99218 - Infermieristica nella cronicità (BO2)

Learning outcomes

At the end of the module the student possesses knowledge relating to the methodology, organizational and clinical care models for taking charge, management and continuity of care in chronic and fragile situations. Develops knowledge related to therapeutic education. Recognizes and values the resources of the family, the community and the service network.

Course contents

1. PRINCIPLES OF CARING FOR PERSONS WITH CHRONIC ILLNESS

Evolution of health needs connected to new "fragility" and chronicity
The care paradigm: from "to cure" to "to care" Meaning of taking charge ("taking care")
The components and models of taking charge of priority health problems

Taking charge in practice: health and social aspects with particular reference to the importance of involving the person, the caregiver and the family (significant people for the patient) and organizational aspects.

2 CARE SETTINGS AND MODELS FOR CHRONIC CARE

The importance of teamwork in taking charge within a service network.
The characteristics of the interventions and the organization of services as a network
Notes on organizational structures and regulatory aspects of reference
The transitional care model and intermediate care
The chronic care model
Chronic care settings (clinics, home, intermediate care, health/community homes)
The nurse in the area: skills in different settings for assisting patients with chronic pathologies


3. TOOLS, FIGURES FOR TAKING CHARGE

The management of the sick person in the team in taking charge: the necessary tools for personalized assistance

The tools for assessment and taking charge, the PAI, the rating scales


4. CARE MANAGEMENT

Prevalent chronic diseases, diagnostic therapeutic care pathways, therapeutic education, self care and therapeutic alliance
- Nursing care planning for patients with chronic illnesses:

hypertension
heart failure
chronic liver cirrhosis
COPD in chronicity
Alzheimer's and Parkinson's dementias
rheumatological diseases
oncological disease in chronicity and end of life

Readings/Bibliography

Scalorbi S., Longobucco Y., Trentin A., INFERMIERISTICA PREVENTIVA, DI FAMIGLIA E DI COMUNITÀ McGraw-Hill, Milano, 2022 Seconda edizione ISBN 8838655642

Judith M. Wilkinson, Laurie Barcus, Diagnosi infermieristiche con NOC e NIC, 2017 seconda edizione Casa Editrice Ambrosiana

Amaducci G., Artioli G., Narrare la malattia, Nuovi strumenti per la professione infermieristica, Edit.Carocci Faber, Roma, 2007

Giuseppe D'Imperio, L' organizzazione come rete di relazione, Edit.Libreria Univ. Benedetti, 2010

A.Dalponte, F.Olivetti Manoukian, “ Lavorare con la cronicità” Edit.Carrocci Faber, 2004

G.Cavazza, C.Malvi, La fragilità degli anziani, Strategie, progetti, strumenti per invecchiare bene, Maggioli Editore, 2014.

G. Maciocco, Malattie croniche: nuovi modelli assistenziali, Edit. Prospettive sanitarie e sociali, 2006

NANDA International, Inc. Diagnosi Infermieristiche: Definizioni e Classificazione 2021-2023, Casa Editrice Ambrosiana, Milano

Lynda Juall Carpenito-Moyet Diagnosi infermieristiche. Applicazione alla pratica clinica Casa Editrice Ambrosiana, 2020

Sasso L., Gagliano C., Bagnasco A., Scienze infermieristiche generali e cliniche, Edit. McGraw-Hill Education; 3 edizione, Milano, 2016

Sasso L., Silvestro A., Rocco G., Tibaldi L.; Moggia F., Scienze infermieristiche in Area Critica, Edit. McGraw-Hill Education; 2 edizione, Milano, 2012

Valenti D., Moggia F. Le alternative possibili che il medico internista può proporre alla dimissione, rispetto all'aumento di intensità di cura e l'assistenza ospedaliera ordinaria: la rete di cure palliative. QUADERNI - Italian Journal of Medicine 2017; 5(5): 55-71

Delibera Regione Emilia Romagna 2016 - Case sella Salute: indicazioni regionali per il coordinamento e lo sviluppo delle comunità di professionisti e della medicina di iniziativa

Parte I. Il percorso clinico e assistenziale nelle insufficienze croniche d'organo "end-stage". Recenti Prog 9 Med 2014; 105: 9-24

Teaching methods

Active teaching: presentation of prototypical cases according to the problem based learning methodology

Simulations with individual care planning

Assessment methods

The certification evaluation will take place through two tests:

Written and subsequently oral in the same appeal:

Written: Care planning on a clinical case with identification of a Nursing Diagnosis and a Collaborative Problem complete with related objectives and interventions (preparatory for the oral exam) [max time: 20 minutes].

Oral: open questions on the program.

Teaching tools

Computer, video projector, books, articles, videos.

Office hours

See the website of Fabrizio Moggia