Search

Copyright of Italian Journal of Nursing (IJN) / Giornale Italiano di Infermieristica is the property of Collegio IPASVI MI-LO-MB - Ordine Professioni Infermieristiche MI-LO-MB and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

. The implementation of family nursing: the experience of a District of Venice., Introduction: The need to provide district nursing care for patients with simple and complex chronic diseases requires planning and investment in the training of nurses., Objective: To describe the model of management of simple chronic care with the implementation of the Family Nursing in the Districts of the Azienda ULSS 3 Serenissima., Methods: After the analysis of the epidemiological and socio-demographic data of the resident population, and the stratification in classes homogeneous for resource use, according to the Adjusted Clinical Group model, the candidates for the family nurse's position were trained with an ad hoc course., Results: The preferred target for the experimental implementation of Family Nursing care was the elderly population with chronic diseases in District 1, not followed by other health services. At the end of 2022 12 Family Nurses candidates were identified. After a training course, they gradually took over patients with simple chronic conditions, starting with the District 1 with the highest prevalence., Conclusions: In the year 2022, 614 new patients started to be cared for by Family Nurses, in 2023 approximately 900 patients are being followed and monitored by the Family Nurse.

Copyright of Children's Nurses: Italian Journal of Pediatric Nursing Science / Infermieri dei Bambini: Giornale Italiano di Scienze Infermieristiche Pediatriche is the property of Societa Italiana di Scienze Infermieristiche Pediatriche and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

. The family and community nurse-led proactive management of COPD patients: experience of an Italian health district., Introduction: Integrated care management for COPD may reduce healthcare utilisation, improving cost-efficiency., Aim: To assess the primary outcomes of a family and community nurse-led proactive management of COPD patients of an Italian health district., Methods: Target population comprised men and women >60 years, resident in the municipalities of Collegno and Grugliasco (metropolitan area of Turin). Administrative databases (hospital discharge records, drug prescriptions, legal exemptions) were first used to identify patients with diagnosis of COPD; the cases were validated by the General Practitioners (GPs). The 335 patients were enrolled from July 1, 2015 to November 30, 2016. Family and community nurses were responsible for anamnesis, spirometry, assessment of adherence to therapy, counselling and healthy lifestyles education. GPs were responsible for the clinical staging and revision of therapy. Patients were followed-up to 12 months., Results: Improvements were observed in smoking cessation (prevalence of smokers from 23.9% to 20%), BMI normalization (in 13.4% of patients out of standard), physical activity (from 32.5% to 64.5% of patients), and pneumococcal vaccinations (from 14.9% to 58%). The last two outcomes were statistically significant. Patients showed high levels of satisfaction; 12-months compliance was 62.1%., Conclusion: A family and community nurse-led proactive management of COPD patients in primary care is feasible and effective. Interventions should be structured, personalised and multi-component, oriented at motivating, engaging and supporting the patients. Positive results led to continue and extend the programme.

Background: Media play a key part in shaping nurses' social perception. Newspapers were chosen as the subject of this content analysis, as they are the main resource that Italians use to inform themselves. For this reason, ne wspapers are an appropriate resource to analyse the image of the nurse that, as found in literature, is seen as a dynamic phenomenon that changes according to different scenarios. Given the media focus on nurses during COVID- 19 it seems reasonable to analyse what nurse image was emerged., Method: A Content Analysis with an inductive process was conducted. The analysis' objective was to evaluate the image of the nurse in national and local newspapers, published between the 30th of January and the 18th of May 2020. A triangulation methodology was used between the two researchers to ensure data quality., R Esults: Five themes were identified. The risks for the nurse's psycho-physic wellbeing. Taking responsibility and human relations despite barriers. The acknowledgment of professional attributes. Uncertainty on the continuity of the nurses' social role emerged from the media. Nurses only wish to be appreciated for what they do. The agreement between the researchers on the themes has a Krippendor ff 's alpha between =0.713 and =0.985., Conclusions: The media's interest highlighted the nurses' competence in assisting patients with COVID-19. However, there isn't in-depth analysis, of the contemporar y image of the nurse, specifically in relation to leadership. Positive and negative tropes are recalled. The superficiality and fragility of the mediatic phenomena emerged, as opposed to a real positive strengthening of the nurse's social perception.

Nursing requires a complex set of skills encompassing professional clinical judgment, values and attitudes. In order to outline the future career path of the specialist nurse, the European Federation of Nurses Association compared the EU Directive 2013/55/EU with the Competency Framework, an important document on guidelines written by a group of experts and focusing on the recognition of nurses' educational requirements. The aim of our research is to identify the special skill set required from nurses on haemodialysis wards through the development of an exploratory survey and the comparison of its results with the EFN guidelines and the Directive 2013/55/EU. The survey was conducted across eighteen dialysis centers in Tuscany. Through focus groups, debates and reflections, 28 skills were identified as pertaining exclusively to nurses working with haemodialysis patients. This preliminary study aims at demonstrating the need to define and recognize these specialist skills in order to ensure an effective and integrated nursing leadership in disease management., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

. Disphagia: a guide to the assessment. Dysphagia is a frequent symptom in clinical and care practice; taking care of the person with dysphagia requires multidisciplinary approaches, however it involves nurses' responsibility in their daily relationship with the patients and frequent updates on the evolution of assessment, diagnostic and treatment tools. This contribution proposes an update on the different levels of assessment: from screening procedures to the clinical evaluation of dysphagia and presents the main tools used in clinical practice.

Over the past few years, clinical research has developed considerably. To achieve adequate quality standards in its design and management, it was necessary to set up dedicated and qualified multi-professional teams, made up not only of medical personnel. This has led to the emergence of new professional roles, such as that of the research nurse (clinical research nurse, study nurse or clinical trial nurse). While in Europe this professional role is defined, in Italy it has started to assert itself only recently, with a profile linked mainly to practical rather than managerial tasks. The role is not yet recognized at institutional level and is not registered. The goal of our research was to understand how many research centers can rely on the presence of a research nurse in their staff and what was the research nurse's contribution to achieving the satisfaction of patients enrolled in clinical studies and on the work of the research team.

Introduction: In February 2020 the first case of COVID-19 arrived in Canton Ticino. Since then, many things have changed at great speed, especially in health organizations, and these changes have had a strong impact on the nursing profession. The objective of this research was: to investigate the experiences of nurses at different organizational levels who were confronted with the COVID pandemic in the first month in which it occurred., Methods: Narrative Research. The data collection was carried out involving a group of 20 nurses working in different contexts and roles in Canton Ticino. The collected narrations were analyzed through a thematic analysis of their content using Nvivo 12®., Results: The thematic analysis of the narrations made it possible to define 26 themes and 6 macro-themes: Pandemic, What changes, Communication, Emotions/experiences, Role and image, Interprofessional collaboration. The results of this research make it possible to understand how a heterogeneous group of nurses experienced the particular period of pandemic in Canton Ticino and which reflections were derived from it. Some of the aspects highlighted can be compared with what is present in the international literature on the subject in order to find common ways of action for the nursing leadership, in the different Countries, facing the need to organize, manage and support nursing professionals in this and future pandemic situations., Conclusions: The results of this research can be used both at an organisational and educational level and can be the starting point for future research.

Introduction: Professional self-concept is a contextualized multidimensional concept that describes the subjective experiences and feelings of nurses with regard to nursing roles. Professional self-concept starts to develop during the academic years. Yet, there is still limited understanding about the factors affecting nursing students' professional self-concept, which is a potential problem. Poor professional self-concept negatively affects nurses' clinical practice, job satisfaction, and retention in the profession., Aim: This study aimed to explore factors affecting Iranian nursing students' professional self- concept from the perspectives of nursing students, nursing instructors, and hospital nurses., Methods: This exploratory qualitative study was carried out from June 2018 to April 2019. Participants were four hospital nurses, three clinical nursing instructors, and four nursing stu- dents who were purposively selected from the Shiraz University of Medical Sciences, Shiraz, Iran. Data were gathered via in-depth semi-structured interviews and were analyzed via con- ventional content analysis proposed by Graneheim and Lundman., Findings: In total, 610 primary codes were generated and grouped into eleven subthemes and five main themes. The main themes of the study were professional instructors, competent nur- ses, informed choice of nursing profession, difficulties of nursing profession, and congruence between students' personal-professional values and nursing profession., Conclusion: Professional self-concept is affected by different personal, educational, envi- ronmental, and social factors. Nursing instructors, hospital managers, and nurse managers can use the findings of this study to support nursing students, promote their professional self-con- cept, and ensure their retention in the profession.

Introduction: Military corps have always been supported by healthcare providers who took care of the injured and sick soldiers. Traditionally the military nurse's figure has never been fully appreciated to the point that, even nowadays, it is still searching for its own identity., Aim: The aim of the study is to describe the military nurse's role from the Second War for Italian Independence (1859) to the conquest of Rome (1870)., Methods: Historical investigation. Secondary sources were consulted to carry out a geopolitical and historical contextualization of the reference period, while to trace the military nurse's evolution the team referred to primary sources. All the mentioned sources were analyzed according to Chabod's methodology (2012)., Results: The military nurse was born as a corpsman. The Risorgimento wars contributed to highlight the major contribution that nurses could give to military healthcare. In 1863 the Ministry of War elaborated a new and innovative profile for military nurses which foresaw particular physical and moral requirements, but also specific competences. Even though a new ideal of nurse was created, the Military Nurses Corp did not experience any changes: the nurses' activities remained transporting the injured and assisting doctors., Conclusions: Primary sources analysis highlighted an important attention towards the military nurse's role and education after national unity, although the gap shown by the military healthcare service during the Risorgimento battles was evident. Such condition facilitated the development of the first rescue committees which became, at a later time, the International Red Cross. The committees popularity allowed the volunteers to gain higher fame and social prestige than military nurses.

Vaccine hesitancy represents an increasingly important global health issue. Nurses, together with other healthcare professionals, can play a key role in increasing vaccination uptake. The aim of this article is to analyze the main elements of positive communication styles used in vaccination campaigns and initiatives. The most important components in style, construction and contents used in several vaccination campaigns were evaluated through an original instrument, specifically developed for the present study. The most relevant aspects of nursing expertise and competencies were mixed with foundations of mass communication theory, in order to develop a framework made by 13 items, useful to evaluate different aspects of immunization campaigns. A multi-professional project was developed, to obtain a deep integration between nurse expertise in health promotion and other groups with similar public health orientation. The Authors further evaluated sociological instruments and theories from other fields, as mass communication theory and the social/behavioral approach. An integrative review was performed, about the following main themes: vaccination adherence basis; nurse role in health promotion; health education competences; multi-professionals integration in public health; positive communication style; efficacy evaluation. Key elements were collected, to prepare an original instrument to be used in evaluating several communication campaigns. The evaluation framework (13 items) was prepared and applied to vaccine communication in different institutional settings in the last five years. Main components are: elements taken from main communication models (persuasive communication models); nurse competencies in health education; public health expertise (from an expert panel). The main findings of this study regard the usefulness of evaluating main aspects of communication in the vaccine field. Nurses' knowledge and competencies in health promotion and health education add relevant meanings and cues to act against the causes for not vaccinating. It shows that is worth analyzing the main aspects of communication techniques and evaluating innovative methods to increase population confidence levels in public health.

Introduction: Literature has shown that the process of procurement of organs and tissues is fundamental in determining the number of donations. Starting from these assumptions, an integrated procurement model of organs and tissues has been designed and tested, where nurse specialists in organ donation coordinate the team and the entire process., Aim: To evaluate the effectiveness of the Integrated Procurement Models in terms of identifying potential donors and the number of donations., Methods: A retrospective observational study was conducted before and after the introduction of the new procurement model in a large University Hospital in Rome. The data of potential donors identified, the number of donations made and the efficiency indicators of the donation process were compared., Results: 692 potential donors were identified. The introduction of the integrated model increased the number of actual donors (from 31 to 51), brain death assessments (from 69 to 99), and the efficiency indicators of the donation process (from 0.25 to 0.29). From the comparison between the activities before and after the introduction of the integrated procurement model, statistically significant differences emerged regarding the number of donors and the amount of corneal tissue extracted., Conclusions: The adoption of the standardized Integrated Procurement Model would increase the number of potential donors and actual donations, thanks also to the key role assumed by the nurse specializing in organ donation as team and process coordinator.

. The team-based care models in primary care: General Practitioners' perspectives on nurses' role., Introduction: In the last decade in Italy, different team-based primary care models have been developed that involve the collaboration of General Practitioners (GPs) with other professionals, such as nurses., Aims: To investigate the GPs attitude towards the role and levels of autonomy of nurses in the primary care settings., Methods: A two-phase exploratory study was performed: 1) a focus group with a purposeful sample of 12 GPs was conducted to identify the potential patients-clients/problems and activities that might be assigned to nurses; 2) a questionnaire was developed to analyze the levels of autonomy GPs assigned to nurses for different patients-clients/problems and activities. The questionnaire was administered to a convenience sample of 45 GPs, who were also interviewed to explain their choices., Results: GPs recognized autonomy to nurses in the assessment, monitoring and education on lifestyles, prevention of falls, malnutrition and compliance with treatments; in performing technical and organizational activities. They believed necessary supervision or providing indications to nurses in the management of chronic patients, especially in the assessment of signs and symptoms of deterioration, in monitoring and follow-up and partly on the contents of health education. Finally, GPs felt responsible of the management of pluri-pathological and unstable patients, such as heart failure patients, due to their highly unpredictable and rapid deterioration., Conclusions: GPs expressed a positive attitude towards the role of nurses in the primary care setting, which varied depending on patients' instability and clinical complexity.

. The nurses' tasks performed by aids in hospital settings: a mixed-methods study., Introduction: The role of Nurses' aides (NAs) in the clinical practice has been widely debated to date., Aims: To describe the activities/tasks performed by NAs and the dedicated time; to identify the activities/tasks shifted from nurses to NAs and to investigate the motivations., Methods: A multi-center mixed-methods study was conducted. Fifty-six NAs working in 17 hospitals in the North-Italy were observed during daily practice and then interviewed about the motivations associated with task shifting., Results: NAs mainly performed direct care tasks (67.7% of the observed time), such as helping with personal hygiene, feeding and mobilization. Larger hospitals (p = 0.034), surgical units (p = 0.001), a skill mix> 40% (p = 0.044) and a reduced nurse to patient ratio (p = 0.041), were significantly associated with a higher amount of indirect care activities/tasks performed by NAs. The tasks shifted most frequently from nurses to NAs were: mobilization (22; 39.3%) and personal hygiene (21; 37.5%) of unstable patients, feeding patients with dysphagia (19; 34%), intra-venous set replacement (16; 28.6%) and pressure ulcers' dressing (11; 19.6%). NAs reported that they chose to act autonomously because of their experience and the trust-based relationship with nurses, in order to promptly respond to patients needs and to reduce nurse workload., Conclusions: It is necessary to further assess the development of the NAs role in the hospital setting to understand their inclusion in the nursing care.

Chronic diseases require continuous healthcare that is not fully guaranteed by the Italian Health System which is more oriented towards acute care. In the Lazio region (city of Palombara Sabina), a Nursing-Led in-patient unit is present with the aim to care for patients affected by chronic diseases. The aim of this study was to describe the type of healthcare delivered by this unit. A descriptive-comparative design was used. All 290 patients admitted to the Nursing-Led Unit, during 2014 and 2015 participated in the study. The following variables were analyzed: socio-demographic characteristics of patients, reasons for admission, nursing diagnoses and interventions, medical diagnoses and interventions, Barthel index, length of stay, mortality rate, and discharge rate to acute care hospitals. The mean age of participants was 78 years old (SD 11,4) and the most frequent reason for admission was the need to receive a medium-high intensity nursing care (14,5%). The most frequent nursing diagnoses were bathing/hygiene self-care deficit (78,3%) and impaired physical mobility (74,8%). Hypertensive heart disease was the most frequent medical diagnosis (32,4%). The mean length of stay was 19 days, the mortality rate was 2,1% and the discharge rate to an acute care hospital was 9%. Significant improvements in patient dependency levels, as measured by the Barthel index, were observed at discharge with respect to admission (p < 0,001). The NursingLed Unit seems to be strategic in the delivery of care to older adults affected by multiple chronic diseases, in some phases of their condition. The results of this study indicate that the Palombara Sabina's nursing-led unit may contribute in reducing hospital admissions and achieving favorable patient outcomes when additional nursing interventions are needed.

. The recent global economic recession has affected nursing working conditions in terms of salary reductions, increased workload and staff shortages. Poor nursing working conditions are associated with higher levels of burnout. A literature review was conducted to identify contributions of European nurses from 2010 on the consequences of the economic crisis on the health services. Only few contributions were identified and from a limited number of countries (UK, Italy, Spain and Greece).

Introduction: Obesity is a major public health problem because it is a risk factor for various chronic diseases and its incidence is constantly increasing due to changes in diet and lifestyle. In Italy, studies show that 32% of the population aged between 18 and 69 years is overweight and 10% is obese. The aim of this study was to measure the anthropometric characteristics of a sample population of the city of Rome (Italy) and correlate these with dietary habits and socio-demographic characteristics of participants in order to evaluate their specific health and educational needs., Methods: A cross-sectional study was conducted in February 2015 by administering an ad-hoc questionnaire to subjects over 18 years of age attending a General Practitioner's practice in Rome (Italy). The questionnaire collected demographic, clinical and anthropometric data, and information regarding dietary habits., Results: The sample consisted of 150 individuals with a mean age of 47,8 years. Fifty nine percent were women. The mean Body Mass Index (BMI) was 26.7. The average blood pressure was 131/80 mmHg. BMI values were higher in respondents with a lower educational level and BMI was significantly associated with the quality of the source of nutrition information used., Conclusions: Poor and unreliable information regarding proper nutrition can correlate with the risk of overweight and the consequent development of chronic diseases. The family or community nurse could play a critical role in prevention, by helping to provide correct information for specific populations and by planning training and prevention activities with the GP.

Objectives: Occupational Health Nurses have gradually changed their role. To provide a national and international overview concerning the Occupational Health Nurse's role and to evaluate which are the regulatory/professional elements currently in force in Italy that may permit to better structure and develop Occupational Health Nurse's technical/scientific knowledges., Methods: Literature and regulatory texts review in Italy and abroad; on sight research in some public and private Occupational Health services., Results: Occupational Health Nurses' role abroad is well established and it's primarily aimed to preventive health interventions and health promotions. In Italy, on the contrary, the role of nurses in Occupational Health is almost always accessory in the implementation of health surveillance and workers' health education. This fact seems to be the result of the absence of a specific training course for those professionals, that could better define their legal profile., Conclusions: We verified the need that the training curricula of the Nursing Degree and of the Post-graduate Degree in Nursing and Midwifery Sciences give more space for teaching specific Occupational Health skills. It seems useful to propose the activation of specific post-graduate training courses for nurses who wish to focus specifically their professional activity in our disciplinary field., Competing Interests: The authors of this article have no conflict of interests to disclose., (Copyright© by Aracne Editrice, Roma, Italy.)

In recent years, nursing autonomy has increased: clinical nurses in their daily practice undertake several independent and collaborative decisions. In addition, during nursing surveillance, clinical nurses collect data, intercept signs and/or symptoms of decline, early detect emerging problems and trigger a decision-making process by identifying interventions that lead to the attention of physicians, in advance - in order to be allowed to undertake the intervention; or after having implemented the intervention - in order to get an endorsement. The "near-decision making" process in a non-nursing field of autonomy, daily occurs, as a complex process that involves several aspects: individual, interpersonal, and organizational factors. To fill in the literature gap, a purposeful sample of expert nurses has been interviewed; then, using the hybrid model of Schwartz-Barcott & Kim, the concept of "near-decision making" has been described, as well as its attributes, antecedents and consequences were identified.

Aim: To describe the occurrence and the typology of waste in the nurses clinical practice as well as the differences between the medical and surgical area., Methods: A cross-sectional study was conducted in a north eastern Italian hospital. Data collection, conducted on 100 nurses in September 2015, was carried out using a semi-structured questionnaire consisting of 56 items and eight dimensions (Overproduction / Underutilisation, Wait, Stocks, Process, Inefficiency and Errors, Material Transport and Information Flows, Movements, Dispersion of Knowledge)., Results: In a nurses' working week 2,028 ± 9.2 waste occurrences were reported, with an average of 20.2 ±9.2 per nurse. Seven hundred fifty-nine (37.4%) of them occurred in the medical area, while 1,269 (63.6%) occurred in the surgical area. The most frequent number of waste (398; 19.6%) occurred in the "Process" dimension. Across the investigated dimensions, the main types of waste were: the inappropriate use of energy (30.0%), waiting for the physician (17.1%), shortage of materials (33.1%), the excess of human resources distributed in a sub-optimal manner (31.8%), human resources shortage (22.4%), incomprehensible and/or incomplete therapeutic prescriptions (22.6%), the search of materials in distant warehouses or in outside locale (23.9%), the transfer of team members from one department to another (30.0%), and limited application of scientific evidence in clinical practice (51.7%). No statistical differences emerged between the two investigated clinical areas (p-value = 0.480)., Conclusions: The study is a contribution to the national debate on the phenomenon of waste in health care organizations, and provides useful insights on the possible strategies of its containment.

Aim: This research aimed to explore the literature regarding the model of the Shared Decision Making (SDM) in the field of nursing., Method: A scoping review was conducted. The electronic literature research was made on Medline, CINAHL, The Cochrane Library, Google Scholar, using a combination of key words: "Decision Making", "Shared Decision Making", "Nursing", "Nursing Patient relationship". The review was carried out following the Levac model., Results: 29 studies were included, in a time range between 1972 and 2015. The analysis identifies the main characteristics of the SDM model, the tools for its implementation, the patients experience, the fields of application and the integration among SDM e evidence based practice., Conclusion: the analysis showed that the Shared Decision Making model is not widespread, especially in the Italian context. This phenomenon could be explained by three fundamental aspects. The concept is not widely disseminated and full scientific maturity. His application also seems to be related to extensive knowledge of gold standard interventions and possible alternatives. Finally, there are cultural barriers to the implementation of the SDM.

Introduction: In 2004, the Oncology Institute of Southern Switzerland (IOSI) started a program to improve cancer pain treatment, through training of health professionals and the introduction of monitoring tools ., Aim: The aim is to evaluate patient relief from pain (effective pain control), with attention to nursing role (pain assessment, monitoring and documentation)., Method: Retrospective study. The health records of patients admitted in the last three months of 2010 were consulted to evaluate how pain was assessed and managed., Results: Out of 177 patients admitted, 93 (52.6 %) experienced pain during hospitalization and 85 were included in the analysis . Sixty-two out of 85 (72.9 %) received drugs in reserve > = 2 days. They had pain from 2 to 28 days (median 4). For 56/62 patients ( 90.3 %) analgesic therapy was changed one or more times and 40 of them ( 63.4 % ) received strong opioids during hospitalization . In 8/62 cases pain wasn't documented, and overall, in 25/85 (29.4 %) intensity or any other feature weren't documented., Conclusions: At IOSI there is a good pharmacological control of pain. Analgesics are prescribed upon entry and are modulated according to patient needs, even with wide administration of opioids. The issue to improve is pain assessment and monitoring by nurses, whose role is mainly oriented to contribute to the pharmacological management of this symptom.

Complexity of nursing care represents an important indicator in the planning and management of nursing resources and healthcare management. However, the term is not clearly defined in the literature. The aim of this article is to outline the main concepts associated with complexity of nursing care, trying to shed light on the different variables that constitute it. We conducted a review of the literature and selected 12 articles. The terms associated with the concept of complexity of nursing care include nursing intensity, nursing work, nursing workload, patient acuity and severity of illness. The literature review indicates that complexity of nursing care appears to be one of the variables of care intensity, the latter being defined as a commitment of care delivered to the patient. It is associated with the concepts of nursing work, nursing workload, patient acuity and severity of illness. Understanding and clarifying the concept of complexity of care is fundamental in order to measure and evaluate the real demand for nursing care by individual patients.

Summary: The implementation of the week surgery in an orthopedic and urology ward and the assessment of its impact., Introduction: The week surgery (WS) is one of the models organized according the intensity of care that allows the improvement of the appropriateness of the hospital admissions., Aim: To describe the implementation and the impact of the WS on costs and levels of care., Methods: The WS was gradually implemented in an orthopedic and urology ward. The planning of the surgeries was modified, the wards where patients would have been transferred during the week-end where identified, the nurses were supported by expert nurses to learn new skills and clinical pathways were implemented. The periods January-June 2012 and 2013 were compared identifying a set of indicators according to the health technology assessment method., Results: The nurses were able to take vacations according to schedule; the cost of outsourcing services were reduced (-4.953 Euros) as well as those of consumables. The nursing care could be guaranteed employing less (-5) full-time nurses; the global clinical performance of the ward did not vary. Unfortunately several urology patients could not be discharged during the week-ends., Conclusions: A good planning of the surgeries according to the patients' length of staying, together with interventions to increase the staff-skill mix, and the clinical pathways allowed an effective and efficient implementation of the WS model without jeopardizing patients' safety.