“Health for all” is nurses’ goal for world’s people Text and photos by Patricia Patterson

Nurses representing some 96 countries considered issues such as primary health

care, social and economic welfare, and mental health.

450

What would you choose as the basic issues in health care today? Genetic engineering? Arti- ficial life support? Rising costs? For about one billion of the world’s people, the issues would more likely be enough food to eat, a supply of safe drinking water, and immunization against infectious diseases like tetanus, polio, and tuberculosis. These are the people who inhabit the rural areas and urban slums of the develop- ing countries-those whose most basic needs are unmet despite our advanced knowledge and sophisticated technology.

Nursing provides a forum for these concerns every four years at the congress of the Interna- tional Council of Nurses (ICN), which offers educational sessions, exhibits, and sessions of the policy-making Council of National Rep- resentatives. Some 6,100 nurses from 96 countries attended-the highest representa- tion ever at an ICN congress.

Meeting June 28 to July 3 in Los Angeles, the ICN adopted the theme of the World Health Organization (WHO)-“Health for All by the Year 2000.” The focus is primary health care-defined by one nurse as “health care for the people by the people.” Emphasis is on

AORN Journal, September 1981, Vol34, No 3

patient education and community services such as nutrition, safe water, maternal and child health, immunization, and disease pre- vention.

As the world’s largest group of health work- ers, nurses are a key part of this effort. But like American nurses they are frustrated about their lack of recognition. In some countries, governments and physicians do not recognize professional nursing organizations. Nurses the world over had similar complaints about being treated as “handmaidens” to physi- cians. Throughout the week, feeling was in- tense that nursing must be strong and unified to serve people better.

Health for all is an “unfinished slogan,” Mar- gretta M Styles stated in her address on action for the future. “It is only half of what we have been saying.” The other half is a strong pro- fession. “Health for all depends on health for nursing” was her amended slogan. Professor and dean at the University of California, San Francisco, Styles is best known as chairman of a committee that conducted a national study of nurse credentialing.

Concern about nursing’s worldwide strength is consistent with ICN’s major purposes- promoting the development of strong national nurses associations, assisting the associations to improve nursing standards and the compe- tence of nurses, assisting associations to im- prove the status of nurses in their countries, and serving as the international voice for nurses and nursing. The members of ICN are not individual nurses but national nurses associations. One organization from each country is admitted to ICN. The US representative is the American Nurses’ Association (ANA).

Attending the meeting for AORN were Nancy Mehaffy, president, and Margaret Huth Meeker, president-elect. Mehaffy and Meeker met other OR nurses Tuesday and Thursday at the Marketplace, an event that encouraged small groups with special interests to get to- gether. They also arranged for nurses from Sweden, England, and Australia to visit OR suites in the Los Angeles area. And they pro- moted AORN’s Third World Conference to be held in 1983 in Hawaii.

At the opening ceremonies, the audience stood on chairs and craned their necks to glimpse the colorful native costumes in the processional of national representatives. The

Arriving for opening ceremonies. Below, AORN President Nancy Mehaffy poses with nurses from Korea.

AORN Journal, September 1981, Vol34, No 3 451

Harness new ideas to change system, keynoter suggests

The foremost challenge for the international nursing community is “to keep alive the vision of a better tomorrow for the human family,” keynoter Alice J Baumgart, RN, told nurses at the first plenary session of the ICN. She is professor and dean, School of Nursing, Queen’s University, Kingston, Ontario, Canada.

Baumgart described some of the difficulties in achieving by the year 2000, the goal of “health care for all.” In third world countries, wars and internal strife, population growth, the rising cost of oil, and food and fuel wood depletion have “separated millions of people from the prospects of a decent existence,” she said. In industrialized countries, a depressed economy and a growing diversion of resources to military purposes “have provoked a shameful retreat from social concerns.”

Baumgart addressed three issues she believes need to be faced if nursing is to make an impact on the health of people. They are: (1) the changing focus and scope of nursing services; (2) emergence of a new consciousness among nurses; and (3) an altered role of professional associations.

“The majority of practicing nurses today are ill-prepared for a future in which health care for all is the operating premise,” she told the audience. The current model of nursing education and practice is “firmly tied to the hospitals and perspectives of curative medicine.” But primary care, she explained, “requires a different technology, different orientations, even a different ethic.”

She defended nursing’s record of accomplishments in “putting ‘health’ into health care.” Baumgart noted, “Many of the ideas nursing is now using and refining-promoting healthy family life, educating people about health matters,

positive promotion of well-being, prevention of illness, and instruction in self-help-are critical in making primary health care for all an effective reality.”

But it is men’s perspectives that have determined which health issues and problems are “considered salient,” Baumgart pointed out. She called this “a situation which has resulted in devaluing of nursing knowledge and perspectives and a trivializing of health care needs and requirements of women in many parts of the world.”

Looking at the new consciousness of nurses, Baurngart spoke of the “rapidly escalating numbers of nurses in many countries who are discontented with their status and working conditions.” She finds that these nurses are beginning to challenge the values and rewards of the old system and play a role in transformation. The nursing shortage, she said, “offers nursing a splendid opportunity to exercise leadership in redesigning nursing services so as to promote innovation and excellence in nursing practice and provide satisfying long-term career opportunities.”

But if nursing is to bring primary care to all people, Baumgart believes that “professional associations must take on a different character and form.” She believes that professional associations need to give higher priority to lobbying and political action.

interest group in health care and is consulted, “policy decisions with far-reaching implications for nursing services and education are still being made without input from nurses,” she said.

Speaking of what is ahead for nurses in the next decades, Baumgart suggested directing attention to the “many hopeful developments in nursing rather than dwelling on recurrent problems.” She recommended harnessing the new consciousness of nurses to the goal of health care for all. Her final recommendation was to reexamine the professional associations to assure that they play an effective political role.

Although nursing is recognized as a key

454 AORN Journal, September 1981, Vol34, No 3

roll call of nations tested one’s memory of geography. Welcomed as new members were Cuba, Cyprus, Guatemala, Hungary, Lesotho, Luxembourg, Malawi, Seychelles, and Tonga. Lesotho is surrounded by the Republic of South Africa, the tiny island nation of Seychel- les is located in the Indian Ocean off east Af- rica, and Tonga is east of the Fiji Islands in the South Pacific.

Action during the week reflected the twin themes of primary health care and profes- sional autonomy. ICN’s policy-making body, the Council of National Representatives, met for two days. Sitting on the council is one rep- resentative, usually tke nurses association president, from each member nation. ANA President Barbara Nichols represented the US. She was also elected to the ICN board of directors as a member-at-large.

On primary health care, ICN is encouraging its members to set up information systems and action plans, promote a team spirit with others, and support legislation. So far, the effort has had limited success. Only one-third of ICN members replied to a questionnaire about their plans, and there were major obstacles such as a lack of government support and political in- stability in a number of countries.

Some floundering is understandable when the problem is so vast. An estimated 70% to 85% of the population in developing countries have no access to health care institutions. Of about 4 million nurses in the world, only 15% work in these countries, which have 66% of the global population. Many of these practice in urban hospitals, far from people in farms and villages.

As away to build professional autonomy, the council chose social and economic welfare for nurses as its priority for the next two years. The belief is that improved salaries and working conditions are a major route to a stronger pro- fession. One emphasis is to encourage coun- tries experienced in labor relations to share expertise with those new to the activity.

Proliferation of new categories of health care workers was addressed in a statement that urges national nurses associations to get involved in planning for these new roles. “Whenever new categories of health workers are created, this should be done within an overall health manpower development plan,” the statement said.

Other major council actions were encouraging ICN to be more active in promoting nursing research

0 promoting nursing education and service in mental health

0 endorsing the efforts of the World Health Organization and UNICEF to abolish the practice of female circumcision, excision, and mutilation

0 instructing ICN to develop guidelines to carry out its 1975 statement on the role of nurses caring for detainees and prisoners condemning violence against patients and health personnel in the performance of their duties.

Female circumcision or excision is a tradi- tional practice of some groups in Africa, the Middle East, Asia, and Australia. Three basic types are sunna circumcision, removal of the

Before opening ceremonies, the plaza in front of the Los Angeles Convention Center was flooded with colorful costumes.

AORN Journal, September 1981, Vol34, No 3 d- 455

clitoral prepuce or a tiny skinfold; excision or clitoridectomy, which may include minora and part or most of the external female genitalia; and infibulation, closing of the vagina by sew- ing or other fastening devices immediately after excision, with a small opening for elimina- tion of urine and menstrual blood.

The intention is to ensure fidelity and carry out ancestral decrees. Hemorrhage and se- vere shock, infection, tetanus, and septicemia are some of the results. Lives of women and their babies may be threatened if the vagina is not reopened before delivery.

ICN is emphasizing education and health care for these women. The organization does not want to scare people away from seeking treatment by passing judgment on the prac- tice, said ICN President Olive Anstey. She is a member of the Royal Australian Nursing Fed- eration, sponsor of the resolution.

Canada sought the guidelines on prisoners

At a panel discussion on future health care, a nurse from Lesotho advocates promotion of breast-feeding.

and detainees because it believed nurses needed specific advice on how to act in cases of torture or abuse. The 1975 ICN statement condemned such practices and urged nurses to take “appropriate action” but did not provide guidance on what should be done.

Introducing the resolution on violence, Lebanon reported there had been incidents in which patients had been attacked and killed in their beds. Delegates from Greece testified that the statement would lend support to the Geneva Convention articles protecting health personnel.

The World Health Organization’s vote on May 20 toban advertising of infantformula was not on the ICN agenda, but it was on the minds of many nurses. The US was the only country to vote against the ban in a highly controversial action. The ICN supported the WHO, and the ANA has “strongly protested” the US vote.

WHO believes some international corpora- tions such as Nestle have been pushing infant formula in areas where mothers would be bet- ter off breast-feeding their infants. ICN has been particularly concerned about formula being sold by uniformed persons who may rep- resent themselves as nurses. Throughout the week, nurses from the developing countries asked for help and offered advice on encourag- ing breast-feeding.

“Dumping” of unsuitable or out-of-date drugs on the third world was predicted to take the place of infant formula advertising as the next explosive international health issue. The Swedish Nurses Association asked the ICN in 1979 to look into exploitation of developing countries by pharmaceutical companies. There are reports that manufacturers have been promoting and selling products, such as high-estrogen contraceptives and out-dated antibiotics and insulin, which they are not per- mitted to sell in some industrialized nations. ICN has distributed a discussion guide on the issue to its member national nurses associ- ations.

Emigration of nurses to work in other coun- tries was not officially addressed either, al- though it is a hot issue in California. During the same week, the California Board of Nursing was holding hearings on whether to extend interim permits for foreign nurses, who in California are mostly Filipinos.

At a press conference, ICN Executive Direc-

458 AORN Journal, September 1981, Vol34, No 3

tor Connie Holleran said, “We don’t like to see recruiting, but we understand why nurses would want to leave some countries for economic reasons.” She said she believed nurses should have mobility if they can meet the standards of the country where they are moving.

President Anstey added that the ICN had been concerned about reports of some coun- tries “developing physicians and nurses for export.” A WHO official who was a guest at the congress said that nurses’ training in many developing countries is more suited to meeting the needs of industrialized countries like the US than to meeting the needs of their own people. David Tejada de Rivero, WHO assis- tant director general, said WHO had recently issued a report recommending changes in nursing education for developing nations.

All through the week, the color and pagean- try of the congress contrasted sharply with the complex and overwhelming issues that were being discussed. The sophisticated nursing vocabulary we are used to using-“nursing theory,” “conceptual framework,” “parame- ters for nursing research”-seemed in- adequate terms when addressing the task of how to bring basic health care to some one

billion needy people. A panel on future health care was unable to help a Spanish nurse with her question-Can we find a way of channel- ing our massive spending on arms into this noble goal of health care for all?

These global problems demand focus, so at every congress, the outgoing ICN president selects a watchword to guide its members for the next four years. Accountability had been the word for the last quadrennium, with an emphasis on standards of nursing practice and ethical questions.

As the next watchword, Olive Anstey chose freedom. Announcing her choice at the closing sessions, she said it embodied all ICN hoped to achieve-“the free will of nurses and the patients we serve,” implying both responsibil- ity and accountability.

Council representatives listen to deliberations.

AORN Journal, September 1981, Vol34, No 3 459