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国际护士理事会第23届会议热点
Highlights of the 23rd Quadrennial Congress of
International Council of Nurses Congress
2005年5月21－27日
台湾台北
May 21-27, 2005; Taipei, Taiwan
Barbara Sheer, DNSc, FAANP
Introduction
Taipei is a modern city with an ancient past. Arriving at the modern Chiang Kai-shek Airport was a pleasure. Before we went through customs, we saw a familiar sight -- the International Council of Nurses (ICN) logo was located on a table with information for ICN conference participants. This was our introduction to a modern city, where skyscrapers and ancient temples exist side by side. The venue for the conference was the Convention and Trade Center, which happens to be within a block of the world's tallest building, "Taipei 101." The transportation system is efficient, and much of city can be accessed by the subway system called the MRT (Mass Rapid Transit). Many of the signs are in English as well, easing the way for foreign travelers. When travelers look lost, the Taiwanese citizens often offer assistance. Help offered to us ranged from help with subway tickets to offering to share umbrellas.
The Opening Ceremony
Under tight security, the doors opened on May
22, 2005 for the 23rd Quadrennial Congress of
the International Council of Nurses (ICN) in Taipei.
After a brief welcome from Judith A. Oulton, ICN
Chief Executive Director, the parade of nations
began with delegates dressed in their national
dress, representing over 131 countries. It was
an inspiring site to see all the countries march
in side by side, sharing the same goals for health
in their communities and nations. There was a
global presence and an atmosphere of solidarity.
Included in the march this year was the group's
newest member, the United Arab Emirates.
Christine Hancock, ICN President, opened the ceremony and introduced Chen Shui-Bian, President of Taiwan, for official greetings. In his opening remarks, President Chen praised the work of the Taiwan Nurses Association for their century of achievement in research, leadership, and their contribution to the health of a nation with a population of 23 million people.[1] Taiwan's healthcare status is ranked second in the world. Taiwan has also offered disaster relief when needed by the global community. Despite these efforts, Taiwan has been denied membership in the World Health Organization. President Chen made an appeal to the audience of 3500 nurses to use their collective influence to make healthcare a humanitarian rather than a political issue.
The President of the Taiwan Nurses Association, Sheuan Lee, welcomed the audience and said, "We make dreams come true. Let us write a history for history will honor us."[2] In her address, she recalled that since the last ICN Congress, the world has seen many disasters. Nurses are in a position to heal the wounded but need knowledge. Knowledge is the power to do things in the right way. Through innovation, we can look at the world from a different angle and contribute to society. Finally, nurses need to have the vitality to continue to generate new knowledge and pass it on to others. The conference theme of knowledge, innovation, and vitality was the common thread that connected the keynote addresses, concurrent sessions, and the participants.
Special Awards
Two awards were given at the ceremony. The Christiane
Reimann Award, ICN's most prestigious award, was
given to Dr. Margretta Madden Styles, a former
president of ICN and the American Nurses Association
(ANA), for her lifelong commitment to leadership
in nursing. Dr. Styles has done significant research
on credentialing, education, and regulation. She
accepted the award with grace and dignity in the
presence of her children, who attended the ceremony.
The Human Rights Award was given to Stephen Lewis, UN Envoy for HIV/AIDS in Africa, for his contributions to health and human rights. This award is the only award given to someone who is not a nurse. In accepting the award, Mr. Lewis recognized the nurses who struggle against AIDS and the millions who live with AIDS every day. The following day, he gave a keynote address with a focus on health and human rights. Mr. Lewis is a long-time advocate of both health and gender equality.
The ICN President, Christine Hancock, introduced the conference theme.[3] Innovation, knowledge, and vitality are the core of nursing care. Healthcare is evolving. From a global perspective, nurses see natural and manmade disasters. For instance, hunger and poverty coexist with a global of epidemic of obesity. Nurses are on the move, gaining knowledge and creating innovative ways to deal with health issues. In the address, Ms. Hancock highlighted 2 issues: the nursing workforce and the impact of HIV/AIDS.
The global shortage and the migration of nurses are significant issues. Ms. Hancock called upon every country to support the education of their country's nurses. Nursing is not a commodity to be outsourced. Most nurses are underpaid, and despite expertise in healthcare, their voices are not heard in the political arena. With wealthy countries recruiting nurses from poorer countries, nursing migration is a grave concern that leaves the poorer countries with a severe nursing shortage. Workforce issues must be addressed on a global scale.
The second issue is the impact of HIV/AIDS. In Africa, a generation has been lost because of the devastation of HIV. Ms. Hancock reported that in some countries, 80% of the healthcare is delivered by nurses. She called upon nurses to be role models. Nurses care for the patients and the communities. Nurses take action. Richer countries can learn much from the poorer countries. Nursing is caring in action.
Cultural Entertainment Experience
After the address, the audience was treated to
a wonderful program of entertainment. The program
brought together unlikely performers in song,
dance, and acting. The program, entitled "The
Sound of Ocean and Mountains," was performed
by the U theatre and Zhuo-Feng Primary School
choir. The Zhuo-Feng primary school educates the
Bunun children, who are one of 10 indigenous tribes.
In 1952, when a recording of the children's song
was sent to UNESCO, musicology scholars were surprised
that a primitive tribe was able to create sophisticated
and beautiful harmonies.[4] This event had an
impact on Western musicological theory. The children
are educated in their own tongue and culture,
helping them gain an understanding of their traditions
and share them with others. Dressed in their native
dress, they sang, and their harmony filled the
auditorium as the audience fell silent.
This performance was paired with the U Theatre. The U-people believe that a combination of Tao and artistic skill is the goal of life. The performances delve into the meaning of self. The program was a blending of differences to create a harmonious cultural experience. This was a microcosm of the 4000 Congress participants who came to learn from each other, network, and then return to their respective countries with a better understanding of the world we live in and the world we serve. And so the conference began with great expectations and anticipation. The entertainment program clearly set the stage for the days to come.
Nursing and Innovation
In a session entitled "Nursing at the Forefront
of Innovation," Frances Hughes, Professor
in the School of Nursing and Director of the Center
for Mental Health Research, Policy and Service
Development at the University of Auckland, New
Zealand, highlighted significant innovations of
nursing throughout history.[5] Dr. Hughes gave
examples of nursing innovation in research, practice,
technology, and policy. She began by discussing
the Native Health Nursing Scheme of 1911 that
was a response to a population need. The scheme
raised the profile of nurses and gave them increased
autonomy and accountability to care for indigenous
populations. Dr Hughes offered news clips from
1946 to visualize the district health nurse who
arrived to care for the Maori by grey car and
horseback. The district health nurse was the healthcare
link to the community. She was caring, autonomous,
and offered access to care for remote populations.
In the area of research, the work of Linda H. Aiken, PhD, RN, University of Pennsylvania, was highlighted. Dr. Aiken was a pioneer in interhospital outcome studies and applied objective performance measures to establish evidence-based practice and the development of the magnet hospital movement.
The Tongan Health Society Diabetes Clinic in Auckland, New Zealand, was presented as an innovative practice model. The clinic offers holistic care and consultations in Tongan language in a cultural setting with native music in the background. Exercise classes are offered along with podiatric services. Patients are encouraged to come to the center for coffee or lunch. Another innovation is a mobile surgical service consisting of a bus that travels to remote areas and offers surgical procedures to those who cannot access traditional healthcare services.
Nurses have been leaders in using technology and health informatics. In New Zealand, in conjunction with Microsoft NZ, 145,000 people benefit by the use of smart phones that assist in integrating health information.
Two policy examples were given. The first example was the Kenyan Nursing Workforce Project, designed to measure workflow data, such as the outmigration of Kenyan nurses. The data can be used to facilitate planning for an effective workforce and assess the impact of HIV/AIDS on nursing.
The second was the UK Community Matrons, established in 2001.The project aimed at securing and assuring high standards through leadership, ensuring support systems, and providing a visible and accessible presence for nursing in healthcare.
Sometimes described as a "disruptive" innovation in healthcare, nurse practitioners (NPs) provide quality care and devote more time to the patients. Dr. Hughes believes that innovation is an integral part of all strategies. Leadership clears the way for creativity, and technology is an enabler.
Nurse Practitioner/Advanced Practice Nursing
Network
After a brief introduction by Dr. Rosemary Goodyear,
the chair of the NP/APN Network, Dr. Loretta Ford,
the founder of the NP movement 40 years ago, addressed
the audience.[6] The United States currently has
106,000 NPs. About 75% to 80% are master's prepared.
Educational programs are graduating 5000 to 6000
new graduates per year. However, the numbers do
not tell the whole story. NPs across the country
contribute significantly to the healthcare workforce.
Healthcare is about power, control, and money. NPs are a powerful group but have often been invisible in terms of reimbursement and prescribing medications. They have been able to fill in the gaps and provide accessible affordable care to those who need it most. The Minute Clinic, a new innovation in healthcare, is an NP-managed health system that provides efficient, cost-effective healthcare that is accessible.[7] The model was piloted in 2 locations in Minnesota and Maryland. The concept is simple: the clinics are located in retail stores and commercial venues to care for people with common illnesses, with a minimal wait. No appointments are necessary.
The patient signs in and may be given a beeper so they can shop while waiting. The aim is for the patient to be seen within 15 to 20 minutes for common illnesses. The cost is a fraction of that of an urgent care or emergency room and accepts most insurance plans. Information about the visit is sent to the patient's primary care provider. Common tests can be done and prescriptions written and filled in the area. With the escalating healthcare costs and the increase in the number of uninsured, this model is supported by patients, insurers, and industry. As the concept is expanded, additional NPs will be needed to fill the growing demand.
Advanced Practice Developments in the Far East
A panel moderated by Madrean Schober, MSN, past
chair of the NP/APN Network, focused on the development
of advanced nursing practice in Taiwan, Hong Kong,
and Singapore. The first speaker, Dr. Yu-Mei Chao,
Research Fellow of the Center for Health Policy
Research and Development, National Health Research
Institutes, and 3rd Vice President of ICN, represented
the Taiwan Ministry of Health.[8] Although the
concept of advanced practice nursing began in
the 1970s, it was not supported by stakeholders
in these countries.
A resurgence of interest in advanced practice nursing occurred in 1995 with the implementation of National Health Insurance. Health services are cost driven, and medical residents could no longer provide the core workforce. Nursing was in a position to fill the gap. Twenty-five percent of the nurses in Taiwan have a bachelor's degree or higher. Seizing the opportunity, nursing was in a position to collaborate on a proposal to design NP training. The purpose of the policy is to upgrade education, establish national standards, and improve collaboration. In August 2005, a 3-month training program will begin to orient physicians and nursing faculty to teach in the new curriculum.
Dr. Woung-Ru Tang, Associate Professor, Director, APN Program, Chang Gung University ( CGU) School of Nursing, in Tao-Yan, Taiwan, described the advanced practice graduate program that has been in place for 2 years.[9] In addition, Chang Gung Memorial Hospital (CGMH), the largest medical center in Taiwan, has trained several hundred NPs in the past 20 years under a hospital-based training program. Currently, 354 NPs provide primary care at CGMH.
To fully prepare an NP to provide high quality of care in the changing health system, CGU develops an APN program at the graduate level under a higher education system. For quality control, only 20 students are selected from 140 applicants each year. Through international collaboration with Oregon Health and Science University, the APN program receives excellent comments, not only from Taiwan but also around the world. The hope is that the NP training in Taiwan can shift from hospital-based training program to a higher education system in order to promote nursing professional status and provide high quality care.
Dr. Alice Yuen Loke, Associate Professor, School
of Nursing, Hong Kong Polytechnic University,
gave an update of the master's program initiated
in 2001.[10] All nursing education in Hong Kong
is at the university level and advanced practice
is at the master's level. Additional information
on their progress can be found in the latest
NP/APN Network Bulletin
.
The final panel speaker was Beng Choo Ang, Chief Nursing Officer, Ministry of Health, and Registrar of the Singapore Nursing Board. The speaker pointed out that it is very clear that advanced practice nursing is on the move in this area of Asia from the development of advanced practice programs, to legislation, and regulation.
Accomplishments of the Advanced Practice Nursing
Network
The NP/APN Network was formed to share information
and provide support for countries developing the
advanced practice role. Since the group began,
a definition of advanced practice has been approved
and a scope and standards of practice is in its
seventh draft and is available on the
NP/APN Network Web site
Four bulletins are published and have been translated
into French and Spanish. The NP/APN Network is
looking for additional members who are interested
in advanced practice to be part of the membership,
serve on committees, and offer their expertise
as part of the resource bank.
Over 50 countries have been identified as either
having or establishing advanced practice roles.
Everyone is welcome, and there are vacancies on
some committees. The next NP/APN Network conference
will be held in Sandton, South Africa, June 28-30,
2006. A call for abstracts is due by August 1,
2005. Information is available by sending an email
message to
np2006@denosa.org.za
. As the ICN conference drew to a close, we accomplished
more than we dreamed possible. Nursing is on the
move. Nurses are knowledgeable, innovative, and
vital. We have come together and are a global
force for change.
Figure 1.
Hong Kong Nursing Council
Figure 2.
Malaysian Nurses at the ICN Network Exhibit
Figure 3.
Rosemary Goodyear, Loretta Ford, and Aiko Yamamoto
(Japan)
Figure 4.
Panel: Barbara Sheer, Elizabeth Foley (Australia),
Madrean Schober, Petri Roodbol (The Netherlands)
Figure 5.
National Theatre and National Concert Hall
Figure 6.
Chiang Kai-shek Memorial Hall
Figure 7.
National Theatre and National Concert Hall