In this article we will reflect on challenges for nurse pratitioners facing changes in modern health care, especially in mental health care. We will formulate some critical questions concerning the competences that nurse practitioners must develop in order to cope with patient needs. There are demographic developments that cause an increase of chronic diseases and more comorbidity. Our ideas about health and how to realize good health are changing. The focus is now much more upon living with chronic diseases, accepting that total cure can not always be realized,  and trying to have a good quality of life. At the same time policymakers recognize that the rising cost of health care threatens to become uncontrollable, so they instigate policy measures aimed at more efficiency, for instance by promoting stepped care, that is cheap light forms of care where possible and more expensive high care, often in hospitals, where necessary. In our opinion the problem of aging, rising prevalence of chronic diseases, of health-care consumption, of rising health-care costs, and changing needs of health-care consumers are not only restricted to the Netherlands but form a global problem. In the Netherlands this provides new opportunities for nurse practitioners. In 2015 the Dutch Committee on ‘Innovation in Healthcare Professions’ (commissioned by the Ministry of Health) has issued an opinion on the organization of affordable and accessible health-care in 2030 (Zorginstituut, 2015). This commission assumes: 1) according with Huber et. al. (2011), that health is the ability to adapt and self-manage social, physical and emotional challenges and that health is not a ‘state of complete well-being’, as the current WHO definition of health assumes , 2) not everything which is possible, should be done, and 3) in first instance, patients should be guided and supported by generalists and not by specialists. According to this committee, nurse practitioners can play a central role in these developments as they are familiar with a lot of healthcare professionals and they focus on the patient. In line with the Dutch Committee on ‘Innovation in Healthcare Professions’, we assume that shared decision making, co-creation, and self-management will be important concepts of the next decade within the healthcare system. To realize shared decision making and self-management in practice, collaboration is necessary, i.e. collaboration between the healthcare professional and the patient, between the healthcare professional and the family and informal networks around the patient, between healthcare professionals with various backgrounds, and between institutes.

The underlying new concept on Health is to see health as  ‘positive health’ (see textbox). We do not any longer follow the concept of health as a state of complete physical, mental and social well-being as this concept (formulated by the WHO in 1948) implicated that many people must be classified as ill even where they coped with their disease very well and they themselves would not describe themselves as ill. 

“Health is the capacity of people to adapt and direct  their coping with adversities of life against the background of physical, emotional and social challenges. Being healthy means to be able to adapt to disruptions, show resilience and maintain a balance of refind this balance physically, mentally and socially ” (Huber et al, 2011).

Coping with symptoms of an disease and being able to adapt to disruptions, showing resilience and maintaining a balance of refind this balance physically, mentally and socially means that health professionals must facilitate this. The role of nurses to support this process becomes more and more important as we move into an era of personalized health care with treatment ‘tailored’ to the specific individual needs of the patient.  These specific individual needs will often depend on where the patient stands in the transition stage from health to illness and vice versa and the incurring consequences this can have for daily life. Transition moments as defined by Tomlinson (1996) are. a movement from one state to another that is accompanied by change in roles, relationships, or patterns of behavior” (in: Marineau, 2005) Transition moments concern turning points in the life course or in the career as a patient with a necessity to reorient oneself on one’s past, the present situation and the future still to come. Meaning must be found in a new situation, losses must be integrated in one’s life, a new balance (re-) established and a new identity may even be wanted. According to Meleis (2000) it is the task of nurses to support patients during transition moments and pay attention to essential aspects inherent to the experience of transition: awareness, engagement, time span, the relevance of critical points and events and how these are experienced. Dealing with these aspects in a good way is what positive health is all about and may contribute to vigour (vitality) and the strength to move on to a new phase in life. Patient resilience and capacity for self management will be strengthened ánd quality of life will improve (Huber & Staps, 2016). In mental health care the taking of one’s life in own hands again, (re)finding a positive identity and start living according one’s values, is often called: recovery.

The question now is how nurses in mental health care can deal with all the demands that are made on their competences, from the perspective outlined as above. We think the answer can be found with person-centredness.