Nurses and healthcare providers

Challenges faced and needs to be addressed

Designing the requirements for services deployed in the healthcare system implies taking up the views and experiences of 6 million nurses in the EU and Europe. Representing the largest occupational group of the healthcare sector and providing the majority of direct care, nurses play a central role in the delivery and quality of care.

They are daily in close contact with patients/clients, working at their bedside/environment and therefore nurses become contextually aware of their needs and demands for care. When shifting some care delivery from a direct to a digital way, making use of ICT solutions, the role of the nurse stays frontline, being in charge of maintaining and empowering the relation between providers and users and facilitating permanent quality and safety at distance.

How SmartCare helps addressing these needs

The effective and efficient use of services when redesigning care systems towards a more integrated approach, necessitate specific requirements to be taken up:

  • System: integrated care refers to a system where the patient treatment and care is made as simple as possible, enabling health and social care provision in a flexible and personalised way (Lloyd, J. and S. Wait. 2006). Therefore, in order to achieve a successful implementation of eHealth services, it is essential to “build” first an integrated system which is effectively working for the providers and users (De Raeve P, 2012). Systematic changes are required to adapt the old system to the new one, establishing specific care pathways, allowing the patient’s “journey” to be mapped and followed at any time by health and social care professionals. The strict demarcation between hospital, community, primary and social care has to be rethought and reconfigured in a way that integration and cooperation benefit patient centred care (De Raeve P, 2011). The result is a coordinated care system, flexible enough to meet the needs of both patients and health/social care professionals. Obstacles preventing patients to move easily from one service to another shall therefore be removed from the reimbursement system (Lambert T, 2013).
  • Support on ICT-solutions’ usability: an integrated care system can work only if the tools used daily by both patients and professionals are “usable” enough and don’t represent an obstacle for the care. Therefore, both patients and health/social care professionals should be involved in the product design since the beginning of the process, in order to put on the market a product that responds already to the users’ necessities, resulting in a higher acceptance of the new service (O’Donnell P, 2011). Additionally, the ICT tools has to be easily accessible from different places (hospitals, communities, homes, etc.), without technology-related problems, such as installation issues or picture/sound quality issues. Specific and clear operating instructions have to be at disposal at any time prior and during its use.
  • Workforce: One of the fundamental pillars to promote high quality healthcare is a highly dedicated and skilled workforce (De Raeve P, 2012). Therefore the system can efficiently work only by foreseeing an adequate and complete health workforce, able to tackle with the new coordinated care and the new eHealth services. As all nurses working at different levels participate in the patient care process, they all need to be aware of the new system’s features. Healthcare assistants, registered nurses, specialist nurses and advance nurse practitioners working in the integrated care system need to have the right understanding of the innovative care processes.
  • Education: There is evidence showing that highly educated nurses have improved efficiency, enhanced patient care and improved health outcomes (Delamaire M. and Lafortune G, 2010; RCN, 2012). Specifically, when dealing with innovative eHealth services, nursing education need to be reviewed and updated accordingly to the skills and eSkills required to enhance professional capacity, able to achieve integrated working. Within the framework of the Modernisation of the Directive 2005/36/EC on the Mutual Recognition of the Professional Qualifications, a specific set of competences for nurses have been established in Article 31, setting the basis for the further design of a competency framework, including communication and eHealth skills. Within an integrated care model using eHealth services, nurses become key in fostering patient care at distance, especially through the capability to be autonomous in the decision-making process, assessing the patient, diagnosing the problem, planning and implementing appropriate treatments and evaluating the health outcomes (Directive 2005/36/EC).  Additionally, in order to keep professionals skills up-to-date with technological advances and new clinical approaches, the access to lifelong learning and Continuous Professional Development (CPD) become essential. Despite CPD systems vary significantly across the EU, in almost all Member States there are formal or informal programmes, aiming at creating the conditions to adapt skills to new healthcare needs.
  • Communication between patient, social and health professionals: in the integrated care model, it is essential that the different actors involved in the care process work together in a coordinated way. Being the delivery of care provided at distance, the communication between nurses, social care workers and patients have to be continuous and effective, meeting up regularly online and face-to-face to discuss the progress made and to identify areas of challenges. This is crucial to monitor the patient’s care journey mapped in the pathway prepared and agreed at the beginning of the process. The system should prevent communication and infrastructures barriers, such as the distance between health facilities or the lack of internet/telephone facilities at the centres.
  • Patient empowerment: within an integrated and patient-health system, patient empowerment becomes a core value and milestone in health system reform. When moving from direct to digitalised care, it is essential to ensure the same level of quality of care, or even to improve it. To achieve this ambitious result, it is crucial to start from the attention given to the patient, who needs to be empowered through education, communication and attention. Only in this way the patient will feel comfortable in the new care system and more involved in the care process as well as in the decisions taken, leading to better satisfaction with the treatment (O’Donnell P, 2011). Additionally, the use of ICT offers the opportunity to support the patient in providing information to better understand the care process and to make informed choices. The patient then will feel more comfortable with the new instruments and services used, resulting in better outcomes.