This paper explores the impacts of an ageing population with chronic diseases on nursing practice in Singapore. It also seeks to analyse the current influence on nursing and the contemporary nurses role plus the potential impact on health care system in Singapore. The nurse is the image of health worker. For many in health facilities all over the world, and in Singapore, this is a profession of passion for the ill and the afflicted where nurses provides services to patients medical and mental needs. As assessed, nurses also assists in treatment and day to day care and home-based care, facilitates psychosocial research and facilitates medical care in general. Chronic diseases in Singapore are on an exponential increase which has resulted in continuous demand on nurses in terms of working hours and the hours dedicated per patient. This has a negative influence on the overall healthcare system in Singapore due to increasing the nurse to patient ratio.
It is the ultimate desire of all people to continually enjoy sound and healthy life. A health population is said to have diverse significance that a society and a country enjoy. With a health population, money employed in the health sector to buy medicine, remunerate health offices, build health infrastructures, and fund research find its way in more development oriented projects. Healthy individuals are also able to work; hence, cater for their needs, and at the same time, contribute in the revenue kitty of the nation. Therefore, healthy individuals are bound to serve as the basis for prevention efforts across their society. They are also bound to pledge their support to established health and human services (HHS) to foster a healthier society, and in the long-run, a healthier nation.
Aging is a fate that befalls every individual that is blessed to get to that stage (Cheah, 2001). In addition to the myriad benefit that a nation derive from the aging population in terms of expertise, experience among others, the same condition presents some challenges that the country has to put up with. In Singapore, one of the major institutions that face direct impacts of ageing is the nursing fraternity which has to put up with the increasing chronic diseases in individuals, especially during their old age. According to U.S. department of health and human services, (2010), an ageing population suffers from multiple chronic diseases like asthma, hypertension, diabetes and heart complications that require prompt and effective attention. Such diseases do not only present positive impacts, but, in actual facts, the negatives impacts outdo any positives that an ageing population would present to the nursing fraternity.
The trend of population growth in developed countries which includes Singapore, indicate that there is an increasingly ageing population. This coupled with lifestyle changes has been influential on the rise in prevalence in chronic diseases as reported by Brenda and Yeoh, (2009). According to them, complex illnesses that have prolonged durations are rarely cured completely. The morbidity and mortality of these diseases have since overtaken the infectious diseases and they account for more than 83% of all deaths among people of 65 years and above according to the world health organization (Yeo, Harris, & Majeed, 2012). Some of the rising cases of chronic diseases in developed countries are cardiovascular diseases which are non communicable diseases that have complex causes and contribute to disabilities. Other examples include cancer, diabetes, arthritis, sclerosis, respiratory diseases, depression, end-stage renal disease all of which are on the rise as explained by Ramirez & Sylvia (2008).
The increasingly aged population which is estimated to be increase by 20% by the year 2030 is one of the most rapidly rising ageing population in the world, and this has played a big role in the rise of the prevalence (Wong, 2008). While this may also be attributed to better detection methods at early stages, it has had a notable impact on the nursing fraternitys daily routine as patients require continuous attention of health workers especially nurses to attend to them. This in turn puts strain on the already stretched nursing work force, prompting even the government to plan reducing the estimated patient nurse population ratio from the current 249 to 210 patients for every nurse so as to ease the pressure on nurses. As observed by Wong and Chieh (2008), Singapore has about 34200 trained nurses to take care of about 8 to 10 patients in the larger hospitals.
Social care burdens of the Singaporean nurses are evident due to an increasing number of elders with a preference for home based care as it is with most developed economies (Brenda and Yeoh, 2009). The most common stressors in nursing profession include workload and emotional distress due to continuous contact with the afflicted. In addition, prominent job dissatisfaction usually arise from role ambiguity and conflict of interest which is as a result of unscheduled job assignments which is often the case when dealing with aged patients with chronic diseases (Parikh, Atish, & Tanmay, 2004). Generally, the patients expectations in Singapore have gone up and increasingly nurses need to be very competent in medical and/or psycho-social assessment. In addition, general continuous professional development to keep up with global trends and be at par with nurses hired from China, Philippine and other countries to cater for the shortages (Wong & Chieh, 2008). The recognition of Advanced practice Nurse (APN) by the government and regulators was welcome. Nurses have to keep up to date registers and at the same time contact new patients who might be disinterested in honoring follow-ups (Cleary, Horsfall, Mathulakshmi, Hapell, & Hunt, 2013). The contemporary nurse has a role of developing a personally tuned plan for each patient that will ensure or enhance compliance. He or she has to also act as an accessible link between the patient and professionals so as to maintain condition improvement and prevent worsening health which would not be beneficial to the health workers, the government or the individual (Cheah & Heng, 2001). The nurses also have to juggle between managing home based patients and in-hospital assignments in a country that is still working to establish community nursing programs. For these reasons, newly recruited nurses who are starting on the chronic disease management programs undergo more training for extra medical skills especially in physical examination and prescribing, identifying multiple conditions so as to develop a realistic rehabilitation plan.
The impact this has had on the individual nurse is that too much demand on the nurses lead to job dissatisfaction and consequently many social and psychological disorders when stress levels are beyond the nurse coping ability as reflected by Tosh, Anq, & Devi (2012). Nursing is ranked top as most stressful job in health and/or medical occupation and 27th in 130 diverse occupations by the American national institute of health (Golshiri, et al., 2012). Unexpected response of patients, irregular patients conditions and sharing of the patients psychological situation are some of the contributors to emotional distress among nurses. In the medical profession, one of the most rewarding attribute is the positive response of a medical case a health worker is dealing with. Most of the doctors do not interact with the patients with chronic conditions as much as the nurses do, more so if the patients are elderly and have to be cared for at homes, the nurse who handle such cases have to remain committed to caring for an aged patient with sometimes debilitating chronic condition that will only end fatally. Sometime, they may not be at liberty to reveal the outcome of the condition and these impacts negatively on the psychology of the average nurse.
Chronic diseases have a largely negative impact on the health system. Some of the positive impact is that clinicians and nurses get real experience and are more prepared to deal with similar conditions in future. This is not an advantage that the state maybe looking forward to discourage because, the diseases experienced during old age present a bigger challenge in terms of the fiscal demand, especially in sheer consideration that 80% of Singapores primary healthcare is provided by the state as put by (Wong & Chieh, 2008). While the remaining 20%, is reliant on private sector and/or family health care providers. Chronic diseases have a protracted timeline with most of them ending fatally, or leaving the individual in a state that they cannot manage to contribute to the economy positively (Baker, 2011). The eminent conditions also present a huge budgetary constrain on healthcare facilities due to issues like readmission, and continuous follow ups among other health care services. This calls for a multifaceted approach and complications management as well as community care centers that would serve as prevention and management points (Ramirez & Sylvia, 2008).
This is usually complicated by duplication of cost and services where a patient moves to a different health facility or on other health care service providers due to claims of dissatisfaction. This becomes a great challenge when there are no online patient databases and only acts to tie up funds which would have been used on other patients. In future clinical data may have to be put online or on a platform that can be share by health practitioners countrywide so as to prevent duplication and enhance sharing of information from the data from various health facilities under the ministry of health (MOH). Such a move would will ease sharing of experiences also by doctors and nurses and eventually lead to better healthcare. Under the primary care partnership scheme and the Elder shield insurance, the government is reported to be actively involved in providing essential subsidies for chronic diseases. This serves as cushion for the savings of patients with significant chronic conditions (Wong & Chieh, 2008)).
In addition to the above issues, there is also direct pressure on hospitals facilities. To illustrate this, in 2008, the number of hospital beds that were available in Singapore would only serve patients at a ratio of 3 beds per every 1000 patients requiring admission (Wong & Chieh, 2008). Hence, as the population becomes more elderly the demand for such basic needs would increase. In addition, the work load on the side of the nurses would also double, noting that they are also in the process of aging.
While the state encourages maximization on funds such as the Medifund, Medisave and Medishield so as to balance between affordability, accessibility and quality and give Singapore one of the best medical services in the world as observed by (Wong & Chieh, 2008). Singapore is ranked 6th worldwide by the world health organization. Despite this, the medical services are still not free of charge and this is crafted so as to curb over utilization and indirectly encourage healthy lifestyle that in turn will reduce the prevalence of lifestyle-chronic disease in old age (Baker, 2011). The largely simple approach of the Singaporean government creates a different approach on Medicare where everybody is covered as opposed to the US version where a large number of people are left out as reported by Cheah, Wong, and Pang (2010).
As demographic trends gravitate towards more people above the bracket of 65 years, healthcare systems become more challenged by chronic diseases of old age; hence, the need for more inclusive healthcare. According to Kalisch, Lee, and Monica (2010), nurses may have heavy workload in hospitals, care centers and home-based patients but they remain adequately compensated and very motivated. In addition, majority of them consider passion and not salary as the driving force. Teamwork, patient, compliance and trust has been associated with high level of job satisfaction where it exists.
With a promise from the government of a possible 20% pay rise in 2014, and Advance Practice Nurse Recognition, nursing practice in this country will only get better opportunities and their roles continue expanding as observed by Derbyshire & Davies (2011). APNs have more authority and more involvement in patient management especially those with chronic diseases who are under their care. They act as bridge between the nurse and the doctor. Nevertheless, there is an ongoing cause of concern for doctors who may feel less powerful and fail to provide support to these advanced nurses and the nursing practice; hence, the need for clear roles to prevent over wrapping between the nurses, APNs doctors and specialists (Mehta, 2006).
Singapore may have one of the highest percentages of chronic diseases among the aged in the world, but this city state has managed to attain one of the most successful health systems in the world in terms of efficiency, effectiveness and government involvement. The nurse in Singapore has a central role. The recent recognition of APNs will go a long way in retention of most experienced nurses in Singapore. The integration concept will also help management of community based care by providing support framework for aged care facilities and nursing homes, by moving from compartmentalization to an information sharing system. The nursing practice has not and will not rise above specialists practice and doctors role in caring for aged patients with chronic diseases, but it has received more recognition and will continue to be fundamental in the healthcare system of Singapore.
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