The Future of Nursing: Caring for an Aging Population

Medicine and healthcare are always at the forefront of innovation and research, and the caring and healthcare professions today look very different from in the days of our parents and grandparents. What will the role be for nurses in the future, and how will we manage an aging population in Singapore?

The role of nurses has been subjected to many changes over the years – now a far cry from the image of ‘the lady with the lamp’. Today’s nurses are trained in the science and physiology of medicine, and have an array of modern technology to facilitate treatment and complex care based on clinical research and evidence-based science. Nurses have increasingly taken on roles traditionally held by doctors, and healthcare assistants and non-registered nursing staff have taken over the traditional roles of the registered nurse.

Despite the increasingly sophisticated nature of medicine and healthcare, the fundamentals of a nurse’s role remain the same – to provide the best possible care to their patients.

The aging population

Advances in modern medicine and improved access to healthcare and healthy food and lifestyle options has meant that people are living longer than ever. It also means that people are living longer after developing medical conditions associated with aging; aging is an independent risk factor for many health conditions and diseases, some of which are very serious. This means that people are living longer than ever, and while medicine can also mean that people also have improved quality of life for a longer period of time, it does mean that there is now a large, and growing population of older people, some with significant medical histories and comorbidities.

In addition to an aging population, birth rates are also reducing worldwide – access to birth control and a changing socio-economic world profile means that people are having fewer babies than ever before. The birth rate in Singapore has actually dropped to lower than the death rate, which means that the population is, in effect, not being replaced. There are both negatives and positives to a natural small decline in population for some countries, but assuming that the population trajectory continues as is, the average age of the population will continue to significantly rise.[i]

In a healthcare context, this means that there will be a much smaller ratio of young people to old people. As people are likely to develop more health and social care needs as they age, an aging population may mean a shift in the number of working aged people compared to retired persons, and this may mean that more people need health and social care input, with a smaller population of people available to go into caring professions. The World Health Organization (WHO) estimated a needs-based shortage of around 17 million healthcare workers worldwide in 2013.[ii]

Technology in nursing and healthcare

Every so often, a clickbait headline will warn nurses that their job is about to be taken over by robots; as a role dependent on holistic and individualised human interaction, it is very unlikely that any nurses are going to lose their jobs because of advancing technology. Technology, however, can be employed to make healthcare easier and safer.[iii] Increased access to automated external defibrillators both in hospital and in the community means that anyone – even people with no experience at all – can provide lifesaving care improving outcomes from out-of-hospital arrests; this technology relies on a machine which detects and distinguishes between different types of cardiac arrhythmia, attempting to defibrillate only where there is a potentially shockable rhythm.[iv]

Technology in hospital care

The aim of technology in health and medicine is to improve patient safety, patient outcomes, and working conditions. One recent example is the use of digital, rather than paper care records. This can mean reducing the risk of loss or corruption of records, and also mean that access to a patient’s medical history, allergies and other details is instant and inoperable between different healthcare services.[v] It can also mean that user access can be restricted to granular ‘need to know’ levels and also be auditable, reducing the risk of inappropriate viewing of private data.[vi]

Using handheld devices to input records at the bedside also gives users the choice to request support without leaving the patient’s side. A nurse or carer can perform observations, enter blood pressure, heart rate, fluid intake and output and other routine procedures. A digital patient care system can calculate a risk score according to out-of-range results, and give the user the option to alert other team members if they’re concerned about the patient. These results can be ‘pinged’ to the devices of nominated users in a set hierarchy and help can arrive without the patient ever being left alone.[vii]

Where nurses used to have to estimate the duration of an IV drip by counting a drip rate, they now use pumps which provide consistent, measured flow rates and alert staff to any problems. Where cardiologists used to rely on a stethoscope and pulse, we now have nurses highly trained in cardiac electrophysiology and patients on continuous ambulatory monitors; monitors which can detect arrhythmias and alert staff to potentially sick patients.

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Technology in home care

Nurses in the community, nursing homes and social care also benefit from innovation. Wrist and pendant call buttons, falls sensors and reactive continence aids can alert staff to potential concerns – this kind of remote monitoring can be beneficial in at least two ways – firstly, it frees nursing team members up from repetitive and unnecessary tasks while still maintaining patient safety. Secondly, it can help to maintain the privacy and dignity of the person being cared for. For example, an effective chair or bed sensor which alerts carers to a patient at risk of falls getting up by themselves can respond to that, rather than having to have that person within view all the time. Being watched, even if a person understands that it’s for their own safety, can be embarrassing and distressing. This kind of one-to-one care also has a huge impact on the staffing resources of care providers.

Further home care support designed by lateral thinking technologists focuses on understanding an individual’s behaviour. A vulnerable person living alone may not want or need someone to be with them all the time, but may require more than the occasional check-in. App-based technology in tandem with electrical socket sensors and door sensors can alert a designated family member or other loved one when the vulnerable person might be at risk. If an elderly person always puts the kettle on by 10am, for example, their failure to do so could trigger an alert sent to an app on a relative’s phone, prompting them to check in on the at-risk individual.[viii]  

The future

The future of technology in medicine looks like science fiction – robotic surgery can be performed guided by surgeons half-way across the globe; patients’ scans can be superimposed through optical devices to aid precision interventions; implantable devices can aid monitoring and treatment, like the most up-to-date ‘artificial pancreas’ insulin pump technology.  

It’s important to remember, however, that nursing is not a passive role that is shaped by advances in technology; technology is created by people, for people. Nurses are innovators and inventors, and it is with the input of healthcare professionals that change is made. Technology can support nursing care, and will be increasingly important in combating the relative shortage of healthcare workers as the average age of the general population increases. Aids are meant to support workers in providing the best possible care, and also to help maintain the safety of workers themselves. Equipment for helping lift patients after a fall has meant that health and social care workers are less at risk of back injuries.

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A career in nursing

Nursing is a career pathway with incredible scope for progression. People with a nursing background can work in all areas of healthcare and medicine, and nurses are increasingly specialised, performing as independent practitioners, prescribers, and highly trained professionals. Registered nurses are trained to at least degree level and have a Bachelor of Science degree as well as their professional registration. Nursing is an art, and a science.

With the challenges of the aging population and the increasing sophistication of modern medicine, there has never been a better time to go into nursing. Nursing career pathways are many and varied, and nurses are valued as professionals and members of the community.

There is still an antiquated public perception of nursing as a menial, task-based role. However, anyone who has had to experience health and social care services first-hand will understand the value of the caring professions. Nurses do sometimes work in unpleasant conditions, where people are at their sickest and in need of intimate personal care – but it is work that needs to be done and any caring interaction is an important moment that can be performed with grace and skill. The face of nursing has changed, but the things people want and need from nurses are basically the same – good care.

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