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Nurses: The Critical Link in Improving Health Care for the Underserved

Resource type: News

Gara LaMarche |

Jennifer Wilson, Bermuda’s Nurse of the Year for 2008, spends her days driving the Azmobile from one island school to another. She coordinates an island-wide asthma education programme for Open Airways, an Atlantic-supported organisation that has helped cut hospital admissions for asthma sufferers by nearly three-quarters since its founding 10 years ago. These are critical gains because one-tenth of the island’s adults and one-third of its children have asthma, which approaches epidemic proportions in many low-income communities around the world. Bermuda’s high humidity and the number of motor vehicles on the 24-square mile island (52,000, many of them diesel) provides an ideal environment for potential allergic triggers.

Nurses like Jennifer Wilson are on the front lines of service for underserved communities everywhere Atlantic works, and yet they are too often the unsung heroines and heroes of medical care for those who need it most. I have three cousins who are registered nurses and three more who are direct care workers for frail older adults, so I feel a special attachment to these extraordinary caregivers. I was thrilled, on coming to Atlantic last year, to find that the foundation is in the vanguard of recognising and supporting the critical role they play in meeting the health needs of poor and vulnerable people throughout the countries in which we work.

Viet Nam

In Viet Nam, the development of the nursing profession has been neglected for decades, resulting in a severe shortage of nurses in the country. One of the most pressing areas of need is the education of nurse academics – nurses who teach nursing, in essence. Currently most teaching in nursing programmes is done by doctors, which results in a nurse who is trained as a doctor’s assistant rather than one who is able to meet the standards of contemporary nursing practice and patient care. One of the reasons there are so few nurse academics is due to the lack of training programmes in the country. A master’s degree is required of all teachers in Viet Nam, but there is only one Master of Nursing programme there, introduced in 2007. The need to study abroad significantly limits nurses’ professional development: in all of Viet Nam, there is only one nurse with a Ph.D. and about 40 nurses with a master’s degree – most in non-nursing fields.

Clearly, in order to tackle significant health care issues in Viet Nam, attention must first be given to the training of nurses. The Atlantic board has just approved a significant grant to the Queensland Institute of Technology School of Nursing to support the Viet Nam Nurses’ Association (VNA) as it improves nurse training and professional development in Viet Nam. The VNA will enhance the teaching ability of nurse teachers, improve curriculum to meet international standards, and engage in advocacy, policy and continuing education on issues relating to nursing standards, education, leadership and development.

South Africa

In South Africa, we’ve identified nursing as one of the critical areas for improvement of the nation’s public health system. South Africa’s nurses form the backbone of the health system and constitute nearly 50 per cent of health professionals. Eighty per cent of all public sector trained nurses receive education and training through nursing colleges.

But as in nearly all fields in South Africa, the past decade has seen major restructuring in nursing and nurse training. Closures and mergers of hospitals, changes in legislation, re-orientation of mission and regulation, and radical shifts in demographics are just a few of the facets of comprehensive change, taking place against the background of increasing burdens of disease (especially HIV/AIDS) and rising expectations and aspirations for improved health.

There are about a dozen nurse training institutions in South Africa, all under-resourced relative to the demand for increased nurse production. Further, the globalisation of the health sector has offered attractive alternatives to the higher echelons of the nursing profession, leading to acute shortages of more specialised trained nurses and nurse educators. Atlantic is responding to these challenges by supporting the training institutions at key stress points, and building their capacity to increase the volume, quality and training of nurses. Strengthening these institutions also strengthens their voices in policy debate and advocacy.

Atlantic will spend an estimated ZAR150 million (US $18 million) over the next five years in support of nursing education at specialized nursing colleges, universities and colleges of technology. Our initial support focuses on South Africa’s two largest nursing training colleges, which produce more than half of all nurses in the country: KwaZulu-Natal Nursing College and Lilitha College, in the Eastern Cape.

These historically disadvantaged institutions require a higher level of support than the universities. In particular, they need to improve infrastructure and increase their ability to implement the new curriculum needed to comply with the Nursing Act of 2005. The Act introduced new scopes of nursing practice and new procedures to accredit nurses.

Inyathelo, the South African Institute for Advancement, a Cape Town-based nonprofit institution specialising in capacity-building for civil society institutions, is helping to coordinate this programme.

United States

In the United States, our work with nurses is centered in our Ageing Programme. A grant to New York University for its NICHE (Nurses Improving the Care of the Healthsystem Elders) service helps nurses increase their confidence and competence to care for older patients. Participating hospitals have shown improvements in patient outcomes such as lower readmission rates and fewer falls. At the start of the grant, 197 hospitals were using the NICHE approach to quality improvement. The goal is to expand to 600 participating hospitals.

Another series of grants, to the Visiting Nurses Association, aims to improve care for older patients by strengthening the geriatric capacity of home health care managers and their field nurses. One grant helped to create a systematic way, tested at first in a pilot programme, for home health care nurses to adopt best practices in medications management and pain management. The second phase of the programme involved developing business plans to expand the programme throughout the country.

A grant to the American Academy of Nursing for the Fagin awards supports the development of independent nurse researchers who serve as role models and mentors for future nurse faculty. Since the inception of the Claire M. Fagin Fellowship seven years ago, we have made a total of 58 fellowship awards. Our partners in this effort are the John A. Hartford Foundation, supporting a total of 152 fellows and scholars. Alumni of the programme are now teaching nursing students in 36 states across the U.S.

One Atlantic grantee in particular is working to address one of the systemic problems in the U.S. health care system – high turnover among care providers. Our support for the Paraprofessional Healthcare Institute aims to end the widespread “cycle of instability,” in which both direct-care workers and their supervisors experience a lack of mutual support and a resulting high rate of turn-over, which in turn threatens quality of care. PHI provides direct care worker supervisory training to nurses as a means to help break this cycle of instability and improve the quality of care received by older adults in long term care.

Jennifer Wilson, Bermuda’s Nurse of the Year, knows first-hand that a shortage of nurses in countries around the world means one thing: a drop in the quality of care afforded to the most vulnerable among us. That’s especially true in underserved countries like Viet Nam and South Africa. Atlantic and our grantees are helping to reverse that trend by giving nurses the training, tools and respect they deserve. It’s one of the best paths to healthy societies.

Gara LaMarche

Links to organisations mentioned in this column: