A recent literature review of studies conducted on the effects of substituting doctors with nurse practitioners and physician associates in the long-term care of elderly patients has found that they are as good - or better - than doctors in improving the health of older patients.

In fact, there has been a rise in countries around the world increasingly utilising nurse practitioners and physician associates to deal with care of the elderly.

Reducing the burden of an ageing population

The roles of nurse practitioners and physician associates began in the US with the first nurse practitioner in the 1940s and the first physician associate in the 1960s. Both roles now exist in over 50 countries around the world.

Trained in areas such as midwifery, anaesthetics and even performance of certain procedures, nurse practitioners can work independently of doctors whereas physician associates – as the name suggests – must accompany doctors.

Such ‘super nurses’ are as good as doctors at preventing deaths, prescribing drugs and performing physical exams. The researchers assessed factors such as patient morbidity, mortality, satisfaction, quality of life, quality of healthcare, medication use and costs.

The review conducted by researchers at Radboud University Medical Centre, Netherlands, found that these ‘super nurses’ were better able to prevent secondary complications following medical procedures and see care through to completion.

“Physician associates have an increasing role to play in primary care as part of a multi-skilled workforce, alongside pharmacists and advanced nurse practitioners,” says Professor Liz Hughes, director and dean at Health Education England.

More training of nurses will be required

The emotional costs of dealing with the fear and anxiety of elderly patients can also put a lot of pressure on increasingly busy doctors. Involving nurses more deeply in answering patient questions on the details of prognosis and side effects of therapy, as well as providing reassurance and support during treatment, will be able to provide support effectively.

However, specializing in areas such as palliative care and cancer would require nurses to train more. Komal Patel, a nurse at Brampton Civic Hospital in Canada, said she took on more qualifications to be better prepared to answer patient questions.

“Patients are constantly asking questions,” she said. “If I hadn’t been taking courses, I’d have to [tell them] ‘Okay, I’ll come back to you.’”

In Canada, nurses are offered courses incorporating evidence-based treatments, workshops, patient coaching and a heavy emphasis on how to listen and talk to patients about their emotional concerns.

“It allows for the most appropriate care for the patient that they’re looking after,” said Simonne Simon, an advanced practice nurse (APN) educator at one of Canada’s institutes.

Reducing the burden of ageing populations

With more training for nurses and specialisations, better quality as well as stable healthcare services can be given to patients. Physician associates will be able to provide “continuity of care” for patients,” according to Hughes, that GPs may find more difficult to fulfil.

Services of nurse practitioners and physician associates are also cheaper than doctors, which will help make healthcare more affordable in face of the soaring costs. In Singapore, the role of an APN is important to alleviate the burden of an ageing population with greater and long-term healthcare needs.

Thus, for countries with an ageing population, ‘super nurses’ will be seen as indispensable to fill the demand for better quality care for the elderly. MIMS

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