By Marjorie Gott
This ebook is a superb combination of overall healthiness coverage and nursing perform. It identifies the forces that experience ruled switch within the nationwide health and wellbeing structures of industrialised international locations - the shift of priorities from health center to ambulatory care, the enormous growth in smooth know-how, the increase in expenses and efforts at cost-containment, the renewed emphasis on disorder prevention and future health promoting. while, this publication brings to existence the impression of those forces and the particular perform of nursing, demonstrating how 'technology' and 'caring' might be harmonised. It exhibits via overseas case reports methods for nurses to maximize their contribution to sufferer care and to give a contribution to the enhanced effectiveness of nationwide wellbeing and fitness systems.' Milton I Roemer, within the Foreword
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Additional info for Nursing Practice, Policy and Change
The ®eld of primary healthcare in particular has been deluged with re-educative advice, mostly concerned with interdisciplinary working. The concept of interdisciplinary care is based on the premise that healthcare is delivered by a team, each member having their own set of professional skills. The job of the team leader is to co-ordinate skills to maximise eective and ecient healthcare delivery (yet protectionist working practices may sometimes militate against this). Interdisciplinary care recognises and utilises the dierent skills of team members, but the margins of care and responsibility are blurred and shared.
A number of alternative nurse practitioner models exist. The ®rst is the doctor substitute. This model has had limited applicability in the UK with 99% of the population registered with a general medical practitioner. Not all groups have access to primary medical care, however. Barbara Burke-Masters was a doctor substitute in the 1980s for homeless alcoholics in London's East End who were not registered with a GP. A variant of this model are the triage nurses within accident and emergency departments; some also provide treatment, request X-rays and arrange discharge.
The model of alternative ®rst point of contact nurse practitioners can be enhanced, however, by borrowing from the other models described above. A measure of substitution is likely to be both feasible and desirable, for example, nurse practitioner appointments may be oered when doctors' appointments are fully booked, or a doctor has had to cancel a surgery. The doctor's assistant model has worked successfully in the relationship between practice nurses and family doctors, and elements from it may be useful as the nurse practitioner role in primary care emerges.