NURSING AND MIDWIFERY PRACTICE & HEALTH SERVICE DELIVERY … · 2019-07-10 · Nurses contributions towards achievement of SDGs by 2030 is critical. Nurses and midwives need to participate

THE UNIVERSITY OF NAIROBI IS ISO 9001:2015 CERTIFIED. http://www.uonbi.ac.ke/

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


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


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


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


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


Assuring Highest Level of Education With Required

Distinct Competencies for Every Level


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


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.


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.




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



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


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.


Building Nurses’ capacity to lead change,

formulate policies and innovate service delivery


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


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:


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.

. THE UNIVERSITY OF NAIROBI IS ISO 9001:2015 CERTIFIED. http://www.uonbi.ac.ke/

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.


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.


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:


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.


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.


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


http://hdl.handle.net/10755/623527

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

and Midwifery Perspectives: Six Case Studies. Geneva: WHO

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.


THANK YOU

FOR

YOUR ATTENTION


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NURSING AND MIDWIFERY PRACTICE & HEALTH SERVICE DELIVERY … · 2019-07-10 · Nurses contributions towards achievement of SDGs by 2030 is critical. Nurses and midwives need to participate