PROFFESIONALISM IN NURSING.docx

**[PROFFESIONALISM IN NURSING ]** A nurse: A professional nurse is an individual who has successfully undergone a prescribed nursing training program, has passed a licensing examination and is registered by the national nursing regulatory body, in our context the Nursing Council of Kenya (NCK). **...

**[PROFFESIONALISM IN NURSING ]** A nurse: A professional nurse is an individual who has successfully undergone a prescribed nursing training program, has passed a licensing examination and is registered by the national nursing regulatory body, in our context the Nursing Council of Kenya (NCK). **Professionalism**; The competence or skill expected of a professional. **Characteristics of a Professional Nurse** A professional nurse: - Displays high standards of performance and integrity in nursing practice - Seeks constantly to improve her/his technical and interpersonal skills through continuing education and research - Uses sound judgement and discretion in dealing with patients/clients and their relatives - Provides holistic care to patients, family and community - Deals competently with crisis situations - Puts what is good for professional services to patients ahead of self-interest - Coordinates and evaluates nursing services in cooperation with members of other health services (collaboration and networking) - Is not overly concerned with the materialistic aspects of nursing - Expects to find satisfaction and spiritual values in their work - Feels responsible for the status of nursing and tries to advance and never to retard it - Has inner resources to which she/he can turn to, for renewal of faith and courage when weary and discouraged - Is proud of her/his profession and considers it to be at par with other professions like medicine or law or any other vocation practiced for compensation, which at the same time contributes in its own unique way to the welfare of humanity **Personal Attributes** Personal attributes that help a nurse to display professionalism include: - Good personal appearance with a voice that does not scare patients - A ready smile, gentle hand, orderly in thought and action - Emotionally mature, compassionate, dignified, tolerant, friendly, sympathetic and interested in other people  All characteristics are advantageous to the creation of a friendly and conducive environment for the patient\'s recovery. As a nurse, you must at all times have serenity of mind and self-control to be able to handle a variety of situations and patients. ***Remember: A professional nurse at all times displays integrity, commitment and ethical behavior. They display intelligence, good judgement and handle emergencies well.\ *** ***A professional nurse is also responsible in professional and social situations.*** **Personal Grooming** Personal grooming is very important to nurses. Remember, every patient has a mental picture or image of how their nurse should be. The nurse\'s appearance provides security and hope to a patient.   A nurse\'s uniform should not be tight or very loose to hinder free movement during an emergency. It must be very clean to prevent cross infection and is to be well pressed. The dress or skirt should be below the knee cap to give allowance for bending. The material should not be \'see-through the uniform should be well maintained, that is, fallen buttons or torn zippers should be replaced, rips and tears mended and stains removed.  As you are aware, hair is a source of micro-organisms. Female nurses should tie back long hair neatly. Male nurses should have their beards. Shoes should be low-heeled and soft to avoid making excessive noise, which may disturb patients. The nurse should maintain daily care of shoes, socks. Nails should be trimmed and colored nail polish avoided. ***Remember: The patients have a right to identify the nurse who is providing their care. It is advisable therefore to wear an identification tag at all times showing full names and qualifications.*** **Historical Background** Historically the nursing practice in Kenya, just like anywhere else in the world, was performed on a tradition that sick people received care from female family members in their own homes. Therefore, it can be said that the family is the oldest and the most used health care delivery service in the world. Currently this approach to care provision is known as \'family nursing\'. \* *  As social conditions and health care needs change, the nurses\' roles and nursing practices continue to alter in response to these changes. Florence Nightingale is the founder of professional nursing. She initiated formal nursing training using a curriculum replacing apprenticeship.  Western medicine in Kenya was introduced with the arrival of missionaries in 1895. Doctors and nurses were brought from Britain and Europe. They trained dressers and assistants on the job. Later on, they began to conduct basic training in missionary hospitals. In 1949, a nurses, midwives and health visitors' council were formed by an ordinance. In 1950, formal nursing training at enrolled and registered levels was started. The practice of nursing followed a medical model. The patient was nursed as fragments of diseased body parts using task allocation. **Task Allocation/Job Assignment** This method of dividing duties was based on the industrial concept of division of labor. The patient was fragmented into a series of jobs assigned to different nurses of different grades. Thus, a hierarchy of tasks and staff was created for patients. This resulted in lack of continuity of care, with patients subordinated to the system rather than being central to it. You may recall a practice in the wards whereby the most junior nurse was assigned sluice rooms, others observations, wound dressings, drug administration, specimen collection, theatre cases, doctors round and so on. In the 1950s, nurse leaders in North America began to recognize that the development of nursing knowledge and practice must run simultaneously with research. Florence Nightingale in 1859 wrote that nursing was more than the administration of medicine. This shows that Florence Nightingale had recognized that nursing needed a combination of both intellectual and practical skills. In the 1960s to 1980s, many developments and changes in nursing took place stemming from the professional desire for innovation and change in practice. The nurses\' leaders felt that the patient was alienated from their own care, and that there was a need for improvements in nursing. Nurse leaders began trying to demonstrate that nursing was a profession with its own unique body of knowledge. **Nursing theories** **These are organized bodies of knowledge to define what nursing is** In 1860 **Florence nightingale** defined nursing in her environmental theory as the act of utilizing patient's environment to assist them in recovery **Virginia Handerson's** nursing need theory conceptualized nurse's role as assisting the sick or healthy individuals to gain independence in meeting 14 fundamental needs Virginia Henderson (1966) delineates the unique functions of the nurse as follows: *\"...to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.\"* **Hildegard Peplau** introduced her theory of interpersonal relations that emphasizes the nurse =client relationship as the foundation of nursing practice **Dorothea orems** stated in her theory that nursing care is required if patient is unable to fulfill biological ,physiological, developmental or social needs **Fayeh Abdellh** published her work-topology of 21 nursing problems which shifted the focus of nursing from a disease-centered approach to a patient centered approach **Roy's adaptation theory:a**ccording to Roy ,a person is a psycho-social being in constant interaction with changing environment.he/she uses different mechanisms to adapt.the adaptation model states that **You must be wondering how these developments were reflected on nursing in Kenya**? In the 1960s and 1970s task allocation was exclusively practiced in the context of hospital nursing. Task assignment is still practiced when there is shortage of staff. During the said period, however, lots of changes took place in the health delivery system in Kenya. Politically, independence was attained in 1963. The KANU manifesto declared its intention to fight what it saw as the three greatest enemies of development: poverty, illiteracy and disease. Within this context, health care had to be made available to the community. This led to the introduction of community health nursing training (KECHN) in 1966 at MTC Kisumu. Midwifery training had already been introduced in the 1950\'s at enrolled level, and at registered level in 1965. At the same time, expatriate nurses who were administrators of nursing services, and nursing educators were leaving the country at independence. In anticipation of gaps in training and skills, a Diploma in Advanced Nursing was started in 1968 at the University of Nairobi to prepare Nurse Educators and administrators. **What is Health?** Many people think that health is the absence of illness but the World Health Organization (WHO) in 1946 defined health as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. The health delivery services in the 1970\'s laid great emphasis on community-based health care in the implementation of Primary Health care concept (WHO, 1978). Nurse leaders worldwide became dissatisfied with the task allocation method of organizing patient care as it alienated the patient from the nursing care. Nurses felt that there should be accountability of the care being given with a view to improving the quality of care. Therefore, in the 1980\'s nurses started moving away from \'tasks\' to individualized nursing care. This moves away from a pre-occupation with tasks to a focus on patients led to the introduction of a nursing process that provided a systematic method for individualized nursing. The progression of these systems started with patient allocation to team nursing and then primary nursing **The Nursing Process** The nursing process was introduced in the 1970'S The nursing process; is wholly feasible in the context of practice, which is organized on the basis of patient allocation, team nursing or primary nursing. Assessing, planning, implementing and evaluating are embedded in everyday nursing practice. **Nursing Models of care** **A nursing model**; a systematically constructed, scientifically based and logically related set of concepts of nursing practice together with the theoretical bases of these concepts and the values required for their use by the practitioner. Models are developed carefully and methodically, usually as a result of prolonged research and may involve many months or years of observing nursing practice and thinking about why nursing is carried out. **Primary Nursing** **or total nursing care** This is a patient-centered nursing system. One nurse\ (the primary nurse) assumes individual responsibility for a particular patient. this responsibility extends over the entire period the patient requires nursing although in practice there has to be delegation to other nurses (the associate nurses) during periods of absence from the ward. The potential benefits of primary nursing for patients are continuity of care and cover. The concept of primary nursing responds to the directive of putting patients first and it embodies the ideals of individualized nursing. Therefore, if nurses are to accomplish the goals of nursing as defined by the nursing leader, nursing must have a body of theoretical knowledge on which to base its practice. **Team or functional nursing care**. A model using the nurse as a team leader and Other nurses by dividing the work by function such as 'medication nurse' or 'treatment nurse 'patient assistants to perform activities such as bathing, feeding etc. **Total patient care** Each nurse is allocated a small number of patients (up to six) to look after during a whole work shift. **Nursing Ethics** You are being prepared to practice professional nursing which involves adherence to the code of ethics. **Ethics;** morals and philosophical principles that define actions as being either right or wrong. The ethical concepts touch on your practice as you interact with other people, the society, co-workers and the profession. **Guidelines** - You should always hold personal information in confidence and use your discretion in sharing this information. - You should always remember that it is your responsibility to keep abreast with current trends in the nursing profession so as to maintain competence in nursing practice through continuing education. - Always maintain the highest standards of nursing care possible within the given reality of a specific situation. - When accepting any responsibilities delegated to you, ensure that you are competent to carry out the assignment. - Maintain professional standards of personal conduct that reflect credit upon the profession at all times. - Share with other citizens the responsibility for initiating and supporting action to meet the health and social needs of the public during your practice. - Sustain a co-operating relationship with co-workers in nursing and other fields. - Take appropriate action to safeguard the individual when a co-worker or any other person endangers their care. - You have a major role in determining and implementing desirable standards of nursing practice and nursing education. - Be active in developing a core of professional knowledge. - Acting through a professional organization, you are to participate in establishing and maintaining equitable social and economic working conditions in nursing. This, therefore, means that you are to be a member of your professional association. nursing is universal. Inherent in nursing is respect for life, dignity and rights of man. It is unrestricted by considerations of **have you heard of the International Council of Nurses Code of Ethics** The International Council of Nurses (ICN) Code of Ethics was adopted in Mexico City in 1973. It states that the fundamental responsibility of the nurse is to promote health, prevent illness, restore health and alleviate suffering. Moreover, the need for nursing is universal. Inherent in nursing is respect for life, dignity and the rights of man. Nurses are to provide care to individuals regardless of nationality, race, creed, color, age, sex, politics or social status. **Nurses and people** The nurse's primary responsibility is to those people who require nursing care. The nurse, in providing care, promotes an environment in which the values, customs and spiritual beliefs of the individual are respected. The nurse holds in confidence personal information and uses judgement in sharing this information. **Nurses and practice** The nurse carries personal responsibility for nurse practice and for maintaining competence by continual learning. The nurse maintains the highest standards of nursing care possible within the reality of a specific situation. The nurse uses judgement in relation to individual competence when accepting and delegating responsibilities. The nurse when acting in professional capacity should at all times maintain standards of personal conduct which reflect credit upon the profession. **Nurse and Co-workers** The nurse sustains a cooperative relationship with co-workers in nursing and other fields. The nurse takes appropriate action to safeguard the individual when their care is endangered by a co-worker or any other person. **Nurses and the profession** The nurse plays the major role in determining and implementing desirable standards of nursing practice and nursing education. The nurse is active in developing a core of professional knowledge. The nurse, acting through the professional organization, participates in establishing and maintaining equitable social and economic working conditions in nursing. **Code of Ethics as applied to Nursing** - The fundamental responsibility of the nurse is threefold; to conserve life, to alleviate suffering and to promote health. - The nurse shall maintain at all times the highest standards of nursing care and of professional conduct. - The nurse must not only be well prepared to practice but shall maintain knowledge and skill at a consistently high level. - The religious beliefs of a patient shall be respected. - Nurses hold in confidence all personal information entrusted to them. - Nurses recognize not only the responsibilities but the limitations of their professional functions, do not recommend or give medical treatment without medical orders except in emergencies, and report such action to a physician as soon as possible. - The nurse is under an obligation to carry out the physician's orders intelligently and loyally and to refuse to participate in unethical procedures. - The nurse sustains confidence in the physician and other members of the health team; incompetence or unethical conduct of associates should be exposed but only to the proper authority. - The nurse is entitled to just remuneration and accepts only such compensation as the contract, actual or implied, provides. - Nurses do not permit their names to be used in connection with the advertisement of products or with any other forms of self-advertisement. - The nurse co-operates with and maintains harmonious relationships with members of other professions and with nursing colleagues. - The nurse adheres to standards of personal ethics which reflect credit upon the profession. - In personal conduct, nurses should not knowingly disregard the accepted pattern of behavior of the community in which they live and work. - The nurse participates and shares responsibilities with other citizens and other health professions in promoting efforts to meet the health needs of the public -- local, state, national and international. **Professional Organizations** Now we are going to discuss some professional nursing organizations which include: - National Nurses Association of Kenya (NNAK) - East Central Southern Africa College of Nursing (ECSACON)  - Nursing council of Kenya \[NCK\] - Kenya progressive Nursing Association \[KEPNA\] - International Council of Nurses (ICN) Nurses in Kenya, just like any other countries in the world, are members of professional organizations at national, regional and global levels. In Kenya the professional nursing organization that has both regional and international recognition is the National Nurses Association of Kenya (NNAK). **The National Nurses Association of Kenya** The National Nurses Association of Kenya (NNAK) is a professional association for nurses, which is registered by the Registrar of Societies as a welfare association. The Association has branches in all provinces. Members in each branch elect a Branch Chairman, Secretary and Treasurer. In turn, these elect national office bearers every two years who comprise the National Chairman, Vice Chairman, Secretary, Treasurer, Organizing Secretary and their respective Vices. The Association has an Executive Committee which comprises of national office bearers and branch chairmen. Various nursing disciplines are represented as chapters, for example, midwives, operating theatre nurses, mental health and psychiatric nurses, educationists, intensive care nurses and private practice nurses. The headquarters of [[NNAK]](javascript:glossaryWin('NNAK','National%20Nurses%20Association%20of%20Kenya','ltr');) is in Nairobi. [[NNAK]](javascript:glossaryWin('NNAK','National%20Nurses%20Association%20of%20Kenya','ltr');) is a member of a regional body known as the East Central Southern Africa College of Nursing (ECSACON) whose offices are situated in Arusha, Tanzania, the Association of Professional Societies of East Africa (APSEA) and the International Council of Nurses (ICN) situated in Geneva. Additionally, NNAK collaborates with other professional bodies such as the Royal College of Nurses, Royal College of Midwives, the Canadian Nurses Association, American Nurses Association, Kenya Medical Association (KMA), the Association of Kenya Obstetricians/Gynecologists (KOGS) and other health organisations. **Functions of the National Nurses Association of Kenya** The functions of the National Nurses Association of Kenya are: - Promoting nursing and maintaining the interest and practice of all aspects of the profession as a whole - Promoting and maintaining high standards of nursing education - Stimulating and encouraging nursing research - Promoting co-operation between this body and other national and international professional bodies - Promoting good understanding between the Association, central and local governments and all communities - Acting as a local representative body of the nursing profession - Supporting a high standard of nursing ethics, conduct and practice which is organized and functions unrestricted by consideration of nationality, race, creed, politics, sex or social status -  Assisting whenever possible members who by reason of adversity or ill health are in need of help - Arranging and holding periodic meetings of the Association for professional, educational and social purposes - Circulating such information as may be thought necessary by means of a journal, bulletin or any other method - Accepting or refusing any gift endowed or bequest made to or acquired by the Association or for the purposes of any specific object connected with the science, art of nursing and executing any charitable or other trusts which may be considered expedient or desirable in the interests of the Association - Maintaining an up to date list of all members in Section 4 a (i), (ii) and  (iv) of the NNAK constitution - Performing all such other lawful things as may from time to time be conducive to the attainment of furtherance of the above functions. (NNAK Constitution, section 3 1987)  **Chapters** The chapters of [[NNAK]](javascript:glossaryWin('NNAK','National%20Nurses%20Association%20of%20Kenya','ltr');) include: - Midwives - Education - Theatre Nurses - Mental Health and Psychiatric Nurses - General Nurses - Private Nurse Practitioners - Pediatric Nurses **National Executive Committee** This is a very large committee comprising the national executives who run the office at the headquarters (the National Chairman, two Vice Chairmen, an Honorary Secretary and the Vice Treasurer, organizing Secretary and the Editor). Other members are the Branch Chairmen, Chairmen of Chapters, Division of Nursing ([[MOH]](javascript:glossaryWin('MOH','Ministry%20of%20Health','ltr');)) and the Nursing Council of Kenya. Other committees in the [[NNAK]](javascript:glossaryWin('NNAK','National%20Nurses%20Association%20of%20Kenya','ltr');) are the Education, Editorial and Finance Committees. The Division of Nursing, on behalf of the Ministry of Health, deals with employment issues for nurses and sponsorship for higher education. Furthermore, it provides working facilities for nurses, technical know how and supervision. On the other hand, the Nursing Council of Kenya deals with training of nurses, maintenance of standards of nursing education and nursing practice and, additionally, the regulation of nurses\' conduct. Finally, NNAK serves as an advocate for the nurses and the community. The [[NNAK]](javascript:glossaryWin('NNAK','National%20Nurses%20Association%20of%20Kenya','ltr');)\'s activities, as you will note, are geared towards promoting excellence in nursing. There are national activities such as the Florence Nightingale week, Annual General Meetings, branch activities and chapter activities which aim to improve the quality of nursing and reproductive health care. Finally, there are those activities channeled by [[ICN]](javascript:glossaryWin('ICN','International%20Council%20of%20Nurses','ltr');)/[[ECSACON]](javascript:glossaryWin('ECSACON','East%20Central%20Southern%20Africa%20College%20of%20Nursing','ltr');) through the Ministry of Health. Apart from the discussed activities, there are several meetings conducted at the NNAK, such as quarterly Executive Committee meetings and monthly meetings for the chapters. The following are just some brief highlights of what you will acquire from the NNAK: - Updates in knowledge, attitude and skills in nursing and midwifery practice to improve your performance for quality care to patients/clients - Interactions and the opportunity to share experiences with other nurses - The formation of links with other organizations - Advocacy on welfare issues such as better education as well as better remuneration and improved conditions of service So far we have been discussing your professional body, which is a member of a regional body known as [[ECSACON]](javascript:glossaryWin('ECSACON','East%20Central%20Southern%20Africa%20College%20of%20Nursing','ltr');). Let us now highlight a few points about this body. **The East Central Southern Africa College of Nursing (ECSACON)** ECSACON is a professional agency of the Commonwealth Regional Health Community (CRHC). Its main objective is to promote and reinforce professional excellence through the development of programs. It is expected that this will, in turn, strengthen nursing and midwifery practice, education, research, leadership and management to improve service delivery and uplift the quality of health of the communities in the East Central Southern Africa (ECSA) region. ECSACON is a corporate body of nurses and midwives of member states comprising Botswana, Lesotho, Kenya, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Swaziland, Tanzania, Uganda, Zambia, Zimbabwe and any other states that will accede to membership of CRHC for the ECSA region. The membership of the college consists of individual nurses/midwifes and Professional organizations such as: - NationalNurse/Midwifery Association (NNAS/NMAS)  - National Nursing Councils (NNCS) An individual can become a member once registered by the Nurses Regulatory Body as a nurse/midwife in any of the member states. **Benefits of Membership to ECSACON** The first benefit is knowledge. This knowledge is obtained through the many activities [[ECSACON]](javascript:glossaryWin('ECSACON','East%20Central%20Southern%20Africa%20College%20of%20Nursing','ltr');) conducts, such as quadrennial conferences where nurses from member countries meet and share research finding on topics of national interests in health. They exchange information on various topical issues on nursing, midwifery and health, mapping the way forward for excellence in nursing/midwifery, education and practice. Interacting with nurses from the region is a benefit on its own. Apart from this, ECSACON has conducted many projects, for example, on research, leadership and management, advocacy and so on. Members are also provided with reading materials through the CNR or Nursing Council. **Members also have rights and privileges.** **ECSACON - Membership Rights and Privileges** The membership rights and privileges of ECSACON are: - Voting and speaking at the ECSACON meetings - Nominating candidates for ECSACON elections and Standing Committees - Participating in ECSACON conferences, workshops, seminars and other professional activities as appropriately promoted by ECSACON - Nominating candidates for ECSACON fellowships and awards - Receiving professional guidance and assistance from ECSACON - Receiving from or through ECSACON documents and periodic information about activities and news about nursing worldwide - Having their professional articles of regional and international interest published in ECSACON newsletter/journal/ magazines - Enjoying benefits established by ECSACON  **International Council of Nurses (ICN)** READ The International Council of Nurses is a federation of nurses' associations (NNAS) in 122 countries. It was founded in 1899. ICN was the first health professionals' organizations to be formed and remains the largest among international organizations relating to the provision of health care. It is operated by nurses for nurses. The Secretariat of the ICN is based in Geneva and consists of a president, a chief executive and members. ICN works to ensure quality nursing and sound health policies for all. It strives for the advancement of nursing knowledge and the presence of a worldwide respected nursing profession and a competent, satisfied nursing workforce. The ICN has goals and core values that guide its activities. [[Goals]](file://D:%5CJACOB%5CJEREMY%5CModule%25201%2520General%2520Nursing%5CUnit%25201Professionalism%2520in%2520Nursing%5Cpages%5Cpg20060220031634670.html) The **goals** of ICN are to influence health and nursing globally and strengthen national nurses associations.   [[Values]](file://D:%5CJACOB%5CJEREMY%5CModule%25201%2520General%2520Nursing%5CUnit%25201Professionalism%2520in%2520Nursing%5Cpages%5Cpg20060220031634670.html) The **values** of ICN are to encourage visionary leadership, inclusiveness, flexibility and partnership among all member states and the achievement of excellence in nursing/midwifery education and practice. [[Vision]](file://D:%5CJACOB%5CJEREMY%5CModule%25201%2520General%2520Nursing%5CUnit%25201Professionalism%2520in%2520Nursing%5Cpages%5Cpg20060220031634670.html) The ICN states that its **vision** is to unite all nurses within the ICN to speak with one voice as advocates of all that ICN serves; to acknowledge that a human being has the right to preventive and curative care; to spearhead the health care progress and shape health policy around the world through enhancing nurses\' expertise, strength, their numbers, alignment of their efforts and collaboration with the public and other health professionals. The ICN mission statement is derived from this vision. [[Mission]](file://D:%5CJACOB%5CJEREMY%5CModule%25201%2520General%2520Nursing%5CUnit%25201Professionalism%2520in%2520Nursing%5Cpages%5Cpg20060220031634670.html) The ICN\'s **mission** is to lead societies to better health and to promote healthy lifestyles, workplaces and communities; to support strategies which alleviate poverty, pollution and other causes of illness, while incorporating science and advanced technology in the provision of compassionate and ethical caring; to shape nursing education in accordance with values, policies, standards and conditions that free nurses to practise to the full extent of their education and abilities within multi-disciplinary health teams.  [Philosophy] The ICN **philosophy** entails commitment to caring, advocating on behalf of patients, and helping people help themselves. ICN ensures that the nursing profession is highly valued, appropriately utilized , recognized, rewarded and represented throughout the healthcare system.   You have now gone through the [[ICN]](javascript:glossaryWin('ICN','International%20Council%20of%20Nurses','ltr');) vision, mission and philosophy. You should have identified some crucial themes such as the role of the nurse as: - Provider of nursing care and health services - Policy maker - Collaborator with the public and other\ health professionals Health is a universal right of every human being regardless of the social status. You have to encompass teamwork within multi-disciplinary teams. Finally, you have to keep abreast by incorporating science and technology into the health delivery\       **Kenya progressive Nurses Association \[KPNA\]** **Is a national and global professional voice of Kenyan nurses representing nurses all over the country.** **The Nursing Council of Kenya** NCK is a body corporate mandated with regulation of nursing education and practice in Kenya. One of its regulatory tools is a code of ethics and code of conduct. The membership of the council consists of: ---------------- -------------------------------------------------------------------------------------------------------  Two ex-\ \...the Director of Medical Services and the Chief Nursing officer.  officials\...  One \ \...responsible for education.  person\...  Two\ \...representing religious organisations providing health services in Kenya.  persons\...  Two\ \...representing nursing associations (one from NNAK and one from KEPNA\  persons\...    (Kenya Progressive Nurses Association).  Four\ \...nominated by the outgoing council to represent: General Nursing, Midwifery\  persons\...    and Community Health Nursing.                                                                       Eleven\ \...who may be involved in clinical practice, nursing education and\  elected\    administration. They must be registered nurses as follows: Three registered\  members\...    nurses, three midwives, three community health nurses and two psychiatric\    nurses. ---------------- ------------------------------------------------------------------------------------------------------- standing committees **Functions of the Nursing Council** The functions of the Nursing Council are: - Establishing and improving of all branches of the nursing profession in all their aspects and to safeguard the interest of all nurses - Establishing and improving the standards of professional nursing and of health care within the community - Prescribing and regulating syllabuses of instruction and courses of training for persons seeking registration or enrolment under the Act - Recommending to the Minister institutions to be approved for the training of persons seeking registration or enrolment under the Act - Prescribing and conducting examinations for persons seeking registration or enrolment under the Act. - Prescribing badges, insignia or uniforms to be worn by persons registered, licensed or enrolled under the Act - Regarding the conduct of person registered, licensed or enrolled under the act, and to take such disciplinary measures as may be necessary to maintain a proper standard of conduct among such persons - Regarding the standards for nursing care, qualified staff, facilities, conditions and environment of health institutions - Directing and supervising the compilation and maintenance of registers, rolls and records required to be kept under sections 12, 14 and 16 - Advising the Minister on matters concerning all aspects of nursing **The Full Council** This is composed of the 22 members of the council. The main functions of the full council is to make decisions and to ratify the decisions of the six standing committees. The council meets every three months. **The Standing Committees** The Standing Committees meet every three months except the Registration and Education Standing Committees which meet monthly. They meet to discuss issues under their mandate. You shall now look at the roles of the various committees. *.* **The Education Standing Committee** The committee deals with all issues that relate to nursing education such as: - Designing nursing programs, syllabus and national curriculum according to the health needs of the community - Scrutiny of institutional curriculum to see whether they meet the minimum standards for producing a safe practitioner - Formulating training materials like education policies, guidelines and procedures and log books for recording clinical practice learning - Monitoring students during training for example discontinuations, readmissions and discipline cases. - Dealing with examinations. This includes setting examinations, packaging and dispatch of examinations to training institutions, administration of examinations and receipt of examination scripts in liaison with the training institutions. It also involves the marking of examination scripts, moderation of examination results and presenting the results to various committees and Full Council. The Council ratifies the examination results. Examination results are then released to the individual candidates, training institutions and provincial nursing officers. - Approving training institutions and monitoring the institutions to ensure that standards of nursing education are maintained. Areas being monitored include:\ - Facilities in the school of nursing and clinical area\ - Approved teacher/student ratio of 1:10\ - Adequate clinical area staff\ - Adequate bed occupancy at a minimum of 60%\ - Facilitating continuing education for nurses\ - Guiding nurses and their supervisors on what the nurses must know to be able to offer updated\   quality care to patients and clients **The Standards and Ethics Committee**\  \ This committee deals with: - Initiation and maintenance of standards of nursing education and nursing practice - Coordinates council visits to health institutions for the purposes of monitoring the quality of nursing education or quality of care being offered to patients and clients respectively - Coordinates research sub-committee meetings which facilitate research and surveys related to nursing practice and nursing education   **Registration and Licensing Standing Committee** The Registration and Licensing Standing Committee meets every month. It deals with the registration, enrolment and licensing of nurses for nursing practice. This is applicable to those trained in Kenya and those trained outside Kenya. Kenyan law states that nurses are not allowed to practice nursing prior to registration, enrolment or licensing by the Nursing Council. This Committee also licenses nurses for private practice and processes licensing for practice and retention of nurses in the registers, rolls and records. **Investigations Standing Committee** This committee investigates all cases of professional misconduct, negligence, malpractice and impropriety. This is to establish whether the alleged crime has been committed and whether the nurse has a case to answer or not. A recommendation is then made to the Full Council which in turn institutes disciplinary proceedings. **Finance Standing Committee** This committee deals with all financial issues of the Council in relation to income and expenditure. **Disciplinary Committee** This is a Standing Committee which deals with disciplinary cases recommended by the investigations standing committee. It is independent of the Full Council. Members are drawn from experienced nurses practicing general nursing, midwifery, community health nursing, mental health and psychiatric nursing, the legal advisor and a representative of the Chief Nursing Officer. The registrar is the secretary. **The Nursing Council Secretariat** All activities of the Nursing Council are coordinated by the Secretariat. The Nursing Council Secretariat conducts the day-to-day activities of the Council. The Secretariat is composed of council officers and council staff. The **council officers** who are the registrar, education officers, examination officers, registration officers and standards and ethics officers are currently employees of the Ministry of Health deployed to work at the council. They coordinate various Standing Committees and Subcommittees as discussed earlier. As a practicing nurse you may be familiar with the offences under the 257 Act. The **council staff** includes the accountant, accounts assistant, secretaries, copy typists, records clerk, driver and supportive staff who are employees of the Council.   **Nursing Council Elections** The Nursing Council of Kenya conducts elections of council members every three years. All registered nurses are eligible to vie for representation of various disciplines for example general nurses, midwives, community health nurses and mental health and psychiatric nurses. The nurses may be practising either in clinical practice, nursing education or leadership and management **Legal Aspects of Nursing in Kenya** As a nurse you are liable to the national laws as well as professional ethics related to your practice. You have already studied the functions of the Nursing Council and the\ Disciplinary Committee. **Examples of Offences** **NEGLIGENCE:** You will be charged with this offence if you do not provide the expected care to a patient or client in the field you were trained in. **MISCONDUCT** **Is improper behavior or deliberate violation of standards.** **Its usually intentional** Misconduct includes stealing drugs or hospital property, forgery or fraud, coming on duty while drunk, fighting while on duty or use of abusive language. ** MALPRACTICE** Remember you are a trained nurse. If you provide substandard care to patients, you will be charged of malpractice. In addition, if you also perform procedures that are out of your scope of practice you may be charged with malpractice. ** IMPROPRIIETY** As a nurse the profession binds you to conduct yourself professionally while on duty or off duty. If you fight in a bar or anywhere or conduct yourself unprofessionally you will have discredited or shamed the nursing profession and will, therefore, be liable to be charged with impropriety. **Legal acts Related to Nursing Practice** The following are some of the laws that are relevant to nursing practitioner **The Public Health Act (cap 242)** This Act is commonly referred to as the mother Act among the Acts of Health Professionals. It describes the health delivery services in the country. **Pharmacy and Poisons Act (Cap 244)** You should be familiar with this law because of drug prescription and administration. **Medical Practitioners and Dentists Act Cap (253)** In your community health nursing practice or private nurse practice you will be expected to diagnose and treat minor ailments, this encroaches on this law.   **Narcotic Drugs and Psychotropic Substances (Control) Act 1994** While dealing with the dangerous drugs, you will be required to be familiar with this law. This also applies to dealing with drug misuse and abuse.   **Mental Health Act Cap (248)** You have been exposed to mental health and psychiatric nursing. You will interact with such patients in your practice as a general nurse, midwife and community health nurse.   **Other Laws Related to Nursing Practice** **Medical Laboratory Technicians and Technologists Act (1999)** You will be taking body specimens from patients and clients.\ You should therefore be familiar with this law. **Clinical Medicine Act** This law is related to the medical Practitioners and Dentists Act because of diagnosing and treating minor ailments.   **Food, Drugs and Chemicals Act** You will be dealing with the nutritional status of the patient. In addition, you are one of the food handlers in the hospital. Familiarize yourself with the law.   **Children and Young Persons Act** In your practice you will be interacting with babies, children, adolescents and teenagers. This may be in wards, departments, clinics, maternity, school health and the community. Remember children have rights - Enjoyment of rights and freedoms is recognized and guaranteed irrespective of race, ethnic group, color, sex, language, relation, political or other opinion, national and social origin of the child\'s parents or legal guardians. This includes fortune, birth or status. - Best interests of the child should be the primary consideration. - The right to life is inherent and should be protected by law. Death sentence should not be pronounced for crimes committed by the child. - Right from birth to a name. The child should be registered immediately after birth, and has a right to acquire a nationality. - Freedom of expression. - Freedom of association. - Freedom of thought, conscience and religion. - Protection of privacy. - Right to education. - Right to rest and leisure, to engage in play and recreation and cultural activities appropriate to the age of the child and to participate freely in cultural life and the arts. - A mentally or physically disabled child has the right to special measures of protection in keeping with his physical and moral needs under conditions which ensure his dignity, promote his self-reliance and active participation in the community. - Right to enjoy the best attainable state of physical, mental and spiritual health. - Protection from all forms of economic exploitation and from performing any work that is likely to be hazardous or to interfere with the child\'s physical, mental, spiritual, moral or social development. - Protection from all forms of torture, inhuman or degrading treatment, especially physical or mental injury or abuse, neglect or maltreatment including sexual abuse while in the care of a parent, legal guardian, or school authority or any other person who has the care of the child. **Bill of Rights** In the process of the provision of health care, both the patients and the nurse have a Bill of Rights. You will study them separately. **The Patient\'s Bill of Rights** Earlier in the unit we discussed that health care is a right to every individual in this country. You should always remember that as you provide care to the patient, they have a right to: - Considerate and respectful care. - Obtain complete information concerning their treatment, progress and prognosis of the disease/condition. In certain situations the patients may not be in a reasonable condition to understand or it may be medically inadvisable to give particular information. Therefore, an appropriate person should be given the information on their behalf. - Know by name the person caring for them. - Receive information necessary for them to give informed consent prior to the commencement of any procedure and/or treatment except for emergencies. The information given should include specific procedures and/or treatment, the medical risks involved, probable duration of incapacitation, where alternative significant medical care or treatment exist, or when the patient requests for information concerning medical alternatives, they have the right to such information. The patients also have the right to know the name of the person providing the treatment. - Refuse treatment to the extent permitted by law but must be informed of the medical consequences of their action. - Privacy concerning their care. Those persons not directly involved in the care must get permission from the patient in order to be present. - Confidentiality with regard to all communication and records pertaining to their care. - Expect that a hospital within its capacity can make reasonable response to the patient\'s request for service. The hospital must provide evaluation service and/or referral as determined by the urgency of condition. When medically permissible, patients may be transferred to another health facility only after they have received adequate information and explanation concerning the need for and alternatives to such a transfer. The receiving health institution must first have accepted the transfer for the patients. - Obtain information as to any relationship of their hospital to other healthcare facilities and education institution in so far as their care is concerned. - Obtain information regarding the existence of any professional relationship among individuals by name who are treating them. - Be advised if the hospital proposes to engage in or perform human experimentation affecting their care or treatment. Patients have the right to refuse to participate in such research. - Expect reasonable continuity of care and have the right to know in advance appointment times and doctors' availability. - Question and receive an explanation of their bill regardless of source of payment (Note - some medical practitioners may unnecessarily inflate the bill if the patient is insured). - Know what hospital rules and regulations apply to his/her conduct as a patient. **Nurses Bill of Rights** You as a nurse have many rights. You are entitled to human rights, and the rights of a worker. As a worker you have the right to a safe environment, adequate working tools and supplies, right to risk allowance, right to professional autonomy and the right to opportunities for further education, promotion and career development. **Code of Regulations** As an employee you must acquaint yourself with the code of regulations of the organization you have joined. If you are employed by the government of Kenya, then it is worthy to familiarize yourself with the government code of regulations which contains: - Organization of government and procedures or conduct of government business - The Public Service Commission - Correspondence; Publication and Printing - Terms and conditions of employment - Annual staff appraisal reports - Rules of conduct - Salaries, increments and seniority - Advances, allowances, transport, housing, medical privileges, leave, examinations and courses of training etc. You are now aware that the Nursing Council of Kenya is responsible for the provision of quality care to patients and clients. This is why it is a requirement by the Council that all nurses in the country update their knowledge and skills through continuing education and professional development. You are now able to differentiate between the National Nurses Association of Kenya and the Nursing Council of Kenya **Scope of practice in Kenya** **It's a document that describes the range of interests, capabilities and professional activities of nurses in Kenya.** **The major principle of the scope of practice is that members of the nursing profession will provide only those services for which they are adequately prepared through their academic and clinical training and experience.** **SCOPE OF NURSING PRACTISE FRAMEWORK** 1. **Nursing is autonomous** 2. **Nursing practice responds to client's health needs along the continuum of health** 3. **Nursing practice is based on application of nursing process to patient care** 4. **Nursing interventions include promotive, curative, preventive and rehabilitative care** 5. **Nursing practice embraces knowledge, skills, and attitude to ensure that clients or patients receive quality care** 6. **In providing care, the nurse functions as a multidisciplinary healthcare team to ensure interests and rights of the patients** 7. **Using innovative strategies, the nurse advocates for safe and supportive working environments that facilitate the provision of quality care in various settings** - **Diagnosing, treating, evaluating and managing acute and chronic illness** - **Obtaining medical histories and conducting physical examinations** - **Providing information to include all aspects of sexual and reproductive health** - **Ensuring infection prevention and control while carrying out nursing procedures** - **Providing care to patients in emergency setting** - **Providing prenatal care and family planning** - **Proving well-child care including screening and immunizations** - **Counselling and educating patients on healthy behaviors, self-care skills and treatment options** - **Advocating for patient to obtain optimum health** - **Developing appropriate health messages for clients in different settings** - **Utilizing research findings to improve care** - **Caring for dying patient and care of recently diseased.** You will now look at professional nursing which will start with the disciplines of nursing in Kenya. The disciplines of nursing include: - - - - - - **Basic Programs** **1.cetificate in nursing** In this program, the nurse is prepared at certificate level to provide promotive, preventive, curative, rehabilitative and palliative nursing care to the individual, family and community. she/he functions under the direction of the registered nurse The only certificate nursing program that is currently in place is the Kenya Enrolled Community Health Nursing which is being conducted by the government, mission and private institutions. All these programs are tailored in such a way that there is an integration of general nursing, midwifery, community health nursing, mental health and psychiatric nursing. **2 Basic diplomas in nursing \[KRCHN\]** The nurse is prepared at diploma level in clinical practice, management, clinical teaching, counselling and research. she/he is registered to function at operational and managerial level There are two basic Diploma programs in Kenya: the Kenya Registered Nursing (KRN) and Kenya Registered Community Health Nursing (KRCHN). KRN is being conducted at the Nairobi Hospital and Mater hospital in Nairobi. KRCHN is being conducted by many schools of nursing sponsored by the government, mission and private organizations **3.Post basic diploma**: In this program, a nurse has a post basic diploma in a branch of nursing such as midwifery, accident and emergency, pediatrics, community health, critical care, anesthesia, perioperative and neonatal nursing. **4.Diploma in advanced nursing** This is a nurse who has gone through a higher diploma program in nursing in a recognized university with more in-depth scientific base including nursing management, community health, teaching and research **5.Bachelor's degree in nursing \[BScN**\] The nurse is prepared at a degree level as a clinical practitioner, nurse educator, manager, counselor and researcher.is capable f providing leadership in major fields of nursing. He/she is a registered nurse. having been prepared in a program with more depth scientific base The BScN nurse should be in a position to apply critical thinking in solving patients' problems **6.Master's degree in nursing** Nurse prepared at master's level with specialization in one field of nursing. this is a nurse specialist who can engage, in advanced nurse practice **7.Doctorate or PhD in nursing** This is the highest academic level of preparation of the nurse.it enables him to assume status of academia, research and consultancy. **Emerging issues in nursing** - Increasing stress related to personal and professional responsibility - Expectations of personal freedom of choice have led to ethical issues related to abortion, right to die, and lifestyle preferences - Political and economic influences on health and healthcare competency and performance-based evaluation are more strengthened to safeguard nurses and employers. - Rapid development of knowledge and information.in speciality of education - Home based care and self care is increasing in popilarityis increasing in popularity - Technology - Nursing advocacy and actions - Looming nursing shortage - Rise of hospice care - **1.Factors influencing nursing education globally and locally** **2.Adaptations to innovation in nursing practice** **3.Emerging issues and trends in nursing.** **4.proffessional nurse positive attitudes towards nursing as a profession.** **Community based /public health nursing** Community health nursing, public health nursing and home-based care nursing may be discussed together The idea of community-oriented nursing practice is that nursing intervention can promote wellness, reduce spread of illness and improve the health status of groups of citizens or the community at large Its emphasis is on primary, secondary and tertiary prevention. Nurses in these settings traditionally focused on maternal health and chronic care. Community based nursing occurs in a variety of settings including home settings. These patients usually have identified needs which usually relate to illness, injury or disability. Community based programs and agencies for specific populations e.g., elderly as well as **hospices**, and independent professional nursing practices provide home health care services.Hospice care is the kind of care that focuses on the quality of life for people and caregivers who are experiencing life limiting illness. With shorter hospital stays and increased use of outpatient care services, nurses have a choice of practicing in a variety of healthcare delivery settings. Community nursing centers are **nurse managed** and provide primary care such as immunizations, health assessment and screening services, patient and family education and counselling etc. Various agencies provide care at home and in the community to meet needs of patients who are discharged from acute care institutions to their homes still in their recovery process. Many of these patients are elderly, and many have multiple medical and nursing diagnoses and problems e.g., those that require intensive nursing care, ventilatory support, intravenous nutrition and medication etc. As a result, there are many opportunities for employment in the community and home care settings.it requires high -level assessment skills, critical thinking and decision making because, you will be working in a setting where other medical staff are not there to validate observations and decisions Therefore, for these reasons, the scope of practice not only includes the care of patients within a hospital ,but also the care in the home and community. **Expanded nursing roles** Professional nursing is adapting to meet changing health needs and expectations. the role of the nurse has expanded to improve the distribution of healthcare services and also to decrease the cost of healthcare. Nurses may receive advanced education in different specialties such as family care, oncology, intensive care etc. Where they can get titles such as **nurse practitioner**, clinical **nurs**e specialist or even **advanced practice nurse.** **Nurses who function** in these roles provide direct care to patients through independent practice within a hospital or in collaboration with a physician. Specialization in nursing has evolved in recent years Most states require NP's and CNS to have a graduate level education where they provide direct healthcare to patients and collaborate with other health professionals In developed states, nurse practitioners have prescriptive authority. they also engage in management, education, consultation and research. With advanced practice roles, professional organizations continue to clearly define the scope of practice for nurses. To give them the authority to perform activities that were previously restricted to the practice of medicine. These functions include diagnosis, treatment and performance of certain invasive procedures and also prescription of medication. The board of nursing in each state stipulates regulations regarding these functions. There is increasing evidence that Nurses have also have engaged in organizational structures to collaboratively make clinical decisions.