There is no cure without care

摘要

Even if we find the perfect cures for all the ills in the world, we would still need to care. Our COVID vaccines were on strategy, but health professionals still had to provide the life saving personal or fundamental care that restored and healed people. This observation that curing requires care is a truism that tends to get lost. The reason I'm raising this is simple. Think of what's happening across the world post pandemic: worldwide shortage of nurses, nurses on strike in the UK; disillusionment from experienced nurse leaders in Sweden, the Netherlands and Denmark to mention but a few countries (Kitson, Conroy, et al., 2022); nursing leaders in Canada, the US and Australia building back confidence and self-belief in a profession that aspires to tackle such issues as health inequality and the social determinants of health (National Academies of Sciences, Engineering and Medicine, 2021; Registered Nurses' Association of Ontario, 2021). Governments scrambling to solve the qualified nursing supply problem by thinking of job redesign, substitution, international recruitment, use of technology and other ways to provide an adequate workforce, or to reduce the reliance on people (in this case qualified nurses) to do the caring work. Health and care systems trying desperately to cope with the mounting pressures of more older vulnerable people needing more time to recover, more complex co-morbidity creating even more need for health and care systems to be integrated and take a holistic approach to managing peoples' health and care needs. We have to provide solutions to these challenges and start to generate new ways of embracing the ‘care’ challenge and in particular how we take responsibility for fundamental care delivery (Feo et al., 2018). Essentially, we have three options to determine how essential, basic, fundamental care delivery for patients is going to unfold over the next few years and how we as nurses ought to be shaping the agenda. Option 1: Stop doing and being responsible for fundamental care delivery (Less Care). Option 2: Do more and be more responsible for fundamental care delivery (More Care). Option 3: Be responsible for fundamental care delivery redesign (Better Care). In this option, the nursing profession would explicitly state that it is no longer responsible for the personal (essential, basic, fundamental) care of patients and clients across all health and care delivery systems. Nurses instead would become ‘clinical protocol managers’ and co-ordinators of clinical interventions aimed to cure patients. They would follow medical orders, monitor complex patient groups, manage safety and quality systems and help patients navigate their way through a range of health and care system boundaries. Nurses would not ‘do’ or deliver fundamental care nor would they be responsible for those carers who would be recruited to do it. Personal or fundamental care (eating, personal hygiene, mobilizing, etc.) would be delegated to healthcare assistants, family members, the patient themselves or a mix of all three. Clinical interest in personal care would manifest itself in Activities of Daily Living Assessments in order to set goals and instruct the patient and their care network on managing their recovery—pursuing their own cure. The attractions of this option would be to deregulate care within the health and care systems hence addressing the nursing shortages. It would mean that nursing roles would be defined more around clinical interventions and supporting medical activity. This re-definition could address the chronic nursing shortage by creating more specialization and devolving the ‘care’ work to assistants and others. It would mean that qualified nurses would not have to manage the moral distress of having to take responsibility for fundamental care delivery when systems are lacking resources to do so and do not value fundamental care as a contribution to successful recovery. It would mean that health systems would be expl