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Introducing the Family Health Nurse Concept in Europe Purpose Presenting the Family Health Nurse FHN as advance role of nursing, the paper aims to stimulate reflection on the potential of this role and the best model to pursue for its introduction in European Health Systems. Objectives: inform about the role of FHN and its potential contribution to the development of prevention strategies and integrated care for all the population, presenting studies results on case management and good practises in Europe. Background: Ageing of population, economic recession, advances in technology, increasing complexity of health needs, structural changes in health care delivery, underscore the search for innovative, cost-effective approaches to health care worldwide. Maintaining the current mode of service delivery will be insufficient to meet the health demands of the future. As part of the Health21 health policy framework, the WHO Europe Office introduced the Family Health Nurse (FHN) a key professional in achieving the overarching aims of Health21: "promoting and protecting people's health throughout the course of their lives; and reducing the incidence of and suffering from the main diseases and injuries" (WHO Regional Office for Europe,1998, p. 8). FHN plays multidimensional activities focused not only on the individual, but also on families, groups and populations to support promotion of health and is proactive in primary, secondary and, above all, tertiary prevention of disease/illness and disability and to maintain an individual in his or her family and community. (Martin 2013) The FHN is a "case manager" able to read, assess and respond to the health needs of citizens and families, to support the autonomy, to coordinate interventions of health and social services, to activate associations of the territory, friendship and neighbouring networks , to control the passage of information and the continuity of care in case of hospitalization, to provide personalized advice and assistance to self-help and for structural improvements, housing and organizational changes necessary for a more sustainable coexistence. Integrated Care needs certainly policies, structural organizations and tools, but also actors that can realize the contact between services and people: a role that FHN, if recognised as a OMS -Eu 21 proposed, could play. To reach these goals is important an advanced learning program for nurses, because the role is different from district and home visiting nurses working in the primary care. The University San Luigi Gonzaga of Turin offers, since 2005, a post graduate course in Family and Community Nursing , called 1°level Master. The program is very stimulating, with the aim of not only to give more knowledge, but to enable a personal growth and learning "out the box" thinking to find creative solutions. Tele-health and ICT teachings have been introduced in the current edition of the Master. Following the Turin experience, 5 more Universities are now launching the program. In order to support the introduction of the role, AIFeC and Turin University, have built a network between universities, health service managers, district nurses, GPs associations, citizens associations, unions and colleges of nurses and have been given consulting for small projects all over in Italy because many studies and analyses identify in inter-professional issues the big obstacle for change. (OECD. 2010) In Sicily and Lazio Region two drafts law have been presented on FHN. International contacts have been established with Spain, Portugal, France and Scotland Universities and Local Health Services. In Spain, Family and Community Nurses have a strong tradition and in 2010 a new post graduate course has been launched. The program lasts two years and is residential, with many courses and internships in common with General Practitioner Physician students. Where the role is fully implemented, has been proved the satisfaction of citizens and other health professionals as GPs and social Workers. Scotland has been pilot of OMS EU study in 2006 and in 2011-2013 the University of the West of Scotland led the European Family Health Nursing Project with Armenia, Austria, Germany, Italy, Poland, Portugal, Romania, Slovenia, and Spain as partners. University of the West of Scotland is launching now a MSc in Family Health, first in Europe. Conclusions: The FHN , as recommended by WHO-EU Health 21, could be a key professional with GPs , for Integrated care and health promotion, strategic to tackle the demographic challenge in Europe. In some countries has been trained but is still not acknowledged and fully used the potential of the role. Many nurses figures are employed in primary care, with important results, such as of palliative care, case management, ChC M, Family Nurse Partnership, Nurses Clinics, Community Nurses, Home Care etc, but are focused on illness and there is lack a "citizen-family centred" coordination and proactiveness. Mladovsky and colleagues (2009) reinforce that the challenges for the countries across Europe will be significant and that further research and learning from the experience of each country are essential. A large research project based on developing FHN workforce for integrated care and on collecting data about cost-effectiveness, could be the way to fostering the acknowledgement of the role in Europe. [ABSTRACT FROM AUTHOR]

Over the last decade, increased attention has been placed on measuring and improving the health care experience of patients. Patient experience is an integral component of service quality and is increasingly recognised as one of the three "pillars of quality in healthcare" alongside clinical effectiveness and patient safety. Despite the complexity surrounding which definition to embrace or which components/constructs to measure, there is general agreement that patient experience in a health care context is formed during the moments when the operation (health service) and consumer (the patient) meet. The series of encounters and consecutive events or steps (activities, interventions, or staff interactions, for example) can be viewed as the patient journey or process of care. Patients living with complex chronic diseases typically receive care from many providers and move frequently within health care settings, so understanding the full impact of a disease on patient experience, in its widest possible context, is central. Gaining a clear picture of the entire patient journey, beginning with characterizing the initial impact of the disease and then mapping the pathway to diagnosis, is essential to identify the critical challenges that patients and their families face while on the road to discover and receive effective treatment and care. The paper used a customer experience mapping in order to understand the journey of patients with HCV (Hepatitis C Virus) and NASH (Nonalcoholic steatohepatitis) within 10 healthcare organizations (hospital trusts and local health authorities) in Italy. The overall aim was to gather information on the real patient journey and on the health and social services used in order to analyse what service users really think and feel, moving through to identify the key conditions for improving the care management of chronic patients. We employed mixed methods in order to exploit a multiple case-study analysis. These included a literature review of theoretical frameworks to map the patient journey and an in-depth analysis of 10 integrated care pathway conducted through local documents analysis, focus groups with professionals and patients, interviews with key managers of the services, and a survey distributed to patients and caregivers. Poor communications, incomplete transfer of information, inadequate education of health professionals, limited access to expertise services, and the absence of a reference contact to ensure continuity of care all contribute to patient dissatisfaction along the journey. The engagement of patients has a central role in the change process within healthcare organizations especially for the definition of integrated clinical pathway. The project underlined firstly that healthcare organizations should respect and take into account patient perceptions, preferences and expectations and consider their emotional journey while defining the integrated clinical pathway; secondly, that the experience of patients could be a driver to implement operation and strategic models to redesign the integrated care pathway and finally, linked to this, that there is a growing need to plan strategies within the healthcare organization to internalize the point of view of patients within the broader clinical and managerial process. [ABSTRACT FROM AUTHOR]