Tesi etd-09242025-120921
Link copiato negli appunti
Tipo di tesi
Corso di Dottorato (D.M.226/2021)
Autore
MOSCHETTI, FRANCESCA
URN
etd-09242025-120921
Titolo
Empowering Health through changing roles to promote People and Communities' Wellbeing: The long journey of Nursing role
Settore scientifico disciplinare
MED/45
Corso di studi
Ph.D. in Health Science, Technology and Management - Ph.D. in Health Science, Technology and Management
Relatori
relatore Prof.ssa NUTI, SABINA
Parole chiave
- Nessuna parola chiave trovata
Data inizio appello
13/02/2026;
Disponibilità
parziale
Riassunto analitico
This doctoral research addresses a central challenge for contemporary health systems: how to move from reactive and resource-intensive models of care toward approaches that are preventive, people-centered, and sustainable. Rising health needs, demographic transitions, and persistent inequalities demand not only technological solutions but also a profound rethinking of professional roles, responsibilities, and governance arrangements. Within this transformation, nurses emerge as a strategic case study. Their proximity to citizens, their regulatory positioning, and their evolving competencies make them pivotal in shaping new environments where individuals and communities are activated as co-producers of health.
The thesis adopts an interdisciplinary and multi-method approach to investigate how the evolution of professional roles, particularly nursing, can contribute to building learning environments that foster empowerment, participation, and trust. Across diverse empirical contexts, the research explores the shift from traditional models of care delivery to frameworks that emphasize engagement, co-design, and the redistribution of responsibilities between professionals and citizens.
The first contribution examines how patient experience measures can be integrated into system governance to reinforce relational dimensions of care. Drawing on regional data from Tuscany, the analysis demonstrates that teamwork, respect, and emotional support are not peripheral but central drivers of patient satisfaction and institutional performance. These findings highlight the value of patient-reported indicators not merely as feedback tools, but as levers to align organizational strategies with relational quality.
The second contribution investigates co-design as a transformative methodology in health promotion. Through a participatory intervention in remote schools, adolescents, professionals, and institutions collaborated to develop preventive strategies. The study shows that co-design builds legitimacy, enhances mutual trust, and enables a shift from prescriptive to facilitative professional roles. In fragile social and geographic contexts, where prevention often struggles to gain traction, participatory processes reveal their potential to overcome barriers of distance, distrust, and disengagement.
The third contribution analyses the role of technology in reshaping preventive care. A comparative pilot of two cardiac screening models for adolescents (one traditional, the other based on smart devices and asynchronous tele-reporting) demonstrates that digital models are both feasible and acceptable. Beyond efficiency gains, the findings reveal how technology can redistribute tasks, reduce the dependence on resource-intensive multiprofessional teams, and expand access to prevention in underserved areas.
Taken together, these studies articulate three overarching propositions. First, trust and participation are foundational for sustainable innovation: without them, even the most advanced models risk failing to engage populations meaningfully. Second, professionals should be enabled, not merely trained, to adopt facilitative roles that privilege empowerment, prevention, and relational care. This requires systemic adjustments in governance, evaluation metrics, and continuing education. Third, health systems should integrate measures of experience, engagement, and relational quality into their performance frameworks if they are to support innovation that is both effective and equitable.
The thesis contributes to the literature on value-based healthcare, participatory governance, and health system transformation by proposing a reframing of nursing. Rather than portraying nurses as solitary agents of change, the research situates their evolving role within a broader ecosystem of co-production, where competencies, institutional support, and citizen engagement converge to create sustainable wellbeing.
Ultimately, the work calls for a collective transition: from healthcare to health creation, from delivery to co-design, and from professional dominance to distributed responsibility. Empowerment is not a linear path, but it can be intentionally cultivated, through roles, relationships, and environments that turn care into a shared endeavour for lifelong health.
The thesis adopts an interdisciplinary and multi-method approach to investigate how the evolution of professional roles, particularly nursing, can contribute to building learning environments that foster empowerment, participation, and trust. Across diverse empirical contexts, the research explores the shift from traditional models of care delivery to frameworks that emphasize engagement, co-design, and the redistribution of responsibilities between professionals and citizens.
The first contribution examines how patient experience measures can be integrated into system governance to reinforce relational dimensions of care. Drawing on regional data from Tuscany, the analysis demonstrates that teamwork, respect, and emotional support are not peripheral but central drivers of patient satisfaction and institutional performance. These findings highlight the value of patient-reported indicators not merely as feedback tools, but as levers to align organizational strategies with relational quality.
The second contribution investigates co-design as a transformative methodology in health promotion. Through a participatory intervention in remote schools, adolescents, professionals, and institutions collaborated to develop preventive strategies. The study shows that co-design builds legitimacy, enhances mutual trust, and enables a shift from prescriptive to facilitative professional roles. In fragile social and geographic contexts, where prevention often struggles to gain traction, participatory processes reveal their potential to overcome barriers of distance, distrust, and disengagement.
The third contribution analyses the role of technology in reshaping preventive care. A comparative pilot of two cardiac screening models for adolescents (one traditional, the other based on smart devices and asynchronous tele-reporting) demonstrates that digital models are both feasible and acceptable. Beyond efficiency gains, the findings reveal how technology can redistribute tasks, reduce the dependence on resource-intensive multiprofessional teams, and expand access to prevention in underserved areas.
Taken together, these studies articulate three overarching propositions. First, trust and participation are foundational for sustainable innovation: without them, even the most advanced models risk failing to engage populations meaningfully. Second, professionals should be enabled, not merely trained, to adopt facilitative roles that privilege empowerment, prevention, and relational care. This requires systemic adjustments in governance, evaluation metrics, and continuing education. Third, health systems should integrate measures of experience, engagement, and relational quality into their performance frameworks if they are to support innovation that is both effective and equitable.
The thesis contributes to the literature on value-based healthcare, participatory governance, and health system transformation by proposing a reframing of nursing. Rather than portraying nurses as solitary agents of change, the research situates their evolving role within a broader ecosystem of co-production, where competencies, institutional support, and citizen engagement converge to create sustainable wellbeing.
Ultimately, the work calls for a collective transition: from healthcare to health creation, from delivery to co-design, and from professional dominance to distributed responsibility. Empowerment is not a linear path, but it can be intentionally cultivated, through roles, relationships, and environments that turn care into a shared endeavour for lifelong health.
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