Abstract
Introduction: This contribution describes four different experiences of active engagement along the care pathway of people with chronic illness, performed at home and at the nursing clinic of the ASUGI Health District n. 1 in Trieste by a local care team.
 Case description: The Home Nursing Service, named SID, of the Local Districts of Trieste is based on the principle of improving the quality of life of citizens by providing adequate home care in the logic of continuity of care, consistently with the needs of the person, after a multidimensional assessment and the construction of a personalized care plan, aimed at increasing engagement and participation. ù
 Conclusions: This experience contributed to the cultural growth of professionals and to the systematic introduction of the PHE-S® evaluation tool in the home setting, improving also their relational skills.
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