CHAPTER 1 Nursing practice – the essence of caring
Introduction
The current challenges for health care
Although the focus of this book is on health care in the UK and the context in which nursing takes place, its content has much wider relevance. As the World Health Organization (WHO 2003) pointed out, health care does not take place in isolation from political, economic and cultural realities within a country. Nurses constitute a major proportion of the health care workforce in many countries, and certainly those of the WHO European Region, of which the UK is a part, and provide nursing care in environments that are touched by these realities. Many of the challenges that face nurses in UK are not dissimilar to those facing nurses in other countries (WHO 2000, 2003).
Health, illness and disease
A useful distinction can be drawn between ‘illness’ and ‘disease’. An ‘illness’ is what the patient experiences; a ‘disease’ is a description of pathological abnormality, made from the clinician’s point of view. As long ago as 1977, Eisenberg drew this distinction between the personal and professional views, stating, ‘Illnesses are experiences of changes in one’s state of being and social function; diseases are abnormalities in the structure and function of the body organs and systems’ (Eisenberg 1977). The concept of ‘illness’ therefore embraces all the experiential aspects of a disorder: what that patient lives through. This book addresses all three concepts: the disease or disorder and its effect on the body; the illness and how this may be manifested; and the nursing care required to restore health. Nursing management and health promotion are inseparable and nurses are in an ideal position to promote health. The aim of health promotion is to provide individuals with knowledge and skills to make healthy choices about their lifestyle and every nursing interaction presents an opportunity for teaching. For example, patients recovering from a heart attack may be interested in reviewing their diet or may wish to stop smoking.
Changing demography
The population of the UK is ageing. In 2008 the percentage of the population aged 65 and over increased to 16% from 15% in 1983, which means an increase of 1.5 million people in this age group. This trend is projected to continue and by 2033 it is predicted that 23% of the population will be aged 65 and over (Office for National Statistics 2009). Nurses will therefore contribute increasingly to health care for older adults and will need a sound understanding of older people’s perspectives and of their experiences of illness and disability. Nursing also has a significant role in maintaining health in older age, both for older people who remain fit, and for those who must cope with health-related problems (Audit Commission 2004, WHO 2005).
Although not inevitable, older people are more likely to have long-term illness and because of the ageing population, the number of people in England with a long-term condition is set to rise by 23% over the next 25 years. Whilst just 17% of the under 40s have a long-term condition, 3 out of every 5 people aged over 60 have a long-term condition (Department of Health 2010a). Older adults are also more likely to have a combination of illnesses (e.g. cancer and cardiovascular disease) and are more likely to be admitted to hospital or require long-term care within the community (Scottish Executive 2005). The resurgence of diseases such as tuberculosis the challenge of health care-associated infection and HIV/AIDS affects all age groups.
Changing care provision
There are tensions in current approaches to health care delivery, all of which affect nursing practice. For example, there is a mismatch between the need for proactive, integrated and preventive care for people with long-term conditions and a health care system that is perceived as prioritising specialised, episodic care for acute conditions. In the NHS Second Stage Review, Lord Darzi (Department of Health 2008) identified six key goals: tackling obesity, reducing alcohol harm, treating drug addiction, reducing smoking rates, improving sexual health and improving mental health.
In 2010 the new UK Government published its long-term vision for the future of the NHS in England. Equality and excellence: Liberating the NHS (Department of Health 2010b) set out the proposed reforms designed to ‘put patients at the heart of everything the NHS does’. The focus will be on continuously improving the outcomes of health care and empowering and freeing up clinicians to become more innovative. The importance of shared decision-making is captured in the phrase no decision about me without me (Department of Health 2010b, p. 3). As Darzi (Department of Health 2008) pointed out, the public now expects not just services that are there when they need them, and treat them in the way that they want to be treated, but services that they can influence and shape for themselves. Nurses are well placed to respond to these changing demands, with many of the services for long-term conditions now led by nurses.
Changing nursing roles
Modernising Nursing Careers (Department of Health 2006) recognised that nurses’ roles and responsibilities needed to change. In particular it stated that nurses needed to (Department of Health 2006, p. 10):
Professional accountability
Student nurses are not professionally accountable until they become registered nurses but they are subject to guidance from the Nursing and Midwifery Council (NMC). Guidance on professional conduct for nursing and midwifery students (Nursing and Midwifery Council 2010a), which is based on The Code, sets out the personal and professional conduct expected of students in order for them to be considered fit to practise. Once registered, The Code (Nursing and Midwifery Council 2008) sets out the standards of conduct, performance and ethics that are expected of nurses and midwives. Professional registered nurses are personally accountable for their actions and omissions in their practice and must always be able to justify their decisions (Nursing and Midwifery Council 2008). Fundamental nursing care is increasingly being delivered by health care assistants and associate practitioners, which means that registered nurses are accountable for care they are not delivering themselves. The Code requires that if nurses are delegating care to another professional, health care support staff, carer or relative they must ‘…delegate effectively and are accountable for the appropriateness of the delegation’ (Nursing and Midwifery Council 2008). The NMC (2008, p. 6) states that it is the nurse’s responsibility to:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
