Our philosophy of care is to assist the person, whether they are healthy or sick, in order to recover an optimal state of health and increasingly improve their state of health.
According to Internursing, taking care of a person means first of all respecting, stimulating and enhancing the unfolding of their existence.
If the other is welcomed in their uniqueness, the person who takes care must necessarily start from the uniqueness of the subject to whom he is addressing this care; this will involve an attitude that is attentive to the other, welcoming, listening and unconditional openness.
We guarantee the right of every patient to receive quality care while respecting their needs, their values, their dignity, the principle of information and their consent.
We are committed to ensuring the involvement of the people who are significant to them.
We guarantee maximum quality of life, providing tailor-made and/or individualized care depending on the patient's state of health. We guarantee attention to the emotions and requests of the patient.
We are committed to providing home care and treatment where the safety and effectiveness of care can be guaranteed without risk to the integrity of the patient and his family.
Furthermore, we are committed to optimizing the resources available in the patient's living environment in order to contain the health care costs of the user and his family.
We give priority to the recovery and/or maintenance of the independence of the person being assisted in carrying out daily activities.
It is our moral responsibility to work to achieve the well-being of the user and therefore not to harm his health and autonomy.
Every decision is made with the user and his family in order to optimize the search for solutions and treatments suitable for the user, carrying out a careful assessment of the situation.
The care situation is shared with the doctor who authorizes the care.
Sometimes the home care process places limits on us; we are committed to accepting them, collaborating with other figures and health facilities in order to maintain the continuity and quality of care.

A. CONTEXT OF CARE

Our home care service, with its qualified, motivated and specialized staff, offers the person in need and his family quality of life, daily well-being, health care and end-of-life support, in constant respect of the needs and habits of the individual. Furthermore, we offer an innovative service that promotes the maintenance of autonomy for the elderly and people with bio-psycho-social difficulties in order to prevent institutionalization.
Support, help and care are combined in an interdisciplinary way to focus on collaboration and relationships between healthcare professionals, users and their families.
Internursing guarantees high-quality services provided by specialized healthcare professionals, such as nurses, geriatric assistants, social health workers, care assistants and healthcare collaborators, carefully selected.
The service is operational every day from 07.00 to 21.00;
Spitex assistance is provided on medical prescription and nursing assessment; it takes care of the client's primary needs and is recognized by all Swiss health insurance funds under the compulsory basic insurance (LaMal).

B. MAIN REASONS FOR THE EXISTENCE OF A CONCEPTUAL MODEL OF NURSING CARE

Nursing care has long evolved; research has developed theoretical models over time that have improved nursing practice. Progressively, the profession has developed its own body of knowledge; concepts and theories continue to evolve to support and further develop the practical component of nursing care. The conceptual evolution of nursing has also incorporated theories from non-nursing sources, including systems, human needs, change, problem solving and decision making theories, thus leading to the formation of a body of knowledge based on scientific evidence, supported by thousands of studies in all areas of nursing, which today trains the new nurse professional. 1
The rational organization of care produced by the nurse is oriented to respond to both general and more specific needs of sick, healthy or dying people (Henderson). Various authors have described their vision of care in general theories, and many of these have contributed to the development of other more specific ones in relation to various contexts and situations of care, often understood as a sequence of pre-established phases, but also as a relationship between subjects or as influence (see Rogers and his school). Those who identify assistance as a logical-systematic process, we find the following common elements: 

• Assessment: process of systematic collection of data, which will result in the selection and organization of such data, with the drafting of a brief final report. This first phase aims to describe, as completely as possible, the clinical-demographic situation of the patient taken into care, defining the general picture as precisely as possible (holistic view of the patient)
• Diagnosis: interpretation of the data from the assessment based on the guiding hypotheses, in evaluating the patient's needs, drawing a final judgment
• Planning: development of objectives and interventions aimed at raising the patient's socio-psycho-physiological state of health (well-being) to the levels prior to the development of the problem(s), and, if the patient adheres, also to higher levels of well-being
• Implementation: implementation of the care plan through planned nursing interventions.
• Evaluation: determination of the patient's responses to nursing interventions and the degree of success in achieving the objectives.

It is now established that a conceptual model of care nursing stimulates the caregiver to greater professional autonomy, promoting the development of analytical skills that allow him to define the purposes of nursing practice, research, orientation and purpose of care.
Furthermore, the caregiver, finding himself more stimulated and sensitized to question himself, will be more aware of his role. The awareness of greater theoretical knowledge will increase the power of the caregiver who, using a systematically developed methodology for each user - which describes, predicts and controls phenomena - will promote a greater probability of obtaining realistic individualized success in care.

C. NURSING CARE MANAGEMENT TOOL WITHIN INTERNURSING

Internursing has embraced the philosophy of the InterRAI-HC system (Resident Assessment Instrument - Home Care), an assessment tool developed in the USA in the 1980s. Today it is a consolidated and well-established tool at an international level. The system helps home care professionals to assess the user's needs and resources in a differentiated way and, with the information collected, to plan the intervention in a targeted way.
The use of this tool optimizes the quality of care.

D. THE ASSESSMENT

The central element in the needs assessment with InterRAI-HC is the MDS (minimum data set): it allows the accurate assessment and analysis of the psychophysical capacities and limits present. It supports and facilitates, thanks to a common language, the work of the personnel in charge. The tool increases the capacity for observation and assessment and helps to clarify whether the person's global situation has been taken into consideration. In fact, the system allows a person-centered assessment of needs.

E. NURSING DIAGNOSIS

Nursing diagnosis is the identification of a real or potential problem of a person, related to the possible causes that determined it. The NANDA method is applied within our service. 3
To draft a nursing diagnosis, the following are essential:

• Data collection, both subjective and objective
• Analysis of data over time

This allows us to identify:

• Unsatisfied needs
• Existing problems
• Potential problems

Following a very specific method and appropriate language, the nursing diagnosis is therefore subject to well-defined rules:

• it is a component of the care process and has the purpose of planning individualized care;
• follows the process of analysis and synthesis
• is the nursing responsibility
• is a statement of nursing judgment

Therefore, the nursing diagnosis:

• is a statement of a real or potential problem
• is expressed in written form with concise and clear language
• includes the description of the problem and the cause
• is specifically centered on people
• provides the direction for the development of the care plan
• is the basis for nursing interventions, as it falls within the object of study of the nursing discipline
• is based on a data collection process

F. PLANNING

Care planning is developed according to the functional models of Marjory Gordon4 which originate from the person-environment interaction: each model is the expression of a bio-interaction-psycho-social.
The care plan is a work tool that the nurse has at his disposal to be able to structure his interventions with the users, consistently with the principles of the global approach to the person and the care situation. The use of the care plan has several advantages and facilitates the therapeutic work because:

• It promotes communication
• It establishes responsibilities
• It finalizes data collection
• It facilitates the individualization of care
• It ensures the continuity of therapeutic interventions
• It allows for precise and timely verification of the work
• It promotes interdisciplinary collaboration
• It increases the effectiveness of care
• It allows for professional improvement

The care plan is made up of 4 work phases:

Diagnostic phase:
collection, analysis of data and identification of resources; development of nursing diagnosis and identification of related problems

Planning phase:
definition of objectives and planning of interventions,

Execution phase:
application of planning,

Evaluation phase:
evaluation of the result based on the achievement of objectives.



Health Management
Version 001 created 04.2015
Version 002 updated 04.2021