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Jackson Jackson ChakayaChakaya MscMsc; ; BscBsc((HonsHons); CCN; KRCHN; FRCN); CCN; KRCHN; FRCN

Senior Lecturer Senior Lecturer

The Nairobi Hospital The Nairobi Hospital ––School of NursingSchool of Nursing

From Evidence to Action: The future of

Nursing Practice in Kenya

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“All people everywhere will have access to “All people everywhere will have access to skilled, motivated, and supported health skilled, motivated, and supported health worker, within a robust health system”worker, within a robust health system”

Global Health workforce Alliance Global Health workforce Alliance

www.icn.chwww.icn.ch

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Disclaimer

Systematic review done between

2013 - 2014

From Evidence to Action: The future From Evidence to Action: The future

of Nursing Practice in Kenyaof Nursing Practice in Kenya

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Presentation OutlinePresentation Outline

Background of nursing practice Background of nursing practice

oFrom Nightingale to Watson to Wanjiku: the

transformation of nursing practice

Current trends in practiceCurrent trends in practice

The Future nursing practice. The Future nursing practice.

oo From Evidence to Action in nursing practice! From Evidence to Action in nursing practice! 4

Nursing practice has evolution into a profession Nursing practice has evolution into a profession

overtime. As early as 1732 Local governments in overtime. As early as 1732 Local governments in

colonel America established Almshouses to care colonel America established Almshouses to care

for sick individuals. for sick individuals.

Florence Nightingale (1873) is considered the Florence Nightingale (1873) is considered the

founder of modern Nursing & 1founder of modern Nursing & 1stst nursing Theorist.nursing Theorist.

Background of nursing practice Background of nursing practice

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Nightingale to Watson Nightingale to Watson et al… et al…

From the „lady with the lamp‟ to nurse From the „lady with the lamp‟ to nurse

practitioner whose practice is anchored on practitioner whose practice is anchored on

theories and evidence. theories and evidence.

Several theorists including NightingaleSeveral theorists including Nightingale and and

others have shaped nursing practice. others have shaped nursing practice.

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Nursing in Kenya…Nursing in Kenya…

In Kenya In Kenya ….the „dresser (later ….the „dresser (later Assistant Enrolled

Nurses Grade I and II) to EN then ECN later RN, to EN then ECN later RN,

KRCHN and KRCHN and BsNBsN. Currently . Currently MsNMsN and PhDsand PhDs

Before 1950…Nursing education was without a

formal framework

o In 1952, first examination for Assistant Enrolled

Nurses Grade I and II. http://en.wikipedia.org/wiki/Nursing_in_Kenya7

‘‘Wanjiku’sWanjiku’s’ nursing practice’ nursing practice

King George Hospital (Now KNH) became the first King George Hospital (Now KNH) became the first

hospital to commence Kenya Registered Nurse training hospital to commence Kenya Registered Nurse training

In 987 Kenya Registered Community Health Nurse In 987 Kenya Registered Community Health Nurse

(KRCHN) training was establishment. (KRCHN) training was establishment.

However, our However, our WanjikuWanjiku nurse utilized little evidence nurse utilized little evidence

instead practice was experiential instead practice was experiential “Usually we did it…”“Usually we did it…”

http://en.wikipedia.org/wiki/Nursing_in_Kenya

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The continuum of nursing The continuum of nursing The transformation of nursing The transformation of nursing

practice practice

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Current trends in nursing practice Current trends in nursing practice

1. Where Art Thou, Nurse?

◦ Nurse shortage possess challenge

to nursing practice.

◦ Currently Kenya‟s doctor: nurse is

has 1:8

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2.2. The Patient Safety ImperativeThe Patient Safety Imperative

Several recent studies have turned the Several recent studies have turned the

spotlight on nursing as a safety net.spotlight on nursing as a safety net.

1n 2013 Kenya estimated 1% to 2% of 1n 2013 Kenya estimated 1% to 2% of

hospital inpatientshospital inpatients of medical errors of medical errors

Trends…Trends…

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Trends…Trends…

3.3. Healthcare cost and Shorter Lengths of Healthcare cost and Shorter Lengths of

Hospital StayHospital Stay

Effective nursing care and hospital stay and Effective nursing care and hospital stay and

quality of life outcomes quality of life outcomes

4.4. Healthcare Consumerism and "EHealthcare Consumerism and "E--Health”Health”

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Trends…Trends…

5.5. Technological Wonders and WoesTechnological Wonders and Woes

6.6. WebWeb--Based Nursing DegreesBased Nursing Degrees

7.7. Disparities in Healthcare and nursing practiceDisparities in Healthcare and nursing practice

8.8. Living With Chronic DiseaseLiving With Chronic Disease

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9.9. Return of Resistant Strains, Communicable Return of Resistant Strains, Communicable

and NCD and NCD

◦◦ It started with AIDS after 1980s then cancers, then It started with AIDS after 1980s then cancers, then

SARS, now MDR burgs(MDR Pseudo & TB). SARS, now MDR burgs(MDR Pseudo & TB).

◦◦ Now Hypertension, Diabetes, cardiac Now Hypertension, Diabetes, cardiac

conditions….And now Ebolaconditions….And now Ebola

Trends…Trends…

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The challenges The challenges

Training and research Training and research –– Mushrooming of new Mushrooming of new

nurse training schools Vs Quality educationnurse training schools Vs Quality education

Research in practice. Research in practice. Where are nurse researchers?Where are nurse researchers?

Quality systems Quality systems –– are our systems working?are our systems working?

Technology and the nurse practitioner Technology and the nurse practitioner

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Nursing practice in devolved Nursing practice in devolved

healthcare systemshealthcare systems

Chapter Eleven(11): Fourth schedule Part 2 (ii)

Challenges

◦ Transition from national to County Govt‟s

◦ Implementation of the healthcare function

◦ Staff demonization – resulting from

administrative authority 16

Opportunity despite the challenges…Opportunity despite the challenges…

An Opportunity for Nurses

Information technology advances in nursing Information technology advances in nursing

practice practice

EAC Nurses Vs Quality practice Nurses Vs Quality practice

Community Nursing experts…NCK have Nursing experts…NCK have

commenced a register)commenced a register)

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So what can be done?So what can be done?

….to improve nursing ….to improve nursing

practicepractice

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Nursing practice Pillars Nursing practice Pillars

1. Clinical Practice

◦ Policy and protocol of practice

◦ Quality nursing practice & Healthcare

2. Administration

3. Research & research utilization

4. Education & Lifelong learning

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NHS Education for Scotland 19

Nurse engagement at levels Nurse engagement at levels

NHS Education for Scotland 20

The future… “ the

dream”

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The Future: Evidence to action The Future: Evidence to action

Model: Model: Leading Change, Advancing Leading Change, Advancing

HealthHealth

IOM Robert Wood Johnson Foundation

Report (2010)

MakesMakes Eight (8) recommendations: Eight (8) recommendations:

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Leading Change, Advancing Health Model Leading Change, Advancing Health Model

Recommendations:Recommendations:

1.1. Remove scopeRemove scope--ofof--practice barriers practice barriers

2.2. Expand opportunities for nurses to lead and Expand opportunities for nurses to lead and

diffuse collaborative improvement effortdiffuse collaborative improvement effort

3.3. Implement nurse residency programsImplement nurse residency programs

4.4. Increase the proportions of nurses with a Increase the proportions of nurses with a BsNBsN

degrees to 80 percent by 2020degrees to 80 percent by 2020

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5.5. Double the number of nurses with PhDs by 2020. Double the number of nurses with PhDs by 2020.

6.6. Ensure that nurses engage in life long learningEnsure that nurses engage in life long learning

7.7. Prepare and enable nurses to lead change to Prepare and enable nurses to lead change to

advance healthadvance health

8.8. Build an infrastructure for the collection and Build an infrastructure for the collection and

analysis of analysis of interprofessionalinterprofessional healthcare workforce healthcare workforce

data.data.

Leading Change, Advancing Health Model Leading Change, Advancing Health Model

Recommendations:Recommendations:

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Recom.1: Remove scopeRecom.1: Remove scope--ofof--practice barriers practice barriers

Advanced practice registered nurses should be Advanced practice registered nurses should be

able to practice to the full extent of their able to practice to the full extent of their

education and trainingeducation and training

In Kenya, it may be necessary to negotiate for In Kenya, it may be necessary to negotiate for

more scope more scope

(Pillar 1)(Pillar 1)25

Recom.2: Expand opportunities for nurses to lead and Recom.2: Expand opportunities for nurses to lead and

diffuse collaborative improvement effortdiffuse collaborative improvement effort

…. and nursing associations should expand …. and nursing associations should expand

opportunities for nurses to lead and manage opportunities for nurses to lead and manage

collaborative efforts with other health care teamcollaborative efforts with other health care team

Pillar 2Pillar 226

Recom.2: Expand opportunities for nurses to lead…Recom.2: Expand opportunities for nurses to lead…

In Kenya…nurses to conduct research and to In Kenya…nurses to conduct research and to

redesign and improve practice environments and redesign and improve practice environments and

health systemshealth systems

Nurses at administrative level should participate Nurses at administrative level should participate

in policy and protocol development in policy and protocol development (Pillar 2)(Pillar 2)27

Recom.2: Expand opportunities for nurses to Recom.2: Expand opportunities for nurses to

lead… within lead… within devolved healthcare systemsdevolved healthcare systems

In Kenya…Adopt a functioning systemIn Kenya…Adopt a functioning system

◦◦ NHS NHS ––UkUk, Australian system , Australian system

◦◦ US federal Health Care US federal Health Care

(National and County Policy level (National and County Policy level

(Pillar 2)(Pillar 2)28

Recom.3: Implement nurse residency programsRecom.3: Implement nurse residency programs

◦◦ …states boards and health care organizations …states boards and health care organizations

should take actions to support nurses‟ should take actions to support nurses‟

completion of a transitioncompletion of a transition--toto--practice programpractice program

◦◦ Kenya: Establish mechanism to ensure postKenya: Establish mechanism to ensure post--

education transition. education transition.

Thanks Thanks AMREFAMREF and and othersothers for starting onfor starting on--job job

continuous learning continuous learning

Pillar 4Pillar 4 29

Recom.4: Increase the proportions of Recom.4: Increase the proportions of

nurses with a nurses with a BsNBsN degrees to 80 percent degrees to 80 percent

by 2020by 2020

Kenya should aim to double number by 2030Kenya should aim to double number by 2030

Have degree residency and nonHave degree residency and non--residential residential

courses courses

Online degrees Vs Quality nurse education Online degrees Vs Quality nurse education

Pillar 4Pillar 430

Recom.5: Double the number of nurses Recom.5: Double the number of nurses with doctorate by 2020. with doctorate by 2020.

◦ Kenya has currently 2 PhD proudly registered by the NCK. Others on the PhD but in different fields mostly public health etc

Redefine Kenya Registered Advanced Nurse Redefine Kenya Registered Advanced Nurse

Practitioners (KRANP) for Masters and PhD levels. Practitioners (KRANP) for Masters and PhD levels.

Consider Nurse Practice consultantsConsider Nurse Practice consultants

◦◦ Pillar 4Pillar 431

Recom.6: Ensure that nurses engage in Recom.6: Ensure that nurses engage in life long learninglife long learning

Transforming nursing practice thro Transforming nursing practice thro trainingtraining

Transform KRCHN to Kenya Registered Transform KRCHN to Kenya Registered

Nurse Practitioner(KRNP) for first level Nurse Practitioner(KRNP) for first level

nurses… nurses…

CPD & evidenceCPD & evidence--based practicebased practice

Pillar 4Pillar 432

Recom.6: ….nurses engage in life Recom.6: ….nurses engage in life long learninglong learning

??Introduce Kenya Registered Specialist Nurse

(e.g KRCCS) for specialist courses like CCN,

PreopN

Consider sponsorship and scholarship for nurses

Mentorship and preceptors: clinical and research

Pillar 433

Lifelong learning: Lifelong learning:

Benner. P. (1984) model Benner. P. (1984) model

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Recom.7: Prepare and enable nurses to lead Recom.7: Prepare and enable nurses to lead

change to advance healthchange to advance health

…. nursing workforce to assume leadership positions across

all levels, public, private, and governmental……

◦◦ Policy review of systems & Protocol development Policy review of systems & Protocol development

◦◦ Nurses should take up strategic roles at counties (CECs; Nurses should take up strategic roles at counties (CECs;

COOs, CHE)COOs, CHE)

◦◦ Medical Directorate run by a nurse?? Medical Directorate run by a nurse??

Pillar 2Pillar 235

Recom.8: Build an infrastructure for the Recom.8: Build an infrastructure for the

collection and analysis of collection and analysis of interprofessionalinterprofessional

health care workforce data. health care workforce data.

In Kenya…need to engage in research and In Kenya…need to engage in research and

evidenceevidence--based practicebased practice

Use evidence to inform practiceUse evidence to inform practice

Establish CQI departments across institutionsEstablish CQI departments across institutions

(Pillar 1 &(Pillar 1 & 3)36

Research into practice Research into practice –– Research Research utilizationutilization

Evidence is key to quality nursing serviceo Systematic reviews o Critical appraisals o Scientific researcho Audits o Case studies

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5.5. Communication in Healthcare practice Communication in Healthcare practice

What has been the challenge in nursing practice?

Consider KEMRI-Wellcome Trust training model

in nurse curricula.

Pillar 5Pillar 5

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Techno-gurus or techno-robots ?!

◦ From Hi-tech equipment for

monitoring, diagnostic, and even

management. … from techno-beds to

‘techno-knowledge, Internet Smart

phones, ipads, tablets etc impact practice

Technology Utilization Technology Utilization

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…Technology & Nursing …Technology & Nursing

NNursing informatics professionals ursing informatics professionals : :

what‟s the effects on patient carewhat‟s the effects on patient care

◦◦ Paperless technology documentation Paperless technology documentation ––

will we be left behind?will we be left behind?

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Conclusion…Conclusion…

From a ‘dresser’ to advanced nurse practitioner in

Kenya; Paradigm Shift focusing on four areas: Paradigm Shift focusing on four areas:

1. NCK should ‘transform’ nursing cadres.

2. Change in nurse training into specialist nurses

3. Change in communication practice

4. The technology-savvy nurse in practice

ReferencesReferences Benner, P (1984) Model of Skills Acquisition

http://currentnursing.com/nursing_theory/Patricia_Benner_From_Novice_to_Expert.html

IOM (2010) The Future of Nursing: Leading Change, Advancing Health http://www.thefutureofnursing.org/IOM-

Report

MOH (2012) Kenya Workforce Report :The status of Nursing in Kenya

Lohr KN (ed.) Medicare: A Strategy for Quality Assurance. Vols I and II. Washington, DC: National Academy

Press, 1990.

National Leadership and Innovation Agency (2010) Framework for Advanced Nursing, Midwifery and Allied

Health Professional Practice in

Wales.http://www.wales.nhs.uk/sitesplus/documents/829/NLIAH%20Advanced%20Practice%20Framework.pdf

National Quality measures Clearinghouse (2014). Mediacation errors in hospitals – Challenges and

recommendations for their measurement available at http://www.qualitymeasures.ahrq.gov/expert/expert-

commentary.aspx?id=47856

NHS education for Scotland available at http://www.careerframework.nes.scot.nhs.uk/using-the-

framework/pillars-of-practice.aspx

Penn Nursing Science available at http://www.nursing.upenn.edu/nhhc/Pages/Welcome.aspx

Robert Johnson Foundation & George Washington University (2014) Charting nurses future available at

http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf411417

Scottish Government Health Departments (2008) Supporting the Development of Advanced Nursing Practice -

A Toolkit Approach

http://www.aanpe.org/LinkClick.aspx?fileticket=giFsLijsCRw%3D&tabid=1051&mid=2508&language=en-US

Sugrue, Mark D. (2013)Transforming nursing through technology available at

http://www.nursingcenter.com/lnc/pdfjournal?AID=1236309&an=00002727-201110000-

00013&Journal_ID=&Issue_ID= 45

Acknowledgement Acknowledgement

Colleagues at the Cecily Colleagues at the Cecily McDonellMcDonell School of Nursing School of Nursing ––TNHTNH

KEMRIKEMRI--WellcomeWellcome Trust Trust –– KilifiKilifi

Sue Hooton OBE Sue Hooton OBE –– Quality Director 5Bur... NHS Quality Director 5Bur... NHS –– UK UK (mentor)(mentor)

AneAne HaalandHaaland MsCMsC –– University of Oslo Norway University of Oslo Norway (mentor)(mentor)

My Mentees and students: Cecily My Mentees and students: Cecily McDonellMcDonell; KEMRI; KEMRI--WT ; WT ; Gertrude‟s CH for making me who I am!Gertrude‟s CH for making me who I am!

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Thank You!!Thank You!!

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Questions Questions

& &

Discussions Discussions

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NHS NHS –– UK structure UK structure

National Directors

Policy Directorate

Patients and Information

Operations Directorate

Nursing Directorate

Medical Directorate

HR Directorate

Finance Directorate

Commissioning Development50

Benner, P. 1984 model Benner, P. 1984 model

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