Contexts of Contemporary Nursing

Graham R. Williamson,Tim Jenkinson,Tracey Proctor-Childs

• Éditeur: Learning Matters
• Année: 2010
• ISBN:
  9781844456802
• Édition: 2
• Sujet: Medicina
• Sous-sujet: Habilidades de enfermería

A wide variety of factors impact on the scope of nursing practice, including government policies, organisational structures, the media, education, future healthcare directions and service users themselves. It is an NMC requirement that nurses understand these factors in order to deliver quality care. This book provides a clear and practical introduction to these contexts for the new nursing student. The new edition (formerly ?Nursing in Contemporary Healthcare Practice?) has been revised to cover the organisational structures that students will find themselves working in, the various bodies involved in healthcare policy and the big issues in current and future healthcare delivery.

Part 1

The development and structure of modern healthcare services

Chapter 1

The establishment and structure
of the National Health Service

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Draft NMC Standards for Pre-registration Nursing Education

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This chapter will address the following draft competencies:

Domain: Professional values

1. All nurses must practise confidently according to The Code: Standards of conduct, performance and ethics for nurses and midwives (NMC, 2008), and other ethical and legal codes, recognising and responding appropriately to situations in day-to-day practice.

6. All nurses must understand the roles and responsibilities of other health and social care professionals and seek to work with them collaboratively for the benefit of all people in need of care.

9. All nurses must recognise the limits of their own competence and knowledge. They must reflect on their own practice and seek advice from, or refer to, other professionals where necessary.

Domain: Communication and interpersonal skills

2. All nurses must use a range of communication skills and technologies to support person-centred care and enhance the quality and safety of healthcare. They must make sure that people receive all the information they need about their care in a language and manner that is right for them, and that allows them to make informed choices and consent to treatment.

Domain: Leadership, management and team working

5. All nurses must continue their professional development, supporting the professional and personal development of others, demonstrating leadership, reflective practice, supervision, quality improvement and teaching skills.

8. All nurses must work effectively across professional and agency boundaries, respecting and making the most of the contributions made by others to achieve integrated person-centred care.

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Draft Essential Skills Clusters

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This chapter will address the following draft ESCs:

Cluster: Care, compassion and communication

1. As partners in the care process, people can trust a newly registered graduate nurse to provide collaborative care based on the highest standards, knowledge and competence.

By first progression point:

iii. Promotes a professional image.

iv. Shows respect for others.

v. Is able to engage with people and build caring professional relationships.

Cluster: Organisational aspects of care

14. People can trust the newly registered graduate nurse to be autonomous and confident as a member of the multi-disciplinary or multi-agency team and to inspire confidence in others.

By first progression point:

i. Works within the NMC Code of Professional Conduct (2008) and adheres to the guidance on professional conduct for nursing and midwifery students.

By second progression point:

iii. Values others’ roles and responsibilities within the team and interacts appropriately.

iv. Reflects on own practice and discusses issues with other members of the team to enhance learning.

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Chapter aims

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After reading this chapter you will be able to:

• understand why the NHS was established in 1948;
• summarise its development up to 1997, including the idea of a mixed economy of welfare.

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Introduction

In order to explain the development of modern-day healthcare this chapter examines the organisation of healthcare before the NHS, and the history and policy of the NHS from its establishment in 1948 to 1997.

Pre-NHS healthcare in Britain

The national organisation of healthcare in the NHS was not achieved as a revolutionary idea, although the establishment of the NHS in the post-war period was a ‘watershed’ or ‘tipping point’ in that central government intervened on a large scale effectively to nationalise the healthcare sector after World War II (WWII). Before this, healthcare needs were met in a variety of ways and, in Britain, service provision had grown since the mid-nineteenth century, as charity, voluntary and church organisations established facilities for the poor and needy, with local authorities providing a range of services. Central government passed health-related legislation, particularly for public health regarding clean water, factory conditions and the control of infectious diseases. A system of health insurance was established in 1911 to provide a basic minimum when workers were unwell, and there was also some healthcare as part of poor law provision (Webster, 2002). In the period up to the beginning of WWII, local government and voluntary provision expanded but provided nowhere near comprehensive coverage: for example, nearly half the population qualified for the post-1911 National Health Insurance (NHI), but this only gave them access to general practitioner services, not hospital care, and excluded the unemployed, dependants and children (Baggott, 2004).

It is by no means certain that a universal national system would have come about without WWII, but the war made it imperative that British healthcare was better organised as massive military and civilian casualties were anticipated; the voluntary sector still played an important part until the new system came into being. In the interwar period (1918–39) there were 1,000 independent, self-governing charity or voluntary hospitals, and 3,000 local government facilities, without any system of coordination or control. They differed in that, traditionally, the charity hospitals relied on donations for their funding, charged the rich for treatment and cared for the poor for free. However, it was difficult for the poor to gain admission to them. By 1938, these hospitals were often short of funds, and were charging patients for treatment, caring for about one third of sick people at this time. Local government controlled other hospital facilities, often targeted at specific illnesses such as infectious diseases, tuberculosis and mental problems, with some provision for maternity care. In addition, local authorities had responsibility for the Poor Law hospitals and the workhouses, in which the ‘less deserving’ poor were forced to live until these establishments were abolished in 1929. Early attempts following the Royal Commission on the Poor Laws in 1909 – to establish the principle of free healthcare for the poor by right – were dismissed as too radical (Baggott, 2004).

Many of the country’s poor lived in squalid housing conditions, and, although the Victorians had made great advances in public health by providing clean water and sewerage in cities and towns following the 1848 Public Health Act, there were still great inequalities in the health of the rich and the poor, reflecting the great inequalities in income. Working-class women had the worst health status. They were not covered by the post-1911 NHI system, they usually lived on incomes below accepted poverty levels even when their husbands were working, and they were often required to deny themselves healthcare and decent food in order to maintain a healthy breadwinner husband and for the sake of their children (Webster, 2002).

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Activity 1.1

Reflection

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Imagine that you are a woman living in London in 1900. Your husband is ill and requires costly treatment; as he is the only breadwinner his health needs get priority.

• How must it feel to prioritise his treatment above that of your children or yourself?
• What sorts of emotions do you think you might experience?

This activity will help develop your reflective skills, which in very basic terms means making sense of, and learning from, experiences in a structured way. This is a very important skill that will allow you to become an independent and active learner throughout your professional life.

Once you start to think about the significance or meaning of the experience, you are moving to the next main part of reflection – ‘why is this important?’ or ‘so what?’ The questions above will help you to start thinking about this, but you can explore the issue further on your own or with others.

There is a brief outline answer at the end of the chapter.

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Activity 1.2

Evidence-based practice and research

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The term ‘public health’ has been used in the preceding discussion.

• What is your understanding of the term ‘public health’?
• Write down your own definition, and then look up the term in textbooks and on the internet. Write a paragraph summarising the information you have found.
• How does your definition compare to those you have found?

Learning basic skills in researching information is essential at this stage of your programme of study. You will be engaged in a variety of modules and expected to be able to work to deadlines and assimilate (absorb) information and synthesise (combine various viewpoints to come up with a new understanding) knowledge in order to answer module assignments. Although these might seem like abstract academic skills in relation to actually caring for patients, in the twenty-first century, skilled nursing care requires a mix of theoretical knowledge and practical skills. As you are at an early stage of your career, it may be difficult to see how theory links to practice, but as you progress these links will become more obvious. Looking up material, as in this activity, will give you some practice at obtaining and synthesising information.

A sample answer is provided at the end of the chapter.

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The birth of the National Health Service

It is difficult for generations born after WWII in the United Kingdom (UK) to appreciate the impact that this major historical event had on British society. The country’s infrastructure was badly damaged by bombing, and its people emerged from the war years victorious but battered. As part of the process of rebuilding society, the incoming post-war Labour government introduced the reforms first formulated by William Beveridge, a Liberal politician who later became a peer. A high degree of consensus emerged around the proposals for government to inter...

Table des matières

• Cover
• Title
• Copyright
• Contents
• List of abbreviations
• Foreword
• About the authors
• Acknowledgements
• Introduction
• Part 1 The development and structure of modern healthcare services
• Part 2 Groups involved in healthcare policy
• Part 3 Key issues in healthcare policy
• Part 4 Conclusions
• References
• Index