ブックタイトルThe Journal of Humanitarian Studies

概要

The Journal of Humanitarian Studies

Journal of Humanitarian Studies Vol. 4, 2015demographic changes?resulting in fewer young people of working age?will be the major factorsinfluencing the levels and types of care needed and society’s capacity to provide them.Over the next 25 years, the care required for patients with chronic ailments will reach levels never beforeseen. In particular, because of the rapidly increasing incidence of various forms of dementia, a significantexpansion in the number of nursing staff is to be expected. Old-aged people in Switzerland today generallyhave a good quality of life. However, old people’s homes are beginning to undergo a profound change asthey have to provide ever more intensive care to patients in extreme old age.The shortage of physicians is another factor influencing the future of healthcare, especially on the frontline.The average age of general practitioners in Switzerland is 58 years old. Very few medical studentschoose this field of medicine because they are more attracted to the better-paid specialisations. Theshortage of general practitioners has led to political calls for front-line care to be shared between a rangeof health professionals. The legislative framework is changing as a consequence of this. Very soon, nursesin Switzerland will be called upon to develop the skills of a“nurse practitioner”(as it is known in NorthAmerica), especially in areas where there are few general or family practitioners.However, there is not only a shortage of general practitioners; the national average number of nurses trainedin Switzerland still seems very insufficient for dealing with all the possible scenarios of the country’s futurehealthcare challenges. Switzerland is far from being nationally self-sufficient in nursing staff; only 50% aredomestic. French-speaking Switzerland is close to 80% self-sufficient. This is directly related to its policyof ending lower-level nursing courses?which only created confusion as to the profession’s true skills?and introducing university-level training.Efforts must therefore continue in order to significantly reduce Switzerland’s dependence on foreign staffand avoid potentially unethical hiring practices which strip other countries’healthcare systems of theprofessionals that they have invested in so much.In parallel with this, requirements in terms of the quality and safety of care have grown strongly. Thesehave driven healthcare providers to do everything possible in order to significantly reduce the humanand financial costs associated with critical incidents and errors. International consensus suggests that thecost of these incidents could be up to 10% of healthcare budgets?that is such a huge price to pay thatit demands action. Numerous studies, such as Aiken’s in the USA, have shown a significant correlationbetween the level of nurses’education and the number of medical complications, infections, post-surgicaldeaths and therapeutic errors, as well as the length of hospital stay and the number of re-admittances. Itthus seems legitimate to link the quality and safety of care to the level of training of carers. This is onemore argument in favour of having a complete, three-stage university-level education in nursing care?Bachelor’s, Master’s and doctoral levels.A multitude of factors determines quality of care. An analysis of nursing outcomes allows us to focusparticularly on those factors that are strongly dependent on nursing practice: nurse-sensitive outcomeindicators. The use of standard practices, based on research results or expert consensus, now seems to bean accepted and expected means of helping nurses to improve and adapt their practices continuously andback-up their decisions. Evidence-based nursing (EBN) is introduced from the start of nursing training,and all future healthcare professionals in French-speaking Switzerland are taught how to use scientificdatabases (e.g. Medline and CINHAL) and how to carry out a literature review. Nevertheless, the processof transferring scientific knowledge into clinical practice is a particularly complex one. This skill isapproached more thoroughly during the Master’s in Nursing Science; it is an important part of the trainingfor specialised clinical nurses at this level, as they may specifically be required to do it professionally.38人道研究ジャーナルVol. 4, 2015