PROFESSIONAL ADJUSTMENT NAC.docx

**[Table of Content]** {#section.TOCHeading} [COURSE OUTLINE iv](#course-outline) [Course objectives iv](#course-objectives) [Course content v](#course-content) [INTRODUCTION TO PROFESSIONAL ADJUSTMENT 1](#introduction-to-professional-adjustment) [WHAT IS A PROFESSION? 1](#what-is-a-profession) [PROFESSIONALISM 1](#professionalism) [PROCESS OF ATTAINING PROFESSIONALISM 1](#process-of-attaining-professionalism) [GENERAL CRITERIA FOR A PROFESSION 1](#general-criteria-for-a-profession) [CHARACTERISTICS OF A PROFESSION 1](#characteristics-of-a-profession) [NURSING 2](#nursing) [COMMON THEMES IN NURSING 3](#common-themes-in-nursing) [NURSING AS AN ART 3](#nursing-as-an-art) [NURSING AS A SCIENCE 3](#nursing-as-a-science) [HISTORY OF NURSING IN THE WORLD 5](#history-of-nursing-in-the-world) [STAGES OF THE DEVELOPMENT OF NURSING 6](#stages-of-the-development-of-nursing) [PRIMITIVE ERA 6](#primitive-era) [HISTORY OF NURSING IN GHANA 15](#history-of-nursing-in-ghana) [NURSING EDUCATION IN GHANA PRIOR TO INDEPENDENCE 18](#nursing-education-in-ghana-prior-to-independence) [POST GRADUATE DEGREE IN NURSING 21](#post-graduate-degree-in-nursing) [ENROLLED NURSING 23](#enrolled-nursing) [MIDWIFERY 23](#midwifery) [REGISTERED MENTAL NURSING PROGRAMME 23](#registered-mental-nursing-programme) [HEALTH CARE ASSISTANT (HCA) 24](#health-care-assistant-hca) [NURSE ASSISTANT CLINICAL (NAC) 24](#nurse-assistant-clinical-nac) [PUBLIC HEALTH NURSING (PHN) 24](#public-health-nursing-phn) [COMMUNITY HEALTH NURSING 24](#community-health-nursing) [CHALLENGES TO THE GROWTH OF NURSING EDUCATION 26](#challenges-to-the-growth-of-nursing-education) [NURSING IN THE 21^ST^ CENTURY 26](#nursing-in-the-21st-century) [NURSING AND RELATED ORGANIZATIONS AND ASSOCIATIONS 28](#nursing-and-related-organizations-and-associations) [THE NURSING AND MIDWIFERY COUNCIL FOR GHANA (NMC) 28](#the-nursing-and-midwifery-council-for-ghana-nmc) [GHANA REGISTERED NURSES ASSOCIATION (GRNA) 34](#ghana-registered-nurses-association-grna) [GHANA COLLEGE OF NURSES AND MIDWIVES (GCNM) 39](#ghana-college-of-nurses-and-midwives-gcnm) [COMMONWEALTH NURSES FEDERATION 42](#commonwealth-nurses-federation) [THE WEST AFRICAN COLLEGE OF NURSING 44](#the-west-african-college-of-nursing) [INTERNATIONAL COUNCIL OF NURSING 45](#international-council-of-nursing) [NURSING EDUCATIONAL PROGRAMMES IN GHANA 48](#nursing-educational-programmes-in-ghana) [COMMUNICATION IN NURSING 53](#communication-in-nursing) [THERAPEUTIC COMMUNICATION 64](#therapeutic-communication) [NURSES ATTITUDE TOWARDS THE PATIENTS' RELATIVES AND FRIEINDS 68](#nurses-attitude-towards-the-patients-relatives-and-frieinds) [CUSTOMER CARE AND INTERPERSONAL RELATIONSHIP 75](#customer-care-and-interpersonal-relationship) [ETHICS AND ETHICAL CODES IN NURSING 78](#ethics-and-ethical-codes-in-nursing) [LEGAL ASPECTS OF PROFESSIONAL NURSING PRACTICE 81](#_Toc118996889) [THE GHANA HEALTH SERVICE: PATIENT'S CHARTER 82](#the-ghana-health-service-patients-charter) [ETHICAL CODES IN NURSING 85](#ethical-codes-in-nursing) [GHANA NURSES' CODE 86](#ghana-nurses-code) [THE FLORENCE NIGHTINGALE'S (NURSES) PLEDGE 90](#the-florence-nightingales-nurses-pledge) [HOSPITAL ETIQUETTE 93](#hospital-etiquette) [THE LAW, THE NURSE AND SOCIETY 94](#the-law-the-nurse-and-society) [SPIRITUAL NEEDS OF THE PATIENT 108](#spiritual-needs-of-the-patient) [NURSE'S DUTY TOWARDS PATIENT'S RELIGIOUS BELIEFS 111](#nurses-duty-towards-patients-religious-beliefs) [NURSING THEORIES AND PRINCIPLES 117](#_Toc118996898) [MYRA ESTRIN LEVINE'S CONSERVATION PRINCIPLE 120](#_Toc118996899) [MASLOW'S HIERARCHY OF NEEDS 123](#_Toc118996900) [JOB DESCRIPTION/SCOPE OF PRACTICE 135](#job-descriptionscope-of-practice) [EXPECTED BEHAVIOUR AND ATTITUDE OF THE REGISTERED GENERAL NURSE 137](#expected-behaviour-and-attitude-of-the-registered-general-nurse) [DRESSING CODE FOR PRACTICE 141](#dressing-code-for-practice) [GHANAIAN SIGN LANGUAGE 148](#ghanaian-sign-language) [MEMBERS OF THE HEALTH TEAM 149](#members-of-the-health-team) [QUALITY ASSURANCE 154](#quality-assurance) [References 157](#references) **[\ ]** COURSE OUTLINE ============== This course provides information on basic principles underlying health and disease in nursing and enables the student develop the requisite skills and positive attitude to meet the physical, psychological, social and spiritual needs of patients/clients. It is also designed to equip student nurse with the history, theories, development, legal aspects of the profession as well as provide her with the right skills and attitude for practice. Course objectives ----------------- By the end of the course, the student will be able to: a. Discuss the history and development of nursing paying attention to contributions of major players. b. Describe the various nursing organizations and identify their roles. c. Discuss the role of the Health Professions Regulatory bodies in Ghana. d. Describe the educational programmes in Ghana. e. Discuss the ethical code of conduct for nurses and apply it to meet the needs of the profession f. Explain and Internalize the Nurses' pledge. g. Demonstrate hospital etiquette in the day to day work. h. Demonstrate the concept of customer care i. Discuss the law and human right issues that regulate/influence the conduct and practice of nursing. j. Explain the major beliefs of the various types of religious denominations and the effect of these beliefs in the individual. k. Identify the place and role of the hospital chaplain and nursing. l. Develop skills to meet the individual's psychological, social and spiritual needs m. Communicate effectively with all clients especially persons with hearing impairment n. List members of the health team and their roles o. Explain the concept of quality assurance and improvement p. Provide care based on conceptual and theoretical principle Course content -------------- 1. Introduction to nursing a. History and Development of nursing from in the world and Ghana. Contributions of major players b. Nurses and Midwives Associations and groups: Ghana Registered Nurses' Association, Ghana Registered Midwives Association, International Council of Nurses, International Council of midwives, The Commonwealth Nurses Federation, The West African College of Nursing, the West African College of nursing, Ghana College of Nurses and Midwives c. Health professions Regulatory Bodies in Ghana 2. Educational programmes in nursing 3. Ethics and ethical code of nursing a. Ethical issues in nursing: patient's charter, consent to treatment, clinical trials, confidentiality, patient's properties, signing legal documents, (witnessing wills ect). b. The nurses' pledge. c. qualities of a nurse; adjusting to clinical nursing, appearance 4. Hospital etiquette 5. Customer care and interpersonal relationships 6. The law, the nurse and the society a. Nurses Regulations: L1 683 of 1971, Mental Health Act 2012, Act 846, Health professions Regulatory Bodies Act 2013, Act 857, Specialist Health Training and Plant Medicine Research Act 2011, Act 833 b. Identification and notification of coroner's case, autopsy and inquest. c. Human Rights Charter, Patient's Charter, the nurse as a witness in court; Common offences: tort, intentional/unintentional, negligence, malpractice, defamation (libel, slander) etc. d. Criminal offences to persons and property: murder, rape, manslaughter, embezzlement. 7. Spiritual needs of a patient a. Assessment of spiritual needs: spiritual healing, concepts and existing religions in ghana and the world, beliefs about illness and the conscience of the patient. b. The duties and responsibilities of the hospital chaplain 8. The principles and theories a. Selected nursing principles i. Fuerst and Wolfs principle ii. Myra Levine conservative principle iii. Maslows hierarchy of needs b. Selected nursing theories i. Florence Nightingale ii. Virginia Henderson (environment) iii. Betty Neuman (system model) iv. Dorothea Orem,s (self care model) 9. Job Description/Scope of Practice a. Registered General Nurse b. Nurse Assistant (clinical) 10. Expected behavior and attitude of the Registered General Nurse a. Effective communication b. Assertive behavior c. Managing challenging behaviours d. Handling clients' complaints 11. Dress code of the Registered General Nurse 12. Interpersonal skills a. Individuality of man b. Communication skills (verbal and non-verbal) c. Ghanaian sign language 13. The Health Team a. Members of the health team b. Factors promoting effective team work 14. Quality Assurance and improvement a. Concepts of quality assurance b. Importance of quality health care c. Dimensions of quality assurance d. Evaluating quality of care e. Monitoring quality care i. Patients point of view ii. Medical providers point of view iii. Hospital manager's point of view **[\ ]** INTRODUCTION TO PROFESSIONAL ADJUSTMENT ======================================= WHAT IS A PROFESSION? --------------------- An occupation that requires advanced knowledge and skills and grows out of society's need for special services (Polit & Hungler, 1997). An occupation, vocation or career where specialized knowledge of a subject, field or science is applied. A profession therefore requires specialized knowledge and intense academic preparation for the acquisition of skills to practice. An occupation that involves prolonged academic training and formal qualification. Members of a profession determine the standard of training and practice A professional is one who practices a learned profession. PROFESSIONALISM --------------- This involves professional character, spirit or methods. It also encompasses teaching activities found in various occupational groups whose members aspire to be professional. To be considered as a profession, there are general criteria that must exist for the chosen occupation. PROCESS OF ATTAINING PROFESSIONALISM ------------------------------------ Professionalization is a dynamic process. Nursing may be described as a semi profession or an emerging profession. Just as the human being is viewed as being in the process of becoming, so might nursing be viewed. Thus the term developing or aspiring profession is more useful GENERAL CRITERIA FOR A PROFESSION --------------------------------- A body of knowledge on which skills and services are based. An ability to deliver unique service to other humans. Education that is standardized and based in colleges and universities Control of standards for practice Responsibility and accountability of members for their own actions Career commitment by member CHARACTERISTICS OF A PROFESSION ------------------------------- 1. Specialized education carried out at Hospitals, Colleges and universities 2. Nursing should claim expertise over the occupation in order to move from the perception that it is an emerging profession 3. Body of Knowledge- there is a conceptual framework that guides practice, research and nursing education. Nursing must monopolize the practice of nursing and three kinds of knowledge have been proposed to be the basis for nursing practice 4. Service Nurses like other professionals render special service to benefit humankind and society 5. Autonomy- It is the ability to be independent in taking decisions. In addition, a profession is autonomous if it regulates itself and sets standards for its member 6. Professional organization-it deals with issues concerning its members. E.g., GRNMA 7. Code of ethics- Defines the standard of the profession. NURSING ------- The word nurse originates from Latin word "nutricia" meaning to nurture or nourish. Nursing is both an art and science. It is a profession that uses specialized skills and knowledge to give care to the whole person in both health and illness. The science of nursing is knowledge based for what is done and the art of nursing in the skill application of that knowledge to help others reach maximum functions and quality of life. Nursing today is far different from nursing as it was practiced 50 years ago. Traditionally, the role of the nurse was based on meeting the fundamental needs of the sick and infirmed patients. This definition carried with it many implications of non-nursing tasks such as ward cleaning, cooking and clerical activities, but these tasks are now done by other members of staff. **DEFINITION** The approved definition of nursing by the International Council of Nursing (ICN) was written by Virginia Henderson. She defined nursing as: **"The unique function of the nurse to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery or to a peaceful death that he will perform unaided if he had the necessary strength, will or knowledge and to do this in such a way as to help him gain independence as rapidly as possible"** American Nurses' Association (ANA) defines nursing as the diagnosis and treatment of human responses to actual and potential health problem. COMMON THEMES IN NURSING ------------------------ [Note]: - In the latter half of the 20^th^ century, number of nurse theorists developed their own theoretical definitions. They go beyond simplest common definitions. They describe what nursing is, and the inter-relationship between nurses, nursing, the client, and the intended client outcome -- health. **Certain themes are common to many of these definitions: -** - Nursing is caring - Nursing is an art - Nursing is a science - Nursing is client centered - Nursing is holistic - Nursing is adaptive - Nursing is a helping profession - Nursing is concerned with health promotion, health maintenance and health restoration. NURSING AS AN ART ----------------- An art is a body of practical knowledge which helps us know how to work to produce certain results, nursing as an art requires a sympathetic heart and willing hands, and the purpose of nursing is to help maintain or attain health for an individual. The art of nursing is the skill application of that knowledge to help others reach maximum function and quality of life. It is the intentional creative use of oneself, based upon skill and expertise, to transmit emotion and meaning to another. Nursing as an art means that it is a practical knowledge used to work out solutions for various nursing problems. NURSING AS A SCIENCE -------------------- A science is a body of knowledge based on a large number of carefully collected facts which have been arranged and classified in such a way to establish certain laws and principles. Nursing as a science requires a sound broad type of education and a thorough knowledge of the human nature and hence knowledge in courses/subjects such as, physical and biological sciences (Anatomy and physiology microbiology, social science and medical science). The science of nursing is the knowledge base for the care that is given. Nursing as a science means that it deals with human needs and problems. The science of nursing is built upon a systematic method of problem solving called the nursing process. For this, nurses study biological and social sciences including Physics, Chemistry, Anatomy, Physiology and Microbiology among others. **Scope of nursing** - Promoting health and wellness - Preventing illness - Restoring health - Caring for the dying **Promoting health and wellness** - Improving nutrition and physical fitness - Preventing drug and alcohol - Restricting smoking and - Preventing accidents and injury in the home and workplace **Preventing illness** - Immunizations - Prenatal and infant care - Prevention of sexually transmitted infection **Restoring health** - Providing direct care to the ill person - Performing diagnostic and assessment procedure - Consulting with other health care professionals about client problems - Teaching client about recovery activities - Rehabilitating clients to their optimal functional level **Caring for the dying** - Helping clients live as comfortable as possible until death - Helping support persons cope with death HISTORY OF NURSING IN THE WORLD ------------------------------- From the beginning of time the nurse has been regarded as a care giver. During the early years of the [Christian Church](http://en.wikipedia.org/wiki/Christian_Church), St. Paul sent a deaconess Phoebe to Rome so as to visit the sick. She took care of both women and men. Knights, nuns, priests and monks provided nursing care as Christian charity. In the 16th century, Protestant reformers shut down the monasteries and convents, allowing a few to continue in operation hundred municipal hospices. Those nuns who had been serving as nurses were given pensions or told to get married and stay home. In Catholic areas however the role of the nursing sister continued uninterrupted. In early civilization, humans believed that illness had supernatural causes. The theory of animism was developed in an attempt to understand the cause of mysterious changes in body functions. This theory was based on the belief that everything in nature was alive with invisible forces and endowed with power. Good spirits brought health and evil spirits brought sickness and death. The physician was a medicine man who treated diseases by chanting, inspiring fear or opening the skull to release evil spirits. The nurse was usually the mother who cared for her family during sickness by providing physical care and herbal medicine. This nurturing and caring role of the nurse continued to the present. Humans also believed that illness was caused by sin and the god's displeasure; temple became the centres of medical care. Priests were highly regarded as physicians. The nurse was viewed as a slave carrying out task based on the order of the priest. During the same period, the ancient Hebrews proposed rules for ethical human relationships, mental health and disease control through the Ten Commandments and Mosaic health code. Nurses cared for the sick persons in their homes and the community and also practiced as midwives. The nursing profession has a proud history. Traditional female roles of wife, mother, daughter and sister have always included the care and nurturing of other family members. Artifacts in earliest primitive societies establish the existence of individuals, both men and women who comforted and cared for the sick and those unable to care for themselves. Throughout history, nursing has been integrated into every facet of life. Legacy of human caring was initiated when according to the bible in Exodus 2, midwives Shiphrah and Ruth recued the baby Moses and hid him to save his life. Caring has progressed throughout the years, responding to psychological, social, environmental and physiological needs of society. There are also artistic representations of individuals who assisted the society's healers in curing. The traditional nursing role was one of humanistic caring, nurturing, comforting and supporting. Nursing began with men as health healers. Nursing in the earliest times was practiced without any formal education or prior knowledge or theoretical based. It was seen as a profession reserved for drunkard, prostitutes and without any respect for those who practiced it. However nursing has undergone many changes. It has migrated through primitive era/culture, ancient civilization, Christian era, middle Ages, the reformation and Nightingale\'s era. In spite of all these revolutions nursing still maintains its nurturing and caring role and it is now expressed by deliberate and intelligent application of scientific knowledge and theories. STAGES OF THE DEVELOPMENT OF NURSING ------------------------------------ - PRIMITIVE ERA - CHRISTIAN ERA - NURSING IN THE MIDDLE AGES PRIMITIVE ERA ------------- Nursing is believed to have originated with the primitive mother who cared for the ill members of her family. They provided the necessities of life by persistent effort and ingenuity through trial and error. Nursing formed part of their ethical and humanitarian responsibilities. Women cared for children, elderly and sick members of the family and neighbors in times of illness using simple procedures based on their skills. http://image.slidesharecdn.com/hon-introprexanera-100212045002-phpapp02/95/history-of-nursing-intro-pre-christan-era-8-728.jpg?cb=1265950711 ![http://www.tn4me.org/pics/fulls/05Nursing.jpg](media/image4.jpeg) **[PRE-HISTORIC PERIOD]** In the pre historic period, nursing was strongly delineated by health practices which were guided by beliefs of magic, religion and superstition. Individuals who were sick were considered to be cursed by evil spirits and evil gods. Members of tribes participated in rituals, wore mask, and engaged in demonstrative dances to rid the sick of demonic possession of the body. Sacrifices including human sacrifices and offerings were made to rid the body of evil gods, demons and spirits. Many tribes used special herbs, roots and vegetables to cast out curse on illness. Medicine in Egypt reached advanced stage of knowledge. The custom of embalming enabled the Egyptians to become well acquainted with organs of the body. From clinical observation, they learned to recognize some 250 different diseases and treatment; therefore they developed drugs and procedure including surgery. http://www.ancientcraft.co.uk/Archaeology/stone-age/shaman1.jpg **[NURSING IN ANCIENT CIVILIZATION]** The health care in ancient civilization was strangely influenced by religion and the supernatural. There was no highly organized provision of nursing care but women served as providers. Obstetrics was done solely by mid wives among the Egyptians. Most birth attendants were friends among the ancient Babylonians, nursing was practiced as a domestic servant or slave job in which the nurse was either male or female. There were account of female servants who breastfed the infants of their masters \[Wet Nurses\]. Treatment of illness included massages, exercises and administration of herbs and acupuncture. Natural remedies and therapies were also used in particular in treatment of mental illness. With the decline of Egyptian civilization, the first correlation of women with healing arts is found in Greek mythology in the person of Decorative Aesculapius who eventually became deified as God of healing. ![http://s3.amazonaws.com/s3.timetoast.com/public/uploads/photos/8170319/egyptian-medicine.jpg?1478367775](media/image6.jpeg) http://thumb101.shutterstock.com/thumb\_small/592786/592786,1296597037,3/stock-vector-snake-and-cup-caduceus-and-staff-of-asclepius-medical-symbols-each-image-on-it-s-own-layer-70277599.jpg ![https://farm3.staticflickr.com/2453/3557210637\_050ff5a05c\_z.jpg?zz=1](media/image8.jpeg) **[EARLY CIVILIZATION]** Civilization is believed to have started from Egypt where ancient Egyptians are noted for their health care. They were the first to use the concept of suture in repairing wounds. They were also the first to develop community planning that resulted in a decrease in public health problems. (One of the main early public health problems was the spread of disease through contaminated water source). Special laws on cleanliness, food use and preservation, drinking, exercise and sexual relations were developed. Palestine (from 1400 to 1200 BC) for instance wrote laws to prohibit the eating of animals that were dead longer than 3 days. Greek (from 1500 to 100 BC). Greek philosophers sought to understand man and his relationship with the gods, nature and other men. The first correlation of women with the healing arts is found in Greek mythology in the person of Aesculapius who became deified as the god of healing. One of his children Hygeia became the goddess of health and another Panacea from which comes our word for word for "Cure all", became the restorer of health. They believed that the gods and goddesses of Greek mythology controlled health and illness. Temples were built in honor of Aesculapius, the god of medicine. http://aquariusthewaterbearer.com/wp-content/uploads/2014/12/Hygeia-and-Water-Snake.jpg Greek goddess of health Hippocrates (460 -- 362 BC) considered the "father of medicine", paved the way in establishing scientific knowledge in medicine. He taught physicians to use their eyes and ears to reason from facts rather than from gratuitous assumptions. His writings on dislocations were unexcelled under the discovery of the X -- rays. Hippocrates was the first to attribute disease to natural causes rather than supernatural causes and curses of gods. His teaching also emphasized the patient centered approach and use of the scientific method of solving problems. ![http://1.bp.blogspot.com/\_P1aSfh7IEUE/TL3q\_iE75yI/AAAAAAAABFc/NOSYyduvl8Q/s1600/hippocrates-father+of+medicine.jpg](media/image10.jpeg) **Hippocrates** **[CHRISTIAN ERA]** The teaching and works of Christ has a profound effect on nursing and medicine as he expressed empathy to orphans, poor, travelers and the sick. Christians based their principle of love your neighbor as yourself; Christ parable of the Good Samaritan religious orders ministered and cared for the sick. The first organized visiting nurses or home health nurses began with establishment of the Order Deaconesses. The women who acted as deaconesses were appointed by the Bishop because they were women with good social standing who practiced the corporal http://upload.wikimedia.org/wikipedia/commons/thumb/0/00/RedCrossNursen.jpg/300px-RedCrossNursen.jpg ![http://www.lisburn.com/churches/church-news-2012/church-news-images-2012/kathleen-lillie1.jpg](media/image12.jpeg) **[BEFORE THE MIDDLE AGES]** The early Christian church and teachings of Christ expressed succor to orphans, the poor, travelers and above all, the sick. The deaconesses of the early church visited the sick, much like the modern public health nurses. Phoebe was a Greek lady who was remembered as the bearer of Saint Paul's epistle to the Romans. Visiting nurses became an important part of the work of the early deaconesses and Phoebe is often referred to as the first visiting nurse and first deaconess. In Rome, the 1^st^ large hospital was established by Fabiola, a beautiful worldly woman who thereby did penance for her 2^nd^ marriage. She administered this hospital so well that her death was mourned by all Rome. A few centuries later in the western world, the first hospitals under the auspices of the Roman Catholic Church was founded which still exist. **[MOSLEM MEDICINE AND HOSPITALS]** During the 8^th^ to 10^th^ centuries, magnificent hospitals were constructed throughout the Moslem world. The well-endowed hospital was in Cairo and was especially for infidels. http://ee\_ce\_img.s3.amazonaws.com/cache/ce\_img/media/remote/ce\_img/https\_ee\_channel\_images.s3.amazonaws.com/article-figures/4908/article-g23\_400\_243.jpg **[MIDDLE AGES (476 BC -- 1450 AD)]** This period followed the fall of the Roman Empire where women used herbs and new methods of healing whiles men continued to use purging, leaching and mercury. This was the period which saw the Roman Catholic Church as a central figure in the organization of management of health care. Most changes in health care were based on the Christian concepts of charity and the sanctity of human life. Wives of the emperors and other women considered noble became nurses. These women devoted themselves for caring for the sick, often carrying baskets of food and medicine as they travelled from house to house. Widows and unmarried women became nuns and deaconesses. Two of these deaconesses, Dorcas and Phoebe are mentioned in the bible as outstanding for the care they provided the sick. During the middle Ages, physicians spent most of their time translating medical essays, they provided very little medical care. Poorly trained barbers, who lacked any formal medical education performed surgery and medical treatments that were bloody or messy. Nurses also provided some medical care, although in most hospitals and monasteries female nurses who were not midwives were forbidden to witness child birth, help with gynecologic examinations, or even diaper male infants. Also theses female nurses were not permitted to have contact with male patients, administer enemas or care for a man with a venereal disease. Female midwives did, however, provide the bulk of obstetric care within the community. During the crusades which lasted almost 200 years, (from 1096 to 1291), military nursing orders known as TEMPLARS and HOSPTALIERS were founded. **[INFLUENCE OF THE CRUSADERS ON NURSING]** As the middle Ages advanced, 3 organizations developed and have persisted in some form to the present day. They are the military orders, regular or religious orders, and secular orders. **[MILITARY ORDERS]** These were sphere-headed by a man who supposedly combined a lofty spirit devoted to the service of God with a fierce belligerent temper. As he travelled, he carried the principle of and the glory of Knighthood to their fullest throughout Europe and the Mediterranean basin. Here, men went to battle and then retired to nurse the, sick. They were called night hospitaliers. Later on in life, they devoted themselves entirely to nursing. Two great influences shaped nursing practices during this period; the military and the religions. Gradually, the care of the sick was considered more a religious duty. Three (3) nursing orders became preeminent: a. Knights of St. John b. Tentonic Knights c. Knights of Saint Lazarus Corresponding to these were 3 orders of women who tended to female patients in special hospitals. The order of Saint John -- Italian and was highly successful in its mission. It established an ambulance service and was a major organizer of the International Red Cross. This order established customs that remain the heritage of nursing today. Military in character, it was steeped in a tradition of discipline. Modern nursing traces its tradition of obedience to the principles of complete and unquestionable deviation to charity held forth by the order of Saint John. **[REGULAR ORDERS]** The crusaders brought insecurity to the lives of the people so nurses could not provide nursing care in their homes. Hence they sought refuge behind moats and watts, and this led to the establishment of monasteries. The early hospital was called a *Hotel Dieu*. During epidemics, care of the sick was performed by volunteers. One outstanding volunteer was saint Catherine of Siena (1347 -- 1380). In 1372, a plaque came to Siena and Catherine went to work day and night caring for the sick. There was no uniform, so the nurses wore their regular clothes while on duty. **[SECULAR ORDERS]** According to Grace Delonghery, issues and trends in nursing became increasingly clear. Consequently secular orders were developed that were separate branches of the regular holy orders but required uniformity in dress and religious observances. E.g. the third order of Saint Frances, the order of Saint Vincent de Paul, and the sisters of charity. **[THE RENAISSANCE (1300 -- 1600)]** This period is referred to as the revival of learning. New emphasis was given to medical education but nursing education was practically nonexistent. Fore runners of the great medial development of this period are: - - Leonardo da Vinci (anatomical studies and sketches) - Andre Vesalius (developed anatomy as a science) - William Harvey (founded medical science based on fact rather than tradition). - Ambrose Pare (military surgeon, he also devised artificial limbs for the victims of war). During this period, nursing reached a high level of organization and efficiency in the religious and military orders. **[THE REFORMATION]** The reformation was a religious movement that resulted in a conflict between Roman Catholics and Protestants. During this period, religious facilities that provided health care closed. Nursing sank to its lowest levels. In England, over a hundred hospitals were closed and for sometime, there was little or no provision for institutional care of the sick. When the demand became too great to be ignored, lay person were appointed to run the hospitals. Women were encouraged toward charitable services but their main duties included bearing and caring for children in their homes. Hospital work was no longer appealing to women of high economic status and the individuals who worked as nurses in hospitals were often female prisoners, prostitutes and drunks. Nursing was no longer the respected profession it had once been. This period is referred to as the "Dark ages of Nursing". The only profession available to women was acting and that was not respectable. The chief duties of a nurse in those days were to take care of the physical needs of the patient, making sure of reasonable cleanliness although this was not considered essential in early municipal hospital. Nursing existed in a low and dismal state, without organizations and without social standing. Nurses were considered the most menial of servants. They frequently worked 24 or 48 hours at a time and pay was insufficient to support themselves to mention dependents. The future of these looked bleak. HISTORY OF NURSING IN GHANA --------------------------- Ironically nursing in Ghana was started with men. They were not called nurses but male orderlies trained with a modified curriculum to suit their low educational background. Those trained were exclusively men. It was impossible to recruit females to take up nursing. Four main reasons were identified: - Young people with education were principally males and it was from among\ them that pupil nurses could be drawn. - Until girl\'s school began to be establishing, parents were shy of sending their\ daughters to school. Schools were largely dominated by boys. - The attitude at that time was that nursing was a menial work which involved\ close physical contact with and handing of sick people in hospitals where most\ of the sick people were males. - Another important reason was that this difficult and menial labour was rewarded with outrageously low salaries. The system of training was that of apprenticeship for a period of three years. Training was given to centers where European nursing sisters were based. These centers were initially Accra, Cape Coast, Sekondi and latter Kumasi and much latter Koforidua. As medical facilities were extended to various part of the colony, more candidates were recruited trained in improvised facilities. The teaching was based on curricula which took into consideration the universally low education standards of the time. The training in these government nursing institutions included the teaching of elementary Anatomy and Physiology, Medical and Surgical Nursing, Hygiene and First Aid. A certificate was awarded at the end of three years to successful candidates. This was the Director of Medical Services certificate. The main problem affecting the recruitment of suitable candidates for training was the gross inadequacy of the educational background of prospective trainees. Having trained the nurses, the Health Department had great difficulty retaining their service. The department was consequently perpetually short of nurses. Year by year the Department made several complaints about the shortages of nurses. For whereas dispensing was quite popular, nursing was considered menial work by the educated Gold Coast Youth. The hours of work (night work was abhorrent to), the discipline the work involved and the poor pay , all conspired to rendering the nursing profession distinctly unpopular.The educated youth did not care for employment which required so much effort, attention and care ,and which was rewarded , after all the trouble with a most ridiculous salary. Accordingly, the trained nurse was only too anxious and keen to resign his position or abandon his training at the least pretext. As with the dispensers , in the 1910s it was much more worth the while for the Gold Coast Youth with some education to take up the more pleasant and remunerative work of a cocoa buyer\'s clerk.To counter this ,the Medical Department made regular representation to the government the matter of better salaries for the nurses but it was not until 1912 when the new scheme was accepted by the government.The scheme also sought to improve the employment conditions and to trainees and retention of the trained nurses continued to be a problem which plagued the Gold Coast Medical Department.The number of trained nurses ,up to 1920, remained small and static. **1921:** There were only *64* nurses and nurses-in training. **1923:** Gold Coast Hospital (Korle- Bu) was opened. This brought a major advancement in nursing and training of nurses. **1930:** There was accelerated growth in the training of nurses, the number increased and exceeded 200. Because nursing had become a critical factor in modernization of public health facilities in the 1920s. The advanced training for nurses and midwives formed part of the agendum of the Third Conference of the senior members of the West Africa Medical staff held in Accra in 1925 and of the 1927 committee appointed by the secretary of state to work out a plan for establishment of a West African Medical College. In 1928, a scheme for increasing the number of nurses - in - training at Korle - Bu, Kumasi and Sekondi hospitals was worked out and soon put in operation The objectives of this exercise was to keep constantly in training a supernumerary reserve at the larger centres, so that when calls for staff came from outstations it would be possible to furnish at once properly trained personnel and avoid the dislocation of and impairment of efficiency at the larger centres. This increased the strength of the nursing staff somewhat in the 1930s and 1940s but not by very much, for significant proportion of trained nurses resigned their positions, largely on account of poor salaries, as it had been in the earlier decades. But the training of dispenser nurses in 1931 made up somehow for the shortage of professional nurses. But the shortage of the 1940s was so serious that Dr. Balfour Kirk, director of medical services 1941-1943 advocated a hold on expansion of hospital facilities to allow the training of nurses and other supporting staff. All along the highest and responsible positions in the nursing profession, from matron downwards were held by European nurses whose number exceeded 30 by 1940. The towns which were graced with European nursing sisters were Accra, Kumasi, Sekondi-Takoradi and Tamale. The first nurses in this country were male orderlies who were recruited and trained to help the few missionary doctors who had been posted to the Gold Coast to look after the health of their compatriots and their families. Their duties included bathing, feeding of patients, dressing their wounds and administering simple drugs. Organized medical services started in 1878 when medical officers sent by the British Colonial Government for training arrived in the country. The first colonial sister arrived in Ghana, then Gold Coast, in 1899 followed by others. The colonial sister was recorded to have given some form of on-the-job training to the orderlies who were mostly men, though a few women were also trained. They were given some simple lessons in human anatomy and physiology, surgical and medical nursing and first aid principles/techniques. The successful ones were appointed 2^nd^ division nurses in the civil service with the opportunity to rise to 1^st^ division nurses. These 2^nd^ division nurses were awarded the director of medical services certificate. Recruitment of male orderlies was necessary because local customs did not permit young girls to provide nursing care to non-relatives. NURSING EDUCATION IN GHANA PRIOR TO INDEPENDENCE ------------------------------------------------ Nursing education in Ghana prior to independence must be understood in the context of the organization of health care services by the colonial administrators. In the late 19^th^ century, the Gold Coast was referred to as the "White Man's Grave", due to the prevalence of serous tropical diseases such as malaria and yellow fever. Improvement of health conditions in the Gold Coast was a priority for Great Britain because of the rich mineral resources in the colony. Two British nursing sisters were therefore appointed by the colonial government to assist with looking after the health needs of the European government officials in the Gold Coast in 1878. In 1880, the Gold Coast medical department was created with responsibilities for preventive service such as vaccination & sanitation following the arrival of the nursing sisters, a few women began to be trained as nurses, although most nurses continued to be men. The British nursing sisters gave lessons to the nurses in human anatomy & physiology, surgical and medical nursing, and first aid. Nurses who successfully completed this training were awarded a Director of medical Service Certificate and became 2nd division nurses in the colonial service. The 1928, a new maternity hospital in Accra was able to recruit women to it midwifery school, perhaps with the traditional roles of women in society. The Midwives Board was formed to carry out the terms of the ordinance in relation to the training, examination registration, and practice of midwifery in the Gold Coast. Until 1945, all senior nurses in Ghana, including purse tutors, were white colonial sisters. This pattern changed in the years following 1945. Recognizing that the system apprenticeship could not produce nurses of the caliber required to fill the highest positions in the service, Dr. Kirk drew up plans for a school of nursing with a defined syllabus for training. This led to the starting of the first State Registered Nursing (SRN) Training in Kumasi. Isabel Hutton arrived from Britain to start a nursing school, in January 1945. This nursing school was fashioned after the British system, for Ghanaian nurses in accordance with the provisions of the Nurses' Ordinance of 1947. This training school for state registered nurses (SRNs) was initially located in Kumasi, in rented premises which sewed both as a college and hostel with a number of five (5) students. They received practical training at the Kumasi Central Hospital, now Komfo Anokye Teaching Hospital. In 1948, the entire school was moved to (new buildings in Accra) to its permanent college was established with the aim of training high caliber nurses to replace the foreign nurses at post and later to supervise and administer new established hospitals. Thus In 1948 Korle-Bu NTC was completed. The students at Kumasi were then transferred to Korle-Bu. It was significant that entrance into NTC was restricted to only females and males began to lose their dominance in the nursing profession in Ghana. Miss Isobel Hutton, Miss Kay Storrier and Miss Gladys Burton were the three appointed tutors before the school began in 1945 in Kumasi and later moved to Accra in 1948. Miss Hutton became the first principal of the college in 1956. In 1946, these sisters began negotiating for the legislative recognition of the college by the General Nursing Council of England and Wales. They laid down the standard of training. It was while Miss Hutton was in London in 1947 that she achieved a critical success of obtaining in principle, reciprocity for State Registered Nurses trained in Ghana. The training was a 3^1^/~2~ year programmed based on the pattern maintained for training S.R.Ns in Britain. Although most practicing nurses in the country at the time were men, only women were eligible to enter the new college for S.R.Ns. Historical document do not offer an explanation for this gender shift in the preparation of nurses for practice. The curriculum at this time followed the syllabus set out by the General Nursing Council (GNC) of England and whales, to ensure that locally trained nurses could be accepted for registration in Britain, to undergo post-basic courses there another eventually to take over the nursing duties of the country from the British colonial nursing sisters. Concurrent with the establishment of the SRN program was the training of qualified registered nurses (QRNs) in the Gold Coast. The SRN was a higher qualification than the QRN, although the QRN was considerably higher than that of the state-enrolled nurse in the United Kingdom. The QRN was established in 1948. Consequently the apprenticeship system of training for the QRNs was retained. By 1952, females were in overwhelming numbers and males nurses had practically disappeared. **[NURSING EDUCATION IN THE POST -- INDEPENDENCE PERIOD]** Post Colonial Era-; 1957 saw Gold Coast attaining independence and the last colonial official left the country. Matron Docia A. N. Kisseih was the first Ghanaian nurse to be appointed Chief Nursing Officer (CNO), after the departure of the last British Matron, and she took over from the European sister who was in charge of the Gold Coast Nursing Services. (She died in September, 2008.R.I.P) ![https://i0.wp.com/static.wixstatic.com/media/6753e1\_afb7dc2b8bad1aa2dd190ef7f34693e6.jpg/v1/fit/w\_600,h\_220,q\_90/6753e1\_afb7dc2b8bad1aa2dd190ef7f34693e6.jpg?ssl=1](media/image14.jpeg) At the time of independence in 1957, education for SRNs was offered by two government training schools located in Accra and Kumasi. Government schools in Cape Coast, Sekondi-Takoradi, and Tamale provided training for QRNs. Mission hospitals, such as the Seventh -- Day Adventist Hospital in Atibie, Kwahu, provided QRN training and midwifery. In 1958, a government decision to train doctors locally at the University of Ghana necessitated enlargement and modernization of Korle-bu hospital to become a teaching hospital. This decision had an impact on the evolution of nursing education and practice in Ghana. Several SRNs were sent to the United Kingdom to gain specialized expertise in the variety of areas such orthopedic, genitourinary and sick children's nursing as well as in the organization of a central sterilizing department. The need for the education of more nurse tutors to assume teaching and leadership roles in nurses' training colleges was also recognized during the years following independence. Majorie Houghton, a former member of the GNC, was invited by the government of Ghana in 1961 to evaluate the nursing training lasting 4 years, the one grade of professional nurses to be assisted by auxiliaries. She also high lighted the need for tutors and clinical instructors and participated in discussions at the University of Ghana regarding a tutorship course. By 1963 Ghanaian nursing was caught up in many of the rapid technical organizational change found in many western countries. The objectives in nursing education were to make nurses more responsible and to help them to be more effective team members. This of course involves a deeper understanding of patient. To meet the demand of technological growth in health service the MOH, UNICEF, WHO and the University of Ghana jointly sponsored Nursing Education Programme at the university level, In this same year (September, 1963), the department of nursing at Legon was established for higher nursing education. C.N.O. Dr. Docia Kisseih was instrumental in this; she was the first head of department. The programme was Diploma in Nursing, Education and a Certificate Programme in Nursing Management (during the long vacation). These two programmes at the university helped produce several nurse-educators and nurse managers to provide the needed expert skills on the ward and in the schools. A degree programme was introduced in 1980 to run concurrently with the diploma programme. A similar programme was established at KNUST since 2003/2004 academic year awarding a BSc in Nursing for a 4 year period. (Thus, KNUST also started a degree programme for nurses in 2003 Currently other universities in the country are all running nursing programmes. UDS in Tamale and Cape Coast University are also offering a first-degree programme in nursing. Other private institutions like Garden City, Valley View and Central University are also offering degree in nursing. POST GRADUATE DEGREE IN NURSING ------------------------------- In 2001 the diploma programme was phased out at the University of Ghana and a master\'s degree in nursing was also introduced. (MPhil and MSc in nursing). It took off in 2000/2001 academic year at the UG Legon. The requirement was a first or second class upper and a bachelors\' degree programme or its equivalent. The master of philosophy programme offers administration education and child health among others. **The University of Cape Coast also runs a master\'s degree programme for long serving tutors with diploma in nursing.** The development of nursing education in Ghana made significant progress with the establishment of the first university program for nurses at the University of Ghana. This initiative under the leadership of Doctor Docia Kisseih, represented a tripartite agreement between the Ghana Government, the World Health Organization (WHO), and the United Nations International Children's Education Fund (UNICEF). On the advice of Doctor Rae Chittick, the Canadian WHO consultant hired to plan and implement the program. This two year post basic diploma was to prepare nurse tutors, administrators and supervisors. Financial support for a library and the purchase of two buses to transport nursing students to their community placements was provided by UNICEF. Ghanaian nurses began to return from graduate studies overseas to take up teaching position in the University of Ghana's Department and Nursing. Ayodele Akiwumi was one of the theses nurses and held the position of senior lecturer in the department from the mid-1960s until her retirement in 1995. (She died in 2004. RIP). In the late 1960s, the Ghanaian government once again approached WHO for assistance in the development of a comprehensive diploma program for SRNs. The comprehensive curriculum added education in the social science, public health, obstetrics, and psychiatry to the basic program. The comprehensive curriculum-based curriculum was later changed to competency-based curriculum. Nursing continued to grow. In 1962 the curriculum for training of professional nurses was revised. A legislative instrument was passed to amend and nullify the former programme. In 1970 the Comprehensive nursing programme was introduced. Thus, a new curriculum for SRN was established in place of the 1945 programme that was the comprehensive nursing, which raised the standard of nursing profession to provide a total but individualized care to client and the family. It also prepared the nurse to function both in hospital and community setting. This was to broaden the basic training of the professional nurse to include areas such as obstetrics, psychology and sociology, public health and psychiatric nursing. The objective of this new programme was to produce a nurse who can render a total patient care in any given community. (A Polyvalent Nurse) The growth of medical technology increased the demand for hospital care and public health services which resulted in a growing demand for nursing skills to keep abreast with the times. There was a shift from teaching specific facts to that of experimental teaching; that\'s teaching a process of enquiry. As a result, nurses began to delegate menial tasks to auxiliaries in a response to the need to make the best use of trained personnel. In 1989/90 the programme was reviewed by a committee comprising nursing educators and clinicians in order to prepare a competency-based training programme. The current revision in 1993 was made with ever-rapid changing trends in education with health care in mind. The purpose was to prepare a nurse who would be able to function as a general nurse practitioner in health care institutions and community. The revised edition was based on the semester and course credit systems to enable nursing education integrate effectively in the new system of education. Entry requirement was previously GCE 'O' Level with 5 credits including English, Science and Maths. Age: 18 years and above. The current SRN programme has been reviewed and changed to a diploma awarding institution with a 3-year training duration. Requirements are SSCE/WSSE. Thus the NTCs have gone through another change in the nursing training curriculum. The SRN has phased out and in its place is a diploma programme leading to RGN/RMN etc. in Diploma. ENROLLED NURSING ---------------- This was introduced in 1963 and the main aim was to relieve the professional nurse of non-skilled nursing duties so that she could concentrate on technical nursing. They were called nursing assistants, this name was abolished to enrolled nursing in 1968. The maximum qualification for entry was middle school leaving certificate and duration of training was 18 months at the beginning but later became 2 years. MIDWIFERY --------- Organized midwifery started in 1928 in Korle-Bu and Kumasi. Presently there are more than 10 midwifery institutions including mission schools in the country. Earlier on, the minimum requirement was middle school leaving certificate, which trained pupils as straight midwives. **[DURATION OF COURSE FOR OTHER CATEGORIES (POST BASIC MIDWIFERY)]** 1. QRN's had 18 months training in midwifery 2. Enrolled nurses -- 2 years 3. SRNs -- 12 months -- no more exist 4. Community health nurses -- 2 years Currently -- Direct Midwifery -- 3 years duration. 3 years (Diploma). Age 18 and above with an entry requirement: - SSCE/WSSE. REGISTERED MENTAL NURSING PROGRAMME ----------------------------------- The 1957 former QRMN was reviewed and upgraded to the new RMN programe in 1974 and further reviewed in 1989/90 alongside the basic competency based curriculum. The aim was to provide a total and individualized care to the mental patient and his family in both the health care institution and the community. An entry requirement was formally, GCE O' Level C 5 credits including English, Maths and Science. Age: 18 and above. Course available at Pantang and Ankaful (Cape Coast) duration of course was 3 years for non-nurses and 18 months for qualified SRNs. It has now been upgraded to diploma status (RMN). Entry requirement now SSCE/WSSE. HEALTH CARE ASSISTANT (HCA) --------------------------- In view of the acute shortage of nurses in Korle-bu. Korle-bu decided to train health care assistants to provide basic nursing care. HCA program was started on a pilot basis in the year 2001, February 15. They were trained for duration of 3 months on the job. They also had lectures in the classroom. The 1^st^ batch of students was 50. To qualify for this programme, one needed to have SSS or GCE \'0\' Level certificate. The curriculum has been reviewed. They are now trained for 2 years as health assistants, clinical. NURSE ASSISTANT CLINICAL (NAC) ------------------------------ Duration -- 2 years Entry requirements: SSCE/WSSE. PUBLIC HEALTH NURSING (PHN) --------------------------- This started in 1952. The staffs were normally known as health visitors. Generally, they provide general health and the welfare of infants, they also advice on feeding, rendering nursing care and home visit were carried out. They followed up discharge patients at home and planned health education programmes in the community. They served as preventive nurses. Formal training programme started in 1962 at Korle-Bu with a capacity of students. COMMUNITY HEALTH NURSING ------------------------ Community Health Nursing (CHN) an auxiliary to PHN was started in 1960 at Tamale and in 1962 another one was opened at Akim Oda with a third one in Ho in 1965. The forth CHN school was opened at Winneba with the recent one in Navrogo. Currently Fomena and some private institutions across the country also run this programme. The aim is to train personnel to assist PHMs in their duties. Duration of course is 2 years. Entry requirement formally was middle school leaving certificate including a pass in an entrance examination but now SSSCE or WASSCE or GCE \'O\' Level certificate. There are CHN schools being established in all the 10Regions of Ghana. **POST BASIC COURSES** Ophthalmic nursing. Intensive Care nursing, ENT nursing and anaesthesia are some post basic programmes available for diploma nurses with 3 years working experience. It is a 4 semester course. **In conclusion, modern scientific nursing took root from Florence Nightingale. With introduction of nursing in Ghana, it has evolved from its apprentice system of training during the early years of colonial era to its present enviable levels of qualification to the master\'s level with improved knowledge and practiced skills. Looking into the future, all knowledge loving people of the nursing profession are looking forward for the commencement of a Doctorate Degree in Nursing. This we believe will pave way for nurses to climb the academic ladder to become professors. This can be achieved when we keep in mind the message of yesterday and evaluate our position today and anticipate our goals and desires of tomorrow.** Nursing today, has metamorphosed from cocoon of the colonial times is about to break out into a butterfly. We are yet to see the colours. Today nurses are highly trained. Some have their doctorate degrees and many more hold their master degrees. There are few professors. The big question is what is the impact of the medical and nursing practices in Ghana? TIME WIILL TELL. Unfortunately, in spite of the effort made by past administrations including colonial masters, to stop nurses from leaving the service the canker continues. Highly trained nurses are leaving this time not just the service but the country as well. Reasons? The same as it was during the colonial era. Low salaries compared to that of doctors and poor working conditions and environment. Recent governments are trying hard to improve the situation for nurses and health workers as a whole; But it will take time for these new incentives to hold the nurses back from greener pastures. Nursing is still dynamic and it is only when students of nursing keep in mind the message of \'yesterday\' that we can evaluate our position \'today\' and find grounds for anticipating the future. CHALLENGES TO THE GROWTH OF NURSING EDUCATION --------------------------------------------- Nursing education in the years following independence was fraught with problems for tutors and students alike. - Text books when available were frequently outdated and not convenient and accessible. - Limited audiovisual equipment in training colleges. - Heavy burden of tropical diseases such as malaria resulting high rates of absenteeism. - Increased intake of students resulting in overcrowding and - Problems at the clinical area. NURSING IN THE 21^ST^ CENTURY ----------------------------- Professional nurses in the 21^st^ century are faced with many challenges within the health care system. In addition to the issues of access, cost quality and accountability in health care, nurses today are faced with an aging population, complex consumer values and an increasing intercultural society. Nurses have identified numerous areas of concern, including insufficient staffing, inadequate salaries, effects of stress and over work, lack of participation in decision making and dissatisfaction to the quality of their own nursing care. Changing duties, responsibilities and conflicts amidst nursing shortages and public concern over patient safety and quality of care characterize present day practices. These areas require professional nurses to have care competence in critical thinking, communication, inter disciplinary team, collaborate assessment, leadership and technical skills, as well as knowledge of health promotion or disease prevention, information technology, health system and public policy. **[FLORENCE NIGHTINGALE (1820 -- 1910)]** http://static.wixstatic.com/media/6753e1\_906e87de390d998ca2f27a79c325573a.jpg\_srz\_210\_229\_85\_22\_0.50\_1.20\_0.00\_jpg\_srz Florence Nightingale was born in 1820 to wealthy English parents in Florence, Italy. She grew up in England, well versed in social skills and well educated. She attended nursing school at the age of 31 at in [Kaiserswerth](http://en.wikipedia.org/wiki/Kaiserswerth) in Germany after parental protests. Florence was working in London when the Crimean war broke out (1854 -- 1856) between Britain, France and Turkey. They were fighting for control of access to the Mediterranean Sea from the black sea. Nursing care was provided by the sisters of mercy and charity to the Russian and Turkish troops. British troops were ignored. Conditions for troops, especially those injured, were deplorable. Mortality rates for the British were 420/1000 wounded. Nightingale was approached by the secretary of war to provide care to the troops; she and 38 other women went to provide care to 4000 troops. **Florence Findings** - The wounded lay on the floor in filth - Filthy hospitals with no beds, no soap, no medicines or other supplies - She hired people to wash and clean, often working well into the night - She and others made rounds at night carrying an oil lamp -- now the symbol for nursing - She brought about major reforms in hygiene, sanitation and nursing practice **Florence Nightingale achievements** - The death rate dropped to 22/1000 wounded - She herself became ill during the war and spent the rest of her life as a semi invalid - Still remained active in promoting nursing - Known for her efforts to establish formal nursing education - Is considered to be the first nursing theorist - Remained intellectually active unit her death at age 90. - Nightingale stressed the following points in nursing: - High moral character - Technical skill - Obedience - Nursing as a respected vocation - Initiated a major reform in nursing NURSING AND RELATED ORGANIZATIONS AND ASSOCIATIONS -------------------------------------------------- **[INTRODUCTION]** Nursing as a profession has a number of organizations as well as statutory bodies that seek to ensure and maintain a high standard of nursing education and practice, locally, nationally and inter-nationally. The organizations also seek to ensure the safety of both nursing care providers and beneficiaries. These organizations and statutory bodies included: - Nursing and Midwifery Council for Ghana. - International Council of Nurses (ICN). - Commonwealth Nurses Federation (CNF). - The West African College of Nursing. - Registered Nurses' Association. - Registered Midwives' Association THE NURSING AND MIDWIFERY COUNCIL FOR GHANA (NMC) ------------------------------------------------- ![](media/image16.png) This is the regulatory body for the nursing profession in Ghana. There were two separate bodies namely, - - It became necessary to merge the two in August 1972 to form the Nurses and Midwives Council of Ghana backed by Legislative Instrument (LI) NRC decree 117 (NRCD 117 of 1972). It was inaugurated on the said date. { Thus the Nurses'& Midwives' Council for Ghana was formed as a result of a merger by the then Nurses Board and Midwives Board as decreed by the National Redemption council Decree 117 (NRCD 117 of 1972) 1. **We are accountable** i. We act in the best interests of people who use or need the services of nurses and midwives. ii. We take responsibility for our actions and are open and transparent. We are fair iii. We act with integrity and can be trusted to use our powers responsibly. iv. We are consistent in the way we deal with people and show consideration and understanding. 2. **We are professional** i. We are known for our expertise and work to high standards in all we do. ii. We look for innovative solutions and learn from our mistakes. We are progressive iii. We provide strategic direction and lead the way in modern healthcare regulation. iv. We build and maintain networks and work in partnership with others to fulfi l our aims. We are inclusive v. We respect and value everyone for their contribution, celebrate peoples' differences and provide equality of opportunity for all. vi. We consult, encourage feedback, listen and respond to our stakeholders. 3. **The NMC and you**: Embracing excellence together Welcome You're enrolled on an education and training programme that's preparing you to enter a profession which carries with it great privilege and responsibility. As a nursing or midwifery student, you should be proud of the profession you're preparing to enter into, and look forward to upholding the values and standards that have made the UK's nurses and midwives so well regarded across the world. The council is assisted to perform its duties by standing committees such as - - - **[MEMBERSHIP]** Council has a joint membership that oversees its functions. Membership of the council is constituted as provided in the Decree as follows: - - - - - **[FUNCTIONS OF THE COUNCIL]** They shall be concerned with the nursing and midwifery profession and, in particular with the organization of the training and education of nurses and midwives. 1. Establish standards and provide guidelines for the development of a curriculum for the training of nurse assistants, nurses and midwives 2. Register and maintain a register of practitioners 3. Exercise discipline powers over practitioners 4. Prescribe and maintain professional standards and conduct for practitioners 5. In collaboration with appropriate government agencies ensure that nursing and midwifery institutions are accredited 6. Determine and implement post-registration, continuing education and continuing professional development programmes for practitioners 7. Conduct licensing examination for registration for nurses, midwives and nurse assistants 8. Ensure that the education and training of nurses and midwives and other nursing practitioners are carried out at approved educational institutions for efficient nursing and midwifery practice 9. Advice the minister on matters relating to the practice of nursing and midwifery 10. Monitor and inspect training and health facilities in collaboration with the health facilities Regulatory Agency and 11. Perform any other functions that are ancillary to the object of the Council **[Responsibilities of the Council]** 1. In addition to the functions above, the other responsibilities and duties of the council include the following: 2. Verification of registration/licensing (foreign and local) 3. Orientation of foreign-trained nurses and midwives into the Ghanaian setting; 4. Support supervision of nurses and midwives at both public and private health facilities; and 5. Supervision and inspection of nursing and midwifery training schools and health facilities **[Professional Identification Number (PIN)]** - "PIN/AIN now renewable every year" - The council has reviewed the duration of the validity of professional /auxiliary identification number (PIN/AIN) issued to practicing nursing and midwives including auxiliaries from three to yearly - The new duration is in conformity with global trends in nursing and midwifery regulation **[Registration ]** - All nurses and midwives practicing in Ghana must be registered with the NMC and nursing and midwifery department works to maintain these high standards and influence change to ensure that all nurses and midwives working in country continue to adopt the most up-to-date clinical practices. This is done by setting standards for practice, education and supervision of nurse and midwives. The council is able to carry out its characteristics through the work of committees and employment of professional personnel and various grades of clerical staff. **Some Standing Committees include:** - - - - - - Appointment committee - Code of ethics committee - Curriculum committee - Professional committee **Administrative devices comprise** - Indexing of newly enrolled nurses and midwives (students). - Registration and enrolment of qualified persons - Administration of exams - Financial administration **CHAIRMAN OF THE COUNCIL** The chairman of the council shall be a registered nurse -- midwife elected by the members of the council from among their numbers. Currently the registrar/ CEO of the council is Philomina Wooley The immediate past registrar, Mr. Felix Nyanteh The council deals with only problems connected with the characteristics laid down by the statue. It does not concern itself with problems relating to salaries or condition of service for nurses and midwives. This is done by GRNA. **COMMITTEES OF THE COUNCIL** **DISCIPLINARY COMMITTEE** Disciplinary committee actions are taken against some acts of misconduct with or without the approval from the attorney general. Offences punishable include: 1\. Criminal cases reported by court proceedings. 2\. Misappropriation of drugs whether taken from the drug cupboard or obtained by falsification of prescription. 3\. Stealing 4\. Advertising or signing an advertisement to promote the sale of commercial products by a registered nurse or midwife. 5. Practicing nursing or midwifery without registering: or enrolling with the council. **EXAMINATION COMMITTEE** The committee is concerned with the selection of question for examination, adjudication and publication of exam results and all other administrative mailers that relate to examination. **EDUCATION AND TRAINING** The council is concerned with the establishment of a form of training for training for nurses and midwives. **REGISTRATION AND ENROLLMENT** The council has separate register for all professional qualifications that is RGN, RMN, Midwifery, PHN, Tutors and auxiliary qualification such as enrolled nurses and community health nurses. The council expects all nurses who are qualified to register with the council before practicing in Ghana. This is applied to locally train as well as foreign trained nurses. ***FINANCE AND GENERAL-PURPOSE COMMITTEE*** *This committee deals with any item outside the preview of the committee already mentioned and control of finances of the council.* *The council is supported by subventions which are released quarterly in equal parts according to the financial year through the Ministry of Health. This is the council\'s main source of income.* GHANA REGISTERED NURSES ASSOCIATION (GRNA) ------------------------------------------ Ghana Registered Nurses and Midwives **HISTORY** The Ghana Registered Nurses' Association (GRNA) was formed in March 1960 as a result of a merger of two (2) former nursing associations in the country at the time. i. Society of Registered Nursing of Ghana (made up of QRNS) and ii. State Registered Nurses' Association (SRN) The society of Registered Nurses of Ghana had Mr. E.A Mettle Nunoo as a leader and drew its membership from the Qualified Registered Nurses (QRNs). He state Registered Nurses Association on the other hand was lead by Ms Docia Kisseih and drew its membership from the state Registered Nurses (SRNs). The newly born association GRNA had Dr. Docia Naki Kisseih as its first president, and Mr. E.A. Mettle Nunoo as the first vice president, with *Ms. Cynthia Bravo as its general secretary.* Its mission was to provide a central organization that would advance the interest of the nursing profession in Ghana and worldwide. *It was registered into full membership of the International council of Nurses (ICN) at its quadrennial conference held in Melbourne in 1961. It is governed by the National Executive Council which comprises elected representatives from branches of the national body representing all region s in Ghana.* GRNA is a professional Association independent and non-partisan in nature. The GRNA is the exclusive mouth piece for all Nurses in Ghana in matters that affect them. [MOTTO OF THE ASSOCIATION]: Unity is strength ***[MISSION]*** *Is to promote the socio - economic well-being of the nurse providing, promotive, preventive and curative health service delivery.* **[AIMS / OBJECTIVES]** **AIM** The aim of the association is to provide a central organization for all nurses in the country. 1. To bring all practicing nurses in Ghana into a unified body. 2. To advance the interest of the nursing profession locally and internationally. 3. To promote generally, a better understanding and dignity of the profession. 4. To maintain the honour and independence of the profession with special reference to professional standards, conduct, discipline and etiquette. 5. To promote nursing education and research. 6. To affiliate and promote good relations with the international council of nurses, Commonwealth Nurses Federation, the International Confideration of Midwives and similar organizations of nurses in other countries. 7. To promote and support the law reforms on all matters affecting the nursing profession. 8. To recommend deserving members for scholarship awards. **[MEMBERSHIP]** Membership of GRNA is open to all nurses in Ghana, registered or enrolled by the Nurses' and midwives' council for Ghana. Membership is acquired and maintained through; 1. Registration or completion of membership enrollment form. \(2) Payment of enrollment fee, monthly dues *and other dues* instituted by the association. \(3) Having a membership card duely signed by the general secretary and the national president. **[VISION]** Developing the nurse scientifically to cope with the contemporary challenging changes in the health service. Prolonging the life-span of all people living in Ghana, and Raise the socio economic status of nurse. **[GRNA ACTIVITIES]** Maintaining and improving Nursing care standards. Promoting nursing education and research Promoting the socio-economic welfare of Ghanaian nurse i.e (Negotiation conditions of service for Nurses) Seeking partnership with government and other stakeholders to promote industrial peace to enhance productivity. - Collaborate with other trade union organizations nationally and internationally. **ORGANIZATIONAL STRUCTURE** The organogram of the association is positioned to facilitated communication and implementation of policies. - Local Branches (At all health care facilities in Ghana ) - District Branches(All districts as decentralized functional areas of GRNA ) - Regional Branches(Supervise decentralized areas and link them to the national\ secretary - *Its secretariat is run by National Executives and Administration Personnel.* - The National Executives are elected quadrennially , headed by GRNA president with the\ powers to implements policies and decisions of the council and National Delegates\ conference. - The National council is made up of National Executives and Regional Chairpersons and\ Secretaries who meet quarterly to formulate policies and other products of GRNA. - The National Delegates Conference meets biennially to discuss GRNA constitutional\ matters (the higher authority of the association). **[NATIONAL EXECUTIVES (NEW ELECT) ]** 1. NATIONAL PRESIDENT: - 2. 1^ST^ VICE PRESIDENT: - 3. 2^ND^ VICE PRESIDENT: - 4. SECRETATRY:- 5. TREASURER: -. 6. PUBLIC RELATIONS OFFICER: -. **[COMMITTEES OF THE ASSOCIATION]** The association has the following standing committees. 1. Finance Committee 2. Education Committee (Promotes nurses education and research). 3. Socio -- Economic and Welfare Committee (Sees to the general welfare of members).' 4. Transport Committee (Sees to matters concerning transportation). 5. Building Committee (Responsible for building projects). **ON INTERNATIONAL STAGE** The GRNA is recognized as important body in nursing worldwide. It\'s a member of good standing in the following international nursing organizations: International Council of Nurses since 1961 (ICN) Common Wealth Nurses Federation (CNF) GRNA advises and supports professional nurse association of sister - African countries. **THE GHANA REGISTERED MIDWIVES' ASSOCIATION (GRMA)** ![Image result for GRMA logo](media/image18.jpeg) The GRMA was founded in 1935. Official recognition of the Association as an organization for midwives in the country was attained in 1953. It was admitted as a member of the International Confederation of Midwives (I.C.M) in 1954. The Association is non-governmental. **VISION** It has a vision for creating a healthy society for Ghanaian women, and their families through quality reproductive health services. **[THE MISSION STATEMENT]**: GRMA seeks to provide integrated services that ensure accessibility of total reproductive health care and child survival services to all, especially women through community mobilization and participation, and in collaboration with all partners in the health delivery system. **[OBJECTIVES]** 1. To advance the provision of maternal care and to develop the role of the midwife as a professional practitioner 2. To raise the standard of practice of midwifery in Ghana by organizing capacity building training programs 3. To promote and protect the interest and welfare of midwives in their practice 4. To promote mutual respect, goodwill, and understanding among midwives and between midwives and the community 5. To advise and articulate the opinions and wishes of midwives on matters pertaining to the efficient, orderly, and peaceful practice of their profession 6. To encourage, educate, and motivate women and families to seek professional medical attention 7. To monitor, evaluate, and conduct research into programs of interest to the Association 8. To publish journals, pamphlets, monographs, report of conferences, seminars, discussions, visits, and other papers relevant to the aims of the Association 9. To project the image of the association internationally through participation at international conferences and contributions bodies such as the International Confederation of Midwives (ICM) 10. Additionally, the organization seeks to increase the enrollment of public sector midwives, to provide a facility for training/conferences of midwives in Accra, and to launch a website for disseminating information on midwifery practices in Ghana. **[MEMBERSHIP]** Membership is opened to all midwives registered with the Nurses and Midwives Council for Ghana. Membership stands at over 500 with about 18% constituting midwives in the public sector. The other 82% constitutes midwives who own and work in their private maternity homes; these form the bedrock of the association. **[ADMINISTRATION]** The administrative structure of the association consists of the Council of National Executives, Regional Executives and the Secretariat Staff. The national executive is made up of the president, the vice president, the secretary, the assistant secretary and the treasurer. The general council which is the highest authority of the association consists of all the national executive members, the regional chairpersons from all the 10 regions. Representatives from Nurses' and Midwives Council for Ghana, Representatives of GRNA, and legal advisor from Attorney General's Office, the chief nursing officer and a medical officer representing Ghana Medical/Association. **ACTIVITIES** The Association provides services by educating its members and does the following: Reproductive Health Maternal and Child Health and Immunization. - Family planning - Syndromic management of STDs including HIV/AIDS - Basic obstetrics - Post abortion care - Primary Health Care - Counseling and general health education GHANA COLLEGE OF NURSES AND MIDWIVES (GCNM) ------------------------------------------- The Ghana College of Nurses and Midwives (GCNM) is a body corporate with perpetual succession established by the provisions of the SPECIALIST HEALTH TRAINING AND PLANT MEDICINE RESEARCH ACT 2011, PART THREE (ACT 833). **Mandate:** To 1. Promote specialist education in nursing, midwifery and related disciplines 2. Promote continuous professional development in nursing, midwifery and related disciplines 3. Promote postgraduate nursing, midwifery and related disciplines for the College 4. Contribute to the formulation of policies to improve health outcomes and public health generally. **Functions:** Ghana College of Nurses and Midwives is established to: 1. Organise and supervise specialist training, continuous professional development and support postgraduate or post diploma research in nursing, midwifery and related disciplines 2. Conduct and organise specialist examinations in nursing, midwifery and related disciplines 3. Publish journals and pamphlets 4. Award diplomas and certificates on completion of specialist training and confer professional distinctions 5. Foster cooperation with other institutions with similar objectives 6. Initiate and participate in actions and discussions aimed at improving health outcomes, and formulation of public health policies in collaboration with other relevant institutions 7. Perform other functions that are ancillary to the objectives of the College 8. The professional academic institution aims at further nurturing a cohort of nurses and midwives with a capacity to provide specialist services for health improvements in Ghana and beyond. 9. The details below describe the criteria for the categories of potential members of the College and their eligibility criteria. 10. The descriptions take cognisance of the various levels of training of nurses and midwives in Ghana and their rights to access to career advancement through academic structures that recognise previous learning. 11. Also described are the emblems and colours of the College and their significance; backgrounds to the College and interlinkages. **Governing Council** The GCNM by the provisions of ACT 833 has a Governing Council comprising a Chairperson, President of College and representations from educational, regulatory and leadership arms of Nursing, Midwifery and related professional backgrounds with the core responsibilities to ensure proper and effective performance of the functions of the College **Mission:** To promote specialist education, continuous professional development and postgraduate nursing, midwifery and related programmes and contribute to the formulation of policies to improve health outcomes. **Vision:** Cadres of committed, intellectually and skillfully competent, contemporary nurses and midwives with specialized education providing quality improved care. **Goal:** To develop a cutting-edge cadre of nurses and midwives with higher level education, who are motivated in leading and developing the future of nursing and midwifery as specialist clinicians, academicians, researchers and managers in Ghana, Africa and beyond. We aim to build upon foundations set and strengthen competencies through: 1. academics 2. clinical care 3. sense of professionalism 4. research and 5. leadership and management drive **Philosophy** Qualified professional nurses are the most appropriate care givers to the sick and well persons. Qualified professional midwives are the most appropriate care givers to attend to adolescents and women through their sexual and reproductive life cycle and beyond. Higher professional education is: - A privilege for accessing true education: An opportunity to: - Further serve humanity and profession in humility at all levels of care - Lead and drive change - Share and build competencies through role modeling and mentoring - Advocate for improved care Belief: "Intelligence plus character is the goal of "True Education". **Values:** GCNM stands for C.R.E.A.T.E: - C -- Change through leadership, role-modeling and mentorship - R -- Results oriented and research focused - E -- Engagement for teamwork in health care - A -- Accountability - T -- Thinking strategically - E -- Ethics for optimal, efficient professional conduct **Motto:** Integrity, Professionalism and Excellence **Integrity:** Good character, moral soundness reliability and trustworthy professional. COMMONWEALTH NURSES FEDERATION ------------------------------ **[About CNF]** - The commonwealth nurses federation (CNF) was established in 1973. - The CNF works with its membership, national nursing and midwifery associations from commonwealth countries in order to influence health policy, develop nursing networks, improve nursing standards and competence and strengthen nursing leadership throughout the commonwealth. - It is a credible, democratic and participatory organization. It is involved in the promotion of high standards of professional practice. There are currently 36 paid up members associations. - The CNF represents nurses and midwives from commonwealth countries at commonwealth meetings. Links nurses and midwives from commonwealth countries together with regular communication. - Conducts education and training workshops in commonwealth countries - Supports national nursing and midwifery organizations to develop their potential to lobby and influence policy and government decisions **[CNF Constitution April 2011]** Nurses and midwives form the majority of health care workers across all health care settings and particularly in the primary health care context. In rural settings and in developing countries the nurse or midwife may be the only local source of health care. The commonwealth nurse federation (CNF), founded in 1973 is a federation of national nursing and midwifery associations in commonwealth countries. The CNF has regular and constructive contact with major commonwealth bodies in London including the commonwealth secretariat and the commonwealth foundation. The CNF is an accredited commonwealth body, which allows involvement in annual health ministers' meetings, the biennial commonwealth people's forum held prior to the commonwealth heads of government meeting and other commonwealth meetings such as the civil society consultations. The CNF is managed by an elected board, which consists of a president, a vice president and a member from each of its six regions. The federation has two appointed officers -- an executive secretary and a treasurer board **[Objectives]** T he CNF'S current constitution was agreed in 2005. It exists to: - Influence health policy throughout the commonwealth, - Develop nursing networks - Enhance nursing education - Improve nursing standards and competence and - Strengthen nursing leadership. The CNF makes a constructive and influential contribution to the work of the commonwealth steering committee for nursing and midwifery. The CNF is committed to involving active participatory membership and collaborating with commonwealth and international organizations such as the international council of nurses, the international confederation of midwives and the world health organization. **[Work Programmes ]** The CNF's current work programme includes the following: - Membership development, - Conducting in-country projects with national nursing organizations involving capacity building and training, - Communicating with member organizations through a newsletter and the website, - Conducting and facilitating research on commonwealth countries - Commonwealth steering committee for nursing and midwifery - Participating in the work of the commonwealth HIV/AIDS Action Group. **[Membership ]** Membership of the commonwealth nurses federation (CNF) is open to all national nursing and midwifery associations in commonwealth countries. Members associations of the CNF are divided into six regions: - - Atlantic Region - East, Central and Southern Africa Region - Europe Region - Pacific Region - Asia Region - West Africa Region Subscription rates 2010 -- 2012 There are currently fifty-four (54) commonwealth countries. Meetings and General Meetings are held every two years. **[History and Mission ]** - Collaboration with other international nursing and health bodies - Participating in a contributing to Commonwealth Health Ministers' and Heads of Government meetings - Participating in and contributing to Commonwealth Health Ministers and other Commonwealth meetings - Promoting Commonwealth Day. THE WEST AFRICAN COLLEGE OF NURSING ----------------------------------- WACN started at the first African Commonwealth Nurses Seminar held in Ghana at the University of Ghana in January, 1974, with representatives from The Gambia, Ghana, Nigeria and Sierra Leone. There were observers from Liberia, East, Central and Southern Africa. Commonwealth Nurses Federation sponsored the seminar while Ghana hosted it. There were resource persons from the sponsors, Le. Britain, Canada and W.H.O. In 1978, A Provisional Council should be set up for a period of two years to work towards the establishment of a West African College of Nursing. The Draft Constitution was finally approved and signed by the AHIM in October, 1980 in Accra, Ghana. The Joint Curriculum Review Committee identified five areas in Nursing that needed to be developed in the member countries. They include: 1. Medical/Surgical Nursing 2. Maternal and Child Health Nursing 3. Mental Health and Psychiatric Nursing 4. Community Health Nursing 5. Nursing Administration/Management and Education. The College received moral and financial support from the WAHC, WHO, Canadian Nurses\' Association, Commonwealth Fund for Technical Cooperation (CFTC) and individuals. On 1st April, 1980, the first Coordinator for Nursing Affairs. Mrs. Joana Samarasinghe, SRN, SCM. Public Health Nurse Tutor, Master's Degree in Education and Health Planning assumed office. **Membership of the college:** The membership of the College comprises Foundation Fellows, Honorary Fellows and Fellows as indicated in the Constitution. Meetings are held annually. **MOTTO:** Unity, Knowledge and Service **THE CREST:** The following ideas are reflected in the College Crest: - Continuity of life - represented by a Circle. - Inter-relatedness of life and the total environment, represented by a woven cord. - Nightingale Lamp, illuminating a book symbolizing search for knowledge. - Colours. INTERNATIONAL COUNCIL OF NURSING -------------------------------- The international council of nurses (ICN) is a federation of more than 130 national nurses associations (NNAs), representing more than 13 million nurses worldwide. Founded in 1899, ICN is the world's first and widest reaching international organization for health professionals. Operated by nurses and leading nurses internationally, ICN works to ensure quality nursing care for all, sound health policies globally, the advancement of nursing knowledge and the presence worldwide of a respected nursing profession and a competent and satisfied nursing worldwide. **[Vision of ICN for the Future of Nursing ]** United within the ICN, the nurses of all nations speak with one voice. We speak as advocates for all those we serve and for all the un-served, insisting that social justice, prevention, care and cure be the right of every human being. We are in the vanguard of health care progress, shaping health policy around the world through our expertise, the strength of our numbers, our strategic and economic contributions the alignment of our efforts and our collaboration with the public, health professionals other partner and individuals, families, communities for whom were provide care. **[Mission]** Our mission is to lead our societies toward better health. Working together within the ICN, we harness the knowledge and enthusiasm of the entire nursing profession to promote healthy lifestyles, healthy workplaces and healthy communities. We foster the health of our societies as well as individuals by supporting strategies of sustainable development that mitigate poverty, pollution and other underlying causes of illness. Working together, we are at the forefront of incorporating advanced technology into health care without losing the human element. We are determined that science and technology remain the servant of compassionate and ethical caring that includes meeting spiritual and emotional needs. Working together and reaching out to involve nursing students, we are achieving higher levels of nursing education in every nation -- education that is liberally and scientifically based, flexible and culturally sensitive and founded on the core values of our profession. We ensure that nurses are educated for broad provider and policy roles that fully integrate and utilize nursing within multidisciplinary health teams. We equip nurse to be skilled points of entry for health care, able to care for clients and to guide them to other caregivers as appropriate. We continually add new clusters of competencies to lead and reflect dynamic changes in health care and we ensure that health care systems recognize and reward those competencies. Together, we work for values, policies, standards and conditions that free nurse to practice to the full extent of their education and ability and within safe and caring environments. Our work together is guided by a common philosophy of nursing: a commitment to caring in the fullest sense, being advocates for our patients, helping people to help themselves and doing for people what they would do unaided if they had the necessary strength, will or knowledge. Our mutual efforts assure that ICN is dynamic, inclusive and proactive and that the nursing profession is highly valued everywhere, and appropriately utilized, recognized, rewarded and represented throughout the health care system. Our highest reward is the certain knowledge that our work is shaping a future of healthy people in a healthy world. **[Definition of Nursing by ICN]** **Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management and education are also key nursing roles.** **[The White Heart Symbol of Nursing ]** **The white heart** was officially launched as a universal symbol for nursing in 1999, on the occasion of the 100^th^ anniversary of the international council of nurses. The symbol is meant to characterize the caring, knowledge and humanity that infuse the work and spirit of nursing. The white heart is also a unifying symbol for nurses globally. **White** was selected because it brings together all colours, demonstrating nursing's acceptance of all people. White also has a world-wide association with nursing, caring, hygiene and comfort. The heart shape communicates humanity and the central place that nursing has in quality health care. **Wear or give a white heart pin**. You will remind the world around you of the value and proud tradition of nursing. All proceeds from sales of the white heart pin will go to ICN's **[Florence Nightingale International Foundation]** in support of the **[Girl Child Education Fund]** NURSING EDUCATIONAL PROGRAMMES IN GHANA --------------------------------------- **[INTRODUCTION ]** Nursing education throughout history has demonstrated its ever-changing in meeting relevant societal health needs. These changes have become necessary because individuals, families and communities who benefit from nursing services also live in an environment which is in dynamism. It is therefore imperative that as we expand to meet the growing demands of society, there is the need to critically examine the quantity and quality issues in nursing education that impact on it positively and negatively. **[Nursing Education: Early Pre -- Independence Era ]** First nurses in Ghana were male orderlies who were recruited and trained to help the few missionary doctors posted to the Gold Coast to attend to their health needs of the compatriot's and their families in commerce, missionary work and colonial service (Akiwumi, 1994). ***Their main duties include;*** - Bathing - Feeding of patients - Dressing of wounds - Administration of simple drugs. 1878 marked the commencement of organized medical services and arrival of medical officers in Accra and later as the years went by, it was spread to other regions and towns. No attempt was made to train people to care for the sick. In 1899, the first nursing sister for training came from the British Colonial Government. At this time, the majority of the nurses were males with few females because they taught the work was not suitable for women. Their training was more practical oriented that is they had more training on the ward (practical) once a week. Those with formal education attended lectures. ***Those with formal education were given lesson on:*** - Human anatomy and physiology - Surgical nursing - Medical nursing - First aid techniques - Essential of nursing - Public health ***Certificate awarded:*** Director of Medical Service Certificate ***Position:*** Second Division Nurses in Civil Service with the opportunity to raise to First Division (Ministry of Information 1971) **[Nursing Education: Middle Pre -- Independence Era ]** Midwifery training started in 1928 after the building of the maternity hospital in Korle-Bu in 1927. The school was more popular in 1931 with females attracted better to the education. Formal nursing training began in 1945 when the State Registered Nursing School was established (SRN). **The aim** was to prepare higher caliber nurses of the same standard as British nursing sisters to replace the foreign nurses as supervisors and administrators in the hospitals. **Entry requirement:** Secondary school graduates (GCE O' level), however limited number of the girls with good grades were accepted with Middle Schools Leaving Certificate (MSCL) who spend one year in pre-nursing school doing general education courses **Qualified Registered Nurses** (QRN) programme with lower standard started at the same time. The aim was to satisfy the numeric demand for nursing personnel Entry requirement was MSLC only and the students do not go through pre-nursing training. The Nurses' Ordinance and a Statutory Board of 1946 came into force in 1947 which was to regulate the training, examination, registration and practice in nurses. **[Nursing Education: Late Pre -- Independence Era ]** In 1950, a trained Public Health Nursing Tutor

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