Evolving Practice of Nursing and Patient Care Delivery Models

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An objective of the nursing and patient care reform is an access to a cheaper treatment for patients. It is necessary to reduce the direct communication between doctor and patient. On the one hand, qualified and experienced doctors have become a natural phenomenon in medicine, but on the other hand, their high competitive wages reduce the availability of medical care. And, in fact, a doctor is too valuable, both literally and figuratively, expensive tool, which is generally used in not sufficient manner. So in the future we will need low-cost medical care.

The performance of this need is yet progressing very well. To implement significant changes in nursery care it is necessary to determine frames of doctor’s authority. Medical staff, aside from doctors includes:

- Doctors’ assistants (can conduct a survey and operate with simple diagnoses, prescribe treatment, cooperate with doctors, help them and replace them in some occasions)
- Nurses with Masters Degree (can work independently, but the range of options is less than assistants’, also need the help of doctors who advise their patients and themselves. Known as family nurses)
- Paramedics – a ,”combat” unit of the ambulance, aimed at solving emergencies of different types (traumas, heart attacks, etc.), may carry out emergency aid; in complex occasions call a doctor for support.
- Nurses in hospitals - a kind of doctor's hands and eyes - she can not make the diagnosis, she can not prescribe treatment, but may influence the decision of the doctor, because the doctor sees a patient one time a day for 10 minutes, whilst a nurse - 12 hours (Brooks, 2013).

And now the most important issue: the principles of the future of nursing, based on the concepts of continuity or continuum of care, and experience of care organizations.

First of all, it is important to provide medical care service with two types of nurses:
 1) The typical nurse who inserts needles (but it must be a specialist of superior quality)
 2) Nurse, who specializes in healthy way of living (can be called "valeologist").

The basis for the formation of the concept of a healthy lifestyle should be the technology of evidence-based medicine. There should be a government order for the scientific development of an issue of healthy lifestyle, the formation of the health of the methodology.

The institutions for nurses should perform scientific work on the formation of technology of saving health (of which who are not yet sick) on the basis of evidentiary medicine. We kill two birds with one stone: we educate specialists, professors of health, and provide the basis for a healthy society. This social program should include the principles for future specialist integration into the society and the structure of health care, education, manufacturing, child care, etc.

The main problem today is that there is no science that would be interested in healthy population. Doctors do not coincide - they have other problems. If there are no sick people, doctors will lose their job - it is profitable for them to have sick people, who always apply for help (Peters, 2010). Most likely we will see the strong opposition of doctors, yelling "quackery", "fraud”, etc.

I believe that such a project can be fully realized in several decades, but the trend and concepts should be enshrined now.

The formation of the future specialist valeologist (or nurse on healthy lifestyle) will be based on the institution of nursing. Depending on the talent and ambitions of the students they would be able to choose a role of a nurse in a medical institution or to become an expert on healthy living and to perform private practice on the basis of such institutions. 

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