The InSieMe Project: Developing the role of the MS Nurse in Italy

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The InSieMe ProjectDeveloping the role of the
MS Nurse in Italy

• R. Motta, RN
• Social and Health Services and Research, Italian
  MS Society, ITALY

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InSieMe Infermieri per la Sclerosi Multipla

• Together Nurses for Multiple
• Sclerosis

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Background

• Approximately 52,000 affected with MS
• Socialized health system
• Inadequate distribution of human resources in
  hospitals and out-patient services (ie.
  patientneurologist ratio - northern Italy 571
  vs 341 in southern)
• No special training/education in MS for allied
  healthcare professionals

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AIMCreate, develop, formalize role of MS nurse
in Italy

• GOALS
• Develop nurses specialized in MS
• Standardize healthcare practices in MS nursing
• Mechanism for exchange and professional growth
• Peer support network

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Phases of InSieMe- develop curriculum-
choose 1st 10 centres/nurses- intensive,
comprehensive training on MS- regional courses
- national conference- develop a permanente
organization or group
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Phase 1Develop curriculumTopics chosen based
on -IOMSN Core Curriculum -Canadian MS Care
Plan -Focus groups of professionals and
persons with MS
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MODULES PROGRAM.
Day 1 Overview of multiple sclerosis Understanding the basics of neurological examination and EDSS Identifying and coordinating an interdisciplinary team
Day 2 Disease modifying agents Evaluating materials provided by the pharmaceutical industry Are they always useful? Complementary and alternative therapies Nutrition Fatigue
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Day 3 Urinary dysfunction Using the voiding diary for initial assessment of urinary dysfunction The role of self-catheterization for patients with MS Bowel dysfunction Sexuality Learning to be comfortable talking about sexuality with patients
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Day 4 Cognitive dysfunction Psychosocial aspects Spasticity Tremor Pain
Day 5 Employment issues, legislation and patient and caregiver rights Aids for activities of daily living Resources for the MS nurse Resources for people with MS and their families Documentation
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Phase 2Choose core group of 10
nursesQuestionnaire to 200 neurology
department ? MS clinic exists? ? Dedicated
nurse? ? HoursCriteria - dedicated nurse
following MS pts.- MS clinic open gt 3
days/week- geographical distribution
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Course teaching methods

• Lecture
• Question and answer
• Quiz the audience
• Small group tasks
• Role-playing
• Case studies and case presentations
• Practice visits with patients
• Demonstrations
• Discussion

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Phase 3Training- 5 day course on MS (with 10
nurses)- 2 day/session for revising
curriculum- 3 day course for learning speaker
skills
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Phase 4 Regional course- 10 courses offered
in 10 sites- neurologist were invited to
identify nurse to attend- 1 nurse for each
neurology department in Italy- project covered
all costs except for participants travel
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Centres involved in InSieMe
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1
5
23
23
25
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11
14
8
3
6
13
1
4
8
5
1
8
10
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Key to success - 1CHOOSE THE RIGHT PEOPLE!-
motivated- dedicated- energetic- organized-
open to new experiences- open to challenges
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Key to success - 2- vary teaching methods-
involve partecipants throughout course
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Phase 5National Conference? 1st conference
dedicated to nurses working in MS? Speakers
are nurses!? Program does not exclude nurses
who did not attend regional course? Opportunity
for starting a support network
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1st Annual MS Nurse Conference 25-26 October,
2003 Bologna, Italy? 240 registrants so
far? Launch of new society for Italian MS
Nurses - registration fee includes 1 year
membership in new society
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Conference program
MS nurse Defining a new role Results of the
InSieMe project The impact of InSieMe on MS
patients Improving quality in MS centres The
Cagliari MS Centre as a model The role of the MS
nurse in teaching autonomy The meaning of
autonomy in chronic illness Legislation
regarding patient rights Self-management of
fatigue Sexuality lets start talking about
it Confronting bladder problems The future of
MS nurses in Italy The IOMSN experience Creating
and applying guidelines in MS nursing A new
dialogue between nurse and neurologist Looking
toward the future SISM
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Phase 6SISM- Italian MS Nurse Society?
Founded by a group of MS nurses and Italian MS
Society? Goals for 1st year - continuing
education - guideline development - 2nd annual
conference? Official affiliate of IOMSN
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In countries where no MS Nurse exists people
(nurses, pwMS, other health care professionals)
have to convinced of importance of MS Nurse -
give materials that support and promote
project to put in hospitals and MSS
branches - write a final exam that is
reasonably challenging (with possibility for
failing) - give certificates ? for
completing course ? for passing exam -
offer CE credits, if possible
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(No Transcript)
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Challenges? cultural barriers? cost?
time/personnel
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Challengescultural barriers - nurses
themselves inflexible to change, unwilling to
take on active role and more responsabilities
- patients, families accustomed to
communicating only with neurologist -
physician unwilling to acknowledge a
non-physician can be responsible for
management and decision-making
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Challengescost (hotel and catering for
regional courses and printed materials
very expensive) - smaller-scale (start
small) - use MS Society/hospital structures
rather than hotels - promote project in
materials already produced by MS Society
(i.e. magazine, newsletter, etc.)
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Challenges time/personnel (we used 2 full-time
people for 3 years) - use a person with/in MS
Society who is able to organize the project
and is knowledgable about MS - involve MS
experts and others who will collaborate for
free
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Conclusions? where the MS nurse does not exist
MS Societies must act? creating MS Nurse
experts is a long-term commitment? MS Nurse
has the possibility to improve the quality of
life for people with MS