Shift the focus

Healthful Vitality | 04/11/2019 | By Neal Elliott | Shift the focus

Traditionally, hospitals have been viewed as a beacon of shining light to the sick or injured. With the advancement of medical technology and knowledge, these institutions are more able than ever to provide the highest quality treatment, preventing morbidity and death on an increasingly grand scale. The care delivered in these facilities is often viewed through rose-tinted spectacles by those who work within them. After all, they do a lot of good for a lot of people.

Shift the focus- The context

However, a growing body of evidence suggests that these institutions are in many cases not the ideal place for a person to receive healthcare [1]. People often need to travel a great distance to their hospital, which can take them away from their support networks. There is also the risk of hospital acquired infection or other nosocomial injury that often exacerbate underlying problems [2]. Although great strides are being taken to overcome these issues, they remain a genuine risk of admission to hospital [3].

Shift the focus to drive the expansion of community-based care

As we continue to acquire a greater understanding of illness and disease through research, there is an increasing appreciation of the need for better preventative care through lifestyle modification [4]. We now understand that a proactive approach to health can prevent disease development, which is reflected throughout society. Notably, generation after generation, understanding the impact of healthy eating, exercise, and smoking cessation on health is further established as common knowledge. Therefore, expanding community-based care should be the next incredible drive within healthcare.

Shift the focus from the traditional reactionary model

The traditional reactionary model of the hospital as an urgent response to illness is changing, giving way to a more communal and preventative model of healthcare. Not only does a pre-emptive approach improve the lives of individuals by preventing suffering, it is also imperative from a utilitarian perspective as it can ultimately reduce cost burden of healthcare for nations. Through the expansion of healthcare roles in the community, it may be possible to keep people healthier in their own homes and communities, particularly in the management of chronic illnesses and the treatment of acute exacerbations within the community [4,5].

An expanding team of registered nurses

These services are currently being delivered by an expanding team of registered nurses. With a person-centred approach to the delivery of care, they continue to carve out roles within the preventative and community-based care model. Indeed, there is an argument for the proliferation and expansion of roles such as acute response teams. The goal of these nurse lead teams is the prevention of the need for the hospital admission

These teams are often centred around those most at risk of serious complications if not treated early, such as the early IV anti-microbial treatment of infection in those with pre-existing chronic illness. Early intervention with anti-microbials is associated with reduced morbidity and mortality, which places teams in contact with at risk patients in the community in a position to significantly reduce the risk of serious complications. The interventions of these teams are constantly expanding, with their scope of practice extending to include treatments that have been previously only been administered in hospitals [6, 7].

The demand for the specialization of nurses in specific fields requires a shift the focus

With more care taking place in the community, there exists an increasing demand for the specialization of nurses in specific fields. For example, chronic lung disease specialist nurses working within the community monitor their patient populations. They also liaise with medical staff to provide rescue packs. As a result, a person with chronic lung disease has easy access to anti-microbials and steroids within their own homes. Therefore, these specialist nurses empower such patients to manage their own health and remain at home supported by the community teams [6, 7]. These new and exciting roles represent a paradigm shift in how we think about healthcare.

Inherent challenge for developed nations

This presents an inherent challenge for developed nations. In developed countries, staff shortages in healthcare are a persistent problem. Many of the roles expanding within the community are specialized nursing roles. The UK currently estimates its deficit of trained staff at approximately 100,000, a significant issue for healthcare provision [9]. Even if each unfilled post were to be allocated a trainee today, it would take three years to qualify these students to practice. This trend reoccurs in the USA, Canada, and many other countries. Historically, developed nations have overcome these immediate staff shortages by importing Nurses from other countries. Given the decreasing popularity of nursing as a career choice in some developed nations [8], coupled with the increased demand for nurses, it can only fill these additional staffing gaps immediately by a single means [9].

The migration of nurses

The migration of nurses is not a new concept. Notably, as far back as the 1950s, the UK has sought to fill its skill gaps by enticing nurses from abroad to come and work in Britain. The promise of significantly better-earning potential than that of their native countries has drawn a massive volume of nurses away from their home countries. Indeed, there are thriving communities founded by migrants in the USA and the UK that exist almost entirely due to nurse migration. While exporting nurses from developing countries raises critical ethical questions, adding trained nurses to the workforce is unquestionably beneficial for the importing country [10].

Whist in the short term, this solution appears to be an inevitability; governments in developed nations must be mindful of the reasons for the shortfall of nurses in their respective countries. The value that society places upon nursing care and the decreasing appeal of the profession amongst its populace should be of grave concern. This is a growing problem facing healthcare providers and governing bodies alike [9].

Final thoughts

As nursing roles continue to expand into the community, this shift in focus should be mirrored by how we promote nursing as a career choice within society. The mobility of international nurses has been of great benefit to the receiving nation. However, there remains a solid argument to be made for better training and incentives for native nurses. The aim would be to balance the workforce between highly skilled migrant nurses and native nurses, providing the experience and skills required while retaining the local cultural knowledge essential for effective community care. While addressing these issues is daunting, they must be addressed effectively if we genuinely wish to shift the focus.

Also Read: COVID-19 and Shift Towards Telemedicine

References:

1. Lee, G. Pickstone, N. Facultad, J. & Titchener. (2017).  The Future of Community Nursing: Hospital in the home.  British Journal of Community Nursing. 22(4)
2. Centre for Disease Control. (2018). HAI Data and Statistics. https://www.cdc.gov/hai/data/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fhai%2Fsurveillance%2Findex.html
3. Haverstick, S. (2017) Patients’ Hand Washing and Reducing Hospital-Acquired Infection. Critical Care Nurse. 37(3)
4. Szanton, S. L. et el. (2015). Preliminary Data from Community Aging in Place, Advancing Better Living for Elders, a Patient‐Directed, Team‐Based Intervention to Improve Physical Function and Decrease Nursing Home Utilization: The First 100 Individuals to Complete a Centres for Medicare and Medicaid Services Innovation Project.  Journal of the American Geriatrics Society. 62(2), 371-374
5. Bauer, L. & Bodenheimer, T. (2017). Expanded roles of registered nurses in primary care delivery of the future.  Nursing Outlook, 65(5), 624-632
6. Poghosyan, L. Liu, J., & Norful, A.A. (2017). Nurse Practitioners as primary care providers with their own patient panels and organizational structures: A cross-sectional study.  International Journal of Nursing Studies. 74, 1-7
7. Smolowitz, J. et el. (2015).  Role of the registered nurse in primary health care: Meeting health care needs in the 21st century.  Nursing Outlook, 63(2), 130-136
8. Stephenson, J. (2018). Nursing Course applications have crashed by third in two years. Nursing Times.  Retrieved from: https://www.nursingtimes.net/news/education/nursing-course-applications-have-crashed-by-third-in-two-years/7025246.article
9. The kings fund. 2018.  https://www.kingsfund.org.uk/press/press-releases/staffing-shortfall-major-risk-nhs-long-term-plan
10. Davda, L., Gallagher, J, E., & Radford, D. R. (2018). Migration motives and integration of international human resources of health in the United Kingdom: systematic review and meta-synthesis of qualitative studies using framework analysis. Human Resources for Health. 16 (27).