Working with individuals, families and communities to enhance choice and health management: How the new nursing framework can save the NHS 

The effectiveness with which nurses and midwives deliver on their commitment under the new nursing framework, to “work with individuals, families and communities to equip them to make informed choices and manage their own health” has the potential to meet some of the current challenges facing the National Health Service. Integral to a shift from primary to community care, commitment number 3 of ‘Leading Change, Adding Value’, creates an opportunity for nurses to spearhead a transformation in healthcare, which over time can reduce healthcare costs, alleviate staffing pressures and most importantly, empower individuals, families and communities towards healthcare management and effective prevention.

According to ‘Patient Involvement in Health Care Decision Making: A Review’, “patients’ participation in decision-making in health care and treatment is not a new area, but currently it has become a political necessity in many countries and health care systems around the world.” Apart from the benefits to patients, which include greater satisfaction with services, improved treatment outcomes, reduced anxiety and emotions, and an overall improvement in quality of life, supporting individuals, families and communities to “self care” and “self management” could reduce GP visits by as much as 40%, visits to Accident and Emergency by 50% and reduce expenditure on drugs, says the Self Care Forum.  Citing data collected from a six-month study on patients who completed an Expert Patients Programme, “for very £1 invested in self care for long-term conditions,” says the forum, “£3 is saved in reducing avoidable hospital admissions and improving participants’ quality of life.”

The Self Care Forum, set up in May 2011 in collaboration with the Department of Health, assists healthcare services, patients and the public to embed “self care … into everyday life,” and operates under the premise that a shift towards a self care perspective can save the NHS.  “Patients are the health service’s biggest untapped resource,” says the forum, and among other healthcare professionals, nurses can help to tap this potential by encouraging self care in every consultation and assisting patients, as well as their familial and communal networks to understand the role they have to play, feel competent to take part in the decision-making process and develop the confidence, skills and insight to seek out information, understand and ask questions.

Moving care to the community

The UK isn’t the only country where shifting perspective towards community-based healthcare is seen as a viable way to “improve productivity whilst reducing or stabilising health care costs.” According to Royal College of Nursing’s report ‘Moving Care to the Community: An International Perspective’, many countries acknowledge this need and in places where policies have been effective, like in Denmark, Sweden and Canada, the focus has been on “preventative and self care techniques.” Denmark’s Skævinge project, which was piloted in 1984 and ran for 25 years, is said to have formed the foundation of long-term care in Denmark. The project, which bridged the gap between nursing homes and home care services by integrating them, encouraged older people “to live as independently as possible and use their own resources, while nursing staff were responsible for treatment, care and supervision.” There was a successful reduction in service expenditure, as a result, even with an increase in the elderly population. In Sweden, where the length of stay in hospital is “lower compared to other European countries,” part of the strategy for moving healthcare to the community included giving patients greater choice over private and public healthcare and removing restrictions on geographically zoned treatment.

Establishing strong community bonds through communication is paramount

The new nursing framework, ‘Leading Change, Adding Value’ understands that a focus on enabling individuals, families and communities to take responsibility for health and well-being is vital to reducing the impact on health services of an ageing population plagued by the effects of “obesity, poor diet, lack of exercise, smoking and excessive alcohol consumption.” Among its approaches, nurses will form one of the pillars of “strong communities where people feel socially connected and that services are responsive to their needs” and they will also understand and build “on the strengths that exist in local communities.” How nurses interact with patients will be critical to this approach,” suggests ‘Supporting people to self-manage; Education and training for healthcare practitioners: A review of the evidence to promote discussion’, a research paper published by NHS Education for Scotland.

Communication and counselling skills and an understanding of different consultation styles will be central, it says, to nurses’ ability to implement the approach effectively. Other keys skills according to the paper include being able to support and enable people to access appropriate information to manage their self care needs including the use of technology, access to support networks and opportunities to participate in the planning, development and evaluation of services. Working collaboratively with patients, families and communities to set goals and problem solve would be enhanced by a non-judgemental approach and further collaborative working with a diverse range of community providers.

A robust understanding of behaviour change encompassing an understanding of “self-efficacy, motivation, stages of change, the role of peers and goal setting,” as well as specialist skills for “working with young people and those with mental illness and drug addictions”, are also crucial for implementing community-based/person-centred healthcare models, and overcoming some of the barriers to individual and communal health ownership.

Especially when dealing with chronic conditions, identifying the barriers to self care, will in fact, be the first step towards collaboration, according to ‘Helping patients with chronic conditions overcome barriers to self-care.’  Nurses will need to expand their awareness of the “physical, psychological, cognitive, economic, and social and cultural” obstacles that can undermine their efforts and use strategies like motivational interviewing and targeted assessments designed to assess cultural beliefs and enhance self-efficacy, to overcome them.