National Care Strategy

Section: Editorial

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Zabalegui Yárnoz A. Estrategia Nacional de Cuidados. Metas Enferm mar 2022; 25(2):3-6. Doi: 2022.25.1003081879


Adelaida Zabalegui Yárnoz


Doctora en Enfermería por la New York University. Miembro del Comité de Dirección Nursing Now Challenge. Subdirectora de Enfermería del Hospital Clínic de Barcelona (España).

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Versión en Español


Estrategia Nacional de Cuidados

Our healthcare system is highly stressed, both in the care setting as in terms of budgets. We must reassess healthcare in an intelligent and efficient manner. Regardless of the important healthcare improvements achieved in the past 20 years, out health system still presents structural challenges. The latest report by the OECD, “State of health in the EU. Spain, National Health Profile for 2021” (1) states that there is still a reduced number of nurses in our country (the rate is very inferior to the European mean), and the health expenditure per capita and overall is inferior to the mean in the European Union countries (2,488 € vs. 3,523 €/patient). On the other hand, during the pandemic it has been clear that there is a need for improvement in “healthcare” in all care settings.

During the final act for the Nursing Now campaign, which was held in the Ministry of Health on December 20th, 2021, the Spanish Minister of Health, Carolina Darias, announced the creation of the “National Care Strategy”, which represents a major opportunity for collaboration between autonomous communities, as well as professional and patient associations, among other agents, in order to improve care. This strategy must be led and managed by nurses, as they are responsible for patient and citizen care, offering first line support to healthcare professionals. Its final objective is to improve the quality of care, person-centred, and to contribute to sustainable healthcare development and social wellbeing.

Care is defined as the timely, fast, continuous and permanent assistance, targeted to solving specific problems which affect the personal dimension of those individuals demanding some service (Ministry of Health, 2009). Care is a multidimensional activity targeted to all persons, at all times of their life cycle, in order to maintain health and life. As a science, Nursing cares by facilitating the wellbeing of individuals, families and communities, through evidence-based practices. Its practice includes autonomous and independent care, offered to people of all ages, to healthy or sick families, groups and communities, in all settings; this includes health promotion, disease prevention, and care for ill, disabled, and dying people (ICN, 2002) (2).

The persistent pandemic has shown the strengths and weaknesses of our health system. The pre-COVID scenario maintained a curative, reactive approach to care, focused on the disease, with fragmented activities of care, even uncoordinated and ruled by professional individualism. On the other hand, the post-COVID view of healthcare must increase its population-focused, proactive and preventive approach, led by an interprofessional team based on competence (knowledge, skills and attitudes), integrated into networks, focused on measurable results for wellbeing, health and economy, and with an active participation by patients and citizens.

In order to improve care, it is essential to form a panel of experts from different settings, such as Primary, Specialized and Sociosanitary Care, as well as from academic, management and research areas, alongside representatives from society, patients, and other healthcare professionals. This panel should be the starting point for the National Care Strategy, articulating the actions for care improvement in social and healthcare sectors, and reinforcing collaboration and strategic alliances, and care based on best practices. Besides, it will be oriented according to the evaluation of interventions, monitoring of care provided (research and planning of care which will identify unwanted deviations from excellent care), and the adaptation of care based on surveys conducted on providers, professionals, patients and citizens (person-centred care). Summing up, it must provide an ecosystem of health and social care which optimizes its performance, both for professionals and for patients and citizens. It is essential to accept that persons (patients or users) are the main actors in health and social assistance, and this will require to abandon the current paternalistic attitude, in order to co-create and innovate in a close and humanistic manner, anticipating needs, connecting Primary Care with home care to a higher extent, and redefining the roles in the healthcare team, in order to encourage autonomy of management to improve care and reinforce health and social assistance.

Nurses are positioned as drivers of change in the National Care Strategy, due to their demonstrated competence and commitment; also due to their clinical experience, open mind, holistic view of the complexity of care and capacity for team work, and their empathetic and respectful attitude, with active listening, which conveys union between patient and family, as well as their fast adaptation to change, with sustained and constant alertness towards the needs of persons in order to respond to them, streamlining those resources required. On the other hand, nurses keep their commitment to solve health inequalities in collaboration with other experts, and have become a trusted voice for the society.

The recommendations by Nursing Now Spain, which incorporate the knowledge acquired during the Spanish experience of the COVID-19 pandemics, put forward five Nursing actions which are essential for the National Care Strategy:

  • Coordination. We need to improve the coordination of care between national and regional governments, in order to reach an adequate management, and strengthen it through social and healthcare integration. Each region needs to strengthen the coordination between levels of care of Primary Care, community and hospital care, sociosanitary and residential centers, considering patients and users as central elements and, therefore, active participants. We must also implement a proactive strategy for early detection of problems in care and health promotion. In this sense, the Ministry of Health, the regional ministries, and the health and social managements must be aware that the solution to these challenges that we face includes the creation of the Directorate of Care in the Ministry and the Regional Health Ministries, as recommended by the World Health Organization (WHO) (2021) (3).
  • Competence. There are well trained nurses in Spain, with university degrees, masters, specializations and doctorates. Nurses are in charge of leading, evaluating and providing Nursing care oriented to the promotion, maintenance and recovery of health, as well as the prevention of diseases and disabilities (4). The coherence of the Health System also depends in an essential manner of an increase in the number of nurses involved in decision making, in the development of health policies, and in the political dialogue about healthcare.
  • Coverage. More economic resources are needed in order to increase the number of nurses, by creating stable teams of care, and thus respond to the needs for care in the population. Likewise, it is necessary to create and implement a cross-sectional regulatory framework of advanced practice with specific positions for its development and that of Specialized Nursing, to provide the best care possible within multidisciplinary teams. This investment will contribute to the sustainability of care.
  • Adaptation of geriatric care. The model for geriatric and sociosanitary care centers must be reviewed and updated in its structure, by providing staff and updating their skills, in order to improve their management and coordination with healthcare centers. This new model must recruit those healthcare professionals with the highest ability to cover the demands for care of a vulnerable and complex population.
  • Access to data and digitalisation of information. Care requires access to data and information, including its outcomes. Nurses are responsible to a high extent of collecting healthcare data, and therefore the design of digital tools must be promoted, in order to support nurses in their daily work and to facilitate their fast collection of relevant data. It is important that the care outcomes measurement incorporates the notion of quality of care and patient experience.
  • Faced with the urgent need to implement actions for improvement in Health Care, these proposals could be the basis for defining the “Nursing Care Strategy”, expected to have a noticeable impact on the health and wellbeing of citizens, and for the economic and social development of our country.


    1. OECD and WHO. Unión Europea, 2021. State of Health in the EU. España, Perfil sanitario nacional 2021 [internet] [citado 15 feb 2022]. Disponible en:

    2. Consejo Internacional de Enfermeras (CIE) 2002. Definiciones de Enfermería [internet]. CIE [citado 15 feb 2022]. Disponible en:

    3. WHO-Europe. Dec 2021-4464-44227-62471. Building better together. Roadmap to guide implementation of the Global Strategic Directions for Nursing and Midwifery in the WHO European Region. Copenhagen, Denmark. Geneva: WHO; 2021.

    4. Ley 44/2003, de 21 de noviembre, de ordenación de las profesiones sanitarias. Boletín Oficial del Estado (BOE) [internet], núm. 280, de 22 de noviembre de 2003 [citado 15 feb 2022]. Disponible en: