Sánchez-Martín C Inmaculada
Delegación Territorial de Salud de Gipuzkoa, Donostia-San Sebastián, España.
Enferm Clin. 2014 Jan-Feb;24(1):79-89. doi: 10.1016/j.enfcli.2013.12.007. Epub 2014 Jan 25.
The increase in chronic diseases and the progressive ageing of the population is a source of concern for the different agencies with responsibility for health care. This has led to the creation of many documents focused on the analysis of the current situation and care of chronic diseases, including the WHO recommendations intended to assist countries and health services design and implement strategies that will address the existing demand, control and prevention of chronic diseases. In addition, there is a need to respond to the demand generated by chronic diseases in every sense, and from the different systems it is becoming more difficult to get enough support from multidisciplinary teams where the nurse has a central importance. While chronic diseases are becoming a threat due to the costs they generate, it is also an opportunity for nursing to be at the forefront for advanced care requirements, performed by professionals with recognized advanced clinical skills and ability for case management while monitoring and controlling complex chronic patients. The different services of the National Health System have introduced nurses that play different roles (cases managers, liaison nurses, advanced practice nurses and so on). However, it could be argued that they are not being trained to a desirable development level. It is therefore time for health care authorities to determine the role of the advanced practice nurse in relation to functional positions, and allow them to make an advance in the development of unified skills for the whole National Health System. From our experience we have learned that the advanced practice nurse is a resource that helps in the sustainability of services, thanks to the efficiency shown in the results obtained from the care given to both chronic and complex chronic patients.
慢性病的增加以及人口的逐步老龄化是负责医疗保健的不同机构所关注的问题。这导致了许多专注于分析慢性病现状和护理的文件的产生，包括世界卫生组织的建议，旨在协助各国和卫生服务机构设计和实施应对现有需求、控制和预防慢性病的战略。此外，需要从各个方面应对慢性病产生的需求，而从不同系统中越来越难以从多学科团队获得足够的支持，在这些团队中护士起着核心作用。虽然慢性病因其产生的成本正成为一种威胁，但这也是护理行业的一个机遇，使其能够站在由具有公认的先进临床技能和病例管理能力的专业人员，在监测和控制复杂慢性病患者的同时满足高级护理需求的前沿。国家卫生系统的不同服务部门引入了扮演不同角色的护士（病例管理员、联络护士、高级执业护士等）。然而，可以说他们没有得到理想的发展水平的培训。因此，现在是医疗保健当局确定高级执业护士在职能岗位方面的作用，并允许他们在整个国家卫生系统中统一技能发展方面取得进展的时候了。从我们的经验中我们了解到，高级执业护士是一种有助于服务可持续性的资源，这得益于对慢性病和复杂慢性病患者护理所取得的成果中所显示的效率。
