By Debra Wood, RN, contributor
March 28, 2013 - Noncommunicable diseases kill 60 percent of the world’s people, and nurses and midwives have an opportunity and responsibility to play a critical role in lessening the risk and burden of cardiovascular diseases, cancers, chronic respiratory disease and diabetes, according to a new World Health Organization (WHO) report, co-authored by a UCLA nursing professor.
“We know that in the 21st century, the majority of people are suffering from noncommunicable diseases,” said Linda Sarna, PhD, RN, FAAN, AOCN, professor and Lulu Wolf-Hassenplug Endowed Chair in Nursing at the UCLA School of Nursing in Los Angeles. “There can be preventive actions nurses can assist [patients] in taking to decrease the risk or decrease the morbidity.”
Linda Sarna, PhD, RN, FAAN, AOCN, said nurses and midwives have the expertise to help individuals and communities improve health outcomes.
Sarna and Stella Bialous, RN, MScN, DrPH, FAAN, senior consultant with the WHO and president of Tobacco Policy International, had collaborated in the past and recognized an opportunity to work together again to help shape global nursing policy about noncommunicable diseases (NCDs). Their completed paper, “Enhancing Nursing and Midwifery Capacity to Contribute to the Prevention, Treatment and Management of Noncommunicable Diseases,” published in February.
“We wanted to make sure nurses were at the table when new policies were put out, because we knew in many cases they might be the ones delivering the intervention. And we wanted to underscore that nursing is evidence-based,” Sarna said.
They collaborated with WHO’s nursing chief and presented their initial findings from their inquiries into nursing contributions to patient care and prevention of NCDs at two global events: the WHO Global Forum for Government Nursing and Midwifery Officers (the Global Forum) and the joint meeting of the International Confederation of Midwives, the International Council of Nurses and the WHO (the TRIAD).
“After we presented our findings and suggestions from this monograph, there was validation of the proposal,” Bialous said. “Both meetings issued statements supportive of statements in the monograph.”
The challenge and opportunity
Although largely preventable through evidence-based interventions, NCDs pose a threat to eradicating poverty and improving health outcomes. Eighty-percent of deaths from NCDs occur in low- and middle-income countries, where 90 percent of the deaths occur before age 60 years. The report indicates WHO estimates that unless action is taken to increase efforts to address NCDs, the cumulative economic losses to low- and middle-income countries from cardiovascular diseases, cancers, chronic respiratory disease and diabetes will surpass $7 trillion (in U.S. dollars) from 2011 to 2025.
“It is no longer acceptable to ignore the leading causes of preventable disease in the world,” said Bialous, adding that a part of the report outlines past research and emphasizes the urgency of addressing noncommunicable diseases worldwide. Nurses are in a position to do that.
The world’s 19 million nurses and midwives comprise more than 50 percent of all health care providers in most countries. In many lower-income countries, people will have more contact with a nurse and not a physician. In all countries, nurses closely interact with patients.
“Nurses by their sheer numbers are well positioned,” Bialous said. “They will be developing policies and be implementing at the village level, at the community level.”
Nurses interact with patients and can educate and influence health behaviors in the inpatient and outpatient settings. They can identify patient behaviors that contribute risk and refer for follow-up care.
“Nurses need to look in the broadest fashion, similar to what Florence Nightingale did, to look at the causes of illness that we can intervene with,” Sarna said.
Nurses can implement WHO’s recommended “best buys” to address NCDs, those things that are proven cost effective, feasible and with a low implementation cost.
“Many of these preventive measures are things nurses are already doing, but could do more,” Bialous said.
Suggested actions include talking about smoking and offering smoking cessation interventions, promoting physical activity, providing dietary guidance, and screening for and treating the harmful use of alcohol.
“In some cases, it may not be new information, but we want to increase the uptake of these interventions,” Sarna said. “We are trying to reframe what modern nursing is about, and that’s the promotion of health as well as the treatment of illness. There needs to be an expectation that this is what good nursing practice includes.”
In addition to clinical practice, the document presents evidence-based nursing interventions that involve policy, advocacy, research and education. For the individual nurse, that includes engaging policy-makers and voicing support for policies to promote the prevention, treatment and rehabilitation of NCDs, becoming involved with advocacy groups, and creating workplace committees to work through ideas about how to integrate health promotion activities into daily practice.
The monograph also offers suggestions for additional nursing research and education that could increase nurses’ capacity to intervene with patients. The authors hope to encourage nursing schools to offer curricula that addresses nurses’ role in counseling people about unhealthy behaviors and encouraging smart lifestyle choices.
“Nursing care should include preventive elements and nursing education needs to include skills and training, so nurses are prepared to deliver the best possible care for noncommunicable diseases,” Sarna said.
The report includes benchmarks to measure nursing progress in addressing NCDs.
Aimed at getting nurses on board, the 38-page report will be sent to chief nursing officers in countries around the world, policy-making bodies and journals; it’s currently available for download on the WHO website.
“We want to make certain the widest audience as possible is aware of this,” Sarna said. “This is also about interdisciplinary activities to emphasize a nursing perspective about expectations and quality of care.”
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