Continuing on from her previous blog post, ‘Nursing Humanities’, Catherine Kelsey begins her second paper by asking nurses to reconsider the use of the medical model of care in nursing and to seek alternative models as a means of ensuring that healthcare provision becomes truly person-centred and humanitarian.
Coined by Laing (1971), the ‘medical model’ continues to be used to diagnose and, where appropriate, prescribe treatments. Unchallenged for almost a century this model has failed to recognise the importance of the many existing social determinants of health that have the capacity to impact negatively on wellbeing. These include pollution, discrimination, stressful work and social problems, (Germov 2013) as well as others including social class, ethnicity, gender and occupation (Adibi 2014). Furthermore, positive health and wellbeing depends on meeting the basic needs of happiness, the ability to develop harmonious relationships and the commitment to ensuring the security of all peoples, all of which are included in the World Health Organisation constitution (WHO 2006). The work of Maslow (2012) can also be considered an important aspect of this argument, for he argues that once the physiological and safety needs of individuals are met the need for belonging, prestige, and self-actualisation is of paramount importance.
To increase the possibility of these needs being met, healthcare professionals need to communicate in such a way that empowers patients to take responsibility for their own health and wellbeing. Emphasised throughout the Five Year Forward View (NHS 2014) effective collaborative working can help facilitate the development of interdisciplinary professional teams and in so doing encourage effective purposeful relationships with patients, one of the aims of which is to help patients develop personal coping strategies. Furthermore, healthcare professionals who empower patients to be responsible for their own health are relinquishing professional power, an approach based upon Foucault’s power/knowledge theory, one which can be a dynamic and productive influence within society (Gaventa 2003).
In recent years, healthcare reforms and political drivers have led to people being treated earlier and more efficiently, ultimately leading to increased longevity (Rowe 2009). Despite this progress, the modern day approach to health and social care provision has failed to keep pace with the needs of an ageing population (ONS 2013), the challenging burden of disease (Ham et al. 2012); increasing public expectations (NHS 2013) and continued inequalities within health (Appleby et al., 2011). Increasingly, differential diagnosis is becoming a collaborative effort between the healthcare professionals, the patient and their families as a potential means of improving diagnostic performance (Ball 2015). However, confirming the correct diagnosis is perhaps not the only answer; we treat the patient, but ultimately the patient returns at a later date with the same health problem. This phenomenon often occurs as a result of the failure to recognise that the patient is returning to the same situation, which initially led to the problem. Utilising the biopsychosocial model of care (Engels 1977) with its emphasis on the psychological and social as well as the medical aspects of health and wellbeing will help focus the consultation and enable the experienced and more advanced healthcare practitioner to think more widely in terms of care provision. However, the concern is that as skills become increasingly advanced, as consultations increase and patient expectations continue to rise, nurses will simply adopt the medical model of care, and in so doing fail to take action to reduce the significant burden of health inequalities.
Developing advanced skills presents its own unique challenges. Astrow (2013) argues that in developing effective relationships with patients, physicians must be able to withstand significant episodes of intense pressure, stress and anxiety. This also applies to nurses. Emotional resilience is increasingly being considered as an important aspect of maintaining personal health and wellbeing. According to Chen (2010), resilient nurses are reflective, optimistic and socially competent; they possess good problem-solving skills and have a sense of purpose.
As pressures on leadership and service provision increase, universities need to consider how best to support nurses to develop emotional resilience and self-confidence, to enable the effective management and increasing demands of an already strained service (Council of Deans of Health 2016). Promoting the development of emotional resilience in the nursing curriculum can help to support self-awareness, recognition of personal success as well as potential failings. This can be particularly challenging in an increasingly demanding clinical environment, in which great healthcare flourishes but, disappointingly, where significant errors can occur. Developing this humanistic approach to personal wellbeing could help to create empathic well-rounded nurses who are able to actively encourage patient involvement, effective decision making, and the taking of personal responsibility for our own health.
Today, nursing is in a unique position to influence patient outcomes and, along with other healthcare professionals, nurses are increasingly embracing many of the traditional roles of the physician, in both primary and secondary care. For example, differential diagnoses are being made by a panoply of healthcare professionals.
Amidst this explosion of new roles, the Government’s main answer to dealing with the staffing crisis, a word of caution should be sounded. We must be aware of the importance of reducing the risk that diagnosis becomes the only priority of nursing care, rather than seeing the patient as a human being. It could be argued that this responsibility lies firmly in the hands of nurse educationalists who must recognise the importance of integrating nursing humanities firmly into professional nursing curricula, for only then are we likely to have nurses who are sufficiently skilled and knowledgeable enough to meet the requirements of 21st Century healthcare provision.
References
Adibi, H. (2014) ‘mHealth: Its Implications within the Biomedical and Social Models of Health – a Critical Review’, Cyber Journals: Multidisciplinary Journals in Science and Technology, Journal of Selected Areas in Health Informatics. 4, (2): 16-23.
Appleby, J. (2015) How is the NHS Performing? Kings Fund Quarterly Monitoring Report.
Astrow, A.B. (2013) ‘Is Medicine a Spiritual Vocation?’, Society.
Ball, J. (2015) Preface. In: Balogh, E.P., Miller, B.T., Ball, J.R., (Eds) Improving Diagnosis in Health Care. The National Academies Press, Washington, D.C. pp. xiii.
Chen, J-Y. (2010) ‘Problem-based learning: developing resilience in nursing students’, Kaohsiung Journal of Medical Sciences.
Council of Deans of Health (2016) Educating the Future Nurse – a paper for discussion. Council of Deans, London.
Engels, G. (1977) ‘The need for a new medical model: a challenge for biomedicine’, Science, New Series 196 (4286): 129-136.
Gaventa, J. (2003) ‘Power after Lukes: a review of the literature’, Institute of Development Studies, Brighton.
Germov, J. (2013) ‘Imagining Health Problems as Social Issues’. In: Germov, J. ed. Second Opinion. An Introduction to Health Sociology. 5th ed. Oxford University Press, Melbourne.
Ham, C. Dixon, A. Brooke B. (2012) Transforming the delivery of health and social care. The case for fundamental change. Kings Fund, London.
Laing, R.D. (1971) The Politics of the Family and Other Essays. Tavistock Publications, London.
Maslow, A.H. (2012) A Theory of Human Motivation. Start Publishing LLC. New York.
National Health Service (2013) The NHS Belongs to the People: A Call for Action. NHS, London.
National Health Service (2014) Five Year Forward View. NHS, London.
Office for National Statistics (2013) ‘What does the 2011 Census tell us about Older People?’, Office for National Statistics, London.
Rowe, R. (2003) The roles of the lay member in primary care groups and trusts: do they enhance public accountability? Dissertation Abstracts International: A – The Humanities and Social Sciences, University of Bristol.
World Health Organisation (2006) Constitution of the World Health Organisation.