Efficient, cost effective and patient centred care matching the needs of a complex, rapid changing health care industry is important as it undergoes a complete reconstruction. Keeping in mind its intricate nature, it is imperative that collaboration occurs in all stages of the planning process to ensure a smooth transition.
The sheer volume of changes can be overwhelming, however nurses need to seek the window of opportunity and develop a new set of skills or utilize existing skills focusing on flexibility and adaptability to create new career pathways that can move nursing in a direction that has not been seen before. What is paramount in this equation however is the need to use knowledge from our past, building on its foundations to ensure sustainability.
This literature review is based on discussing the Bio-Medical Model beginning with a historical perspective, synthesizing components within, leading to events which have driven the need for major changes in the health structure, design, process and delivery of health care.
By reflecting on the past we can gain an understanding on economic, cultural, political and social influences that have helped shape our health climate and the way we work. This will enable us to gain knowledge and apply this to our future using a well grounded approach.
Throughout history there have been many leaders who have contributed to shaping the Bio-Medical Model of Health and Illness which is the dominant model used in Medicine within the Western World, and is over centuries old.
Rene Descartes in the 1700s recognized the mind and body were separate entities hence today there are different practitioners treating them, each with their own set of literature and research. (Cannon,R. 2014).
( Maher, n.d) argues that the mind and body are inextricably bound and there is no division between them. Alternatively some of the Eastern traditions work on the philosophy that the mind, body and all existential matter work together like a well oiled machine.(Large, E 1996).
Many other people helped lay the foundations of the Bio-medical model of Health and illness for instance Louis Pasteur recognised that diseases are spread by bacteria and could be killed through sterilisation with Koch building on this concept by discovering that certain bacteria caused a particular type of disease.
Joseph Lister played his part in medical science discovering that germs had the potential to cause illness and death. John Dalton stated that matter was made up of atoms which set up further research in physics.(Liang et al; 2006). These are just a few areas which operated under the umbrella of biomedical model of Health and Illness.
The Biomedical Model is based on science and focuses on health as being devoid of disease. Science usually uses a system of enquiry which occurs through observation, experimentation, collecting data, hypothesizing and predicting resulting in a conclusion. Progress in science does not demonstrate allegiance to open interpretation rather favours accuracy and predictability.
The main function of health services is to cure the sick and disabled working under a physiological framework. (Greenhill, 2008). Illness creates a physical change in the body due to chemical imbalances, viruses, bacteria, or genetic causes. (“Introduction to Health Psychology”. n.d.).
Working within the Biomedical framework, the relationship between health and illness is confirmed whereby a person is considered to be either ill or healthy and there are no grey areas in between.
Recognition of Patterns of illness is derived from signs and symptoms provided by patients assisting doctors in constructing a medical history in which further investigation can occur. Obtaining pathology is one method which guided doctors in enabling some form of treatment to be implemented. The patient is then expected to recover and therefore they are cured. (McGraw,n.d.).
The social constructs of medicine under the Bio-medical model has been one where the doctor is a person who holds the knowledge, is competent in nature and ultimately the gatekeeper. They have been held in high esteem by the public due to their professional standing. This belief system was strengthened by the fact that the doctor held the power, was trusted and ultimately had the monopoly in health services which were self regulated. It was he who treated the illness. (Crinson, I 2014).
During the 19th Century through regulating the profession, power was given to doctors to self regulate and the ability to regulate other health disciplines occurred so that they would exercise domination within the health service. Adams,T 2013).
Using Parsons Systems model with its roots embedded in biomedicine, illness is considered to of course being undesirable with the ill individual,who must take on that persona and seek help accordingly, co-operating with directives from a health professional. Based on Parson’s theory no onus occurs on behalf of the individual in relation to health ownership, resulting in people when ill have the right to withdraw from their social responsibilities such as attending school or work. (Parsons, 2011).
This type of belief system is somewhat contradictory in terms where in some cultural contexts however, individuals are made to feel responsible for their medical conditions and often ridiculed such as those that smoke and those that consume large amounts of alcohol, while others in comparison are made to feel blameless. (Lupton, 2012).
Philosophy has influenced and transfigured meta-physical medicine into scientific medicine. The philosophical changes focus on knowledge drawn through observation, and experiences and therefore knowledge is based on facts, evidence and research (empiricism) (Thomas, 2014). Secularism progressed with the shift of dominance of religious and spiritual influence in health and physical reductionism which involved dissecting and interpreting complex processes into small parts resulting in a broader understanding of illness.( Beresford, 2010).
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Doctors are seen to make judgments on who is ill and who is not.( Ekobi, 2013). Conditions of a person are evaluated rather than the impact a condition has on them. (Leimkuehler, 2005). Alterations within the body are defined, measured and isolated. Patients often take a passive role in the Doctor/Nurse relationship. The doctor is an authoritative figure who gives an order or suggestion and the patient obeys. (Darkins & Cary, 2000).
Treatment of illness occurs from an outside intervention directed and controlled usually by the doctor either physically such as through surgery or chemically using medication. (Vallis & McHugh 2011
The psychological, social, behavioural and environmental aspects are not usually given much emphasis in treatment of patients for practitioners working under the auspices of the biomedical model. Difficulties occur when explaining chronic pain and underlying pathophysiology is examined in isolation, making it difficult to explain why treatments fail. (Lewis 2014).
Literature from many sources have outlined the increase in costs, nursing recruitment and retention problems, aged population, technological advances and a more informed society have all contributed to the medical model of practice that no longer meets people’s health needs both on an individual level and globally.
The biopsychosocial supports the view that illness culminates from one or a number of causes such as biological, psychological or environmental issues. (Waddell G & Aylward 2010). Albelson et al supports this and identifies causative factors such as age, genetic makeup, social support, social role in society, level of income and many other internal and external elements, which necessitates promotion of initiatives within health policies and management. The social model is not designed as a substitute for the biomedical model but it is there to complement it. (Germov,J 2013).
A qualitative study executed in Canada investigated whether or not population health was integrated, as a focus for future plans within their health programmes. Results demonstrated that although there was inclusion within their policies, however leaders in the health field acknowledged the need to develop flexible frameworks, and they emphasized the importance of sharing a large body of knowledge that could be adapted across different contexts.
Evidence based practice has been used within the biomedical model of health, and is important in justifying and being accountable for your work. Your ideals and values within the framework and model that underpins your work culture guides your practice and therefore this will dictate how you would answer the question “What is health promotion?” One may answer by helping people cope with their social environment, or maybe to look at how their environment can work to their advantage or by reviewing the medical treatment given which would provide optimum results. (Raphael, 2000).
For a smooth transition from one paradigm to another, requires people to be engaged in the change process by enhancing their abilities and willingness to become active rather than proactive in their health. Research has shown that by adopting the following principles this will be beneficial to all concerned.
Importance should be highlighted in involving all parties in the decision making process from contributing to the healthcare design, and delivery to the point of evaluation. Encouraging willing participants to promote patient centred care through advocacy, optimises policy development. Targeting resources to those that are most vulnerable reduce inequalities in health care is valuable in making positive changes. (Self Management Alliance, 2010).
How you envisage healthcare in the very near future hopefully will be a system run by efficient knowledgeable staff who delivers quality, patient centred care in a timely fashion. A system which focuses on prevention and embracing a holistic approach in easily accessible, user friendly settings, staff will promote empowerment so that people can take back some control over health practices whilst making informed choices with the aim of addressing the who, where, what and why principles when it comes to all that affects ones health. Working as one close unit together as individuals, family, friends, and community and globally will go a long way in the improving health for all.
Medicine is no longer a static process with predictable ways of measuring all health outcomes .Riding the journey and embracing change both in the health industry and that of society which is subjected to internal and external forces, through reflection the ride can be made smoother by our history can set the climate for open discussion and effective communication so that we can reproduce the conceptual dimensions which worked to our advantage, and bypass the rest.
What is abundantly clear is the need for nurses to learn the importance of having their voice heard through joint decision making processes and move on from a culture that in the past has subtly led nurses to being second cousins to other professions. It should be noted that with such complexities of an everychanging world is medicine requiring a change in health paradigm there is no one panacea within this context. When it comes to designing the perfect health care system we can’t just leave it up to serendipity.
Just something for us to ponder over is Christiaan Barnards words which are as follows:
I don’t believe medical discoveries are doing much to advance human life. As fast as we create ways to extend it we are inventing ways to shorten it.
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