Nursing in the years to come

26 World Health • 47th Year, No. 5, September-October 1994 Nursing in the years to come Margretta Madden Styles Nurses are becoming increasingly autonomous and moving into the field of independent practice. Particularly in countries where many are illiterate, nurses are investigating new approaches to make community members partners in health care delivery, and not merely passtve consumers. I n Mexico, nurses are educating rural inhabitants about nutrition and disease prevention. In Africa, they are counselling HIV I AIDS patients and families in their homes and explaining to whole communi- ties in town hall meetings how to prevent the disease. In Italy, a nurse- runindependentemploymentagency answers nursing needs at homes and in institutions. And in the USA, nursing centres give families and the homeless direct access to both cura- tive and preventive care. These are a few examples of how nurses worldwide are shaking off tradition and responding to new health needs, not only in health care facilities but in communities, homes, schools, the workplace and even "in the street". Their reach is also far wider, as they search out the more vulnerable: the poor, refugees, sub- stance abusers, the elderly, persons with HIV/AIDS, and women. As health care systems are being restructured, funding services diver- sified and hospital stays shortened, nurses are collaborating with other health professionals to provide the necessary skilled care, inside and outside hospitals. They are also becoming increasingly autonomous, creating independent support ser- vices that make the self-employed nurse directly accountable to the client. Nurse-centred consultation mod- els are already proving their success in helping families to care for low- weight babies discharged too early from hospital, the elderly, the handi- capped and the chronically ill or mentally ill. And the trend towards independent practice is occurring not only in industrialized countries. In Benin, for instance, nurses recently began practising independently in response to a government freeze on nursing posts in hospitals. In their campaigns to assure quality patient care, nurses are form- ing partnerships among themselves and with other health professionals, networking across borders, and working together to develop stan- dards in their countries. Innovative models One foretaste of what nurses can achieve in primary health care is taking place in the Republic of Korea, where over 2000 community health posts are being staffed and managed wholly by specially trained community nurses. The 1994 Sasakawa Prize was awarded to the instigator of this project, Dr Mo-Im Kim, Dean of Yonsei University 's College of Nursing in Seoul (a WHO Collaborating Centre for Nursing Development) and former President of the International Council of Nurses (ICN). This programme provides not only high quality care in remote areas but also contributes to overall community development. Another new model for primary health care - this time to meet the needs of the frail elderly living in cities -has been developed by St To respond to health needs, nurses need to go out and meet people, even in the street. World Health • 47th Year, No.5, September-October 1994 27 Nurses today are keeping pace with the advances of health technology. A nurse monitors the status of a cardiovascular patient in intensive care. Luke's College of Nursing in Tokyo (also a WHO Collaborating Centre for Nursing Development). So far, it has established: 1) a nursing home for the elderly; 2) a volunteer support team consisting of district welfare commissioners, police, firemen and lay citizens; 3) a home care support centre; and 4) a programme to study ways of improving housing arrange- ments. Education has been and will be the key to nursing's evolutionary progress as a profession and the fulfilment of nurses' multiple roles in primary health care. Besides illness prevention, health promotion and community-based care, nursing curricula in the future will put more emphasis on health care economics so as to arm nurses with the knowl- edge to implement cost-effective care. Courses will also include health policy and planning so that they can work better with decision- makers and ensure that the quality of care is not threatened when health services are rationed. Already in countries where much of the popula- tion will be illiterate for some time to come, nurses are investigating new approaches to make community members partners in health care delivery, and not merely passive consumers. The importance of nursing re- search to scientific bodies of knowl- edge has been highlighted by the recent establishment of the National Institute for Nursing Research at the National Institutes of Health in the USA. Its purpose is to provide a strong scientific base for nursing practice. New technologies Nurses are also keeping pace with the fast-changing medical technolo- gies by becoming highly skilled in the new technologies and in such specialties as nurse midwifery, anaesthesia, cancer and other ill- nesses. A significant change in nursing practice will result from computer-based patient records which give a picture of the patient from birth to death and will further empower consumers to be responsi- ble for their own health. With the focus on wellness, nurses will thus be more productive, responsible and accountable for patient outcomes. In developing countries where the AIDS pandemic is already rampant, nurses and other health professionals will also be battling with the re- There is a rapidly increasing need for nursing care of the chronically sick. emergence of such preventable diseases as malaria and tuberculosis, and the populations' sudden vulnera- bility to new infections. All of these dramatically increase the need for nursing care to the severely ill and the dying, as well as for health edu- cation, particularly environmental hygiene. As mobilizers in communities, nurses are joining the townspeople in lobbying for accessible health facili- ties and for such basic infrastructure as roads, drinking-water, sewage and refuse disposal, transport to clinics, child care centres, and maintenance of the cold chain for vaccines. Nurses around the world will continue to be an important link in the health care chain. A prime motivator in this regard is the International Council of Nurses, which is working through its 114 national nurses' associations to strengthen nursing forces worldwide. And to give nurses adequate support and recognition in all countries, WHO has created a Global Advisory Group on Nursing and Midwifery charged with finding "innovative and practical options to ensure the opti- mal contribution of nursing for the health of all people in the world." • Dr Margretta Madden Styles is Professor Emeritus at lhe School of Nursing, University of California, San Francisco, and President of the lnterncitional Council of Nurses, 3 place jean· Marleau, 1 20 1 Geneva, Switzerland.