The Journal of Continuing Education in Nursing

FAYE G. ABDELLAH: A NEW APPOINTMENT ..DISCUSSES HEALTH CARE SYSTEMS: A MUST FOR HEALTH CARE IN THE 70s

Abstract

The major change for the professional nurse in the 70s will be her expanded role in health delivery systems. There will be many different kinds of delivery systems developed, but the nurse will continue to be the sustaining link in the system. Working with the physician in a greatly expanded role, she will be able to assume many more independent functions. A major segment of all health delivery systems will be preventive services. It is here that the nurse must assume much of the responsibility. The nurse also will be sharing the responsibility with the physician in early diagnosis. The nurse will have greater responsibility for seeing that health services are accessible to various socioeconomic classes. She needs to see that the patient enters the appropriate access route in the system whether it be for primary, secondary, or tertiary care. Once the patient leaves the system, she is also the key person responsible for foHowup care.

Health delivery systems must be measured and compared for their effectiveness. It is here that the nurse researcher, working as a member of an interdiscipl inary team, can make a significant contribution. Critically needed are instruments to measure these systems as well as criterion measures. Nursing effectiveness must be measured in its broadest sense against other new emerging health workers as physician assistants and MEDEX types. The major shift toward preventive health care in the 70s strengthens the role of the professional nurse - and ongoing research may identify a new health professional similar to the family health practitioner being developed in a few settings.

In my dual role of Chief Nurse Officer, USPHS and Associate Director for Health Services Development in the National Center for Health Services Research and Development, I will be devoting a major portion of my time to the development of nursing programs such as PRIMEX* concerned with new types of health delivery systems fully utilizing the competencies of the nurse. Of concern will be the relative effectiveness and efficiency of such programs as compared to MEDEX type programs. Once different delivery systems are tested, legislative, administrative, and other actions will be needed to implement the plan nationally.

As new health delivery systems are developed and tested, changes in preparation of the nurse practitioner at both the undergraduate and graduate levels can be expected. Greater emphasis will need to be placed upon continuing education for all nurses. Nurses should take the leadership in developing structural programs that promote positive change and continuing professional growth.

An Innovative System in the Delivery of Health Services

The existing delivery systems of health care with the acute shortages of manpower and facilities are inadequate. As the 70s brings a National Health System closer to reality it is imperative that rational medical and nursing care delivery systems be developed, tested, and implemented. It is within such delivery systems that the professional nurse will find herself functioning. Therefore, any consideration of patient-centered approaches to nursing services must be considered within the structure of a health care delivery system. The physician and nurse form the central core of the delivery system.

The concept of preventive maintenance services has emerged as an important aspect in the development in any delivery system of health care. Implementing such a delivery system will demand a greatly expanded role for the professional nurse where initial assessment of priority based on patients' needs is paramount. The accepted truth that medical care is a right of every individual cannot become a reality until there are delivery systems of medical care capable of delivering high quality medical and nursing services.

Medical and nursing leaders agree…

Dr. Paye G. Abdellah is the third Chief Nurse Officer and Assistant Surgeon General of the United States Public Health Service. She is also Associate Director for Health Services Development, a recently created post in the National Center for Health Services Research and Development. In her role as Chief Nurse Officer, Dr. Abdeilah will advise Dr. Jesse L. Steinfeld, Surgeon General, on policy and programs relating to nursing. In the National Center, she will be responsible for the development and implementation of nursing programs important to the organization and delivery of health services.

A graduate of Fitkin Memorial Hospital School of Nursing in New Jersey, Dr. Abdellah received her Ed. D. from Columbia University. She has been a member of the faculties of Yale University School of Nursing and Teacher's College, Columbia University, and Visiting Professor at the University of Colorado, the University of Washington and the University of Minnesota. Dr. Abdellah has been on the staff of the U.S. Public Health Service since 1949 and has conducted several statewide nursing surveys and directed many nursing research projects.

In 1957, Dr. Abdellah was on loan to the Western Interstate Commission for Higher Education as their first nurse consultant. She was later detailed to the Division of Hospital and Medical Facilities to be principal investigator of the Progressive Patient Care Study, the first Public Health Service experiment to convert a traditionally-operated hospital ?? one for care around medical and nursing needs of patients.

In 1963, Dr. Abdellah developed the first federal Nurse Scientist training program for the preparation of nurse researchers.

From 1966-1969, Dr. Abdellah served as project officer and scientific consultant to the Mellzer. Pinneo, Kitchell research project on intensive coronary care which resulted in the internationally acclaimed "Intensive Coronary Care, Multimedia Instructional System"* that has contributed to the saving of approximately 100,000 lives a year.

Before her selection as Chief Nurse Officer, she was Director of the Office of Research Training in the National Center for Health Services Research and Development 1969-1970. It was then she developed the first Federal training program for Health Services Researchers and Health Services Administrators. These individuals will form an important cadre of health services research corps.

She is the author or coauthor of more than fifty publications in nursing and related health fields. These include the books Patient-Centered Approaches to Nursing (Macmillan, 1969); Effect of Nurse Staffing on Satisfactions with Nursing Care (American Hospital Association, i958); and Intensive Care - Concepts and Practices for Nurse Specialists (Charles Press, i969).

Dr, Abdellah is a member of the Board of Trustees of the American Nurses' Foundation and a member of the NLN Historical Committee on Archives; she is also a member of the American Psychological Association, The New York Academy of Sciences, The American Association for the Advancement of Science, and serves on the Editorial Advisory Committee of Nursing Research. Membership in honor societies include Pi Lamda Theta and Sigma Theta Tau.

In 1964, she was the recipient of the Federal Nursing Service A ward for advancing professional nursing; and in /965. the Army Nurse Corps Award for Nursing Research. In 1967, the Degree of Doctor of Laws, Honoris Causa, was conferred upon Dr. Abdellah by Case Western Reserve University for her pioneering work in nursing research and the establishment of the first programs to train nurse scientists. In 1969, she received the "Award for Distinguished Achievement in Research and Scholarship" from the Nursing Education Alumni Association of Columbia University.

The major change for the professional nurse in the 70s will be her expanded role in health delivery systems. There will be many different kinds of delivery systems developed, but the nurse will continue to be the sustaining link in the system. Working with the physician in a greatly expanded role, she will be able to assume many more independent functions. A major segment of all health delivery systems will be preventive services. It is here that the nurse must assume much of the responsibility. The nurse also will be sharing the responsibility with the physician in early diagnosis. The nurse will have greater responsibility for seeing that health services are accessible to various socioeconomic classes. She needs to see that the patient enters the appropriate access route in the system whether it be for primary, secondary, or tertiary care. Once the patient leaves the system, she is also the key person responsible for foHowup care.

Health delivery systems must be measured and compared for their effectiveness. It is here that the nurse researcher, working as a member of an interdiscipl inary team, can make a significant contribution. Critically needed are instruments to measure these systems as well as criterion measures. Nursing effectiveness must be measured in its broadest sense against other new emerging health workers as physician assistants and MEDEX types. The major shift toward preventive health care in the 70s strengthens the role of the professional nurse - and ongoing research may identify a new health professional similar to the family health practitioner being developed in a few settings.

In my dual role of Chief Nurse Officer, USPHS and Associate Director for Health Services Development in the National Center for Health Services Research and Development, I will be devoting a major portion of my time to the development of nursing programs such as PRIMEX* concerned with new types of health delivery systems fully utilizing the competencies of the nurse. Of concern will be the relative effectiveness and efficiency of such programs as compared to MEDEX type programs. Once different delivery systems are tested, legislative, administrative, and other actions will be needed to implement the plan nationally.

As new health delivery systems are developed and tested, changes in preparation of the nurse practitioner at both the undergraduate and graduate levels can be expected. Greater emphasis will need to be placed upon continuing education for all nurses. Nurses should take the leadership in developing structural programs that promote positive change and continuing professional growth.

An Innovative System in the Delivery of Health Services

The existing delivery systems of health care with the acute shortages of manpower and facilities are inadequate. As the 70s brings a National Health System closer to reality it is imperative that rational medical and nursing care delivery systems be developed, tested, and implemented. It is within such delivery systems that the professional nurse will find herself functioning. Therefore, any consideration of patient-centered approaches to nursing services must be considered within the structure of a health care delivery system. The physician and nurse form the central core of the delivery system.

The concept of preventive maintenance services has emerged as an important aspect in the development in any delivery system of health care. Implementing such a delivery system will demand a greatly expanded role for the professional nurse where initial assessment of priority based on patients' needs is paramount. The accepted truth that medical care is a right of every individual cannot become a reality until there are delivery systems of medical care capable of delivering high quality medical and nursing services.

Medical and nursing leaders agree that the patterns of delivery of health care are changing and must change. It is inevitable that professional nurses must accept larger and more significant responsibilities if the health needs of the people are to be met.

Problems to be Overcome

The expanded roles of the nurse require acceptance on the part of nurses of responsibilities in the health care systems beyond those that are usually expected of the professional nurse who has had baccalaureate degree preparation in education.

The acceptance of extended roles by the nurse depends upon the existence of the following characteristics in a situation.

1. The needs of the patient, family or group of persons are highly specialized.

2. Highly specialized scientific knowledge and skills are required in order to deal with the patients1 needs.

3. The situation consistently accepts the nurse as the appropriate individual to function in the extended role and makes it possible for her to maintain this role continuously.*

An issue unresolved is whether or not the expanding roles of nurses should include the diagnoses and treatment of pathology and disease as a responsibility delegated by a physician and carried on under his guidance.

The NLN Committee to Study the Nurse's Role in the Delivery of Health Services recommended that the expanding roles of nurses should include an extension of responsibilities already recognized as nursing intervention and nursing decision making rather than the technical functions described under the work of the physician's assistant.

As new delivery of health systems for care develop, one must reappraise training programs for nursing practice. One needs to ask constantly, "Training for what?" The knowledge and skills necessary to perform effectively in the delivery of health services must be attuned to the health services needs of society.

Mandate for the 70s

I see the following directions of change for the 70s:

* Nurses will share in health care.

* Nurses will be responsible for coordinating services for care, cure and rehabilitation of the patient.

* Nurses must be scholars, searchers for new knowledge and skilled practitioners.

* Nurses must work interdependent Iy with all others who provide services for the recovery of the sick, the prevention of disease and the maintenance of a healthy population.

* Nurses will take more active part in local, state, national and international bodies that will plan for and advise on the delivery of health services. Such bodies will attempt to identify the knowledge and competencies of all health workers, the educational requirements for each category of worker, and the organ izat tonai patterns that will be most effective for the delivery of health services.

* Continuing education will be essential for all nurses and will be provided primarily in schools and service agencies.

* Nurses will move into an expanded role as assistants to patients.

* Nursing will become an interdependent health service, one that complements and is a vital part in the delivery of health services.

* Nurses' responsibility in the health care delivery system will move from a focus on hospital care to a focus on preventive care and ambulatory care services as the point of entry into the health care system. Ambulatory care centers can provide preventive, diagnostic, educational and treatment services for the entire community.

* Community nursing services will be based in ambulatory care centers, neighborhood health centers, regional medical programs and local community health centers.

Department of HealthtEducation and Welfare

Rockville, Maryland

December 10. 1970

10.3928/0022-0124-19710101-05

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