Essentials of Nursing Adults

Karen Elcock, Wendy Wright, Paul Newcombe, Fiona Everett, Karen Elcock, Wendy Wright, Paul Newcombe, Fiona Everett

• Publisher: SAGE Publications Ltd
• Year: 2018
• ISBN:
  9781526453853
• Edition: 1
• Topic: Medicina
• Subtopic: Enfermería

Drawing together the best of text, video and interactive material for the definitive guide to adult nursing.

This one-stop-shop will enable students to understand the core aspects of care, learn the essential nursing skills and knowledge that underpin practice, deal with the complexities of the role and apply their learning to common conditions and patient groups. It has been developed in line with the 2018 NMC standards to provide a complete learning resource for adult nursing students.

Key features:

• Uses patient centered care and evidence-based practice as guiding principles throughout
• Clear and engaging features to help students understand the core theory and knowledge, apply it to nursing practice, revise for assessments and exams, and go further in their independent study.
• 12 months free access to aninteractive eBook version, meaning you can access the book anytime.

The book is supported by online resources, including linkstoup to100instructional videos, case studies and accompanying questions, access to selected SAGE journal articles, weblinks, multiple-choice quizzes, and glossary flashcards.

Designed to make learning flexible and fun, leaving students better prepared for practice and ready to thrive in their future careers.

1 The changing world of healthcare

Paul Newcombe

Karen Elcock

This chapter covers

• The impact of a growing and ageing population and the increase in long-term conditions
• The impact of lifestyle choices and a shifting focus to prevention
• Changing expectations of healthcare
• New care models, increasing use of technology and changes in professional roles
• Nursing in a global context.

Nursing has changed significantly since I qualified in the 1980s, back then nurses did not even give IV drugs, now I work in a GP surgery running my own clinics and am a nurse prescriber.

Ali, GP practice nurse

Introduction

As Ali points out above, working in healthcare means that you are going to be exposed to constant change. Each UK government makes changes to the structure of our healthcare systems and processes in an attempt to continue to deliver a first-class service within financial constraints. Nurses are at the front line of care delivery and so inevitably feel the impact of these changes. The role of the nurse has changed significantly over the last 30 years and nurses now perform a wide range of skills that were once only undertaken by doctors. This blurring of boundaries is also occurring within nursing with an expectation that nurses both understand the needs of clients in all fields of practice and are able to respond to these needs. This makes sense as you will meet adults with both physical and mental health problems, and children and people with learning disabilities in both community and hospital settings, and you will need to recognise and provide care for all their needs. Being an adult nurse is exciting as it offers such a diverse range of job opportunities in hospitals, the community, the independent and voluntary sectors across the UK and in other countries. This chapter will look at some of the key policies that have influenced how care is structured and delivered and the drivers behind them. It will explore the changes in professional roles and the increased use of Information Technology and how both are transforming how and where care is delivered. Examples of care models being used across the UK will be given and we will finish with a discussion of the global context of care, recognising that some of you may decide to work abroad in the future.

The impact of a growing and ageing population

The first, most important and constant change in healthcare is the rapidly growing population. The current world population is over 7.5 billion and it is growing at about 1% per year (83 million people). UK population growth is a little slower at 0.6%, but at 64.6 million people, the current UK population is 15% bigger than in 1975, with half of this growth occurring since 2005. This UK growth is due to increased immigration, an increased birth rate and increased life expectancy. The direct impact on nursing is a greater demand for healthcare services, which arguably haven’t fully kept pace. Nurses must also address the needs of an increasingly diverse population and, particularly for adult nurses, the needs of an ageing population.

By 2031, minority ethnic groups will make up 15% of some parts of the UK and 37% of the population in London. Increased diversity offers enormous enrichment to the UK; however, it also presents huge challenges. A changing population brings changing healthcare needs. For example, some ethnic groups have much higher rates of conditions such as diabetes and communicable diseases like HIV, whereas others have lower rates of cancer. More than 100 languages are spoken in many parts of the UK (250 or more in London), with 2% of the population unable to speak English well or at all. As an adult nurse, you will need to address this communication barrier in order to provide culturally competent care (Douglas et al., 2014).

The UK’s ageing population, while partly due to a surge in birth rate after the Second World War – so-called Baby Boomers – is also attributable to improved health outcomes. People are not only living longer, but they also have an increased ‘healthy life expectancy’ (the number of years without illness/disability). However, the number of older adults (>65 years) is expected to account for almost 25% of the UK population by 2046 (Table 1.1). This means that there will be gradually less adults of working age to support those reaching state pension age. This has obvious financial implications but will also impact on the supply and demand of the nursing workforce.

While many older adults are leading healthy lives, most will increasingly seek the services of healthcare providers as they grow older. More than 40% of people admitted to acute hospitals are over 65 years old and length of stay increases with age.

Table 1.1

Source: Office for National Statistics (2017)

1. Population estimates data are used for 1996 to 2016, while 2014-based population projections are used for 2026 and 2036.

Additionally, a number of other factors arise:

• Increased frailty, incidence of falls and subsequent neck of femur fractures
• Increased disability, including sight and hearing loss, resulting in reduced ability to carry out activities of daily living (ADL) independently
• Increased malnutrition
• Increased incontinence
• Increased incidence of mental health problems, such as depression and dementia
• Increased loneliness and social isolation
• Increased burden on unpaid family carers, many of whom are older adults themselves.

Age UK (2018)

See also Chapter 31

See also Chapter 19

See also Chapter 20

The impact of long-term conditions

Another factor that increases with age is the incidence of long-term conditions (LTC). More than 40% of over 65s and more than half of over 75s have a LTC compared with a third of the general UK population. These are diseases for which there is no cure, but which require ongoing treatment in order to manage the impact on the individual. This is a huge economic burden on the NHS and will also make up a large part of your work as an adult nurse. Examples of LTCs include: diabetes; respiratory disease, such as chronic obstructive pulmonary disease (COPD); cardiovascular disease, such as hypertension, stroke, coronary heart disease and heart failure; neurological disease, such as Parkinson’s; musculoskeletal disease, such as arthritis; and cancer. There is also a huge overlap between LTC and mental health (MH) problems: a third of people with a LTC also have MH problems, predominantly depression and anxiety. Similarly, while a fifth of the UK population have a MH problem, nearly a half of these also have a LTC (The Kings Fund, 2013). As a result, the physical and psychological care of people encountered by adult nurses must always be inextricably linked.

See also Chapter 18

See also Chapter 19

Preparation for Practice Placements 1.1

When you prepare for a new placement, you should always research the population you will be caring for. You can access the healthcare organisations’ websites, but also those of the local council, for example.

What are the demographics (age, ethnicities, socioeconomic profile, incidence of long-term conditions, etc.)? Is this similar to what you have experienced before? Do you need to do any further reading around particular groups you may encounter? Will there be any communication or cultural issues you can prepare for?

The impact of lifestyle choices

Although a...