Rivista per le Medical Humanities

Claudia Zanini
rMH 39, 2018, 11-16

Scientific evidence on care methodology of health professionals

Caregivers too get sick. They fall ill with stress, depression, exhaustion, and burnout. The latter has been precisely identified as the most serious negative consequence of workrelated stress in the healthcare sector. In a survey conducted by the Swiss Health Observatory, 15% of health workers report a high level of exhaustion. The resulting discomforts are felt in the first place on the professional level, with reduced interest in work, worsening of professional performance, increased absenteeism, aggressive attitudes towards patients and colleagues, and in the first place in private life, with insomnia, sense of frustration and failure, apathy, risk of substance abuse and suicidal ideation. Recently, burnout has started to be considered not only as an individual problem, but also as a structural problem, linked to the work environment and to the work organisation. This change in perspective suggests that achieving a burnout reduction does not only require support for health workers, but ultimately also a change in organisations. In line with this assumption, a recent systematic review and meta-analysis of the literature has shown that interventions at the individual level (e.g. mindfulness, stress management techniques, development of managerial and communication skills) can actually help reduce burnout. Interventions at the structural are, however, significantly more effective (e.g. interventions that combine changes in planning, workload reductions, and promotion of communication amongst team members with a better effort/ reward balance). Health organisations should therefore act on both levels, if they want to ensure quality care while reducing the costs resulting from reduced staff productivity and rapid employee turnover.

Giovanna Pezzoli
rMH 39, 2018, 17-19

The role of institutions in caring for caregivers

Today’s working reality obliges every professional to cope with multiple aspects. Every worker is called upon to respond to solicitations by seeking the right measure between his physical, cognitive, emotional, and relational energies. In this sense, the world of health care is no exception. As a mater of fact, due to its very peculiar nature, where interpersonal relationships develop in all their dimensions, the risk factors increase accordingly. Today, we talk about caring in the sense of “taking care of”. At the centre of the caring practice, we find the patient and the caregiver, with their respective emotions, r vulnerabilities, and network of relationships: they both need to be given the same importance. Healthcare institutions must consider that today, in order to offer quality care, there is a need for caregivers themselves be taken care of. The Nursing Area of the Cantonal Hospital has been working in this direction for many years. Following the introduction of the concept of “relationship-based care”, the necessary measures to address these needs have already been put in place in various areas of the organisation. However, in my opinion, this theme still remains the real challenge to be faced for healthcare institutions.

Antonello Ambrosio
rMH 39, 2018, 20-24

Teaching how to be nurses

What does it mean to face, in the dualism between disciplinary skills and emotional experience, the path that leads to achieving specialisation in a nursing discipline such as Urgent Care? In the number of the most sought-after skills, we find – among the first in the standings, so to say – the need to be and feel to be up to the task, as far as their roles are concerned, in the management of seriously ill patients. Some - times it happens that the clinical conditions overcome the very concept of “serious”, resulting in a tragic epilogue. The scientific literature provides evidence of the fact that, similarly to what happens in other professions called upon to intervene in emergency situations, the possibility of incurring – in the context of one’s professional life – a Post-Traumatic Stress Disorder (ptsd) is high. It could be thought that young people – both professionally and from an age point of view – are the most exposed at this juncture, although this is not exactly what is observed, both in literature and in the local observation, during the two-year post-diploma specialisation period. The literature shows that it is rather people with a longer professional experience to be subjected to a dual path, namely: one that sees them become structurally solid, and the other that sees them be more exposed to ptsd. The assumptions that can be formulated regarding the reasons why in an initial phase one kind of remains “invulnerable” are   multiple and deserve closer investigation.

Paola Zanotti
rMH 39, 2018, 25-30

A single click to prevent burnout in oncology

In helping professions, the relationship between caregivers and patients/family members involves a deep emotional involvement. The risk consists of that form of work-related stress, referred to as burnout, i.e. a state of fatigue and frustration arising from a relationship that does not result in the expected reward and that operators may be poorly aware of. There is no specific effective therapy for a framework of manifest burnout. The only real remedy is prevention. The idea of a photography workshop arises from the search for a concrete and useful tool to be offered to the caring team that is able to encourage and stimulate both awareness with respect to one’s own emotional experience and the in-depth approach and implementation of some specific strategies aimed at burnout prevention. The intervention based on preventive approach has recourse to therapeutic photography, as an instrument of investigation, reflection and comparison, which allows a facilitated access to feelings and thoughts, making greater self-awareness possible. The workshop in - cludes some meetings during which the participants testify – through images – aspects and peculiarities inherent to their own experience, to the interaction with the workplace, as well as to their relationships with colleagues and patients. The expected results go in the direction of a confirmation of the effectiveness of photography as a tool that allows greater self-awareness, as well as facilitating interaction with others, improving one’s professional well-being and, consequently, the quality of the care services offered.

Nicola Grignoli
Giovanni Isella
Claudia Nesa
Ilaria Massari
Carlo Schönholzer
rMH 39, 2018, 31-34

Living together with the

Dialysis-requiring kidney failure is a path shared step by step between patients and caregivers: the decision to start therapy, the rhythm of multi-weekly sessions, the uncertainty about kidney transplantation, and monitoring. This close co - hab itation over time with patients and their emotional reactions generates a type of distress in caregivers which, however, can hardly be recognised. It is deemed necessary to propose initiatives aimed at preventing burnout or moral distress. Since the early 2000s, the Nephrology and Haemodialysis Service of the Lugano Regional Hospital (eoc) and the Psychiatry and Medical Psychology Service (osc) have been collaborating organising interdisciplinary meetings, which have eventually given rise to a pilot project. These meetings now see the involvement of the two hospital departments as well as of different professional figures (including doctors, nurses, and nursing care assistants). The meeting, which are held with a frequency of six annual sessions, are conducted by psychologists/ psychotherapists according to the special method that is peculiar to the Balint groups: starting from a clinical case, full freedom of speech is ensured and the caregivers’ emotions are interpreted. The topics discussed starting from the clinical cases presented were noted and described qualitatively. The evolution of this liaison psychiatry project shows a progressive focus of the group discussions on situations characterised by aggressiveness towards patients defined as “difficult”. The analysis of specialised literature makes it possible to clarify how in some cases the patient’s difficult emotional experience is reflected in the caregiver who, just like the former, bears a background of experienced anger and sense of impotence, and suggests some recommendations regarding the maintenance of a relationship therapeutic. The legitimisation of the caregivers’ emotional experience and the comparison amongst various professional figures and clinical activities could be a protective factor for the satisfaction   and quality of life of nephrology/haemodialysis caregivers.

Ornella Manzocchi
rMH 39, 2018, 35-44

Supervision as self-care with the Other

The essay is divided into four parts, as if they were the movements of a musical composition. The first part or movement could be called “sostenuto”. It tells about the reflections and teachings arising from the meetings with the supervisors whom the author was lucky enough to meet. The second part or movement, which could be defined as “largo”, is dedicated to the traces of virtual meetings that took place with thinkers who, through their writings, played – for the writer too – the role of supervisors. The third time or movement, which could be referred as “andante con brio”, is marked by the conversations-intervisions that the author was lucky enough to share with some of her colleagues. And finally, the concluding act, in the form of “adagio”, is a tribute to poetry that becomes supervision. In the writer’s perspective, this composition in four movements supports and encourages us to go further and further, not to take for granted, to dare, to resist, to get indignant, to suspend just enough to better understand and be critical. In this sense, supervision proves to be above all care for one’s own person and one’s well-being, according to the moments dedicated to the care of the Other. Supervision encourages to experiment, then to generate and build, and finally to keep alive an important capacity that John Keats, in his Letters on poetry, referred to as “negative capacity”.

Graziano Martignoni
rMH 39, 2018, 45-50

Self-care, care of the Other, and care of the world

How to talk about that “taking care of Care” of which Medical Humanities are real participating observers? How to tell the gestures, words, voices, thoughts and affections that revolve around the patient’s bed and in front of his painful and questioning face? Care has been sailing from time immemorial with ever different vessels. Today, the comparison, sometimes pacifying, some other times bellicose, takes place between a kind of care built upon evidence and one based on narration. What is at stake in the former is the search for evidence, while in the latter the listening to the track, a track that turns into word, sparkle, and then sometimes even history. The narration seeks the traces of wounded existence, which it inhabits at the same time. How to host that spark in our caring gestures, in our words, in our being in front of other people’s pain? How to preserve the subtle knowledge of the sensitive soul, which belongs more to the order of analogy and correspondence than to that of separations? And how, then, to preserve Care in the caregiver by taking care of the caregiver himself? Not only “know yourself”, but “take care of yourself”: this is the challenge. Practical wisdom is not just about knowing, it makes one “be differently”, as Hadot writes. Wisdom is therefore the thing without which one is, yet is not differently. However, it is not yet clear what is meant by that “differently”.

Michela Luraschi
rMH 39, 2018, 51-54

Supporting those who support within the family

In the field of home care, we find different figures, namely: there are professionals, and there are family members. A kinship tie, an emotional relationship, the intensity and duration of caregiving: that is what a caring family member is. He acts spontaneously, but also out of duty. His intervention is essential to let his loved one(s) live at home. The house, as it is a place where the caring family member is linked and where professionals can and must enter with gentleness and discretion, paying attention to both one and the other, i.e. to those who support and those who are supported. For the caring family member, constantly confronted with a deep sense of responsibility and loneliness, it is important to be able to find a balance in his own being, amongst his different roles. He is a caregiver, but also a person: with skills and limits, with needs and desires. Entering this complex interweaving of dynamics and delicate relationships is a path that must be followed carefully. Giving voice to this interweaving   represents a social responsibility.

Renzo Rigotti
rMH 39, 2018, 55-57

The Care Team and those who take care of it: a personal vision

Following the recognition by the dms in 1980 of the diagnosis of Post-Traumatic Stress Disorder, thanks to the pressure of the veterans who survived the Vietnam war, a growing awareness begun, here too, of the need to take care not only of the victims, but also of survivors and witnesses of nonwar tragic events. The goal is the prevention of this disorder. The intervention is not so much based on psychological or psychotherapeutic approaches as on concepts such as solidarity, reception and help. It is about being able to lend a concrete helping hand, with empathy and generosity, and then withdraw mostly in a anonymous way, so as not to create a sense of debt in the beneficiary, but leaving him instead – hopefully – with an experience of human solidarity. The main problem for the caregiver, who is a volunteer without necessarily a professional training in the social-health-psychological field, is to maintain his centre and not to become in turn a victim in front of a tragic situation. It is therefore important to be attentive and aware of one’s state before going into action: am I in a position to face a painful situation? Being able to rely at any time on an external support, both practical (i.e. the coordinator) and psychological (i.e. the psychotherapist “on picket duty”), provides a way out from situations that have become unmanageable and suffocating. The drafting, at the end of the intervention, of a written report, as well as the verbal report to the coordinator (defusing), allow a first cleaning to remove the dust left on the skin. The detailed and thorough washing will then be carried out during the supervision meetings, conducted by a psychotherapist trained in psychotraumatology, so as to also work through those emotions that we sometimes try to remove with all our strength. We should not forget that the foundation of caregiver’s care lies in training, both basic (theoretical notions of psychotraumatology, practical exercises with role-playing   games, training in spiritual assistance) and continuous.

Alba Masullo
Katia Tunesi
rMH 39, 2018, 58-60

Motivating and supporting the volunteers of the Ticino League Against Cancer

In the complexity of an oncological disease, there are manifold issues, and amongst the various figures that revolve around the patient there are also the volunteers of the Ticino League Against Cancer (ltc). A substantial importance for the ltc volunteers, in addition to accompanying the patient, lies with all those interventions aimed at supporting and relieving the caring family member. That is why the Ticino League Against Cancer deems it very important to turn its attention and provide its support to ltc volunteers, who become in turn caregivers of caregivers. The volunteer, like the caring family member, is, first of all, a person, with his own life, job, interests, affections, projects, and sometimes also possible health problems. He is above all a person who needs to feel useful and wants to be helpful. All the more so, the volunteer must live peacefully. For this reason it is important to make sure that he does not come up against physical and emotional overload condition. A volunteer who feels well and is properly supported is a much more effective “caregiver” able to maintain lucidity, awareness and balance even in the most complex situations. It is essential to create listening and support spaces for volunteers with the purpose of identifying their needs and difficulties, as well as, in a process of co-constructing reflections and new meanings, rediscovering the resources that allow experiencing this important role peacefully and satisfactorily for everyone. This can be done through coordination meetings with the coordinators and social workers, with the psychologist’s supervision, with the aid of basic and continuing training.

Guenda Bernegger
rMH 39, 2018, 61-63

Can Medical Humanities take care of caregivers?

Caregivers need to equip themselves including with cultural tools and to be able to rely on them because, as Marc Augé said, “the disease is too big an event to be dealt with by a single individual” – i.e. the patient, the caregiver – but it is also too big to be dealt with by a single discipline. Hence, the need for the interdisciplinary approach that distinguishes the Medical Humanities and for a dialogue with the sciences of the spirit and the arts, which have always contributed to thinking and representing what it means to be a man, sickness and in health. While ultimately aiming at providing the patient with better care, through a more sensitive understanding of the experience of illness, the “cultural sciences of medicine” allow at the same time the operator to broaden the representation of their professionalism, to strengthen their capacity to face the questions that accompany suffering, drawing on the reservoir of responses proposed by culture. In designing a visible and shareable background of practices, both recognisable and recognised, a horizon – even symbolic – in which to root one’s own gestures, the Medical Humanities can therefore help caregivers to think about themselves as “cultural operators” as well. In particular, thanks to the dialogue with the arts and literature, they allow cultivating and nourishing, amongst others, the imaginative function, thereby making each act more meaningful, both for the patient and the caregiver who performs it.

Lia Rinaldi
rMH 39, 2018, 95-98

Journey to the Middle Earth. Caring daughters' experiences and home nurses' role

The ever-increasing ageing of the Swiss population is highlighting more and more the need to put in place urgent measures to maintain the autonomy and health of the elderly at home (Giudici, Cavalli, Egloff, Masotti 2015). Despite the increasing development of home care services, in many cases the constant presence of a caring family member is necessary in order to allow the elderly to stay at home for as long as possible (Perrig-Chiello 2015). The research, conducted by the author for a degree thesis in nursing care at the Department of Business Administration, Healthcare and Social Sciences of the supsi and presented here in summary form, was aimed at providing a closer insight in a narrative way the phenomenon of the so-called “sandwich generation”, and in particular the impact of the care experience on the caring daughters, frequently referred to by the literature as figures at high risk of overload, in relation to the multiplicity of roles that they are increasingly obliged to play within society, straddling between their old and new family (Cossette, Lévesque, Laurin 1995).

Nicole Augustoni
rMH 39, 2018, 99-104

Ad astra per aspera. Resilience and migrant women admitted on a provisional basis

“Ad astra per aspera”, i.e. “Through hardships to the stars” is the title of a work that the author dedicates to all the people who have lost their lives because of too restrictive migration policies. Developed as a degree thesis in social work at the Department of Business Administration, Healthcare and Social Sciences of the supsi, the research, of which a reduced version is proposed here, starts with an analysis of the political situation in the field of Swiss and European asylum, to focus on the issue of the statute of ordinary temporary admission and on the personal experience of five migrant women. The interviews highlighted the difficulties in the migration process, but above all the resources and strategies through which the women managed to overcome such adversities. From the social worker’s point of view, the aim was to identify suitable interventions to accompany and support people admitted on a provisional basis, also thanks to a greater knowledge and awareness of the situation experienced by these women.

Aronne Luraschi
rMH 39, 2018, 105-111

Spiritual social work. A reflection in seven questions and five elements

The author starts from the observation that the interest in the spiritual dimension is of increasing importance and weight in the perspective of a better and more accurate caring of the person in a holistic vision. His work aims firstly at offering a research on how much literature has produced about the topic under examination, proposing definitions through which to elaborate five elements constitutive of the human vector of spirituality and, starting from these, seven questions to be submitted to the operators of a Protected Laboratory. The analysis of the interviews made starting from this basis allows the author to propose useful reflections for the educational work, both in the relationship with others and with oneself. The paper presents, in a re-elaborated form, a research conducted as a thesis work on social work, carried out at the end of the Bachelor’s course at the Department of Business Administration, Healthcare and Social Sciences of the supsi.