2023-10-19 18:19:30
Chronically ill, elderly, frail people, people who live in internal areas where broadband is unknown and therefore it is impossible to connect to the network, let alone carry out a teleconsultation or a remote electrocardiogram. The Fnopi (National Federation of Nursing Professions Associations) is raising the alarm on ‘new digital fragilities’, ready to take to the field with various strategies: training, responsibility and co-design of models for taking care of assisted people, simplifying the treatment paths and improving therapeutic adherence and appropriateness.
There is a ‘digital fragility’ risk for the 14 million most serious chronically ill patients (in total chronic conditions affect over 22 million Italians) – we read in an Fnopi note – and also for the 13 million inhabitants in the internal areas where the quality of healthcare provision is often difficult. The solution that the new healthcare model designed by the Pnrr has designed especially for them is teleassistance, and in the last two years tenders for over 2.5 billion have been launched for ‘connected care’. But as happens in traditional models, after the diagnosis and prescription of therapy, who assists the citizen in the area? – they ask themselves from Fnopi – Who checks your health conditions and adherence to therapies? Who checks, records and intervenes in the case of further health needs so that he is not left alone?
In the new structures and in the model designed by the Pnrr with decree 77/2022 for the reorganization of assistance in the territory, it is the nurse who does it, in particular the family and community nurse present in the various targets and at home – continues the note – with precise responsibility at all levels and which provides support to the patient for all his clinical, healthcare and even social needs. The same must happen in “connected care”: how to achieve it Fnopi has put it in black and white in a document presented in Rome on the occasion of “Welfair – The healthcare fair”.
“Digital health – explains Barbara Mangiacavalli, president of Fnopi – is, under certain conditions, an opportunity for the protection of health in the country, to which the nursing professions can make an important contribution and in turn be valorised. For this reason the Federation has explained its position for the success of digital healthcare, in particular of all that part that is implemented in the territory: the development of digital relational skills must become part of the training courses of the care professions and in this context the participation of the assisted person and of the caregiver to the care process is a central element; his awareness represents an opportunity because it influences the outcomes of care while improving his perception of the service received”.
The document defines ‘last mile’ as the place of proximity that begins from the home of the assisted person (the home as the first place of care) and develops around it with direct services for citizens, easily accessible and with the least impact possible on their organization of life, determining the guiding criterion in investment, organizational and technological choices of digital health. It is necessary to develop an organizational model – the note details – which provides for the active participation of the assisted person and his private network in a logical of co-planning, because his participation and that of the caregiver in the care process is a central element: awareness is an opportunity, it influences the outcomes of care and also improves his perception of the service received. The new digital health settings, underlines the Fnopi document, must develop the reciprocity of care processes. The quality of the relationship is an instrument of trust, motivation, therapeutic adherence and general outcome of the treatment process.
The development of digital relational skills must become part of the training courses of care professions and, by these, it must be “taught” to citizens, especially the most vulnerable, otherwise the spread of digital services and online systems risks opening up, in the short and medium term, a new different, excluding many citizens who present various forms of fragility (sensory deficits, income, education, connectivity, language, etc.). And on professional responsibility linked to digital health, the Fnopi document underlines the need for an amendment to law 24/2017 (on professional responsibility in healthcare), because it must be considered as the responsibility present in any healthcare context, where it is limited to cases of willful misconduct or gross negligence, precisely because it is based on the direct and agreed relationship with the patient and not on pre-established models.
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