Modernisation of Roles
SA 211
NURS 6035 Seminar Presentations
The Role of the Patient
SICK ROLE
RESPONSIBILITY
CHOICE
EXPERT PATIENT
• Following the formation of the NHS in the late 1940s, Parsons
(1975) presented the idea of the ‘sick role’ in which the patient
is seen as a social deviant and there is a hierarchical inequality
between the patient and therapeutic agencies.
• The sick role was thought to be socially constructed by:
• Assertion and acceptance by self and others of being a
victim of illness.
• Exemption of ordinary daily obligations e.g. by staying in
bed.
• Seeking help from an institutionalised health service agency
which entails an admission that being sick is
undesirable/deviant and requires proper management.
• Parson’s theory suggested that patients only choice was to
accept the fact that they were ill and seek professional help to
get better. Patients could no longer self refer to hospital as they
had done in the past, instead they had to be referred by a GP.
• The nurse-patient relationship was not an equal one at this
time. Instead, the nurse was the figure of authority, and the
patient was expected to obediently entrust his care to her.
• Through the 1950s and 1960s the involvement of patients in
their care became more common.
• The Chief Nursing Officer (1948-1958), Dame Elizabeth
Cockayne, commented on the change of role (Rivett):
‘The patient’s point of view is given more attention today,
indeed the patient is part of the team. We find ourselves doing
things with patients, and not just for them as previously,
leading them to self-direction and graduated degrees of
independence.’
• Nursing care became a partnership with the patient with
increasing treatment options available and a collaborative
approach to managing conditions.
• More emphasis was also put on patients taking responsibility for
their own health with increasing education and information
available for patients towards the end of the twentieth century.
• Increasingly policy has been focused on a health service which
will enable people to take responsibility for their own health
while still providing a free at point of use service as needed.
• The NHS Plan (2000) placed a renewed importance on the
patient’s role in their own care, with a shift towards patient
choice, listening to patient views and clinical choices made in
consultation with the patient.
• Patient choice has continued to hold a prominent position in
policy to the present continuing through the change of
governments.
• Patient choice can be seen from two very different angles:
• A patient’s lifestyle choices – with an increasing
emphasis on health promotion and encouraging
people to choose healthy behaviours.
• Treatment choices – a patient’s ability to consider
different treatment options, location, provider or to
refuse treatment.
• The two White Papers issued in 2010 each have one of these
angles central to their proposals. Equity and Excellence (2010a)
particularly has a focus on increasing treatment choices for
individuals although in reality this could create inequalities.
• Knowledge and experience of their condition held by the patient
has in the past been an untapped resource. Utilising it could
greatly benefit the quality of patients’ care and ultimately their
quality of life.
• The idea of developing a major initiative on Expert Patients was
set out in the Government’s 1999 White Paper, Saving Lives: Our
Healthier Nation. A further commitment to implementing a
formal programme was made in The NHS Plan (2000).
• A patient’s knowledge of his or her condition would ideally be
developed to a level whereby self-management, within the
boundaries of a medical regime, becomes a real option.
• It has been reported that patients want more care available
outside hospitals and to be able to take responsibility for their
own health, demand for community nurses is likely to rise.
• Modern technology is increasingly being utilised in the
development of telecare which allows those with long term
conditions to be monitored remotely by trained staff. Patients
would need to be educated and empowered to use this type of
system (Giordano et al 2010).
DH 1999
Saving Lives:
Our Healthier
Nation
1942
The
Beveridge
Report
DH 1997
The New
NHS
1946
The NHS Act
DH 2000
The NHS
Plan
DH 2001a
The Expert
Patient
DH 2001c
Valuing
People
DH 2001b
Tackling Health
Inequalities
DH 2004a
Agenda for
Change
DH 2004b
Choosing
Health
DH 2005a
Independence,
Wellbeing &
Choice
DH 2005b
Self-care: A
Real Choice
DH 2006a
Our Health,
Our Care,
Our Say
DH 2006b
Modernising Nursing
Careers:
Setting the Direction
DH 2010a
Equity &
Excellence
DH 2010b
Healthy Lives,
Healthy People
The Role of the Nurse
TENDING THE ‘SICK’
• The NHS Act (1946) failed to provide for the training of nurses.
This meant that the number of trained nurses and their skill
level did not match the ambitions laid out in the Beveridge
Report (1942).
• Entry requirements and training standards for nursing had
relaxed during the second world war and in many places the
number of students greatly exceeded trained staff. For 600
beds, Aberdeen Royal Infirmary had 93 trained staff and 330
students (Rivett).
• There was therefore a reliance on students as part of the
workforce which inevitably impacted on the trained nursing role
and the nurse-patient relationship.
• In 1952 more stringent standards were reintroduced by the
General Nursing Council and the foundations for building nursing
as a profession were laid (Tweddell 2008).
MANAGERS
SPECIALISTS
EDUCATORS / ADVOCATES
• Through the 1950s and 1960s the role of the nurse went through
a transitional period from lack of training and hands on care to
improved education and training and a wider responsibility to
both give hands on care and a take a lead in its provision.
• The role of matron disappeared in the late 1960s but was
reintroduced in 2001 following ‘The NHS Plan’. Modern matrons
were a key part of modernising the NHS with the aim to improve
patient experience.
• In 2004 knowledge and skills frameworks (KSFs) were introduced
as part of Agenda for Change (2004a). These outline key
competencies for any role in the NHS to identify skills needed
and guide individual’s development.
• With the transition of students to supernumerary status and the
resulting increase in health care support workers. Nurses also
nearly always act as managers within their team.
• Many nurses now operate in specialist fields and advanced
practice ensuring that experienced and highly skilled nurses stay
close to patient care (DH 2006b).
• Over 50,000 nurses in the UK can now prescribe for their
patients (DH 2006b).
• NMC definitions of advanced practitioners with role expansion
involving physical examination, making a final diagnosis,
carrying out treatment and prescribing are difficult to
distinguish from that of doctors roles (Wiseman 2007).
• It is thought that in future nurses roles will continue to extend
and become more specialist (Longley, Shaw and Dolan 2007).
• Essential nursing care could then be increasingly completed by
health care support workers and the growing numbers of
assistant practitioners, who are currently unregistered.
Responsibility for care given needs to be clearly defined.
• Historically, the role of patient advocacy for nurses has been a
moral obligation. Advocacy is usually employed by someone
powerful on behalf of someone who has no power (Teasdale
1998).
• The idea of advocacy holds true for nursing with additional
aspects including of educating patients to understand their
condition to empower them to self advocacy.
• Practicability of nurse advocacy can be limited in practice as it’s
difficult to teach and nurses may not be the most impartial
people to provide advocacy, importance of keeping the patient’s
best interest at the centre of care.
• Supporting staff with training to educate patients is highlighted
in the white paper Choosing Health (DH 2004b). This is crucial to
allow patients to make informed choices.
• Patient education and self-management is one of the main areas
thought to help reduce rehospitalisation (IHI 2009).
OTHER REFERENCES
Giordano, R., Clark, M. Goodwin. (2010). Perspectives on telehealth and telecare: Learning from the 12 Whole System Demonstrator Action Network (WSDAN) sites Briefing Paper. The King’s Fund
Institute for Healthcare Improvement (IHI) (2009) Effective Interventions to Reduce Rehospitalisations: A Survey of the Published Evidence, Available at: http://www.ihi.org/offerings/Initiatives/STAAR/Documents/STAAR_A_Survey_of_the_Published_Evidence.pdf
Longley, Shaw and Dolan (2007) Nursing: Towards 2015 Alternative scenarios for healthcare, nursing and nurse education in the UK in 2015 (Commissioned by the NMC)
Parsons, T. (1975) ‘The sick role and the role of the physician reconsidered’, Milbank Memorial Fund Quarterly, 53(3), pp 257-278
RESEARCH POSTER PRESENTATION DESIGN © 2011
www.PosterPresentations.com
Rivett, G. National Health Service history: 1948 – 1957 – Establishing the National Health Service, http://nhshistory.net/Chapter%201.htm#Nursing (Accessed 22 February 2012)
Teasdale (1998) Advocacy in Health Care. Oxford: Blackwell Science
Tweddell, L. (2008) The birth of the NHS – July 5th 1948: The facts, figures and quotes that shaped the history of the national health service, Available at: http://www.nursingtimes.net/the-birth-of-the-nhs-july-5th-1948/441954.article (Accessed: 22 February 2012)
Wiseman H. (2007) Advanced nursing practice – the influences and accountabilities. British Journal of Nursing, 16(3), 167-173