Volume 43 Number 3
The value of nursing
Laurent O Chabal, Denise Hibbert
For referencing Chabal LO and Hibbert D. The value of nursing. WCET® Journal 2023;43(3):8-9.
Never doubt that a small group of thoughtful, committed people can change the world; indeed it is the only thing that ever has – Margaret Mead1.
Florence Nightingale’s work in the 1850s demonstrated how important nurses are within the healthcare system – not only dealing with the prevention, control and management of conditions for patients, but also in terms of anticipating, planning and leading initiatives, and in advocacy and empowering others. She implemented actions that are still relevant today and planted the seeds of evidence-based nursing care, advanced practice, and the science of nursing.
Today, more than 170 years later, nurses’ working conditions are still challenging across the world. More than ever before, nurses and nursing are facing common challenges that affect the ethos of nursing, particularly the ability to attract and retain nurses as a lifelong career option. Nursing shortages, a high staff turnover within healthcare organisations, challenging workload and conditions, job-related stress, as well as mental health and sleep disorders, have a huge impact on the quality and continuity of care; this in turn has economic implications for organisations and impacts the sustainability of the nursing profession.
Not only do we need to have more trained nurses, but we need to retain them in clinical practice, and that comes with better recognition. As essential workers, nurses were applauded at the beginning of the COVID-19 pandemic for the sacrifices and the crucial work that was undertaken – these were the faces of Time’s ‘Person of the Year’ front page. We are still those essential workers, and nurses should be key partners in decision making within all levels of the healthcare system.
Recent changes include the introduction of specialised fields of nursing and nurse specialists or nurse practitioners; however, there is limited global consistency. Through legislative or regulatory processes, many countries have enabled specialist nurses to be able to assess and prescribe diagnostic or clinical care under their respective countries’ guiding protocols; some countries even allow privileges to provide first line medical management. In many countries, nurses perform clinical care under the direction of the treating doctor or physician.
It is therefore puzzling that after all these years, we do not have agreement on an international standardised nursing degree, and in some countries not even at a national level. This would seem important when around the world we are seeing increased instances of chronic multifactorial diseases, poly medication, ageing populations, and complex patients requiring an advanced structure of care inclusive of interprofessional practice.
It is even more puzzling to see how the ability to select or prescribe wound dressings, ostomy appliances and associated products is so limited in many countries, especially when specialist nurses are more likely to have the knowledge and expertise to understand indications, contraindications and application of these various products, particularly when to (re)assess, to discontinue, or to refer to another specialised healthcare professional for advice.
As specialist enterostomal therapists (ET), wound ostomy continence (WOC) nurses, we are more costly and, on the surface, do not appear to bring enough financial benefit to health services. However, the reality is that there are hidden savings that need to be taken into consideration, such as patient benefits and improved health outcomes. Almost all studies looking at the benefits of ET, WOC and stoma nursing demonstrate enhancements in care and/or health outcomes in one way or another.
It is beneficial to make specialised nurses such as wound ostomy continence nurses more visible by promoting their roles, functions, skills and resultant clinical outcomes, thereby increasing awareness worldwide of the value of these roles. This is especially so when healthcare organisations suffer increasing economic and budgetary constraints, and when better care should come before profit. We know that successful interprofessional coordination, collaboration and communication are rewards for our abilities. Further, valuing the patient as an expert of their condition and experience are also crucial factors for successful outcomes.
The International Council of Nurses (ICN) Congress, held in Montreal in July 2023, was an opportunity to meet nurses from all over the world and to share and feel the real diversity of our nursing profession. There is still work to be done in gaining recognition for the nursing profession overall and within our respective specialty fields. Such recognition would enable us to claim the value of our care, including the cost benefits we generate by screening, initiating preventative actions, managing complications and minimising recurrent presentations. To gain our rightful place in the interprofessional team with our own skills and knowledge, not as a threat but as a capital gain for better patient outcomes, is a common goal and key component to more efficient healthcare organisations and health systems globally.
Being a part of this congress has also been an opportunity to let the worldwide community of nurses learn about us, not only as ET/ WOC/ stoma nurses / clinicians but also as an organisation (the WCET®). This was achieved in different ways – through ePoster presentations, our presence at the WCET®/ Nurses Specialised in Wound Ostomy and Continence Canada (NSWOCC) booth, and with discussions with participants.
The WCET® also supports the Wound Ostomy Continence Nurses (WOCN®) Society’s initiative of endeavouring to quantify the impact of WOC nursing and provide valuable justification for WOC nursing positions via their Value of a WOC nurse quality improvement project2. We look forward learning more about the outcomes and benefits of this study and hope our own WCET® initiatives on this topic come to fruition.
The last WCET® Norma N. Gill webinar was also really inspiring regarding valuable leadership skills and lessons learnt from our founder (Norma N Gill), our pioneers and mentors – many thanks to Dr Kathleen Leask Capitulo for her inspiring talk. We hope you had a chance to connect, learn and be inspired for your own daily practice.
When speaking of the value of nursing, we must mention the outstanding work of Dr Barbara J Braden and her team on pressure injury screening and prevention that is acclaimed worldwide. We are still mourning her recent passing and will keep her in our thoughts and hearts. All our prayers go to her family, relatives, friends and colleagues. She will be much missed by us all; may she rest in peace. Dr Braden was exemplary proof on how nurses can make a positive difference internationally in every healthcare setting. The Braden Scale for Preventing Pressure Sore Risk had a significant and positive impact on the necessity for early screening, as well as the identification and mitigation of risk factors for pressure injuries, through a coordinated evidence-based plan of care. Please refer to our WCET® BullETin 2021;18(3) and 2023;20(2) for tributes to Barbara and her outstanding legacy.
As we prepare for an update of the WCET® International Ostomy Guideline 2020, we thank Hollister® for their ongoing support on this important project. Also many thanks to Dr Emily Haesler for agreeing to join the group as methodologist; we are sure her contribution will be an asset to bring this new edition to another level. As with previous editions, you might be invited to contribute your expertise as a stakeholder or reviewer. Your support will be greatly appreciated.
We also take this opportunity to warmly thank Prilli Stevens, WCET® President 1980–1984, the first WCET® President to also be a professional nurse and a WCET® life member, for allowing us to republish the posters she developed and published in 2012 as historical documents. WCET® members will be able to download these posters for free as memorabilia from our online store. The WCET® Education Committee will work on reviewing and updating some of them as needed and/or create new ones based on recent evidence, so stay tuned.
When looking back on our achievements in relation to our last biennial and annual reports, and knowing that the Executive Board (EB) have not had a chance to meet all together in person since 2019 with differing time zones spanning 12 hours across the world, we could not be prouder of the team and its supporters. As a dynamic ever-changing organisation, a new phase of transition for the EB has now started, allowing the incoming new EB members to be mentored by the sitting EB members. When the time comes, the new EB will be ready and empowered to continue the good work and help move us forward.
The low results of the membership survey have been analysed and compared to previous surveys for relevance. As previously mentioned, they will be used to assess the success of the 2019–2023 Strategic Plan, and to discuss and agree on the 2023–2027 Plan. Once again, many thanks for all of you who replied; your comments are valued. An article about the highlights of the survey will be published in the WCET® Journal and, for the first time ever, before our next biennial congress, so stay tuned to read more about this.
Thanks again for all you do daily for your patients, your community and beyond. To quote Donna Wilk Cardillo, “Nurses are the heart of healthcare”3. So be proud, be fierce, be yourself. You are heroes.
Sincerely
Laurent & Denise
护理的价值
Laurent O Chabal, Denise Hibbert
永远不要怀疑一小部分坚定的人能够改变世界；实际上，世界一向是由这些人所改变的。Å\Å\玛格丽特·米徳1。
弗罗伦斯 南丁格尔在19世纪50年代的成就与贡献证明了护士在医疗保健系统中的重要性，护士不仅负责处理患者的疾病预防、控制和管理，并且在预见、计划和领导举措方面，以及在倡导和赋予他人权力方面发挥作用。她采取的行动对当今世界产生了深远影响，并播下了循证护理、高级实践和护理科学的种子。
如今，170多年过去后，全世界护士的工作条件仍极具挑战性。与以往任何时候相比，护士和护理人员均面临着更为严峻的、会影响护理学理念的共同挑战，特别是吸引和留住护士并使之成为其终身职业选择的能力。护士短缺、医疗保健机构内的高员工流动率、极具挑战性的工作负荷和工作条件、工作相关压力以及心理健康和睡眠障碍对护理质量和连续性产生了巨大影响；进而对机构产生经济影响，并影响护理专业的可持续性。
我们不仅需要更多受过培训的护士，还需要在临床实践中留住他们，这需要提高他们的职业认可度。作为关键工作者，护士在COVID-19大流行开始时因其做出的牺牲和开展的至关重要的工作而受到赞扬；此外，《时代》周刊“年度风云人物”头版中也出现了他们的面孔。我们仍然是关键工作者，并且护士应该成为参与医疗保健系统中各级决策的关键合作伙伴。
最新变化包括引入护理和专科护士或执业护士专业领域；然而，全球一致性有限。通过立法或监管过程，许多国家使专科护士能够根据相应国家的指导方案评估和开具诊断或临床护理处方；一些国家甚至允许护士享受特殊待遇，以提供一线医学管理。在许多国家，护士在主治医生或医师的指导下开展临床护理。
因此，令人费解的是，这么多年后，我们仍未就国际标准化护理学学位达成一致，一些国家甚至未在全国范围内达成一致。当我们看到世界各地慢性多因素疾病、多重用药、老龄化人群和需要高级护理结构（包括跨专业实践在内）的复杂患者的实例増加时，实现上述目标就变得十分重要。
更令人费解的是，在许多国家，选择或开具伤口敷料、造口器械和相关产品处方的能力严重受限，在专科护士可能更了解各类产品的适应症、禁忌和使用相关信息和专业知识的情况下，以及当（重新）评估、停药或转诊至另一名医疗保健专业人员以寻求建议时尤是如此。
作为专科肠造口治疗师（ET）、伤口造口失禁（WOC）护士，我们的成本更高，并且表面上似乎并未给医疗服务机构带来足够的经济利益。然而，现实情况是，需考虑到隐性的成本节约，如患者获益和改善的健康结局。几乎所有关注ET、WOC和造口护理获益的研究均证实，护理和/或健康结局通过某种方式得到改善。
通过宣传专业护士（如伤口、造口、失禁专科护士）的角色、作用、技能和由此产生的临床结局使其受到更多关注，有利于提高全球对这类角色价值的认识。当医疗保健机构受到越来越多的经济和预算限制，以及当更佳的护理应优先于盈利时，情况尤其如此。我们知道，只有具备足够的能力才能实现成功的跨专业协调、协作和沟通。此外，将患者视为其病情和经验的专家也是实现成功结局的关键因素。
2023年7月在蒙特利尔举行的国际护士理事会（ICN）大会为我们提供了会见世界各地护士的平台，有助于我们分享和感受护理专业中真实存在的多样性。在获得总体和我们各自专业领域内的护理专业认可方面，仍有许多工作有待完成。此类认可将有助于我们强调护理的价值，包括我们通过筛查、启动预防措施、管理并发症和尽量减少症状复发产生的成本效益。以自身具备的技能和知识在跨专业团队中发挥适当的作用，不会造成威胁，而会带来可实现更佳患者结局的资本收益，这是全球更高效的医疗保健机构和卫生系统的共同目标和关键组成部分。
参与本次大会也使我们拥有了与全球护士社区相互交流以増进理解的机会，我们不仅作为ET/WOC/造口护士/临床医生，而且还作为一个组织（WCET®）参与其中。上述目标通过不同方式实现，包括电子海报展示、展示WCET®/加拿大伤口、造口、失禁专业护士（NSWOCC）展台以及与参与者进行讨论。
WCET®还支持伤口、造口、失禁专科护士（WOCN®）学会努力对WOC护理的影响进行量化的倡议，并通过其WOC护士的价值Å\Å\质量改进项目2为WOC护理职位的价值提供依据。我们期待更加深入地了解这项研究的结果和获益，并希望我们关于该主题的WCET®倡议取得丰硕成果。
最后一次WCET® Norma N. Gill网络研讨会也十分鼓舞人心，会中介绍了我们的创始人（Norma N Gill）、先驱和导师的宝贵领导技能以及从他们身上获得的经验教训。在此，特别感谢Kathleen Leask Capitulo博士鼓舞人心的发言。我们希望您有机会进行交流、学习，并为自己的日常实践带来启发。
在谈到护理的价值时，我们不得不提到Barbara J Braden博士及其团队在压力性损伤筛查和预防方面的杰出贡献，他们的工作在世界范围内广受好评。Braden博士于最近与世长辞，我们深感哀悼和惋惜，她将永远留在我们的思想和心中。我们为她的家人、亲属、朋友和同事祈祷，并且对她无比思念，愿她安息。Braden博士以身作则，证明了护士如何在国际上的各种医疗保健环境中发挥积极作用。Braden压疮风险预防量表对早期筛查的必要性以及通过协调循证护理计划识别和缓解压力性损伤风险因素产生了显著的积极影响。Barbara博士的颂词及其杰出贡献请参阅WCET® BullETin 2021;18(3)和2023;20(2)。
随着我们准备对WCET®国际造口指南2020进行更新，我们衷心感谢Hollister®对这一重要项目的持续支持。此外，我们还向Emily Haesler博士致以谢意，感谢她同意作为方法学家加入小组；我们相信，她做出的贡献是使新版本更上一层楼的宝贵财富。与先前的版本一样，可能会邀请您作为利益相关者或审查人提供您的专业知识。我们十分感谢您的支持。
此外，我们还希望借此机会向Prilli Stevens女士（1980至1984年间担任WCET®主席，即首位WCET®主席，也是一名专业护士和WCET®终身会员）致以衷心的谢意，感谢她允许我们转载她在2012年制定和出版的海报作为历史文件。WCET®成员将能够从我们的在线商店中免费下载这些海报留作纪念。WCET®教育委员会将根据需要审查和更新其中一些海报，和/或根据最新证据制作新海报，所以敬请关注。
当回顾我们在最近的两年期报告和年度报告方面取得的成就，以及了解到执行委员会（EB）自2019年来因世界各地不同时区相差12小时而从未有机会亲自会面时，我们为我们的团队及其合作者感到无比自豪。作为一个不断变化的动态组织，EB已开始踏入新的过渡阶段，使即将加入的EB新成员能够接受现任EB成员的指导。届时，将迎来全新的EB，其将充满动力，以继续完成高质量工作，帮助我们不断向前迈进。
对成员调查的较低结果进行了分析，并与先前的调查进行了比较，以确定相关性。如前所述，其将用于评估2019-2023年战略规划是否成功执行，并讨论和商定2023-2027年战略规划。再次感谢您的回复；您的意见对我们非常重要。将在WCET®杂志上发表关于调查要点的论文，这是我们首次在下一次两年期大会之前发布，因此敬请关注以获取更多相关内容。
再次感谢您每天为您的患者、您的社区以及您在其他方面所做的一切。正如Donna Wilk Cardillo所述，“护士是医疗保健的核心力量”3。因此，为自己感到骄傲，勇敢无畏，活出自我。你就是英雄。
此致
Laurent和Denise
Author(s)
Laurent O Chabal
BSc (CBP) RN OncPall (Cert) Dip (WH) ET EAWT
WCET® President 2022–2026
Denise Hibbert
MSc-WHTR RGN BSc DipHE ONC STN FSSCRS
WCET® President-Elect 2022–2026
References
- https://www.managementisajourney.com/
- WOCN®. The value of a WOC nurse; 2023. Available from: https://www.wocn.org/the-value-of-a-woc-nurse/
- https://www.qcs.co.uk/nurses-heart-healthcare
