Continuity of Care Challenges for Professional Nursing Practice





	
   
  






Editorial


Continuity of Care Challenges for Professional Nursing Practice


Desafíos en la continuidad de cuidados para la práctica profesional de enfermería


Desafios na continuidade de cuidados para a prática profissional de enfermagem






 






10.5294/aqui.2022.22.1.1





Cristina García-Vivar1

Nelia Soto-Ruiz2

Paula Escalada-Hernández3

Marta Ferraz-Torres4

Maria Rosario Orzanco-Garralda5

Leticia San Martín-Rodríguez6



1  0000-0002-6022-559X Health Sciences Department,
  Universidad Pública de Navarra (UPNA), Spain; Instituto de Investigación Sanitaria de
  Navarra (IdiSNA), Spain. cristina.garciavivar@unavarra.es


2  0000-0002-5161-2272 Health Sciences Department, Universidad Pública de Navarra (UPNA), Spain; Instituto de Investigación Sanitaria de
  Navarra (IdiSNA), Spain. nelia.soto@unavarra.es


3  0000-0003-2263-156X Health Sciences Department, Universidad Pública de Navarra (UPNA), Spain; Instituto de Investigación Sanitaria de
  Navarra (IdiSNA), Spain. paula.escalada@unavarra.es


4   0000-0002-7740-2572 Health Sciences Department,
  Universidad Pública de Navarra (UPNA), Spain;
  Hospital Universitario de Navarra, Spain. marta.ferraz@unavarra.es


5   0000-0003-0283-5741 Health Sciences Department,
  Universidad Pública de Navarra (UPNA), Spain; Navarra Primary Care Service, Centro de Salud Burlada, Spain. mrosario.orzanco@unavarra.es


6  0000-0002-9097-7493 Health Sciences Department,
  Universidad Pública de Navarra (UPNA); Instituto de Investigación Sanitaria de
  Navarra (IdiSNA), Spain. leticia.sanmartin@unavarra.es




Keywords (Source DeCS): Nursing care; leadership; innovation; nursing shared governance; nurses role.


Palabras clave (Fuente DeCS): Cuidados de enfermería; liderazgo; innovación; gobernanza compartida en enfermería; perfil de
  competencias de los profesionales de enfermería.


Palavras-chave (Fonte DeCS): Cuidados de enfermagem; liderança; inovação; governança compartilhada de enfermagem; papel do profissional de enfermagem.




To reference this editorial / Para citar
  este editorial / Para citar este editorial: García-Vivar C, Soto-Ruiz N, Escalada-Hernández P, Ferraz-Torres M, Orzanco-Garralda MR, San
  Martín-Rodríguez L. Continuity of Care Challenges for Professional Nursing Practice. Aquichan. 2022;22(1):e2211.
  DOI: https://doi.org/10.5294/aqui.2022.22.1.1




  


In recent
  decades, health systems have faced the need to transform their vertical
  structure, conceived under the paradigm of fragmentation between various
  departments and different care levels, into a more horizontal structure in
  which healthcare organization is more consistent with the natural transfer of a
  patient between care levels and services or departments and caters to the needs
  of users. Mainly, continuity of care constitutes one of the mainstays on
  which care programs for chronic and multi-pathological patients are based. This
  type of patient has complex needs that require long-term care and specific
  guidelines to deal with the multiple transitions between care levels (1).


The
  transformation of health services has developed and implemented new functional
  and care areas, such as home hospitalization units or chronic or
  multi-pathological patient care units, to respond to the growing health demand
  of chronic processes. These new resources are vital to promoting continuity of
  chronic care and show positive results at multiple levels, such as fewer rehospitalizations (2). Besides, new nursing
  profiles, such as case management nurses or liaison nurses, and many other
  nursing initiatives and innovations are emerging to foster continuity of
  healthcare, avoid care fragmentation, obtain positive effects on the quality of
  care for chronic patients, and reduce hospital readmissions (3).

  
In this
  global commitment to attach further importance to continuity of care
  —understood as care coherent, connected, and consistent with the needs of the
  patient and their family—, there should be a strategic design that considers
  the three dimensions of continuity of care and maintains a hierarchical
  relationship between them, each being fundamental for the operation of the
  others (4). The relational
  dimension refers to
  the interaction between professionals and patients and their families over
  time; the
  informational dimension means
  the use and transmission of information, and the managerial dimension is related to the coordination
  between professionals and services. Thus, several challenges are associated
  with these three dimensions of continuity of care for nurses' professional
  practice, as addressed below.

  
Effective communication
  and collaboration among healthcare professionals are critical to appropriate
  continuity of care. One of the challenges for nurses, related to the relational
  dimension of continuity of care, is establishing collaborative relationships
  between the health professionals who care for the patient in multiple clinical
  contexts (5). Displaying leadership and trust is essential to make
  the rest of the professionals understand nurses' skills in continuity of care
  while recognizing and respecting the functions of other health workers. Another
  fundamental aspect of collaboration is shared access to complete patient
  information, which includes querying the patient's various electronic records
  and transmitting information in a systematic and structured manner when
  transferring the patient to other care levels.

  
The
  emergence of new professional profiles, such as the liaison nurse or case manager, facilitates the relationship of the
  patient and their family with health professionals. Thus, the therapeutic relationship
  must be established with the same person (liaison nurse or case manager) to
  build trust. In turn, professionals may gain more detailed patient knowledge to
  favor comprehensive care by meeting individual needs. The transmission of
  information and communication with the patient and their family will benefit
  from the bond forged between them.

  
Without a
  doubt, the digital transformation of health organizations is one of the tough
  challenges. It is about incorporating technological innovations —such as wearables or smart clothing to control and
  quickly obtain body data from the patient at home— and managing a change in
  guaranteeing adequate data reception, registration, use, security, and
  protection.

  
Furthermore,
  the COVID-19 pandemic accelerated our understanding of the potential technology
  for continuity of care. Indeed, the use of information and communication
  technologies (ICT) in health, known as e-health, to meet the needs of patients,
  families, communities, and health professionals is already a reality. Under the
  concept of "mobile health" or m-health, mobile devices —widely used
  in the worst moments of the pandemic— encourage communication among
  professionals and with the patient and their family.

  
Regarding
  ICT implementation in the health field, we cannot ignore the enormous challenge
  of educating and training nurses and other health professionals in innovation
  and ICT (6). Similarly, patients and families must be educated to
  maximize the potential for efficient health systems. Greater empowerment of the
  patient and their family stimulates participation in decision-making and,
  undoubtedly, optimizes the transmission of information between them, resulting
  in better management of the disease. The development of nurses' teaching skills
  is essential for adequate health literacy, identifying the degree of acceptance
  of these technologies by patients and families and their concerns about the use
  of applications, and offering strategies to improve access to ICT, especially
  by the most vulnerable groups.

  
Nurses,
  particularly those in formal leadership positions in organizations, play a
  crucial role in managing health services and the care provided. Nurse managers collaborate with
  other professionals and other knowledge domains and care levels. Thus, transformational
  nursing leadership is always sought to uphold positive work environments and
  the well-being of individuals.

  
In this
  context of nursing leadership, the advanced practice nurse (APN) has appeared
  to a greater or lesser extent in numerous countries. This nurse has expert
  knowledge, leadership, complex decision-making skills, and advanced clinical
  abilities to improve nursing practice (7, 8). Although these new professional
  profiles and roles are demonstrating high efficiency in user satisfaction and
  managing the demand and needs of patients with chronic diseases, it is
  complicated to implement and adapt current clinical management and coordination
  structures, such as the recognition and delimitation of responsibilities and an
  appropriate academic and economic as­sessment of APNs. Therefore, this
  situation constitutes a significant challenge for nurse managers.

  
Finally,
  the COVID-19 pandemic has entailed the redesign of care management processes:
  defining new guidelines for action, redistributing staffing and staff rotation
  to care for COVID-19 patients without neglecting the rest of patients,
  promoting nurse training in record time for patient safety, and adapting
  nurses' work dynamics to respond to new health circumstances. Indisputably,
  this experience has been a worldwide pilot of creative, committed, and even
  resilient management in which nurse managers have become a cornerstone. Now it
  is time to recover and re-adapt to serve the increasing volume of patients with
  acute and chronic diseases due to the deficit of care and tackle the impact of
  a lack of physical activity in elderly, frail, or disabled people because of
  lockdown. We have a new challenge that requires implementing innovative
  organizational strategies that respond effectively and efficiently to the
  current healthcare context.

  
Continuity
  of care is critical in caring for individuals and families with complex health
  needs who require professional care over time. The
  digital transformation of health organizations supports a more continuous and
  closer relationship between the professional and the patients and their
  families, the better transmission of information, and the improved coordination
  between medical attention and nursing care. Thus, as usual, every challenge
  becomes an opportunity.

  
Nursing
  research is fundamental for the profession and necessary to promote innovative
  quality care and influence health policies. So, the inno-CARE research group on
  new nursing practices at the Universidad Pública de
  Navarra (Spain) is working to improve continuity of care, both from nursing
  innovation and new technologies and from knowledge generation, to develop new
  care models centered on the patient with complex chronic diseases and their family.
  We understand that translational research not only requires collaboration
  between diverse nursing profiles (care nurses, researchers, and managers) and
  between different health workers but also transformational leadership to
  produce a change in the health system, currently oriented to professionals,
  toward a user-centered care
  system, focused on
  the patient and their family at different healthcare levels. Unquestionably,
  this is a tremendous challenge for nurses across the globe.




  


References


1. Kianfar S, Carayon P, Hundt AS, Hoonakker P. Care coordination for chronically ill
  patients: Identifying coordination activities and interdependencies. Appl Ergon. 2019;80:9-16. DOI: https://doi.org/10.1016/j.apergo.2019.05.002


2.
  Yang F, Xiong ZF, Yang C, Li L, Qiao G, Wang Y, et al. Continuity of care to prevent readmissions for patients with chronic
  obstructive pulmonary disease: a systematic review and meta-analysis. COPD. 2017; 14(2):251-261. DOI: https://doi.org/10.1080/15412555.2016.1256384


3. Facchinetti G, D'Angelo D, Piredda M, Petitti T, Matarese M, Oliveti A, et al. Continuity of care
  interventions for preventing hospital readmission of older people with chronic
  diseases: A meta-analysis. Int J Nurs Stud. 2020; 101 :103396. DOI: https://doi.org/10.1016/j.ijnurstu.2019.103396


4.
  Bahr SJ, Weiss ME. Clarifying model for continuity of care: A
  concept analysis. Int J Nurs Pract. 2019;5(2):e12704.
  DOI: https://doi.org/10.1111/ijn.12704

  
5.
  Östman M, Bàck-Pettersson S, Sundler AJ, Sandvik AH. Nurses' experiences of continuity of
  care for patients with heart failure: A thematic analysis. J Clin Nurs. 2021;30(1-2):276-286. DOI: https://doi.org/10.1111/jocn.15547


6. Escalada-Hernández P, Soto Ruiz N, San
  Martín-Rodríguez L. Design and evaluation of a prototype of augmented reality
  applied to medical devices. Int J Med Inform. 2019;128:87-92. DOI: https://doi.org/10.1016/j.ijmedinf.2019.05.004


7. Vivar CG, Pardavila Belio MI, Del Barrio Linares M, Canga Armayor N. Enfermería de práctica avanzada:
  desarrollo de un modelo emergente. Rev Rol Enferm. 2013;36(10):660-666. Disponible en: https://medes.com/publication/85878


8. San Martín-Rodríguez, L. Práctica avanzada en Enfermería y nuevos modelos de organización
  sanitaria. Enf Clin. 2016;26(3):155-157. DOI: https://doi.org/10.1016/j.enfcli.2016.04.007






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