Educational project
COMID Ticino - The didactic project in the Master's Degree in Nursing Care.
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As part of the Master of Science in Nursing (MScN) course of study, in the 3rd semester it has been decided to apply a teaching methodology with a strong focus on the interconnection between clinical practice and research.
The syllabus of the modules Advanced Clinical Practice: Chronic Diseases and Research, Methods and Scientific Writing 3 were developed in full coherence with the CanMeds and the Hamric competence profile through the realisation of an innovative training experience. Starting from an in-depth treatment of the best scientific evidence on the topics of Fragility and Complexity, an intervention of data collection, interviews and focus groups was perfected, carried out by the students directly in the home care services, alongside nurses who carry out clinical activities on a daily basis and who were invited to participate in this project through the involvement of the institutions for which they serve. Meeting and sharing with colleagues working in home care enabled the students to better understand the complexity of care delivered in the Spitex (home care) environment and to study and conduct an experience in practice to learn about, understand and experiment with methods of detecting the complexity of care at the Spitex level. Finally, this teaching project allowed the students to be an active part of a nursing research project in which they were active in the various stages of planning and data collection.
Project in brief
The project started by analysing the following context:
global health systems are undergoing major changes;
The next step was to analyse international scientific literature to understand how they acted in other contexts. The experience of Geneva turned out to be interesting, where, considering the difficulty of professionals in identifying the complexity of patients' situations at home, the home care institution (imad) developed a specific multidimensional complexity assessment tool for home nursing practice: the COMID (Catherine Busnel et al., 2018, 2021). The COMID includes 30 items, 5 for each of the 6 sections considered: health status, socio-economic factors, mental health, behaviour, instability, actors. For each item there is a positive or negative response (no = 0 and yes = 1), resulting in an overall score that can vary between 0 and 30. The COMID is compiled by a professional who has completed specific training and is familiar with the patient's situation following the periodic global standardised assessment (InterRAI-HC) and is intended to be a decision-making aid for identifying the elements of complexity and not a tool for classifying complexity. Specifically, the compilation of the COMID makes it possible to identify the elements that need to be discussed by the home care team and/or the interprofessional network, allowing the planning and implementation of specific and targeted actions for the person assisted. The compilation of the tool can be completed in a few minutes and it can be used periodically when the situation requires it. According to previous studies, the tool is to be considered reliable, but also easy to use, useful and relevant for clinical practice (Catherine Busnel et al., 2018; Vallet et al., 2019).
Studio Design
The research project followed the mixed-methods methodology and included a validation study of the Italian translation of the tool and a qualitative study. The timing of the realisation of the study phases is illustrated in the project鈥檚 Gantt Chart.
Validation study of the Italian language translation of the tool
As in the validation study of the original tool (Vallet et al, 2019), the validation study of the Italian language translation of the tool also aimed to verify its internal consistency and intervalutator reliability. The COMID sheet which had previously been translated into Italian and for which we were granted permission to use, was tested by a group of nurses composed of two clusters: MScN student nurses and nurses from the spitex (3 public and 2 private), who freely joined the study. Before entering the field and using the COMID, all nurses attended a specific training consisting of a theoretical and a practical part and the use of the Italian version of the implementation guide.
Qualitative study
The qualitative study was divided into two parts:
Project in brief
The project started by analysing the following context:
global health systems are undergoing major changes;
- the ageing of the population and the increase in chronic diseases are contributing to an accelerated shift from a care system centred on acute diseases and hospitalisation to one based on outpatient care;
- the increase in the number of people with comorbidity makes home-based interventions increasingly complex and requires an adaptation of the home care approach.
The next step was to analyse international scientific literature to understand how they acted in other contexts. The experience of Geneva turned out to be interesting, where, considering the difficulty of professionals in identifying the complexity of patients' situations at home, the home care institution (imad) developed a specific multidimensional complexity assessment tool for home nursing practice: the COMID (Catherine Busnel et al., 2018, 2021). The COMID includes 30 items, 5 for each of the 6 sections considered: health status, socio-economic factors, mental health, behaviour, instability, actors. For each item there is a positive or negative response (no = 0 and yes = 1), resulting in an overall score that can vary between 0 and 30. The COMID is compiled by a professional who has completed specific training and is familiar with the patient's situation following the periodic global standardised assessment (InterRAI-HC) and is intended to be a decision-making aid for identifying the elements of complexity and not a tool for classifying complexity. Specifically, the compilation of the COMID makes it possible to identify the elements that need to be discussed by the home care team and/or the interprofessional network, allowing the planning and implementation of specific and targeted actions for the person assisted. The compilation of the tool can be completed in a few minutes and it can be used periodically when the situation requires it. According to previous studies, the tool is to be considered reliable, but also easy to use, useful and relevant for clinical practice (Catherine Busnel et al., 2018; Vallet et al., 2019).
Studio Design
The research project followed the mixed-methods methodology and included a validation study of the Italian translation of the tool and a qualitative study. The timing of the realisation of the study phases is illustrated in the project鈥檚 Gantt Chart.
Validation study of the Italian language translation of the tool
As in the validation study of the original tool (Vallet et al, 2019), the validation study of the Italian language translation of the tool also aimed to verify its internal consistency and intervalutator reliability. The COMID sheet which had previously been translated into Italian and for which we were granted permission to use, was tested by a group of nurses composed of two clusters: MScN student nurses and nurses from the spitex (3 public and 2 private), who freely joined the study. Before entering the field and using the COMID, all nurses attended a specific training consisting of a theoretical and a practical part and the use of the Italian version of the implementation guide.
Qualitative study
The qualitative study was divided into two parts:
- The first part aimed to explore the ease of use of the COMID, the perceived usefulness with respect to clinical reasoning and the acceptability of the tool among those who used it.
- The second part aimed to explore the possibility of implementing the COMID instrument, post-study, in Ticino's home care services by means of two focus-groups of up to one hour each with nurses, nursing managers and facility managers.