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The Future of Renal Nursing
Patient Centered Care in the Digital Era
Marjelka Trkulja
Empowering renal nurses for the future
She started her carrier in 1993 as Renal Nurse in University Clinical Hospital Centre in Rijeka,
Croatia. From 2002 till 2008 she was mentor for haemodialysis part of the nursing education at
The School of Medicine in Rijeka.
From 2008 till 2017 was part of Fresenius Medical Care team in Croatia on the position of the
Country Nursing Manager, as well as EDTNA/ERCA Brand Ambassador for Croatia for 5 years.
She joint Fresenius Medical Care Management team in Bad Homburg as Head of Nursing Care in
2017.
RN, MSN, Director of Nursing Care
Marjelka Trkulja, Nursing Director
Prague, 15.09.2019
Empowering renal nurses for the future
Statistical facts 1
European health report 2018. More than numbers – evidence for all. Copenhagen: WHO Regional Office for Europe; 2018. Wan He, Daniel Goodkind, and Paul Kowal U.S. Census Bureau, International Population Reports, P95/16-1, An Aging World: 2015, U.S. Government Publishing Office, Washington, DC,2016 https://medium.com/the-mission/how-to-tackle-the-healthcare-worker-shortage-6e731db5c15d ERA-EDTA Registry: ERA-EDTA Registry Annual Report 2016. Amsterdam UMC, location AMC, Department of Medical Informatics, Amsterdam, the Netherlands, 2018.
15/09/2019 EDTNA/ERCA CES© 2019 Fresenius Medical Care
Incidence of
patients over 75 y
p. million age related
population in EU
.
>1100
60,6
76,7 -77,9
74,0-75,6
71,7-74,6
Prevalence mean age
Life expectancy
general population
2010-2015
.
Patient survival
probability (%) 2 years
2010-2015
Incident dialysis
patients with
diabetes survival
probability(%)
2 years (2011-2014
2010-2015
Statistical facts 2
15/09/2019 EDTNA/ERCA CES© 2019 Fresenius Medical Care
Population older
than 65
By 2050
16.7 percent of the world total
population
1,6 billion
33% increase
12,9 mil
1 in 4
The global
burden of NCDs
in people aged
60 and older
1990-2010
NCD: heart and lung
diseases, diabetes,
depression, and dementia,.
Global shortfall
of healthcare
workers
by 2035
World Health Organization
(WHO)
Population with
more chronic
health conditions
2012
CDC
Percent of people
over 65 who live
alone
2010-2016
29,9-30,9
European health report 2018. More than numbers – evidence for all. Copenhagen: WHO Regional Office for Europe; 2018. Wan He, Daniel Goodkind, and Paul Kowal U.S. Census Bureau, International Population Reports, P95/16-1, An Aging World: 2015, U.S. Government Publishing Office, Washington, DC,2016 https://medium.com/the-mission/how-to-tackle-the-healthcare-worker-shortage-6e731db5c15d ERA-EDTA Registry: ERA-EDTA Registry Annual Report 2016. Amsterdam UMC, location AMC, Department of Medical Informatics, Amsterdam, the Netherlands, 2018.
Usual circle of illness at present
15/09/2019 EDTNA/ERCA CES© 2019 Fresenius Medical Care
UNDER CONTROL
SYMPTOMS
RECOVERED
GP AND/OR HOSPITAL
HOME OUTSIDE
Long drive Waiting time
No/shortage of staff Equipment not working Nosocomial infections…
Need for Physiotherapy Antibiotic therapy
Pain Loneliness…
Illness
HOLISTIC PERSON
Physiotherapy
or other therapy
PEER
GROUP
Follow up
and recovery
CARE Visits
Health
education
Online peer
group
Nurse as
health coach or
case manager
App +
WebApp
Health
Tracking
Future circle of illness and change to person, not only patient
Health problem
Consultations
CARE Visits
Consultations
15/09/2019
15/09/2019 EDTNA/ERCA CES© 2019 Fresenius Medical Care
Empowerment of the patients
Home Stakeholder Consultation
In-center Bystander
Order
Empowerment of the nurses
15/09/2019 EDTNA/ERCA CES© 2019 Fresenius Medical Care
Dissatisfaction with nursing as a career
Leaving the job in the next year
Leaving reasons
Most often activities left undone
Replacement cost of each new nurse in 2007
What are we missing?
Nurses must stop 'eating their young’ and support their development!
25% 20-50%
Developing or updating nursing care plans (42%)
Comfort/ talk with patients (53%)
Educating patients and families (41%)
$82,000 to $88,000
poor nurse-physician relationships, poor leadership and burnout!
Eurohealth 2016; 22(1). Jones, C.B. (2008). Revisiting nurse turnover costs: Adjusting for inflation. Journal of Nursing Administration, 38(1), 11-18 https://www.nurseuncut.com.au/cne-nurses-must-stop-eating-their-young/
Empowerment of the nurses
Institute of Medicine 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. https://doi.org/10.17226/12956.
15/09/2019 EDTNA/ERCA CES© 2019 Fresenius Medical Care
Key recommendations
Nurses should practice to the
full extent of their education
and training
Nurses should achieve
higher levels of education
and training through an
improved education system
that promotes seamless
academic progression
Nurses should be full
partners, with physicians and
other health professionals, in
redesigning health care in
the United States
Effective workforce planning
and policy making require
better data collection and
an improved information
infrastructure
Empowerment of the nurses
15/09/2019 EDTNA/ERCA CES© 2019 Fresenius Medical Care
Education and practice
Education and training
Need for qualified nurses to meet changing population needs, technology development and care models
standardizing education for future needs
supporting higher education and career development
evidence based practice, innovation and research
developing critical thinking skills to make complex clinical decisions
Institute of Medicine 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. https://doi.org/10.17226/12956. European strategic directions for strengthening nursing and midwifery towards Health 2020 goals
Empowerment of the nurses
15/09/2019 EDTNA/ERCA CES© 2019 Fresenius Medical Care
Education and practice
Nursing Practice
Need to enable nurses to practice to the full extent of education and training
Regulations to enable practicing on highest education level
develop career paths as health coaches, nurse-led care clinics, system
innovators, nurse practitioners
engage in new paths in emerging fields like telehealth, informatics, and
genetics and genomics, and as scientists and leaders in society.
Institute of Medicine 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. https://doi.org/10.17226/12956. European strategic directions for strengthening nursing and midwifery towards Health 2020 goals
Empowerment of the nurses
15/09/2019 EDTNA/ERCA CES© 2019 Fresenius Medical Care
Effective workforce, leadership and data collection
Effective workforce and positive work environment
Leadership opportunities that engage nurses to realize the full potential of nursing
workforce
Promote positive workforce planning and optimizing skill mix to provide safe
and effective care
Involving nurses in health-care industry strategy development and
deployment
Information infrastructure and data collection
Institute of Medicine 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. https://doi.org/10.17226/12956. European strategic directions for strengthening nursing and midwifery towards Health 2020 goals
Empowerment of the nurses
15/09/2019 EDTNA/ERCA CES© 2019 Fresenius Medical Care
Partnering within Healthcare
Partnerships
Interdisciplinary and intersectoral collaboration for providing people-centred care and improved health outcomes.
Including nurses as effective members of the multidisciplinary team to:
Enable health systems to respond to changing demographics and burden of chronic
diseases,
Fully utilize current and future technologies,
Improve patient outcomes
Institute of Medicine 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. https://doi.org/10.17226/12956. European strategic directions for strengthening nursing and midwifery towards Health 2020 goals
Start of dialysis as science
194
5
Management of the dialysis machine
1945 -
2005
Management of the dialysis patient
200
5-
201
9
Full Partnering in Management of care?
201
9-
203
0
Future direction in nursing?
15/09/2019 EDTNA/ERCA CES© 2019 Fresenius Medical Care
Be an active driver of your own change and progress!
References
1. European health report 2018. More than numbers – evidence for all. Copenhagen: WHO Regional Office for Europe; 2018.
2. Wan He, Daniel Goodkind, and Paul Kowal U.S. Census Bureau, International Population Reports, P95/16-1, An Aging World: 2015, U.S. Government Publishing Office, Washington, DC,2016.
3. https://medium.com/the-mission/how-to-tackle-the-healthcare-worker-shortage-6e731db5c15d
4. Institute of Medicine 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. https://doi.org/10.17226/12956.
5. European strategic directions for strengthening nursing and midwifery towards Health 2020 goals
6. ERA-EDTA Registry: ERA-EDTA Registry Annual Report 2016. Amsterdam UMC, location AMC, Department of Medical Informatics, Amsterdam, the Netherlands, 2018.
8. Eurohealth 2016; 22(1).
9. Jones, C.B. (2008). Revisiting nurse turnover costs: Adjusting for inflation. Journal of Nursing Administration, 38(1), 11-18
15/09/2019 EDTNA/ERCA CES© 2019 Fresenius Medical Care
Plenarium