Nurses and midwives work in coordinating roles to ensure a comprehensive continuum of services
Nurses and midwives strengthen primary health care by serving as coordinators and as a point of contact among services. A variety of new health care models and innovative practices are used across the Region, ranging from small-scale projects to nationwide nursing and midwifery reform. Nursing and midwifery roles are evolving, particularly in health promotion, disease prevention, disease disclosure and support, long-term rehabilitation and the management and coordination of care of chronic diseases.
Russian Federation (case study 33)
Overview: In the city of Toliatty, nurses coordinate tuberculosis (TB) care in the TB dispensary. Before 2012, HIV-positive patients with TB and their family members could receive HIV drugs only at the AIDS centre. An agreement was made between the AIDS centre and the TB dispensary to allow nurses to coordinate treatment, including distribution of antiretroviral drugs prescribed by physicians. This was a logical arrangement, given that effective treatment of HIV infection improves the immune status of patients and is therefore beneficial for the treatment of TB. The head nurse served as the coordinator between the two institutions and prepared information for each patient on the basis of their records and laboratory tests. Patients gave informed signed consent and entrusted their prescriptions of antiretroviral drugs to the head nurse for controlled treatment.
Outcomes: The use of nurses for treating both HIV infection and TB resulted in better treatment outcomes for patients. For example, of all HIV/TB-positive patients who received treatment in 2012, 79% had no TB bacteria in sputum samples on discharge; by 2013, the proportion had increased to 86%. The project also advanced the nursing role, by encouraging nurses to provide valuable independent input to services for patients with both TB and HIV infection. Ward nurses and the head nurse played important roles in the multi-professional team and were recognized as equal partners.
Health 2020 goal: Strengthening people-centred health systems
Ireland (case study 15)
Overview: Many of the obstetric risks associated with pregnancy during adolescence appear to be strongly linked to social factors that can be reduced by high-quality antenatal care. In recognition of this conclusion, a multidisciplinary antenatal adolescent clinic was established in 2012. The outpatient facility comprises a midwife clinic and an obstetric consultant clinic, held on the same day, in the Rotunda maternity hospital in Dublin. One midwife was assigned to each pregnant adolescent, and he or she provided the majority of the girl's antenatal care.
Outcomes: The midwife clinic benefited adolescents by improving the continuity of care during pregnancy and increasing opportunities for health promotion and antenatal education. The service also fostered trusting professional relationships and communication between the midwives and the adolescents. The multidisciplinary team built effective communication and professional working relationships, which fostered mutual respect among the professionals. The existence of the midwife clinic also reduced the consultant obstetrician's workload in the adolescent service and allowed reallocation of their time to other hospital departments. More than half the adolescents in the sample remained at low risk throughout pregnancy.
Health 2020 goal: Investing in health through a life-course approach and empowering people