Innovations in the nursing care of the chronically ill: a literature review from an international perspective

Abstract

This literature review focuses on substitution-related innovations in the nursing care of chronic patients in six western industrialized countries. Differences between primary and secondary care-orientated countries in the kind of innovations implemented are discussed. Health care systems are increasingly being confronted with chronic patients who need complex interventions tailored to their individual needs. However, it seems that today's health care professionals, organizations and budgets are not sufficiently prepared to provide this kind of care. As a result, health care policy in many countries targets innovations which reduce health care costs and, at the same time, improve the quality of care. Frequently, these innovations are related directly to the 'substitution of care' phenomenon, in which care is provided by the most appropriate professional at the lowest cost level, and encompass advanced nursing practice, hospital-at-home care and integrated care. The main conclusion of this paper is that integrated care innovations are implemented in both primary care as well as in secondary care-orientated countries. However, innovations in hospital-at-home care and advanced nursing practice are primarily implemented in primary care-orientated countries. Whether these innovations positively influence the quality of care, costs of care or patients' use of health care facilities remains rather unclear.

Nursing interventions for patients with chronic conditions

“…Reducing health care costs can be achieved by the ‘substitution of care’– a phenomenon, in which the most appropriate professional at the lowest cost level provides care, e.g. giving highly specialized nurses responsibilities and tasks usually undertaken by medical specialists (Temmink et al. 2000).…”

Prevalent nursing diagnoses and interventions in the hospitalized elder care

“…The Nurses play an important role in the care for chronic patients. Innovations relating to the nursing practice and care for chronic patients are being implemented in many countries to produce new forms of health care (4) .…”

Nurse practitioners in Canada: Beginnings, benefits, and barriers

“…Healthcare systems throughout the western world are facing many changes and are often perceived as being ill‐equipped to deal with these changes (Temmink, Francke, Hutten, van der Zee, & Abu‐Saad, 2000). In Canada, for example, a shortage of physicians, as well as the aging of the population and the concomitant increase in healthcare demands, have led to accessibility problems, decreases in satisfaction with care, and fears that the present system is untenable.…”