This paper aims to show how new concepts and approaches to healthcare delivery are going to influence the work of registered nurses. In particular, we need to focus on such notions as population health and primary healthcare, which have changed the role of nurses and enlarged the scope of their duties. In addition to that, it is necessary to compare personal definitions of health and those ones, proposed by scholars. This analysis will enable us to better understand the functions of nurses, as well as those skills, which they need to possess.
The concept of population health and its implications for the registered nurses
Such term as population health is relatively new; it first emerged in Canada and later became popular in many other countries, including Australia. Even at this moment, its definition lacks clarity, for example, in their article David Kindig and Greg Stoddart says that it is “the health outcomes of a group, including the distribution of such outcomes within the group” (2003, p 380). In this case, the word health outcome includes such elements as life expectancy, mortality rates, fertility, or recovery rates among various groups of population (Australian Institute of Health and Welfare, 2010).
As we can see there are several measurements that help to evaluate public health and this is one of the reasons why this term is difficult to define. Still, this concept gave rise to a new approach in healthcare delivery, which is based on the premise that medical workers ought to improve the health of not only individuals but of the entire community (Kindig & Stoddart, 2003). This approach is aimed at reducing the inequalities between various groups of people; in particular, it is relevant to the needs of low-income populations.
Nurses are supposed to play a crucial role in the implementation of this approach. They must be able to do the following tasks:
- to assess and identify the health needs of the population;
- to share information that would encourage people to adopt healthy lifestyles;
- to screen at-risk groups of the population, especially if we are speaking about those people, who are below the poverty line (Royal College of Nursing, 2007, p 1).
These activities are instrumental in the prevention and treatment of diseases. If we examine competency standards, established for the registered nurses in Australia, we can point out that they are aligned with the new roles of these medical workers. For instance, according to the Australian Nursing and Midwifery Council (ANMC), a nurse should be able to act as an educator, who promotes a healthy way of life and instructs patients (2006, p 10).
Moreover, one should bear in mind that currently more attention is being paid to the continuous professional development of nurses. Namely, they must be well-aware of the most recent research findings and more importantly, use these findings while implementing care (ANMC, 2006, p 6). We should note that the new approach to healthcare delivery places emphasis on the effective collaboration of medical workers, and nurses are an inseparable part of this process. They need to become a link between the patient and other members of the healthcare team (ANMC, 2006, p 9). To some extent, they will perform the function of coordinators. Overall, we can argue that in the new environment, nurses occupy more prominent positions than they did before, but they also have to take new responsibilities.
Primary health care and its impact on the work of the registered nurses
Primary health care (PHC) can be regarded as medical aid, which is universally available to an individual, irrespective of his/her social, legal, or income status (WHO, 1978, unpaged). It was first introduced at the conference of Alma-Ata in 1978 when medical workers from all over the world agreed on the fact that health care must be a generally recognized human right. One should take into consideration that PHC cannot be viewed only as a medical aid, given to an emergency patient; more likely it is a continuum of care that includes evaluation of patient’s needs, treatment, consultations, and follow-up assessments. The Australian government strives to carry out a reform of primary health care. This reform has to fulfill the following objectives:
- to minimize the need for hospitalization of the patient, and reduce the time, spent in the hospital, which means that healthcare providers should focus on the prevention of diseases and not only on their treatment;
- to reduce the gaps in health status, existing between various layers of society;
- to provide a patient with an opportunity to choose among various health care providers (Australian Government, 2009, p 8).
In theory, this new strategy will help to improve population health in the country and reduce the expenses on Medicare or at least make these expenditures more efficient.
Again, a successful outcome is hardly possible without the active participation of nurses. They will need to take a vital part in cancer screening programs, school dental and oral health programs, the assessment of elderly people, outreach programs, aimed at the needs of indigenous people (Australian Government, 2009, p 18). This is only a shortlist of those activities and goals that cannot be achieved without these healthcare professionals. Judging from these facts, we can say that a nurse will be required to possess many competencies:
- ability to communicate with people, belonging to different cultural and ethnic backgrounds;
- excellent assessment and screening skills;
- a profound knowledge of medicine-related disciplines such as oral and sex hygiene, or disinfection;
- ability to choose such treatment mode that would be most suitable for the patient’s financial status (ANMC, 2006).
Thus, we can argue that the scope of nurses’ duties and responsibilities has been widened. Nonetheless, one has to take into account that these new requirements must be reflected in the education and training of nurses; otherwise, the incentives of the government will not be put into execution. The thing is that these tasks cannot be successfully done if a person lacks any previous experience, and this is why it is necessary to tailor such a training program that would prepare students for these new roles.
Comparison of personal definition of health with its conceptualizations in the literature
I have to admit that for a very long time I have defined health as a state of both body and mind when there are no noticeable signs of physical or mental illness. Of course, now that I have become a medical student, I know that health is a much more comprehensive term. Yet, for me, it is associated primarily with the mere absence of disease. Such definition of health can be given by a patient, not a healthcare professional, but still, it has the right to exist. On the whole, we can find a great number of definitions to this notion. For instance, according to the World Health Organization, health can be viewed as “the state of complete social, mental, and physical well-being” (WHO, 2006, p 1).
Thus, it is possible to say that the scope of my definition is much narrower as it encompasses only physical and mental conditions while excluding social ones. Secondly, my explanation is based on the premise that a person, who does not experience pain or any other form of discomfort, can regard oneself as healthy. I can put forward several arguments in support of my definition: first, there are many diseases such as AIDS that cannot be cured completely; healthcare workers can only mitigate their effects; 2) secondly, at some stages, when the progress of the disease is irreversible, the key task of a nurse or physician is to minimize the sufferings of the patient.
It should be mentioned that the definition of health has undergone several transformations. First, it became evident to many scholars that in itself health is dynamic, which means that various age groups have different standards of being healthy (McKenzie et al, 2008, p 6). Nowadays, medical workers maintain that health is a condition when a person can lead a socially-productive life (Bonita et al, 2006, p 15). This means that a person can have an illness but it must not prevent him from enjoying life.
This discussion shows that the very notion of being healthy is subjective in its nature. Therefore, it allows room for several interpretations. My definition of health stresses the importance of pain management, while those ones, proposed by scholars focus on an active and productive lifestyle. It seems that each of these definitions should be taken into account by nurses and practitioners.
The impact of this information on my future role as a nurse
When I will become a practicing nurse, I will inevitably rely on various definitions of health as they help to identify the main tasks of a medical worker. Moreover, I always have to remember that patients and nurses usually have different perceptions of health, and this difference in perception is one of the greatest obstacles, faced by healthcare providers. First, while assessing the patient’s health, a nurse must not rely only on the subjective opinion of this person. The problem is that many have people become so accustomed to a disease that they no longer regard it as something abnormal. One of the most common examples is a person’s unwillingness to go to the dentist only due to the fact that he/she has no toothache. Such people believe that by alleviating the pain, they will become healthy and make the disease disappear (Martin, 2010, p 21).
Naturally, this is a very dangerous misconception, and I will do my best to dissuade the patients from behaving in this way. They must know that in the vast majority of cases negative treatment outcomes can be explained by the fact that, a patient asked for professional assistance too late. As it has been noted in the previous section of the paper, a nurse has to act as an educator, who promotes a healthy lifestyle. This task is crucial for screening at-risk patients and prevention diseases.
Additionally, as a nurse, I will have to do everything to make sure that the patient is able to lead an active social lifestyle. In other words, the illness must not prevent him from his usual daily activities. Again, the fact that a person has an illness does not necessarily mean that he/she cannot communicate with his/her friends and relatives, or that he must not lead an active way of life. This is particularly relevant to elderly people, who are often forced to lie in bed even though many of them do not want to.
When speaking about the elderly population, we may mention such concept as productive aging, according to which an old person should be encouraged to take trips abroad, do physical exercises, if it is permissible, and establish long-term relations with other people (Morrow-Howell, et al 2002). This is an example of social, physical, and mental well-being. Nurses can significantly contribute to the promotion of productive aging.
Finally, in my capacity as a nurse, I will need to take every step in order to alleviate the sufferings of those patients, whose illness cannot be cured completely. One should remember that absence of pain is also a constituent part of health and a nurse is to ensure that the patient feels as comfortable as possible. This discussion shows that different definitions of the word health help to see various objectives which nurses and other medical workers have to achieve. None of the definitions, presented in this paper, should be entirely rejected as each of them throws new light on the role of healthcare professionals.
The role of nurses has changed dramatically over the last decades; they no longer can be considered as people, who do only menial jobs. Nowadays, they act as assessors of personal and public health needs, coordinators, and promoters of public health. The increasing popularity of such concepts as public health and primary healthcare enables them to occupy a more important position in the workforce hierarchy, but it also raises their performance standards. As we have identified in the paper, a registered nurse must possess a great number of skills and competencies, which were not previously required from them. These healthcare professionals will play an instrumental role in improving the quality of public health in Australia; without their involvement, none of the government incentives can be put into practice.
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