CORE NURSING VALUES REVISITED

NAR Nursing AssemblySan Antonio

February 2012

Overview

• Context: ICN TB Project

• What are Core Nursing Values?

• Why do we need to revisit them?

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

ICN TB Project coverage

Essential Elements of TFT

AIMS ELEMENTS

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

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

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

Positive Observations

• Care • Commitment• Innovation• Skills• Leadership• Management • Tenacity• Autonomy

(hidden)• Success

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)

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

What makes you feel good?

Poor care

Poor outcomes

Low morale

High morale

Good outcomes

Good care

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)

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

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

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

Finfgeld-Connett, 2008Expert Nursing

Practice- Clinical

competence- Assessment skills

- Empowerment

Intimate relationships

- Deep involvement

- Sharing thoughts and

feelings

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

Expert Nursing Practice• Clinical competence• Assessment skills• Empowerment

Intimate relation-

shipsInterpersonal

sensitivity

Current picture

• Patient-centredness

• Acceptance• openness • availability

• Deep involvement

• Sharing thoughts and feelings

Which nurse is more skilled?

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

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

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?

Why revisitCore 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

What helps or hinders you being the nurse you

want to be?

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?

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