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Jackson Jackson ChakayaChakaya MscMsc; ; BscBsc((HonsHons); CCN; KRCHN; FRCN); CCN; KRCHN; FRCN
Senior Lecturer Senior Lecturer
The Nairobi Hospital The Nairobi Hospital ––School of NursingSchool of Nursing
From Evidence to Action: The future of
Nursing Practice in Kenya
1
“All people everywhere will have access to “All people everywhere will have access to skilled, motivated, and supported health skilled, motivated, and supported health worker, within a robust health system”worker, within a robust health system”
Global Health workforce Alliance Global Health workforce Alliance
www.icn.chwww.icn.ch
2
Disclaimer
Systematic review done between
2013 - 2014
From Evidence to Action: The future From Evidence to Action: The future
of Nursing Practice in Kenyaof Nursing Practice in Kenya
3
Presentation OutlinePresentation Outline
Background of nursing practice Background of nursing practice
oFrom Nightingale to Watson to Wanjiku: the
transformation of nursing practice
Current trends in practiceCurrent trends in practice
The Future nursing practice. The Future nursing practice.
oo From Evidence to Action in nursing practice! From Evidence to Action in nursing practice! 4
Nursing practice has evolution into a profession Nursing practice has evolution into a profession
overtime. As early as 1732 Local governments in overtime. As early as 1732 Local governments in
colonel America established Almshouses to care colonel America established Almshouses to care
for sick individuals. for sick individuals.
Florence Nightingale (1873) is considered the Florence Nightingale (1873) is considered the
founder of modern Nursing & 1founder of modern Nursing & 1stst nursing Theorist.nursing Theorist.
Background of nursing practice Background of nursing practice
5
Nightingale to Watson Nightingale to Watson et al… et al…
From the „lady with the lamp‟ to nurse From the „lady with the lamp‟ to nurse
practitioner whose practice is anchored on practitioner whose practice is anchored on
theories and evidence. theories and evidence.
Several theorists including NightingaleSeveral theorists including Nightingale and and
others have shaped nursing practice. others have shaped nursing practice.
6
Nursing in Kenya…Nursing in Kenya…
In Kenya In Kenya ….the „dresser (later ….the „dresser (later Assistant Enrolled
Nurses Grade I and II) to EN then ECN later RN, to EN then ECN later RN,
KRCHN and KRCHN and BsNBsN. Currently . Currently MsNMsN and PhDsand PhDs
Before 1950…Nursing education was without a
formal framework
o In 1952, first examination for Assistant Enrolled
Nurses Grade I and II. http://en.wikipedia.org/wiki/Nursing_in_Kenya7
‘‘Wanjiku’sWanjiku’s’ nursing practice’ nursing practice
King George Hospital (Now KNH) became the first King George Hospital (Now KNH) became the first
hospital to commence Kenya Registered Nurse training hospital to commence Kenya Registered Nurse training
In 987 Kenya Registered Community Health Nurse In 987 Kenya Registered Community Health Nurse
(KRCHN) training was establishment. (KRCHN) training was establishment.
However, our However, our WanjikuWanjiku nurse utilized little evidence nurse utilized little evidence
instead practice was experiential instead practice was experiential “Usually we did it…”“Usually we did it…”
http://en.wikipedia.org/wiki/Nursing_in_Kenya
8
The continuum of nursing The continuum of nursing The transformation of nursing The transformation of nursing
practice practice
9
Current trends in nursing practice Current trends in nursing practice
1. Where Art Thou, Nurse?
◦ Nurse shortage possess challenge
to nursing practice.
◦ Currently Kenya‟s doctor: nurse is
has 1:8
10
2.2. The Patient Safety ImperativeThe Patient Safety Imperative
Several recent studies have turned the Several recent studies have turned the
spotlight on nursing as a safety net.spotlight on nursing as a safety net.
1n 2013 Kenya estimated 1% to 2% of 1n 2013 Kenya estimated 1% to 2% of
hospital inpatientshospital inpatients of medical errors of medical errors
Trends…Trends…
11
Trends…Trends…
3.3. Healthcare cost and Shorter Lengths of Healthcare cost and Shorter Lengths of
Hospital StayHospital Stay
Effective nursing care and hospital stay and Effective nursing care and hospital stay and
quality of life outcomes quality of life outcomes
4.4. Healthcare Consumerism and "EHealthcare Consumerism and "E--Health”Health”
12
Trends…Trends…
5.5. Technological Wonders and WoesTechnological Wonders and Woes
6.6. WebWeb--Based Nursing DegreesBased Nursing Degrees
7.7. Disparities in Healthcare and nursing practiceDisparities in Healthcare and nursing practice
8.8. Living With Chronic DiseaseLiving With Chronic Disease
13
9.9. Return of Resistant Strains, Communicable Return of Resistant Strains, Communicable
and NCD and NCD
◦◦ It started with AIDS after 1980s then cancers, then It started with AIDS after 1980s then cancers, then
SARS, now MDR burgs(MDR Pseudo & TB). SARS, now MDR burgs(MDR Pseudo & TB).
◦◦ Now Hypertension, Diabetes, cardiac Now Hypertension, Diabetes, cardiac
conditions….And now Ebolaconditions….And now Ebola
Trends…Trends…
14
The challenges The challenges
Training and research Training and research –– Mushrooming of new Mushrooming of new
nurse training schools Vs Quality educationnurse training schools Vs Quality education
Research in practice. Research in practice. Where are nurse researchers?Where are nurse researchers?
Quality systems Quality systems –– are our systems working?are our systems working?
Technology and the nurse practitioner Technology and the nurse practitioner
15
Nursing practice in devolved Nursing practice in devolved
healthcare systemshealthcare systems
Chapter Eleven(11): Fourth schedule Part 2 (ii)
Challenges
◦ Transition from national to County Govt‟s
◦ Implementation of the healthcare function
◦ Staff demonization – resulting from
administrative authority 16
Opportunity despite the challenges…Opportunity despite the challenges…
An Opportunity for Nurses
Information technology advances in nursing Information technology advances in nursing
practice practice
EAC Nurses Vs Quality practice Nurses Vs Quality practice
Community Nursing experts…NCK have Nursing experts…NCK have
commenced a register)commenced a register)
17
So what can be done?So what can be done?
….to improve nursing ….to improve nursing
practicepractice
18
Nursing practice Pillars Nursing practice Pillars
1. Clinical Practice
◦ Policy and protocol of practice
◦ Quality nursing practice & Healthcare
2. Administration
3. Research & research utilization
4. Education & Lifelong learning
5. Communication in healthcare htt
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NHS Education for Scotland 19
The Future: Evidence to action The Future: Evidence to action
Model: Model: Leading Change, Advancing Leading Change, Advancing
HealthHealth
IOM Robert Wood Johnson Foundation
Report (2010)
MakesMakes Eight (8) recommendations: Eight (8) recommendations:
22
Leading Change, Advancing Health Model Leading Change, Advancing Health Model
Recommendations:Recommendations:
1.1. Remove scopeRemove scope--ofof--practice barriers practice barriers
2.2. Expand opportunities for nurses to lead and Expand opportunities for nurses to lead and
diffuse collaborative improvement effortdiffuse collaborative improvement effort
3.3. Implement nurse residency programsImplement nurse residency programs
4.4. Increase the proportions of nurses with a Increase the proportions of nurses with a BsNBsN
degrees to 80 percent by 2020degrees to 80 percent by 2020
23
5.5. Double the number of nurses with PhDs by 2020. Double the number of nurses with PhDs by 2020.
6.6. Ensure that nurses engage in life long learningEnsure that nurses engage in life long learning
7.7. Prepare and enable nurses to lead change to Prepare and enable nurses to lead change to
advance healthadvance health
8.8. Build an infrastructure for the collection and Build an infrastructure for the collection and
analysis of analysis of interprofessionalinterprofessional healthcare workforce healthcare workforce
data.data.
Leading Change, Advancing Health Model Leading Change, Advancing Health Model
Recommendations:Recommendations:
24
Recom.1: Remove scopeRecom.1: Remove scope--ofof--practice barriers practice barriers
Advanced practice registered nurses should be Advanced practice registered nurses should be
able to practice to the full extent of their able to practice to the full extent of their
education and trainingeducation and training
In Kenya, it may be necessary to negotiate for In Kenya, it may be necessary to negotiate for
more scope more scope
(Pillar 1)(Pillar 1)25
Recom.2: Expand opportunities for nurses to lead and Recom.2: Expand opportunities for nurses to lead and
diffuse collaborative improvement effortdiffuse collaborative improvement effort
…. and nursing associations should expand …. and nursing associations should expand
opportunities for nurses to lead and manage opportunities for nurses to lead and manage
collaborative efforts with other health care teamcollaborative efforts with other health care team
Pillar 2Pillar 226
Recom.2: Expand opportunities for nurses to lead…Recom.2: Expand opportunities for nurses to lead…
In Kenya…nurses to conduct research and to In Kenya…nurses to conduct research and to
redesign and improve practice environments and redesign and improve practice environments and
health systemshealth systems
Nurses at administrative level should participate Nurses at administrative level should participate
in policy and protocol development in policy and protocol development (Pillar 2)(Pillar 2)27
Recom.2: Expand opportunities for nurses to Recom.2: Expand opportunities for nurses to
lead… within lead… within devolved healthcare systemsdevolved healthcare systems
In Kenya…Adopt a functioning systemIn Kenya…Adopt a functioning system
◦◦ NHS NHS ––UkUk, Australian system , Australian system
◦◦ US federal Health Care US federal Health Care
(National and County Policy level (National and County Policy level
(Pillar 2)(Pillar 2)28
Recom.3: Implement nurse residency programsRecom.3: Implement nurse residency programs
◦◦ …states boards and health care organizations …states boards and health care organizations
should take actions to support nurses‟ should take actions to support nurses‟
completion of a transitioncompletion of a transition--toto--practice programpractice program
◦◦ Kenya: Establish mechanism to ensure postKenya: Establish mechanism to ensure post--
education transition. education transition.
Thanks Thanks AMREFAMREF and and othersothers for starting onfor starting on--job job
continuous learning continuous learning
Pillar 4Pillar 4 29
Recom.4: Increase the proportions of Recom.4: Increase the proportions of
nurses with a nurses with a BsNBsN degrees to 80 percent degrees to 80 percent
by 2020by 2020
Kenya should aim to double number by 2030Kenya should aim to double number by 2030
Have degree residency and nonHave degree residency and non--residential residential
courses courses
Online degrees Vs Quality nurse education Online degrees Vs Quality nurse education
Pillar 4Pillar 430
Recom.5: Double the number of nurses Recom.5: Double the number of nurses with doctorate by 2020. with doctorate by 2020.
◦ Kenya has currently 2 PhD proudly registered by the NCK. Others on the PhD but in different fields mostly public health etc
Redefine Kenya Registered Advanced Nurse Redefine Kenya Registered Advanced Nurse
Practitioners (KRANP) for Masters and PhD levels. Practitioners (KRANP) for Masters and PhD levels.
Consider Nurse Practice consultantsConsider Nurse Practice consultants
◦◦ Pillar 4Pillar 431
Recom.6: Ensure that nurses engage in Recom.6: Ensure that nurses engage in life long learninglife long learning
Transforming nursing practice thro Transforming nursing practice thro trainingtraining
Transform KRCHN to Kenya Registered Transform KRCHN to Kenya Registered
Nurse Practitioner(KRNP) for first level Nurse Practitioner(KRNP) for first level
nurses… nurses…
CPD & evidenceCPD & evidence--based practicebased practice
Pillar 4Pillar 432
Recom.6: ….nurses engage in life Recom.6: ….nurses engage in life long learninglong learning
??Introduce Kenya Registered Specialist Nurse
(e.g KRCCS) for specialist courses like CCN,
PreopN
Consider sponsorship and scholarship for nurses
Mentorship and preceptors: clinical and research
Pillar 433
Recom.7: Prepare and enable nurses to lead Recom.7: Prepare and enable nurses to lead
change to advance healthchange to advance health
…. nursing workforce to assume leadership positions across
all levels, public, private, and governmental……
◦◦ Policy review of systems & Protocol development Policy review of systems & Protocol development
◦◦ Nurses should take up strategic roles at counties (CECs; Nurses should take up strategic roles at counties (CECs;
COOs, CHE)COOs, CHE)
◦◦ Medical Directorate run by a nurse?? Medical Directorate run by a nurse??
Pillar 2Pillar 235
Recom.8: Build an infrastructure for the Recom.8: Build an infrastructure for the
collection and analysis of collection and analysis of interprofessionalinterprofessional
health care workforce data. health care workforce data.
In Kenya…need to engage in research and In Kenya…need to engage in research and
evidenceevidence--based practicebased practice
Use evidence to inform practiceUse evidence to inform practice
Establish CQI departments across institutionsEstablish CQI departments across institutions
(Pillar 1 &(Pillar 1 & 3)36
Research into practice Research into practice –– Research Research utilizationutilization
Evidence is key to quality nursing serviceo Systematic reviews o Critical appraisals o Scientific researcho Audits o Case studies
37
5.5. Communication in Healthcare practice Communication in Healthcare practice
What has been the challenge in nursing practice?
Consider KEMRI-Wellcome Trust training model
in nurse curricula.
Pillar 5Pillar 5
38
Techno-gurus or techno-robots ?!
◦ From Hi-tech equipment for
monitoring, diagnostic, and even
management. … from techno-beds to
‘techno-knowledge, Internet Smart
phones, ipads, tablets etc impact practice
Technology Utilization Technology Utilization
40
…Technology & Nursing …Technology & Nursing
NNursing informatics professionals ursing informatics professionals : :
what‟s the effects on patient carewhat‟s the effects on patient care
◦◦ Paperless technology documentation Paperless technology documentation ––
will we be left behind?will we be left behind?
41
Conclusion…Conclusion…
From a ‘dresser’ to advanced nurse practitioner in
Kenya; Paradigm Shift focusing on four areas: Paradigm Shift focusing on four areas:
1. NCK should ‘transform’ nursing cadres.
2. Change in nurse training into specialist nurses
3. Change in communication practice
4. The technology-savvy nurse in practice
ReferencesReferences Benner, P (1984) Model of Skills Acquisition
http://currentnursing.com/nursing_theory/Patricia_Benner_From_Novice_to_Expert.html
IOM (2010) The Future of Nursing: Leading Change, Advancing Health http://www.thefutureofnursing.org/IOM-
Report
MOH (2012) Kenya Workforce Report :The status of Nursing in Kenya
Lohr KN (ed.) Medicare: A Strategy for Quality Assurance. Vols I and II. Washington, DC: National Academy
Press, 1990.
National Leadership and Innovation Agency (2010) Framework for Advanced Nursing, Midwifery and Allied
Health Professional Practice in
Wales.http://www.wales.nhs.uk/sitesplus/documents/829/NLIAH%20Advanced%20Practice%20Framework.pdf
National Quality measures Clearinghouse (2014). Mediacation errors in hospitals – Challenges and
recommendations for their measurement available at http://www.qualitymeasures.ahrq.gov/expert/expert-
commentary.aspx?id=47856
NHS education for Scotland available at http://www.careerframework.nes.scot.nhs.uk/using-the-
framework/pillars-of-practice.aspx
Penn Nursing Science available at http://www.nursing.upenn.edu/nhhc/Pages/Welcome.aspx
Robert Johnson Foundation & George Washington University (2014) Charting nurses future available at
http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf411417
Scottish Government Health Departments (2008) Supporting the Development of Advanced Nursing Practice -
A Toolkit Approach
http://www.aanpe.org/LinkClick.aspx?fileticket=giFsLijsCRw%3D&tabid=1051&mid=2508&language=en-US
Sugrue, Mark D. (2013)Transforming nursing through technology available at
http://www.nursingcenter.com/lnc/pdfjournal?AID=1236309&an=00002727-201110000-
00013&Journal_ID=&Issue_ID= 45
Acknowledgement Acknowledgement
Colleagues at the Cecily Colleagues at the Cecily McDonellMcDonell School of Nursing School of Nursing ––TNHTNH
KEMRIKEMRI--WellcomeWellcome Trust Trust –– KilifiKilifi
Sue Hooton OBE Sue Hooton OBE –– Quality Director 5Bur... NHS Quality Director 5Bur... NHS –– UK UK (mentor)(mentor)
AneAne HaalandHaaland MsCMsC –– University of Oslo Norway University of Oslo Norway (mentor)(mentor)
My Mentees and students: Cecily My Mentees and students: Cecily McDonellMcDonell; KEMRI; KEMRI--WT ; WT ; Gertrude‟s CH for making me who I am!Gertrude‟s CH for making me who I am!
46
NHS NHS –– UK structure UK structure
National Directors
Policy Directorate
Patients and Information
Operations Directorate
Nursing Directorate
Medical Directorate
HR Directorate
Finance Directorate
Commissioning Development50