nurses and doctors can work together
TRANSCRIPT
![Page 1: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/1.jpg)
Nurses and doctors can work together
Roger WatsonProfessor of Nursing
47th Conference German College ofGeneral Practitionersand Family Physicians
MUNICH13/14 September 2013
![Page 2: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/2.jpg)
![Page 3: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/3.jpg)
![Page 4: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/4.jpg)
![Page 5: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/5.jpg)
![Page 6: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/6.jpg)
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
![Page 7: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/7.jpg)
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
![Page 8: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/8.jpg)
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)
![Page 9: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/9.jpg)
What did this handsome surgeon, old enoughto be her father, want of her? Did he expect
her to be more than a devoted nurse?
![Page 10: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/10.jpg)
![Page 11: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/11.jpg)
![Page 12: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/12.jpg)
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?
![Page 13: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/13.jpg)
21st Century nurses
• Educated– BSc– MSc– PhD
![Page 14: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/14.jpg)
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.
![Page 15: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/15.jpg)
…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%...
![Page 16: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/16.jpg)
21st Century nurses
• Educated– BSc– MSc– PhD
• Specialist
![Page 17: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/17.jpg)
![Page 18: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/18.jpg)
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)
![Page 19: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/19.jpg)
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.
![Page 20: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/20.jpg)
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.
![Page 21: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/21.jpg)
![Page 22: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/22.jpg)
![Page 23: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/23.jpg)
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.
![Page 24: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/24.jpg)
21st Century nurses
• Educated– BSc– MSc– PhD
• Specialist
• Advanced
![Page 25: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/25.jpg)
The available evidence suggests that appropriately trained nurses can perform diagnostic endoscopy safely and with similar outcomes to doctors
![Page 26: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/26.jpg)
Achieving interprofessionalism
![Page 27: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/27.jpg)
Health systems…
…worldwide are struggling to keep up, as they become more complex and costly, placing additional demands on health workers
![Page 28: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/28.jpg)
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.
![Page 29: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/29.jpg)
![Page 30: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/30.jpg)
![Page 31: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/31.jpg)
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.
![Page 32: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/32.jpg)
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.
![Page 33: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/33.jpg)
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.
![Page 34: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/34.jpg)
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…
![Page 35: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/35.jpg)
![Page 36: Nurses and doctors can work together](https://reader036.vdocument.in/reader036/viewer/2022062310/58f314981a28ab611f8b456f/html5/thumbnails/36.jpg)
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