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CORE NURSING VALUES REVISITED

CORE NURSING VALUES REVISITED. NAR Nursing Assembly San 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

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CORE NURSING VALUES REVISITED

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  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 alliedhealthworkers have so far received training fromthesetrainers

  4. ICN TB Project coverage

  5. Essential Elements of TFT

  6. Challenges Observed • Care startswhen pt registered • Overcrowded ‘mixed’ wards • Program focus not patient focus • No system to identify non-attenders • Slow response to non-attenders • Ill-equippedRx supporters • Lack of medical backup • Distance fromhospital to family • Lack of flexibility of clinic times etc

  7. Feedback from nurses • Lack of recognition • Overwhelmingworkloads • Frustration withdefaulters • 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. 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) Impact

  10. 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 Value of Nurse led training

  11. What makes you feel good?

  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)

  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

  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. Current picture • Expert Nursing Practice • Clinical competence • Assessment skills • Empowerment • Interpersonal sensitivity • Intimate relation-ships 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 revisitCore Nursing Values?

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

  25. Tipping the balance…. • How do wemake sure patients are in the best state for nature to cure them? • How do wemake 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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