Nursing and Medicine

1
Nursing and Medicine

• As yet there has not been a sensible discussion
  with the nursing profession about what nurses and
  doctors respectively bring to a therapeutic
  relationship. A debate is needed about the
  difference between nurses and doctors.
• Kings Fund 2008

2
Mark Radcliffe 2000

• Medicine remains in the ascendancy but so what?
  The capacity to cure has greater market value
  than dealing with distress. And so it should.

3
John Humphrys 2008

• I couldnt talk to her because by the time I
  arrived she was unconscious but they are so
  bloody brilliant in these hospices. It was a big
  room that she was in and it was 9 o clock at
  night. They hadnt turned on the lights and there
  was this soft light coming in from the corridor.
  I was sitting at the window in the corner and the
  nurse who came in didnt see me.

4
Continued

• She bent over to her and stroked her forehead
  and talked to her and obviously my wife couldnt
  hear her but she said something, and you know, it
  felt like.love. If I could have done, I would
  have gone over and hugged the nurse.

5
Caring is

• Human caring is a powerful creative activity
  with impact!
• David Reilly
• its the care, compassion and communication
  which are remembered and which shape subsequent
  experience of health and health care. Such
  memories can last for decades.
• Kenneth Calman 2001

6
The Placebo

• Literally I will please
• A sham treatment plus a good bedside manner
  Godlee 2008
• if a sham treatment plus a good doctor-patient
  interaction can be so powerful, doesnt this
  become a useful treatment in its own right?

7
The placebo

• Godlee qualifies this by saying
• for some conditions, the placebo effect may
  after all be one of the most powerful tools in
  your medical bag, but only if you know how to use
  it

8
Steven Wright

• so much of the effectiveness of nursing is based
  not so much on what nurses do to patients, but on
  how they do it to them
• He adds that as nurses our aim is not merely that
  patients get better (the cure) but that they feel
  better (the care).

9
Monica Fletcher

• as the vocation of nursing has evolved we seem
  to have lost fundamental values. Nursing now
  focuses less on patients and more on acquiring
  knowledge and skills to further its status.

10
John Alcolado MRCP 2000

• The minority of nurses who wish to take full
  medical histories, examine patients and prescribe
  drugs should take a medical degree
• When is a nurse really a doctor in all but name?

11
Dan Ariely 2008

• Professions started somewhere deep in the past
  in religion and then spread to medicine and the
  law. Individuals who had mastered esoteric
  knowledge, it was said, not only had a monopoly
  on the practice of that knowledge, but an
  obligation to use that power wisely and honestly.

12
Barbara Safriet JD 2007

• Overlap among professions is necessary. No one
  profession actually owns a skill or activity in
  and of itself. One activity does not define a
  profession, but it is the entire scope of
  activities within the practice that makes any
  particular profession unique.

13
Safriet continued

• Simply because a skill or activity is within one
  professions skill set does not mean another
  profession cannot and should not include it in
  its own scope of practice.
• No one professional has enough skills or
  knowledge to perform all aspects of the
  professions scope of practice

14
The imperatives of the ANP role

• 1. The ANP must be trained, competent and
  accredited with ongoing clinical supervision and
  educational/professional development
• 2. The ANP must add to the quality of patient
  care effective and sensitive response to patient
  need

15
The imperatives of the ANP role

• 3. The ANP must provide evidence based practice
• Safriet asks how does the new skill or service
  fit within/enhance a current area of expertise,
  and is there evidence that the procedure or
  skill is beneficial to public health?

16
Salvage and Smith 2000

• For decades we understood the professions as a
  conventional nuclear family, with doctor-father,
  nurse-mother and patient-child
• but the patient has grown up. A new 3-way
  partnership should displace the vanishing family

17
BMJ fast responses 2006

• Dumbing down medicine
• The death of good nursing care
• Jumped up and uppity
• Contempt for nursing care
• We are trying to protect patients from a nursing
  profession that does not nurse, but does appear
  desperate to become doctors

18
The Editorial..

• if as she argues, the distinction between
  medicine (cure) and nursing (care) will become
  increasingly blurred, how much blurring will it
  take before the distinction becomes meaningless?
• Fiona Godlee
• Maybe it was a lot less messy when as is said in
  the 1880 editorial the nurse must be a person
  who plays blind obedience to (doctors) orders.

19
Medicine and Nursing. Cure or care?

• the distinction between medicine (diagnosis and
  cure) and nursing (care) has become increasingly
  blurred. Medicine and nursing from part of a
  continuum, and where you are on that continuum-
  whether you are a doctor or a nurse- changes
  depending on what the patient needs from you at
  any one time.

20
Understanding Doctors (Kings Fund 2008)

• what we end up with is a mish-mash of role
  substitutions of people who may be imperfectly
  prepared in terms of their foundation of
  educationand this is a potential problem and
  will ultimately erode not just medicine but the
  values associated with the other professional
  clusters as well