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Global Case Management: The “Nurse Case Manager” Model Applied to Day Surgery in Italy

Palese, Alvisa DDSI, RN, BcsN; Comuzzi, Chiara RN, BcsN; Bresadola, Vittorio MD


Day Surgery (DS) and prehospitalization emerged in Italy—as it had previously in the United States and other European countries—as able to improve healthcare and reduce costs. The purpose of this study was to evaluate the impact of the Nurse Case Manager (NCM) Model on patients undergoing DS procedures. The study assessed the intensity of pain, anxiety, and stress factors, and the level of discomfort experienced. The quasi-experimental study design involved two groups of patients (at two different DS hospital centers): one using the NCM model (Ward A) the other based on team nursing (Ward B). All patients undergoing DS for (a) varicose veins, (b) inguinal hernia, (c) breast biopsy, and (d) hemorrhoids were included. A valid questionnaire interview based on 22 questions was used (1) the morning before surgery, (2) the evening after surgery, and (3) 48 hr after the operation, by telephone. Of the145 patients that were involved, 66 were from Ward A (45.5%) and 79 from Ward B (54.5%). When patient care was based on the NCM Model (Ward A), it seemed that (a) the pathway before DS was more efficient; (b) they perceived lower levels of perioperative anxiety and pain; and (c) they recognized the DS center as a unique point of reference for all postoperative problems.

Alvisa Palese, DDSI, RN, BcsN, is a nurse educator and clinical tutor in the School of Nursing at Udine University in Italy. She is on the boards of the “Nursing Services and Research Council” (“Assistenza Infermieristica e Ricerca”), Italian Nursing Journal Index in CINHAL, NCI, and MEDLINE. She is a frequent speaker at Italian Nursing Congresses and she has had more than 70 articles published.

Chiara Comuzzi, RN, BcsN, is a general nurse in the Department of Surgery at the University of Udine Hospital in Italy.

Vittorio Bresadola, MD, is the Associate Professor of the General Surgical Department at the University of Udine Hospital in Italy. He is a member of the “Italian Society of Endoscopic Surgery and Minimum-Invasion Techniques,” the European Association for Endoscopic Surgery (EAES), the Society for Surgery of the Alimentary Tract (SSAT), and the “Groupe Europeen Etude Maladies Oesophage” (GEMO). Professor Bresadola lectures in Nursing and Medical Schools and has had more than 130 original articles published.

Address correspondence to Alvisa Palese, DDSI, RN, BcsN, School of Nursing, Viale Ungheria 18, 33100 Udine, Italy (

© 2005 Lippincott Williams & Wilkins, Inc.