VOL: 97, ISSUE: 17, PAGE NO: 33
Pat Ramdhanie RGN HV DNDThe debate over nursing versus social care never ends, especially in the field of long-term care. A cynic might say that the difficulties are financial because nurses are a scarce resource, if not a luxury item. If it is becoming harder to find new nurses, then a way must be found to require fewer of them. And what better way to do so than to look at nursing care as simply a list of tasks that have to be performed?
The debate over nursing versus social care never ends, especially in the field of long-term care. A cynic might say that the difficulties are financial because nurses are a scarce resource, if not a luxury item. If it is becoming harder to find new nurses, then a way must be found to require fewer of them. And what better way to do so than to look at nursing care as simply a list of tasks that have to be performed?
Curiously, the same criterion has not been applied to that other scarce commodity, GPs. After all, they just talk to people and write the occasional prescription. But what about all the knowledge that informs those tasks?
Precisely. And what about all the knowledge that nurses use to make caring look so easy that some people seem to think anyone could do it?
The resource implications of long-term care funding have led to the decision that nursing care is that which is actually delivered by a nurse. A simple solution, after all, as 'normal' caring is easy, isn't it? You need nurses only for the complicated, high-tech stuff.
Rather than relating the definition of nursing to tasks, wouldn't it be a better idea to relate it to the amount of time it takes to deliver care?
When patients require care, the amount of time it takes to deliver it is usually, although not always, an indication of their health status. The poorer or more fragile the state of physical or mental health, the greater the time it will take to deliver the care. There is a high probability that the patient's needs will turn out to be complex, even if they are not immediately obvious.
The care itself does not have to be given by nurses but it will need to be prescribed, directed and monitored by them. They must be able to ensure that the care staff have, or will acquire, the necessary skills to deliver appropriate care and be able to maintain the optimum health of their patients.
In 2002, care in the private and voluntary sector will be delivered in care homes, not nursing or residential homes. Those involved in caring for older people should start thinking now about how much time it actually takes to care - and start adding up the costs.
When a patient needs attention every hour of the day because he or she has dementia, all the health care staff should be aware that not only custodial care is required but also skilled interventions that make sense of the patient's needs and anxieties.
Providing custodial care may achieve cheaper short-term results, but delivering skilled nursing interventions provides better long-term outcomes for those who are dependent and in need of quality care.
It is easy to measure how much time has been spent with a patient. And time, after all, is money.