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- 1. @@ JacksonJackson ChakayaChakaya MscMsc;; BscBsc((HonsHons); CCN; KRCHN; FRCN); CCN; KRCHN; FRCN Senior LecturerSenior Lecturer The Nairobi HospitalThe Nairobi Hospital ¨C¨CSchool of NursingSchool of Nursing From Evidence to Action:The future of Nursing Practice in Kenya 1
- 2. ¡°All people everywhere will have access to¡°All people everywhere will have access to skilled, motivated, and supported healthskilled, motivated, and supported health worker, within a robust health system¡±worker, within a robust health system¡± Global Health workforce AllianceGlobal Health workforce Alliance www.icn.chwww.icn.ch 2
- 3. Disclaimer ?Systematic review done between 2013 - 2014 From Evidence to Action:The futureFrom Evidence to Action:The future of Nursing Practice in Kenyaof Nursing Practice in Kenya 3
- 4. Presentation OutlinePresentation Outline Background of nursing practiceBackground 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
- 5. ??Nursing practice has evolution into a professionNursing practice has evolution into a profession overtime. As early as 1732 Local governments inovertime. As early as 1732 Local governments in colonel America established Almshouses to carecolonel America established Almshouses to care for sick individuals.for sick individuals. ??Florence Nightingale (1873) is considered theFlorence Nightingale (1873) is considered the founder of modern Nursing & 1founder of modern Nursing & 1stst nursing Theorist.nursing Theorist. Background of nursing practiceBackground of nursing practice 5
- 6. Nightingale to WatsonNightingale to Watson et al¡et al¡ ??From the ?lady with the lamp? to nurseFrom the ?lady with the lamp? to nurse practitioner whose practice is anchored onpractitioner whose practice is anchored on theories and evidence.theories and evidence. ??Several theorists including NightingaleSeveral theorists including Nightingale andand others have shaped nursing practice.others have shaped nursing practice. 6
- 7. Nursing in Kenya¡Nursing in Kenya¡ ??In KenyaIn 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 andKRCHN and BsNBsN. Currently. Currently MsNMsN and PhDsand PhDs ? Before 1950¡Nursing education was without a formal framework oIn 1952, first examination for Assistant Enrolled Nurses Grade I and II. http://en.wikipedia.org/wiki/Nursing_in_Kenya7
- 8. ¡®¡®Wanjiku¡¯sWanjiku¡¯s¡¯ nursing practice¡¯ nursing practice ??King George Hospital (Now KNH) became the firstKing George Hospital (Now KNH) became the first hospital to commence Kenya Registered Nurse traininghospital to commence Kenya Registered Nurse training ??In 987 Kenya Registered Community Health NurseIn 987 Kenya Registered Community Health Nurse (KRCHN) training was establishment.(KRCHN) training was establishment. ??However, ourHowever, our WanjikuWanjiku nurse utilized little evidencenurse utilized little evidence instead practice was experientialinstead practice was experiential ¡°Usually we did it¡¡±¡°Usually we did it¡¡± http://en.wikipedia.org/wiki/Nursing_in_Kenya 8
- 9. The continuum of nursingThe continuum of nursing The transformation of nursingThe transformation of nursing practicepractice 9
- 10. Current trends in nursing practiceCurrent 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 10
- 11. 2.2. The Patient Safety ImperativeThe Patient Safety Imperative ?? Several recent studies have turned theSeveral 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% of1n 2013 Kenya estimated 1% to 2% of hospital inpatientshospital inpatients of medical errorsof medical errors Trends¡Trends¡ 11
- 12. Trends¡Trends¡ 3.3. Healthcare cost and Shorter Lengths ofHealthcare cost and Shorter Lengths of Hospital StayHospital Stay ?? Effective nursing care and hospital stay andEffective nursing care and hospital stay and quality of life outcomesquality of life outcomes 4.4. Healthcare Consumerism and "EHealthcare Consumerism and "E--Health¡±Health¡± 12
- 13. 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 13
- 14. 9.9. Return of Resistant Strains, CommunicableReturn of Resistant Strains, Communicable and NCDand NCD ?? It started with AIDS after 1980s then cancers, thenIt 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, cardiacNow Hypertension, Diabetes, cardiac conditions¡.And now Ebolaconditions¡.And now Ebola Trends¡Trends¡ 14
- 15. The challengesThe challenges ??Training and researchTraining and research ¨C¨C Mushrooming of newMushrooming 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 systemsQuality systems ¨C¨C are our systems working?are our systems working? ??Technology and the nurse practitionerTechnology and the nurse practitioner 15
- 16. Nursing practice in devolvedNursing 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 ¨C resulting from administrative authority 16
- 17. Opportunity despite the challenges¡Opportunity despite the challenges¡ An Opportunity for Nurses ?? Information technology advances in nursingInformation technology advances in nursing practicepractice ? EAC Nurses Vs Quality practiceNurses Vs Quality practice ? Community Nursing experts¡NCK haveNursing experts¡NCK have commenced a register)commenced a register) 17
- 18. So what can be done?So what can be done? ¡.to improve nursing¡.to improve nursing practicepractice 18
- 19. Nursing practice PillarsNursing practice Pillars 1. Clinical Practice ? Policy and protocol of practice ? Quality nursing practice & Healthcare 2. Administration 3. Research & research utilization 4. Education & Lifelong learning 5. Communication in healthcare http://www.ehow.com/list_6849606_fivehttp://www.ehow.com/list_6849606_five--pillarspillars--nursing_.htmlnursing_.html NHS Education for Scotland 19
- 20. Nurse engagement at levelsNurse engagement at levels NHS Education for Scotland 20
- 21. The future¡ ¡° the dream¡± 21
- 22. The Future: Evidence to actionThe Future: Evidence to action ?? Model:Model: Leading Change, AdvancingLeading Change, Advancing HealthHealth IOM RobertWood Johnson Foundation Report (2010) MakesMakes Eight (8) recommendations:Eight (8) recommendations: 22
- 23. Leading Change, Advancing Health ModelLeading Change, Advancing Health Model Recommendations:Recommendations: 1.1. Remove scopeRemove scope--ofof--practice barrierspractice barriers 2.2. Expand opportunities for nurses to lead andExpand 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 aIncrease the proportions of nurses with a BsNBsN degrees to 80 percent by 2020degrees to 80 percent by 2020 23
- 24. 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 toPrepare and enable nurses to lead change to advance healthadvance health 8.8. Build an infrastructure for the collection andBuild an infrastructure for the collection and analysis ofanalysis of interprofessionalinterprofessional healthcare workforcehealthcare workforce data.data. Leading Change, Advancing Health ModelLeading Change, Advancing Health Model Recommendations:Recommendations: 24
- 25. Recom.1: Remove scopeRecom.1: Remove scope--ofof--practice barrierspractice barriers ?? Advanced practice registered nurses should beAdvanced practice registered nurses should be able to practice to the full extent of theirable to practice to the full extent of their education and trainingeducation and training ?? In Kenya, it may be necessary to negotiate forIn Kenya, it may be necessary to negotiate for more scopemore scope (Pillar 1)(Pillar 1) 25
- 26. Recom.2: Expand opportunities for nurses to lead andRecom.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 manageopportunities for nurses to lead and manage collaborative efforts with other health care teamcollaborative efforts with other health care team Pillar 2Pillar 2 26
- 27. Recom.2: Expand opportunities for nurses to lead¡Recom.2: Expand opportunities for nurses to lead¡ ?? In Kenya¡nurses to conduct research and toIn Kenya¡nurses to conduct research and to redesign and improve practice environments andredesign and improve practice environments and health systemshealth systems ?? Nurses at administrative level should participateNurses at administrative level should participate in policy and protocol developmentin policy and protocol development (Pillar 2)(Pillar 2) 27
- 28. Recom.2: Expand opportunities for nurses toRecom.2: Expand opportunities for nurses to lead¡ withinlead¡ within devolved healthcare systemsdevolved healthcare systems ?? In Kenya¡Adopt a functioning systemIn Kenya¡Adopt a functioning system ?? NHSNHS ¨C¨CUkUk, Australian system, Australian system ?? US federal Health CareUS federal Health Care (National and County Policy level(National and County Policy level (Pillar 2)(Pillar 2) 28
- 29. 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. ?? ThanksThanks AMREFAMREF andand othersothers for starting onfor starting on--jobjob continuous learningcontinuous learning Pillar 4Pillar 4 29
- 30. Recom.4: Increase the proportions ofRecom.4: Increase the proportions of nurses with anurses with a BsNBsN degrees to 80 percentdegrees 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--residentialresidential coursescourses ?? Online degrees Vs Quality nurse educationOnline degrees Vs Quality nurse education Pillar 4Pillar 4 30
- 31. Recom.5: Double the number of nursesRecom.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 NurseRedefine 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 4 31
- 32. Recom.6: Ensure that nurses engage inRecom.6: Ensure that nurses engage in life long learninglife long learning ??Transforming nursing practice throTransforming nursing practice thro trainingtraining ?? Transform KRCHN to Kenya RegisteredTransform KRCHN to Kenya Registered Nurse Practitioner(KRNP) for first levelNurse Practitioner(KRNP) for first level nurses¡nurses¡ ?? CPD & evidenceCPD & evidence--based practicebased practice Pillar 4Pillar 4 32
- 33. Recom.6: ¡.nurses engage in lifeRecom.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 4 33
- 34. Lifelong learning:Lifelong learning: Benner. P. (1984) modelBenner. P. (1984) model 34
- 35. ?? Recom.7: Prepare and enable nurses to leadRecom.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 developmentPolicy 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 2 35
- 36. ?? Recom.8: Build an infrastructure for theRecom.8: Build an infrastructure for the collection and analysis ofcollection and analysis of interprofessionalinterprofessional health care workforce data.health care workforce data. ?? In Kenya¡need to engage in research andIn 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
- 37. Research into practiceResearch into practice ¨C¨C ResearchResearch utilizationutilization Evidence is key to quality nursing service o Systematic reviews o Critical appraisals o Scientific research o Audits o Case studies 37
- 38. 5.5. Communication in Healthcare practiceCommunication in Healthcare practice What has been the challenge in nursing practice? ? Consider KEMRI-Wellcome Trust training model in nurse curricula. Pillar 5Pillar 5 38
- 39. ? 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 UtilizationTechnology Utilization 40
- 40. ¡Technology & Nursing¡Technology & Nursing ?? NNursing informatics professionalsursing informatics professionals :: what?s the effects on patient carewhat?s the effects on patient care ?? Paperless technology documentationPaperless technology documentation ¨C¨C will we be left behind?will we be left behind? 41
- 41. 42
- 42. 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
- 43. 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) KenyaWorkforce 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 ¨C 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 & GeorgeWashington 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 - AToolkit 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- 45
- 44. AcknowledgementAcknowledgement ?? Colleagues at the CecilyColleagues at the Cecily McDonellMcDonell School of NursingSchool of Nursing ¨C¨C TNHTNH ?? KEMRIKEMRI--WellcomeWellcome TrustTrust ¨C¨C KilifiKilifi ?? Sue Hooton OBESue Hooton OBE ¨C¨C Quality Director 5Bur... NHSQuality Director 5Bur... NHS ¨C¨C UKUK (mentor)(mentor) ?? AneAne HaalandHaaland MsCMsC ¨C¨C University of Oslo NorwayUniversity of Oslo Norway (mentor)(mentor) ?? My Mentees and students: CecilyMy 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! 46
- 47. NHSNHS ¨C¨C UK structureUK structure ? National Directors ? Policy Directorate ? Patients and Information ? Operations Directorate ? Nursing Directorate ? Medical Directorate ? HR Directorate ? Finance Directorate ? Commissioning Development 50
- 48. Benner, P. 1984 modelBenner, P. 1984 model 51