05/10/2022 Overview: Today was highly academically focused. We attended classes at BCU all morning, and then visited the Birmingham Botanical Gardens. Finally we had dinner at a lovely French restaurant called Bistro Pierre.
Nursing is an Action, Not a Title. This apt statement shared in today’s lecture stood out to me as the thread stringing together the international nursing community. All around the world, nurses work extremely hard to advocate for their patients and provide the best quality care possible. Today we learned how several health care services function in UK ; specifically we looked into various sects of health care, training, and educational provisions. Beginning with health care, the UK has both private and public services. The widely known National Health Service (NHS), is a public health service available to anyone living in the UK. The United States equivalent would either be Medicare or Medicaid. The NHS was created to facilitate free health care based at the point of need from the cradle to the grave. It is a complex system, being the largest employer in the UK, and the 5th largest employer in the world.
The NHS is great in many ways, but it is far from perfect. Similar to public health services in the US, there is gatekeeping interwoven in health provisions. Power dynamics play a large role in the NHS. General Practitioner Physicians (GPs) hold much of the authority in the UK health system. GPs are what Americans would consider Primary Care physicans.T hey gatekeep referrals to secondary care in most situations, expect in cases of an emergency. GPs are apart of Clinical Commisioning Groups (CCGs), which are groups of physicians who decide what services money is allocated for, and at which hospitals it is spent at. The business pitches for hospitals becomes complicated because the NHS has many private sector counterparts. A CCG’s location can influence access to patient care, especially because different CCGs will pay for certian health services while others will not. This practice is comparable to how some insurance companies in the US will cover a procedure while others will not.
We also learned about a few specific UK nursing practices. Operation Department Practioners (ODPs), while not offical registered nurses, work in anesthetics, surgery, and post-op care. Being an ODP is a very multidisciplinary career. ODPs assisit in surgeries and care, but they hold the primary goal of patient advocacy. There are a few professions in the US similar to the ODP, such as a scrub nurse or ICU case worker. It seems that an ODP would act in both of these roles, whereas in the US, our medical team members are much more specialized. To borrow some language from one of our BCU professors, in the US we tend to remain in our sillos of care. Being and ODP is a perfect example of multidisciplinary engagement.
In tandum with ODPs, we learned about Community nursing. Community nursing covers any nursing care patients need when they are in their own home and cannot make it to the GP.
These nurses preform patient assessments, wound care, continence care, hydration management, therapies, and palliative care; they can also prescribe medicines if needed. Community Nursing serves the community, so these nurses must adapt to diversity. They are not assigned based on religion, language, or background. Often times interpreters are available when there is a language barrier; however, community nurses need to be prepared to encounter multicultural experiences. There truly is not an equivalent to a community nurse in the US. We have palliative care home teams, who work with occupational therapists, social workers, and physician assistants. It seems that care in the United States is really spread out between individuals, but there is not a individual who encompasses all the skills necessary to care for a patient in full in the home setting.
Midwifery was the sect of nursing that we learned about that has the most similarities to practice in the US. Midwives engage with women during the antenatal period, pregnancy, birthing, and postnatal period. Women both in the UK and in the US are encouraged to begin antenatal care as early as 8 weeks of gestation. The average home birth rate in the UK is only 2.8%, but there has slight increase in recent years (which may be linked to the COVID pandemic). This low statistic is similar to the US, especially because it has become the social norm during the past 60 years to receive OB and midwifery care through local hospital clinics.
In the UK midwives are trained and qualified to act as the lead professional in normal vaginal births. We are fortunate that in the US, midwives can also take lead in forecep and water births. The most jarring part of today’s lecture was learning about maternal morbidity rates in the UK. For starters, they are quiet similar to that of the US, specifically to that of Pittsburgh, which is just sad. We learned that although the UK is one of the safest places in the world for a woman to give birth, Asian women are twice as likely to die in the birthing process and post-natal periods compared to white women. And black women are twice as likely to die in the birthing process and post-natal periods compared to white women. This latter statistic matches the prospects for black mothers in the Pittsburgh. I need to collect my thoughts on this complex health disparity. I may write about it later on during the trip.
I would just like to add a quick note about the Birmingham Botanical Gardens. Everything was so lovely there. The entire time we were exploring, I quite literally felt like a princess. I have to thank my parents for gifting me with a deep appreciation for the outdoors and for gardening in general. Hopefully, one day we can come visit as a family!
