The effectiveness of nursing in intermediate care related to an integrated concept of dependency: a case study using the Modified Barthel index

Introduction. A new care setting was established In modern society, called intermediate care (IC). It refers to residential structures aimed at link hospital and patient’s home, ensuring improved and personalized continuity of care and achieve better health outcomes. Patients admitted in this setting are usually elderly, with high levels of dependency. One of the most used assessment tools for dependency is Barthel Index (BI) and its modified version: the Modified Barthel Index (MBI). The aim of this paper is to verify if care in community hospital (intermediate care) improves patient independence (measured with Modified Barthel Index), and this improvement is linked to an appropriate care model. Methods. A case study of a hypothetical patient has been developed, according to the Rosenberg Model. Data emerging from the case study has been compared with international literature. Care dependency is very a broad concept and includes both objective data and patient’s perceptions. Care dependency, therefore, could be described and assessed from an objective and a subjective point of view, in term of person’s affect. The case-analysis provides possible indicators regarding the meaning of dependency and is the start point for a targeted assessment of Nursing Diagnoses (NDs). Results. The functional domains of NANDA-I taxonomy 2024-2026 related to dependency were identified through the case analysis. Each ND was examined with reference to objective and subjective diagnostic indicators, thus highlighting the diagnoses related to each 14-independence topic presented by Hillcoat-Nallétamby. The MBI has been used as nursing outcome together with other psycho-social indicators. Discussion. MBI is proved to be an indicator of the effectiveness of nursing care provided in the intermediate care settings. However, in order to define a patient as independent, the physical domain should be integrated with his/her psychosocial experiences according to identified Nursing Diagnosis. Conclusion. An integrated nursing assessment leads to the identification of the Nursing Diagnosis influenced by the experience of dependency. Nursing Plan should include patient’s emotions and other aspects related to his/her social life.