Upon completion of the course, the student will be able to:

KNOWLEDGE AND UNDERSTANDING
• Describe the main sensory, motor, intellectual and psychic disabilities;
• Know the use of the International Classification of Functioning, Disability and Health (ICF);
• Describe the epidemiology of disability in Italy according to the most recent ISTAT data;
• Know the main national and regional regulatory references for the protection of the health of frail and disabled people;
• Describe the etiopathological determinants and risk factors for the development of chronic-degenerative diseases and disabilities;
• Recognize the nursing role within the care network and organizational models for chronicity;
• Describe the Chronic care model (CCM) for the promotion of self-care
• Describe the factors that worsen the quality of life of people with chronic degenerative problems and their families;
• Describe the fundamental principles of self-care for chronic degenerative diseases;
• Recognize the role of the client's empowerment in care planning

APPLIED KNOWLEDGE AND UNDERSTANDING
Complete a nursing care plan care for a person with chronic degenerative disease:
• Targeted assessment with particular reference in people suffering from arterial hypertension, diabetes mellitus, chronic lesions and peripheral vascular disease, chronic respiratory failure, heart failure, neurodegenerative diseases, dementia diseases, chronic liver diseases;
• Formulation of prevalent nursing diagnoses;
• Formulation of objectives, times and methods of verification;
• Planning of suitable assistance interventions according to the conditions of the client;
• Planning of interventions to prevent and reduce risk and environmental factors favoring the decline of physical function, the reduction of quality of life, social isolation and the onset of disability.
• Planning of educational interventions for the active participation of the client and his / her family in decisions and assistance programs
• Planning of family support interventions (ascertaining the caregiver burden and resources that can be activated).

MAKING JUDGMENTS
• Critically evaluate the applicability of therapeutic/rehabilitative interventions suitable for the specific situation;
• Verify the achievement of the planned care goals.

COMMUNICATION SKILLS
• Use appropriate specific terminology, with attention to reducing discriminations.

LEARNING SKILLS
• Identify suitable sources for professional updating.

For a better understanding of the topics covered in this teaching, the student should have basic knowledge of Nursing disciplines in the medical area and General Nursing III (1st semester courses).

1) Definitions and epidemiology
2) Theoretical frameworks of reference
3) Assessment and assessment tools
4) Common caregiving issues (adherence, coping, health awareness, energy balance, self-esteem, role performance, and well-being)

Apuzzo, L., Iodice, M., Gambella, M., Scarpa, A., & Burrai, F. (2021). Il Chronic Care Model. Giornale di Clinica Nefrologica e Dialisi, 33, 141–145. https://doi.org/10.33393/gcnd.2021.2242

Coleman, K., Austin, B. T., Brach, C., & Wagner, E. H. (2009). Evidence On The Chronic Care Model In The New Millennium. Health Affairs, 28(1), 75–85. https://doi.org/10.1377/hlthaff.28.1.75

Davy, C., Bleasel, J., Liu, H., Tchan, M., Ponniah, S., & Brown, A. (2015). Effectiveness of chronic care models: Opportunities for improving healthcare practice and health outcomes: a systematic review. BMC Health Services Research, 15(1), 194. https://doi.org/10.1186/s12913-015-0854-8

Direzione centrale salute, politiche sociali e disabilità FVG. (2022). Portale Italiano delle Classificazioni Sanitarie. https://www.reteclassificazioni.it/portal_main.php?portal_view=public_custom_page&id=25

Dochterman, J. M., Butcher, H. K., Bulechek, G. M., Wagner, C., & Rigon, L. A. (2020). Classificazione NIC degli interventi infermieristici (3° edizione). CEA.

Moorhead, S., Johnson, M., Maas, M., Swanson, E., & Rigon, L. A. (2020). Classificazione NOC dei risultati infermieristici. Misurazione dei risultati di salute (3° edizione). CEA.

NANDA-I. (2018). Diagnosi infermieristiche—Definizioni e classificazione 2018-2020 (T. H. H. S. Kamitsuru, A c. Di; Undicesima edizione). Casa Editrice Ambrosiana.

Riegel, B., Dunbar, S. B., Fitzsimons, D., Freedland, K. E., Lee, C. S., Middleton, S., Stromberg, A., Vellone, E., Webber, D. E., & Jaarsma, T. (2021). Self-care research: Where are we now? Where are we going? International Journal of Nursing Studies, 116, 103402. https://doi.org/10.1016/j.ijnurstu.2019.103402
Riegel, B., Jaarsma, T., Lee, C. S., & Strömberg, A. (2019). Integrating Symptoms Into the Middle-Range Theory of Self-Care of Chronic Illness. Advances in Nursing Science, 42(3), 206–215. https://doi.org/10.1097/ANS.0000000000000237
Riegel, B., Jaarsma, T., & Strömberg, A. (2012). A Middle-Range Theory of Self-Care of Chronic Illness. Advances in Nursing Science, 35(3), 194–204. https://doi.org/10.1097/ANS.0b013e318261b1ba

Wilkinson, J. M., & Barcus, L. (2017). Diagnosi infermieristiche con NOC e NIC (Seconda edizione). Casa Editrice Ambrosiana.

World Health Organization. (s.d.). International Classification of Functioning, Disability and Health (ICF). Recuperato 24 agosto 2022, da https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health

World Health Organization. (2005). ICF versione breve: Classificazione Internazionale del Funzionamento, della disabilità e della salute. Erickson.
World Health Organization. (2023). WHO framework for meaningful engagement of people living with noncommunicable diseases, and mental health and neurological conditions. World Health Organization.

The course aims to provide the student with the knowledge and skills necessary to take care of the person with chronic degenerative diseases, identifying the assistance needs and preparing the most suitable educational, therapeutic and rehabilitative interventions for the person and the family, in a multidisciplinary perspective.

Topics covered:
1) Definitions and epidemiology: new definition of health, non-communicable diseases and causes of death, risk factors, general care objectives
2) Theoretical frameworks of reference: Determinants of health, Chronic care model, Keizer pyramid, ACG system, Intensity of care, National Chronicity Plan,
3) Assessment and assessment tools: ICF 2018 and its history, WHODAS, Functional Independence Measure and Functional Assessment Measure (FIM and FAM), Quality of Life (QoL) and Health-Related Quality of Life (HRQL) and self-care measures
4) Common care problems: declined according to the use of the NNN taxonomy (NANDA, NIC and NOC) for chronic degenerative pathologies (in particular arterial hypertension, diabetes mellitus, chronic lesions and peripheral vascular disease, chronic respiratory insufficiency, heart failure, neurodegenerative pathologies , dementia and chronic liver disease). The main aspects of care will be therapeutic adherence, coping as a nursing problem, health awareness and intervention on non-health determinants, energy balance, self-esteem, role performance and well-being, sense of helplessness.

Lectures and flipped classrooms with the support of digital presentations and videos, during which students will be invited to form working groups.
During the course elements of gamification will be proposed, which will allow a bonus to the final grade. Various exemplary clinical situations will be presented which the students will have to analyze and finally propose in a group a plan of care.
Furthermore, a team-based learning experience will be offered, which will serve as a valid formative assessment ('prova in itinere'), thereby reducing the portion of the syllabus assessed in the final examination.

All the study material and on topics discussed in class is available on the Moodle platform of the course, including links to the shown videos.

The written exam will be administered via the Moodle platform and will consist of 9 closed-ended questions (including multiple choice, categorization, and ranking formats) and 3 open-ended questions. Each question will carry a score ranging from 1 to 5 points, with higher scores assigned to open-ended questions and those involving categorization and ranking. The total duration of the exam is 1 hour.
The final grade will be expressed on a 30-point scale, with 18/30 representing the minimum passing score. An optional bonus of 2 points may be awarded for active participation in class activities through gamification, as certified by a downloadable certificate available on Moodle at the end of the course. This bonus is applicable only if the exam score, as calculated by the platform, is already sufficient (i.e., at least 18/30).
A final score exceeding 30/30 will result in the award of honors (cum laude).
Closed-ended questions will be automatically graded by Moodle, including decimal scores for partially correct answers. Open-ended questions will receive the maximum score if the student demonstrates excellent knowledge of the topic, provides a comprehensive response, and uses precise and appropriate language. Lower scores may be assigned if the response is incomplete, partially correct, or presented in a confused manner with poor or inadequate language use. A score of 0 points will be given if the student fails to respond or demonstrates insufficient understanding of the content. The score assigned to each open-ended question will be visible on Moodle during the exam.
The exam results will be communicated individually via Moodle. Students will have 2 days from the time the grade is posted to decline the grade, after which it will be considered automatically accepted.
Students who participate in the team-based learning activity and receive a positive evaluation, according to the procedures explained during the first class, will be eligible for a simplified final exam, in which the topics covered during the team-based learning session will be considered as already acquired. The grade (out of 30) obtained in the team-based learning activity may be averaged with the final exam grade, should the student choose to use it. Students retain the right to decline the team-based learning grade.

This course explores topics closely related to one or more goals of the United Nations 2030 Agenda for Sustainable Development (SDGs) (#3 and 10)