European country to be involved with the COVID-19 pandemic. As a result, many healthcare professionals were deployed and suddenly faced end-of-life care management and its challenges. Aims: To understand the experiences of palliative care professionals deployed in supporting emergency and critical care staff during the COVID-19 first and second pandemic waves. Research design: A qualitative descriptive design was adopted, and in-depth interviews were used to investigate and analyse participants' perceptions and points of view. Participants and research context: Twenty-four healthcare professionals (physicians, nurses, psychologists, physiotherapists, and spiritual support) from the most affected areas of Italy were recruited via the Italian society of palliative care and researchers' network. Ethical considerations: The University Institutional Board granted ethical approval. Participants gave written informed consent and agreed to be video-recorded. Findings: The overarching theme highlighted participants' experience supporting health professionals to negotiate ethical complexity in end-of-life care. Crucial topics that emerged within themes were: training emergency department professionals on ethical dimensions of palliative and end-of-life care, preserving dying patients' dignity and developing ethical competence in managing end-of-life care. Conclusions: Our study showed palliative care teams' challenges in supporting health professionals' ethical awareness in emergencies. However, while they highlighted their concerns in dealing with the emergency staff's lack of ethical perspectives, they also reported the positive impact of an ethically-informed palliative care approach. Lastly, this study illuminates how palliative care professionals' clinical and ethical competence might have assisted a cultural change in caring for dying patients during COVID-19 and future emergencies. [ABSTRACT FROM AUTHOR]

Recently health care (HC) organizations have increasingly embarked on organizational climate (OC) assessment with the intent to improve their efficiency and the quality of the delivered services. This is important; however, it is even if more crucial to ensure that workers engaged in the evaluation process are aware of the importance of their fruitful engagement in this investigation as well as of its potential benefits. From the management viewpoint, this is crucial to plan and implement management initiatives able to create a great place to work. The purpose of this paper is to shed empirical light on how, in effect, HC workers perceive OC for itself and as a performance driver to assess and manage. The study was carried out through an action research (AR) project, which included the use of both qualitative and quantitative approaches. Key phases of the AR project were some focus groups and a survey. During the focus groups, several methods and approaches were adopted for getting opinions from people and animating discussion. About the survey, a total sample of 560 HC workers was investigated. The AR project has shown that even if HC workers intuitively conceive OC as an important performance driver, the meaning of the construct is not completely clear. Moreover, a good level of awareness among HC workers about how and why OC can improve individual and organizational performance represents a key issue to address in evaluating and managing OC. [ABSTRACT FROM PUBLISHER]

The Caregiver Skills Training programme is an evidence-informed group intervention developed by the World Health Organization to counter the treatment gap for neurodevelopmental disorders in children. We examined feasibility and acceptability of Caregiver Skills Training in public child neuropsychiatry services in Italy. Following a formative adaptation process and a pre-pilot implementation, the programme was piloted in six centres. Caregivers of children (2–5 years) with autism spectrum disorder were randomised to either Caregiver Skills Training (n = 43) or treatment as usual (n = 43). Professionals' and caregivers' experiences in the treatment arm were examined with focus groups and questionnaires. The programme was largely considered acceptable, relevant and feasible. Specific implementation challenges and suggestions for optimising the package are discussed. Across the globe, children with neurodevelopmental disorders, including autism, have limited access to care through public services. To improve access to care the World Health Organization developed a novel, open-access programme: the Caregiver Skills Training programme. The Caregiver Skills Training consists of nine group sessions and three individual home visits, focused on training the caregiver on how to use everyday play and home routines as opportunities for learning and development. We implemented Caregiver Skills Training in public child neuropsychiatry services in Italy and examined with questionnaires and focus groups how feasible it was to deliver the programme in public health settings and how acceptable and relevant it was for caregiver users. We found that the Caregiver Skills Training was largely considered acceptable and relevant for families and feasible to deliver. We discuss potential solutions to address the specific implementation challenges that were identified, such as strategies to improve training of interventionists and overcome barriers to caregiver participation. [ABSTRACT FROM AUTHOR]

Evidence of sexual violence against men and boys in many conflict-affected settings is increasingly recognized. Yet relatively little is currently known about the varied forms, sites, and impacts of this violence. Further, scant research on sexual violence against men and boys in displacement contexts has been undertaken to date. To begin to address these knowledge gaps, we undertook a multicountry, qualitative, exploratory study to gain insights into these issues. Study settings and populations were Rohingya refugees in Bangladesh; refugees and migrants who had traveled through Libya residing in Italy; and refugees from eastern Democratic Republic of the Congo (DRC), Somalia, and South Sudan residing in Nairobi and Mombasa, Kenya. Methods included 55 semi-structured focus group discussions with 310 refugees and semi-structured key informant interviews with 148 aid workers and human rights experts. Data were thematically analyzed using NVivo 12. Findings suggest that sexual violence against men and boys may not be rare in Myanmar (northern Rakhine state), Libya, eastern DRC, and South Sudan. Frequently reported forms of violence in these settings were genital violence, forced witnessing of sexual violence, and rape. Sites where violence was often reported included border crossings, along the roadside, and during imprisonment. In host countries, forms of sexual violence included sexual abuse of boys, sexual exploitation particularly of adolescents and persons with diverse sexual orientation and gender identity, and rape. Impacts on survivors involved short- and long-term physical, mental, economic, and familial dimensions. These findings aim to inform sexual violence-related prevention, mitigation, and response efforts in humanitarian settings. More research is warranted, including on sexual violence against men and boys in Somalia, sexual violence by family and community members in conflict and displacement settings, sexual exploitation of adolescent boys, and sexual violence including sexual exploitation of persons with diverse sexual orientation and gender identity. [ABSTRACT FROM AUTHOR]

Background: Despite the extensive research and intense debate on coercion in psychiatry we have seen in recent years, little is still known about formally voluntarily admitted patients, who experience high levels of perceived coercion during their admission to a psychiatric hospital. Aims: The purpose of the present research was to explore forms of treatment pressure put on patients, not only by clinicians, but also by patients' relatives, during admission to psychiatric hospitals in Italy, Poland and the United Kingdom. Methods: Data were obtained via in-depth, semi-structured interviews with patients (N = 108) diagnosed with various mental disorders (ICD-10: F20–F49) hospitalised in psychiatric inpatient wards. Maximum variation sampling was applied to ensure the inclusion of patients with different socio-demographic and clinical characteristics. The study applied a common methodology to secure comparability and consistency across participating countries. The qualitative data from each country were transcribed verbatim, coded and subjected to theoretical thematic analysis. Results: The results of the analysis confirm that the legal classifications of involuntary and voluntary hospitalisation do not capture the fundamental distinctions between patients who are and are not coerced into treatment. Our findings show that the level of perceived coercion in voluntary patients ranges from 'persuasion' and 'interpersonal leverage' (categorised as treatment pressures) to 'threat', 'someone else's decisions' and 'violence' (categorised as informal coercion). Conclusion: We suggest that the term 'treatment pressures' be applied to techniques for convincing patients to follow a suggested course of treatment by offering advice and support in getting professional help, as well as using emotional arguments based on the personal relationship with the patient. In turn, we propose to reserve the term 'informal coercion' to describe practices for pressuring patients into treatment by threatening them, by making them believe that they have no choice, and by taking away their power to make autonomous decisions. [ABSTRACT FROM AUTHOR]

Background: Home palliative care services have played an essential role during the first wave of the SARS-CoV-2 outbreak by providing symptom control, drug procurement, and psychological support for frail patients and their families unable to leave their homes. Aim: To understand how home palliative care professionals were affected by the outbreak, describing changes and challenges in their daily work as well as their reactions to the Covid-19 pandemic in Italy. Design: Qualitative study conducted using telephone semi-structured interviews, with thematic analysis. Setting/participants: Thirty home care professionals working for an Italian non-profit organization which provides home palliative care for cancer patients and their families. Results: Three main themes were identified. The first theme showed both patient-related and practice-related challenges participants faced in their daily work, requiring the implementation of different communication methods and patient and family education on risk prevention. The second theme showed the perception of increased responsibility and being the only landmark for family played a decisive role in participants' positive attitude. The third theme highlighted the participants' perception of the critical role of a home care setting in this emergency situation. Conclusions: The first wave of the Covid-19 pandemic brought many challenges and stressors for home palliative care professionals. On the other side, they reported a satisfaction with their critical role in carrying out their work with patients at risk. [ABSTRACT FROM AUTHOR]

Background: Advance care planning and advance directives play a key role in the care of life-threatening illnesses such as amyotrophic lateral sclerosis. Aim: The aim of the present study is to explore how the introduction of these features by law improves the experience of end-of-life care. Design: Five focus groups were conducted in Italy 1 year after the new law on advance directives was introduced. Setting/Participants: Purposive sampling was used to recruit 24 health professionals and 23 family caregivers of patients with amyotrophic lateral sclerosis, for a total of 47 participants. Results: The thematic analysis, conducted through the use of ATLAS.ti software, identified four thematic areas: best practices, managing difficulties, care relationships and proposals. The results indicated a lack of organization, collaboration and continuity on the part of healthcare services and professionals, a lack of information on palliative care, advance care planning, and advance directives. End-of-life care is often left to the good will of the individual professional. Difficulties can also derive from ethical dilemmas concerning end-of-life decision-making and from a lack of communication and relationships between health professionals, patients and their families. Conclusion: The introduction of advance directives by law has not been sufficient to improve end-of-life care. In order to make legal regulation effective, the organization of healthcare services needs to be improved and clearer procedures have to be implemented and shared with patients and families. [ABSTRACT FROM AUTHOR]

This qualitative study analyses the social representations of health, illness and care, considering the similarities and differences between 30 nurses from different regions. We conducted three intra-ethnic focus groups and two inter-ethnic focus groups. This study shows similarities between the nurses' representations. All participants believed that the psychological sphere affects individual's health, that disease is an imbalance between physical and psychological factors and that interpersonal aspects are essential for care. Differences emerged regarding many facets. Eastern European nurses placed more importance on psychological aspects, South American nurses emphasised interpersonal relationships and Italian nurses focused their attention on economic aspects and their impact on health, illness and care. [ABSTRACT FROM AUTHOR]

Purpose: Older Italian migrants in Australia are a vulnerable group, with high rates of type 2 diabetes and low levels of English language proficiency. The project explored the experience of living with diabetes and factors that facilitated or inhibited access to diabetes services. Method: Focus groups were conducted in Italian with 13 participants with type 2 diabetes, aged 68 to 85 years. Results: Findings indicate five main themes, including (a) the value of health, (b) the impact of diabetes, (c) making changes, (d) managing diabetes, and (e) access to information and services. Conclusion: The social context of food, presented the greatest impediment to successful diabetes self-management for this group of older Italian migrants. Participants identified a need for greater community engagement and education. Implications for Practice: A need for greater access to interpreters and information in Italian was identified. Counselling services may be necessary for this group. [ABSTRACT FROM AUTHOR]

Background: Stakeholders are people with an interest in a topic. Internationally, stakeholder involvement in palliative care research and health technology assessment requires development. Stakeholder involvement adds value throughout research (from prioritising topics to disseminating findings). Philosophies and understandings about the best ways to involve stakeholders in research differ internationally. Stakeholder involvement took place in seven countries (England, Germany, Italy, Lithuania, the Netherlands, Norway and Poland). Findings informed a project that developed concepts and methods for health technology assessment and applied these to evaluate models of palliative care service delivery. Aims: To report on stakeholder involvement in the INTEGRATE-HTA project and how issues identified informed project development. Design: Using stakeholder consultation or a qualitative research design, as appropriate locally, stakeholders in seven countries acted as 'advisors' to aid researchers' decision making. Thematic analysis was used to identify key issues across countries. Setting/participants: A total of 132 stakeholders (82 professionals and 50 'lay' people) aged ≥18 participated in individual face-to-face or telephone interviews, consultation meetings or focus groups. Results: Different stakeholder involvement methods were used successfully to identify key issues in palliative care. A total of 23 issues common to three or more countries informed decisions about the intervention and comparator of interest, sub questions and specific assessments within the health technology assessment. Conclusion: Stakeholders, including patients and families undergoing palliative care, can inform project decision making using various involvement methods according to the local context. Researchers should consider local understandings about stakeholder involvement as views of appropriate and feasible methods vary. Methods for stakeholder involvement, especially consultation, need further development. [ABSTRACT FROM AUTHOR]

The concept of political parallelism identifies the different forms in which the media and politics can interact. However, media partisanship has always been almost exclusively limited to news media. This study shows that the Italian media system is at the center of a significant change, in regard to the way in which mass media political parallelism works and develops. Due to structural reasons, Italy’s political parallelism crosses the threshold of the news media and seems to fully apply to popular media as well. The politicization of popular media has been investigated through a content analysis of the Berlusconi-owned Chi (the most read magazine in Italy with 3.5 million readers on average). By proposing four models of coverage, the authors will show that the coverage strategies put in place by Chi convey the extent to which the covered subjects are politically and personally close to the undisputed leader, Berlusconi. [ABSTRACT FROM AUTHOR]

The article presents a qualitative study on health professionals' concerns regarding the Liverpool Care of the Dying Pathway (LCP-I). Topics discussed include end-of-life care, the Consolidated Criteria for Reporting Qualitative Research (COREQ), and educational and professional background of hospital healthcare staff.