(Adnkronos) –
Home nursing care works: 91.7% of patients are satisfied and promote it. In the Local Health Authorities, Community Homes 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 Local Health Authorities), but 92.2% still guarantee home care with nursing staff. These 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 survey, which 77 out of 110 local health authorities participated in, 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 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 Local Health Authority is 10.1 out of 17. The pathway for cancer patients is present in 40.3% of the facilities and the activities for chronic patients are provided by 74% of the Local Health Authority, while those for users with disabilities are provided by 59.7%. Family and community nursing services are provided by 68.8% of the companies while 26% of the Local Health Authority codes them as ‘proximity nurses’. Approximately half of the Local Health Authority provides 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 Local Health Authorities, assistance activities provided by nurses are also guaranteed: blood sampling, simple and advanced dressings, administration of drugs, management of devices, therapeutic and health education, training of caregivers, monitoring and measurement of health conditions, assessment of family conditions, palliative care, clinical assistance procedures such as management of bladder catheters, management of nutrition/devices for the administration of enteral nutrition. In home care, 49.5 out of a 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%) declared themselves 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 declare a medium-high workload while 10.3% consider 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 in 5 nurses declared having suffered one in the last 12 months, but 36.9% had suffered three or more in the same period of time. Thanks to the capillarity of the surveys, the Aidomus study was able to calculate the daily cost of a nurse who works in the home care service, including the time spent at home (about 24 minutes per access), the time to reach him, 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 also compared and confirmed by the analysis of 12 tender specifications at national level in 10 Italian Regions, which shows 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 paid by the NHS, there is a saving and economic sustainability is contained in a double action: the value of the home nursing care provided and the missed 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 price list, 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 shortages, 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 the 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 – it continues – to implement models that provide for the involvement of nurses with specific training in territorial care”, also given the satisfaction expressed by users. “The survey conducted on the satisfaction of nurses with respect to their work – underlines Fnopi – impacts on the ‘retentio’ of the nurses themselves and demonstrates a greater attractiveness of the specific home setting. : The data collected on missed care will allow, with future investigations, 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 seem to always 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”. —[email protected] (Web Info)