The Need for Change in the Indian Healthcare System With Respect to Infection Control

Does the Indian healthcare system provide a comprehensive range of health services? Is the healthcare system entirely independent? Does the system operate under different management, rules and political authority? If yes is your answer to these queries, then one has to wonder how far the healthcare system is useful to India’s citizens? Can a middle-class family, let alone an impoverished family, afford good healthcare, in India? The answer to that question is still open.

Today we live in the amidst of a host of infections: both known and unknown. How are healthcare organizations and institutions recognizing this fact and acting on this recognition? Are patients treated in a hospital free of infections, and has the treatment been effective? If the answers are yes, do we have evidence to this effect, which is research-based, detailing strategies or protocols? For instance, many bacterial contagions were effortlessly treated with antibiotics previously; unlike the present where such contagions have been difficult to control, on account of the antibiotic resistance built up by the bacteria. Some examples are those of the Methicillin-Resistant Staphylococcus Aureus (MRSA) bacteria (common in hospitals) and the tuberculosis-causing bacteria, Mycobacterium tuberculosis. Under the circumstances, it is not surprising that, more than any disease, antibiotic resistance is rapidly growing as one of the most dangerous threats to individual wellbeing currently, as per the World Health Organization (WHO). Being healthcare paramedics, it is important that we understand the implications of this threat, after every medical or nursing intervention: an understanding that will enable us to ensure effective and quality healthcare delivery.

Let us take a look at how the United Kingdom’s NHS (National Health Service) functions. In the UK, the NHS is primarily sponsored by the government. It delivers a wide array of public well-being services, a majority of which are free at the point of use, for legal resident of the UK. Thus, the healthcare in the UK is structured independently and also operates under different management, rules, and political authority. Complementing this service, the NMC (Nursing and Midwifery Council) keeps updating treatment regimens and protocols, by analysing latest research outcomes on new medical or nursing interventions; which further strengthens the delivery of high-quality care through the NHS.

For example, a nurse witnessing a patient’s fall in a hospital set-up follows the ABCDE approach for client care assessment and uses the SBAR approach to inform senior health personnel, about that patient’s health condition, using relevant processes for the reporting. Such an approach is not widely practised in the Indian Scenario. Applying such an approach in the Indian healthcare system will help healthcare providers prioritise their work, report relevant and adequate information,  and provide effective patient care.

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Will Nursing Be The Highest Paid Profession In The Future?

The question is rhetorical, of course, and the answer is no. The reason, though, the question is being asked is because of the large projected worldwide shortage of nurses within the next decade-and-a-half.

The shortage is expected to arise on account of an increase in the demand for nurses. This increase in demand is linked to a variety of factors:

• The world’s aging population is going to be needing more nursing care. The United Nations’ World Population Aging 2013 report has some interesting facts about the imminent greying of the world’s population. Population aging is happening on account of decreasing mortality and declining fertility, and the global share of older people (aged 60 years and above) will increase from 11.7% in 2013 to a projected 21.1% in 2050; or, in terms of numbers, from 841 million in 2013, to more than 2 billion in 2050.
• Lifestyle changes are resulting in a spike in chronic conditions such as diabetes, obesity, and hypertension; conditions which will require increased medical intervention.
• Advances in medical science are making it possible for an individual to survive severe trauma, albeit with significantly reduced functional capabilities. Such individuals will require regular nursing care.
• The move from therapeutic care to preventative care is going to place additional stress on the nursing fraternity, as nurses will constitute an inordinate proportion of the healthcare professionals driving preventative healthcare.

The demand has started rising in the developed world, and will gradually spread to the less developed world and least developed countries. The US Bureau of Labor Statistics (BLS) projects the employment of registered nurses to grow 19%, in the USA, from 2012 to 2022; faster than the average for all occupations.

As a counterpoint to the increased demand for nurses in the developed world, are the constraints to supply in meeting this demand. The reasons for the supply constraints are primarily:

• An increase in the number of nurses leaving the workforce, in the developed world, as the “baby boomers” generation reaches retirement age.
• There is little or no nurse staffing surplus left to cut in large healthcare institutions, as most cuts were carried out at the turn of the last century; and on account of the realization that nurse staffing is closely associated with patient outcomes – quality of care reduces with a decrease in the nurse-to-patient ratio.
• Given the lead time required to train a registered nurse, and the fact that the nursing profession still carries vestiges of its vocational origins, there is a significant lead time for new supply to narrow the demand gap.

This mismatch between demand and supply, as any person with an understanding of economics will tell you, will first result in an increase in wages. A paper, by Joanne Spetz and Ruth Given, modeling wage growth and supply in the US market, arrives at the conclusion that wages, adjusted for inflation, “must increase 3.2 – 3.8 percent per year between 2002 and 2016, with wages cumulatively rising up to 69 percent, to end the shortage”.

Hence the question: will nursing be the highest paid profession in the future? However, as wages increase, affected parties (healthcare organizations, governments, etc.) will look at tempering this increase through initiatives outside the healthcare profession.

Two developments will have a direct impact on wages that nurses can command:

• Developments in robotics will make the job of nurses easier, thereby increasing their productivity. While it may be inadvisable and certainly unfeasible in the near future, to have robots play a direct role in patient care, they can certainly assist a nurse deliver better care, more efficiently.
• Advances in medical science – specifically in genetics/epigenetics and stem cell research – may allow medical practitioners to alleviate the deleterious effects of old age (dementia, lower immunity, disequilibrium, and brittle bones) to such an extent as to reduce the burden on a country’s healthcare system.

Any which way, these are interesting and exciting times for the nursing profession, and the rhetorical question headlining this blog is just a concise articulation of the sign of the times.

We would be interested to hear your thoughts on the wage-potential of the nursing profession.

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Florence Nightingale and International Nurses Day

The 12^th May, each year, is celebrated as International Nurses Day. This day allows nurses to celebrate their profession and to show the world that nurses are the backbone of the healthcare system. Many people wonder why International Nurses Day is celebrated on 12^th May. The reason is simple: it is the birthday of the great Florence Nightingale, who was the founder of modern nursing, and who was responsible for establishing nursing as a profession.

Florence Nightingale was born on the 12^th May, 1820, into a rich, upper-class British family. Her father William Edward Nightingale named her Florence after the city she was born in: Florence, in Italy. Nightingale was fortunate in that her father believed women should be educated, contrary to social convention during the Victorian era, and he personally taught her Italian, Latin, Greek, philosophy, history, writing, and mathematics.

She took up nursing, against her family’s (mother’s and sister’s) wishes. She learned basic nursing skills at Germany, in July 1850, where she received training at The Institution of Protestant Deaconesses, at Kaiserswerth-am-Rhein.

Florence Nightingale achieved national fame during the Crimean War (1853 – 1856) when she worked very hard to provide the best nursing care to the British soldiers. During the Crimean War she was popularly known as “The Lady with the Lamp”, after her habit of making rounds at night. This fame and popularity allowed her to set up a fund, the Nightingale Fund, in 1855 for the training of nurses.

Florence Nightingale used the fund to set up the Nightingale Training School at St. Thomas’ Hospital on 9^th July 1860, the first secular nursing school. The first trained Nightingale nurses began work in 1855. The school still runs, as the Florence Nightingale School of Nursing and Midwifery, and is part of King’s College London. She also took an initiative in training midwives.

In 1859, Florence Nightingale wrote Notes on Nursing: What it is and what it is not, now considered a classic introduction to nursing, to serve as a key component of the curriculum at the Nightingale School and other nursing schools. The book sold well among the general public too. She assisted in setting up nursing schools in the USA, Australia, and Japan, through the alumni of the Nightingale School, and thereby achieved international recognition. She also carried out pioneering work in hospital planning; knowledge that quickly spread all around the world.

Despite suffering from ill-health in her later years, she was phenomenally productive, generating a large corpus of written work. In 1907, she became the first woman to be awarded the Order of Merit, an exclusive award from the British monarch, for her achievements. She died on 13^th August, 1910, at the age of ninety. As per her wishes, her family declined the offer of a burial in Westminster Abbey, and she is buried in the graveyard at St. Margaret Church in East Wellow, Hampshire, England.

Her life and her achievements ensure that Florence Nightingale remains the biggest role model for nurses, throughout the world.

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Emulating, Rather Than Only Commemorating, Florence Nightingale This International Nurses Day

12^th May is International Nurses Day, celebrated by the International Council of Nurses (ICN) since 1965. The significance of the date, as we all know, is that it is the birth anniversary of Florence Nightingale, the founder of modern nursing. She established the first secular nursing school in 1860, the Nightingale Training School , at St. Thomas’ Hospital, London, and, in doing so, laid the foundation of professional nursing. Nursing programs the world over can trace their provenance to this act.

Florence Nightingale, however, was more than just a pioneer in the field of nursing, and we would be doing her a grave injustice by commemorating her birth anniversary solely for her nursing achievements, howsoever illustrious and decorated they may be. She was also a statistician, a social reformer, and a prodigious writer. Florence Nightingale was a polymath, and her achievements outside nursing too should serve as an inspiration to both nurses and to the general public.

Florence Nightingale was a pioneer in the graphical representation of statistics, and she was elected the first female member of the Royal Statistical Society. She is credited with developing a form of the pie chart now known as the polar area diagram,and sometimes referred to as the Nightingale rose diagram, to illustrate seasonal sources of patient mortality in the military field hospital she managed during the Crimean War. The illustration below depicts her graphical representation of the statistics. Her objective was to bring down mortality rates, and to do so she observed and collected data, collated it, analyzed it for insights, and rendered the data in forms easily understood by a layperson.

Figure 1: Florence Nightingale’s Representation of Mortality Statistics in One Theatre of the Crimean War (Source: Wikipedia – http://en.wikipedia.org/wiki/File:Nightingale-mortality.jpg)

 

When she was at the front, during the Crimean War she believed the high death rates were due to poor nutrition and lack of medical supplies, rather than due to poor sanitary conditions at field hospitals. However, when she returned to England and began collecting evidence for the Royal Commission on the Health of the Army, she came to realise that most of the fatalities were actually on account of poor living conditions. She was broadminded enough to change her stance, and subsequently became a passionate advocate of sanitary living conditions; as well as made significant contributions to the subject of the sanitary design of hospitals.

Possibly on account of her systematic and syncretic approach to analyzing a problem, her thinking, in some areas of medicine, was far ahead of her time. She was an active proponent of preventative medicine, as opposed to therapeutic medicine, and realized that healthcare needed to be approached from a holistic rather than a symptomatic perspective: both of which reflect 21^st century healthcare trends.

Finally, in an age when women of means were expected to marry and bear children only, and were groomed accordingly, she had the courage of her passion and her convictions to blaze her own path.

These accomplishments of Florence Nightingale are as important as the work she carried out in the field of nursing, and should inspire global nurses today to approach their profession with the objective of improving healthcare practices and outcomes the world over.

In India, the National Florence Nightingale Award 2014 has gone to Dr. Punitha Vijaya Ezhilarasu, Professor and Head of the Department of Surgical Nursing, College of Nursing, Christian Medical College (CMC CON), Vellore. She will receive the award from the President of India on the 12^th of May.

Why don’t you drop in a line telling us who has been selected for this honour in your country?

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