Sunday, 27 November 2016

Hungary for advanced nurse practice, a glimpse of naivety, and a placed booked for a longer life

Péc is a lovely city in the Southern part of Hungary. I have been before and was privileged to be able to spend some time there last week. I had been invited to present a paper at an international nursing conference organised by the University of Péc's. The focus of the conference was Advanced Nursing Practice. We had run such a programme in my old School for over 10 years and, I had invited my colleague Anabella, the programme director to present her experience. Unfortunately she was unable to make the trip due to other commitments. So I came, and I am very glad I did.

There was a real sense of energy about the conference, an energy that clearly underpinned a determination to develop and put in place the concept of advanced practice in taking the nursing profession forward. There were other international speakers there, from the US, Slovenia, and the Czech Republic. The International Council of Nurses was represented as was the Hungarian Secretary of State for Health. The presence of the latter was an unprecedented show of political will and support. The papers delivered on both days enthusiastically stated the professions' ambitions and assertively identified the issues and challenges that will need to be dealt with. The energy and enthusiasm was infectious and I am very confident that progress will be made.

Many of the issues appeared universal – a lack of funding; the difficulty in designing a curriculum that reflects the profession of nursing and its attributes whilst also educating and training in areas usually associated with medicine; who should teach the students; the poor image of nursing; and of course medical opposition to the proposed changes. In some ways, it was an event that very much reflected the discussion I'd been part of at a meeting in London last Monday. I attended the Nursing and Midwifery Council thought leaders group looking at the educational preparation for graduate nurses in 2025-30. The discussion was powerful and focused, well that was until colleagues from one of the big 5 consulting companies came to speak with us about the ongoing educational framework review.

Now I don't mind naivety in others, in fact sometimes I think it can be both cathartic and very productive. I wasn't convinced this was the case with these consultants. I think they were just naïve. Geraldine Walters, the recently appointed Director of Nursing and Midwifery Education, Standards and Policy at the NMC joined us and she at least appeared to have an open mind in terms of what the role of NMC might be in determining the future shape of nurses education in the UK.

Yesterday as I travelled the 200 km back to Budapest I was able to reflect on the differences and similarities of both these sets of discussions. There were many. Both nations are politically, economically and demographically challenged and current models of health care are unsustainable. Demand for health care exponentially outstrips our capacity to provide it. The shape and rapidity of change in health services almost out paces our ability to develop the skilled and knowledgeable workforce required to provide it. However, I was buoyed up to see that psychology, and the recognition of the importance of the interpersonal relationship were being foregrounded in both conversations.

This was something reinforced in my dipping into a book given to me as a gift by my new colleague Aniko. She has claims to citizenship in Serbia, Hungary and the US, and is currently working in Ohio improving the quality of care provided by medics and nurses. The book Complications, by Atual Gawande is written in the style of one of my favourite authors, the late and great Oliver Sacks, the Poet Laureate of Medicine. Amidst the technology of medical intervention, the despair of disease, both Gawande and Sacks successfully remind us of the importance of remembering the person who should be central to our work – the patient, and another human being. 

I have to confess, I have not read an actual book, as in something printed on paper for a number of years. Apparently 1 in 3 people in the UK rarely or never read for pleasure. But that is not what I am talking about. I meant that these days most of my reading happens on line, or through my Kindle (other readers are available). Not that how you read matters when gaining the benefits of reading. In a study published recently in the journal Social Science and Medicine, Avni Bavishi and colleagues claim that reading is not simply an indulgent pastime, but a form of life support. Their paper claims that people who regularly read books tend to be healthier, richer and better educated in general, all of which could contribute to a longer life (and there is no need to read the small print)!