Waste not - Want not: An Item for Discussion (to refine) ...

Proposed item for discussion:

That this meeting reflect on the need and case for a generic and foundational conceptual framework across health and social care disciplines. This will help all (lifelong) learners to develop as reflective practitioners and critical thinkers to better support integrated and person-centred care, to appreciate and achieve parity of esteem and the leadership required to further high quality healthcare outcomes, health promotion and self-care.

Many nurses, including students, will no doubt have heard the words of wisdom: “Things go round in big-big circles, some of them decades long. You'll see!” We realise there are problems that seem perpetual. Health care seems to have its share of legacy issues, that is, problems that stretch across the decades and confound successive generations of practitioners, managers and policy makers. These issues are ongoing subjects for discussion and debate like this proposal. Nursing is a vibrant profession, things, including 'us' change. There are theories and practises that (thankfully) fall out of fashion. Nurse education is no exception with its own approaches. Some are permanent becoming accepted fixtures, while others wax and wane. Respective examples are educational technology, a fixture whether on the desk, one's lap, in the hand or simulation lab; nursing theory and models of nursing had their moment several decades ago as now they struggle for attention. To a degree this is understandable; curricula are over-crowded, practice must be evidence-based, healthcare is multidisciplinary, nursing is person, patient and carer-centred. Society also 'moves on'. Crucially, however; we must remember that to nurse - is to be a reflective practitioner and critical thinker.

Mention of models and theories of nursing may reveal something of the proposer. Much has changed for the profession since the late 1970s. Nursing [UK] has been challenged both publicly and from within; culminating in serious individual and organisational failures. Such incidents, plus associated reports and recommendations, called into question the quality of nurse education, nursing and care. No system is 100% effective in terms of checks and balances: to err is human. In nursing, however, our constant aspiration should be to disprove this fact of human frailty. In healthcare and nursing so much of what we do is predicated on the quality of our communications. Demographic trends impose pressure on proportionally fewer staff. There are more patients and carers who need reassurance, explanation, time and attention. How can nursing solve the ongoing productivity conundrum?

While communication is the common factor for all health disciplines and the essence of humanity, there is no accepted overarching theory of health communication. Although this may seem an academic question, in healthcare it is paramount. Poor communication can undermine shared awareness, responsibilities, understanding and is a constant factor in patient safety. Now, we must also recognise the patient as expert and raise the level of health literacy of the public. While there is progress in overcoming stigma within mental health, public mental health remains lost within public health. The issue of parity of esteem, extends beyond the much debated and still to be reconciled fields of physical and mental health care.

In response, this discussion calls for a generic, foundational conceptual framework across all fields of nursing, including midwifery, learning disability, mental health, veterans and prison services and end of life. If more argument is needed then without such a generic framework, the health and social care goal of our times - that of truly 'integrated care' - will just be (circular?) hyperbole. For the people who are self-caring and those in our care, the empathy and rapport they experience will more likely be process-driven, our patient-carer-public-centred care invariably off-target.

Supporting information:

Francis Report

https://researchbriefings.parliament.uk/ResearchBriefing/Summary/SN06690

NMC Code

https://www.nmc.org.uk/standards/code/read-the-code-online/#fourth

NMC Revalidation

http://revalidation.nmc.org.uk/what-you-need-to-do/reflective-discussion.html

RCN: Revalidation

https://www.rcn.org.uk/professional-development/revalidation/reflection-and-reflective-discussion

NICE: Reflection and reflective practice

https://www.evidence.nhs.uk/search?q=reflection+OR+%22reflective+practice

HSJ: The importance of reflective practices

https://www.hsj.co.uk/workforce/the-importance-of-reflective-practices/5048994.article

The King's Fund: Integrated Care

https://www.kingsfund.org.uk/publications/making-sense-integrated-care-systems

The King's Fund: Shared responsibility for Health

https://www.kingsfund.org.uk/publications/shared-responsibility-health

Health and Social Care Act 2012

http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted