PROGRESS AND FUTURE DIRECTIONS SUMMARY DOCUMENT

Transcription

1 PROGRESS AND FUTURE DIRECTIONS SUMMARY DOCUMENT

2 WHO/EIP/OSD/ Original: English Distr: Limited STRENGTHENING NURSING AND MIDWIFERY PROGRESS AND FUTURE DIRECTIONS S U M M A R Y D O C U M E N T WORLD HEALTH ORGANIZATION GENEVA 2001 I

3 Copyright World Health Organization This document is not a formal publication of the World Health Organization (WHO) and all rights are reserved by the Organization. This document may, however, be reviewed, abstracted, quoted or translated in part, but not for sale or for use in conjunction with commercial purposes. No part of this document may be stored in a retrieval system or transmitted in any form or by any means electronic, mechanical, or other without the prior written permission of WHO. Design by RSdeSigns.com. II

4 ACKNOWLEDGEMENTS This summary report of progress on the implementation of World Health Assembly resolution WHA49.1 is the result of contributions by experts in nursing and midwifery and in the health and policy disciplines. The Review Committee members, both within and outside the World Health Organization, provided feedback during the development of the report and forwarded relevant documents and data sources. In addition, there was active involvement of professional organizations, such as the International Council of Nurses and the International Confederation of Midwives, and the Global Network of WHO Collaborating Centres for Nursing and Midwifery. The seed of this close working partnership between WHO expertise and other organizations concerned with nursing and midwifery will undoubtedly continue to grow. Orvill Adams Director, Department of Organization of Health Services Delivery Evidence and Information for Policy Cluster Naeema Al-Gasseer, RN, Ph. D Senior Scientist for Nursing and Midwifery Evidence and Information for Policy Cluster III

5 REVIEW COMMITTEE MEMBERS Prof. Laeticia King (Director, WHO Collaborating Centre for Nursing and Midwifery, South Africa) Dr Joyce Thompson (Director, WHO Collaborating Centre for Nursing and Midwifery, USA) Dr Marla Salmon (former Chairperson of the Global Advisory Group on Nursing and Midwifery) Dr Denise Geolot (Chief Nurse, United States of America) Dr Judith Shamian (Chief Nurse, Canada) Dr Sawsan Majali (Nurse Expert, Jordan) Ms Fatima Al-Riffai (Chief Nurse, United Arab Emirates) Dame Yvonne Moore (former GAG member) Prof. Anna Maslin (deputized for UK Chief Nurse) Prof. Ilta Lange (Nurse Expert, Chile) Ms Judith Oulton (Chief Executive Officer, International Council of Nurses) Ms Petra ten Hoope- Bender (Secretary General, International Confederation of Midwives) Ms Else Melgaard (International Red Cross and Red Crescent Federation) Ms Magda Awases (Regional Adviser for Nursing and Midwifery, WHO African Region) Dr Fariba Al-Darazi (Regional Adviser for Nursing and Allied Health Personnel, WHO Eastern Mediterranean Region) Dr Sandra Land (Regional Adviser for Nursing, WHO Region of the Americas) Dr Maricel Manfredi (Regional Adviser for Nursing, WHO Region of the Americas) Dr Abdulla Assa edi (WHO Representative in Jordan) Dr James Mwanzia (WHO Representative in Gambia) Dr Luis Sambo (Director of Programme Management, WHO African Region) Ms Kathleen Fritsch (Regional Adviser for Nursing, WHO Western Pacific Region) Ms Ainna Fawcett Henesy (Regional Adviser for Nursing and Midwifery, WHO European Region) Dr Dominique Egger (Team Coordinator for Capacity Strengthening for Planning and Management, WHO) Dr Jorn Heldrup (Scientist, WHO) Dr David Nabarro (Executive Director, WHO). In addition to the above persons, many experts and colleagues from WHO provided input and support during the whole process of developing this report. Writing Team Members: Ms Nancy McKay, Dr Naeema Al-Gasseer, Dr Susan Vonderheid, Dr Enaam Abou Youssef, Ms Vena Persaud, and Mr Orvill Adams. IV

6 CONTENTS INTRODUCTION AND BACKGROUND 1 PURPOSE AND METHODOLOGY 2 PROGRESS MADE IN IMPLEMENTING RESOLUTION WHA PRESENT CHALLENGES AND STRATEGIC ISSUES 5 HOW CAN NURSING AND MIDWIFERY SERVICES MEET THE CHALLENGES? 10 GOALS FOR STRENGTHENING HEALTH AND HEALTH SYSTEMS DEVELOPMENT 18 WHO SUPPORT 19 BIBLIOGRAPHY 20 V

7

8 STRENGTHENING NURSING AND MIDWIFERY INTRODUCTION AND BACKGROUND This document provides information and details of the contribution of nursing and midwifery to health and development during the period Despite differences in local contexts, nursing and midwifery services are an essential foundation and support for every health system. These services are found wherever health services are delivered, regardless of the service level, speciality area, or service location. 1

9 STRENGTHENING NURSING AND MIDWIFERY PURPOSE AND METHODOLOGY Under the mandate of the World Health Assembly resolution WHA49.1, a team in WHO s Department of Organization of Health Services Delivery prepared this report with guidance from a multidisciplinary Review Committee which included WHO staff and external participants. Through open consultations, information was sought from within WHO and elsewhere at all levels. Sources of data included WHO regional reports, selected country case studies, WHO collaborating centre reports, external documents, and the scientific literature. The review methodology chosen has limitations. During the past four years, for example, there was no systematic approach to data collection at country, regional or global levels, and no systematic reporting on activities by WHO to address the items in resolution WHA49.1. Thus, accurate comparisons with present or past situations are not possible. 2

10 STRENGTHENING NURSING AND MIDWIFERY PROGRESS MADE IN IMPLEMENTING RESOLUTION WHA 49.1 The health care environment has been turbulent over the last four years, with dramatic restructuring and transitional changes. The World Health Organization, however, has created a strategic agenda for the WHO Secretariat in order to increase the evidence and information base for decision-making and priority-setting. Resolution WHA49.1 directed the WHO Secretariat to report on progress in the implementation of the resolution at all levels. Partners, including nongovernmental (NGO) and professional organizations, have led or collaborated with WHO in many activities. Key areas of progress are summarized which reflect general progress, cites selected country examples, and identifies the outcomes of efforts by the WHO Secretariat and Regional Offices. The Global Advisory Group on Nursing and Midwifery (GAG/NM) continues to inform the Director-General and provide policy advice. Within the context of WHO s strategic directions and World Health Assembly resolutions, guidance is provided on a global agenda for action. Two meetings have been held during the past four years. Thirty-five WHO Collaborating Centres for Nursing and Midwifery are supporting WHO s efforts. The centres are also part of a Global Network and have plans of work consistent with WHO s goals. The collaborating centres demonstrate increased involvement, particularly in the following areas: Capacity-building e.g. training by Jordan of nurse educators in the Syrian Arab Republic; the WHO African Regional Office s (AFRO) support to the University of South Africa in publishing the first 3

11 STRENGTHENING NURSING AND MIDWIFERY African journal for nursing and midwifery researchers in the region. Collaborative research projects e.g. between South Korean and Thai universities in Community Action Research, and Scotland working with the WHO European Regional Office (EURO) on the Family Health Nurse. Interregional initiatives e.g. Pan American Network for Nursing and Midwifery Collaborating Centres, with an emphasis on North South collaboration e.g. the University of Illinois (USA) with the University of Botswana, and Canada with South Africa. Key enabling factors identified were national nursing and midwifery plans, and regulation and nurse involvement in policy. Inhibiting factors cited were economic constraints, lack of information, persistent workforce issues, and limitations in workforce competence due to inadequate education and training of providers. Above all, political support and commitment were viewed as essential for any significant advancement to occur. 4

12 STRENGTHENING NURSING AND MIDWIFERY PRESENT CHALLENGES AND STRATEGIC ISSUES Challenges now confronting the nursing and midwifery services must be considered first, prior to identification of specific strategies. Impact of Health Care Reform and Cost Containment on Services and on the Workforce. In many countries, economic downturns, debts and geopolitical transitions have been impeding health system development and sometimes result in gaps in the services, efficiency, and equitable access. Reform initiatives affect the number and mix of providers, which can restrict access to and reduce the volume of nursing and midwifery services. Caseloads often soar and nurses and midwives have to function under incredible stress, a situation which puts at risk both the quality and safety of the service. Existing human resource issues are complicated and innovative practices can be delayed. Nurses and midwives should be regarded as a part of the solution to improving the quality, access, and cost of care, and not as a cost-containment target. Provider Mobility and Consumer Demand. As a result of the implementation of trade agreements under the World Trade Organization (WTO), there is an increase in mobility of nurses and midwives and this is expected to continue. Increased mobility of the health workforce is likely to aggravate provider shortages in some areas, exacerbated by increased consumer awareness of and demand for nursing and midwifery services. Knowledge Explosion and Access to Technology Solutions. Scientific advances have been accelerating, driven by the quest for an evidence base to 5

13 STRENGTHENING NURSING AND MIDWIFERY inform health practices. Although ongoing developments in communication technology are facilitating global communications and the rapid dissemination of results, the systems, tools and training are often not made accessible to health providers. If developing countries continuously have difficulty to develop, assess and transfer health technology, the North South gap could continue to widen. Advances in health informatics, including telehealth and distance education, are having an impact on our concept of health services and training and are raising public and provider expectations. Although progress in technology can lead to service improvements, there are increasing ethical dilemmas (i.e. in bioethics and service equity issues). Epidemiological Changes and Service Response. Communicable and noncommunicable diseases continue to be a global challenge although improvements differ between developed and developing countries. The re-emergence of infectious diseases and increases in chronic health conditions broaden the demand in the health system. Little progress has been made in addressing women s health issues. The aging and disabled populations are shifting service needs to communities where people live and work. It is estimated that mental health will be the leading cause of burden in the world by the year Nurses and midwives must therefore be better prepared to address the increasing complexities and should be supported in developing innovative approaches which will expand the range of nursing and midwifery services and extent of community care. Poverty. International targets have been set for poverty reduction and eradication. Since health is both negatively impacted by poverty and, at the same time, an essential resource for self-sufficien- 6

14 PRESENT CHALLENGES AND STRATEGIC ISSUES cy, the health sector has an important role to play. Many countries lack essential resources to provide access to essential health services owing to various factors, including civil unrest or armed conflict, economic crisis, lack of political commitment, and health system inadequacies. If the effectiveness and affordability of nursing and midwifery services were better recognized, it could lead to increased interventions with individuals, families, and communities. Human Rights and Gender. The existence of gender discrimination in health care is well established. Females in many countries experience health vulnerability as a result of violence, abuse, and socioeconomic deprivation, which results in higher morbidity and mortality rates. International action calls for increased access by females to quality health care as well as to information and related services. Identification of the above-mentioned challenges leads to several strategic issues which will have a significant impact on nursing and midwifery services, if not addressed. Challenges During Health System Change. Health reforms frequently constrain resource allocations to nursing and midwifery services. Difficulties persist in establishing regulatory mechanisms for nurses and midwives, in developing education systems further, and in initiating research efforts. Preparation for management and leadership roles, particularly in nursing and midwifery, has been limited and led to decreased involvement in transitional or change processes. Coordination and harmony among players in the system are sometimes lacking. 7

15 STRENGTHENING NURSING AND MIDWIFERY Limited Utilization of the Scope of Nursing and Midwifery Services. In many countries, the full range of nursing and midwifery skills are not used, in spite of their proven contribution to improving the health of the people as well as efforts to contain costs. Inadequate Link between Evidence, Policy and Practice. There is an evidence policy gap. Policymakers are not fully using existing evidence on the effectiveness of nursing and midwifery services to target individual and community interventions. In addition, reports indicate that the data and research produced, disseminated and adapted to country situations are insufficient. Increased evidence is needed to guide policy and inform practice. Lack of Concerted Action in Addressing Workforce Issues. Health systems need a mix of competent and motivated providers to function well. From a policy and practice perspective, nursing and midwifery services are labour intensive, with females representing the vast majority of the workforce. Systematic workforce issues involve a range of economic, social and political factors including equity in employment. Evidence shows a widespread and increasing shortage of nurses and midwives across geographical areas, service locations, and specialities. Factors directly impacting on the shortage of nurses and midwives. The main factors are unstable funding of the health sector and inadequate planning, management and deployment of human resources. Low salaries and poor working conditions continue to be identified as the main reasons for persistent problems in recruitment, retention and attrition. Many young people and experienced providers in developed and developing countries 8

16 PRESENT CHALLENGES AND STRATEGIC ISSUES alike cannot see the value in entering or remaining in this workforce for such low pay and poor status. In addition, the average age of the workforce now stands at over 43 years in some countries. Canada (in October 2000) and the United Kingdom (in July 1999) launched major policy initiatives to address the shortage crisis and longterm human resources development issues. Other major employment markets, such as the USA and Australia, are increasing recruitment and retention initiatives. As global recruitment efforts intensify, the potential movement of professionals to countries offering better prospects can increase the difficulties in the developing countries. 9

17 STRENGTHENING NURSING AND MIDWIFERY HOW CAN NURSING AND MIDWIFERY SERVICES MEET THE CHALLENGES? Nursing and midwifery services have the largest workforce, often functioning within a network of community organizations and health care workers, especially in rural and underserviced areas. Where expanded roles have been developed and worked to improve health or health system outcomes, efforts should be made to learn from these experiences and use the models for scaling up the services. With the required skills and competencies, nurses and midwives can be flexible and function in many different roles at all service levels in the system. Often with the support of other personnel, professional nurses and midwives can: Address the physical, mental, social and spiritual needs of populations; Provide health promotion, in addition to preventive, curative and rehabilitative services, and care for the terminally who await a peaceful death; Provide long-term support and follow-up, including their availability for care 24 hours a day, seven days a week in required settings; Deliver competent and cost-effective primary care for populations, particularly in serving disadvantaged populations; Communicate well with populations and adapt the interventions to the community s needs, while promoting community development through teamwork and partnership; Mobilize as health agents in situations of emergency, conflict and disaster. 10

18 HOW CAN NURSING AND MIDWIFERY SERVICES MEET THE CHALLENGES? In targeted WHO priority areas, the nursing and midwifery services are often at the core of service provision. Some positive impact has been documented in selected case studies and evidence of this significant contribution can be strengthened in the future. Malaria, HIV/AIDS and tuberculosis. In Senegal and South Africa, nurses are involved in facilitating community participation, as well as in supervising and implementing programmes to combat HIV/AIDS. In Hungary, nurses are involved in reducing the incidence of tuberculosis by organizing screening services and anti-tb campaigns in schools and communities. In Egypt, nurses are involved in early detection and implementation of care protocols for tuberculosis. Maternal health. In Mexico, nurses provide 75% of the services using a risk-based approach in areas of Mexico City where there are serious inadequacies in the perinatal services. Data show that coverage has been expanded. In Djibouti, midwives in Maternal Child Health Clinics are key providers of Safe Motherhood programmes. They deliver prenatal and postnatal consultations, encourage prenatal follow-up, and provide integrated family planning services. Mental health. In Finland, nurses provide a variety of therapeutic interventions to promote patients - mental health in community and institutional settings. The results show patients to be more satisfied with nursing interventions than the help of medication. In Thailand, nurses and midwives provide a variety of mental health services including education, prevention and management of stress, conflict resolution, group and family therapy, and community-based and mobile mental health clinics. 11

19 STRENGTHENING NURSING AND MIDWIFERY Tobacco. In Finland, public health nurses and midwives play an active role in reducing mothers smoking habits during pregnancy. Cancer, cardiovascular disease, and diabetes (chronic diseases). In Belize, improving the quality of life of the chronically ill elderly population is achieved through nursing services in the home. In Bahrain, nurses ran diabetic clinics and cardiac rehabilitation programmes. In Hungary, nurses are involved in the prevention of breast cancer by conducting screening programmes, teaching proper self-breast examination techniques, and giving information on the signs and symptoms of breast cancer. Nurses and midwives are successful in improving service effectiveness. Services have proven to be accessible, affordable and acceptable. This section provides evidence from the literature to demonstrate the contributions of nursing and midwifery services in selected areas. VULNERABLE GROUPS Nurses and midwives are involved in health promotion, prevention, service innovation and leadership in a Maternal Child Care Community Development project in Bogota, Colombia, a municipality with the second highest level of poverty and vulnerability. Survey results showed an increase in healthenhancing behaviour, a decrease in morbidity, and high satisfaction with care. Healthy Pulse, a community-based mental health service managed by nurses in Denmark, aims to prevent mental distress from developing into more serious disorders. The findings indicated reduced medication and substance use, less isolation, and better coping skills among clients. 12

20 HOW CAN NURSING AND MIDWIFERY SERVICES MEET THE CHALLENGES? In Samoa, a Think Tank report confirmed the capacity of Integrated Community Health Nursing Services to reach vulnerable groups and also noted that this was a very effective and efficient way to deliver services to the population. Nurses played a key role in controlling the spread of disease and in addressing the health needs of displaced people after the devastating floods in Mozambique. Responsibilities of the nurses included conducting a rapid needs assessment, coordinating with departments of health, providing education on the prevention and treatment of malaria, cholera and diarrhoea, and distributing water purification tablets. COMMUNITY HEALTH INITIATIVES AND HEALTH PROMOTION In a randomized control trial of patients following myocardial infarction, education by nurses was found to increase the patients knowledge, lessen anxiety and depression, and improve satisfaction and function. In a systematic review, nurses were found to be effective in providing smoking cessation interventions. INNOVATIVE PRACTICE/ NURSE MIDWIFE-LED MODELS/ COST-EFFECTIVENESS In Thailand, approximately 75% of Bangkok s health centres are successfully led by nurses/midwives. Research conducted in North America and the United Kingdom on the nurse practitioner model of primary health care supports positive results in patient outcomes, satisfaction, and cost. 13

21 STRENGTHENING NURSING AND MIDWIFERY In Canada and the United States, nurse practitioners in nursing centres provide 100% of care to patients. Data show that patients from the Abbottsford Centre in Philadelphia use the Emergency Room one-seventh as much as other Medicaid patients, and the cost of inpatient and outpatient care is about 50% less. Nurses have been an important resource in the rise of ambulatory surgery centres, another strategy to reduce hospital costs. In Colombia and Guyana, nurses provide teaching to patients before surgery and monitor post-operative progress at home. In many countries nurses, midwives and allied health personnel are the main providers of health care, particularly in rural and remote areas where vulnerable populations reside. In Guyana these providers deliver as much as 80% of health care; in Chile 92% of child health visits are by nurses; in Colombia more than 75% of consultations for expectant mothers are by nurses; in Kiribati nurses are the only health workers in the rural and remote areas; in Samoa 99.5% of all health care is provided by nurses; and in Indonesia the use of community midwives increased antenatal coverage from 74% to 88%. In Djibouti, access to services in rural and remote areas has been improved by expanding the traditional roles of nurses and midwives to manage primary health care, perform initial diagnosis, prescribe drugs, and refer patients from primary to other levels of care. To ensure that patients were seen by the appropriate practitioner, a project in Scotland expanded the role of nurses and improved the utilization of human resources. Evaluation results showed improvements in practice organization, work- 14

22 HOW CAN NURSING AND MIDWIFERY SERVICES MEET THE CHALLENGES? loads, staff morale, and high patient satisfaction, with 80% of patients preferring to be seen by the nurse than the general practitioner. In Asia, the nursing practice model for care gives the family an important role in caring for patients during hospitalization. This model is cost-effective, providing the individual and family with knowledge and skills to support the patient s care. In Colombia, nurses have established organizations that provide home nursing care to individuals and families, based on increasing demand for hospital services in the home. The World Bank (in 1993) noted that most of the essential clinical and public health services could be delivered cost-effectively by nurses and midwives. In Canada, a number of cost-effective alternatives were identified for managing services in community, home care, and public health. Nurses are providing 80 90% of all anesthesia services in many less developed countries, especially in the remote areas. In Nepal, nurses have played a key role in training and supervising maternal and family child health workers in an innovative and cost-effective approach targeted at maternal mortality rates (MMR), infant mortality rates (IMR), and under-5 mortality rates (U5MR). 15

23 STRENGTHENING NURSING AND MIDWIFERY MORTALITY, MORBIDITY, RISK FACTOR REDUCTION The Asthma School Programme, managed by nurses in Denmark, is aimed at increasing the students ability to manage their condition, thereby reducing both personal and public costs. Research results showed that the number of hospital admissions due to severe asthma attacks hasbeen reduced by half and that asthma-related emergency visits to physicians fell from 60% to 20%. The Parent Programme in Malta is facilitated by midwives. It aims to promote safe motherhood through education of pregnant women and their partners, families of teenagers, and single parents. The results indicated increased safety in childbirth and improved health in early childhood. Parents made more informed choices during the antenatal, intrapartum and postnatal phases, and reported a high level of satisfaction with the programme. As a result of supporting well-trained nurses in Cambodia, surgical deaths have declined as much as 80%. Care by nurse midwives has been shown to reduce morbidity in a study in which midwifery care was associated with a lower risk of abnormal labour. The results of a meta-analysis on tuberculosis indicated that directly observed therapy and incentive components were found to be effective in reducing the incidence of tuberculosis. The most frequently reported service providers were registered nurses. 16

24 HOW CAN NURSING AND MIDWIFERY SERVICES MEET THE CHALLENGES? In the United Kingdom, the Gloucestershire Royal NHS Trust has instituted integrated care pathways to improve service quality including nursing care. For a population of stroke patients, morbidity and length of stay were reduced resulting in minimum annual savings of (about US$ ). For patients with fractured femur, the potential for reduced length of stay was identified with nominal annual savings of (about US$ ). FINANCING AND RESPONSIVENESS Studies indicate that the use of nurse case managers in urban and rural hospitals increased the quality and access and decreased the costs. A nurse-run radiotherapy outpatient clinic demonstrated a positive impact on patient care and service continuity. In Belize, expanded hours of operation for Maternal Child Health Clinics have improved service utilization and access to services, which contributed to making pregnancies safer. In South Korea, nurses deliver home care services in rural areas, based on increasing public demand for more cost-effective services. Nurses and midwives helped to expand antenatal service coverage in Mozambique from 63% to 85% between 1995 and 1998, which contributed to the achievement of national health goals. In Belize, nurses have mobilized private sector financing for health care and recommended outreach services for those who do not have access to health care. 17

25 GOALS FOR STRENGTHENING HEALTH AND HEALTH SYSTEMS DEVELOPMENT Four key goals are proposed to address the strategic issues and further develop Nursing and Midwifery Services to improve the health of people and strengthen the health system. GOAL 1 Improve access to quality health services, including nursing and midwifery services for individuals, families and communities, particularly poor and marginalized populations. GOAL 2 Increase the evidence base in order to direct the development and provision of effective nursing and midwifery services that reduce risk factors and respond to health needs. GOAL 3 Strengthen the human resources policy, planning and management system to create a health service environment conducive to the delivery of quality nursing and midwifery services. GOAL 4 Build leadership and management capacity within health and nursing and midwifery services in order to strengthen health system development, focusing on policy, regulatory mechanisms, and resource generation and allocation. 18

26 WHO SUPPORT WHO reports indicate an increase in the provision of technical support, in the development and implementation of norms and standards, the development of tools and guidelines, and advocacy for policy development. Technical support was provided based on countries requests in several areas, such as assessment of nursing and midwifery services, development and implementation of national action plans and quality assurance programmes, and evaluation of nursing and midwifery education and services. Norms and standards for nursing and midwifery education and practice were developed with partners such as the International Council of Nurses and the International Confederation of Midwives. Tools and guidelines have also been developed and implemented for disease control, risk reduction, health care management, and service delivery. WHO s support in advocacy has been demonstrated by the development and endorsement of position statements and ministerial declarations. 19

27 STRENGTHENING NURSING AND MIDWIFERY BIBLIOGRAPHY AFRO regional report: Progress made on the implementation of Resolution WHA49.1 on strengthening nursing and midwifery and the plan for future directions. Harare, WHO Regional Office for Africa, Aiken L, Clarke S, Sloane D. Hospital restructuring. Does it affect care and outcomes. Journal of Nursing Administration, 2000, 30(10): Aiken L. Good nursing care = lower death rates. N J Nurse, 1994, 24(8): 1. Annual report: The Joint CC for Nursing and Midwifery Development. Phayatai, Bangkok, Mahidol University, Annual report: WHO CC for International Nursing Development in Primary Health Care. Chicago, University of Illinois, Annual report: WHO CC for Postgraduate Distance Education and Research in Nursing and Midwifery Development. Pretoria, University of South Africa, Annual report: WHO CC for Research and Training for Nursing Development in Primary Health Care. Seoul, Yonsei University, Brown S et al. A meta-analysis of nurse practitioners and nurse midwives in primary care. Nursing Research, 1995, 44: Buchan J, O May F. Globalisation and healthcare labour markets: A case study from the United Kingdom Buerhaus P, Staiger DO, Auerbach DI. Implications of an aging registered nurse workforce. Journal of the American Medical Association, 2000, 283(22): Canadian Ministry of Health. Nursing strategy for Canada. Ottawa, Case studies report: Kingdom of Cambodia: Contribution of nursing and midwifery to health systems performance and goals. Manila, WHO Regional Office for the Western Pacific,

28 BIBLIOGRAPHY Case study: Analysis of the contribution of nursing and midwifery to health systems performance and goals in Viet Nam. Manila, WHO Regional Office for the Western Pacific, Case study: Assessment of nursing contribution to achievement of health goals and systems in Samoa. Manila, WHO Regional Office for the Western Pacific, Case study: Contribution of nursing and midwifery to health systems performance and goals in Lao People s Democratic Republic. Manila, WHO Regional Office for the Western Pacific, Case Study: nursing and midwifery development by country: Thailand. New Delhi, WHO Regional Office for South-East Asia, Case Study: People s Republic of China: Situation analysis and case studies. Manila, WHO Regional Office for the Western Pacific, Dingman S et al. Implementing a caring model to improve patient satisfaction. Journal of Nursing Administration, 1999, 29(12): EMRO regional report: Progress made in implementation of Resolution WHA49.1 on strengthening nursing and midwifery and future directions. Alexandria, WHO Regional Office for the Eastern Mediterranean, Engel C. Health professionals education for adapting to change and for participating in managing change. Education for Health, 2000, 13(1): EURO regional report: Progress in the implementation of Resolution WHA49.1 on strengthening nursing and midwifery and the plan for future directions. Copenhagen, WHO Regional Office for Europe, German Foundation for International Development. Public service reforms and their impact on health sector personnel. Berlin, Gleason-Scott J, Sochalski J, Aiken L. Review of magnet hospital research: Findings and implications for professional nursing practice. Journal of the Nursing Association, 1999, 29(1):

29 STRENGTHENING NURSING AND MIDWIFERY Global Advisory Group on Nursing and Midwifery. Report of the Sixth Meeting. Geneva, World Health Organization, Human Development Report New York, Oxford University Press, International Labour Office and World Health Organization. Public service reforms and their impact on health sector personnel. Case studies in Cameroon, Colombia, Jordan, Philippines, Poland, Uganda. Geneva, Johnston M et al. Impact on patient and inpatient and extended cardiac counselling and rehabilitation: A controlled trial. Psychosomatic Medicine, 1999, 61: Kinnersley P. Randomised controlled trial of nurse practitioner versus general practitioner care for patients requesting «same day» consultations in primary care. British Medical Journal, 2000, 320: Lange A et al. Health policy and the nursing profession: a deafening silence. International Journal of Nursing Practice, 1997, 3(1): 2-9. Lazenbatt A. The role of nursing partnership interventions in improving the health of disadvantaged women. Journal of Nursing Administration, 1999, 30(6): Ma Al aitah R, Cameron S, Armstrong-Stassen M, Horsburgh ME. Effect of gender and education on the quality of nursing work life of Jordanian nurses. Nursing and Health Care Perspectives, 2000, 20(2): Mundinger M. Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial. Journal of the American Medical Association, 2000, 283: Murray C, Lopez A. eds. The Global Burden of Disease. A comprehensive assessment of mortality and disability from disease, injuries and risk factors in 1990 and projected to Cambridge, MA, Harvard School of Public Health, 1996 (Global Burden of Disease and Injury Series). 22

30 BIBLIOGRAPHY Nursing services contributing to equity, access, quality and sustainability in the health services. Washington, DC, WHO Regional Office for the Americas/Pan American Health Organization, Parent ML. A meta-analysis of the effectiveness of tuberculosis programs: the influence of program components on outcomes. Toronto, University of Toronto, Graduate Department of Nursing Science, Rice VH. Nursing intervention and smoking cessation: a metaanalysis. Heart & Lung, 1999, 28: Scott G et al. Review of magnet hospital research: established findings and implications for professional nursing practice. Journal of Nursing Administration, 1999, 29(1): SEARO situation analysis and case studies: An assessment of progress towards resolution WHA49.1 in Nepal. New Delhi, WHO Regional Office for South-East Asia, Sixth Advisory Group of experts on nursing and midwifery meeting report. Harare, WHO Regional Office for Africa, Staiger DO, Auerbach DI, Buerhaus P. Expanding career opportunities for women and the declining interest in nursing as a career. Nursing Economics, 2000, 18(5): Taylor P. Comprehensive nursing case management. An advanced practice model. Nursing Case Management, 1999, 4(1): The Pan American Network of Nursing and Midwifery Collaborating Centers: Nursing and midwifery making a difference. Washington DC, WHO Regional Office for the Americas/Pan American Health Organization, United Kingdom, Department of Health. A Health Service of all the talents: Developing the NHS workforce. Consultation on the review of workforce planning. London, Department of Health, United Kingdom, Department of Health. Guidance on international nursing recruitment. London, Department of Health, National Health Service,

31 STRENGTHENING NURSING AND MIDWIFERY Walraven G, Weeks A. The role of (traditional) birth attendants with midwifery skills in the reduction of maternal mortality. Tropical Medicine and International Health, 1999, 4(8): When care becomes a burden: Diminishing access to adequate nursing. New York, Milbank Memorial Fund, WHO Regional Office for South-East Asia. SEARO regional report: Progress made in the implementation of Resolution WHA49.1 on strengthening nursing and midwifery and the plan for future directions. New Delhi, WHO Regional Office for the Western Pacific. Strengthening nursing and midwifery: Progress made in implementation of resolution WHA49.1. Manila, WHO,UNFPA, UNICEF. Reduction of maternal mortality. Geneva, World Bank. Engendering development through gender equity in rights, resources, and voice. Washington DC, World Bank, World Bank. World Development Report. Washington, DC, World Bank, World Development Report 2000/2001. Attacking poverty. Oxford, Oxford University Press, World Health Organization. Nursing beyond the year Report of a WHO Study Group. Geneva, Switzerland, World Health Organization. World Health Report Health systems: Improving performance. Geneva,

32 HEALTH SYSTEMS ARE BECOMING MORE COMPLEX. IN MANY COUNTRIES, THE ROLE OF THE STATE IS CHANGING RAPIDLY, AND THE PRIVATE SECTOR AND CIVIL SOCIETY ARE EMERGING AS IMPORTANT PLAYERS. WORLDWIDE, PEOPLE'S EXPECTATIONS OF HEALTH CARE SERVICES ARE INCREASING. NURSING AND MIDWIFERY SERVICES PLAY A CRITICAL ROLE IN ACHIEVING THE GOALS OF HEALTH SYSTEMS AND IMPROVING HEALTH OF THE POPULATION. IN ALMOST ALL COUNTRIES OF THE WORLD, QUALIFIED NURSES AND MIDWIVES ARE THE BACKBONE OF THE HEALTH CARE SYSTEM, YET THEY HAVE NOT ENJOYED THE STATUS OR ECONOMIC SUPPORT TO REALIZE THEIR FULL POTENTIAL. IN MAY 1996, THE WORLD HEALTH ASSEMBLY ADOPTED RESOLUTION WHA49.1 ON STRENGTHENING NURSING AND MIDWIFERY. THIS DOCUMENT REPORTS BACK ON THE RESOLUTION AND DISCUSSES GLOBAL PROGRESS IN NURSING AND MIDWIFERY SERVICE DEVELOPMENT DURING THE PERIOD 1996 TO THERE IS A GLOBAL CONCERN FOR THE WIDESPREAD AND INCREASING SHORTAGE OF NURSES AND MIDWIVES. THE SITUATION IS PARTICULARLY ACUTE IN DEVELOPING COUNTRIES, WHERE UNSTABLE AND DWINDLING FUNDING OF THE HEALTH SECTOR COUPLED WITH LOW SALARIES AND POOR WORKING CONDITIONS HAVE ALREADY LED TO MEMBERS OF THE PROFESSION EITHER EMIGRATING IN VAST NUMBERS TO COUNTRIES OFFERING BETTER PROSPECTS, OR LEAVING THE PROFESSION ALTOGETHER.