Il Progetto Veduta presentato da Maria Giulia Marini al 3rd Societal Impact of Pain symposium di Copenhagen dal 29 al 31 Maggio 2012

1. Project V.E.D.U.T.A.
(Valori Esistenziali contro il Dolore nelle Unità di Terapia e
Assistenza)
(Existential Values against pain in the Units of therapy and
assistance)
www.fondazioneistud.it
Societal Impact of Pain,
Copenhagen, May 30 2012,
Maria Giulia Marini

2. Why climate analyses?
• Climate analyses are conducted inside working
organizations or teams, public and private, and
often repeated with a scheduled frequency.
• Issues are the evaluation of workers needs,
their motivations, their work life balance, the
dynamics of communication, the internal
cohesion and collaboration, the strong and
weak points of the organization, the quality of
the leadership.
• Goals consist in improving the satisfaction and
quality of life of workers and defining a model –
bottom up- of shared values.

3. Climate analyses in the fight
against pain
• In the health care sector, the exposure of
personnel to burn is a crucial factor to be
assessed : are physicians and other providers
of care happy?
• Having to face Pain every day, which belongs
to Human condition, there is an overexposure
to human fragility and vulnerability.

4. Pain therapy
"The set of diagnostic and therapeutic
interventions designed to identify and apply to
chronic diseases suitable and appropriate drug
therapies, surgical instruments, and psychological
rehabilitation, variously integrated , in order to
develop appropriate diagnostic and therapeutic
pathways for suppression and pain management “

5. Another Italian and Mediterranean
Pain
The
Economist,
March 2012

6. In Italy; despite the crisis a
profound change is warranted
through the Italian law 38/2010
alliative care and pain management are priority objectives
of the National Health Plan. [...] in order to ensure respect
for the dignity and autonomy of the human person, health
needs, equity in access, quality of care and their
appropriateness regarding specific requirements.
The Minister of Health [...] defines the minimum
requirements [...] to the terminally ill and palliative care
units and pain therapy home care in each region, in order to
define the network palliative care for pain management,
[...], at a staffing plan of care appropriate to the needs of
the resident population and an adequate supply of
professionals with specific skills and experience in
the field of palliative care and pain therapy, even
with regard to family support.

7. The competence requested for
being a pain therapist
"[...] the professionals with specific skills and
experience in the field of palliative care and pain
therapy, for the pediatric age too, with particular
reference to general practitioners and medical
specialists in anesthesia and intensive care,
geriatrics, neurology, oncology, radiotherapy,
pediatrics, physicians with at least three years
experience in the field of palliative care and pain
management, nurses, psychologists and social
workers and other professionals deemed critical. "

8. The issue of professional identity
Pain therapists originates mainly from anesthesists and
they are organized in different care setting (working
groups, hospitals...)
Their function is to “serve” accross the hospital and other
health care department: there are few centers which deal
specifically with the treatment of pain
Difficulties in developing collective professional
identity and building a network

9. The importance of the pain
therapist network
• Feeling of belonging: recognition and
support of professionals who are working
• Information sharing, and resource saving,
moving from a competitive approach to a
cooperative behaviour, able to better negotiate
with regional and central institutions
• Better management of patients who are seen
"as a whole“ and not as splitted fragments

10. Objectives of VEDUTA
• Framing of the professional identity of pain
therapists
• Understanding individual and organizational
needs
• Creation of a situation fostering the network among
pain therapist (such as of “inter-est group” and
within the structures) in a context of very limited
resources

11. VEDUTA project: stories can
catch what questionnaires don’t
catch
• The quantitative variables are means of
demographic data, job description, team
organization and workload, relationship with the
patients, personal motivations and expectations and
the evaluation of the quality of their professional
life.
• Narrative method thinking enrich the quantitative
figures, probing the meaning of the choice of this
profession: humans by nature are storyteller and
stories compel attention and promote reactions and
retention. The qualitative analysis in VEDUTA is
based on narrative free descriptions, which
includes” a semi-structured “fairy tales”-

12. Zoom on narrative
The goal of Project V.E.D.U.T.A. is understanding, through
stories, who are pain therapists, the level of committment,
the living in their organization and what are the major
professional and personal issues they have to face
Thanks to the stories, we can discover the deepest
experience, values ​and needs of the healthcare
professionals
By analyzing the stories, it will be also possible to find
some guidance for the organization of pain care
services.

13. Federdolore-
Health Ministry SICD
professionals of Health
Pain SIAARTI
Therapy
ISAL
CittadinazAttiva
ESRA

14. Project steps
December 2011 Establishment of steering committee
STEP 1 January 2012 Involvement of the scientific societies
STEP January 2012 Definition of the sample
2-3 February 2012 Tools development
March 2012
STEP 4 Conducting the survey
June 2012
Data analysis:
STEP 5 June 2012 - writing reports
July 2012 - share with steering committee
Communication and dissemination
STEP 6 August 2012
October 2012 of the results

15. 340 pain therapist are still in a
reaching process all over Italy
The data are collected in different ways:
•Dissemination through mailing to 350 centers
involved in pain therapy
• Web Sites of Fondazione ISTUD, Federdolore-SICD,
ESRA and SIAARTI
•Local health care management of the centres were
informed about the project.

16. The results which will originate
from the study
• a national map of the distribution of active centers
that deal with pain therapy
• a “climate test” of quality of life, and personal
and organizational needs of the professional
• a starting point for action planning which can
support the professional and his/her health care
organization

17. 43% of compliance on the italian
territory: 152 inyerviews and 66
stories
All regions have completed the online interviews
Territorial answers
20,0%
Answers
15,0%
10,0%
5,0%
0,0%
piemonte
veneto
marche
trentino
abruzzo
umbria
sardegna
toscana
molise
lombardia
campania
puglia
valle
friuli
liguria
lazio
emilia
calabria
basilicata
sicilia
Regions

18. The 152 professionals
72% Men, out of these, 28% filled in the story
28 % Women, out of these 54% filled in the story
57,51% with and 42% without coordination role

19. The village of caring of the
people who suffered
Once upon a time, there was a / an ............... that through a long
journey ........................... came to the village of care for people
who suffered ..........................................
The country was on / in / near
The..........................................................................
In that country there were not only the people who were
suffering who came from .............. and were made
of.......................................... but there were also their beloved
ones around, and they were made of ............................................
And then, in that country, all the others who had settled there to
take care of those who needed, lived and were made
of ...................................................

20. The village of caring of the
people who suffered
When .............. saw for the first time the faces of
people trying to care and thought that these faces
were .................................................................. .. And
then looked at his hands and thought that those hands
were ................. ...............................and then
looked .................................. and listened to their
words …………Then … decided /thought that he would
be staying in that country because it would ……..But
on an evil day it happened that…… But then it
happened also that …Now that country is …
That country will be happy on condition…that

21. Short conclusion while the study
is running
• Strong committment by the scientific societies to
endorse both the quantitative and narrative part
• In a mainly male population (as up to now) there might
be a gender effect: women more able to free themselves
through narrative
• From a first reading from the stories there is full
committment in terms of existential values against pain
and suffering; “patientcentric” values and willing to
achieve the bet possible therapy in patient management.
• However, organizational complains about the difficulties
of application of the law because paucity of resources…
and culture not prepared yet: still a long journey to run

22. “Narrative Medicine fortifies clinical practice with
the narrative competence to recognize, absorb,
metabolize, interpret, and be moved by the stories
of illness:… helps doctors, nurses, social
workers, and therapists to improve the
effectiveness of care by developing the
capacity for attention, reflection, representation,
and affiliation with patients and colleagues.”
Rita Charon
University of Columbia

23. A tribute to Hans Christian
Andersen: a genious of story
telling
“When I tell a fairy tale or a story to
children, I start to talk when adults are
around: the messages and the meanings
are not only for the children but much
more for the grown up people”