Introduction to Nursing PDF

**CHAPTER ONE** INTRODUCTION TO NURSING ======================= Health is ***"a state of complete physical, mental and social wellbeing of an individual and not merely the absence of disease or infirmity"*** (WHO, 1948). This definition by WHO denotes an achievement of harmony between these dimen...

**CHAPTER ONE** INTRODUCTION TO NURSING ======================= Health is ***"a state of complete physical, mental and social wellbeing of an individual and not merely the absence of disease or infirmity"*** (WHO, 1948). This definition by WHO denotes an achievement of harmony between these dimensions of health (physical, mental and social); and health care cannot be left out since diseases whether we like or not, has become part of man. In health care, nurses form a greater part of the health care professionals. A nurse is a person who cares for the sick, wounded, children or the aged and makes a profession out of it. The individual who chooses to be a nurse need to make some adjustment as it is needed in every new sphere. People should be able to adapt to new situations. *The essence of Professional adjustment in nursing curriculum helps the student nurse/ midwife/nurse assistant to adjust to nursing/midwifery as a student and/or qualified practitioner. To be able to adjust oneself, some understanding of the scientific methods of approach is essential. The aim of this course is to equip the student nurse nurse/midwife with values and principles for her practice and professional conduct.* Nursing as a profession is unique because it addresses the responses of individuals and families to the actual and potential health problems in humanistic and holistic manner. Nurses have many roles such as; *care giver, decision makers, advocates, educators, counselors, managers, researchers, team player, among others.* Total nursing care therefore can improve the physical, psychosocial, economic and spiritual well-being of the client. Nursing also encompasses autonomous and collaborative care of individuals of all ages, families and communities, sick or well. It includes the promotion of health, prevention of illness and the care of ill, disabled and dying people. **DEFINITIONS OF NURSING** The word nursing has its root from the Latin term ***NUTRIX*** which means **"*to*** ***nourish*."** **Florence Nightingale** defined nursing as putting a patient into comfortable position and allowing nature to take control; thus, the act of utilizing the environment of the patient to assist him in his recovery. Like Nightingale, **Virginia Henderson** also described nursing in relation to the client and his environment. She saw the nurse as concerned with both well and sick individuals acknowledged that nurses interact with clients even when recovery may not be feasible, and mentioned the teaching and advocacy roles of the nurse. Nursing is an art and science based on knowledge, skills and attitudes. Out of the various definitions, the International Council of Nurses (ICN) adopted the definition by Virginia Henderson, which is a concise statement which most nursing theorists agree as, The unique function of a nurse ***is "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 would have performed 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"*** (Henderson, 1966). Henderson describes what the nurse does and explain that the nurse is temporarily; 1. 1 The consciousness of the unconscious 2. The love of life for the suicidal 3. The leg of the amputee 4. The eyes of the newly blind 5. A means of locomotion for the infant and the paralyzed 6. Knowledge and confidence for the young mother 7. The mouth piece for the dumb and those who are too weak or withdrawn to speak In 1987, the International Council of Nurses established an official definition of nursing as: *Nursing, as an integral part of the healthcare system, encompasses the promotion of health, the prevention of illness, and care of the physically ill, mentally ill and disabled people of all ages, in all healthcare and other community settings.* **Royal College of Nursing (2003**): The purpose of nursing is to promote health, healing, growth & development, & to prevent disease, illness, injury & disability. The most modern definition, collected from a WHO (World Health Organization) publication is: ***Nursing is an art and science based on knowledge, skill and attitudes aimed at assisting the individual, family and community in health and illness, to maintain health, to prevent illness, to alleviate physical, biological and psychological pain, to avoid complications and to fulfill self-reliance in meeting daily health needs.*** These definitions incorporate the key concepts contained in many other definitions of nursing: - A focus on health, not merely on sickness - The identification of human responses to actual or potential health problems as the phenomena of the concern of nursing. Nursing can therefore be considered as; - ***AN ART*** The art of nursing is the skillful application of that knowledge to help others reach maximum function and improve quality of life. It also means that it is a practical knowledge used to work out solutions for various nursing problems. Nursing is an art because it is practiced on human beings with physique (use of hands) and the mind to meet human health needs. It involves giving care to human beings based on sound principles. It requires great sensitivity. Nurses have to interact with threatened, suffering and dying people. Willingness, sympathy, kindness and love are very essential to practice this art. - ***A 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 systematic method of problem solving called the **nursing process**. For this purpose, nurses study biological and social sciences including physics, chemistry, anatomy, physiology, microbiology, pharmacology, hygiene, nutrition, social and public health, general medicine, surgery among others. These sciences form the basis for the understanding of the human body in the area of normal and abnormal functions. - ***AS A PROFESSION*** Nursing as a profession also means that it deals with moral principles devoted to the welfare of humanity. It is based on specialized knowledge and skill. Nurses come into the profession after a period of training. A license by the state is required to practice of professional nursing. The profession is autonomous with its own rules and statues governing it and therefore independent of any other profession. ***A CALL / VOCATION*** It is a vocation which renders service to the sick, caring for body, mind and spirit. It cares for the individual, family, community, society, the nation and the whole world. Nurses all over the world perform dedicated services for their clients. **THE PURPOSE OF NURSING** The key purposes of nursing as emerged from various research works include: 1. To promote and maintain health 2. To care for people when their health is compromised 3. To assist recovery 4. To facilitate independence 5. To meet client's (patient's) needs 6. To improve/maintain the well-being /quality of life 7. To prevent disease, illness, injury and disability 8. To promote healing, growth and development **HISTORY OF NURSING** History is the study of the past which include event, situations and individuals. By learning from historical role models, nurses can enhance their abilities to create positive change in the present and set an objective for the future. The study of nursing history offers another advantage -- learning where the profession has been and its advancement. Learning from the past is a major reason for studying history. Ignoring nursing history can be detrimental to the future of the profession. It is hard to say when the art of nursing began, but if we think about it logically there have always been illness and wounds that needs tendering, so it is fair to say that probably nursing has been around long before written records began For centuries after the birth of Jesus Christ, the Roman Empire ruled most of Europe. During this time, physicians moved from being slaves to high ranking citizens and nursing was finally considered worthy of roman ladies rather than female slaves. The ancient Greek built temples to honor Hygieia/Hygeia, the goddess of health. These temples were more like health spas rather than hospitals and they were religious institutions governed by priests. Priestesses (who were not nurses) attend to those housed in the temples. The nursing that was done by women was performed in the home. Hospital were first established in the Eastern Roman Empire (Byzanthine Empire). St. Jerome was responsible, through one of his disciples, Fabiola for introducing hospitals in the west. Western hospitals were primarily religious and charitable institutions housed in the monasteries and convents. The caregivers had no formal training in therapeutic modalities and volunteered their time to nurse the sick. Hospitals in large Byzantine cities were staffed primarily by paid male assistants and male nurses. Medical practices in Western Europe remained basically unchanged until the 11^th^ and 12^th^ centuries, when formal medical education for physicians was required in a university setting. Although there were not enough physicians to care for all the sick, other caregivers were not required to receive any formal training. During the renaissance (AD 1400 -- 1550), interest in art and sciences emerged. This was also the time many geographic explorations by Europeans. As a result, the world literally expanded. Because of renewed interest in science, universities were established, but no formal nursing schools were established. Because of social status and customs, women were not encouraged to leave their homes, they continued to fulfill the traditional role of nurture/ caregiver in the home. In 1800s, medical schools were founded including the Royal College of Surgeons in London. In France men who were barbers also functioned as surgeons by performing procedures such as leeching, giving enemas and extracting teeth. In the early to mid - 1800s, nursing was considered unseemly for women even though some hospitals relied on women to make beds, scrub floors and bathe the poor. Most nursing care was still performed in the home by female relatives of the ill. In 1836, Theodor Fleidner revived the church order of deaconesses to care for those in a hospital he had founded. These deaconesses of Kaiserwerth became famous because they were the only ones formally trained in nursing. Pastor Fleidner had a profound influence on nursing because Florence Nightingale received her nursing training at the Kaiserwerth Institute. Florence Nightingale is considered the founder of modern nursing. She grew up in a wealthy upper- class family in England during the mid- 1800s. Unlike other young women of her era, Nightingale received a thorough education including Greek, Latin, History, Mathematics and Philosophy. She had always been interested in relieving suffering and caring for the sick. Social mores of the time made it possible for her to consider caring for others because she was not a member of a religious order. She became a nurse over the objectives of society and her family. After completing 3 months course of study in Kaiserwerth Institute, Nightingale became active in reforming health care. The advent of Britain's war in the Crimea presented the stage for Nightingale to further develop the public's awareness of the need for educated nurses. The implementation of her principles in the areas of nursing practiced and environmental modifications resulted in reduced morbidity and mortality rates during the war. Nightingale forged the future of nursing education as a result of her experience in training nurses to care for Britain soldiers. She established Nightingale Training School of Nurses at St. Thomas Hospital in London. This was the first school for nurses that provided both theory -- based knowledge and clinical skill building. she transformed not only the public's perception of nursing but also the method for educating nurses. Some of nightingale's novel beliefs about nursing education were: - A holistic framework inclusive of illness and health - The need for theoretical basis for nursing practice - A liberal education as foundation for nursing practice - The importance of creating an environment that promote healing - The need for a body of nursing knowledge that was distinct from medical knowledge. (Nightingale, 1969). Nightingale introduced many other concepts that though was unique in his time, are still used today. She advocated: 1. Having systematic method of assessing clients 2. Individualizing care on the basis of the client's needs and preferences 3. Maintaining confidentiality. 4. Provision of clean surroundings with fresh air and light to improve quality of care. (Nightingale, 1969). **HISTORY OF FLORENCE NIGHTINGALE** Florence Nightingale was born on May 12, 1820, in Florence, Italy. Worldwide Nurses Day is celebrated on this day. She was the younger of two children. Nightingale's rich British family belong to the top social class. Her mother Frances Nightingale, came from a family of merchant and she took pride in socializing with people of prominent social standing. Despite her mother's interest in social climbing, Florence herself was reportedly uncomfortable in social situations. She preferred to avoid being the center of attention whenever possible. Strong- willed, Florence often butted heads with her mother when she viewed as overly controlling. Still, like many daughters, she was eager to please her mother. Her father was William Shore nightingale, a wealthy land owner who had inherited two Estates, one at Hurst, Derbyshire, and the other in Hampshire, Emblem park when Florence was 5 years old. Florence was raised on the family estate at lea Hurst, where father provided her with classical education, including studies in German, French and Italian. From a very young age, Florence nightingale was active in philanthropy, ministering to the sick and the poor people in the village neighboring her father's estate. By the time she was16 years old it was clear to her that nursing was her calling. She believed it to be her divine purpose. When Nightingale approached her parents and told them about her ambition to become a nurse, they were not pleased. In fact, her parents forbade her to pursue nursing. During that era, a young lady of nightingale's social stature was expected to marry a man of means but not to take a job that was viewed as lowly unskilled labour by the upper social classes. When Nightingale was 17 years old, she refused a marriage proposal from "suitable" gentleman, Richard Monckton Milnes. She explained her reason for turning him down, saying that while she stimulated her intellectually and romantically, her moral, active nature requires satisfaction and that she would not find in marriage life. Determined to pursue her true calling despite her parent's objectives. In 1844, Nightingale enrolled as a nursing student at the Lutheran hospital of pastor Fliedner in Kaiserwerth, Germany. In the early 1850s, Nightingale returned to London, where she took a nursing job in a Middle hospital for ill instructors. Her performance was so impressed to her employer in a way that, Nightingale was promoted to superintendent within just a year of being hired. The position proved challenging as Nightingale was faced with a cholera outbreak and unsanitary conditions conducive to the rapid spread of disease. Nightingale made it her duty to improve hygiene practices, significantly lowering the death rate at the hospital in the process. The hard work took a toll on her health. She had just barely recovered when the biggest challenges of her nursing career presented itself. In October 1853, the Crimea war broke out. The British Empire was at a war against the Russian Empire for control of the Ottoman Empire. Thousands of British soldiers were sent to the black sea, where supplies quickly decreased. By 1854, no fewer than 18,000 soldiers have been admitted into Military hospitals. At the time, there were no female nurses stationed at hospitals in the Crimea. The poor reputation of past female nurses had led to the war office to avoid hiring more. But, after the battle of Alma, England was in uproar about the neglect of their ill and injured soldiers, who not only lacked sufficient Medical attention due to hospital horribly understaffed but also suffered in terribly unsanitary and inhumane conditions. In late 1854, Nightingale received a letter from secretary of war, Sidney Herbert, asking her to organize a group of nurses to attend to the sick and fallen soldiers in the Crimea. Nightingale rose to her calling. She quickly assembled a team of 38 nurses from variety of religious orders, and sailed with them to the Crimea just a few days later. Although they had been warned of the horrid conditions there, nothing could have prepared them for what they saw when they arrived at Scutari, the British Base Hospital in Constantinople. The hospital sat on top of a large cesspool, which contaminated the water and hospital building itself. Patient lay on their own excrement on stretchers, rodents and bugs scurried pass them and most basic supplies such as bandages and soap grew increasingly scarce as the number of ill and wounded progressively increased. Most soldiers were dying from infectious diseases like typhoid and cholera than from injuries incurred in battle. The no-nonsense Nightingale set to work. She procured hundreds of scrub brushes and asked the least infirm patients to scrub the inside of the hospital from floor to ceiling. Nightingale herself spent every waking minute caring for the soldiers. In the evening she moved through the dark hallway carrying a lamp while making her rounds, ministering patient after patient. The soldiers who were moved and comforted by her endless supply of compassion, took to calling her "**the lady with the lamp**." Others simple called her "**the angel of the Crimea**". Her work reduced the hospital's death rate by two- third. In addition to vastly improving the sanitary condition of the hospital, Nightingale created a number of patient service that contributed to improving the quality of their hospital stay. She instituted the creation of an "invalid's kitchen" where appealing food for patient with special dietary requirement was cooked. She established a laundry so that patient would have clean linens. She also instituted a classroom and library, for patient intellectual stimulation and entertainment. Based on her observations in the Crimea, Nightingale wrote notes on *Matters Affecting the Health, Efficiency and Hospital Administration of the British Army*, an 830- page report analyzing her experience and proposal reforms for another military hospitals operating under poor conditions. The book would spark a total restructuring of the war offices administration department, including the establishment of a Royal Commission for the Health of the Army in 1857. Nightingale remained at Scutari for a year and a half. She left in the summer of August 7,1856, once the Crimea conflict was resolved, and returned to her child hood home at Lea Hurt. To her surprise she was met with a hero's welcome, which the humble nurse did her best to avoid. The queen rewarded nightingale-'s work by presenting her with an engraved brooch that came to be known as the "NIGHTINGALE JEWEL" and by granting her a price of Ṩ250,000 from the British government. Nightingale decided to use the money to further her cause In 1860, she funded the establishment of St. Thomas' hospital and within it the Nightingale training school for nurses. Nightingale became a figure of public admiration. Poems, songs and plays were written and dedicated in the heroine's honor. Young women aspired to be like her. Eager to follow her example, even women from the wealthy upper classes started enrolling at the training school. Thanks to Nightingale, nursing was no longer frowned upon by the upper classes, it had in fact, come to be viewed as an honorable vocation. While at Scutari, Nightingale had contracted "Crimean fever" and was never fully recovered. By the time she was 38years old, she was homebound and bed ridden, and was so for the remainder of her life. Fiercely determined, and dedicated as ever to improving health care and alleviating patient's suffering, nightingale continued her work from her bed. Residing in Mayfair, she remained an authority and advocate of health care reform, interviewing politicians and welcoming distinguished visitors from her bed. In 1859, she published *Notes on hospitals*, which focused on how to probably run civilian hospitals. Throughout the U. S Civil war, she was frequently consulted about how to best manage field hospitals. Nightingale also served as an authority on public sanitation issues in India for both the military and the civilians, although she had never been to Indian herself. At 1908, at the age of 88, she was conferred the merit of honor by King Edward. In May of 1910, she received a congratulatory message from King George on her 90^th^ birthday. In August 1910, Florence Nightingale fell ill, but seemed to recover and was reportedly in good spirit. A week later, on the evening of Friday, August 12, 1910, she developed range of troubling symptoms. She died unexpectedly at 2pm the following day, Saturday, August 13, at her home in London. Characteristically, she has expressed the desire that her funeral be a quite and modest affair, despite the public's desire to honor nightingale, who tirelessly devoted her life to preventing disease and ensuring safe and compassionate treatment for the poor and the suffering. Respecting the last wishes, her relatives turned down a national funeral. The "lady with the lamp" was laid to rest in her family's plot at St. Margaret's Church, East Wellow, in Hampshire, England. The Florence Nightingale Museum, which sits at the site of the original Nightingale Training School for Nurses, houses more than 2,000 artifacts commemorating the life and career of the "angel of the Crimea". To this day, Florence Nightingale is broadly acknowledged and revered as the pioneer of *modern nursing.* **HISTORY OF NURSING IN GHANA** **The history of nursing in Ghana reflects the development of healthcare within the country and the progress of the nursing profession. Here is an overview of key historical milestones in nursing in Ghana:** **Early Nursing Practices (Pre-Colonial and Colonial Periods)** **Pre-Colonial Era: Before the arrival of European colonizers, nursing in Ghana was largely informal, provided by traditional healers, herbalists, and midwives using indigenous knowledge to care for the sick and injured.** **Colonial Era: In the 19th century, with the arrival of Christian missionaries and the British colonial government, formal healthcare began to take shape. Early nursing services were introduced as part of missionary health work, primarily serving European settlers and colonial officials.** **Post-Independence Era and Expansion (1957 - 1980s)\*** **1957: After Ghana gained independence, efforts to develop local capacity in healthcare expanded rapidly. Nursing became a key part of national healthcare plans.** **1960s: Ghana's first indigenous Nurse-Midwifery Training School was established. During this period, Ghana began developing its own cadre of nurses, midwives, and public health nurses.** **1970s: The demand for more specialized healthcare led to the expansion of nursing programs and the introduction of training for community health nurses, psychiatric nurses, and public health nurses.** **Professionalization of Nursing (1990s - Present)** **1990s: Nursing education evolved to offer more advanced degrees, such as diplomas and Bachelor's degrees in nursing. Schools of nursing were integrated into universities, with programs accredited by the Nurses and Midwives Council of Ghana.** **2000s: The University of Ghana began offering Bachelor of Science in Nursing (BScN) programs, setting a new standard for nursing education in the country.** **Present: Nursing in Ghana has continued to grow, with postgraduate education (Master's and PhD programs) now available for nurses. Nurses in Ghana today are integral to the healthcare system, holding leadership roles, providing specialized care, and participating in health policy development.** **Challenges and Progress** **Challenges: Ghana has faced nursing shortages, inadequate resources, and issues with rural healthcare delivery. Many nurses have emigrated in search of better opportunities.** **Progress: Efforts to improve working conditions, increase access to higher education, and implement new healthcare policies continue to shape the nursing profession in Ghana.** **Today, Ghanaian nurses are recognized for their vital role in improving healthcare outcomes, both locally and internationally.** **CHAPTER TWO** **NURSES AND MIDWIVES ASSOCIATIONS AND GROUPS** **LOCAL ORGANIZATIONS** **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 3 (ACT 833). **MISSION** To promote specialist education, continuous professional development and post graduate nursing, midwifery and related programs and contribute to the formulation of policies to improve health outcomes. **VISION** Producing cadres of committed, intellectually and skillfully competent, contemporary nurses and midwives with specialized education providing quality improved care **MOTTO** Integrity, Professionalism and Excellence - *Integrity*: Good character, Moral soundness reliability and trustworthy - *Professionalism*: sustained act or reflection of the true and positive ideas of nursing and midwifery - *Excellence*: high quality of care and services. **VALUES** - GCNM stand 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 **GOVERNING COUNCIL** The GCNM by the provisions of ACT 833 has Governing Council comprising 1. Chairperson 2. President of the college 3. Representation from educational regulatory and leadership arms of nursing, midwifery and related professional backgrounds. **MANDATE** 1. To 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** 1. Organize and supervise specialist training, continuous professional development and support postgraduate or post diploma research in nursing, midwifery and related disciplines. 2. Conduct and organize specialist examination 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. **GHANA REGISTERED NURSES AND MIDWIVES' ASSOCIATION (GRNMA)** GRNMA is a professional body for nurses in the country. Membership is opened to all nurses in Ghana, registered or enroll by nurses and midwifes' council of Ghana. Membership is acquired and maintained through registration and payment of monthly and other dues instituted by the association. It was established in MARCH 1960 by the union of two former association (SRN AND QRN). The first president of the association was Dr. Docia Nakei Kissei and the general secretary was Mr. Mettle Nunoo. It was registered into full membership of International Council of Nurses (I.C.N) at its congress held in Melbourne in 1961. It was governed to by its national executives who comprise of elected representatives from the branches of the national body. The organizational structure of the association is position to facilitate communication and implement policies. Local branches are the unit structure of the association and exist in all health care facilities in Ghana. District branches are established in all districts as decentralized functional areas of the GRNMA. Regional branches supervise the decentralized and link them up to the national secretariat. There are nine national executives. They are elected quadrennial. They are headed by the national council, and elected during national delegate's conference. The national council constitutes the national executives and regional chairpersons and their secretaries' meet quarterly to formulate policies and other projects of the association. This is the highest authority of the association. **VISION** a. Developing the nurse scientifically to cope with the contemporary challenging changes in the health service b. Prolonging the lifespan of all the people living in Ghana c. To raise the socio-economic status of the nurse **MOTTO: *'UNITY IS STRENGTH'*** **OBJECTIVES** - To bring all practice nurses in Ghana into a unified body - Advance the interest of the nursing profession locally and internationally - Maintain the honor and independence of the professional nurse with special reference to professional standard, discipline and etiquette - Promote nursing education and research - Promote and support the law reform on all matters affecting the nursing profession. - Affiliate and promote good relations with the international council of nurses, the commonwealth confederation of midwives and similar organizations of nurses in other countries. **FUNCTIONS** - Maintaining and improving nursing care standard - Promoting nursing education and research - Collaborate with other trade union organization nationally and internationally. - Seeking partnership with government and other stakeholders to promote industrial peace to enhance productivity. - G.R.N.M.A advises and support professional nurse associations of sister -- African Countries. - Promote socio- economic wellbeing of the nurse by providing promotive, preventive and curative health delivery services. **MEMBERSHIP** - Every nurse in Ghana upon being registered with the Nursing and Midwifery Council (N.M.C) of Ghana. - Upon payment of an enrollment fees prescribed in the regulation of the association - Completion of association enrollment form - Acquiring a membership card signed by the national president and general secretary of the association. **UNION OF PROFESSIONAL NURSES AND MIDWIVES, GHANA** **The Union of Professional Nurses and Midwives, Ghana (UPNMG) is a professional organization that represents the interests of nurses and midwives in the country. Here is a brief description of the key elements you requested:** **\*Vision Statement:\*** **The Union seeks to create a world-class union that provides comprehensive welfare, strong professional advocacy, and improved working conditions for nurses and midwives in Ghana.** **\*Mandate:\*** **The UPNMG\'s mandate is to champion the professional, social, and economic interests of its members. This includes advocating for better working conditions, fair remuneration, and enhanced welfare packages for nurses and midwives.** **\*MOTTO:\*** **Their motto is "Professionalism and Unity."** **\*FUNCTIONS:\*** **The Union of Professional Nurses and Midwives in Ghana functions primarily to:** **1. Advocate for the rights, welfare, and professional interests of nurses and midwives.** **2. Negotiate for better working conditions and benefits, such as wages, pensions, and healthcare.** **3. Offer legal support and professional guidance to its members.** **4. Organize training and professional development programs to ensure continuous improvement in nursing and midwifery standards.** **5. Foster unity among members and strengthen their collective bargaining power.** **MEMBERSHIP** - Every nurse in Ghana upon being registered with the Nursing and Midwifery Council (N.M.C) of Ghana. - Upon payment of an enrollment fees prescribed in the regulation of the association - Completion of association enrollment form - Acquiring a membership card signed by the national president and general secretary of the association. **GHANA REGISTERED MIDWIVES' ASSOCIATION (GRMA)** This is a professional body of registered midwives in Ghana. It is a non-governmental organization. Its membership is purely voluntary and open to all midwives from both the public and private sector, who have registered with the Nursing and Midwifery Council of Ghana. It was established in 1935.The association receives financial assistance from the MOH, GHS,UNICEF,USAID,UNFPA and other agencies.it is also funded through contribution of its members. **PURPOSE** - To strengthen the members by providing them with continues education and by seeking to promote 6th welfare of the members. Between 1935 and 1957, it was more of a social society but from 1987 until now GRMA has been in the line light (popular) both nationally and internationally. **ACTIVITIES** - GRMA has been working in close relation with the international donor agencies for example USAID, UNICEF, Carnegie Co New York, ACNM, John Hopkin University, Family Health, Columbia University, and local companies such as Johnson Wax. The association provides services by educating its members in the following areas: Reproductive and childbirth and safe motherhood which embodies; basic obstetrics, post abortion care, family planning and counselling, syndrome management of sexually transmitted infection (STIs) and immunization. - Treatment of minor ailments - Counselling and general health education on reproductive issues such as voluntary counselling and testing for HIV status, and prevention of mother to child transmission of HIV/AIDS. The GRMA now has a national council like a board of Governors and the members include all the 10 regional chairpersons in addition to a president and immediate past president, vice president, national treasure and national secretary. Some co-opted person like legal advisor, an obstetrician gynaecologist, registrar for nurses and midwives council are in the group. Ghana registered midwives association has regional representatives who act as external links to the national secretariat. - The national secretariat co-ordinates the day to day activities of the association - A Director who see to the management of various programs - It has a public relation officer - Administrative officer who does the day to day administration - Trainers who are full time and also trainers on part-time basis - Supporting staff eg. drivers, typist, etc. **INTERNATIONAL CONFEDERATION OF MIDWIVES** It is a confederation of association of midwives and it has membership in over 40 countries. It has been divided into 4 geographical regions namely, Europe, America, Africa, and Pacific. We have Mrs. Henrietta Owusu representing Africa. She comes from Ghana. ICM is financed from member subscription congress profits and donation. It is managed by a part time midwifery officer based in London. It has a 3 member board including a chairman, secretary and treasurer **AIMS** - To advance education in midwifery - To spread the knowledge of the art and science of midwifery so as to improve the standard of care provided to mothers, babies and families throughout the world **FUNCTIONS** - ICM promote the midwifery as the key worker in the care of women and the family around the time of childbirth. Slogan or motto in Ghana- Midwives hold key to healthy families - ICM also collect data on the existing midwifery practice, educational and management in each country - ICM provides technical support as needed by member association - ICM disseminate information through their newsletter and at workshops **GHANA NURSING AND MIDWIFERY TRAINEES' ASSOCIATION (G.N.M.T.A)** This is the student nurses' and midwives' association of Ghana. Membership comprises of all students of nurses and midwifery training institutions registered and indexed by the Nurses and Midwives' Council of Ghana. It was established I n 1980's, it is under the control of the G.R.N.M.A. GNMTA has got its advisor at the national level, regional level and the local level. **OBJECTIVES** - To help the students uphold the dignity and ideals of their profession - To promote the spirit of unity among students - To encourage leadership and administrative ability in students in the profession generally and also in the field of arts, sports and games. - To give opportunity to students to write in the nursing journal - To encourage the students to hold exhibition at local, regional and national levels. **FUNCTIONS OF GNMTA** - Organization of meetings and conferences' - Holding exhibitions of educational value - Encourage public speaking and writing - Project undertaking and fund raising - Socio- cultural and recreational activities - Giving awards and prices to meritorious students and institutions - Delegation of students to I.C.N conferences **CHAPTER THREE** **EDUCATIONAL PROGRAMMES IN NURSING** **Introduction** The first colonial nursing sisters arrived in the country in 1899. People were recruited to work in the medical field. But the government provided the more advanced training. The following subjects were taught: anatomy and physiology, first aid medical and surgical nursing. After 3years, they were awarded the director of medical service certificate to work in the civil service. Due to the limitations of training, local trainees were not illegible to enter the senior service and occasionally the senior posts were held by local people who went to study in Britain The first well organized nursing training program was The Qualified Registered Nurse (Q.R.N) which laid the foundation of the local nursing services in Ghana. It was started by Miss Button but attained recognition as QRN in 1948. It was a 3years program. Entry requirement was Middle School Leaving Certificate. Age for applicants was 18years and above. Students who showed more than average ability was allowed to do the State Registered nursing (S.R.N) concentrated course for 2years after the QRN program. The schools were at korle-bu, Kumasi and Agogo. The program was discontinued in 1968. By 1944, it had become necessary to train nurses of higher grade locally. The S.R.N program was aimed at training by standards similar to those of the British trained nurses so that they eventually take responsibility of the colonial nursing sisters and this aimed had been achieved. In 1945, the SRN training school was temporary started with 6 students in Kumasi. The course was 3 years and the requirement were Cambridge Certificate or West African School Certificate. Those with Middle School Leaving Certificate (M.S.L.C) had to do one year pre- nursing course. The pre- nursing course laid emphasis on English, Science, Arithmetic and House craft. The SRN course included - Anatomy and physiology - History of nursing - First aid and bandaging - Medical and surgical nursing - Gynecological nursing - Hygiene - Elementary dietetics and cookery - Junior and senior nursing - Paediatric - Theatre nursing - Pharmacology - Microbiogy. Preliminary examination was held at the end of the first year. The SRN programme was discontinued in 2001. **CURRENT NURSING PROGRAMMES** These programmes prepare graduates to work in nursing and midwifery fields. They are regulated by the nursing and midwifery council of Ghana. Health training institutions offering these programmes are located in each region. Applicants interested in pursuing any of these progammes should note that they shall be required to undertake their Rotation/ Internship/ National Service and at least the first two years of employment in the region of location of the institution attended. With the exception of students who receive support from institutions outside the region of training. **AUXILIARY PROGRAMMES** - Nurse Assistant preventive (NAP) - Nurse Assistant Clinical (NAC) Duration: four semesters (2years). Requirement: can apply with only WASSCE or SSSCE only and NOT combination of the two **BASIC OR DIPLOMA PROGRAMMES** - Registered General Nursing - Registered Midwifery - Registered community health nursing - Registered mental health nursing Duration: six semesters (3years). Requirement: can apply with only WASSCE or SSSCE only and NOT combination of the two. The programme do not require any working experience in any health- related field. However previous experience in health facilities may give the applicant an urge during the interview and selection process. **POST BASIC PROGRAMMES** These are programmes which build upon basic programmes by adding further knowledge and skills and/or encouraging focus on a particular area of study. Some post basic programmes lead to specialization in certain fields of health such; - Anesthesia - Critical Care Nursing - Ophthalmic Nursing - Peri- Operative nursing - Ear, Nose and Throat - Post Basic Midwifery (females) - Public Health Nursing Duration: 1- 2 years. **GRADUATE NURSING PROGRAMS** Graduate programs in nursing offer advanced education and specialization opportunities. Here are some common types of graduate nursing programs: In Ghana, a Master of Philosophy (MPhil) in Nursing is an advanced postgraduate research-based degree, aimed at deepening nursing professionals\' knowledge and skills in research, clinical practice, leadership, and academia. This degree is typically offered by major universities that focus on nursing and healthcare education. It includes coursework and a significant research component, culminating in a thesis. **Duration:** 2 years full-time; part-time options may be available. Entry Requirements: A Bachelor of Science in Nursing (BSc Nursing) or a related field, with a good academic record and some experience in clinical practice. **Focus Areas**: Nursing theory, advanced clinical nursing, nursing education, healthcare management, and research methods. **Master of Science in Nursing (MSN)\*** Purpose: Prepares nurses for advanced practice roles, leadership, education, and specialized clinical work. Specializations: - Family Nurse Practitioner (FNP) - Nurse Educator - Nurse Administrator - Clinical Nurse Leader - Psychiatric-Mental Health Nurse Practitioner (PMHNP) - Nurse Anesthetist (CRNA) Duration: 1-2 years. 2\. Doctor of Nursing Practice (DNP)\* Purpose: Focuses on clinical practice at the highest level, often preparing nurses for leadership roles in healthcare settings. Specializations: Same as MSN, but at an advanced level, with added emphasis on clinical practice and policy. Duration: 3-4 years. **PhD in Nursing** Purpose: Research-focused program designed for nurses who want to contribute to academic research or become professors. Focus: Nursing theory, research methodology, and contributing to the science of nursing. Duration: 3-5 years. **Post-Master\'s Certificates** Purpose: For nurses who already have an MSN but want to specialize in a new area (e.g., from Nurse Educator to FNP). Duration: 1-2 years depending on the program and prior education. **Combined Programs** Examples: MSN/MPH (Master of Public Health) MSN/MBA (Master of Business Administration) Purpose: Prepares nurses for leadership in specific interdisciplinary fields such as public health or healthcare administration. These programs can be pursued either full-time or part-time, and many are available online to accommodate working professionals. **RANKS IN NURSING/MIDWIFERY** In an ascending order we have - Enrolled /community health nurse (EN/ CHN) - Senior Enrolled Nurse/ Senior Community Health Nurse (SEN/SCHN) - Principal Enrolled Nurse/ Senior Community Health Nurse (PEN/PCHN) - Superintendent Enrolled Nurse - Staff nurse/ midwife (SN/SM) - Senior Staff Nurse/Midwife (SSN/SSM) - Nursing Officer (NO) - Senior Nursing Officer (SNO) - Principle Nursing Officer (PNO/ matron) - Deputy Director of Nursing Services (DDNS) - Director of Nursing Service ( DNS) - Chief Nursing Officer (CNO) Some of the above ranks can be identified by the colour of belt they wear. Midwife- black NO - white SNO - blue PNO - green DDNS - mauve DNS - red CNO - marigold **CHAPTER FOUR** **HEALTH PROFESSIONS REGULATORY BODIES IN GHANA** 1. Allied health profession council 2. Medical and dental council 3. Nursing and midwifery council 4. Pharmacy council 5. Psychology council 1. **ALLIED HEALTH PROFESSION COUNCIL** Allied Health Profession Council is an agency under the Ministry of Health, Ghana. It is also the statutory body establish by part III oh the Health Professions Regulatory Bodies (Act 857) Allied Health Professionals include the following 1. Medical Laboratory Science E. g. Medical Laboratory Technician, Medical Laboratory Technologist and Medical Laboratory Scientist. **Objective of the Council** The council is responsible for ensuring the highest standards in the practice of allied health professionals registered under this part. **Functions of the Council** 1. Regulate the standard of service for the practice of allied profession 2. Ensure that the standard of study and training in recognized institutions maintained. 3. Set practice standards of proficiency and conduct for allied health profession 4. Register practitioners 5. Monitor and inspect allied health facilities in collaboration with the Health Facilities Regulatory agency (HEFRA). 6. Facilitate continuing professional development of practitioners 7. Advise the ministers on matters relating to Allied Health Profession 8. Conduct Licensing Examination for the registration of the health profession **Governing body of the Council** The governing body of the Council is a Board consisting of - A chairperson who is a registered practitioner in an allied health profession - Four registered allied health professionals nominated by the relevant allied health professional bodies - One representative of allied health professionals from a relevant allied health training institution nominated by the training institutions, - One representative of the Ministry of Health not below the rank of a Director, - One representative of the Attorney-General not below the level of Principal State Attorney, - Two persons who are not health professionals one of whom is a woman nominated by the Minister, and - The Registrar of the Council. The members of the Board shall be appointed by the President in accordance with article 70 of the Constitution. The Board shall ensure the proper and effective performance of the functions of the Council 2. **MEDICAL AND DENTAL COUNCIL** Medical and Dental Council is an agency under the Ministry of Health that regulates the standards of training and practice of medicine and dentistry in Ghana. It is also the a statutory body establish by part III of the Health Professions Regulatory Bodies (Act 857) **Objective of the Council** The object of the Council is to secure in the public interest the highest standards in the training and practice of medicine and dentistry. **Functions of the Council** To achieve the object, the Council shall - Assess facilities and contents of program s for the training of doctors and dentists and physician assistants in training institutions - Ensure that the pre-registration training of newly qualified doctors and dentists and physician assistants in accredited training institutions meets the required standards - Conduct examinations for the registration of foreign trained medical and dental practitioners and physician assistants - Compile and keep registers of registered practitioners - Prescribe and enforce professional standards and conduct for practitioners - Conduct examinations for the registration of locally trained medical and dental practitioners and physician assistants who do not meet the prescribed conditions for registration; and - Perform any other functions that are ancillary to the object of the council. **Governing body of the council** The governing body of the Council is a Board consisting of 1. A chairperson who is a registered medical or dental practitioner of good standing 2. One registered medical practitioner and one registered dental practitioner elected by medical and dental practitioners 3. One physician assistant or certified registered anesthetist elected by physician assistants and certified registered anesthetists, 4. One member who is a practitioner to represent medical and dental educational institutions which offer training 5. One representative of the Attorney-General not below the level of Principal State Attorney 6. One representative of the Ministry of Health not below the rank of a Director 7. Two other persons who are not health professionals nominated by the Minister one of whom is a woman 8. The Registrar of the Council. The members of the Board shall be appointed by the President in accordance with article 70 of the Constitution. The Board shall ensure the proper and effective performance of the functions of the Council. 3. **NURSING AND MIDWIFERY COUNCIL** The Nursing and Midwifery Council is an agency under the Ministry of Health, Ghana. It is also the a statutory body establish by part III oh the Health Professions Regulatory Bodies (Act 857) **Objective of the Council** The object of the Council is to secure in the public interest the highest standards of training and practice of nursing and midwifery. **Functions of the Council** To achieve the object, the Council shall 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 disciplinary 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 of 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. Advise the minister on matters relating to the practice of nursing and midwifery 10. Monitor and inspect training institutions and health facilities in collaboration with the health facilities regulatory agency 11. Perform any other functions that are ancillary to the object of the council **Governing body of the council** 1. The governing body of the council is a board consisting of - A chairperson who is a registered nurse or midwife of not less than ten years standing as a practitioner - One representative of registered nurses nominated by the nurses professional associations - One registered midwife nominated by the professional associations - One representative from a nursing school of the universities nominated by the universities from among themselves - One representative of a nursing and midwifery school nominated from nursing and midwifery schools - One representative of the attorney-general not below the level of principal state attorney - One representative of the ministry of health not below the rank of a director - One representative of nurses and midwives' professionals within the security agencies - Two other persons who are not health professionals, - The registrar of the council. The members of the board shall be appointed by the president in accordance with article 70 of the constitution. The board shall ensure the proper and effective performance of the functions of the council. **Registration procedure** 1. A person shall not practice nursing or midwifery unless that person is registered as a practitioner in accordance with this Part. 2. A person seeking registration shall apply to the Registrar in the manner determined by the Board. 3. The registration is valid for the period determined by the Board. **Qualification for registration** 1. A person does not qualify to practice as a nurse, midwife or nurse assistant unless that person - Holds a certificate from an institution recognized by the Council - Passes a licentiate or professional examination conducted by the Council. 2. A person shall not be registered to practice as a nurse, midwife or nurse assistant unless that person fulfils the requirements determined by the Board. 3. A person registered by the Board shall pay the prescribed fee. 4. Despite subsection (1), the Board may register a person to practice as a nurse, midwife or nurse assistant on terms and conditions determined by the Board. 5. A person who has obtained a higher degree or additional qualification is entitled to have the higher degree or additional qualification inserted in the register in addition to the qualification previously registered. 4. **THE PHARMACY COUNCIL** **Objective of the Council** The object of the Council is to secure in the public interest the highest standards in the practice of pharmacy in the country **Functions of the Council** To achieve the object, the Council shall - Ensure that the education and training of pharmacists and any other pharmaceutical support staff are carried out at approved educational institutions for efficient pharmacy practice - Set standards for continuous professional development for practitioners and pharmaceutical support staff - Register practitioners - Ensure the equitable and accessible distribution of pharmaceutical premises - Monitor and inspect pharmacy practices where pharmaceutical care is provided - Set and ensure standards for pharmacy practice and professional conduct - Provide guidelines for the education, training, registration, licensing and the practice of all pharmaceutical support staff - Exercise disciplinary power over pharmacists and any other pharmaceutical support staff - Ensure accreditation for pharmacy programmes in collaboration with appropriate State agencies - Develop a management and administrative structure and systems to provide an efficient mechanism to regulate pharmacy practice - Advise the Minister on pharmacy practice and related matters - Perform any other function that is ancillary to the object of the Council. **Governing body of the Council** The governing body of the Council is a Board consisting of - A chairperson who is a registered pharmacist of not less than ten years standing as a pharmacist - One representative of the ministry of health not below the rank of a director, - One representative of an accredited training institution that provides tertiary training for pharmacists nominated by the minister - One registered pharmacist elected by registered pharmacists - Three other persons who may not be health professionals one of whom is a woman nominated by the minister - One representative of the attorney-general not below the level of principal state attorney - The registrar of the council. The members of the Board shall be appointed by the President in accordance with article 70 of the Constitution. The Board shall ensure the proper and effective performance of the functions of the Council. 5. **PSYCHOLOGY COUNCIL** **Objective of the Council** The object of the Council is to secure in the public interest the highest standards in the training and practice of psychology. **Functions of the Psychology Council** To achieve the object, the Council shall - Assess facilities and content of programmes for the training of psychologists and paraprofessionals - Ensure that the pre-registration training of newly qualified psychologists and paraprofessionals in accredited training institutions meets the required standards - Conduct examinations for the registration of foreign trained psychologists and paraprofessionals - Conduct examinations for the registration of locally trained psychologists and paraprofessionals who do not meet the prescribed conditions for registration - Compile and keep registers of registered practitioners - Prescribe and enforce professional standards and conduct for practitioners - Exercise disciplinary power over professionals and paraprofessional - Perform any other functions that are ancillary to the object of the council. The governing body of the council is a board consisting of - A chairperson who is a registered psychologist of not less than ten years standing as a psychologist - Two registered psychologists representing health facilities and industry elected by the practitioners - One representative of an accredited training institution that provides tertiary training for psychologists, who is a practitioner and who shall be nominated by the minister - One registered paraprofessional who has worked for not less than ten years as a paraprofessional - One representative of the attorney-general not below the level of principal state attorney - One representative of the ministry of health not below the rank of a director - One person who is not a psychologist nominated by the minister - The registrar of the council The chairperson and members of the board shall be appointed by the president in accordance with article 70 of the constitution. The board shall ensure the proper and effective performance of the functions of the council **CHAPTER FIVE** **ETHICS AND ETHICAL CODES IN NURSING AND MIDWIFERY** **Introduction** Nursing is a profession that deals with the most personal and private aspects of people's lives. From the beginning of time, and by duration, nurses whether called healers, caretakers nurtures or nurses have cared for those in need in a very personal and intimate way. Nurses are attentive to patients' needs over long period of time. They may have made home visits and may know patients' families. They may care for patients at their bed side for hours and days on end. It is through the intimacy and trust inherent in the nurse- patient relationship that nurses become critical participants in the process of ethical decision making. This chapter includes a discussion of some ethical theories. You may ask how you will use these theories in your practice. You will not choose one theory to use exclusively in your career. Instead, you will have a clear awareness of the distinctions and rules that govern moral and ethical decisions. You will better understand decision-making models at the many levels of the health care system and you will be ready to make clear and consistent ethical choices of your own. Definitions Different authors have defined ethics in various ways apparently because of differences that exist between them or perspective from which they view ethics - Mcfadden (1967) said that ethics is the science which studies the morality of human act through the natural reasoning - Campbel (1969) asserts that it means what is generally or normally accepted in an area - Sahakian (1974) opines that ethics is the study of morals and moral issues. Ethics usually refers to a standardized code as a guide to behavior It is the part of philosophy that deals with the rightness or wrongness of human behavior. It is also concerned with the motive behind behavior. Ethic is a Greek word and moral is a Latin word but both mean the same thing that is wrong or right. **ETHICAL PRINCIPALS USED IN NURSING** Ethical codes are based on principles that can be used to judge behavior. Ethical principles assist decisions making because they standards for measuring actions. The principle of nursing ethics gives the tools to base ethical decisions upon. There are a number of principles that serves as the foundation of ethical decision making in nursing/midwifery care. In some situations, two or more principles conflict with each other, making a decision under these circumstances very difficult. A number of principles serve as foundation of ethical decision making in nursing. These principles are outlined below 1. Beneficence (doing good) 2. Non- maleficence (avoiding harm) 3. Autonomy (self- determination) 4. Justice (treating people fairly) 5. Fidelity (keeping promises) 6. Veracity (truth telling) 7. Confidentiality (respecting privileged information) 1. **BENEFICENCE** This word has its root from Latin "bene" which means "well" and "facere" meaning "to do". The principle of beneficence demands that good be done for the benefit of others. It requires helping clients meet all their needs whether physical, social or emotional. Beneficence is caring in the truest sense. Sometimes, doctors, nurses and families withhold information from patients for sake of beneficence. The problem with doing this is that, it does not allow competent nurses to make their own decisions based on all available information. 2. **NON- MALEFICENCE** The word takes it root from Latin; "non- not", "male- bad" and "facere- to do". The ethical principle non- maleficence requires that no harm be done, either deliberately or unintentionally. This principle also requires that nurses protect individuals who are unable to protect themselves because of their physical or mental conditions. Example epileptic, unconsciousness, depressed and very ill patient. The principle of non- maleficence is the basis for most nursing as well as medical codes of ethics. Intentional harm is never permitted, but some treatment or procedures do bring with them some associated risk. 3. **AUTONOMY** Autonomy is the freedom to make decision for oneself. This principle requires that nurses/ midwives respect client's right to make their own choices about treatment. E.g. inform consent before treatment, surgery nor participation in research. Health care providers are not to coerce patients into decisions and actions that do not reflect the clients' beliefs, values, choices or plans. To be able to make an autonomous choice the individual need to be informed of the purpose, benefit and risks of the procedure. Nurses accomplish this by providing information and supporting clients' choice. Sometimes it also requires respecting another's choice even if you disagree with it. However, autonomy has limit 4. **JUSTICE** The principle of justice obliges nurses and other health care professionals to treat every patient equally regardless of gender, sexual orientation, religion, ethnicity or social standing. Justice, implies choosing the action that is most fair and equitable after reflecting on the claims or right of the individuals involved in the decision As social beings, person have certain obligations and commitments to other social beings. Part of this commitment includes the distribution of goods and services in ways that must benefit others without discrimination or boas. This principle, when upheld, prevents unfair treatment of the sick, disabled, handicapped or other groups of individuals. 5. **FIDELITY** Fidelity means that the nurse acts in good faith to keep promises made to the client and does not make promises that cannot be kept. Fidelity also refers to loyalty to the client 6. **VERACITY** Veracity means truthfulness. Clients expects that nurses, indeed all healthcare professionals, will be truthful in their communications. Truthful communications are necessary to establish and maintain trusting relationship. Intentionally deceiving or misleading a client is violation of this principle. 7. **CONFIDENTIALITY** This principle states that anything said to nurses, midwives and other healthcare providers by their client must be held in the strictest confidence. The principle of confidentiality means that the nurse respects all privilege information about a client. A client must be able to assume that information given to the nurse will be respected and not shared inappropriately. In practice, the nurse will find that these principles occasionally conflict. Exception exist only when clients give permission for the release of specific information or when the law requires the release of specific information. If the nurse does not have the authority to reveal this information, the nurse may be faced with dilemma whether to inform the client on the basis of respect for autonomy or not to tell the truth and violate the principle of veracity. Competing principles must be weighed, consequence examined and a decision made as to how to proceed. **RESOLVING ETHICAL DILEMMA** Ethical delimma is a situation in which a difficult choice has to be made between to courses of action. Resolving ethical dilemma involves steps similar to the nursing process. These steps assist nurses in ethical decision making. These steps include: 1. **Assessing the ethical/ moral situations of the problem** - This involve the recognition of the ethical, legal, and professional dimensions involved. - Does the situation entails substantive moral problems (conflicts among ethical principles) - Are there procedural conflicts? (e.g. who should make the decision?) - Identify the significant people involved and those affected by the decision 2. **Collecting information** - Information include: the medical facts, treatment, treatment options, nursing diagnosis, legal data and the values, beliefs and religious components. - Make a distinctive between the factual information and the values/ beliefs - Validate the patient's capacity or lack of capacity to make decision - Identify any other relevant information that should be elicited - Identify the ethical/ moral issues and the competing claims. 3. **Implementation of the alternatives** - List the alternatives - Compare alternatives with applicable ethical principles and professional code of ethics - choose suitable frameworks and compare outcomes 4. **Evaluation** - Decide and evaluate the decision - Give the ethical reasons for your decision - Give the ethical reasons against your decision **ETHICS AND ETHICAL CODES IN NURSING** **PATIENT'S CHARTER** The Ghana Health Service is for all people living in Ghana irrespective of age, sex, ethnic background and religion The Patients\' Charter is an official document by the government or an organization that enlists various Patients\' Rights and Responsibility along with the Code of Practice, followed by a medical personnel. The service requires collaboration between health workers, patient/clients and society. Thus the attainment of optimal health care is dependent on Team Work. Health facilities must therefore provide for and respect the right and other health care providers. They must be sensitive to patient's socio-cultural and religious background, age, gender and other differences as well as the needs to patients with disabilities. The Ghana Health Service expects health care institutions to adopt the patients Charter to ensure that service personnel as well as patients/clients and their families understand their rights and responsibilities. This charter is made to protect the rights of the patient in the Ghana Health Service. It addresses: a. The Right of the individual to an easily accessible, equitable and comprehensive health care of the highest quality within the resource of the country. b. Respect for the patient as an individual with a right of choice in the decision of his/her health care plans c. The Right to protection from discrimination based on culture, ethnicity, language, religion, gender, age and type of illness or disability d. The responsibility of the patient/client for personal and communal health through preventive, protective and sample curative strategies. **\ THE PATIENT'S RIGHTS** 1. The patient has the right to quality basic health care irrespective of his/her geographical location. 2. The patient is entitled to full information on his/her condition and management and the possible risks involved except in emergency situation when the patient is unable to make a decision and the need for treatment is urgent. 3. The patient is entitled to know of alternative treatment(S) and other health Care providers within the service if these may contribute to improved outcomes. 4. The patient has the right to know the identity of all his/her caregivers and other persons who may handle him/her including students, trainees and ancillary workers. 5. The patient has the right to consent or decline to participate in a proposed research study involving him or her after a full explanation has been given. The patient may withdraw at any stage of the research project. 6. A patient who declines to participate in or withdraws from a research project is entitled to the most effective care available. 7. The patient has the right to privacy during consultation, examination and treatment. In cases where it is necessary to use the patient or his/her case notes for teaching and conferences, the consent of the patient must be sought. 8. The patient is entitled to confidentiality of information obtained about him or her and such information shall not be disclosed to a third party without his/her consent or the person entitled to act on his/her behalf except where such information is required by law or is in the public interest. 9. The patient is entitled to all relevant information regarding policies and regulation of the health facilities that he/she attends. 10. Procedures for complaints, disputes and conflict resolution shall be explained to patients to their accredited representatives. 11. Hospital charges, mode of payments and all forms of anticipated expenditures shall be explained to the patient prior to treatment. 12. Exemption facilities if any shall be made known to the patient. 13. The patient is entitled to personal safely and reasonable security of property is entitled to personal safely and reasonable security of property within the confines of the institution. 14. The patient has the right to a second medical opinion if he/she so desire. **THE PATIENT'S RESPONSIBILITIES** The patient should understanding that he/she is responsible for his/her own health and should therefore co-operate fully with health care providers. The patient is responsible for: 1. Providing full and accurate medical history for his/her diagnosis, treatment, counseling and rehabilitation purposes. 2. Requesting additional information and or clarification regarding his/her health or treatment which may not have been well understood. 3. Complying with prescribed treatment, reporting adverse effect and adhering to follow up requests. 4. Informing his/her healthcare providers of any anticipated problems in following prescribed treatment or advice. 5. Obtaining all necessary information, which have a bearing on his/her management and treatment including all financial implications? 6. Acquiring knowledge on preventive, promotive and simple curative practices and where necessary to seeking early professional help. 7. Maintaining safe and hygienic environment in order to promote good health. 8. Respecting the rights of other patients/clients and health Service personnel. 9. Protecting the property to the Health facility NB: These rights and responsibilities shall be exercised by accredited and recognized representatives on behalf of minors and patients who are unable for whatever reasons to make informed decisions by themselves. To all health care activities the patient's dignity and interest must be paramount. **Consent for Treatment** All patients have the legal right to be informed about his or her condition. The patient should be told the benefit and hazards involved in the proposed treatments and allowed to decide whether or not to accept the proposed plan of care. This is called consent. A patient is permitted to sign consent if above 18 years of age and if below, the relatives of the child would be required to sign the consent after explaining the procedure to them. There are two types of consent, the oral and the written consent forms. In the oral consent, the procedure is explained to the patient including potential consequences and if the patient accepts to do it, then it means oral consent has been sought. This type of consent should be sought before any procedure is carried out on the patient. In the written consent, the explanation has been written on paper and the literate patient is made to sign or thumbprint if illiterate. **Clinical Trial** This involves the initial trial and test on drugs, medical and surgical instruments and procedures on patients or healthy individuals before passed for public use. Informed consent is of high relevance in these situations. Sometimes though they may have been successful in animals, they may be harmful to human beings and as such the individual must be well informed. They must be willing to give their consent without any form of coercion. However a patient may choose to discontinue any clinical trial without any fear and is still entitled to the best of care available. **Confidentiality** It is completely unethical to disclose a patients information to a person not directly related to the patients care. The patient has the right to decide which type of information should be shared and with whom. Sometimes patient information is shared for teaching purpose; in such case the identity of the patient should remain anonymous. **Patient's Properties** The nurse should be able to care and protect the patient's properties and items and return them after the patient has recovered. In this case the nurse must list all the patients' items in the presence of the patient or relatives label them and make sure to tell the patient or relatives the number of items you are safe keeping. In situations where the patient dies, the properties should be given to the relatives or significant others, all these are done to avoid allegations of theft from patients relatives. **Signing Legal Document** A will is a declaration of what someone wishes to do with his property after his death. If a patient should sign a will, the nurse should make sure that the patient is in the right frame of mind. The nurse must never sign legal documents but rather advice the patient to invite a legal practitioner and the relatives. **Witnessing Will** The nurse would be called to witness the signature as the patient signs the will. If a patient wants to write a will, he should be given all the necessary assistance but most hospitals advice the nurse not to get involved in legal matters. According to the law, a will must be in ink and signed voluntarily by patients while in sound mind and must be witnessed by at least 2 people above the age of 21 years. **Personal Appearance** The nurse must appear smart, neat and simple. Shoes of nurses must be comfortable and have rubber sole. Her uniform must be well pressed and up to the level of the knee. The uniform must not be too tight, her hair must be neat and above the collar of her dress. Nails must be short with no fancy rings and nail polish. She must avoid dangling earrings and excessive makeup. However a watch, a professional tie, name thug can be attached to uniform, cap must stiffly starch without wrinkles. She must avoid wearing her apron and cap in public. Men should have their hair and bear neatly shaved. No nurse must chew gum, cola, or stick, drink alcohol or smoke whilst in uniform. The nurse must be adjusted to the responsibility and dignity of the profession. **Receiving and Making Calls** The nurse must identify himself or herself by mentioning his name, title and name of the unit or ward. ***For example, Hello, this is male ward am student nurse Owusu Sandra, how may I help you please?*** The nurse must speak clearly and courteously. After taking the call, thank the caller for calling and let the caller hang up first. In making calls too, identify yourself and the ward you are calling from. Give your message and thank the one receiving the call and hang up. **THE NURSES' PLEDGE** - *I acknowledge that the special training I have received has prepared me as a responsible member of the community* - *I promise to care for the sick with all the skill I possess no matter what their race, creed, colour, politics or social status, sparing no effort to conserve life, alleviate pain and promote health.* - *I promise to respect at all times the dignity of the patients in my charge* - *I promise to hold in confidence all personal information entrusted to me* - *I promise to keep my knowledge and skill at the professional level and to give the highest standard of nursing care to my patients* - *I promise to carry out intelligently and loyalty medical instructions given to me* - *I promise that my personal life shall at all times bring credit to my profession* - *I promise to share in the responsibility of other professions and citizens for promoting health locally, nationally and internationally* - *So help me God.* **THE NIGHTINGALE'S PLEDGE** **QUALITIES OF THE NURSE; ADJUSTING TO CLINICAL NURSING, APPEARANCE** --------------------------------------------------------------------- Character and personality are as important as intelligence in nursing. The nurse must have qualities which she may develop during her training. These include a certain degree of maturing and ***integrity* i**n her work. She must have the necessary fitness to withstand the strain and stress of the work. To these qualities, she must add ***kindness, tolerance, sense of humour and calmness***. She should be able to adopt in all situation pertaining to the profession and should be able to make the necessary social and professional adjustment. Others are: 1. **Honesty** -- high on the list of essential character qualities. Includes ability to report and record accurately and not exaggerate / misrepresent, resist borrowing from others without their permission. 2. The nurse should be able to stand firm for what is **right and just**. 3. The nurse should never appear to be in a hurry; she may however act **smartly**. 4. She should be **reliable, sincere and up-to date (current)** and also should be a friend. 5. Nursing entails considerable sacrifice in order to acquire experience. 6. A nurse is required to be **flexible and adaptive** because of the need of the patient and the circumstances under which nursing will make a great demand on them. 7. Great **patience** is required with exercise of **kindness and compassion**. 8. The nurse should be **observant** to be able to report accurately any changes in the patient's condition 9. The nurse must be **resourceful** and must have initiatives to be able to act in case of any emergency. Particularly it is important for a nurse to know how to handle adequately situations / emergencies that he/she is expected to handle & not cause more havoc. 10. Punctuality **(punctual)** is essential for the patient's comfort and effective running of the hospital. 11. A nurse must be **courteous, polite and considerate** to other health workers, patient and their relative and all visitors. 12. **Tactful;** it involves a delicate perception of the right thing to do or say at the right time. 13. Ability to **control emotion and bold** 14. **Tolerant and understanding**. A character quality of the highest magnitude, involves respecting the rights & privileges of clients, support persons/family & community members, as well as colleagues & other health care providers. 15. **Faithful** 16. **Technically competent** The qualities of a nurse/midwife which help in the making and promoting good interpersonal relationship are, - Believing sincerely in people - Allowing people to express their thoughts and feelings - Having adequate verbal expression - Attempting to understand what people are really communicating (accurate empathy) - Attending to interpersonal processes occurring within the therapeutic relationship - Pointing out discrepancies in behavior **PERSONAL APPEARANCE AND GROOMING AND CLEANLINESS OF NURSES** The nurse must keep herself physically and mentally fit as possible, she should always look neat and observe good personal hygiene to prevent infection. The personal appearance of the nurse is of major importance in establishing good nurse-patient relationship. Neatly dressed, well-groomed nurse looks efficient. Patients are very receptive to the appearance of the nurse. Her ability to make good relationship with them may depend partly on her personal appearance. The nurse should observe the rules of personal hygiene with regard to care of the skin, nails, clothing, hands, feet etc. **SKIN** Taking care of the skin by daily bathing gives protection to the skin against infection. The use of deodorants or anti-perspirants also takes away unpleasant smell. It is also important to shave off unsightly or unkempt hair from under the armpit, pubic parts or moustache. **HAIR** Dirty hair reflects ones character. Clamorous hair styles should be avoided as it harbors microbes. The hair should be neatly and simply styled and should not touch the collar of the uniform. Coloured hair bands should be avoided; ***black is preferred***. **HANDS** Care and cleanliness of the hands need special attention. A contaminated hand is not only dangerous to their owners but also serves as a source of infection to others. Nursing involves holding patients' soiled linen and other things; it therefore becomes important to wash the hands frequently with soap and water. The use of good lotions helps keep the hands clean and smooth all the time. **FINGERNAILS** Nails should be well kept. Close cutting of the nails prevent injuring the patient. It also facilitates washing and scrubbing to remove dirt. Avoid using nail polish. Artificial finger nails and varnish should not be used as they harbor micro-organisms. Only wedding and engagement rings are allowed when on duty as well as breast watch and identification badge. **CLOTHINGS/UNIFORM** The uniform should be washed frequently to avoid it being a reservoir for microbes. It should also be neat and presentable but not too short or tight to expose the nurse; or to sexually harass the patient or co-workers. Also repair lose stitches and replace buttons. Nurses should use prescribed uniform. The uniform should be sewn to the appropriate style and should be below the knee. It should be well ironed together with apron and a cap. The shoe should be rubber sole, modest in style and appropriate colour. **MAKE UPS** Face powder and lip stick should make the skin tone fine as much as possible. Ensure that these make-ups including eye shadows and lashes, and beauty spots should be used in moderation but not to give you an artificial look. Nail polish should not be used. When on duty, light make-up and mild perfume should be worn as strong perfumes makes patient's feels sick and disturb asthmatic patients. **HEALTH** The nurse must be healthy to look, cheerful and energetic. She must have medical exams at least once a year. She must also have regular exercise and eat well balanced diet. **ALCOHOL** Excessive alcohol intake or alcohol dependency may lead to confusion and gradual mental and physical deterioration. The nurse must not drink while on duty or must not be spotted on a drinking bar in uniform. **DRUG ABUSE** The nurse should avoid using drug of any kind or form if not medically prescribed for her. **SLEEP AND REST** The nurse must have at least Six (6) to Eight (8) hours sleep each night, then siesta if possible. Diversional activities like indoor games are very important and therefore encouraged **DOS' AND DONT'S FOR WEARING THE NURSES' UNIFORM** 1. Wear the uniform and cap according to the hospital's policy with pride and dignity. 2. Have the uniform spotlessly clean, well ironed, properly buttoned and of proper length. 3. Wear proper shoes that are polished and have rubber soles. 4. Have a watch with second hand, a pen, a pair of scissor and other articles that are needed in the performance of her duty. 5. Wedding rings and professional pins are the only jewellery that can be worn with the uniform. 6. Don't wear extreme hair style with multicolored ribbons; and also expensive make-ups. 7. Bad habits example chewing of gum, cola, sticks, drinking of alcohol, smoking and others must be avoided while in a uniform. 8. Also eating or fighting in public are to be avoided by professional nurse especially while in uniform. 9. Nurses in uniform should stand when a senior colleague approaches them and also when talking to them. **CHAPTER SIX** **HOSPITAL ETIQUETTE** Etiquette refers to the conventional growth of manners and unwritten code forbidding unprofessional conduct. Nursing is a profession and as such the nurse and student nurses are expected to obey hospital rules in order to maintain the standard of the profession. This also helps to bring discipline into the hospital. The following manners are required of the nurse: - Receiving and making telephone calls must be done courteously - Nurses must plan and carry out their work as their supervisors instruct them to - The nurse should respect the uniform and behave in the uniform as a member of society who has the honour of wearing the uniform will behave - The nurse should respect those in higher ranks because of their knowledge and experience - The nurse should again appreciate that he is living in a society where rules and regulations are essential and should be obeyed. - The nurse should further become familiar with various members of the hospital team. - The nurse should also make it his/her duty to know the hospital personnel by name and rank so that when she meets any member of the hospital team, she will be able to address him by name in courteous manner. - The nurse should not be a selfish person as one cannot live amicably in the hospital as well as in the community. The nurse must learn to give and take. - When addressing colleague nurses use the title "nurse" before the surname of the person. - When the DDNS or another senior staff member come to the ward, the nurse who sees them first should approach them courteously. She must address them with their correct titles. - It is bad manner to remain seated against the wall when approached or spoken to by any member of the higher rank. - The nurse should stand up or remain so until her courtesy has been acknowledged. - On staircase or open points, doors should be opened for them. - Patient care comes first. Never ignore anyone who needs help, is uncomfortable or in danger. - The staff's work as a team, be cooperative and help others - Any unfinished assignment, incidents or changes in the patient's condition must be reported to the supervisor and to the next shift **CHAPTER SEVEN** **CUSTOMER CARE AND INTERPERSONAL RELATIONSHIP** Customer care is the provision of service to clients before, during and after having a service encounter. In customer care, the service provider (Nurse/Midwife) during care builds a personal and emotional connection with the client. **INTERPERSONAL RELATIONSHIP IN NURSING** Interpersonal relationship is the relationship that is established between nurses and patients or nurse and her colleague in nursing care practice. It is important that rapport is established between the nurse, patient and his family as well as other members of the health team. This relationship is of great importance and is the basis of nursing practice. It is this sort of relationship with care as a primary health activity that sets the stage for the giving of help and the receiving of help. In the nurse-client relationship, the nurse has the intention of promoting growth, development, and maturity, improved functioning and coping with the life of the client. The qualities of a nurse/midwife which help in the making and promoting good interpersonal relationship are, - Believing sincerely in people - Allowing people to express their thoughts and feelings - Having adequate verbal expression - Attempting to understand what people are really communicating (accurate empathy) - Attending to interpersonal processes occurring within the therapeutic relationship - Pointing out discrepancies in behavior - **GUIDELINES FOR MAKING GOOD INTERPERSONAL RELATIONSHIP WITH PATIENTS AND CO-WORKERS** A. The nurse should be familiar with each patient's name as well as that of co-workers and address them by name B. Respect everyone individually. C. She should work with co-workers and not give orders to them. D. Clear doubt, admit ignorance and try to learn from every person and each institution. E. The nurse should try and carry out her responsibilities diligently. F. Maintain strictness and discipline in every situation. G. Portray a spirit of loyalty, willingness and honesty. H. Have a mutual trust and understanding and obedience to superiors, these are very essential. I. Should exhibit readiness for work, and be present for all meeting with members of the health team. **COMMUNICATION SKILLS** Communication skills is the ability to convey or share ideas and feelings effectively. For a nurse to effectively communicate, he/she must develop and nature the following skills: 1. **Emotional Intelligence** Emotional intelligence is the ability to understand and manage your emotions so as to communicate\ effectively, avoid stress, overcome challenges and empathise with others. It's a skill which is learned over time rather than obtained. There are four main strands to emotional intelligence: - Self-awareness - Self-management - Social awareness - Relationship management Each of these strands is important in its own way and allows you to communicate confidently with a variety of people. 2. **Cohesion and Clarity** Good communication is much more than saying the right thing; it is about communicating messages clearly and concisely. Before you start a conversation, or begin a discussion, have in mind what the purpose of the communication is and what information you hope to obtain as a result. Lack of clarity and cohesion can result in poor decisions and confusion. 3. **Friendliness** In any type of communication, make sure that the right tone is set. A friendly tone will encourage others to communicate with you. Always try to personalize messages, particularly when working with patients or fellow colleagues. 4. **Confidence** In all interactions, confidence (but not over-confidence) is crucial. Demonstrating confidence will give clients and colleague workers faith in your abilities to deliver as a professional. Conveying confidence can be something as simple as maintaining eye contact during a conversation or using a firm but friendly tone when speaking with people over the phone.\ Be careful not to come across as aggressive, since this will have the opposite effect of what you are hoping to achieve. 5. **Empathy** Within a busy work environment, everyone will have their own ideas about how things should be done. Even if you have disagreements with your colleagues or patient, their point of view should be considered and respected. The goal here is to understand where the other person is coming from -- and respecting their views, even if they are very different from your own. 6. **Respect** Empathy leads into the next communication skill, respect. If you respect the ideas and opinions of others, they will be more likely to communicate with you. Active listening or simply using the name of the person you are speaking to can both be effective. 7. **Listening** Good communication is all about **listening effectively**. Take the time to listen to what the other person is saying and practice active listening. Pay attention to what the other person is saying, ask questions and clarify points, and rephrase what they have said so that you know you have understood correctly. 8. **Open-Mindedness** Try to enter into communications without having an agenda. Strong communications require an open mind and a commitment to understanding other people's points of view. If you disagree with the people you are speaking to, try to reach a middle ground that benefits all parties. Approaching a discussion with an open mind is more likely to result in a successful outcome. 9. **Tone of Voice** The tone of your voice can set the whole mood of the conversation. If you start the discussion in an aggressive or unhelpful manner, the recipient will be more inclined to respond in a similar way. The tone of your voice will include the level of emotion that you use, the volume you use and the level of communication you choose. The same sentence can have a very different meaning depending on which words are emphasized and the tone of your voice. In a patient complaint scenario, for example, your tone of voice should be as calm as possible, since an unfriendly tone of voice will only serve to worsen the situation. 10. **Asking Good Questions** Good questions can help conversations flow and improve the outcome. During a conversation, always aim to ask open-ended questions. These are questions with prompts which encourage the recipient to speak about certain points and they require more detailed responses. If you need further information still, you can use probing questions which request even more information from the recipient, such as \"Tell me exactly how you feel"\ During the conversation, include a mixture of questions including clarification, 'what if' scenarios and open-ended questions to make sure that you achieve what you set out to do at the beginning of the conversation. **CHAPTER EIGHT** **THE LAW, THE NURSE AND SOCIETY** **THE LAW, THE NURSE AND THE PATIENT** In recent past, Ghanaian has been enlightened about legal issues and has been standing for their rights. This is evident by the numerous law suits that have been slapped on numerous health institutions and health professionals in the country because they feel aggrieved by the conduct of the health personnel and the facilities they work in. The most recent is the case between KATH and Suweiba on the alleged stealing of baby by some nurses in the hospital's labour ward. Laws are body of rules, guidelines, regulations that govern society and protect the health, safety and welfare of the people or its citizens. They are established and enforced by legislative authority such as judge or governmental agencies to regulate our social conduct in a formally prescribed and legally binding manner. **Law is** defined as relationships which have been developed by society and state which activities are permissible and those not permissible. **Law** may also be defined as rules and regulations which have been developed by society to provide some form of social control for its people. It may also be defined as the rule of conduct commanding what is right and what is wrong. **Types of law** A. Public law- body of law that deals with relationship between individuals and the state or government and government agencies B. Private /Civil law- body of law that deals with relationship among private individuals Legal issues in nursing/midwifery talk about the laws that bind the practice of nursing/midwifery or nursing as a profession. The rights to practice as a nurse depend on the possession of a license by the Nursing and Midwifery Council of Ghana. ***Licenses*** are legal document that permit persons to offer their skills and knowledge to the public in a particular area covered by the license. The Nursing and Midwifery Council of Ghana has the power to revoke the license because of - incompetence, - conviction of a crime, - falsification of school results, - hidden criminal history among others. In view of this, the nurse/ student nurse has to acquaint themselves with some basic legal issues so as to be able to conduct herself within the confines of the law when carrying out their nursing responsibilities. The nurse as a professional is therefore guided by Nursing Acts, Professional Discipline, Registration and the Status of the Code of Professional Conduct. Furthermore, the nurse as an employee in whatever establishment, must be employed and be given an appointments letters, and a job description to operate and must adhere to the Employment Acts, Contracts, Union like Ghana Registered Nurses and Midwives Association, and health and safety Legislation. As a practitioner, the nurse must be aware of the laws that affect him/her to enable him discharge his duties efficiently and effectively. The nurse must also observe the patients' rights to avoid legal suits **Who is a nurse/midwife?** She is a person who has passed a special training and is licensed to practice the profession.\ Legal aspects of midwifery/nursing are taught in the training colleges under the subject **"***Perspectives in Nursing and Midwifery".* The Nursing and Midwifery Council has the sole legal right of conducting licensure exams for nurses and midwives and it is binding that one must pass this examination before being awarded the license to practice as a nurse.