Community Virtual Ward will set the direction of the future of nursing care

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The concept of a Community Virtual Ward, which was recently tested by the Office of the Department of Health Chief Nursing Office, would set the direction of the future of nursing care, Rachel Kenna, Chief Nursing Officer, Department of Health, told a HMI Dublin Mid Leinster regional meeting.

It was tested on foot of the Labour Court Recommendations for a new Enhanced Nurse Role as part of the new contract. Its objective was to facilitate a sustainable shift of care from the acute setting to the community, through reorganisation of nursing resources and to support the implementation of new approaches to chronic condition management, in line with Sláintecare.

Rachel Kenna
Rachel Kenna

Ms. Kenna was speaking at a ZOOM meeting on “Policy Development and Leadership in Irish Healthcare reflected through the role of the Chief Nursing Officer, Department of Health.”

HMI Council Member, Sharon Morrow, who chaired the meeting, welcomed everyone . She said Ms. Kenna was a registered general and children’s nurse and was previously Deputy Chief Nurse in the DoH and Director of Nursing at CHI Crumlin. Ms. Morrow thanked GSK for sponsoring the meeting.

The Community Virtual Ward modernised integration to support the shift in care to the community and managed a full episode of care that included acute and community nursing services.  

Ms. Kenna said the proof-of-concept of a Community Virtual Ward which they had tested, involved patients with chronic respiratory disease who were discharged earlier from an acute hospital and their subsequent care delivered in their own homes.
“There was a connection back to the hospital, but it was a nurse led solution. The Community Virtual Ward integrated the acute hospital and the community nursing service, enabled by remote monitoring technology. There was shared care with the community with mobility of nursing care delivered through a blended model of remote and direct care. This could be developed to support nursing teams across CHNs and regions.

“A Community Virtual Ward does not have physical beds –it is a model of care that emulates aspects of hospital care in the home,” said Ms. Kenna.

She said the Community Virtual Ward delivered:

  1. Targeted specific interventions in the home, based on the individual’s needs.
  2. A pathway of care that crossed service boundaries, e.g. hospital and community and improved timely access to diagnostics and services based on need.
  3. It used technology enabled solutions to maximise care delivery, engaged patients in their own care and supported mobility of nursing care across the hospital and community. They could do assessments over the ‘phone and see if it was necessary to intervene or if there was some other form of care they could bring on.

The Community Virtual Ward modernised integration to support the shift in care to the community and managed a full episode of care that included acute and community nursing services. Community nurses delivered care in the CVW, they had access to an ANP and there was Consultant and GP connectivity across all care delivery for patients.

It provided clear and robust governance structures to ensure clarity on authority, accountability and decision making. This was a combined governance structure. In this instance, patients stayed under governance of the acute hospital because they had left the hospital early.

It provided a model of care for mobility of nursing services delivering shared care to include the hospital to community. It contributed to bridging the gap between access and coverage, with the community as the central point of contact and enabled the economic value with nurses working to the top of their licence.

The Chief Nursing Office said that when Patient Related Outcome Measures were examined, there was an improvement in symptoms, an improvement in self-efficacy, improved health related QOL, improvement in exercise tolerance and increased adherence.

The cost of care comparator in the Community Virtual Ward was €80 a day, compared to €800 a day for the acute hospital.

Ms. Kenna said that in line with Sláintecare, the Community Virtual Ward provided a community nurse-Led model of care and a capability framework for advancement of community nursing practice that integrated with the acute hospital to bring care closer to home.

It supported flexibility of nursing roles and skill sets that were transferable across community-acute services. This included upskilling of community nursing in chronic disease management and upskilling of acute hospital nursing in case management in the community.

“The general principles of a CVW model will assist in informing community nursing practice development and create opportunities.”

“Nursing and Midwifery have the capacity to bridge the gap between access and coverage, co-ordinate increasingly complex care, fulfil the potential as primary care givers to the full extent of their education and training, enable the full economic value of the nursing and midwifery contribution across care to be realised and change the reference point from which nursing and midwifery are judged.”

The role and responsibility of the Chief Nurse

From a Civil Service Perspective, the Chief Nurse operates at the level of Asst. Secretary General.   The Chief Nurse provides leadership and oversees several units, including Nursing and Midwifery Policy, Strategic Workforce Planning, Population Health Screening, National Patient Safety Office and the Professional Regulation Unit.   The Chief Nurse is a member of the Department Management Committee and works closely with the Minister for Health and the Taoiseach’s and other Government Departments and with operational healthcare services.

The primary responsibility of Nursing and Midwifery policy is to achieve national public health goals through nursing and midwifery.

It works with and oversees the National Patient Safety Office and its workstreams include:

  • Antimicrobial resistance & infection prevention & control which was biggest threat before COVID
  • Clinical effectiveness policy & framework 
  • Patient safety surveillance & performance
  • Patient safety legislation
  • Patient safety & advocacy policy 
  • Patient safety incidents
  • Patient safety governance

Ms. Kenna said the Irish Healthcare system was undergoing a huge amount of reform.  

“There is an opportunity for nursing and midwifery to play a front and centre role in creating the new reality. The modern health system has moved to include health promotion, maintaining health and prevention. Sláintecare will move the system to one that will provide patient centred care, delivered in the community over the next ten years. The response to COVID 19 and patient experience will also drive change in the system.

“The role of the Chief Nursing Officer is to ensure the contribution of the nursing and midwifery voice as part of the overall reform conversation and that the nursing and midwifery voice influences changes for care delivery.

The CNO provides leadership by taking part in the debates that influence health policy and by doing so with a clear understanding of the knowledge embedded in nursing practice. 

“Political policies at various levels dictate who gets what in a democratic society .  They dictate the distribution of resources and priority funding programmes.  You need to be at the table and taking part in the debate.

“To succeed, in the role of Chief Nursing Officer, I will need to be:

A Leader – co-ordinating integrating and evaluating nursery & midwifery, allied health professionals, workforce planning and regulation as a member of the Management Board

A Provider – Providing nursing and midwifery  policy direction. in line with the implementation of Sláintecare and emerging Government priorities. 

An Influencer – Building networks and inspiring general health policy development through a nursing and midwifery perspective.

A Collaborator – Participating in cross-Departmental work and joined-up policy thinking and development.

An Innovator – Driving, implementing and embedding high tech solutions into service delivery through re-tooling nursing, midwifery and allied health professionals.”

Ms. Kenna said Covid had a major impact on  shaping our health system for the future

  • During the past year frontline staff and healthcare managers had shown an ability to adapt and rise to the occasion.
  • Technology had been an enabler for nurses and midwives to continue to provide care and improve access and choice.
  • New approaches to care delivery and development innovation with nurses and midwives at the forefront would shape the future direction of policy.  

Achieving Universal Health Coverage was a Government priority and this would involve many challenges.

Governance and operations at a system level would need to be linked to health indicators at national, regional and local level.  “We need capacity, knowledge, expertise, agile regulatory bodies, robust health indicators that reflect the needs of population and robust financial modelling.  It’s a huge task before us in the coming years.

“There are increasing opportunities for nursing, with nurses as policy setters to address challenges. Nurses and Midwives should inform policy and practice across all layers,  They are able to lead policy changes, the language of policy and patient care makes them natural translators. They can coordinate care across multiple levels and they have professional credibility as experts in their field.”

Ms Kenna concluded by urging health managers to become involved in the discussion on the future of nursing.  “The Office of the Chief Nurse has an expert review underway on the professions of nursing and midwifery and we will be looking for volunteers to come and work with us on that.  if you want to get involved, contact the Chief Nursing Office.  There are projects on which we would love to have you participate.”