Leader: Alberto Dal Molin (UPO); Other collaborator(s): Erika Bassi (UPO), Erica Busca (UPO), Isabella Santomauro (UPO)
The aging population and rising prevalence of chronic diseases and disabilities are increasing healthcare demands, posing challenges to the healthcare system. There is a growing need for sustainable and effective care models tailored to patients, caregivers, and families. In this context, Italian Ministry of Health supports the role of the Family and Community Nurse (FCN) in strengthening health systems and addressing the evolving care needs of aging populations. Task will focus on developing a comprehensive understanding of the FCN's role in improving healthcare delivery, particularly for aging populations and individuals with chronic conditions. By analyzing both national and European perspectives, the study will provide valuable insights into how the FCN can be effectively integrated into healthcare systems, identifying challenges, and best practices.
The task is articulated into four parallel phases:
1. Assessing the Utilization and Impact of Nursing Care Services
The first phase involves two observational study aimed at exploring the utilization of nursing care services in primary care settings, assessing how effectively nursing care addresses patients care needs, and analyzing its impact on health outcomes (eg, hospitalization, emergency department admission).
2. Implementation and Experiences of Family and Community Nurses (FCNs) in Italy
The second phase exploring the implementation of FCN in Italy. This phase will investigate: a) the professional experiences of FCNs, the meaning they attribute to their roles, and b) the challenges and facilitators influencing their implementation into primary healthcare settings.
3. Mapping FCN Training and Expertise Across Europe
The third phase aimed at mapping and describing the level of FCN training, experiences and skills across different European setting.
4. Local FCN Implementation and Mutuality in Relationships
The phase focusing on how family and community nursing is implemented in a specific context (Local health Authority of Biella). This phase will also examine the mutuality in the relationship between FCNs, patients, and their caregivers.
Brief description of the activities and of the intermediate results
1. Assessing the Utilization and Impact of Nursing Care Services
Observational study - 1
- A questionnaire has been developed for a survey on the utilization of nursing services, aligned with the Family and Community Nursing framework. This instrument included validated indicators commonly employed in national statistical surveys. The questionnaire has been added to those scheduled for the upcoming follow-up phase of the EPIC cohort study (Task 3.3. Spoke 10).
2. Implementation and Experiences of Family and Community Nurses (FCNs) in Italy
A qualitative approach was used for this phase. Specifically, a hermeneutic approach was adopted for the first objective, while a descriptive-qualitative approach was applied for the second objective. A total of 24 interviews with FCNs have been conducted in the Piedmont region, and all interviews have been fully transcribed.
3. Mapping FCN Training and Expertise Across Europe
Survey and qualitative study
- For this phase, a European survey was structured, followed by a descriptive qualitative study. The initial quantitative phase of the European Survey has commenced, involving the distribution of a questionnaire via REDCap to 58 healthcare professionals who can provide information regarding primary healthcare settings in their respective countries.
Scoping review
- A scoping review is currently ongoing to map the nurse's roles in caring for elderly people in domiciliary settings
4. Local FCN Implementation and Mutuality in Relationships
The protocol of a qualitative study was submitted to the Local Ethics Committee (15th April 2024)
Main policy, industrial and scientific implications
The Health Professions Directors of the Piedmont region were contacted to share the preliminary findings of point (2).
Brief description of the activities and of the intermediate results
1. Assessing the Utilization and Impact of Nursing Care Services
Observational study - 2
- To understand the role of the FCN, a retrospective observational study was conducted to identify which emergency department admissions were potentially avoidable through a network of territorial services. Results: From 1 January to 31 December 2022, the Emergency Department (ED) of the S.S. Trinità Hospital in Borgomanero registered 43,437 visits, the majority of which were non-urgent (N=39,864; 91.77%) and triaged as green (68.47%), blue (16.47%) or white (6.81%). Of the 43,437 visits, 20,104 (46.28%) were classified as avoidable. Avoidable visits were more common in men (p < 0.0001) and in people under 15 years of age (p < 0.0001). These visits occurred mostly during the day, with a higher proportion of patients arriving in their own car. Conditions such as minor trauma or minor burns showed a marked incidence of avoidable attendances, as did fever, eye problems, urological symptoms, back pain and tumefaction/mass/swelling. The results of this study will be submitted to BMC Nursing.
2. Implementation and Experiences of Family and Community Nurses (FCNs) in Italy
The phase involved FCNs from multiple regions, progressively expanding participant inclusion. Four Italian regions were involved (Piedmont, Trentino-South Tyrol, Apulia, and Tuscany), and 41 FCNs have been included and interviewed.
3. Mapping FCN Training and Expertise Across Europe
Survey and qualitative study
- It was considered appropriate to increase the number of eligible contacts (N=91) for inclusion in the first phase of the study. This expansion was made possible through the development of European collaborative networks and the involvement of a collaborator from the European Academy of Nursing Science.
4. Local FCN Implementation and Mutuality in Relationships
The protocol has been approved (CE number 104/2024).
Main policy, industrial and scientific implications
Our studies are in line with the implementation strategies of community care, in accordance with the NRP and DM 77/2022. The preliminary results of these studies provide evidence for the importance of FCNs in improving healthcare access, reducing unnecessary hospital visits, and enhancing patient-centered care. By mapping their roles at both national and European levels, the research supports policy development, workforce planning, and the expansion of FCN models to strengthen community-based healthcare services.
1. Assessing the Utilization and Impact of Nursing Care Services
Observational study - 1
- EPIC-Turin cohort - Task 3.3. Spoke 10: 60 participants were enrolled, and the data collection is underway.
2. Implementation and Experiences of Family and Community Nurses (FCNs) in Italy
Data analysis is ongoing.
3. Mapping FCN Training and Expertise Across Europe
Survey and qualitative study
- The quantitative phase has been completed. Preliminary results: These are preliminary results derived from an initial analysis of the quantitative phase of the study. Sixteen subjects participated in the study (n=12 women and n=4 men) with an average age of 42 years (SD ± 8). The participants came from 10 European countries: Italy, Spain, Greece, Switzerland, Germany, Norway, Finland, United Kingdom, Netherlands and Turkey. Fourteen subjects reported the presence of an FCN role. The minimum education required varies. In Italy, for example, a bachelor's degree and a postgraduate course in family and community nursing are required to practise as an FCN. In Germany, Finland and Norway, a bachelor's degree is sufficient.
4. Local FCN Implementation and Mutuality in Relationships
To address the first stated objective, a qualitative single-case study was conducted, while a descriptive qualitative study was carried out for the second objective.
Qualitative single-case study
- Background: the qualitative single-case study is the most appropriate methodological approach to answer the "how" and "why" of a given phenomenon. Although current regulations support the adoption of Family and Community Nursing (FCN) across the national territory, this professional role remains heterogeneous and not yet fully systematized. Consequently, the context lacks experiential descriptions related to its development, making this study particularly relevant. Preliminary results: A total of 22 nurses were interviewed since march 2024 to july 2024, including FCNs and top managers. The study participants were predominantly female (N=18), with a relatively short service tenure as FCNs (mean: 4 ± 3.8 years).The vision guiding the implementation of Family and Community Nursing at the Local Health Authority (ASL) of Biella aims to ensure that all nurses working in the district assume the FCN role, provided they undergo appropriate training. A total of 48 factors (barriers and facilitators) were identified, which align with the domains and constructs of the framework adopted during data collection and data analysis (Consolidated Framework for Implementation Research).
Descriptive qualitative study
- Data collection has been completed.
Main policy, industrial and scientific implications
These results may assist policymakers in supporting the implementation of the Family and Community Nurse, a key role in community care in accordance with the PNRR and DM 77/2022. By providing a clearer understanding of FCN implementation, these findings will facilitate evidence-informed decision-making and enhance the integration of FCNs within local primary care services.
Beyond national relevance, the project has significantly contributed to strengthening European collaborations, fostering partnerships that enhance our collective efforts to meet the challenges of community care.
Brief description of the activities and of the intermediate results
1. Assessing the Utilization and Impact of Nursing Care Services
Observational study.
- EPIC-Turin cohort - Task 3.3. Spoke 10: data collection is underway.
2. Implementation and Experiences of Family and Community Nurses (FCNs) in Italy
Phenomenological study
- Preliminary results: A total of 41 FCNs (mean age: 42.7 years, SD ±8.4) from the regions of Piedmont, Trentino-Alto Adige, Tuscany, and Apulia were interviewed. To address the first objective, a hermeneutic approach based on Cohen’s methodology was applied. The analysis identified three main themes: the organization of FCN work, professional interactions, and the meaning attributed to this role.
3. Mapping FCN Training and Expertise Across Europe
Survey and qualitative study
- Qualitative phase: Preliminary results: These are preliminary results derived from an initial analysis of qualitative phase. Semi-structured interviews were conducted from October 2024 to December 2024. Ten subjects participated in the study (woman N=6). The participants came from 9 European Countries: Finland, Germany, Greece, Italy, Netherlands, Norway, Spain, the UK, and Switzerland. A Content Analysis will be used for data analysis.
Scoping review
- Background: Demographic changes and the increasing prevalence of chronic diseases have made home care the primary care setting for the elderly. However, the diversity of professional qualifications and the multiplicity of roles create uncertainty in the definition and mapping of nursing professionals involved in this field. Results: A scoping review was conducted using the JBI methodology, including 14 studies after screening 1,973 references. The studies were primarily conducted in the United Kingdom (n=6). A total of 12 nursing roles were identified, mainly involved in the management of chronic diseases at home, highlighting a wide variety of activities. Article submitted to Geriatric Nursing
4. Local FCN Implementation and Mutuality in Relationships
Descriptive qualitative study
- Background: Mutuality in the nurse-patient relationship is a widely studied concept in hospital settings, demonstrating benefits for both parties involved. However, there is no evidence on how the process of mutuality develops within primary care, where the nurse-patient relationship has the opportunity to establish itself and persist over time. Preliminary results: A total of 15 FCNs and 27 users participated in the study, resulting in 29 interviews. Among these, 14 interviews were conducted with users, including only patients (N=2), patient-caregiver dyads (N=8), and only caregivers (N=4).The average age of the patients was 81.75 years (SD 9.73). Data analysis is ongoing.
Main policy, industrial and scientific implications
The studies provide valuable insights into the evolving role of nursing professionals in community and home care settings, reinforcing the need for clear role definitions, standardized training, and policy support to optimize nursing interventions.
Scientific publications:
- Santomauro I, Bassi E, Durante A, Bracco C, Busca E, Caristia S, Dal Molin A. Nurses’ roles in caring for older people in domiciliary settings: a scoping review protocol. Nurs Rep. 2024;14:744–52. doi:10.3390/nursrep14020057;
National and international conferences:
- Busca E. The implementation of Family and Community Nursing: a protocol of a qualitative study. AGE-IT International Conferences, Venice 20 May 2024
- Santomauro I. Family and Community Nurse in Italy (QUAL-I-FEC): preliminary results of a qualitative-descriptive study using a Rapid Identification of themes from Audio recordings model AGE-IT International Conferences, Venice 20 May 2024
- Busca E. Il processo di implementazione dell’infermieristica di famiglia e comunità: protocollo di uno studio qualitativo. Aging in Progress conference, Novara 3-4 October 2024.
- Santomauro I. The Role of Family and Community Nurse in Europe: preliminary results of international survey (SURVEIFEC) Aging in Progress conference, Novara 3-4 October 2024.
- Busca E. Barriere e facilitatori nell’implementazione dell’infermieristica di famiglia e comunità nell’Asl di Biella: risultati di un case study qualitativo. 4° Congresso Nazionale Cure Territoriali, San Marino 13-14 December 2024
- Busca E. La mutualità nella relazione infermiere di famiglia e comunità e diade paziente-caregiver. 4° Congresso Nazionale Cure Territoriali, San Marino 13-14 December 2024
- Santomauro I. L’implementazione dell’infermieristica di famiglia e comunità in Italia e in Europa: un progetto dottorale 4° Congresso Nazionale Cure Territoriali, San Marino 13-14 December 2024