The Italian Validation of the Healthcare Professional Humanization Scale for Nursing

Purpose: The Healthcare Professional Humanization Scale (HUMAS) is a measure of the evaluation of the humanization of care in nursing professions. Despite being validated for the Spanish language, there still needed validation in Italian, which seems essential considering the cultural differences. Aim: We aimed to test the validity and reliability of the HUMAS with an Italian sample of registered nurses. Methods: The present study used cross-sectional data from 300 nurses that completed the survey. The study's main phases were (a) construction of the Italian version; (b) testing and analyzing the psychometric properties of the scale. The exploratory factor analysis and the Content Validity Index (CVI) were performed. Cronbach's alpha and test-retest were used to determine the reliability. Findings: The final Italian version of HUMAS (HUMAS-I) comprised 19 items grouped into five correlated latent factors, accounting for 68.4% of the variance. Additionally, it exhibited a satisfactory Cronbach's alpha for each latent component and an average CVI for the entire scale of 0.68. Conclusions: The HUMAS-I shows acceptable psychometric proprieties as the original Spanish version. Therefore, it could be an advantageous instrument for use in nursing practice and research.

FEASIBILITY STUDY FOR THE IMPLEMENTATION OF THE SEE AND TREAT PATHWAY IN THE EMERGENCY DEPARTMENT OF SAN CAMILLO-FORLANINI HOSPITAL

Introduction: To date, Emergency Department overcrowding represents one of the most important problems regarding the organisation of emergency healthcare. See and Treat was devised in England around the 1980s to provide an effective solution to the overcrowding issue. The Emergency Nurse Practitioner indicates a faster pathway in selected patients with certain characteristics. This model translates into a reduction in waiting times while maintaining the same quality of care. Aim: To evaluate the potential benefits for patients of the implementation of the See and Treat model within the Emergency Department. Materials and Methods: Using the GIPSE system, all Emergency Department entries from 2019 have been selected. Minor codes in the triage phase have been considered, as well as those potentially falling within the See and Treat protocol. Each included case has been associated to a See and Treat diagnosis. The waiting time and the time spent in the Emergency Department were derived from the data collected. Results: 9.41% of the sample is eligible for the See and Treat method, with an average waiting time of one hour and peaks of almost 4 hours for white codes. The application of the See and Treat model to the population covered by our study would reduce the waiting times at the Emergency Department by 6.99%, reduce the simultaneous presence of users on the Emergency Department by 8.88% and reduce the stay for other minor codes by 4.38%. Discussion: The percentage of patients treatable in the See and Treat system (11%) is in line with the Tuscany trial but statistically lower than the international context (from 63% to 90%). The results obtained from this study showed the significant impact that the See and Treat model could have on reducing overcrowding, positively affecting both users and staff.

Pain Prevalence in two Italian Hospitals. An observational study

INTRODUCTION

Pain is the most common and distressing medical symptom in hospitalized patients in all wards. Pain prevalence among hospitalized patients is an indicator of the quality of health care.

OBJECTIVE

The aim of this study is to describe pain prevalence in two Italian hospitals.

MATERIAL AND METHOD

This is an observational study. It involved hospitalized patients of both sexes, able and unable to self-report. Descriptive analysis and multivariate analysis were applied.

RESULTS

A sample of 754 inpatients were included. In Terni Ho-spital (n = 255), pain prevalence was 80.8%. The mean pain severity was 5.2 (sd ± 3.33). At Rome's San Camillo Hospital (n=499), pain prevalence was 46.9%. Acute pain is more prevalent in women (OR= 0.65; CI 95% 0.43-0.99) and increases with age (OR= 0.97; CI 95% 0.96-0.99). Chronic pain is more prevalent in men (OR= 2.34; CI 95% 1.41-3.97) and increases with age (OR= 1.04; CI 95% 1.03-1.06).

DISCUSSION AND CONCLUSION.

San Camillo Hospital presents data showing reduced pain prevalence, and describing pain even in patients unable to self-report. It is reasonable to believe that pain control by the staff at San Camillo is better, even though both hospitals are equally important regional institutions.

Predictors of nurses' attitudes and knowledge towards pain management in Italy. A cross-sectional study in the hospital settings

INTRODUCTION

Pain is multidimensional, and as such it is the chief reason patients require urgent health care services. If inadequately assessed and untreated, pain may negatively impact on the quality of life of the patient. Pain management is an essential part of Nursing. The aim to this study is to examine the level of knowledge and attitudes with regard to pain among Italian nurses who work in clinical settings.

METHODS

The Ferrell and McCaffery's Knowledge and Attitudes Survey Regarding Pain was distributed to 266 nurses employed in one specialized hospital in Rome, Italy. The staff in the survey work in three different settings: the intensive care unit, the sub-intensive care unit, and an ordinary ward. Descriptive statistics were employed and a logistic regression model was performed to evaluate the factors that may influence the attitude and knowledge of care providers.

RESULTS

49.6% of the sample correctly answered items about attitudes, 47.4% about knowledge, and 36.5% about assessment. The results show that the odds ratio of developing positive attitudes towards pain was 1.76 times higher in nurses employed in the sub-intensive care unit than in other settings. There are no statistically significant associations of knowledge between setting, sex or education.

CONCLUSIONS

Our survey revealed a limited overall level of knowledge and attitudes with regards to pain management among nurses. Implementing specific training for health professionals, starting with academic education, is therefore a priority. Further research is needed on a larger sample of Italian nurses.

[Impact of job satisfaction on nursing turnover: a mixed method study]

AIM

To describe job satisfaction and to explore the rationale for the nurse turnover request.

METHOD

A mix-method was carried out. The study was conducted in Hub Hospital in Rome, using a convenience sampling to all nursing staff on duty in the following areas: medical area, surgical and urgency/emergency areas.

RESULTS

The sample of 133 nurses was found to have good job satisfaction (60.9%). 21% feel dissatisfied and 18% are uncertain about the degree of satisfaction. Nurses belonging to the urgent-emergency area showed the highest satisfaction (43.7%), while the most dissatisfied were nurses of the surgical area (53.3%). The age group between 45-50 years is useful for immediate turnover, compared to the over 50 who prefer to remain in the reality where it operates. The qualitative analysis revealed 7 macro-areas.

CONCLUSIONS

Nurses have good job satisfaction, but many of them believe a turnover is necessary. The findings have important implications for nurses by helping to improve work environments, thus reducing turnover intention.

Violence against women: An observational study in an Italian emergency department

Violence against women is a pervasive phenomenon affecting one in three women aged ≥15 in the world that are more likely to visit an emergency department (ED) for the serious physical and psychological consequences of the abuse. The aim of this observational single-centre study is to describe the socio-demographic and clinical variables associated with violence against women. We enrolled 425 female patients who attended an Italian ED for trauma on 2019 and the patients' information was collected and analyzed with descriptive statistics. The average age of the patients was 41.5 (standard deviation = 14.2) years. 74.6% of the women were Italians, and 86.6% were of metropolitan origin. The reasons for the ED visit included aggression (67.5%), accidental trauma (29.0%) and unknown reasons (3.5%). Multivariate analysis confirmed that three factors were independently associated with violence: nationality (odds ratio [OR] = 0.27; 95% confidence interval [CI], 0.09-0.77), head/face/neck injuries (OR = 7.32; 95% CI, 3.76-14.27) and multiple injuries (OR = 8.52; 95% CI, 1.03-70.47). Age over 25 was a protective factor. The study confirmed that being a foreigner and having head/face/neck injuries or multiple injuries are associated with violence against women.

Prevalence and risk factors of delirium in the intensive care unit: An observational study

BACKGROUND

Several risk factors, such as age, alcohol abuse, dementia, and severe illness, can contribute to the development of delirium. However, limited information is available in the literature regarding the risk of delirium among surgical, trauma, neurological, and medical intensive care patients.

AIM

To describe the prevalence of risk factors associated with delirium in intensive care units.

DESIGN

This study used an observational design.

METHODS

We enrolled 165 patients hospitalized in two intensive care units in Italy. Patients were first evaluated using the Prediction of Delirium model and were subsequently evaluated using the Intensive Care Delirium Screening Checklist; evaluation lasted a maximum of 5 days for each admitted patient after sedation. A logistic regression model was used to identify the prevalence and risk factors of delirium.

RESULTS

The average age of the patients was 57.6 (SD = 18.3) years, and the patients were predominantly male (65.0%). The majority of patients had been subjected to trauma (38.8%); 37.6% had undergone general surgical interventions, and 23.6% had undergone medical interventions. Delirium occurred in 55.8% of the 165 patients. The risk of delirium was independently associated with coma (odds ratio = 10.6; 95% confidence interval, 3.08-39.9) and the Acute Physiology and Chronic Health Evaluation II score (odds ratio = 4.27; 95% confidence interval, 1.58-11.53).

CONCLUSIONS

This study confirmed that coma and the Acute Physiology and Chronic Health Evaluation II score were non-modifiable risk factors for delirium. Further studies could categorize the different types of coma. Proper delirium management could limit the impact on the recovery of these patients, their autonomy, and their reintegration into the social and professional world.

RELEVANCE TO CLINICAL PRACTICE

Delirium increases intensive care unit and hospital length of stay. Early identification and risk factor assessment by critical care nurses are considered the key factors in the treatment of delirium.

[A cross-sectional study on the prevalence and incidence of pressure ulcers in an Italian University Hospital-Umbria Region]

OBJECTIVE

The aim of the present study was to assess the prevalence and incidence of pressure ulcers (PUs) in patients hospitalized in a University Hospital in central Italy.

METHODS

We carried out a prevalence and incidence study on PUs and an additional prevalence estimate of PUs was also produced ten days after the first assessment. All data were explored by descriptive statistics, the Chi-square test and a multivariate analysis.

RESULTS

The prevalence of pressure ulcers was of 6,5%, while it increased to 9,9% at the second assessment ten days after the first measurement. Prevalence was statistically significant and increased with the age of inpatients (p=0,004) and was correlated to the origin of the patients (p=0,002). The incidence of PUs ten days after hospital admittance was of 3,6%. Ulcers are more frequently observed in the general medicine rather than in the surgery and intensive care units. Results showed that there exists a meaningful relationship between increased risk (Braden 16) and the presence of PUs, with an OR of 1,40 (95% CI 1,03-1,62) in high risk patients (Braden -12) and with an OR of 1,61 (95% CI 1,06-2,42) in very high or prohibitive risk patients (Braden 13-16). The most affected areas are the sacrum, the heels and the ankles. Mobilization plans were scarcely available, or do not described.

CONCLUSIONS

The obtained data confirmed the difficulty to measure whether PU prevention practices are being carried out in compliance with the set guidelines presently in use in all the University Hospital Units. There is still a very limited use of available risk assessment tools for predicting PU risk and mobilization plans are still poorly documented. A monitoring and follow-up strategy should be implemented to better understand prevalence and incidence rates.

Correlation between Work Engagement and Burnout among Registered Nurses: an Italian hospital survey

AIM

To investigate the correlation between work engagement and burnout among Italian nurses.

INTRODUCTION

Work engagement is a protective factor against burnout. Both of them may be affected by the cultural and organizational features of the investigated population, which means that results cannot be generalized. In Italy studies to measure how they correlate have never been performed.

METHODS

Monocentric and quantitative observational study. The Maslach Burnout Inventory and the Utrecht Work Engagement Scale were used on a convenience sample of 318 nurses from an Italian hospital to assess the burnout and work engagement levels and to measure the existing correlation between the two conditions.

RESULTS

Work engagement assessment highlighted average values of vigor (57.2%) and absorption (48%), while data referring to burnout demonstrated high levels of emotional exhaustion (55%) and depersonalization (41,5%). The three burnout dimensions and the three work engagement dimensions showed a close and meaningful correlation (p ≤0,01). A correlation between work engagement and burnout has been found.

CONCLUSIONS

The correlation between Work Engagement and Burnout highlighted in Italian nurses should encourage the implementation of strategies which may enhance work engagement levels to limit burnout, improving the well-being of healthcare workers and significantly influencing the quality of the care process.

The prevalence of musculoskeletal disorders and low back pain among Italian nurses: An observational study

BACKGROUND AND AIM OF THE WORK

Musculoskeletal disorders and low back pain have negative impact amongst Italian nurses who work in hospital. Nursing staff are known to be at risk of developing back disorders, where low back pain has a prevalence from 16% to 60% in the world. This study aims to determine the prevalence of musculoskeletal disorders and low back pain among nurses who working in a Roman hospital.

METHODS

Cross sectional study was carried out in an Italian hospital and the Nordic Musculoskeletal Questionnaire-IRSST was administered to 256 registered nurses. Logistic regression analyses were performed to understand risk factors associated with pain.

RESULTS

Nurses reported different locations of pain related to musculoskeletal disorders. The prevalence of low back pain was 90.2% during life, 80% during the last year and 44.5% during the last week. Female sex increases the risk of being affected by low back pain (OR = 2.07, 95% CI= 1.00-4.32).

CONCLUSIONS

Musculoskeletal disorders and low back pain are reported by the majority of nurses interviewed, and a higher prevalence is observed in women. Pain does not depend on the amount of years of work, nor on age or body mass index. In order to assess the prevalence of low back pain carefully, it is recommended to study a greater number of Italian nurses in different hospitals.

[Improving operating room efficiency: an observational and multidimensional approach in the San Camillo-Forlanini Hospital, Rome]

AIM

The management of operating rooms (ORs) is a complex process which requires an effective organizational scheme. In order to amore convinient allocation of resources a rigorous monitoring plan is needed to ensure operating rooms performances. All the necessary actions should be taken to improve the quality of the planning and scheduling procedure.

METHODS

Between April-December, 2016 an organizational analysis has been carried out on the performances of the A.O. S. Camillo-Forlanini Hospital Operating Block applying the "process management" approach to the ORs efficiency. The project involved two different surgical areas of the same operating block the multi-specialist and elective surgery and cardio-vascular surgery . The analyses of the processes was made through the product, patient and safety approach and from different points of view: the "asis", process and stakeholder perspectives. Descriptive statistics was used to process raw data and Student's t-distribution was used to assess the difference between the two means (significant p value ˂0,05). The Coefficient of Variation (CV) was used to describe the variabilityamong data.

RESULTS

The asis approach allowed us to describe the ORs inbound activities. For both operating block the most demanding weekly commitments in terms of time turned out to be the inventory management procedures of controlling and stocking medicines, general medical supplies and instruments (130[DS=±14] for BOE and 30[DS=±18] for CCH. The average time spent on preparing the operating room, separately calculated starting from the first surgical case, was of 27 minutes (SD=± 17) while for the following surgical procedures preparation time decreased to 15 minutes (SD= ± 10), which highlighted a meaningful difference of 12 minutes. A great variability was registered in CCH due to the unpredictability of these operations (CV 82%). The stakeholders' perspective revealed a reasonable level of satisfaction among nurses and surgeons (2.9 vs 2.3, respectively) and in anesthesiologist (2.8-BOE vs 2.4 CCH).Being brought to the surgical suite from an "external Unit" seems to have negatively influenced the patient's perception: preparation time turned out to be significantly lower for CCH patients rather than BOE ones (p˂0,001).The results of the safety procedure approach highlighted a moderate criticality in terms of cleaning up time and delay in the starting time of the first surgical case.

CONCLUSION

More effort should be made to avoid any slowdown during the whole process. It is advisable to implement a lean system that may improve efficiency and quality of the service to reduce wastes and unproductive times. This would inevitably generate a more positive outcomes.

eHealth Literacy Scale: An Nursing Analisys and Italian Validation

BACKGROUND

One of the scales most used to measure quickly and easily eHealth Literacy is the eHealth LiteracyScale (eHEALS); however, there was no validation of this scale in Italian. Therefore, the aim of this study was to adapt and validate the eHealth Literacy Scale (eHEALS) to the italian context.

METHODS

Italian translation of eHEALS was administered along unit to another two scale for measure lifestyle habits self-esteem and life satisfaction). A sample of 650 university students aged between 18 and 45 years was selected. An exploratory factor analysis, confirmatory factor analysis, analysis of invariance, reliability, stability and bivariate correlations were performed.

RESULTS

Exploratory factor analysis revealed a monofactorial structure that explained 67% of variance. Reliability of 0.87 and test-retest correlation of 0.78 was obtained. The questionnaire was invariant by gender. Regarding the criterion validity, a statistically significant and positive correlations between 0.05 and 0.15 with three indicators was obtained (self-esteem, lifestyle habits and life satisfaction). The italian version of the eHEALS tested in this work has shown to be a valid and reliable scale to measure eHealth competence in university students.

Textual Analysis and Data Mining: An Interpreting Research on Nursing

Every day there is a data explosion on the web. In 2013, 5 exabytes of content were created each day. Every hour internet networks carries a quantity of texts equivalent to twenty billion books. For idea Iit is a huge mass of information on the linguistic behavior of people and society that was unthinkable until a few years ago. It is an opportunity for valuable analysis for understanding social phenomena, also in nursing and health care sector.This poster shows the the steps of an idealy strategy for textual statistical analysis and the process of extracting useful information about health care, referring expecially nursing care from journal and web information. We show the potential of web tools of Text Mining applications (DTM, Wordle, Voyant Tools, Taltac 2.10, Treecloud and other web 2.0 app) analyzing text data and information extraction about sentiment, perception, scientific activites and visibility of nursing. This specific analysis is conduct analyzing "Repubblica", first newspaper in Italy (years of analisys: 2012-14) and one italian scientific nursing journal (years: 2012-14).

[Mission woman: a survey on the perception of the "Service of Welcome and Listening" offered in the Emergency Department at the San Camillo Hospital in Rome by women victims of violence]

INTRODUCTION

The project Mission Woman was set up to describe how the service offered by the Emergency Department of the Hospital San Camillo-Forlanini in Rome was perceived by women victims ( or supposed to be) of violence. The objective of this investigation is to frame clients' perception about the service offered by staff in terms of sensitivity, recognition and management of the issue. The access to the Emergency Room is the first contact of the client with a helping relationship which goes beyond the simple provision of medical care.

METHODS

A questionnaire devised for the purpose was filled in by women who have asked for help to the Service "Door Woman" . The Service "Door Woman", set up in 2009, aimed to welcome and listen women victims of violence with the collaboration of different operators in the emergency department: nurses, doctors, psychologists and social workers. The project developed within the Hospital S. Camillo-Forlanini is managed by both professionals of the Emergency Department together with the Charity "Be Free". The service is open 24/7, all year, the clients could be women or children and could receive assistance or medical, nursing, psychosocial and legal counselling. The triage nurses are those who through their expertise could first identify the victims of violence and to introduce them in the path.

CONCLUSION

Despite the level of injuries, who access to the Emergency Room for single or repeated events of violence, may have decided to claim in court and not hide seeking.. The research aims to understand what are the theoretical and practical deficiencies of staff in the management of a issue which is not only medical but also social and legal, as well as structural and organizational weaknesses of the service.

[From admission team to hospital bed management]

Reduction on number of hospital beds i.e. on patients' admission among hospitals in Lazio has lead to a reformulation of health service framework within Lazio indentifying hospital as the only place to go to treat acute and urgent diseases. San Camillo-Forlanini, the largest hospital in Rome, according to the regional health plan, the recovery plan and the redevelopment of network hospital has had a significant reduction of hospital beds leading, as consequence, to the need of an internal reorganization. In order to correctly address this issue, the management of the Hospital started in February 2008 a project, setting up a group made up by nursing coordinators which had as a main aim to manage the number of hospital beds needed for emergencies. This group has been called "Admission Team" and nurses within the group are familiar with hospital policies and organization. The team collaborates daily with physicians and nurses in  emergency room, in order to decide the most appropriate health care protocol for each patient. The project follows a specific methodology i.e. Systemic Analysis. Over the years this project has contributed to the improvement to a number of indicators and more generally to the health care within the hospital together with the enhancement of education of new managerial roles among health professional. In 2009, the Regional Council of Lazio has recognized this project as strategic within private and public hospitals.

Right to life, right to end of life: some considerations

Human rights have undergone constant evolution. Recently, however, new generations of rights are developing: from political and civil rights to social and economic rights, so much so that this period may be defined as the age of human rights. Many differences exist between moral rules and judicial law. While moral rights are not necessarily recorded in statutory law, some judicial laws, which are capable of being imposed and/or appealed within a true territorial government, originate from moral rules. Common sense has reservations about whether human rights can be labelled as laws in a rudimentary way; instead, society places human rights in the category of moral rights. These moral rights, in fact, are not the fruit of compromise, but are absolute and essential to the inner self. Throughout this article, the evolution of end of life rights is discussed, with particular regard to how those rights are directly correlated to organ transplantation.

[Retrospective study regarding the contribution of Italian nurses to the debate on the Englaro case: between paradigms of catholic and non-religious bioethics]

This study presents the results of a retrospective study evaluating the contribution of Italian nurses to the public debate on the Englaro case, analysing the articles published by two major daily newspapers during a precise period. The data collected testify to the intensity of the debate that involved the whole nation in which many diverse social and professional categories took part. The nursing category was principally represented by the Sisters of Mercy who, at the insistence of the media, gave their own opinion although their role in this context was more as personal assistants to Eluana Englaro rather than representatives of a professional category expressing a bioethical opinion.

[The experience to be mother of a preterm infant]

This qualitative study is related to leaving experience of mothers of a preborn child. The sample got saturation after eight women interviews. Verbatim transcriptions have been conducted and categories of meanings formed. Parse theories has been used to give meaning to categories to enhance feelings, hope and dreams of interviewed woman.. Results could be beneficial to orient nursing for a global vision of person's health, in the present case, of a specific group of people. Nurse is viewed as a facilitator supporter with a unique role during human experience.

[EU-Project "healthPROelderly" - evidence-based guidelines on health promotion for older people: social determinants, inequality and sustainability]

In this phase of rapid demographic change and low birth rate , coupled with an increasing life expectancy , the challenge for the future consists of being able to age in good health . European policies should therefore be aimed at promoting healthiness in the elderly and, although some CEE countries have introduced various projects and schemes, the majority are of a national or local nature and do not take into account the European context. The healthPROelderly project, on the other hand , is aimed at collecting information in the countries who participate in the project to pinpoint the best schemes for promoting healthiness in the elderly. This study focuses on the models that have a sustainable approach as far as socio-economical, environmental and lifestyle aspects are concerned. The specific aim of the project is to identify the criteria that have the highest impact on health schemes for the elderly and to establish relative guidelines at local, national and European level.

[Early treatment directives: some considerations]

In a traditional social setting, the entire family was involved when one of its members died; nowadays, this event has been transformed into a private affair. Medicine has alienated us at a time of family intimacy and death has become institutionalized in either a hospital or hospice environment. In a society whose values are changing , is it possible to restore respect and dignity to the final moments of life?. Sometimes life can be shortened or prolonged depending on the opinion of the medical staff, the equipment available in the hospital, the economic status of the family and their country of residence. How far should cure be taken when cure means forcing life to continue regardless of its quality : who chooses how and when to die?. Death is an inevitable aspect of human life and the medical community must accept this as part of their mission. Although intensive care is a precious tool, it may lead to paradoxal situations in which it is difficult to identify the exact moment when a human being becomes a corpse . When death is inevitable , it is no longer possibile to choose between life and death: the only choice left is how the patient chooses to die. The biological testament will be able to answer some of these questions and provide information making it possible to agree to or refuse further medical treatment.In the second part of this paper, that will be published later, the opinions of young people on this topic are will be reported together with those of the nurses whose institutional role is to divulge the necessary information.

[Therapeutical rehabilitation project and burnout: a experience of quali-quantitative research in a psychiatric department]

Burnout is a syndrome which takes to long-term exhaustion and diminished interest, depersonalisation, usually in the work context. Burnout appears specially in help professions- Considering all aspects which characterize the syndrome of burnout, at the department S.P.D.C. of Civitavecchia were made some observances, starting with a quality research to analyze the research problem context. After this it was made a quantity research through help of Maslach Burnout Inventory. The aim of our research is to prove that a change in the organization of the Nursing Department can improve the employees' burnout level, to direct towards an independent management of rehabilitation therapies aimed to relationships. Changes in the organization verified through the project named ATRI consist in four different therapeutical-rehabilitation activities: cooking-, reading-, psicomotion-, music-therapy. The results of research shows how these changes of organization can affect employees' burnout.

[Feminine genitals modification: survey of a new phenomenon for nurse today. Second Part]

The study was performed to find out how much health workers in a Rome Hospital knew about the phenomenon of female genital modifications. For this purpose a questionnaire previously employed in a project financed by the EEC and the Rome City Council was used.

[Female genital modification: survey of new phenomenon for nurses today]

The immigration that there was in Italy in the last years has provoked a big cultural and social change for the country. Nurses that belong to social sector cannot escape from that change, and they have got to admit those new reality and develop new assistential and analysis methodologies. The immigrants that arrive in Italy came from more than 150 counties in the world, poor countries of the third world. The object of this research is to find out how nursing profession confronts itself with a new multiculture situation, the way to conciliate the ethical principles of the profession with the different cultures and learning that medical operators of an Italian hospital got about the immigrants: MGF (feminine genital modifications). The research wants to understand this phenomenon that is very diffuse, so the meeting with the differences is a reason to develop and not a imposition of a value on the other value.

[Bioethics and care: from human rights to quality of care]

The pluralist nature of bioethics and the fact that it spans various branches of science places it in a privileged position to tackle ethical problems that accompany human choices in situations that influence the conditions of living beings. Clearly, issues such as health and care form part of the bioethical sphere of enquiry and it is obviously of fundamental importance that these subjects receive a suitable degree of attention within a branch of science that has always drawn on the contributions of other human sciences. Bioethics looks at the great questions posed by moral principles and seeks to apply them to present concerns.

[When the patient asks for counselling, when the patient doesn't ask for counselling, when the patient refuses therapy]

A large debate that has brought some depths changes is in action. It is on the relationship between patients and health professionals, physicians, nurses, psychologists etc. The path went through the medical paternalism to the phase of the autonomy, thin to reach the ethics of taking care. In these years, bioethics has tried to answer to urgent questions that primarily interest the private sphere of the people. Currently, by contributions of European and American philosophies, an ethics of the responsibility is delineating This, differentiates the ethics of the rights and the rules (autonomy, self-determination). The attitude of taking care postpones to a whole intellectual, affective, moral competences, that every health professional has to possess to establish relationship with people. This allows, beyond the autonomy, a fundamental moral principle that remains, to give a positive emotional answer and support the conditions and the situation of others. In this answer, the availability to be in the identification process is affirmed to, with their problems and, the desire to do the possible to assuage their suffering. If the person is set in a large net of relationships, is able to express autonomy mediating counselling process of health professionals. The client will freely choose to assume self-care responsibilities.

[Saint Antony's healing rituals]

Sant Antonio Abate rouses a particular charm for Italians in general but we focus the attention on Abruzzo people there are many stories and legends about his life and his miracles. This work is a result of a study conducted in the popular culture of Abruzzo Region about the rituals of Sant Antonio. Whom principal function was to protect animals. In the middle of the cult we found his capacities to recover people and animals. The association between the Saint and the fire is connected of his thaumaturgy capacities. The fire is often associated to doctors and to cure sickness, and with him we have therapeutics effects. The hagiographical criticism says that the imagine of Saint has to be referred to a historical fact of IX century in France. Here there was a laic hospital community to recover sick people of cancer egotism that presented hurters blistered skin, fever, eruptions and hallucinations. The pig grass was used to cure egotism and due to this reason sickness was names the evil of Saint Antony or Saint Antonio fire. Due to the multitude of sick people occurring, a hospital run by Augustinians canonists order has been built.

[AIDS and alternative treatments. A nursing point of view]

The new therapeutics protocols used to cure for AIDS are efficient and important for the therapy but it is essential for the patient to know therapeutic modalities and use. These factors are important for the patient's compliance. But besides the official therapy, we can assist to the use of a diverse alternative therapies associated to the conventional. Sometime the alternative therapy helps the official medicine although, too often they are considered old lifestyles survival. The present work want to indicate by a survey, how positive and ill patients face their health reality, how they alleviate their problems and the nursing role. WHO has recommanded to nurses to pay attention to the therapeutic choices of the patients.

[Alternative medicine]

In a critical situation of world official medicine, we can find different alternatives therapies: natural therapy traditional and complementary, survival sometimes, of antique stiles and conditions of life. New sciences presented for them empiricism to the margin of official science. Doctors and sorcerer do the best to defeat the horrible virus that contribute to build symbols categories of sick. The alternatives put dangerously in game the scientific myth of experiment and exhume, if they got lost, antique remedy, almost preserved like cultural wreck very efficient where the medicine is impotent. Besides alternatives and complementary therapies, that are remedies not recognized conventional from official medicine, there are the homeopathic, phytotherapy, pranotherapy, nutritional therapy, the ayurveda, the yoga, ecc. Italians and internationals research show a composite picture of persons that apply that therapies. Object of this work is to understand and know the way that sick lighten their sufferings and role that have o that can assume the nurses to assist this sick.

[AIDS and the new therapies: course of research]

The Authors notice the impact of AIDS on all fields of the social life. After outlining a short story of the disease and of the different therapies applied till now, they review the new ones and point out the necessity to provide nurses with specific and continuous education.