1. Nursing Needs for Elderly People in Lithuania Odeta Vitkūnienė Chief officer LNHS coordination and health care institution department 17 March, 2014 Klaipėda Conference EFEC: Ecvet for Elderly People Care

2. Challenges in health care systems Nursing legislation/regulation Development of nursing services ▫ Primary HC ▫ Patient-out nursing services ▫ Nursing at home ▫ Palliative care Trends and vision of nursing Structure of presentation

3. Challenges in health care systems Demographic trends (elderly, chronically ill) Increasing complexity of health care and technological developments High patient expectations and growing pressure for accountability: Patient safety and quality of care Access to care Health care workforce “Nurses and midwives: a force for health. Survey on the situation of Nursing and Midwifery in the Member States of the European Region of the World Health Organization 2009”

4. Challenges in health care systems De Geers S et all. SWISS MED WKLY 2008;138(43–44):621–628

5. Mission and goals of the MoH MISSION – to keep health and prevention of the citizens. High quality health, safety and accessible health care for all. GOALS: To promote and keep health, implement public health care Assurance of accessible and qualitative personal health care through improvement of the activities of health care institutions. Strengthening management of health care system, wich based on solidarity and justice principles.

6. Legislation Law of Nursing practice and Midwifery practice (Official gazette, 2001, 2009, No., 89-3801) 6

7. Regulation of the MoH List of nursing specializations ( Order of the MoH 17 th of December, 2009) Requirements of programs of nursing specializations (Order of the MoH, 21th of January, 2010) Rules of Nursing practice license (Order of the MoH 30th of December, 2009) Rules of Midwifery practice license (Order of the MoH No.V-1089, 30th of December, 2009) List of the diseases for health checks (Order of the MoH No.V-720, 12th of August, 2010). Professional acquirement ( Order of the MoH No.V-1038, 17th of December, 2009) 7

8. Nursing education

9. Nursing specializations

10. Nursing and midwifery license

11. Development of nursing services Ambulatory services Nursing of diabetes Primary health care PHC Nursing at home Palliative care 11

12. Primary health care Main goals of PHC – prevention and management of chronic diseases Services of primary out-patient personal health care:  Health care services for the disabled people (approx.. 200 thousands per year)  Procedures provided by nurses at home (taking blood tests, bedsore treatment; drop infusion) (approx.. 100 thousands per year) Recipients - patients with the established special permanent nursing needs Services are organised by the Head of Personal Health Care Institution Funding - Compulsory health insurance fund 12

14. Nursing at home Beginning 2008 Caregivers – HC institutions, license for nursing Service recipients – patients with special permanent nursing need (approx. 200 thousands per year) Services are organised by the Head of Personal Health Care Institution Funding - Compulsory health insurance fund Order of the MoH No V-1026, 14 th December, 2007. 14

16. Ambulatory nursing services for patients with diabetes Beginning Since 2008-10-10 define services Since 2011-07-01 m. funding Requirement for HC institution License for nursing Medical devices/equipment Requirement for specialists Nurse Certificate (160 h education) License Kind of services Consultation of nurse diabetologist Medical chiropody Care of the diabetes foot Collaboration Other nurses Family doctor Doctor for endocrinology Surgeon Others specialist 16 The Order No V-337 of the Minister of Health of the Republic of Lithuania dated 8 April 2011

17. Number of nursing services for patients with diabetes 2011 - 2012 Kind of services Number of services Primary consultation of nurse diabetologist (individual)3.110 Continue consultation of nurse diabetologist (individual)3.133 Medical chiropody6.557 Care of the diabetes foot1.380 Consultation of nurse diabetologist (children)272 Bendroji suma14.452 Database of State Patient Fund, 2013

18. Beginning – since 2008 Forms of provision: In out-patient institutions:  at the health care institution  In the patient’s home At a day care centre At the in-patient clinic Services are provided by a doctor, nurse, social worker, other specialists depending on the need. Length of service Length of service - unlimited. Number of services approx. 30 thousands per year Requirements for provision of palliative care services to adults and children confirmed by the Order No V-14 of the Minister of Health of the Republic of Lithuania dated 11 January 2007

20. Trends and vision of nursing

21. Current issues that need attention Mental Health Health Technology Assessment Pharmaceutical sector Directive on patients’ rights in cross- border healthcare Primary care Irrational use of medicines „Brain drain“

22. Preconditions for development of nurses capacity  the lack of health care professionals;  the improvement in access to health care services (especially in rural areas);  the need to better respond to the changing needs of patients and to ensure the quality of continuing care;  the increase in health care costs;  the rise in the level of education among nurses;  the expansion of career opportunities among nurses by reducing emigration.

23. Development of nurses competences - Professional role, responsibility and accountability: Clinical practice; Cooperation, patient consultation and transfer of information; Scientific research and leadership. - The assessment of the state of health and diagnosis. - Therapeutic competence. - Health maintenance and disease and injury prevention.

24. Areas of Practice for Nurses - Nurses could work at the primary, secondary and tertiary levels of health care, however, particular attention should be paid to the primary level of health care. - A nurse may be both an independent service provider or a team member working together with a family physician/doctor or other health or social care professionals, also to ensure home visits.

25. Lithuanian Presidency of the EU Council  EU Member States CMO and CNO meeting  7 October, 2013, Vilnius, Lithuania  Main CNO topic: Advanced nursing practice

26. EU MS CNO Statement During CNO meeting we agreed that EU MS CNO believe that advanced nursing practice (APN) would improve HC outcomes and quality of care. We agreed on thus APN should be within national HC reforms and strategies. EU CNO and others health care players and interested parties have to work towards APN vision, principles, educational requirements and action plans.

27. Advanced Roles Definition Substitutional Additional Nurses Advanced Skills in their Practice Education All Nurses MWs High Quality Patient Care and Good Health Outcomes Licence to Practice Registration (One or Branch) Improving care and health for patients and communities to meet needs of local population Improved career development & retention VISION level of escalation PRINCIPLES scope of practice EDUCATION competencies PLAN legislation (Associates Support Assistants) EU MS CNO Statement Created by EU MS CNO, 7 th Oct,2013, Vilnius

28. Nursing Trends Development of nurses functions and role/ new competencies To create funding mechanism to integrate nursing and social care To develop services of family doctor and nurse: new services forms and kinds To create project of “case management “ in the PHC To improve HC/nursing quality To develop nursing, palliative care, nursing at home and others services.

29. Finnaly, “Nurses need to have more than management, pedagogic or administrative competencies to be effective actors in a changing health care system that is confronted with numerous challenges such as the development of evidence-based care models in an era of cost containment”. De Geest S et all. SWISS MED WKLY 2008;138(43–44):621–628

30. Thank you for your attention Dėkoju už dėmesį www.sam.lt odeta.vitkuniene@sam.lt