Multidisciplinary Primary Care –Nursing Perspective

Thomas K S WongThe Hong Kong Polytechnic University

Report on the WHO/PEPFAR Planning Meeting on Scaling Up Nursing and

Medical Education , 2009

• More than 800,000 doctors and nurses are needed!

• Appropriateness questionable – super-specialists

• Equitable access – rural versus urban demands

• Scaling up medical and nursing education

Research Bulletin (ICN, 2010)

• Global Nurses’ Survey 2009• Sample: 200 nurses in 11 countries• Findings:

– Only 53% were highly likely to stay in the profession

– Although working life seemed improving, almost 50% said their daily workload was worse now than5 years ago

• Health related issues in community - Health, fitness & well-being- Mental health- Sexuality- Obesity- Substance abuse- Social enterprise & poverty- Child abuse- Suicide & death- ……….

Key Areas of Intervention

1. Strengthening educational resources and infrastructure

2. Training and retraining faculty staff3. Making education and training

appropriate and relevant to the needs of populations

4. Decentralizing educational opportunity

Key Areas of Intervention (cont’d)

5. Investing in innovative educational strategies, methodologies and technologies

6. Improving quality assurance and performance mechanisms

7. Linking to national planning processes including other sectors

Key Areas of Intervention (cont’d)

8. Ensuring that regulatory frameworks will create enabling conditions

9. Costing and financing

Transformative EducationTransformative Education

Transformative Education

• Capacity to transform• Making the world and ourselves more

comprehensible• Transform itself, others and collectively the

system• Means sustainability and growth

Transformative power of educationTransformative power of education

School without WallsSchool without Walls

School without Walls

• e-Platform – education, services and research

• Contributors – teachers and practitioners of health related disciplines, students, patients

• Curriculum structure – generic and specific; progression based on mastery level

School without Walls (cont’d)

• Learning approach – PBL, coaching through case conference, simulations, practice under augmented reality, clinical practice (both tele-consultation and physical consultation)

• Assessment – increasing use of health outcome as measurement of learning, be it in simulations, augmented reality or patient community

School without Walls (cont’d)

• Resources – e-library including Cochrane Collaboration, multi-national faculty, mentors, and other stakeholders (Global network)

• Quality assurance – constant peer review (both local and international), public monitoring and professional accreditation

• Potential barriers – Language and government commitments

Sharing of Good Practice

• Uganda – extensive use of communication technologies, community based curriculum and PBL in Makerere University

• India – community based curriculum in Christian Medical College using health indicators to inform curriculum including assessment and quality of students

• Ethiopia – community based inter-disciplinary learning through research that addresses the multi-faceted health challenges in Jimma Medical School

Sharing of Good Practice (cont’d)

• Brazil – ‘open university’ approach for shared distance learning adopted by 12 universities to train 52,000 family physicians and 110,000 health managers using communication technologies in 3 years

• Hong Kong – Chinese Consortium for Nursing Higher Education, an example of academic partnership http://www.chinesenursing.org/

http://www.chinesenursing.org/

Telehealth System

PolyU serverPolyU server

InterfaceInterface介面介面

数御射乐礼书

数

御

射

乐

礼

书

Advanced Practice NurseAcademics & StudentsMedical PractitionerTCM PractitionerNutritionist

Information TechnologistEngineer

BiostatisticianResearcher

PublicityStaff

Community partners (NGOs, Police, Estates, District Board)

Video Conference

APSS IVY - Talked to client today … He is upset because of his illness and how it impairs his life…. He admits to be a unhappy person and feels empty in his life due to his illness. He, however, is not able to express anything different in his life if he is able and healthy. Willing to continue talking to me about his life and family for the next follow up.

CounsellingCounselling ((InitialInitial) )

APSS IVY – 今天与病人交谈，病人情绪不太好，疾病影响着他的生活，使他觉得自己是一个不开心的人并且生活很空虚，然而，他无法具体表达现在的生活给他带来的具体感受。他渴望在下次的复诊中继续和我倾谈。

APSS IVY - Seen client to be in better spirit…He had a few options to solve the problem and after talking for a while, he would try to approach his friends for help…He admits his social circle has widen and he is quite happy about it. He also met with this lady who is also an ex patient of stroke. ….Will continue to give positive feedback at the next session as well.

CounsellingCounselling ((LaterLater StageStage) )

APSS IVY – 与病人再次见面，他的情况有所好转。在交谈一会之后，他有了一些处理问题的想法，他尝试接近他的朋友们去寻求帮助。他觉得这样很快乐。他也与一位前中风患者见面我想他将会继续我们正面的反馈在下一个阶段

Knowledge Based EconomyKnowledge Based Economy

1. Growing potentials come from knowledge and source of knowledge

2. Speed determines outcome3. Inevitable openness resulted

from change4. Technology based innovation

Knowledge Based Economy (cont’d)Knowledge Based Economy (cont’d)

5. Innovation push for infinity• Law of DisruptionChange Technological change

Social change

Industrial change

Political change

Time

Education for the 21st Century(Commissioned by UNESCO, 1995)

4 Pillars of Education

• Learning to do

• Learning to know

• Learning to be

• Learning to livetogether

Entrepreneurship in Higher Education(Kauffman Foundation, 2007)

• Fundamental purpose of learning: Intelligibility

• By making the world and ourselves increasingly comprehensible and thereby manageable, education establishes a foundation for human growth, creativity, fulfillment and progress.

Entrepreneurship in Higher Education (Cont’d)

• Higher education must reflect the experience and conditions of contemporary life.

• Teach students how to make sense of and how to affect the reality in which they will actually live.

Current Roadblocks

• Shortage of appropriate human resources and funding

• Rigid curriculum structure• Traditional pedagogies and

assessment methodology• Lack of incentives• Internal organizational structure

This is more than simply negotiating the different languages and ways of working -- it is about appreciating a breadth of knowledge in theory, approach and discourse.

A second challenge is the disjunct between, on one hand, rhetoric encouraging interdisciplinary research and, on the other, the lack of institutional structure and support for it.

Contemporary discourse

NATURE MagazineVol. 445 | 22 February 2007

Crossing boundaries, hitting barriers

"If universities want to attract innovative young researchers, they should support integrative research"

NATURE MagazineVol. 447 | 7 June 2007

The University of the FutureNature (2007), 446:7139, 949

• Question: How does university serve a society in which people may have to retrain and recreate their careers throughout their adult lives?

• Answer: (1) Actively engaged in issues that concern them; (2) Relatively open to commercial influence; (3) fundamentally interdisciplinary in its approach to both teaching and research.

Interdisciplinary Education

• Philosophical change : from single-disciplinary to, multidisciplinary, interdisciplinary and transdisciplinary focus

• Undergraduate students : experiences span more than one traditional discipline

• Graduate students : acquiring ‘requisite’knowledge in one or more disciplines

Interdisciplinary Education (cont’d)

• Signature pedagogies– Coaching– Simulation– Role-modelling– Co-operative education– Articulating experiential learning

World Class University

The Rise of Asia’s UniversitiesRichard Levin, 2010

President, Yale University

Think Globally, Act Locally

Thank you!あいがとラございました

Report on the WHO/PEPFAR Planning Meeting on Scaling Up Nursing and Medical Education , 2009Research Bulletin (ICN, 2010)Key Areas of InterventionKey Areas of Intervention (cont’d)Key Areas of Intervention (cont’d)Transformative EducationSchool without WallsSchool without Walls (cont’d)School without Walls (cont’d)Sharing of Good PracticeSharing of Good Practice (cont’d)Interface介面Knowledge Based EconomyKnowledge Based Economy (cont’d)Education for the 21st Century�(Commissioned by UNESCO, 1995)Entrepreneurship in Higher Education (Kauffman Foundation, 2007)Entrepreneurship in Higher Education (Cont’d)Current Roadblocks The University of the Future�Nature (2007), 446:7139, 949Interdisciplinary Education Interdisciplinary Education (cont’d)World Class UniversityThink Globally, Act LocallyThank you!