nurses and doctors can work together
TRANSCRIPT
Nurses and doctors can work together
Roger WatsonProfessor of Nursing
47th Conference German College ofGeneral Practitionersand Family Physicians
MUNICH13/14 September 2013
Complexity in care
• Breadth – multiple needs (more than one) that are interrelated or interconected
• Depth of need – profound, severe, serious or intense
Rankin & Regan (2004) Meeting complex needs: the future of social care, IPPR, London
Complexity in care - example• Communication
– Cannot tell you what is wrong
• Cognition– Cannot understand what you are telling them
• Behaviour– Requires management
• Environment
From : northamtonshire.gov.uk
What are we aiming to do as health professionals?• Health is all about people. Beyond the glitterring
surface of modern technology, the core space of every health system is occupied by the unique encounter between one set of people who need services and another who have been entrusted to deliver them.
The Lancet (2010)
What did this handsome surgeon, old enoughto be her father, want of her? Did he expect
her to be more than a devoted nurse?
Complex care
• Nurses are ideally placed to manage complex care needs
– But are nurses prepared to manage complex care?
– Are nurses prepared for interprofessional care?
21st Century nurses
• Educated– BSc– MSc– PhD
Conclusion: In hospitals with higher proportions of nurses educated at the baccalaureate level or higher, surgical patients experienced lower mortality and failure to rescue rates.
…the Institute of Medicine issued a report in which it recommended that the proportion of nurses in the United States who hold at least a bachelor’s degree be increased from the current level of 50% to 80%...
21st Century nurses
• Educated– BSc– MSc– PhD
• Specialist
Removal of foreign bodies from children’s ears: a nurse-led clinic
• A reduction in the hours junior doctors are allowed to work and changes to their training have led to opportunities to develop and expand the scope of nurses, with advanced nurses practitioners leading the way in challenging traditional professional boundaries (RCN 2012)
Removal of foreign bodies from children’s ears: a nurse-led clinic
• Specialist nurses in the UK have been found to be clinically and cost effective (RCN 2010), and have a role in reducing unnecessary hospital admissoins.
Removal of foreign bodies from children’s ears: a nurse-led clinic
• At the ear, nose and throat (ENT) outpatient clincic at Birmingham Children’s Hospital, the success rate for the removal of foreign bodies from children’s ears by junior doctors was low.
• The clinic led by the advanced practitioners was more successful at removing foreign bodies from children’s ears than either the registrar-led or junior doctor-led clinics.
Results. A total of 47 patients in the intervention group and 50 in the control group completed the 12-month trial. The trial revealed no statistically significant differences between groups in mean change of Disease Activity Score 28, VisualAnalogue Scales for pain, the Health Assessment Questionnaire, satisfaction with or confidence in obtaining rheumatology care.
21st Century nurses
• Educated– BSc– MSc– PhD
• Specialist
• Advanced
The available evidence suggests that appropriately trained nurses can perform diagnostic endoscopy safely and with similar outcomes to doctors
Achieving interprofessionalism
Health systems…
…worldwide are struggling to keep up, as they become more complex and costly, placing additional demands on health workers
Professional education…
…has not kept pace with these challenges, largely because of fragmented, outdated, and static curricula that produce ill-equipped graduates.
Laudable efforts to address these deficiencies have mostly floundered, partly because of the so-called tribalism of the professions—i.e. the tendency of the various professions to act in isolation from or even in competition with each other.
Results/findings. Nurses consistently gave more negative responses on every survey question than junior doctors. While nurses said that the amount of collaboration was inadequate, junior doctors were satisfied and views between groups were most divergent (P < 0.01) on questions about overall satisfaction with team decisions.
Recommendations(adapted from The Lancet 2010)
• Promotion of interprofessional and transprofessional education that breaks down professional silos while enhancing collaborative and non-hierarchical relationships in effective teams.
Recommendations(adapted from The Lancet 2010)
• Promote a new professionalism that uses competencies as the objective criterion for the classification of health professionals, transforming present conventional silos.
Recommendations(adapted from The Lancet 2010)
• Nurturing of a culture of critical inquiry as a central function of universities and other institutions of higher learning…
Conclusion
• Care is increasingly complex
• No single profession can cope with the complexity of care on its own
• Nurses are ideally placed to manage aspects of complex care
• Interprofessionalism needs to become normal in education and in practice
@rwatson1955