In December 2014, a law proposal was made to amend the Balduzzi decree, which effectively introduces the figure of the family nurse. It is a law that proposes the full recognition of the nursing profession as a reference figure for the development and strengthening of local home care services, in order to safeguard the health of citizens.

Infermiere di famiglia, il futuro dell’assistenza

Published on 15.03.17 Of Andrea Ferretti – Nurse 24.it

La prima stesura del “The family health nurse – Context, conceptual framework and curriculum¹” was produced by the WHO regional office for Europe in Copenhagen in January 2000. This document describes for the first time the figure of the family nurse, or that health professional who focuses on family health, understood as a family nucleus, and in particular he is responsible for home care, that is to say the set of all those medical, nursing and rehabilitative treatments in order to stabilize the clinical picture and improve the quality of life.

Who is the Family Health Nurse, role and skills

L’infermiere di famiglia non è il community nurse, i.e. the community nurse with whom he is often mistaken. The WHO elaborated the profile of this new figure only a year later and identified him as someone who acts for the well-being of the community, therefore in a space of action different from that of the family, directing him to schools, psychiatric communities and however in a purely non-hospital environment, but not at home.

Since the WHO elaborated this figure, it took six years to have the specialist area recognized as public health (law 43/2006) and therefore the birth of the first ones master's degree. Only in 2012, with the Balduzzi decree, was there a reorganization, at national level, in the field of primary care, home and territorial areas, proposing district polyclinics which, with adequate staff shifts, provide a 24-hour service.

In December 2014, a law proposal was made to amend the Balduzzi decree, which effectively introduces the figure of the family nurse. It is a law that proposes the full recognition of the nursing profession as a reference figure for the development and strengthening of local home care services, in order to safeguard the health of citizens. And here we stopped.

In the world, for example in the UK and the USA, the figures of nursing specialization are already well defined and introduced into the healthcare model, clearly including the family nurse.

The Family Health Nurse in the UK

THEn Uk the family health nurse is associated with a single specialization, i.e. the public healty nurse, a type of nurse who works in large groups and communities and carries out all those educational, relational and practical interventions concerning the maintenance and support of Health. Then there is another superimposable figure, which is that of the generalist nurse: she performs the same tasks, but carried out in a smaller and always equal community of people (just like the family doctor) and is therefore much closer to the definition of the 'Who of family nurses. The salary average varies from 31,000 to 41,000 pounds per year, excluding bonuses, and are sought-after figures for each hospital.

The family nurse in the USA

In the USA, the situation is more specific: after acquiring a bachelor's degree in nursing (the equivalent of our three-year degree), one must take a two-year master's degree in nursing, participating in courses aimed at family care; after which you obtain the qualifying exam (Board certification in family practice through the American nurses credentialing center of the American academy of nurse practitioners) and you become a family nurse practitioner. It is a professional figure who usually acts under the supervision of a doctor (in some American states he acts without a doctor, given their shortage in the USA) and is responsible for the "care" and "cure" of the family's health , providing educational interventions and support in health care in all its phases.

The nurse practitioner can also diagnose diseases, prescribe certain types of drugs and perform therapy, as well as prescribe routine examinations, laboratory tests and diagnostic tests independently. According to some American universities, you can earn $60,000 to $80,000 annually.

L’infermiere di famiglia in Italia, l’esperienza della Lombardia

In Italy, the first (and only) region to introduce the family nurse was the Lombardy, a Varese, dove nel 2014 nasce il primo ambulatorio di infermieri di famiglia. Nei due anni successivi, vi è stata l’implementazione di altri tre distretti (Luino, Busto Arsizio, Desio e Biandronno in collaborazione con l’ambulatorio di Cerea (Verona), insieme per il progetto Globalcareitalia) che agiscono in un raggio di dieci chilometri ciascuno, offrendo una rete territoriale in grado di raggiungere tutta l’utenza.

We interviewed the manager of this service, Maria Rosa Genio.

How did the idea of this clinic come about?

This clinic was born from a market survey carried out between 2008 and 2011. At the time I worked in Integrated Home Care (Adi) and I realized how fragmented the health service provided was, which only protected a small target of users leaving out a huge chunk. Very often we talk about the protection of fragility referring to the elderly and disabled, but for me fragility is also represented by the economic condition that a young family can live. How many fathers of families have lost their jobs and can't afford treatment? Even if it was the simple administration of an injection. How many do not have a territorial reference with which to compare? Why don't they go to the family doctor, but then when the situation becomes unmanageable they go to clog the emergency room?.

What professional model is it based on and how does your job take place?

The operating model implemented by me is based on the figure of general nurse anglosassone e si comporta esattamente come la versione infermieristica del medico di famiglia. Quotidianamente, prima dell’apertura dell’ambulatorio, andiamo al domicilio degli utenti che ne fanno richiesta dando un ordine di priorità alle attività: prima i prelievi, poi le terapie, per ultimo tutto il resto (per esempio le medicazioni). Le consulenze sono una componente fondamentale per la riuscita di una adeguata presa in carico. Interveniamo anche per organizzare strutturalmente il domicilio in occasione di una dimissione pianificata, ci rechiamo in ospedale o presso le strutture prima della dimissione allo scopo di prendere le consegne dal personale ospedaliero e accordarci riguardo la migliore soluzione da adottare per garantire la continuità assistenziale. Inoltre, collaboriamo sistematicamente con la guardia medica che ci interpella per evitare ricorsi al Pronto soccorso, lì dove la situazione è gestibile e risolvibile a domicilio (riposizionamenti di sondino nasogastrico, globi vescicali, broncoaspirazioni, medicazioni saltate, disidratazione ecc…).

Who is your team made up of?

Ours is a multidisciplinary team made up of obs, nurses, fisioterapisti e medici specialisti. La richiesta arriva sempre all’infermiere, che da buon case-manager evaluates and manages the path to be activated by involving all the figures necessary for the recovery of the concept of health. This modus operandi represents our project that we have called global care Italy in charge of our association Maya.

What is the user response to your service?

We periodically carry out performance assessments of our 600 permanent clients, which they greatly appreciate, because they feel dignified and humanly considered in a world where time passes quickly and very often one feels like numbers.

Are there other Italian companies like yours?

There are no other Italian companies, to my knowledge, that work with the same philosophy, if not those linked to us in partnership present in Lunio, Busto Arsizio and Verona. From nursing clinics in Italy ce ne sono tanti, pubblici e privati, specializzati in determinati settori o meno, ma svolgere l’attività di infermiere di famiglia aderente al concetto Oms è tutt’altra cosa. Anzi occhio a quelle realtà che per mero business stanno facendo diventare l’infermiere di famiglia una vera e propria moda! Questo nuoce fortemente all’utente finale del servizio, che non comprende la differenza e potrebbe anche sminuire il valore dell’infermiere di famiglia.

1- The family health nurse – Context, conceptual framework and curriculum