39277 - Clinical Nursing and Rehabilitation in Chronic Disease (BO1)

Learning outcomes

At the end of the module, the student possesses the knowledge about methodology, organizational and clinical models for the care, management and continuity of the assistance in chronicity situations. Develops knowledge about therapeutic education. He knows family and community resources.

Course contents

1. PRINCIPLES OF LOADING THE PERSON WITH CHRONIC DISEASE a) Adopting a "person and family centred" approach b) Caregiver b) Promote patient autonomy and independence and reduce the risk of disability d) Promote self-management of the disease Willingness: Individual and family self-management theory e) Understanding the trajectory of illness (fragility) g) Provide palliative care to non-cancer patients and simultaneous palliative care 2. ASSISTENTIAL SETTINGS AND MODELS FOR CHRONICity a) Primary care d) Nursing home care: features. f) Ensuring the continuity of care - Continuity of information - Continuity in welfare management - Continuity in relationship and cooperation g) Plan the discharge 3. INSTRUMENTS, FIGURES FOR LOADING LOAD a) Integration between figures c) Assessment tools, PAI, assessment scales

4. CHRONIC DISEASES Prevalent chronic diseases, therapeutic therapeutic care pathways, therapeutic education, self-care and therapeutic alliance. Key principles of treatment and self-excitation of hypertension The management of oral anticoagulant therapy (TAO and NAO) Heart failure: Treatment of heart failure, Other treatments The management of the new-born and stable heart failure person The care of the patient with unstable heart failure The weight of the symptoms and palliative approach to the patient with advanced heart failure The key information for the patient on diagnostic investigations Hepatic Cirrhosis: Clinical care of the person with compensated cirrhosis Complications of advanced cirrhosis and pathophysiologic mechanisms Clinical care of the person with advanced cirrhosis and with complications The load of the symptoms and experiences of patients with advanced stage disease cirrhosis Screening and educational interventions for people with alcohol at risk Dementia: Treatment Assistance management of the person suffering from Demenza Dementia and end-of-life care The most commonly used evaluation tools for the person with Demenza Parkinson's Disease: Treatment Assistance management of a patient suffering from Parkinson's disease A tool for evaluating symptoms and their progression in Parkinson's Disease COPD: The Load of Symptoms and Cases of COPD patients in the advanced stage of illness Palliative Care in COPD Non-Invasive Ventilation - NIV l) Rheumatic Diseases: Personal care of the person with rheumatoid arthritis Synthetic presentation of the main rheumatic diseases Skin lesions in autoimmune diseases Endocrine Disorders: Clinical-diagnostic pathway of endocrine diseases (hypothyrodism, hyperthyroidism) Treatment of endocrine diseases Assistance management of the person with endocrine diseases

Readings/Bibliography

Brugnolli A., Saiani L.(2017) Trattato di Medicina e Infermieristica un approccio di cure integrate Volume 3, Sorbona, Edizioni Idelson Gnocchi

S.C. Smeltzer, B.G. Bare, J.L. Hinkle, K.H Cheever(2017)Brunner- Suddarth “Infermieristica medico-chirurgico” Edizione 5, Casa Editrice Ambrosiana.

Mongardi M. (2012) L'assistenza all'anziano. Ospedale, domicilio, territorio, Milano, The Mc Graw-Hill Companies.

Scalorbi S,(2012) Infermieristica preventiva e di comunità ,Milano, McGraw-Hill.

G.Cavazza, C.Malvi, (2014) La fragilità degli anziani, Strategie, progetti, strumenti per invecchiare bene, Maggioli Editore.

P.Chiari, A.Santullo,(2011) L'infermiere case manager : dalla teoria alla prassi, seconda ed., Mc Graw Hill

A.Brambilla, G.Maciocco, (2016) Le Case della Salute , Innovazione e buone pratiche. Carocci Faber editore

Delibera Regione Emilia Romagna 2016 - Case sella Salute: indicazioni regionali per il coordinamento e lo sviluppo delle comunità di professionisti e della medicina di iniziativa

Delibera Regione Emilia Romagna n.124 del 1999 - Assistenza Domiciliare Integrata

-OMS ICF Classificazione Internazionale del Funzionamento, delle disabilità e della salute Casa Editrice Erickson

Teaching methods

Frontal lessons Exercises Presentation and discussion of cases

Assessment methods

Written tests: short answer question and resolution of a case on patient management and oral examination

Teaching tools

Video projector material on the web Video clips

Office hours

See the website of Luisa Sist