Saturday, December 5

From curing to caring: the challenges of Nursing in the face of the change in the healthcare model



The progressive aging of the Spanish population, the increase in life expectancy, the increase in dependency and chronicity, and the abandonment of healthy lifestyles highlights the need to change the healthcare model from curing to caring, adopting a new health perspective that must be led by nursing professionals.

The biopsychosocial care model It starts from individual health problems, group problems and community problems, incorporating human, social, environmental and cultural issues that also influence the health-disease process, and is not only limited to biological variables.

The campaign called «Nursing Now» developed in 2020 globally had the initial objective of contributing to the empowering the nursing profession and improving the quality of care for the population. WHO proposes nursing as the professionals of the future. Considers it necessary to overcome the paradigm and model of biomedical care that faces serious difficulties in respond to the future needs of the population and initiate the steps towards a reform of the sanitary model.

“It is urgent to find new ways to offer elderly people who live at home health care online and also at home”

From this body it has been expressed that the nurses and nurses they are at the heart of most healthcare equipment. Being professionals close to the community, they play a special role in the development of new models of community care and support local efforts to promote health and prevent disease.

Therefore, we should bear in mind that the care for the elderly in geriatric residences, in day centers, in home help, as well as in telecare and community care, it should be led by the Ministry of Health, being provided with assistance services, enough nursing staff; mainly because older people have care needs and not only social problems.

At this time, Each Autonomous Community has regulated the requirements differently that must be gathered by staff working in a nursing home, but it is a question that would have to be analyzed in depth. Moreover, the figure of the current family caregiver will show a decrease in the coming years, due to the reduction in the size of families, the increase in geographical mobility and the increase in the proportion of women entering the labor market.

Looking at other countries, for example Finland, the Finnish authorities are well aware that in the future the cost of caring for the growing population approaching the third and fourth age will represent a significant economic challenge. It is urgent to find new ways to offer older people, who live at home, health care online and also at home, joining it to the creation of other services that allow the elderly to remain at home as long as possible. The experiences of accommodation of the elderly together with students have also proven to be very useful and allow the elderly to remain active, both for the young and for the elderly it is a source of learning (Intergenerational Coexistence Program).

We are going to have more and more patients who require more care, and it is intended to enhance the autonomy of patients, provide tools and resources that promote self-care, achieve effective coping with disease situations, as well as the prevention of complications; definitely, prevent dependency and promote quality of life and in this, nursing plays a key role with education, for example, which it imparts to ensure that the patient understands their disease and its impact.

The value added by the nursing profession is its relationship with people


The value added by the nursing profession is its relationship with people, something related to human warmth, touching the person, explaining what is being done to them, and responding to their doubts and concerns (that is, giving them emotional support). We start from the premise that Nursing as a scientific discipline is within the field of Health Sciences, it is a healthcare profession with evidence-based clinical practice, professional deontology and diagnostic capacity; and the main beneficiaries of this new professional paradigm are the citizens themselves.

At present, attention to health problems is still based on a concrete conceptual model with which health care to the population has been organized throughout life, but it turns out that the scenario that existed until now has changed, has been transformed due to the constant increase in the older adult population, and the change in their needs and demands has caused the need for a professional intervention that allows approach the elderly in all their bio-psycho-social aspects.

Spain is undergoing a process of demographic aging much faster than in other countries of the European Union, the dependency ratio will increase in the coming years, and it will take human resources planning care. It is necessary for the health administration not only to carry out the appropriate organizational adaptation, but it is also necessary to disclose that nursing has the great challenge of caring for and teaching people to take care of themselves.

“It would be good to investigate new ways of managing nursing homes, which are run by qualified caregivers”

In the nursing homes, the labor problem not only affects nurses, but also a whole group of professionals that cover the needs of these people: physiotherapists, social workers, educators, psychologists, as well as general service personnel (kitchen, cleaning, laundry, maintenance). It would be good to investigate new ways of managing nursing homes, which are directed by personnel qualified in providing care. As stated by the World Health Organization: “The lack of health professionals in many countries means that new approaches are required, and traditional role boundaries could be an obstacle”.

At this time, the figure most similar to the advanced practice nurse (APN) would be the nurse case manager (EGC), which is integrated into the map of health resources in primary care. The figure of the nurse case manager is a rising value if the paradigm shift that the National Health System must carry out is taken into account. This nurse does receive specific training for the position and is in charge of assess, plan, implement, coordinate, monitor and evaluate options and services necessary to meet the health needs of a person with a chronic complexity profile (high degree of dependency).

The work that health professionals perform in other non-health settings such as school nursing, occupational health, sports facility nursing, military nursing, nursing in prison institutions, among many other examples, are essential and are profiles with specific health needs to be promoted with the corresponding specialties.

It could be said that there is a series of changes pending to be implemented, because it is too many years to continue to maintain misconceptions and outdated concepts related to the profession. The socio-sanitary problem in Spain is a question of great magnitude, but not resolved.

* Article published in the Special Monograph on Geriatric Nursing, of the journal Geriatricarea

The clinical simulation is essential to take the student to a scenario very similar to the real one.


The importance of clinical simulation practices in Nursing

«The clinical simulation allows us to take the student to a scenario very similar to the real one. You are presented with a simulated situation using an advanced brand mannequin Laerdal® (real simulation guided by computer). It is carried out in pairs or trios, who using their knowledge and skills will have to give a solution to the case raised “, he says Ruben Galiano, professor of the subject Critical Patient Care, within the Third Year of the Degree in Nursing from CEU Cardenal Herrera University in Elche.

In the dynamics of this training, while the students carry out the practice in a room, the rest of the students are in an adjoining room, watching the performance of their classmates and taking notes, to later, guided by the teacher, carry out the Debriefing of the case . “It is done without being evaluated with the sole purpose of learning and adding experience”, warns Rubén Galiano, who in addition to his work as a teacher works as a specialized emergency nurse and who has worked in the ICU of the Hospital La Fe in Valencia and is currently in the Hospital of Elda.

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