The advantages of the nursing profession to any society - Essay Example

Healthcare is a priority for any society that appreciates the welfare of her citizens, and the role of the professional nurse in the quality of healthcare of any society is crucial. However, not all societies appreciate the important role that the nurse plays in qualitative and effective healthcare delivery system. The purpose of this research is to document the cost implications of the absence of solid and working professional nursing community in any society, using community nursing as a yardstick. The research study will make use of a survey questionnaire to collect data from consenting subjects that shall include the elderly with frailty or other patients with special needs and long term admission in hospital settings, and professional nurses that have had several years of experience with special need patients. The consent of the subjects shall be sought before the questionnaire is administered on them and the confidentiality of the subjects maintained. Human subject approval will also be obtained from the School of Nursing. Descriptive statistics and correlational statistics will be used to analyse the data collected to determine the perception of nursing in the community and the perceived cost of long term hospital admission. It is hoped that the results of this study would make the government and healthcare professional redesign the healthcare system around a professional nursing community as is obtained in several developed countries where the roles of the nurse in qualitative healthcare delivery have been appreciated. The Advantages of The Nursing Profession to Any Society. Introduction. Healthcare is unarguably a number one priority for any community or society that holds the welfare of her citizen in high esteem, and nurses, play a very central role in the delivery and quality of healthcare. The roles of the professional nurse in a society's healthcare delivery system is complex and numerous. The nurse help families to live healthily by helping them understand the range of emotional, physical, mental and cultural experiences that they encounter during health and illness and thus to be able to distinguish the signs of good health and the symptoms of diseases. In addition, the professional nurse help people and their loved ones cope with illness, deal with it and if there are no other alternatives, live with it, so that they can still continue with their lives. As if that is not enough, nurses are known to advocate for health promotion, educate patients and the public on the prevention of illness and injury, provide care and assist in cure, participate in rehabilitation, and provide support. No other healthcare professional can reasonable make claims to such a complex and far reaching role in healthcare delivery (Lenburg, 1999; Importance of Nursing, 2006). Nurses do more than care for individuals. They have always have been at the forefront of change in health care and public health, they provide ongoing assessment of people's health. Their round-the-clock presence, observation skills, and vigilance allow doctors to make better diagnoses and propose better treatments. Many lives have been saved because an attentive nurse picked upon early warning signs of an upcoming crisis like cardiac arrest or respiratory failure. According to Thomson (1997), the role of the professional nurse goes beyond the carrying out of tasks usually associated with the profession, especially in countries where the role of the nurse has not been fully appreciated, neither is the nurse restricted to just 'caring' for the patient. She argued that every professional nurse is taught and mandated to act always in such a manner as to: safeguard and promote the interests of individual patients and clients; serve the interests of society, justify public trust and confidence and uphold and enhance the good standing and reputation of the professions One important aspect of nursing that greatly affects the quality of life of any society is community nursing, also referred to as visiting homecare nursing. Community nursing is an integral and important element of nursing care, when placed in the right perspective. On the one hand, community nursing, as provided by professionally trained and educated registered nurses, positively contribute to the welfare of the community, especially as it affects the elderly, the disabled or other special needs patients, such as the substance dependant (Wegner, 2001; Brox and Froystein, 2005; Pelc et al., 2005). On the other hand, community nursing, to the extent that it is defined as an out patient service, is substantiated by economic benefits which is evidenced from the fact that its availability allows for the discharge of elderly and special needs patients from in-care settings, thereby significantly reducing health care costs without jeopardising the quality and level of health care the patients in question receives (Miller et al., 2005). These and many more are the benefits, importance and advantages of the nursing profession to any society. In most part of Europe, the crucial roles of the nursing profession in healthcare delivery has been greatly appreciated, this is evidenced from the numerous government policies and guild lines regulating nursing practice, sound and dynamic nursing curricula and the government support for the nursing profession (Savage & Moore, 2004). Unfortunately, this cannot be said about most developing and Arab countries. In most of these countries, the role of the nurse is often relegated to that of mere subordinates. The reasons for these second class status ascribed to nurses in some countries is often embedded in cultures, religious beliefs or cultural norms. While some reports like Voices of the Arab communities' (2005) argue that in most Arab countries nursing is associated with 'taking orders' and carrying out tasks assigned by doctors, some studies have shown that this does not always account for the lack of importance nurses suffer in these communities. Savage & Moore (2004) believe that the historic relationship that exists between the different health professionals play a role in the status of nurses in these communities. They also explain that governments in most of these countries often favour doctors and other health professionals at the detriment of nurses; this has reduced the affection for the profession among the populace. Though it may be difficult to completely articulate the reasons for the poor status of nurses in Arab countries, it is apparent that the gulf between the quality of health care service in European countries and Arab countries lies in the undervalued status of the nurse, implying a dearth in professionally trained nurses, absence of community nursing and a lack of professional independence (Burau 2005). Also, the fact that Arab countries, such as Kuwait, are in dire need of community nursing programmes is most evident in relation to the elderly. Abul et al., (2004) contend that the absence of community nursing programmes in Kuwait has severely constrained the ability of the medical profession to deliver the requisite healthcare attention to the nation's aged population. Since this absence implies that there are few nursing homes for the elderly in the country and those that require constant care can only receive it within a hospital setting or through the services of a home nurse who may not be qualified, the elderly population is likely to suffer accordingly (Abul et al., 2004). Problem statement Several medical and healthcare professionals have identified the crucial role of the nursing profession to the quality of healthcare delivery in any society. It has been argued that a healthcare system which is not supported by a strong nursing community is likely to be weak since its capacity to deliver effective and efficient health care services to the community it serves will be constrained. This fact has been sufficiently researched and demonstrated. Reports about the deficiencies of healthcare delivery in communities and societies where nursing is not encouraged abound in medical and health literatures. However, the economic benefits of the presence of a solid nursing community or the cost of lack of it have not been seriously considered. While it is reasonable to advocate that nursing is vital to the quality of healthcare delivery and by extension quality of life of a society, there does not seem to be a measure of quantifying the cost of the absence of a sound nursing community to healthcare delivery system of a community. Within this context, quantifying what communities without a sound and solid nursing profession is losing in economic terms would be a good way to stimulate such communities to redesign her healthcare delivery system and review the status of the nurses within the healthcare delivery system. Objectives of the Study The study's objectives may be clarified as follows: 1. To highlight the importance of professional nursing within the health care delivery system. 2. To elaborate on the extent to which a society's elderly need, and may benefit from, the creation of a community nursing system, whether extended by the private or the public health care sector. 3. With reference to Kuwait, to establish the economic cost of the absence of community nursing programmes for the elderly upon the state. Research Hypothesis The implementation of community nursing programmes for the elderly in a society will likely improve the quality of health care services offered to this segment of the population while decreasing the current cost of healthcare for the elderly upon the state. Research Questions 1. How does community nursing address the health issues of the elderly and how may the implementation of community nursing programmes in a society enhance the quality of healthcare delivered to the elderly 2. What are the economic costs of the lack of community nursing programmes for the elderly on any society Literature Review Importance of Nursing The necessity for a solid nursing community in the health delivery system of any community cannot be over emphasised, irrespective of whatever has been said earlier. Another dimension to this topic is that doctors alone cannot effectively be responsible for the entire process of primary healthcare and the need to delegate functions cannot be ignored. In addition, some of the functions within the context of primary healthcare simply do not require the direct and constant attention of a medical doctor, examples includes elderly patients and those special needs, although they do require the attention of a healthcare professional. As such, it is imperative that doctors, in order to be able to provide qualitative medical attention to other medical cases; have to delegate some of the functions within the healthcare process. These functions can only, however, be delegated to a professionally educated and trained nurse (Bryar and Kendall, 2005; Crapper, 2005; Carr and Pearson, 2005; Carr, 2003). This raises an important topic; the role of community nursing in the well being and quality of healthcare provided to the community Community Nursing. Community nursing, as reported by numerous scholars, plays a vital role within the healthcare delivery system and the nature of its services, as they tend towards the home-based, are invaluable for the elderly and those with special needs in the community, whether assessed from the economic or the medical point of view (Kelly and Symonds, 2003; Miller et al., 2005; Brox and Froystein, 2005; Myers, 2005; Pelc et al., 2005). Kitchener and Harrington (2004) contend that community nursing is particularly valuable and vital within the context of long-term rehabilitation and treatment programmes. To comprehend this, it is important to mention that community nursing often assumes one of two possible forms. First, it may be home based and second, where patients receive nursing care in the comfort of their homes, or it may take place within the context of community healthcare institutions, or homes, which are designed to address the needs of long-term care (Kitchener and Harrington, 2004; Newman, 2005). Community nursing, consequent to the fact that it is ideally suited for long-term treatment needs without the limits of an hospital setting, has significant healthcare value. This is because it gives long-term care patients the requisite professional attention, thereby ensuring steady recovery, at a significantly reduced cost. In addition, community nursing scores a vital point even where financial issues are not considered. As observed by Kitchener and Harrington (2004), the increasing demands for hospital beds often result in a scenario where long-term needs patients are released from the hospital with only intermittent follow-ups to ensure that they are abiding by the rehabilitation programme and are progressing according to expectations. Obviously, in such a situation care for the patient is most likely compromised. This is however, not the case with community nursing as patients who require professional care either receive it at home or are admitted to community nursing houses (Kitchener and Harrington, 2004). As may be determined from the above articulation of the benefits of community nursing, it has particular value as regards the care of elderly and ageing populations. Community nursing, whether in the context of at-home or in-centre settings, plays an important role in the care of old patients (Wegner, 2001; Kelly and Symonds, 2003; Newman, 2005; Miller et al, 2005). Such patients may not be suffering from any other ailment besides frailties of age but, nevertheless, require the special attention and supervision of a healthcare professional. Community nursing centres and programmes have efficiently and effectively addressed this need and within this context have substantially contributed to the quality of life enjoyed by senior citizens in countries the roles and importance of nursing have been appreciated and acknowledged (Wegner, 2001; Kelly and Symonds, 2003; Newman, 2005; Miller et al, 2005). Lord, Sherrington and Menz (2001) assert that one of the most prevalent and problematic consequences of ageing, and the subsequent reduction of mobility, musculature and balance, is that the elderly are prone to falling. In fact, in several countries, falling among the elderly has been identified as a common health-related problem, which needs to be addressed through the adoption of strategies designed to prevent falling or, at least, significantly reduce the identified causal, or risk factors (Turrell and Castleden, 1999; Kempton, et al. 2000; Healey et al., 2004). One of the identified preventive strategies directly involves community nursing, as it identifies community nursing programmes for the elderly, whether through in-house services or within homes for the elderly, as integral to the prevention of falling (Turrell and Castleden, 1999; van Beurden, et al. 2000; Lord, Sherrington and Menz, 2001; Healey et al., 2004). However, community nursing does not serve the interest of the elderly population alone, rehabilitation centres, drug treatment centres, children with special needs all require the services and attention of a professional nurse and this cannot be efficiently provided in a hospital settings. Though, most literatures on community nursing tend to look at it from the angle of the senior citizens of any society, a cursory look at the society structure shows that the importance of community nursing goes far beyond the needs of the elderly patients alone. In essence, it is perhaps reasonable to assert that the quality of nursing care and by extension healthcare delivery in a society is determined by the presence and effectiveness of community nursing. In addition, for an efficient and effective community nursing system to evolve within any society, the presence of professionally educated and trained nurses is a vital prerequisite (MacDonald, 2005a; MacDonald, 2005b). Not only that, the medical system must also be supportive of professional nursing and see it as a partner and not a subordinate, on the one hand, while the nursing profession must also adopt an operative standard for best practices and an ethics guideline by which all registered and practicing members must abide (MacDonald, 2005a; MacDonald, 2005b). In other words, a solid nursing base and framework must be present as it functions as the starting point for the evolution of community nursing programmes. Nursing and Quality of Healthcare in Kuwait Shah et al. (2002) report that Kuwait, an oil-rich Gulf Arab country, enjoys, not only one of the highest per capita income figures in the region but the benefits of a state and governmental institutions which comprehend the importance of raising the nation's current human development index (HDI) figures. With this aim in mind, the state invests national resources into the education of native Kuwaiti nationals and on extending quality healthcare services (Shah et al., 2002). The Kuwaiti state, aided by its oil revenues and its low population figure, covers the entire medical and healthcare expenses of its native population and, until recently, of its foreign resident population (Kandela, 1997). Within the context of the stated, one may accurately infer that the Kuwaiti state's healthcare economic burden is high. Not only is that assessment supported by several researchers (Alshubaili et al., 2004; Alramzy et al., 2004; Ayyad et al., 2005) but it introduces a problem which Kuwait is currently confronting. Insofar as it carries the burden of its population's healthcare and medical costs, the resources of the Kuwaiti state are becoming increasingly constrained. It was largely in response to the problem of financial constraints that the state recently decided that it will no longer carry the medical costs of its non native resident population (Kandela, 1997). That, however, is not the solution since a significant portion of economic burden on the healthcare system arises from the absence of both a professional and independent native nursing community and a community nursing system (Alshubaili et al., 2004). The absence of a community nursing system in Kuwait carries a significant economic cost as may be inferred from numerous articles on the topic. Alshubaili et al. (2004) report that consequent to the absence of community nursing programs in Kuwait there is an increasing prevalence towards long-term hospital stays among native Kuwaiti patients, especially the elderly. The researchers, drawing on data from Kuwait's leading hospitals, note that patients who suffer fractured or broken limbs, as one example, tend to stay in hospital twice to three times the international average of a couple of days. They extend their hospital stays as long as it takes to develop greater mobility and the likelihood of their doing so increases as far as the elderly are concerned. This, as the researchers stressed, is unnecessary stay, implying avoidable economic costs (Alshubaili et al., 2004). Concurring, Ayyad et al. (2005) report that unnecessarily lengthy hospital stays are at the core of the health expense burden suffered by the Kuwaiti state. Elderly patients are admitted to hospital with their only complaint being frailty, although this is contrary to the international norm, but not avoidable because they know that they will not be able to access the required care and medical attention at home. In fact, and making their assessments on the basis of available statistics, the researchers determine that the mentioned unnecessarily lengthy hospital stays account for approximately 25-30% of the unnecessary medical expenses incurred by the Kuwaiti state (Ayyad et al. 2005). Though, Alramzy et al. (2004), argue that the failure of the Kuwaiti state to actively encourage citizens to pursue an education in nursing has significantly affected its healthcare system and also increase the cost of healthcare delivery. He believes that the act of importing nurses from other countries to fill the void places a wide hole in the government's finances. However, when one takes a deeper look at the situation, it is obvious that the unwillingness of the populace to follow a nursing career is actually part of the problem and not necessarily the cause of the problem. The values and status attributed to nursing within the cultural settings should be seen as the root of the problem. The citizens would follow a nursing career if the profession is seen to be lucrative, rewarding and beneficial to the health of the community. Also, even in countries where the roles of nursing are greatly acknowledge, there are still problems of shortage of nurses. Summary of Literature Review As is apparent from the studies and literatures reviewed so far, the nursing profession is one that holds serious implication for the quality of healthcare delivery of any community. Studies show that most developed countries have an effective and solid healthcare delivery system, as a result of the professionalisation and technicalisation of the nursing profession. It can thus be inferred that the gulf between the quality of health care service in developed European countries and Arab countries lies in the undervalued status of the nurse, implying a dearth in professionally trained nurses, absence of community nursing and a lack of professional independence. However, none of these studies, apparently, has considered the economic cost and implications of this 'so-called' undervalued status of the nurse. Thus, information and data concerning how the nursing profession and services affect the economic strength of a society is not readily available. This makes it imperative to look at the importance of the nursing profession, from an economic standpoint, in a bid to further buttress the claims that the nurse is an essential component of a qualitative and cost effective health care delivery system. Research Methodology Research Design. For this purpose of this study, a descriptive survey design will be utilized to determine: I. From the perspective of the patient; their attitudes towards and interests for community nursing, what they have gained from community nursing services, or what they believe they have been missing from the lack of community nursing. II. From the perspective of the nurse, what they think about community nursing, the estimated cost of long-term hospital stays that characterises a society without a solid and functional community nursing system, and how this cost is reduced in the presence of a community nursing system Population and Sample A convenience sample of twenty five elderly patients and twenty five nursing staffs will be recruited from a few hospitals, clinics and nursing centres. For the purpose of sampling, criteria for inclusion in the sample will includes, the presence of special needs or long term treatment such as in the elderly, enough literacy to be able to answer the survey questions and long-term hospitalisation or in a nursing care facility. Exclusion criteria include severe mental physical limitations, inability to give consent and health needs, as only those with long term health needs will be considered, while on the part of the nurse, inclusion criteria will include professional registration, at least three years professional experience and must have primarily worked with the elderly populations or those with special needs. Ethical Considerations Approval for the study will be sought from School of Nursing's Human Subjects Committee, as well as any Institutional Review Boards associated with the various hospitals and nursing centres. Participants will be selected from those wishing to participate in the study based on the inclusion criteria. The participants will be given a copy of the informed consent prior to filling out the survey, and a signed consent form will be obtained from each participant. Client confidentiality will be assured by coding each participant form with a corresponding number. The research team and the faculty committee will be the only persons who will have a record of the names that correspond to the numbers. This information will be kept in a locked file-box in a secure office. At the completion of the study, data sheets will be coded and reported as group data. Methods. This study will make use of both primary and secondary data, as this will enable the researcher to effectively quantify the economic implication of the presence or absence of a solid nursing community in the society, using community nursing as a yardstick. For the primary data, this study will use a survey questionnaire to determine the effects and cost implication of a sound nursing profession in the society. Two different survey questionnaires will be used to collect the primary data for this study; one for the patients and another for the nurses. The survey questionnaire for patient subjects will include questions that will enable the researcher analyse the subject's knowledge, interest and believes about the nursing profession. Apparently, this will enable the researcher assess the cultural norms and beliefs of the community and perhaps deduce reasons that militates against the presence of a solid and effective nursing profession. On the other hand, questions in the survey questionnaire provided to the nursing subjects will enable the researcher analyze the cost of long term hospital admission for patients with special needs or long term conditions, as against the cost of keeping such patients in a nursing facility, such as a nursing home or in-house nursing care. Analysis of these data will give a clear idea about the cost implication of the absence of a working community nursing in a community. Data for both survey questionnaires will be collected by the research team via a face to face contact with the research subjects at selected hospitals, clinics, nursing facilities and perhaps community groups. The research team will give instructions on how to fill out the survey questionnaire, which the subjects will be asked to complete. The research team will also remain nearby to collect the completed forms. In addition to the study's primary data, data collected for this study will be used in conjunction with secondary data from previous research studies. The secondary data will be primarily collected through desk-based research. As noted by Jackson (1994) despite the fact that the value of a research is intimately connected to its novelty and the primary data collected for the validation of the proposed hypothesis, a research would loose much of its worth were it to ignore the relevance of secondary data. As Downs (1999) states, secondary data, identified as an unobtrusive data collection methodology, is entirely dependant upon the location of relevant and verifiable previously published academic studies and theories. Upon the location of such previously published research, whether through virtual or physical libraries, it is incumbent upon the researcher to evaluate the data presented therein and to assess it against pre-established validation criteria prior to referencing and exploiting such research. Hence, it is necessary to locate only those researches which present proof of data validation, have painstakingly referenced material, have a clearly articulated theoretical model and methodology and which are authored by scholars or experts in the particular field addressed (Downs, 1999). The research will make use of secondary data for an important reason. As earlier noted by Creswell (2003) the judicious and constructive use of secondary data maximises the value of a research, as it provides the researcher with a clear understanding of the state of the selected topic, thereby enabling the researcher to avoid the presentation of redundant research. Knowledge and acknowledgement of previous research will also ensure that the study being undertaken argues a new hypothesis, explores an issue from previously unthought-of angles and, ultimately presents valuable findings (Creswell, 2003). Secondary data will thus be used in an effort to benefit from earlier research and for the explicit purpose of avoiding a repetition of the conclusions and findings of previous research in the field. In this regard, data about the nursing profession, in general and community nursing, in particular, in two selected European countries will be collected from previous research studies. By comparing what obtains in developed European countries, as it affects community nursing with the data collected from the primary research efforts, the researcher will be able to present a clearer picture of the cost implication of the presence or absence of an effective community nursing structure in a community. Data Collection Plan Given the research team's contact with the research subjects, data will be collected from a variety of selected sites in community settings, such as in hospitals, clinics, community groups, nursing care facilities and nursing offices. Participants for the survey will be selected from men and women; patients and nurses who meet the inclusion criteria of long term disease condition or old age and frailty, long term admission in an hospital or clinic or presence in a nursing care facility, ability to understand and fill the survey questionnaire, professional nursing registration and experience in the care of those with special needs. A member of the research team will visit each selected site to distribute the survey questionnaire, pencil and also answer questions concerning filling out the survey that the participants might ask. For participants who are unable to complete the survey at the time, a self addressed and stamped envelope will be provided for the participant to return the survey by mail. Also, to increase the number of responses to the survey, only subjects who are interested and who understand what the study is about will be provided with the survey questionnaire. Data Analysis The data elicited by the survey questionnaire administered on the patient subjects will be analysed using descriptive statistics to ascertain what the patients think about the nursing profession, why they choose to remain in a hospital settings for a long term instead of staying at home for care, how the society perceives the role of nurses in healthcare delivery and what importance the community at large, and the patients in particular ascribe to community nursing. Also, the data elicited by the survey administered on the nursing subjects will be analysed to determine how the nurses see themselves and their roles in healthcare delivery, their perceived cost of long term hospital stays as against in-house care in a nursing facility and what they think about the cost implication of the absence of a working community nursing structure in a society. Study Limitations No research study can reasonable make claims to perfection, every study must have limitations and shortcomings, however trivial. In this regards, this study suffers a few limitations. Considering the fact the cost implication of a working community nursing is assessed from the view point of a nurse creates the possibility of bias towards the nursing profession. There is a possibility that the professional nurse might be inclined to exaggerate her roles in a community where she has been relegated to a second class healthcare professional. However, this bias in the information provided by subjects is balanced with the secondary data collected on community nursing in other countries where professional nursing is well established. Implications for Practice This research study holds serious implications for both the healthcare professionals and the government. By establishing the cost, both on the government and the populace in terms of quality of healthcare received, of the lack of a standardised and professional nursing community, the government and healthcare professionals might be inclined to redesign healthcare delivery with a better nursing community and encourage a nursing career among the populace. Conclusion So far, it has been sufficiently expressed that the primary objective of this study is to assess the importance of a solid and effective nursing profession to the healthcare delivery system of a society, and by extension, the quality of life of the people inhabiting such community. However, this research study aims to go beyond the hitherto established importance of nursing to the healthcare profession, as is obtained in the several literatures and studies on the topic. In this regard, the researcher intend to look at the implication of the nursing profession from an economic viewpoint, demonstrating that nursing does not only affect the quality of healthcare in a society, but also, the economic strength of such community. Within this context, the study would provide invaluable insight into the extent to which community nursing, as a yardstick for measuring nursing efficiency and relevance in a society, can enhance the quality of healthcare services provided to the elderly, those with long term conditions and others with special needs and by extension, the reason why the relevance and importance of nursing has been largely overlooked in any society. This information might stimulate communities and nations to redesign their healthcare delivery system for better nursing participation and perhaps, further encourage their citizens to pursue a career in nursing. References Abul, A. et al. (2004). 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