Home nursing care works: The 91.7% of patients are satisfied and promote it. In the ASL the community houses are still not very widespread (only in 27.3% of companies), things are a little better for digital health services (present in 57.1% of the Local Health Authorities), but 92.2% still guarantee home care with nursing staff. They are the main Results of the first analysis on home nursing care in Italy Aidomus-It – ‘The contribution of nursing to the development of territoriality’ – conducted for 10 months of 2023 by Cersi, a Center of Excellence for Research and Development in Nursing, which collected and processed the data on behalf of the National Federation of Nursing Professions (Fnopi).
The investigation : which 77 out of 110 local health authorities have joined, equal to 75.3% of the Italian population, is divided into three sections: the first aimed at managers of health professions to analyze the organizational aspects of home care; the second at nurses, to detect the professional characteristics of their work activity and working conditions; the third, aimed at patients to detect the quality and satisfaction of the care received. Almost all patients – as stated in a note – promote the care received at home: 91.7% declare that they have always been treated with courtesy and respect by nurses, 86% have perceived that they were always taking care of them, 83.3% have been listened to carefully, 82% have always been informed by nurses about the times and methods of their intervention. An overall evaluation of the home care received, expressed with votes from 0 to 10, deserved an average of 9.3 (with a peak of 9.4 in the elderly).
The average number of activities provided per ASL is 10.1 out of 17. The path for the oncology patient is present in 40.3% of the facilities and the activities for chronic patients are provided by 74% of the Local Health Authorities, while those for users with disabilities by 59.7%. Family and community nursing services are provided by 68.8% of the companies while 26% of the Local Health Authorities codify them as ‘proximity nurses’. Approximately half of the Local Health Authorities provide specialist nursing consultations and digital health services are present in over half of the companies (51.9%), of which 26% with Teleassistance activities.
In almost all the Local Health Authorities, assistance activities provided by nurses are also guaranteed.: blood sampling, simple and advanced dressings, drug administration, device management, therapeutic and health education, caregiver training, monitoring and measurement of health conditions, evaluation of family conditions, palliative care, clinical care procedures such as management of bladder catheters, management of nutrition/devices for the administration of enteral nutrition. In home care, 49.5, per thousand inhabitants, are over 65s taken care of: 16.8 have serious limitations due to disability and 8.2 have chronic pathologies.
More than 8 out of 10 nurses (83.8%) stated that they were satisfied or very satisfied with their job: only 20.1%, if they could, would leave their job in the next 12 months. About a third stated a medium-high workload while 10.3% considered it high. With respect to the climate of the work group and the possibility of providing safe care, 65.8% reported better scores, with an average of 76.9. With respect to psychosocial conditions in the workplace, 65.8% reported medium criticality. One nurse in 5 stated that they had suffered one in the last 12 months, but 36.9% had suffered three or more in the same period of time.
Thanks to the widespread nature of the surveys, the Aidomus studio was able to calculate the daily cost of a nurse working in the home care serviceincluding the time spent at home (about 24 minutes per access), the time to reach it, to return to the facility and for back-office activities. The value, considering 6.84 accesses/patients per day, is 138.73 euros. The adequacy of the cost estimates was compared and confirmed also by the analysis of 12 tender specifications at national level in 10 Italian Regions from which it appears that the daily cost of a nurse (also considering the average hourly cost contracted by the Local Health Authorities according to the tender specifications) is 152.12 euros for 6.64 accesses. Therefore, if the management of territorial care is the responsibility of the NHS, there is a saving and economic sustainability is enclosed in a dual action: the value of thehome nursing care provided and the no cost of repeated hospitalizations of the elderly and frail.
The study also allows us to economically valorize the real value of the care activities carried out by the nurse at the person’s home: comparing them to the 2023 outpatient tariff, the value of the production guaranteed by nurses is equal to 636.31 euros/day. It follows that, in the event of a lack of structured provision of the service and further nursing shortage, there is a risk of not being able to adequately guarantee such services in the public and contracted regime, forcing the citizen to resort to out of pocket. Also for this reason, Fnopi believes it is necessary and strategic to invest in the nursing profession, supporting it at all levels.
“The organizational data of the study – states the Fnopi Central Committee – underline the need to outline shared and effective organizational models, based above all on the needs of different categories of patients. The different levels of staffing and skill mix affect the efficiency of the response of the healthcare system. It is desirable – he continues – to implement models that include the involvement of nurses with specific training in territorial care”, also given the satisfaction expressed by users.
“The survey conducted on nurses’ satisfaction with their work – Fnopi underlines – impacts on the ‘retentio’ of the nurses themselves and demonstrates a greater attractiveness of the specific home setting. The data collected on missed care (missed care) will allow, with future in-depth studies, to determine the predictors of nursing missed care in the territory (also referred to the single activity) with positive effects on the costs of care in terms of improper re-hospitalizations. Through the structures, currently scarce, such as community homes or nursing units, it would be possible to increase the quantity and complexity of the interventions provided in the territorial area, without the involvement of hospital structures, with an evident impact in terms of responses to the health problems of the citizen and reduction of health costs. Today the distribution of the type of services available and the related resources – concludes the Federation – does not always seem to be in line with the population density and therefore with the requests of the population, contrary to what is underlined by the literature regarding the need to adapt the models as much as possible to the needs of the users”.
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