Editorial: Crossing the caring chasm

摘要

We are experiencing unprecedented change in our health systems. The growing ageing and comorbid profile of health service users creates a range of challenges around how health systems construct more integrated processes to support recovery to health and provide care. While there is an emphasis upon prevention and screening, the trend will continue to be around providing care and support for individuals, families and communities for chronic and lifestyle-induced diseases. The emphasis will therefore be on the need for evidence-based care as much as evidence-based medicine (or cure). By definition, patients with chronic conditions cannot be cured; this means their fundamental care needs are at the centre of their course of care and hence nursing (Henderson 1966). For these reasons, nursing needs to understand its responsibility to members of society around how it combines its caring role with its more traditional nursing role. Possibly one of the biggest challenges facing the nursing profession globally is that the concept of fundamental care has become in some ways detached from the ways we think about and construct nursing (Feo & Kitson 2016). This leads to a fragmentation of care for patients and frustration for nurses and others who are trying to provide person-centred caring services. From a policy perspective, the alignment between caring and nursing is very significant. In the UK, for example, the Willis Report (2016) has recommended an overhaul of the future education and training of registered nurses (RN) and care assistants. This work, based on the findings of the Cavendish Review (2013), has recommended the setting up of a national Care Certificate in order to ensure that these front-line workers, who do the bulk of the personal caring work, are properly equipped to do this and that there is more consistency between the role of care assistants and nurses. Willis (2016) goes on to outline how this foundational training could be the basis of a pathway into nursing so that care assistants who work in health and social care have a more structured and supported career pathway. It is not surprising to see the flurry of policy activity produced in the wake of the Mid-Staffordshire Inquiry (Francis 2013). Important principles such as patient and public involvement in the co-design of services; care based on compassion and respect; and integrated care and services that revolve around the patient rather than the professional are all laudable. In Scandinavia patient, involvement has also been a main focus in healthcare practice. Nursing theory developed in the 1980–1990 illustrates that patients’ involvement is not a new concept in nursing (Scheel 2004). However, over the last 5–6 years, patient involvement has become a much more politicised concept (RN 2016). The Danish national study plan for nursing education has been revised during 2015–16 and patient involvement has been explicitly added as a learning goal and as one of the required competencies for new graduate nurses (RN 2016). However, from a nursing and caring perspective there are some significant omissions in many such policy documents. If not addressed, these omissions could hamper the way in which needed reforms are operationalised, and indeed radically alter the future shape of nursing. It may be self-evident but nowhere in the previously referred to policy documents were there statements to the effect that in every caring or nursing situation, a relationship has to be established to enact what happens between the patient and the carer/nurse (Kitson et al. 2013a). This is a statement of fundamental importance as it determines the nature of the social contract between the two actors. For nursing, the moral responsibility is enshrined in professional codes of conduct. For care assistants, society has only begun to take notice of the expectations of this role and the requirements of it. Some European countries have formal regulation around the role but many including