Advanced Eye Centre Ward PGIMER, Chandigarh, India
Received: 17 February, 2023, Manuscript No. jnhs-23-89612; Editor Assigned: 18 February, 2023, Pre QC No. P-89612; Reviewed: 02 March, 2023, QC No. Q-89612; Revised: 07 March, 2023, Manuscript No. R-89612; Published: 14 March, 2023, DOI: 10.4172/JNHS.2023.9.2.67
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In this review, the author outlines some important health issues in the current global health environment and highlights the nurses' potential for overcoming the perceived challenges and achieving global health. Several shreds of evidence suggest the development of nursing through continuous investment is praiseworthy and promotes affordable and accessible healthcare to the public. Bringing nurses from the backbone to the front bone of healthcare services is the need of the hour in addition to leveraging their clinical capacities, advocacy skills, and talents to lead the healthcare system at all levels. Wide medical knowledge and unique bedside skill of nurses make them superior to other biomedical researchers. Transforming nurses as the leader of the healthcare delivery system could be a better alternative to attaining universal health coverage earlier than the current momentum.
Behavioural science, Global health, Opthalmology, Occuloplasty, Medical pharmacology
Nurses are the pillar of health care architecture and their transformation from ward to the world is essential for strengthening global health. Global health is a multifaceted concept that involves the health of the planet with the support of all countries [1]. The individual countries needed to revamp the existing health care delivery system to attain global health by augmenting the investment in health infrastructure and manpower development [2]. A combined report of World Bank and World Health Organisation (WHO), narrates that half of the world population still does not have access to essential healthcare services and 100 million people tripped into extreme poverty because of health expenditure [3]. Limited availability of doctors in rural areas, and non-affordability of treatment cost makes the situation worse in low to middle-income countries [4]. The scenario is not different for developed countries even with an adequate supply of doctors and health infrastructure. Beause the world has seen the pitfall of developed countries in the management of COVID-19 pandemic and resulted in increased mortality ratesamong devoleped countries including United States [5]. Coming to developing countries, the burden due to non communicable disease are so high that it double the burden of infective diseases. So deliberate strategies needed to refurbish the existing healthcare delivery system to encounter the threat of coomunicable diseases and non-communicable diseases.
According to WHO, the existing pattern of healthcare delivery system need to be modified to achieve global health coverage and sustainable development goal by 2030 [6]. Presently, coutries are following the dogma of doctor centred health care delivery system. Nurses who account for 50% of manpower in the health care system can be considered as an alternative to doctor centred health care delivery system. The Lancet Commission on the Education of Health Professionals recommends to train nurses as "change agents" to meet the fluctuating epidemiological trends. Nurses have been played a leading role in improving global health during the last decades [7]. During the COVID-19 pandemic, the world has seen competency of nurses as a centre of early detection, triaging, holistic care and health promotion of COVID patients [8]. Further reinforcement in nursing will have a triple impact of health promotion, gender equality and supporting fiscal growth [9]. Additionally, nurses have sound medical knowledge, leadership quality, risk-taking habits and empathy towards patients. The potential of the investment in nursing for achieving universal health coverage and sustainable development goals in the current global health environment needs to be explored.
We searched by using the MeSH terms Nurse, Nursing, global health, and Public health in the following database PubMed, Embase, Google Scholar and in the report of national health surveys. No restriction was used. Then focused searches are carried out by using keywords including capability, risk takers, leadership, lifestyle diseases, nurse practitioners, investment and nursing research. The results are illustrated as an answer to the question that the potential of investment in nursing for achieving global health in the current global health environment.
The Capability of Nurses
Nurses are multi-subjected and multi-talented. A graduate nurse studies almost 21 subjects to hold the degree. The wide basic knowledge of medical and behavioural science makes her fit for any situation and speciality. Understanding the own potential and self-investment not limited to the nursing speciality is also required to reach the global platform.
Owing to competency, the best method to understand the competency of healthcare professionals is the assessment of their response during an outbreak of contagious diseases. . If we look at the number of nurses vs other healthcare professionals who got COVID-19 infection, in the early phase of the COVID-19 pandemic, the worldwide infection rate among nurses was 38.6% while it was among other healthcare workers was 61.2% including doctors(31.3%) [10]. Remember nurses account for 50% of the healthcare workforce globally and are frontline workers during the pandemic and have round-clock contact with patients, however, their infection rate is low compared to their workforce density. Another study in Kerala in a tertiary care centre reported that the infection rate among nurses was 19.5% and among other health care workers was 80.9% including doctors (33%) [11]. This low prevalence of COVID infection among nurses compared to other HCWs indicates nurses' competency and their adherence to infection prevention practice. A novel task-shifting study conducted at Andhra Pradhesh for the decentralisation of HIV/ AIDS care demonstrated that 80% of nurses rated as excellent in performing their assigned duties [12]. Another landmark study in South Africa illustrate that nurse-led HIV-TB clinics are being managed as efficient to doctor-led clinic Furthermore, If we look at the nurse's commitment towards national health programmes, a study by Ajay et al reported that nurses(65%) reported medical device adverse event more frequently than doctors(30%) to materiovigilance programme of India [13].
Nurses are Risk Takers
Nurses are successful risk-takers. Historically, the world has admired the work of Florence Nightingale during the Crimean war and she was the first woman to be awarded the Order of Merit. Presently her followers are known as the frontline warriors in the healthcare delivery system. The world has seen the value and sincerity of nurses during the unprecedented COVID-19 pandemic. Nurses worked round the clock even though there is a short supply of personnel protective equipment and supportive logistics. It is the nurses who frequently identify the true source of a problem, maintain a wide range of professional relationships, ask questions, review the available data, actively seek both supporting and opposing arguments, and look for expertise and experience among not only the experts in the field but also other professionals [14].
Leadership Qualities
Nurses are the best choice to lead today's dynamic and demanding healthcare environment. Studies have demonstrated the positive impact of nurse managers' leadership styles on delivering quality patient care [15]. As soon as a nurse joins the service, she has to deal with the problems of patients. She has to hear the complaints of the patients and relatives tolerantly, and have to process the information with her medical knowledge and need to give wise answers accordingly. Mostly patients or doctors sublimate their anger to nurses. Although the problems might not be due to the nurse's mistake, she has to manage such situations logically without losing her self-control. From the role of a team member to a team leader, nurses have developed their leadership quality through their continuous exposure to problems and by responding empathically towards it. Every word and action of nurses will be embedded with empathy which is the hallmark of the nursing profession. This is the biggest advantage of the nurse leaders compared to leaders from other professional cadres. Nurses coordinate patient-centric activities with other departments and ensure the prompt treatment of the patient. This develops their coordination and communication skills. So the leadership quality of nurses moulded over time and the search for a leader with empathy ends at nursing counters.
Fidelity of Nurses
Analysing the reliability of the investment sector is essential for the success of a business. Concerning the fidelity of the nursing profession, it is ranked as the most trustworthy profession continuously for 20 years according to the survey conducted in the USA. The nurses maintain their ethics and honesty percentage far ahead (81%) of doctors(67%) and pharmacist(61%) [16].
Nurses as Lifestyle Disease Modifiers
Today, lifestyle diseases are a major public health threat globally and cause an economic burden to patients and nations as well. World Health Organization (WHO) estimated that 74% per cent of all deaths, 41 million and 56% of the global burden of disease were due to lifestyle diseases. In low- and middle-income countries 86% of premature deaths are caused by lifestyle diseases. Smoking, physical inactivity, overuse of alcohol and unhealthy diets all increase the risk of dying from lifestyle diseases. Early detection, screening, treatment and palliative care are key strategies to prevent lifestyle disease. Nurses, as the point of primary contact, can detect, treat and refer patients with lifestyle diseases and can spread awareness on the prevention of lifestyle diseases. A randomised trial by Firall et al reported that primary care nurses' capacity to manage lifestyle diseases was feasible and safe [17]. Another study by Nikalus et al documented that task shifting from physicians to nurses for the management of hyper tension and diabetes in rural Cameroon reduced the treatment cost and showed promising hypertension and diabetes trends. The patient's systolic BP decreased by 22.8 mmHg (95% CI: -20.6 to -24.9; p < 0.0001) and diastolic BP by 12.4 mmHg (-10.9 to -13.9; p < 0.0001) and fasting blood sugar decreased by 3.4 mmol/l (-2.3 to -4.5; p < 0.001) [18]. A retrospective study done by Keti's et al reported that patients counselled by nurse practitioners had a significant reduction in blood pressure and serum cholesterol level and performed exercises significantly more often than patients counselled by family doctors [19]. Another systemic review suggested that the stroke-specific rehabilitation skills of nurses' contributed to improving outcomes for stroke survivors [20]. Hence the investment in nursing has a promising effect on the prevention and management of non-communicable diseases in the account of feasibility and cost-effective management.
Nurse Practitioners Provides Cost-Effective and Quality Healthcare
To accomplish universal health coverage, health programmes need to target on providing quality health services to economically weaker people, women, children, and people living in villages. However, the existing century-old doctor-centred healthcare delivery system failed to provide universal health coverage, especially healthcare to a deprived part of society [3]. Leveraging nurse practitioner capacities might fill this gap [21]. Numerous studies have shown that nurse-led primary health care could provide quality and affordable care to people that equal or even better care compared to primary care doctors, and achieved equal or better outcomes [22-24]. Nurses undoubtedly achieved higher levels of patient satisfaction, compared to primary care doctors. Furthermore, the frequency of attended patient return visits is slightly higher for nurses, compared to doctors [25].
Nurse Researchers have Unique Bedside Experiences
Generally, clinical research is assisted or conducted by graduates from biomedical or pharmacology backgrounds. However, their inability to think from the patient's perspective due to lack of bedside experience is challenging. Their focus might be limited to data generation referring to the patient as a sample. But a nurse researcher considers the patient as a whole unit because of the unique bedside training she received and considers patients' emotional feelings in addition to data generation.
Value for Investment in Nursing
According to WHO, Investment in nurses is good value for money [7]. The report by Health Employment and Economic Growth of the United Nations (UN) forecasted investments in the health and social sectors to result in a triple return of improved health outcomes and economic growth. Investment in nursing also empowers women's because 70% of the health workforce are women compared to 41% in all other occupation sectors. Since nursing occupations represent a substantial share of females, investment in this profession provides scope for sustainable family and social development [9]. Investment in nursing contributes to alleviating poverty in addition to improvements in health. As the poverty rate of the southern Kerala district was adjudged as "zero" according to NITI Aayog Multi-dimensional Poverty Index (MPI). Despite any industrial establishment, this district attained zero poverty status because of the presence of the highest number of nurses and their migration [26]. Further overall Kerala is the larger exporter of nurses among Indian states. So poverty-deprived countries or states can think about empowering women by providing nursing education. It will secure the health as well as the economy of a family and finally of society.
Global Nurses Requirement
Although nurses account for 50% of global health care, there is a global shortage of nurses, especially in countries including Africa and South East Asia. WHO on 2022 march estimates that an additional 9 million nurses are required for accomplishing the Sustainable Development Goal by the year 2030. This means we need to graduate more than 10 lakh nurses annually. However, countries including India which is known as the largest exporter of nursing professionals only create around 60,000 nurses annually. Nevertheless, this is not enough to meet even the domestic requirements. Further, the outbreak of communicable diseases like COVID-19 increases the nurse's demand. So the demand for nurses commonly surplus the supply.
Today, improved health outcomes and the value of human capital is increasingly recognized from an economic perspective. Spending on health is an investment which strengthens the quality of life, happiness and prosperity. In this new era, investment in nursing is economical and offers excellent long-term potential in terms of family and society development. It is time to capitalize in nursing to bring them from the backbone to the frontbone of the healthcare delivery system for ensuring accessible and affordable global health coverage and sustainable development goal. Transforming nurses as the centre of the healthcare delivery system could be a better alternative for low to middle-income countries to attain their universal health coverage decades earlier than the current momentum.
Overview of Investment Areas in Nursing from Published Research and with Authors' Input
• Thinking out of the box- To date majority of graduate nurses' postgraduate dreams are limited to a master's in a nursing speciality. However, a graduate nurse is eligible to pursue post-graduation in Medical pharmacology, Medical anatomy, Medical Physiology, Clinical Nutrition, Clinical research, Hospital administration & Public health etc. This diversification increases nurses' acceptability across all streams of medicine.
• Invest exclusively to increase the quality and impact of research conducted by nurses so that the members of other medical fraternity build confidence on nurse researchers and approach nurses to carry out their studies.
• Collaborate with research conducted by other specialities of medicine
• Publish impactful systemic reviews and meta-analysis and meta-regression studies.
• Learn more about the global health agenda and sustainable development goals
• Get involved in global health issues, not in the role of angel, but in the role of team leader.
• Associate with premier management institute for developing leadership skills.
• Unwind the perceived thought of working under a medical doctor to working as a team leader at a similar capacity or higher level than a medical doctor.
• A graduate nurse does not limit his/her capabilities as a provider of basic nursing service which can be done by an ANM.
• Advocate, initiate, and document nursing’s role in policy-making.
• More investment is needed to develop a "speciality in speciality" similar to medical speciality. Eg: Opthalmology in medical speciality further divided into specialisation in Lens, Cornea, retina, Occuloplasty etc. This type of smart diversification will increase the job opportunity of nurses and increase the quality of care delivered to patients.
• Increase the number of nursing schools in low to middle-income countries in order to the health needs of their own country in addition to developed countries which will increase the monetary flow.
• Share ideas and achievements of nurses through discussions, publications, conferences, social media and the Internet.
• Support the revolutionary thought by new nursing graduates and promote nurse entrepreneurs.
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