Nurses and midwives can manage processes for quality and better outcomes

The findings presented in the compendium show that nurses and midwives provide safe, high-quality, person-centred care, improve the coverage and integration of health services and reduce the costs of health care organizations and health systems. The case studies show that the involvement of nurses and midwives in higher-level decision-making helps to steer resources and the monitoring of health service and system performance to maintain a focus on people.

Finland (case study 9)

Overview: The care of people with chronic conditions consumes about 78% of all health care spending. Finland has cast nurses in new roles as case managers in the "chronic care model". Use of the model shows that good management can greatly improve the care and the quality of life of patients with chronic diseases and complex needs and reduce the resources required. The role of nurses as case managers was expanded to include coordination of care and resources and management of caseloads. Certain responsibilities were redistributed between nurses and doctors, and nurses were permitted to prescribe, within legislative requirements. Nurses also provided intensified patient education and supported self-care. Their new role called for holistic, creative problem-solving to help people manage their health conditions.

Outcomes: Patients with chronic diseases made fewer emergency visits and had a greater active, participatory role and satisfaction with treatment. A self-care guide was prepared for health care professionals to support the teaching of self-management, and patients received self-care tools. Patient record systems were revised to improve information-sharing and to facilitate the planning of individual patient care. Interactive electronic services were established to ensure faster access to services, more choices and support for self-management.

Health 2020 goal: Tackling Europe's major health challenges: NCDs and communicable diseases

Denmark (case study 4)

Overview: A midwife-led postnatal clinic was introduced in Aarhus University Hospital for assessment of postnatal perineal wound healing. A guideline was prepared on assessing wound healing and secondary perineal repair, and midwives were trained in such assessment, in postnatal pain management and in performing early secondary repair.

Outcomes: Wound healing after primary perineal repair performed by midwives was successful in more than 90% of cases. The preliminary results indicate high patient satisfaction and anatomically good healing after early secondary repairs by midwives. Midwives working in the new service expressed greater work satisfaction.

Health 2020 goal: Investing in health through a life-course approach and empowering people