Nursing Services for the Prevention and Control of Non-Communicable Diseases

Purpose:

There is a global increase in the prevalence rate of noncommunicable diseases (NCDs) not only in the in the Philippines but all over the world. As such, this gained attention from the public health sector, more especially that the trend is not only true in the urban population, which it was significantly identified in the past, but also to the lower socioeconomic groups.  In response to this alarming healthcare situation, several health packages and programs had been developed in all levels of care. Multidisciplinary in nature, nurses have played a role in bridging gaps between health care needs and present services delivered.

The study aims to explore both national and international policies, programs and standards in prevention and control of NCDs where nurses play a vital role. It seeks to identify the status of the local NCD program in selected urban and rural communities with nurses’ involvement. It compares current practice to that of the standard expressed in literature and policies. As the role of nurses may be maximized in this approach, barriers and opportunities are determined and a recommended package of nursing service and delivery are described.

Methods:

Exploratory investigation was conducted considering the elements of policy research. Policies, standards and practice in different nations in Africa, Europe, South Asia and United States, to name a few, were reviewed. Data collection done in 2013 consisted of two phases. First phase was done though a focused group discussion with the different local nursing organizations. Independent roles of nurses and package of nursing services, both documented and undocumented, were determined. The second phase, through interviews, records review, observations, studied the pilot areas for the NCD program status in the Philippines: the municipality of Pateros in Manila for the urban setting, and the province of Guimaras for the rural setting.

Results:

Results of the study show that  the national and international standards and policies on NCDs have a common objective to reduce mortality and morbidity due to NCDs by targeting population in the pre-disease  stage and providing appropriate healthcare packages to those with NCDs. Through the policy and standard reviews majority of these countries’ essential healthcare packages are geared towards deliverable and affordable hence, financially feasible and cost effective services.

 In different countries, similarities seen in nurse led community based interventions involving promotion of physical activity, weight and salt intake reduction, lowering frequency of tobacco use and risk management.  Nurse led clinics are increasingly the most commonly seen set-up. The services are being coordinated with doctors and other health professionals, thus multidisciplinary in approach. Seen also are nurses whose roles are strengthened by specialized trainings which were further empowered to practice though having a recognized set of roles and responsibilities in the team. Through this, family based care is possible which is more accessible to the population. In contrast to the local setting, the PHNs (Public Health Nurses) do not have any explicit roles as described in protocols in NCD prevention programs in health centers. Among their usual tasks include assisting consultation and providing care, community coordination and clerical tasks. Special nurses however serve at the primary level rather than employed in any agency. Most, just like the PDNs, ostomy nurses, and diabetes nurses contract their services with the patients with the referral of the physicians.  

 Generally, the project done in both pilot areas of study reflected positive outcomes, from increasing awareness of people on healthy lifestyle to  incorporating risk assessment  to routine history taking and improving instruments in screening, prevention and treatment. Investing in human resource for health such as utilizing the current oversupply of nurses, and delegating to midwives and trained health workers do minor tasks, are an important strategy in the promoting effectiveness and efficiency of the NCDs programs. 

As the trend in chronic illness management not only involves tertiary care but preventive care and risk management, nurses also moved to a higher level of practice. These kinds of professional development are seen in many countries. Here in the Philippines, as there is no legal barrier in forming groups of nurses practicing specialized care, it will be beneficial both on the side of healthcare service delivery and on the nurses to have this recognized, organized and systematized.  Among the specialty groups are diabetes nurses, emergency care nurses, ostomy nurses, rehabilitation and cardiovascular nurses who can all practice in the hospital, clinic and community settings independently.  

Conclusion:

To be able to render expanded nursing services, as in the case of NCDs, crucial program inclusions are strategies in information dissemination and education, organization of services and specialized personnel training. As such, trainings should be rendered by a competent body of nursing recognized and certified by the regulatory commission. As one of the prominent issues in the pilot community is affordability, health insurance can also subsidize the package of nursing services of the low socio-economic classes, i.e., reimbursement of nursing services by PhilHealth. Similarly, these are also areas of improvements that can be further refined to make the nursing care packages more deliverable and effective.