Community Nurses and Chronic Disease in Israel: Professional Dominance as a Social Justice Issue

• In Event: 3129 - Section on Medical Sociology Refereed Roundtables (1 hour)
  In Refereed Roundtable 60min: Table 8. Culture and Community in Care Delivery

Abstract

Background:
In recent decades, social justice aspects of medicine have received increased attention. In addition to examining the health status of individuals, the importance of understanding and reducing health inequalities has been a focus of international organizations. Prevention and management of chronic diseases is a major cause of these inequalities with a leading medical journal calling it "The Social Justice issue of our Time". Community nurses can potentially make large contributions to chronic illness prevention and management. In Israel, where there are extensive health inequalities, community nurses comprise a third of nurses. However, their potential role in reducing chronic disease may be obstructed by professional dominance of physicians. Despite this, there is insufficient research about community nursing related to chronic illness there and a paucity of cross-national community nursing studies in general.
Aims:
To document chronic-disease related community nursing roles in Israel
To identify changes and trends in community nursing roles that may serve to increase social justice
To understand variations in roles and trends among Israel, the U.S. and U.K.
Methods:
Interviewers performed 55 face-to-face semi-structured in-depth interviews with Israeli health system professionals. Interviews were analyzed to find patterns and trends. Key informant interviews and literature reviews were conducted for two comparisons, the U.S. and U.K.

Results:
Community nurse roles in Israel have expanded, especially for chronic disease control. This trend is expected to accelerate. Key changes include expanded scope, role transfers, and greater proactive work. Commonalities exist among countries, albeit with important differences. However, continued conflicts with physicians exist, which can limit nurses' contributions.

Conclusions:
Community nurses' importance is growing in Israel and elsewhere, especially for chronic disease prevention and management. Enabling community nurses, especially advanced nurse practitioners, to overcome professional dominance and improve chronic disease control can help reduce health inequalities. There may also be untapped opportunities for countries to learn from each other regarding community nursing.

Authors

• Ephraim Shapiro

• Rachel Nissanholtz-Gannot, Ariel University