['See and Treat' in the Emergency Department: legal aspects and professional nursing responsibility]. / 'See and Treat' in Pronto Soccorso: aspetti legali e responsabilità professionale infermieristica.

The article aim to analyze the legal aspects of professional responsibility in the autonomous nursing care of a patient with a minor health problem treated in a See and Treat area of the Emergency Department through a literature review and an analyses of the Italian legislation about professional exercise. Recent studies have shown that the treatment of the emergency patients affected by minor health problems in separated areas of the A&E by skilled nurses proved to be effective in reducing time to medical examination and the overall time spent in the Emergency Department. Several studies have shown the positive effects of the Emergency Nurse Practitioner (ENP) in terms of reduction of time to medical examination with an increase in patient satisfaction, maintaining an adequate level of quality in the care of patients with minor health problems. The introduction of a See and Treat area, together with the institution of advanced post-triage protocols, represents a possible answer to the overcrowding of the Emergency Department. The aim is the reduction of waiting times and proper allocation of both material and professional resources. The "See and Treat" nurse represents an expert nurse, with an adequate level of competence, who acts in respect to the clinical protocols shared between physicians and nurses. The Italian legislation is not in contrast with the introduction of the See and Treat nurse, on the contrary it offers opportunities for further professional development.

[Falls of patients in hospital: testing of a notification system and statistical monitoring]. / Le cadute dei pazienti in ospedale: la sperimentazione di un sistema di segnalazione e di reporting.

BACKGROUND: Falls of hospitalised people and resulting injuries are an important event, particularly in elderly people, since they can be cause of morbidity, disability and mortality. Frequently, fall result in deterioration of quality of life, reduction of personal autonomy and lengthening of stay in hospital. Literature reported one fall in the year in about one third of over 65 years old people; in 25% of old people admitted to hospital; in 43% of total guests in RSA (Ungar et al., 2004, Rubenstein et al., 2002). METHODS: We report data relative to experimental introduction of a new notification system and statistical monitoring, made by the Nursing Directorate of Niguarda Hospital in Milan, in the 8 wards that have recorded the highest number of falls in 2006 and 2007. The reports received (n = 119) made possible to assess the functionality of the system designed with the specific nature of the data collected. Falls of patients with minimal or absent risk factors for falls at the admission (50%) have been analyzed. The relationship of falls with age of patients, drugs assumption and nursing needs have been evaluated. RESULTS: 75% of fallen patients were over 68 years old. Taking a single or a combination of drugs considered as dangerous for falls was a recurring data. The most common modality of falls was to get out of bed. 30% of patients involved presented some nursing care needs (moving and personal hygiene). These needs were not particularly limiting their autonomy, but a nursing support and supervision had been in any case planned. CONCLUSION: Over 68 years old patients, taking drugs dangerous for falls and presenting nursing care needs should be strictly look after by nurses while the mobilization.

How different technologies can fit nursing processes to empower staff and increase quality of care. An Italian case study.

The rapid evolution of healthcare and the need to contain costs, to decrease the time of patients' hospitalization, and to improve the quality of care has led the nursing profession to face new challenges. This paper describes the case study of A.O. Ospedale Niguarda in Milan (Italy), a public healthcare provider where the key role of Nursing is being recognized according to international common practice. Also considering the context of Italian healthcare, attention will be drawn to concrete actions carried out on the organizational side and also for what concerns IT tools supporting nursing activities. This was done aiming with success at rising nurses' knowledge level of the patient, support its activities, increase quality of care, in a precise managerial and methodological framework. We will describe four cases of projects (Intensive Care Unit patient record, First Aid Station care reporting, pressure ulcers management, transfusion traceability) carried out by Niguarda with the support of its partner Fondazione Politecnico di Milano, set up to support bedside nursing activities with the most suitable technology for the purpose.

[Building a quality evaluation system for the nursing triage process]. / Creazione di un sistema di valutazione della qualità del processo di triage infermieristico.

In literature there are no studies regarding the quality evaluation of the whole triage process; however, since it is necessary to evaluate what really happens everyday in the Emergency Rooms, as well as verifying the daily level of throughput, there is a strong need for an appropriate tool. Measuring the quality of triage means improving the caring process. This article presents a new measurement grid, aimed at realizing a Quality Evaluation of Nursing Care. Currently, the most widespread systems used for the QENC are the Australian Triage Scale, the Canadian triage and Acuity Scale and the Italian Group of Triage Scale. The global/biphasic triage system was used in our study because it seems the most accurate, according to literature. There are several indicators that evaluate many aspects of the triage process; every single indicator has a score. The sum of the scores defines the quality level of the nursing triage process. Our paper discusses the application of this score in a major Milan hospital, based upon a preliminary study.

[Evaluation of the quality of nursing care: qualitative and quantitative analysis on a sample of nursing documents]. / La valutazione della qualità dell'assistenza infermieristica: analisi qualitativa e quantitativa su un campione di cartelle infermieristiche.

The theory of continuous quality improvement is related to the principles of Total Quality and focuses on three main elements: client satisfaction, erogation of services and the informative system. In this wide context, the experience of the Niguarda Cà Granda Hospital regarding the introduction of certified nursing documents is described. The aspects considered are the introduction and management of the document, also taking into consideration the strategies adopted for modifying professional behaviour such as training. The evaluation confirms that any project aimed at improving the quality of care can be achieved as long as the Hospital management make a strategic decision and there is involvement of the individual professionals.

[Opinions and expectations of customers: an overview]. / Indagine descrittiva sulle opinioni e le aspettative degli utenti nei confronti dell'infermiere nell'Azienda Ospedaliera Ospedale Niguarda Ca' Granda.

The present article illustrates results of a survey, introduced in occasion of the celebration of the International Day of the Nurse, in the "Ospedale Niguarda Ca' Granda" of Milan, finalized to know the opinions and the expectations that the customers have developed in the comparisons of the nurses, taking into consideration Services and Operating Units. From it turns out that the customers have a much positive image of the nurse as a person who helps more than to be a professional. However when this dimension comes expressed from the customers, it very turns out defined and specified, independent regarding the medical profession.

[The role of nursing in the current health and social health system: nursing management in Italy]. / La funzione infermieristica nell'attuale sistema sanitario e socio-sanitario: quali assetti per il management infermieristico in Italia.

The objects can substantially synthesizes: 1. To reflect on the evolution of the organizational configuration of the nursing function based on the various theoretical contributions; 2. To make a picture of the organizational configurations of nursing function that more frequently appear in the immense and heterogeneous health system; 3. To formulate future hypotheses that concur on nursing autonomy in the comparisons with new and old professions and to strengthen out direct responsibility.