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: (links deactivated and may no longer work)
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
orcid.org/0000-0002-0192-8965
