One of the most important changes occurring in Australian health care today is a long overdue shift away from a disproportionate focus on providers … and on to the most important people, those who need … care.1
– Mary Draper, RMIT, 1997.
How often have you heard in recent times, reference to ‘consumer/patient-centred care’? The term is spoken of as if this were a novel concept, a cleverly conceived idea of the 21st century. The words above were in fact printed in the Foreword to a report written in 1997 – almost 20 years ago! Not such a new idea then.
Within nursing and midwifery circles the apparent newness of ‘patient-centred care’ is almost ludicrous. Although Florence Nightingale2 did not specifically use the term, the focus of her life’s advocacy work was on the ‘person’ being cared for, and providing the most conducive environment for healing. On the eve of National Nurses Week in 2011, an American writer, Joe Tye3 stated:
Nightingale would have been appalled to learn that today there is a movement for “patient-centred care.” You can just imagine her reaction to hearing those three words: “Why do you need a movement? Isn’t the patient in the centre now? If not the patient, then who is in the centre?”
A nurse consultant for the International Council of Nurses, Dr Ghebrehiwet made the claim in a paper titled Nurses and Person-Centred Care4 that a …focus on the patient in a holistic way – as a whole person, not simply a health problem – has always been at the centre of nursing care. Further, he said that nursing leaders and theorists have always promoted a model of nursing care in which the person is a key partner.
Well you may ask then, if nurses and midwives have always practiced person-centred care, and they are the largest cohort of the health workforce at 376,8805 strong, why is this not evident in the health care system of today? Why would people see the need to coin the phrase and start a movement – for ‘consumer/patient-centred care’? (henceforth referred to as ‘person-centred care’). The Australian Nursing and Midwifery Federation (ANMF) argues there are reasons the efforts of nurses and midwives are masked or compromised, and these principally relate to health system structures, funding and workforce issues.
Dr Ghebrehiwet makes the point that the complexity of today’s health care delivery system makes it impossible for any one professional group to provide person-centred care. He asserts the team approach is the cornerstone of person-centred health care6. The range of health team players interacting with the person and their family increases the difficulty of achieving desired health outcomes if there is not a coordinated and team-based approach to person-centred care.
Despite the size of the nursing and midwifery workforce, we are too often absent from decision-making at the strategic levels, in organisations and within bureaucratic and government circles. This means policy decisions on infrastructure and funding which impacts on the practice of nurses and midwives, may not be in the best interests of creating an environment conducive to person-centred care. This can mean seriously compromising the nursing and midwifery workforce contribution to health care teams in general and to person-centred care in particular.
Is it possible to take ‘person-centred care’ from rhetoric to reality? The ANMF says yes, because this approach to care is already within the nursing and midwifery ethos and curricula. However, we need changes to the structures and funding of the health and aged care systems.
While the midwife workforce is stable, a nursing shortage is looming. Workforce planning projections showing a predicted shortfall of approximately 85,000 nurses by 2025, and 123,000 nurses by 2030 under current settings7. How do we mitigate this shortage? By retaining those nurses we already have. Valuing them, recognising their work, improving their wages and conditions, ensuring they have manageable workloads, providing appropriate staffing levels and skills mix, allowing them to work to their full scope of practice. This is entirely achievable, with commitment from Governments through supportive policy, legislation and funding.
Specific actions required are the need to:
- provide sufficient numbers of qualified nurses and midwives to meet the individual, and often times complex, acute or chronic care needs, of people
- ensure fair remuneration of qualified nurses to address recruitment and retention issues in community and residential aged care settings
- enable innovations such as nurse/midwife-led models of care
- implement dedicated roles for nurse practitioners and eligible midwives across public and private health care services, including removal of funding and legislative barriers to enable them to work to their full scope of practice.
Nurse practitioners and eligible midwives should be used more extensively within multidisciplinary teams across the spectrum of health care services, in all geographic locations. They can, and do, undertake important roles which improve access to primary health care services and chronic disease management, for individuals and communities.
We need to shift the major focus of health care from acute tertiary facilities to positioning primary health care at the centre of health policy. Then we need to re-think the way primary health care is delivered, moving to a model that includes multidisciplinary teams offering comprehensive, person-centred primary health care services. Nurses and midwives are key to this change. The system needs to be structured to allow them to contribute their intrinsic care, delivered the way individuals and communities want and need.
Person-centred care is well within our reach. This needs to be the focus of Government policy and the health and aged care systems. Structures and funding must enable each member of the health care team to work to their full scope of practice, to make their unique contribution, whilst cooperatively working towards the same end… person-centred care.
1 Draper, M. 1997. Involving consumers in improving hospital care: lessons from Australian hospitals. Commonwealth Department of Health and Family Services. Canberra.
2Florence Nightingale. 1859. Notes on Nursing: What It Is, and What It Is Not. Published originally by Harrison of Pall Mall. And later in 1974 by Glasgow & London: Blackie & Son Ltd.
3Tye, J. 2011. The Mother of All Hospital Administrators. Written for the National Nurses Week May 6-12, 2011, and National Hospital Wee, May 8-14, 2011. Hospitals and Health Networks. Retrieved on 27/09/2016 from http://www.hhnmag.com/articles/5011-the-mother-of-all-hospital-administrators
4, 6Ghebrehiwet, T. 2011. Nurses and Person-Centred Care. The International Journal of Person Centred Medicine. 1 (1):pp20-22.
5Nursing and Midwifery Board of Australia. Nurse and Midwife – Registrant Data Reporting period: March 2016. Retrieved on 5/10/2016 from http://www.nursingmidwiferyboard.gov.au/About/Statistics.aspx.
7Health Workforce Australia. 2014. Australia’s Future Health Workforce – Nurses Overview. Retrieved on 5/10/2016 from https://www.health.gov.au/internet/main/publishing.nsf/Content/34AA7E6FDB8C16AACA257D9500112F25/$File/AFHW%20-%20Nurses%20overview%20report.pdf