Nursing Needs for Elderly Peoplein Lithuania

Odeta Vitkūnienė

Chief officerLNHS coordination and health care institution department

17 March, 2014Klaipėda

Conference EFEC: Ecvet for Elderly People Care

• Challenges in health care systems

• Nursing legislation/regulation

• Development of nursing services▫Primary HC ▫Patient-out nursing services▫Nursing at home▫Palliative care

• Trends and vision of nursing

Structure of presentation

Challenges in health care systems

• Demographic trends (elderly, chronically ill)• Increasing complexity of health care and

technological developments• High patient expectations and growing pressure

for accountability:• Patient safety and quality of care• Access to care

• Health care workforce

“Nurses and midwives: a force for health. Survey on the situation of Nursing and Midwifery in the Member States of the European Region of the World Health Organization 2009”

Challenges in health care systems

De Geers S et all. SWISS MED WKLY 2008;138(43–44):621–628

Mission and goals of the MoH

MISSION – to keep health and prevention of the citizens. High quality health, safety and accessible health care for all.

GOALS:• To promote and keep health, implement

public health care• Assurance of accessible and qualitative personal health

care through improvement of the activities of health care institutions.

• Strengthening management of health care system, wich based on solidarity and justice principles.

Legislation

Law of Nursing practice and Midwifery practice

(Official gazette, 2001, 2009, No., 89-3801)

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Regulation of the MoHList of nursing specializations (Order of the MoH 17th of December, 2009)

Requirements of programs of nursing specializations (Order of the MoH, 21th of January, 2010)

Rules of Nursing practice license (Order of the MoH 30th of December, 2009)

Rules of Midwifery practice license (Order of the MoH No.V-1089, 30th of December, 2009)

List of the diseases for health checks (Order of the MoH No.V-720, 12th of August, 2010).

Professional acquirement (Order of the MoH No.V-1038, 17th of December, 2009)

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Nursing education

Feature Untill 1991 Since 1992 m. Since 2010-01-01

Conception Medical nurse General practice nurse

General practice nurse

Organizer Medical school College (6), University (3)

College (6), University (3)

Duration 1-2-3 year 3,5 – 4 year

Succession No Since 1994 m. Master degree - 2 year

Since 1998 m. Doctoral degree – 4 year

Individual studies at collegesPostgraduates studies

Nursing specializationsFeatures Until 2009 Since 2010-01-01Specializations

Anesthesia and intensive care Community nursingMental health nursing Children nursingMidwifery

Anesthesia and intensive care Community nursingMental health nursing

Operating theatre nursing Emergency medical care

Duration 1-3 months 3-6 monthsWay of study Theory, practice

Integrated nursing specializations

PracticePostgraduates studies

Certificate Rehabilitation nurse, operating theatre nursing, hemodialysis, diabetes,

Refresher course

Institution Nursing personnel specialization Centre

High schools

Nursing and midwifery licenseFeature Until 2009 Since 2010-01-01Kind Many kinds of license:

general, anesthetic, community, mental health, children, midwifery

One kind of license:general nursing practice or midwifery practice

Duration Time-limited (5 year) Termless Condition Practice

Refresher courseHealth status

DiplomaPractice Permanent Refresher courseRight to live in LithuaniaCertificate about healthLithuanian language

Organization Since 2002 m. MoH commission of licenseSince 2005 m. – Competent institution

Development of nursing services

Ambulatory services

• Nursing of diabetes

Primary health care

• PHC• Nursing at home• Palliative care

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Primary health careMain goals of PHC – prevention and management of chronic diseases

Services of primary out-patient personal health care: Health care services for the disabled people (approx.. 200

thousands per year) Procedures provided by nurses at home (taking blood tests,

bedsore treatment; drop infusion) (approx.. 100 thousands per year)

Recipients - patients with the established special permanent nursing needs

Services are organised by the Head of Personal Health Care Institution

Funding - Compulsory health insurance fund12

2008 2009 2010 20110

50

100

150

200

250

118.442

85.543 91.144 87.822

213.109

154.302 164.586

186.232

Neįgaliųjų sveikatos priežiūra: slaugytojo vizitas į namus Slaugytojo procedūros namuose

Disabled people care

Nurses procedures at home

Number of services provided by nursing personnel

Nursing at home

Beginning 2008 Caregivers – HC institutions, license for nursing

Service recipients – patients with special permanent nursing need (approx. 200 thousands per year)

Services are organised by the Head of Personal Health Care Institution

Funding - Compulsory health insurance fund

Order of the MoH No V-1026, 14th December , 2007

.

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Dynamics of services provided in nursing homes during 2008-2011

Ambulatory nursing services for patients with diabetes

Beginning Since 2008-10-10 define services Since 2011-07-01 m. funding

Requirement for HC institution License for nursing Medical devices/equipment

Requirement for specialists Nurse Certificate (160 h education) License

Kind of services Consultation of nurse diabetologist Medical chiropody Care of the diabetes foot

Collaboration Other nurses Family doctor Doctor for endocrinology Surgeon Others specialist 16The Order No V-337 of the Minister of Health of the Republic of Lithuania dated 8 April 2011

Number of nursing services for patients with diabetes 2011 - 2012

Kind of services Number of services

Primary consultation of nurse diabetologist (individual) 3.110

Continue consultation of nurse diabetologist (individual) 3.133

Medical chiropody 6.557

Care of the diabetes foot 1.380

Consultation of nurse diabetologist (children) 272

Bendroji suma 14.452

Database of State Patient Fund, 2013

Beginning – since 2008

Forms of provision: In out-patient institutions:

at the health care institution In the patient’s home

At a day care centreAt the in-patient clinic

Services are provided by a doctor, nurse, social worker,

other specialists depending on the need.

Length of service - unlimited.

Number of services approx. 30 thousands per year

Requirements for provision of palliative care services to adults and children confirmed by the Order No V-14 of the Minister of Health of the Republic of Lithuania dated 11 January

2007

Palliative care

Amount of palliative care services 2008-2011

Trends and vision of nursing

Current issues that need attention

Mental Health

Health Technology Assessment

Pharmaceutical sector

Directive on patients’ rights in cross-border healthcare

Primary care

Irrational use of medicines

„Brain drain“

Preconditions for development of nurses capacity

the lack of health care professionals;

the improvement in access to health care services (especially in rural areas);

the need to better respond to the changing needs of patients and to ensure the quality of continuing care;

the increase in health care costs;

the rise in the level of education among nurses;

the expansion of career opportunities among nurses by reducing emigration.

Development of nurses competences

- Professional role, responsibility and accountability:• Clinical practice;• Cooperation, patient consultation and transfer of

information;• Scientific research and leadership.

- The assessment of the state of health and diagnosis.

- Therapeutic competence.

- Health maintenance and disease and injury prevention.

Areas of Practice for Nurses

- Nurses could work at the primary, secondary and tertiary levels of health care, however, particular attention should be paid to the primary level of health care.

- A nurse may be both an independent service provider or a team member working together with a family physician/doctor or other health or social care professionals, also to ensure home visits.

Lithuanian Presidency of the EU Council EU Member States CMO and CNO meeting 7 October, 2013, Vilnius, LithuaniaMain CNO topic: Advanced nursing practice

EU MS CNO Statement

•During CNO meeting we agreed that EU MS CNO believe that advanced nursing practice (APN) would improve HC outcomes and quality of care.

•We agreed on thus APN should be within national HC reforms and strategies.

•EU CNO and others health care players and interested parties have to work towards APN vision, principles, educational requirements and action plans.

Advanced RolesDefinition

SubstitutionalAdditional

Nurses Advanced Skills in their Practice

Education

All Nurses MWsHigh Quality Patient Care and

Good Health OutcomesLicence to Practice Registration (One or Branch)

Improving care and health for patients and communities to meet needs of local population

Improved career

development & retention

VISION level of escalationPRINCIPLES scope of practiceEDUCATION competenciesPLAN legislation

(Associates Support Assistants)

EU MS CNO StatementCreated by EU MS CNO , 7th Oct,2013, Vilnius

Nursing Trends

• Development of nurses functions and role/ new competencies

• To create funding mechanism to integrate nursing and social care

• To develop services of family doctor and nurse: new services forms and kinds

• To create project of “case management “ in the PHC

• To improve HC/nursing quality

• To develop nursing, palliative care, nursing at home and others services.

Finnaly,“Nurses need to have more than management, pedagogic or administrative competencies to be effective actors in a changing health care system that is confronted with numerous challenges such as the development of evidence-based care models in an era of cost containment”.

De Geest S et all. SWISS MED WKLY 2008;138(43–44):621–628

Thank you for your attention

Dėkoju už dėmesį

www.sam.ltodeta.vitkuniene@sam.lt