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CORE NURSING VALUES REVISITED NAR Nursing Assembly San Antonio February 2012.

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Presentation on theme: "CORE NURSING VALUES REVISITED NAR Nursing Assembly San Antonio February 2012."— Presentation transcript:

1 CORE NURSING VALUES REVISITED NAR Nursing Assembly San Antonio February 2012

2 Overview Context: ICN TB Project What are Core Nursing Values? Why do we need to revisit them?

3 ICN TB/MDR-TB Project Training for transformation (TFT) in collaboration with National Nurses Associations –In 16 countries with high TB/MDR-TB burden –1300 nurses trained as trainers –56000 nurses and allied health workers have so far received training from these trainers

4 ICN TB Project coverage

5 Essential Elements of TFT AIMSELEMENTS To inspire and motivate using innovative teaching methods Peer education Tailored to context and learning needs Active learning To promote change in practice as well as in the care environment People-centredness Best Practice approach Empowerment To develop essential skills for broadening the scope of practice Critical thinking Teamwork Leadership

6 Challenges Observed Care starts when pt registered Overcrowded ‘mixed’ wards Program focus not patient focus No system to identify non-attenders Slow response to non-attenders Ill-equipped Rx supporters Lack of medical backup Distance from hospital to family Lack of flexibility of clinic times etc

7 Feedback from nurses Lack of recognition Overwhelming workloads Frustration with defaulters Lack of time Fear/stigma Lack of space Lack of masks – stigmatizing solutions Patients dying for lack of drugs

8 Positive Observations Care Commitment Innovation Skills Leadership Management Tenacity Autonomy (hidden) Success

9 Impact Changing attitudes Better patient outcomes Improved HCW safety “She taught us to take more time at the beginning with patients – now we have less default” Kenya evaluation (2010)

10 Value of Nurse led training Colombia 2011 “Reawakens the participant’s identity as a nurse”. Local trainer Ethiopia 2010 “Unlike any other training received as it takes account of our nursing practice”. Participants Lesotho 2009 “This course has reminded me that patients are human beings and not to focus only on the medication”. Participant

11 What makes you feel good? Poor care Poor outcomes Low morale High morale Good outcomes Good care

12 Core Nursing Values –College of Nursing, South Dakota State University (1) –National League for Nursing (2) –MUSC College of Nursing (3) –Piedmont medical Center (4) Human dignity (1) Integrity (1, 2) Autonomy (1) Altruism (1) Social justice(1) Caring (2, 3) Integrity (2, 3) Diversity (2, 3) Excellence (2) Scholarship (3) Lifelong learning (3) Service (3) Creativity (3) Empowerment (3) Collaboration (3) Advocacy (3) Equity (3) Leadership (3, 4)

13 Core nursing values Piedmont Medical Center (4) –reciprocal, respectful relationships –professional image –dedication, selflessness, professional and personal growth, knowledge and empathy. –nurturing –accountability –education and research –strong nurse to patient relationship –patient advocate

14 Core Nursing values Florence Nightingale: “[Nurses] need to put the patient in the best state for nature to cure them” ENABLING ENVIRONMENTS –To access care –To make positive health choices

15 What do patients and carers value? Griffiths et al (2011) –Empathy –Social skills Active listening Good communication –Patience –Confidence and competence –Honesty –Preparedness to learn from patient –Non-judgemental attitude

16 Finfgeld-Connett, 2008 Expert Nursing Practice - Clinical competence - Assessment skills - Empowerment Intimate relationships - Deep involvement - Sharing thoughts and feelings Interpersonal sensitivity - Patient at centre - Acceptance, openness and availability

17 Medicalization of care Glamour in medicine/hi-tech Priority given to diagnosis and cure Career options as nurses Compassion and empathy seen as luxury Hierarchy of evidence: –research re care is largely qualitative –research re cure is largely quantitative

18 Expert Nursing Practice Clinical competence Assessment skills Empowerment Intimate relation- ships Interpersonal sensitivity Current picture Patient- centredness Acceptance openness availability Deep involvement Sharing thoughts and feelings

19 Which nurse is more skilled?

20 Why does this matter? Taking on menial biomedical tasks and passing on menial care tasks has created a harmful hierarchy in which care is devalued Optimum care does not take more time than dealing with impact of lack of care (default, MDR) Care embracing all core values (holistic nursing care) seen as a luxury available IF time and resources allow

21 Core values and nursing care Holistic nursing care is complex and multi- faceted Simple tasks often require embodied high- level skills Requires academic training Relies on research

22 Who is best placed to: Define what nurses do? Decide what resources nurse need to deliver good quality care? Monitor what nurses do? Assess the challenges they face? Solve nursing issues? Recommend level of investment?

23 Why revisit Core Nursing Values? If we cannot articulate our values clearly we cannot defend them If we cannot defend them, others will define them for us If we let others define them patients will suffer We have a duty as patient advocates

24 What helps or hinders you being the nurse you want to be?

25 Tipping the balance…. How do we make sure patients are in the best state for nature to cure them? How do we make sure nurses are in the best state to care?

26 Best Practice Guide for Care of Patients with TB Developed with nurses from at least 20 different countries Defines best practice from real examples Published in 2007 – now due for review

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