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Quality Nursing Care: The Ideals, Challenges And Implications By Justine A - Articles - Nurses Arena Forum

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Quality Nursing Care: The Ideals, Challenges And Implications By Justine A by walex : November 13, 2017, 03:17:37 PM
A Lecture delivered at the induction ceremony of Department of Nursing, College of HeaIth Sciences, Nnamdi Azikiwe University, Awka
 
INTRODUCTION:
Nursing is a profession guided by a unique combination of knowledge, attitude and skills that enable the professional nurse to caringly assist individuals, families, and communities to attain, recover, or maintain health; and where death is inevitable, to have a peaceful transition from present form of existence to another. Nurses, according to the International Council of Nurses (ICN) Code of Ethics as reviewed in 2005, have four fundamental responsibilities: to promote health, to prevent illness, to restore health and to alleviate suffering.
 
Inherent in nursing is respect for human rights, including cultural rights, the right to life and choice, to dignity and to be treated with respect. Nursing care is respectful of and unrestricted by considerations of age, color, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status. A professional nurse is one who has undergone a recognized prescribed course of study and has been duly licensed by the regulatory agency in the country of training and practice as competent to provide nursing services to people who require such.
 
Nurses constitute the largest proportion of workers in the health system (Olanipekun, 2009); hence, nursing department in any facility is usually the largest, and constitutes itsbackbone. Nurses are the closest to, and are with, the patients for longer period of time, than any other health professional. Life is irreplaceable! Entrusting such a valuable treasure (life) to nurses, shows the high level of trust reposed by the public in the professionals; hence, the only right thing expected is provision of quality care that guarantees the preservation of life.
 
The mass media e.g. newspapers, radio station etc do not project us very well to the general public. The doctors, pharmacists even environmental health workers are being projected better to the taste of the Concept of Quality Nursing Care: Quality Nursing Care refers to the best practice of nursing enjoyed by individuals, families and communities, who are the consumers of nursing services. The standard• of nursing practice in Nigeria derives from standards set by the International Council of Nurses (ICN) and the International Confederation of Midwives (ICM); the constitution of the Federal Republic ofNigeria; National Policy on Health and other related policies; the agenda of the government; the philosophy of Nigerian nurses; etc. The Nursing and Midwifery Council of Nigeria (NMCN) regulates education and practice of nurses and midwives in the country and also sets standard of practice.

Some ideals of quality nursing care:
i. Evidence-based method: Through continuing, professional development activities (NMCN organized mandatory continuing professional development programme aimed at ensuring that nurses have what it takes to provide best of care to the patients.
ii. Accessible: Best practices in nursing should be included in the priority agenda of good organizations. It is the responsibility of nurses to advocate for equity and social justice in resource allocation and access to best health care (Rochefort and Clarke, 2010).
iii. Acceptable: The nurse provides accurate and timely information on care to enable the consumer to make spiritually / culturally acceptable and intelligent decision about care. The rights of the patients should be respected and the care should be non-discriminatory and professional ( ICN, 2012).
iv. Effective & Efficient: The objectives of nursing interventions are not only achieved, but achieved within shortest possible time, and sustained at minimal cost.
v. At No (or Minimal Unavoidable) Risk to Patient and to others: No harm is intentionally caused to the Patient and others (other nurses and staff, relatives, etc). Standard precautionary measures are universally observed, while specific precautions are adequately taken where necessary.
vi. No Threat to Relational Coordination: The patient is the focus of care. Relationship between nurses and significant others remains cordial in the interest of the patient / client. Intra / inter professional wrangling is not allowed to jeopardize care.
vii. Patient / Client Reports Satisfaction: Patient satisfaction is fundamental (Otani, et.al, 2010). Patients should express satisfaction with the intelligence, attitude and technical ability of the professional nurse. She should be able to describe the nurse as respectful, responsive, compassionate, trustworthy and honest (ICN,2012).

Challenges facing Quality Nursing Care in Nigeria
Some studies conducted in Nigeria showed that majority of consumers' perceived nursing care as satisfactory, and the nurses as friendly. As time and situations change so has nursing, thereby bringing about challenges facing the practice of nursing even in Nigeria.
- Lack of interest in Research: The nursing professional is at providing quality nursing care by providing scientific base for the practice of nursing. Unfortunately, only very few nurses are interested in research, even though it is the responsibility of all nurses to do research to improve nursing care.
 
- Work Environments: Some work environments are un-conducive and non- supportive for nursing practice, as they lack sufficient facilities and equipment to work on. The nurse herself or himself: The greatest challenge to nursing practice in Nigeria is the nurse herself or himself. Nurse in contemporary Nigeria are less caring, committed and dedicated to meeting the needs of clients. Most nurses are resistant to change, professional development and advancement.
 
- Poor funding of health care: Overall spending in Sub Sahara Africa is low compared to other regions. Most spending is out ofpocket spending by households paid directly at the time of service.
 
- Advancement in Science and Technology: The advancement in science and technology will continue to affect the nursing profession. In the past nursing relied on their experiences, observation and intuition but today, nursing has a
defined body of knowledge specific to the profession and continues to develop this knowledge through research and practice as they relate to new drugs, methods of delivery, disease control and prevention through sterilization and disinfections of equipment.
 
- Non implementation of Nursing Process: In addition, some nurses have attached a lot of constraints such as shortage of staff and lack of stationary as reasons hindering the implementation of the nursing process which is a tool for improve nursing care. The changing roles of the nurse require continued competence.
 
- Non Participation in making Policy: Policy making on health issues is a major challenge to nursing practice. Nurses have traditionally been subordinate to physicians and these have affected their leadership roles in policy making on health issues. Poor representation and participation of nurses in decision making on health matters will not move nursing forward. Inter/intra professional rivalry: This is a major contributing factor hindering the 'successes' of the career. Doctors see patients alone on wards/clinics, and do patients' vital signs themselves while in clinics disregarding the role of the nurses as health team members.

- Quackery: The incursion of quackery in nursing has been a big threat to nursing practice in Nigeria. Everybody on white answers a nurse. This canker worm has eaten up the integrity and image of nursing. Poor Media Projection of Nursing: The mass media e.g. newspapers, radio station etc do not project us very well to tie general public. The doctors, pharmacists even environmental health workers are being projected better to the taste of the people.
 
- Politics: This has eroded the general system including nursing practice e.g. citing of schools, hospitals, health centers and nurse's wages. Remuneration for nurses has been politicized even today.
 
- Lack of Equipment: Unavailability, lack of proper planning and budgeting due to noninvolvement of nurses and many nurse leaders in management's budgetary meetings.
 
- Lack of Continuous Training and Re-orientation: Non-attendance of clinical care workshops by nurses and non-organization of seminar /workshop on clinical nursing issues are all inherent problems in many Nigerian hospitals.
 
- Lack of commitment on the part of nurses: Many nurses just practice for practicing sake; they do not see the intricacies of nursing as a care from nurse professionals rather they are committed to other issues of life than nursing are practice.
 
- Nurses' idea about improvisation: In order to have the favour of management, most nurses are committed to improvisation to a faulty level, instead of asking for the right equipment and materials for nursing care services.
 
- Rural urban migration of nurses: Nurses' idea about rural care and delegation of this care to untrained pepson is a major problem that is causing declining nursing services in Nigeria. Leadership Problem Leading To Poor Management: Most nurse leaders lack experience and they retire away quickly as soon as they enter into nursing administrative arena because of age on entry and number of years in services.
 
- The Educational Goal of the Nurse: Nurses satisfaction with basic qualification and practice for financial reward in the 21St century is another major cause of declining care because it always amount to great competency in terms of advancement in education vise-visa in clinical nursing practice. Poor information system: Poor information system is another cause of declining nursing services, proper planning and budgeting plus monitoring are essential information that have delayed the progress of nursing services in Nigeria.
 
Solutions to the problems of Quality Nursing Care in Nigeria

The solutions to these challenges lie in nurses' hands and in those of policy makers. It is heartwarming to note that the Nursing and Midwifery Council of Nigeria (NMCN) is unrelenting in her efforts to set and enforce standards that ensure Nigerians enjoy safe nursing care. There is periodic review of the curriculum to meet contemporary health demands of the populace. Education and advocacy for the support of the media towards promoting the image ofnurses should continue.
➢ Aggrieved members of the public should be encouraged to freely seek redress while, disciplinary actions against erring nurses should be made public.
➢ Nurses should collaborate on research activities and be able to access funds for research activities towards evidence-based innovations in the profession.
> Advocacy for improved work environment and welfare of nurses should be based on evidence.
> Reducing nurse burnout is an effective strategy for improving quality of care in hospitals (Duffield et.al, 2011).
> Deployment of nurses should be according to specialty area, while rotational headship for nursing should be encouraged in the hospitals.
> Nurses must be adequately represented in the management of hospitals and all the nurses should be engaged in policies to enhance their awareness of the care environment and patient care delivery.
> Nurses should be given more responsibility for the clinical decision making in their patient's care.
> Inter-professional cordiality between nurses and other professionals is fundamental to improving the quality of patient care; hence, genuine and positive relationships must be promoted first among nurses and between department of nursing and others in the hospital.
> Mentorship in nursing should as well be encouraged. Continuous training and development that leads to good leadership and better skills in nursing care services should be encouraged; and this will in turn promote the image of the nurse in the society.
> Nurses leaving professional care to student nurses or pupil midwives: Nurses must practice to show the learners how to do it, nursing professional training is hospital based.
> All cadres of nurses must be committed to this apart from clinical instructors. 
> As nurse leaders we must not confine ourselves to nursing alone we must read wide, socialize well and work as assertive individuals to promote our image and the image of nursing profession in Nigeria.
> Nursing informatics are essential for application of computer into nursing care, lack of knowledge in this area can cause declining care as nurses will fail to utilize computer technology to the advantages of clinical nursing care recipients.

Conclusion
Nigeria is a religious country and almost every nurse is an adherent of a religion; hence the disappointment of some members of the public at the attitude of some nurses. The spiritual part of everyone is often invoked to make people do the right and be fair one to another. It is said that nursing is not just an ART, it has a heART, Nursing is not just a SCIENCE it has a conSCIENCE (Akin-Oke, 2014). While attending to the job-related stressors, nurses should continue to appeal to one another to uphold the ethics of the profession in the fear of God; knowing that the nurse might be the patient someday.
 
References
Akin-Otiko BO (2014). Facilitation Of Behaviour Change Communication Process For Maternal, Newborn, And Child Health At Primary Health Care Level Of Midwifery Practice In Kaduna State. : A Thesis Submitted To The School OfNursing, Faculty OfHealth Sciences, University ICN (2012). International Council of Nurses (2012). The ICN Code of Ethics for Nurses revised 2012. Geneva: ICN.
Olanipekun OA (2009). Expanding the scope of nursing practice in Nigeria - A veritable way forward towards achieving Millennium Development Goals (MDGs). First Annual National Scientific Conference of Association of General Private Nursing Practitioners Held on Thursday, 15th October, 2009; Premier Hotel, Mokola, Ibadan. Otani K, Waterman B, Faulkner KM, Boslaugh S, Dunagan WC (2010). How patient reactions to hospital care
attributes affect the evaluation of overall quality of care, willingness to recommend, and willingness to return.
Journal of Healthcare Management55(1):25-37
Rochefort CM, Clarke SP (. 2010). Nurses' work environments, care rationing, job outcomes, and quality of care on neonatal units. Journal ofAdvanced Nursing66(10):2213-24.

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