The Principles and Practice of Nursing and Health Care CD Resources.Pdf

The principles and practice of nursing and health care Resource material (CD content) © VAN SCHAIK PUBLISHERS Chapter 1 Nature and parameters of nursing practice Anita Serdyn van der Merwe Activity 1.1 Scenario Trigger points You have read the scenario carefully and should analyse the following: • The concerns and needs of the health care providers at the hospital • The concerns and needs of the very ill clients in the medical ward • The concerns and needs of Carey, the senior student nurse • The history of nursing and its influence on nursing practice • The philosophy of nursing as a basis for nursing practice • The behaviours expected of a “professional” as they emerge in this scenario • The difficulties of truly “living by” (consistently applying) an ethos of caring Activity 1.2 Concerns in health care About 18.4 per cent of these nurses no longer practise nursing or practise in related fields, for example in pharmaceutical and medical insurance organisations (Worrall- Clare 2005a; HASA 2006). Statistics indicate a loss of experienced nurses over time. More than 60 per cent of all nurses are between the ages of 40 and 64 years, with an alarming 66.54 per cent of professional nurses falling within this age bracket (SANC 2006). Moreover, 13 496 nurses from South African (about 7 per cent of the local workforce) work in the OECD countries, which excludes countries in the Middle East (WHO 2006: 99). The OECD countries are Australia, Canada, Finland, France, Germany, Ireland, New Zealand, Portugal, the UK and the US. This brain drain represents a significant financial loss in the sense that the cost of educating these professionals is not offset by the benefit of utilising their skills to meet the country’s health care needs. It also 1 severely affects the health care system in the country – the so-called “fatal flows” (WHO 2006). McGrath (2003) reports a 25 per cent nurse post vacancy rate in the public health system in South Africa. This represented 32 000 vacant nursing posts in the country’s public hospitals in 2005. On the other hand, it is projected that a shortfall of nearly 19 000 nurses will exist in 2011 (Venter 2005). The health care environment with which the public health sector deals has changed dramatically due to urbanisation, the proliferation of informal settlements and the HIV/Aids pandemic. Added to these are a challenging and often failing system of referrals from primary health care clinics, the disempowerment of clinicians, strained labour relations, perceived dysfunctional relationships between hospitals and head offices, and dysfunctional management structures within hospitals. In South Africa, the private sector industry has about 25 638 beds compared to the public sector’s 104 559 (Steyn 2005). This industry is proud of its highly skilled nursing workforce, and is committed to providing high quality nursing care. However, the reality and impact of making a profit are daunting. Medical schemes in effect determine the length of stays in hospital, and the reality of making client care decisions on the basis of cost impoverishes compassionate care (Von Dietze & Orb 2000). Nurses in private health care institutions often bear the brunt of saving costs for the provider, dealing with clients who are seeking value for money and satisfying the need for additional documentation. Health care risk management is a critical concern – errors related to fire hazards, medication errors, allergic reactions, poor communication, insensitivity to clients (such as laughing and talking outside a ward), limited privacy, limited information, staff not introducing themselves, and the lack of emotional support for clients are common (Adaptation model 2005). Nurses are disillusioned and frustrated. The shortage of staff (in all health categories, including their own) means they have to work harder to make up for the lack of capacity. They end up with numerous non-nursing duties, doing others’ work, and 2 limited time to be truly with the client – as DENOSA (2006) puts it, “extra workload hurts”. In a study involving 924 respondents, more than 60 per cent of nurses were dissatisfied with their workloads and 80 per cent of them complained of greater workloads, stressful conditions and limited support from management (HASA 2006; HSRC 2003 in Worrall-Clare 2005b ; Venter 2005). The work environment is also hurting – in Sweden the highest risk of workplace violence is in the health care sector (WHO 2006), most frequently physical violence, assaults and bullying. In Canada, nurses have the highest sick leave rate of all workers, while in Zambia death among female nurses in two hospitals increased from 2 per 1000 in 1980 to 26.7 per 1000 in 1991. Botswana lost about 17 per cent of its health workforce to Aids between 1999 and 2005 (WHO 2006). Activity 1.3 The “off-label” use of nurses “Supposedly good has become more bad than good” Such usage triggers a number of ethical questions, for example is it experimentation, does it conform to standards of care, does it leave the prescriber open to a malpractice suit, what are the duties of the prescriber and how controllable are such practices (Mehlman 2005)? Nurses in both private and public practice are working in short- staffed environments and are then also used for activities and responsibilities that are not necessarily part of what they are meant to do and or what they do best. What nurses do best is the skilful rendering of the most intimate personal and competent service. As a way of survival, nurses have to resort to functional task-oriented nursing; failing the client is then not so clear, and it becomes easier to blame others for failures. In more ways than one, it has become better to be safe than sorry. It becomes a difficult challenge to consistently provide compassionate care, and for health carers, suffering from compassion fatigue has become a sad reality that is not often acknowledged or dealt with. Activity 1.4 Nursing profession The history of and current status of the nursing profession in South Africa 3 Florence Nightingale, the pioneer of the nursing profession, showed through her compassion, integrity and dedication that she too embraced the universal values that we call Ubuntu. It is in the spirit of Florence Nightingale and ancient wisdom that nurses need to strengthen nursing care delivery, based on the moral tradition of fairness, social justice, compassion and care. Through human solidarity and the restoration of human dignity and self-respect, nurses contribute to building a healthy, prosperous and peaceful nation. Florence Nightingale portrayed a heroic image of nursing and this was kept alive in South Africa by leaders in the nursing profession such as Henrietta Stockdale and Cecelia Makiwane, who portrayed a nurse as someone who could do something important. As we know, the history of nursing in this country has a rich heritage despite the setbacks that were caused by apartheid. Stalwarts of the nursing profession like Cecilia Makiwane laid a solid foundation of providing selfless nursing care to the poor. Nursing education Henrietta Stockdale saw to it that the nursing profession became autonomous when, through her efforts, South Africa became the first country to register nursing as a profession. As an Anglican nun of the Order of Saint Michael and All Angels, she became the first matron of the new Kimberley hospital in 1981. The nurses she trained were much sought after to establish new hospitals throughout the country. In 1891 Sister Henrietta secured legal recognition of the profession when, through her efforts, an Act was passed by the Cape Parliament which made South Africa the first country in the world to institute compulsory state registration of nurses. Another objective she strove to achieve was to make nursing education a part of the country’s system of higher education, wishing it to enjoy equal status with the training of teachers and so to qualify for public funding support. Nursing education at the degree level was introduced in 1956, and has expanded to such an extent that 13 universities in South Africa now prepare nurses at baccalaureate, honours, masters and doctoral levels. In acknowledgement of Sister Henrietta’s vision and endeavours, a fully-fledged nursing college established in the Northern Cape in July 1980 was named the Henrietta 4 Stockdale Nursing College. The McCord School of Nursing has also contributed much to the development of the nursing profession in South Africa. The focus of the school has always been to respond to the needs of the people. It had its origins in a hospital for Zulu people founded by Dr James McCord, who came to South Africa as a medical missionary in May 1909. There was no one to employ as a nurse, so his wife initially carried out this task. Eventually Dr McCord employed Katie Makhanya as a general assistant and interpreter for the consulting rooms and examination room, after which the hospital was more cheerful and the clinic ran more smoothly. As the load of work increased in the hospital and dispensary, it become necessary to start training nurses who would care for the clients. A Miss MacNeille was engaged for this task. Four students were trained in the first group in 1910. However, the hospital was not yet registered as a training school. Dr Alan Taylor joined Dr McCord in 1921, and contributed to the improvement of nurse training. He applied to the government to recognise the Mission Nursing Home as a hospital, fully qualified to train nurses, but his application was turned down. In the next few years, the hospital underwent considerable expansion, and after an inspection in 1924 it was approved as a training hospital. The nursing training programme was also approved.

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