We as nurses pride ourselves on our person-centred and holistic approach to caring for patients, particularly older people.
But listening to the radio this morning and learning of the new wave of changes that will reshape services for the NHS, I wonder if this will create opportunities for our profession or just become another short-term, tokenistic, political and financially driven incentive that will bang another nail into the coffin of person-centred care?
I have been involved in the profession for a long time and seen the best and worst of nursing.
I still fear the whiff of institutionalisation in some corners, particularly in older people’s care. Why does community care feel so different to hospital care, even when patients in each setting have similar conditions and treatment? Does it really matter that a person is in their own environment?
“Healthcare seamlessly embedded in the very fabric of society”
The answer is ‘yes’, and I see recent political moves as a real opportunity for post-modernisation on a scale never seen before, with the public owning and running such services.
With the demise of community spaces, hospitals could become a hub of not only healthcare activity, but visionary areas providing financial, policing, library and other community related advice centres that impact health; healthcare seamlessly embedded in the very fabric of society.
With the closure of shops and a move towards internet shopping there is an opportunity to redesign community spaces and this is one idea. Hospitals could have council hubs, policing, banking, and preventative health care services such as GP and practice nurses right on the doorstep - what an opportunity to bridge the chasm that many patients fall through when discharged from hospital, one that could prevent the need for readmission.
“I see hospitals of the future as areas of community activity involving all generations and people from all corners of society, an exciting mix of ethnicities, genders, ages and sexual orientation, a unique opportunity to support existing infrastructural factors, and offer support to pursue lifestyle changes.”
Library and college services in this setting would provide older people with an opportunity to brush up on their IT skills which see many left out of the digital age and requiring help and support to make use of it. As a result this excludes them from many areas of public life that we take for granted and will continue to do so in the future if we don’t act.
Further, it is an opportunity for young and old to get together and share their talents and skills.
Lifestyle is the underpinning force that makes up the new public health of the 21st century. Work, housing, diet and other factors common to us all have been held responsible for stress, mental ill health and obesity. A central community area would become a melting pot in which to address all the factors affecting lifestyle and subsequent health with signposting to advice centres and strong community links.
Volunteer roles could be further widened thus broadening the scope for public/patient involvement and present a real opportunity for us to throw open our doors and welcome the public in.
“A central community area would become a melting pot in which to address all the factors affecting lifestyle”
Nurses and their colleagues would benefit too from this new structure. With long shifts and out-of-hours work they will have ready access to important services, thus minimising the impact such lifestyles have on their own health.
I see hospitals of the future as areas of community activity involving all generations and people from all corners of society, an exciting mix of ethnicities, genders, ages and sexual orientation, a unique opportunity to support existing infrastructural factors, and offer support to pursue lifestyle changes. Everyone knows how hard it is to lose weight, stop smoking and avoid stress; this would provide a truly holistic structure addressing important lifestyle factors.
Ensuring the public are involved at the outset, encouraging involvement and altruistic and honest power dynamics to prevent the stench of municipality, we can provide a truly person-centred and holistic service with a ‘bottom up’ approach that is owned by the public.
So, will the current economic, political and market forces result in a truly holistic approach to older people’s care, providing us with a unique opportunity to see the older person as valuable within the context of society?
Or will we as our profession become a victim of such forces due to apathy and feelings of disempowerment caused by our workload?
Only time will tell.
Liz Charalambous is staff nurse at Queens Medical Centre, Nottingham