NURSING AND MIDWIFERY PRACTICE & HEALTH SERVICE DELIVERY … · 2019-07-10 · Nurses contributions...
Transcript of NURSING AND MIDWIFERY PRACTICE & HEALTH SERVICE DELIVERY … · 2019-07-10 · Nurses contributions...
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NURSING AND MIDWIFERY PRACTICE & HEALTH SERVICE DELIVERY
By
Miriam C.A. Wagoro.
RN,PhD, MScN,BScN,PGDip.(Intn’l Research ethics),RM,RPN,RCHN,DAN
During
2nd Conference on Building Capacity For Nursing
&
Midwifery Leadership in Africa
June13th & 14th 2019
St Paul University ,Limuru ,Kenya
THEME: Leading Change, Achieving Universal Health Coverage, Achieving Health
The Question: How do we build capacity of nurses and midwives to lead change, formulate policies,
and innovate service delivery initiatives that assure achievement of UHC and good health as
envisaged in SDG 3?”
Presentation Outcome: Nurse leaders in research, clinical practice, policy and academia will identify
their respective action points towards empowering the nurse and midwife to expand scope of clinical
practice, leadership and research in order to improve service delivery for achievement of UHC and
SDG 3.
Theme & Question
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Nurses and Midwives are critical to achieving UHC: WHY?
Comprise 50% of the global health workforce
Provide up to 90% of health services on a 24-hour basis daily all the year round at every level
of health care system globally and in LMIC.
They are with all populations at every step of their lives
Assure access to preventive, promotive, curative, rehabilitative and palliative care without the
risk of financial hardship
Up to 60−70% of the UHC agenda focus on issues that nurses and midwives handle daily
(MoH,2012;Wagoro & Rakuom ,2015;WHO,2016,WHO,2017)
The context
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Nurses and Midwives understand the quality of health services that make significant impact on
health outcomes of clients/populations
Can influence policies that are effective in achieving UHC if given opportunities in leadership
positions.
Currently, nurses and midwives are hardly in any policy formulation positions for health service
delivery despite the directive by World Health Assembly WHA64.7 to WHO Member States
The consequences of exclusion from policies formulating tables are seen in acute shortage of
human resources and failed intervention strategies for health.
The context
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WHO recommends employment of additional 9 million nurses and midwives for
achievement of UHC and SDG #3
But this may not impact on UHC & SDG #3 since nurses and midwives don’t participate in
formulating policies.
It is unjustifiable that nurses and midwives provide 90% of health services yet health
policies are in the hands of those who provide 10% of health services.
Building capacity of nurses and midwives to lead change, formulation of health policies and
service delivery initiatives assures achievement of UHC and good health that is envisaged
in SDG -3.
The context
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Nursing and Midwifery Practice
&
Health Service Delivery-The Question
How
do we build capacity of nurses and
midwives to lead change, formulate
policies and innovate health service
delivery initiatives that assure
achievement of UHC to advance health
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Assuring Highest Level of Education With Required
Distinct Competencies for Every Level
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Mid-level Undergraduate Masters Doctoral
Knowledge base &
practical skills for
practice based
nursing
Broad Knowledge base
within nursing:
• Cognitive knowledge
• Attitude and
• Psychomotor skills
More specialized
knowledge in a
discipline/field of study:
• Advanced systems
knowledge-Know what
• Specialized skills
Knowledge at the most
advanced frontier of the
discipline/field of study:
• Systems Understanding
knowledge-Know why
• Generate evidence that
informs policy
Level differentiation using clear differentiating attributes /Competencies
EDUCATION PATHWAYS FOR NURSES IN KENYA
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HIGHER DOCTORAL DEGRESS
DOCTORAL DEGREES-PhD
DOCTORAL NURSING DEGREES-PhD-NUSING SPECIALTIES, DNSc, DNP
MSc, OTHER MASTER DEGREES & POST GRAD.QUALIFICATIONS
MSCN, MSN & OTHER POST GRAD.QUALIFICATIONS
CERTS.IN NURSING
BASIC & POSTBASIC DIPS
DAN
BScN BASIC DEGREES-BA, BSc, ETC
Building capacity through transformative education
Catrambone (2017) the president of Sigma
Theta Tau International (STTI) called on all
members of the Honor Society of Nursing, to
“Influence Advance Global Health & Nursing” in
four areas including policy. She argued that
influential nurses see themselves as
professionals with the capacity and
responsibility to influence current and future
healthcare delivery systems.
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Scott and Miles (2013), assert that increasing the number of nurses who are competent in
leadership, requires consideration of 2 critical issues:
o A change in conceptualization of nursing by faculty such that leadership identity
development is seen as a dimension of becoming a nurse, and not just those in formal
leadership roles.
o Designing a comprehensive conceptual framework for lifelong leadership development of
nurses that allows for baseline leadership capacity building in all nurses and advanced
leadership development for those in formal administrative and advanced practice roles.
Building capacity through transformative education
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Building capacity through transformative education
Therefore:
curricular should not only concentrate on
educational content and objectives, but effective,
pedagogy strategies for advancing leadership
development in nursing students at all levels.
Nursing Education must facilitate a paradigm shift
in how nurses view their roles and responsibilities.
Nurses must be socialized to see themselves as
equal partners in leadership with other health
professionals
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Building capacity through transformative education
Nursing education at all levels should begin with
emphasis on self-image and building skills to treat the
self-defeating syndromes of:
Am just a nurse
“Wait for your doctor” as a routine response even
on issues that the nurse is authorized to make
decisions on
Only technical clinical skills matter
Quick fill ins –for other professionals,
Higher degree qualifications are not for bedside
nursing
A nurse is just a nurse
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Barriers to transformative teaching must be
identified and removed.
For example:
Regulatory barriers to expanding nurses’ scope of practice
and professional resistance to expanded nurses’ roles
Difficulties encountered in the transition from education to
practice
Health laws that discriminate against nurses.
Nurses’ attitude of clinging on all tasks despite their
expanding roles.
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Building Nurses’ capacity to lead change,
formulate policies and innovate service delivery
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Nurses require strong leadership competencies to contribute to patient safety and quality of care.
Building capacity of nurses in basic and post basic programs as well as CPD and encouraging
them to lead is critical.
Principles of collaborative policy: Build capacity to collaborate to create strong and
effective structures for policy development at regional and national levels for effective change
to occur.
By working together nurses and midwives’ leaders enhance contributions to bridge disparities
between political strategic direction and actual clinical practice
Build a culture of Nursing research: To identify and develop evidence-based improvements
to care; the improvements must be tested and adopted through policy changes across the
health care system.
Innovations in leadership competencies: Leaders who merely give directions with
expectations of 100% compliance often fail in the current dynamic environment. Nurses must
start adopting a participatory approach to leadership with mutual respect and collaboration.
Nurses, and other health professionals must work together to break down the walls of
hierarchal silos.
Building Nurses’ capacity to lead change,
formulate policies and innovate service delivery
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Contemporary leadership is not a position, but collaborative
processes that take place in groups and communities. Contemporary
leadership style is tied to social responsibility and good citizenship,
which mandates nurses’ to take professional and ethical responsibilities
to champion the human right to health
Thinking outside the box in terms of employment: Nursing
education should prepare nurses to be executives of business, venture
into politics and other platforms from which they can support nursing
other than the health industry
.
Innovations in leadership competencies:
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CHIEF ADMINISTRATIVE
SECRETARY
-MINISTRY OF
ENVIRONMENT
COMMISSIONER WITH
ETHICS AND ANTI-
CORRUPTION
COMMISSION
Advocacy skills for change of societal attitude towards nurses:
Feminine history of nursing encourages policy makers, other health
professionals and the society to view nurses as “functional doers”—
assistants, those who carry out the instructions of others—rather than
scholars or “informed decision makers with autonomy of actions founded
on education, evidence and experience
Build nurses capacity to advocate for change in the attitude and
encourage male enrollment and participation.
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Networking skills: Encourage networking adventures and give opportunities to students to
collaboratively plan and execute multidisciplinary activities identified through networks. Such
activities should be those that help them perfect their leadership and clinical skills for effective
practice.
Coaching: This is a positive leadership style in which senior nurses promote empathy and self-
awareness, helping their juniors to develop long-term goals and plans. In practice, the senior
nurse creates an encouraging environment in which the junior one is guided through constructive
feedbacks to identify their unique strengths and weaknesses and tie them to their personal and
career aspirations.
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Leadership in a Collaborative Environment: Effective nurse and midwife leaders
recognize that no single health professional can deliver care that meets the client’s needs
independently to achieve universal access and health equity. Partnership and collaboration
are necessary at the policy level and in practice.
Leadership in a collaborative environment fosters innovative solutions to problems among
multidisciplinary teams at different levels and institutions without regard to different disciplines, rank,
or institutional affiliation and enact changes based on a higher standard of care or organizational
outcomes. This encourages client-centered care which is a key characteristic in UHC.
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A Conceptual Framework For Examining Nursing And Midwifery Leadership
and Workforce Interventions and Their Impact On Universal Health Access:
Retrieved From Dawson, Nkowane & Whelan (2015).
An outcome of nursing education should be geared towards solving the problems of the
society/world which are currently embodied in UN-SDGs.
Nurses contributions towards achievement of SDGs by 2030 is critical.
Nurses and midwives need to participate in formulation of policies that guide implementation of
strategies for achieving SDGs.
But participation requires a new look at the nursing image, high level nursing qualifications and
strong leadership skills as well as being in positions where decisions about membership to policy
formulation tables are made.
In this presentation pathways to higher l nursing education and training required for leadership
have been presented
Conclusion:
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Nurse Leaders in practice and policy: Determine if nurses at every level recognize the
importance of their leadership in quality of care and when it is important to mediate,
collaborate, or follow others who are acting in leadership roles.
Nurses in academia: examine curricular to reflect not only the content on leadership, but
also the pedagogical strategies for a holistic nursing workforce with self-confidence and
leadership skills.
Regulators of nursing practice: Review nurse education entry criteria that portray nurses
as poor achievers and the practice environments to enforce job descriptions including
leadership roles for nurses.
Implications of the presentation
to nurse leaders in academia, practice, policy,
regulation and research.
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Nurse researchers: investigate how often nurses are included in policy formulating tables,
outcomes of the various health policies on patient health and effect of nursing led health care
interventions.
Work together with relevant organs to translate and apply research findings to practice
All nurse leaders: come out of respective silos and speak with one strong voice to lead. The
voice can help build political support at the highest level in pursuit for inclusion in policy
formulating organs for favourable nursing education, recruitment, employment and
deployment for UHC and beyond.
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Catrambone, C. D. (2017). Influence through Action: Influence to advance global health, Nursing and midwifery. During the
opening plenary of the 44th Biennial Convention http://hdl.handle.net/10755/623527 accessed on 2nd June 2019
Dawson, A. J., Nkowane, A. M., & Whelan, A. (2015). Approaches to improving the contribution of the nursing and midwifery
workforce to increasing universal access to primary health care for vulnerable populations: a systematic
review. Human resources for health, 13(1),97.Doi:10.1186/s12960-015-0096-1
Institute of Medicine, Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing. (2011). the future
of nursing: Leading change, advancing health. Washington, DC: National Academies Press
Lankshear, A. J., Sheldon, T. A., & Maynard, A. (2005). Nurse staffing and healthcare outcomes: a systematic review of the
international research evidence. Advances in Nursing Science, 28(2),163-174.
References
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Pearson, A., Pallas, L. O. B., Thomson, D., Doucette, E., Tucker, D., Wiechula, R., .... & Jordan, Z. (2006). Systematic review of
evidence on the impact of nursing workload and staffing on establishing healthy work environments. International
Journal of Evidence‐Based Healthcare, 4(4), 337-384.
Scott, E. S., & Miles, J. (2013). Advancing leadership capacity in nursing. Nursing administration
quarterly, 37(1), 77-82.
World Health Organization (2013). Interprofessional Collaborative Practice in Primary Health Care: Nursing
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World Health Organization. (2017). Report of the seventh global forum for government chief nurses and
midwives: the future of nursing and midwifery workforce in the context of the sustainable
development goals and universal health coverage.
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THANK YOU
FOR
YOUR ATTENTION
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