Personal paper: medicine in the 1990s needs a team approach

Abstract

SummaryHealth care increasingly emphasises the team approach in which doctors, nurses, and other health workers adapt and develop new skills. Before changes of this kind are widely accepted, however, there must be clarity about the training, status, authority, working relationships, career structure, and remuneration of those who undertake responsibilities well beyond their traditional roles.

Working with glaucoma patients ‐ prospects for "shared care"

“…The current study design could not reveal this, but one could assume that the high satisfaction scores indicate that in most cases there were no inter-professional tensions between the nurses in the study group and their co-workers, except for one clinic where the nurses felt that their work content had been changed. The benefits for the patients of greater cooperation between nurses and physicians are currently being discussed (Casey & Smith 1997, English 1997.…”

“…The safety and efficacy of this approach is currently being evaluated (Hitchings 1995). In many parts of medicine, work historically done by physicians is now taken on by nurses (English 1997). In the care of hypertensive patients it has been known for some time that a more active role of nurses leads to positive results in blood pressure control and patient compliance (Ramsay et al 1982;Lindblom 1984;Stillwell et al 1987).…”

Changing Territories of Health Care Professionals in Primary Care

“…ing from the "team model" [33], or the "clinical nurse leader" [34], to the "advance practice nursing model" [35]. Some questioned the wisdom of shedding menial and routine activities to lower skilled workers [36].…”

“…They consider NPs as core professionals in primary care that can, and should, take a more prominent position in coordinating care and leading teams of experts [33]. Ultimately, NPs face the same financial dilemma as other specialized nurses: the more successful they become in gaining professional independence and higher incomes, the less attractive they may become as substitute for physicians.…”

The role of the nurse in the management of COPD and asthma

“…Yet it is acknowledged that prior to the acceptance of a new role, and the development of new skills, there must be clarity about the nature of training and preparation required. 2 As an absolute minimum nurses should attend an assessed asthma and COPD workshop which ensures that they are competent to maintain a practice register, that they are familiar with techniques such as peak flow and inhaler technique. If they are to be competent when performing investigations such as spirometry and reversibility tests, and are cognisant of issues such as communication and smoking cessation strategies then more advanced study is required (diploma level study).…”