DH Week of Action
Addressing the respiratory healthcare burden - nurses: deflated or inspired?
For the Department of Health’s Week of Action Rebecca Sherrington of the Association of Respiratory Nurse Specialists speaks about their strategy for improving respiratory disease mortality rates
Recently the Association of Respiratory Nurse Specialists (ARNS) reexamined it’s three year strategy. Our vision is to “champion the specialty respiratory nursing community, promote excellence in practice, and influence respiratory health policy.”
If you’re not involved in the ARNS, you might ask, why does this matter, should nurses be concerned about respiratory care and is there a respiratory disease burden, big enough to really have an impact on nursing?
By 2030, the World Health Organisation (WHO) estimates that the four major potentially fatal respiratory diseases - pneumonia, tuberculosis, lung cancer and chronic obstructive pulmonary disease (COPD) - will account for approximately one in five deaths globally, compared to one in six deaths globally in 2008 (ERS, 2013).
In the UK, there are over 4 million people in England affected by asthma and, on average three people die every day in the UK from their asthma. However, it is recognised that 90% of all asthma deaths are preventable if managed properly. In 2010, the UK death rate from asthma was one of the highest in Europe and as a result, a national review of asthma deaths has taken place and will be published in May 2014 (DOH, 2011).
Despite this sizable UK public health problem, we have no national service framework for respiratory disease
COPD kills about 25,000 people a year in England and Wales. Recent figures showed that COPD accounted for 4.8% of all deaths in England between 2007 and 2009. It is the fifth biggest killer disease in the UK and premature mortality from COPD in the UK was almost twice as high as the European average in 2008 and one in eight people over 35 has COPD that has not been properly identified or diagnosed (DOH, 2011) .
What do we believe are the barriers to achieving improvements to high mortality rates and whose responsibility is it?
Despite this sizable UK public health problem, we have no national service framework (NSF) for respiratory disease, although there was an initial drive to implement the COPD and Asthma Clinical Strategy. However political changes have affected the momentum and this strategy is being now being championed within the respiratory community, not at a political level.
There are no major TV campaigns for COPD, no respiratory network for respiratory disease and a general poor public awareness (which may be as a result of respiratory health, not being part of health checks and lack of funding of respiratory charities to fund sizable marketing campaigns in comparison to cardiac public health campaigns).
While there are a number of potential barriers and challenges preventing improvements in respiratory care, as the largest group of health care professionals, nurses are the closest and often those with the greatest responsibility to improve the health of those with respiratory diseases, so are there specific nursing barriers and is the nursing system failing?
Education and learning
A lack of priority and awareness of the severity respiratory, diseases has also resulted in a real lack of funding for affordable training and education of nurses working in all healthcare sectors, particularly in primary care, where general practice nurses (GPNs) may be under pressure to find funding for a range of disease specialties. This then has a huge impact on patient’s treatment, awareness of available resources and most importantly accurate and timely diagnosis’s of respiratory diseases.
Nurse specialists are expected to have post graduate qualifications and beyond. However, often without access to funding, and faced with increases in university fees, nurse specialists too, are finding it increasingly difficult to keep up with this expectation.
Nurses’ personal responsibility
Respiratory nurses need to be more engaged in the activites and lobbying efforts of their professional associations and unions. The momentum of change can only be achieved if individual nurses support each other, articulating their successes and problems.
Respiratory professional associations and charitable groups responsibility
With over 1,000 members, the ARNS now has a responsibility as the only nurse-led nursing organisation to ensure that the nurses’voice is heard at all levels, and vitally that nurses are involved in health services decision making and policy development.
For its membership we need to provide a specific forum to develop nurse skills and knowledge through conferences and social media platforms. ARNS also has a real responsibility to ensure that we work in close collaboration with all respiratory organisations to exchange ideas and information and promote a multidisciplinary approach to future respiratory challenges.
However, the association’s power is restricted by its real lack of funding as it is run by nurses in their own time, with no fixed or secure financial income and is entirely dependent on pharmaceutical sponsorship. This therefore limits the range and number of projects it can work on and the effectiveness to make really wide ranging differences.
There are also the two other major respiratory organisations, the Primary Care Respiratory Society (PCRS) a organisation for all professionals working in primary care and the British Thoracic Society (BTS) who’s aim is to promote optimum standards of care, disseminate research and innovation and advance knowledge.
While both of these organisations have worked tirelessly with key respiratory champions, to raise the standard of care, these organisations have a remit to meet the needs of all healthcare professionals and neither have the capacity to transform the current nursing infrastructure.
We also now have an emerging ‘respiratory alliance’ which will lobby and champion respiratory care, againhow much priority will this give to nursing education, workforce planning and recruitment etc is also yet, to be realised.
National nursing leadership
Nurse leaders must clearly articulate and actively promote the role of the nurse specialist as a core resource and critical contributor to decision making. Over the past year, with the focus on nursing and the critisms levelled at it, the positive impacts that clinical nurse specialist’s have, have been lost. Surely, if the respiratory nurse’s role is to be valued and included in national strategies our roles need to be talked about and promoted by nursing leadership at the highest level.Nurse leadership needs to be promoting the work at every opportunity, listening and engaging with respiratory nurse champions and supporting the creation of potential new ways of working.
Despite this clear evidence of the public health challenge and the poor outcomes associated with respiratory diseases, being achieved within the UK, we believe that the respiratory disease hasn’t been recognised or truly seen as a huge public health challenge, by national nursing or healthcare leadership. Whilst ARNS and other respiratory organisations are working towards promoting the delivery of high quality care, we believe that nursing is missing out, on the real opportunity to proactively respond to this public health challenge.
The role of the nurse in chronic disease is critical, practice nurses; ward based nurses, community nurses, specialist nurses etc. all make a significant contribution from diagnosis to end of life care. We believe that nurses are critical to any change, in respiratory care; however, for this there must be an investment of appropriate resources. We also need an overarching framework in place to meet the UK’s respiratory challenges and nursing leadership to assist nurses in meeting this future public health problem.
- An Outcomes Strategy for COPD and Asthma. Department of Health (2011).
- European Respiratory Society (2013) The Burden of Lung Disease – European Lung White Book. 2nd edition.
Rebecca Sherrington is the chair of the Association of Respiratory Nurse Specialists.
@becksherrington and @arns_uk