Professional Adjustment

HISTORY OF NURSING IN GHANA

BACKGROUND

  • Ironically, nursing in Ghana was started with men.
  • They were not called nurses but male orderlies.
  • They trained with a modified curriculum suited to their low educational background.
  • Those trained were exclusively men.
  • It was impossible to recruit females to take up nursing due to various reasons.

REASONS WHY MALES WERE RECRUITED

Four main reasons:
  • Educational Opportunities:
    • Young people with education were principally males; therefore, pupil nurses were predominantly male.
  • Parental Attitudes:
    • Until girls' schools were established, parents were hesitant to send their daughters to school.
  • School Dynamics:
    • Schools were largely dominated by boys.
  • Perception of Nursing:
    • There was a common belief that nursing was a menial job, often involving close physical contact with sick individuals, most of whom were male patients.
  • Cultural Norms:
    • Local customs did not allow young girls to give nursing care to non-relatives.

DUTIES OF THE MALE NURSES

  • The male orderlies were recruited to assist missionary doctors posted to the Gold Coast.
  • Their duties included:
    • Bathing patients
    • Feeding patients
    • Dressing wounds
    • Administering simple drugs

INITIAL SYSTEM OF TRAINING OF NURSES

  • Training occurred through an apprenticeship model over three years.
  • Training was conducted at centers where European nursing sisters were based, initially in Accra, Cape Coast, and Sekondi, and later in Kumasi.
  • Curriculum:
    • The training curriculum was designed considering the low educational standards of the time.
  • Content:
    • Included basic Anatomy and Physiology, Medical and Surgical Nursing, Hygiene, and First Aid.
  • Certification:
    • Successful candidates were awarded the “Director of Medical Services certificate.”

PROBLEMS AFFECTING THE RECRUITMENT OF CANDIDATES

  • Educational Shortcomings:
    • The main problem was the gross inadequacy of educational backgrounds among prospective trainees.
  • Retention Difficulty:
    • The Health Department struggled to retain trained nurses, resulting in staff shortages each year.
  • Perception of Nursing:
    • Nursing was viewed as menial work by educated youth in Gold Coast, leading to a lack of interest in the profession.
  • Working Conditions:
    • Long hours, especially night shifts, poor pay, and high demand for effort contributed to nursing's unpopularity.
  • Job Alternatives:
    • Educated youth found more lucrative and appealing opportunities elsewhere, such as clerical jobs in cocoa buying.

WAYS ADOPTED TO IMPROVE THE CONDITION OF NURSES

  • The Medical Department made recommendations for better salaries and job conditions for nurses.
  • In 1912, the government accepted a new scheme aimed at improving nurses' job conditions.

NUMBER OF NURSES TRAINED

  • The number of trained nurses remained low and static until the establishment of essential training facilities:
    • 1921: 64 nurses and trainees
    • 1923: Opening of the Gold Coast Hospital (Korle-Bu) marked a significant step forward in nursing education.
    • 1930: Accelerated growth in nursing training, exceeding over 200 qualified nurses.
  • Nursing became crucial in modernizing public health facilities in the 1920s.
  • The Third Conference of the senior members of the West Africa Medical staff in Accra highlighted advanced training for nurses and midwives.

ADVOCACY FOR MORE NURSES

  • The nurse shortage became critical in the 1940s, leading Dr. Balfour Kirk (Director of Medical Services) to advocate for expanded hospital facilities for training nurses and support staff.
  • In the highest nursing positions, European nurses dominated; by 1940, their number exceeded 30.

ROLE OF EUROPEAN NURSING SISTERS

  • European nursing sisters arrived in Ghana in 1899 and played a significant role in nurse training.
  • They provided on-the-job training for male orderlies and a few women, teaching basic human anatomy, surgical and medical nursing, and first aid principles.
  • Successful trainees became second division nurses in the civil service and were awarded the director of medical services certificate.

NURSING EDUCATION IN THE GOLD COAST PRIOR TO INDEPENDENCE

  • The structure of nursing education before independence was significantly influenced by colonial administrators.
  • Late 19th Century Context:
    • The Gold Coast was known as the “White Man’s Grave” due to the prevalence of tropical diseases like malaria and yellow fever.
  • Health Improvement Focus:
    • The British prioritized improving health conditions due to the colony's mineral wealth, leading to the appointment of British nursing sisters in 1878.
  • Medical Department Establishment (1880):
    • Following the arrival of the nursing sisters, women began to be trained as nurses, although men remained the majority.
  • Training by British Sisters:
    • Provided lessons in anatomy, surgical and medical nursing, and first aid; successful completion resulted in the award of the Director of Medical Services Certificate.
  • 1928 Development:
    • The establishment of a maternity hospital in Accra allowed for the recruitment of women into midwifery, reflecting changing societal norms.
  • Midwives Board Creation:
    • Tasked with training, examining, registering, and regulating midwives in the Gold Coast.

INTRODUCTION OF STATE REGISTERED NURSING

  • 1945 Milestone:
    • All senior nurses in Ghana were white colonial sisters until after 1945.
    • Shift towards training high-caliber Ghanaian nurses began, led by Dr. Kirk's initiative for a defined nursing syllabus.
  • Isabel Hutton’s Arrival (1945):
    • Initiated the first State Registered Nursing (SRN) training, modeled after the British system under the Nurses’ Ordinance of 1947.
  • Kumasi Location:
    • SRN training was initially held in rented premises with very limited student numbers (five).
  • Practical Training:
    • Conducted at Kumasi Central Hospital, now the Komfo Anokye Teaching Hospital.
  • Migration to Accra (1948):
    • The school moved to a permanent location in Accra aimed at training competent nurses.
  • QRNs Training Initiation (1948):
    • Concurrently with SRN, the training of qualified registered nurses (QRNs) began, retaining the apprenticeship system.
    • By 1952, nursing education saw a significant increase in female enrollment, and male nurses were becoming a minority.

LOSS OF DOMINANCE OF MALES IN NURSING

  • 1948 Milestone:
    • Completion of Korle-Bu NTC, restricting admission to females and marking a decline in male dominance in nursing.

APPOINTMENT OF TUTORS AND PRINCIPAL FOR TRAINING SCHOOLS

  • Tutors Appointed (1945):
    • Isabel Hutton, Kay Storrier, and Gladys Burton became the first tutors.
    • Hutton became the first principal in 1956.
  • Recognition of College:
    • Negotiations began for legislative recognition of the college by the General Nursing Council of England and Wales.
  • Training Standardization:
    • The training program was 3.5 years, based on the British SRN pattern, limited to women.

REGISTRATION OF NURSES

  • Gender Shift Impact:
    • There is little historical information explaining the gender shift in nursing education during this time.
  • Curriculum Development:
    • Followed the General Nursing Council (GNC) syllabus of England, aiming for local acceptance and opportunities for post-basic courses in British nursing.

POST-INDEPENDENCE NURSING EDUCATION

Ghana's Independence Context (1957):
  • The last colonial official left the country; the first Ghanaian nurse, Matron Docia A. N. Kisseih, was appointed Chief Nursing Officer.
  • 1961 Government Decisions:
    • Introduction of local doctor training led to expanding and modernizing Korle-Bu as a teaching hospital.
  • SRNs Specialization:
    • Several SRNs were sent to the UK for specialized training, focusing on various areas including orthopedics and children’s nursing.
  • Nursing Changes:
    • Major systematic changes occurred within Ghanaian nursing education by 1963, aligning it with global standards in technological growth.
    • The University of Ghana's nursing department established to improve nursing education. Programs: consisted of Diploma in Nursing Education and Nursing Management (during breaks).
  • Degree Introductions:
    • Degree program initiated in 1980; alongside, KNUST began offering Bachelor's degrees for nursing in 2003.

POST GRADUATE DEGREE IN NURSING

  • 2001 Changes:
    • The diploma program phased out at the University of Ghana as a Master's in Nursing was introduced (MPhil and MSc in nursing).
  • Current Qualifications:
    • Nurses are now highly qualified, some pursuing doctorates and many holding master's degrees.

CHALLENGES TO NURSING EDUCATION GROWTH

  • Post-independence, nursing education has faced numerous challenges, including:
    • Outdated textbooks and limited learning materials.
    • The burden of tropical diseases, leading to high absenteeism rates.
    • Limited facilities due to overcrowding in training schools.
    • Clinical area problems impacting practical education.

PROFESSIONAL ADJUSTMENT

COURSE CODE: NUR 201/MID 101/CHN 103

HISTORY AND DEVELOPMENT OF NURSING AND MIDWIFERY

OBJECTIVES

  • At the end of this session, students will be able to:
    • Define Nursing and Midwifery
    • Identify the various stages of development of nursing/midwifery in the world
    • Discuss the development of modern nursing/midwifery
    • Discuss the importance of a profession understanding its own history

DEFINITION OF NURSING

  • Nursing is defined by Virginia Henderson (1966):
    • “to assist the individual sick or well, in the performance of those activities contributing to health, its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible.”

DEFINITION OF MIDWIFERY

  • WHO Definition:
    • Midwifery encompasses care of women during pregnancy, labor, the postpartum period, and newborn care.
    • Responsibilities include:
    • Preventing health problems during pregnancy
    • Detecting abnormal conditions
    • Procuring medical assistance when necessary
    • Executing emergency measures in the absence of medical help

COMMON THEMES IN NURSING/MIDWIFERY

  • Nursing is:
    • Caring
    • An art
    • A science
    • Client-centered
    • Holistic
    • Adaptive
    • A helping profession
    • Concerned with health promotion, health maintenance, and health restoration

WHO IS A NURSE OR MIDWIFE?

  • The word "nurse" derives from the Latin word "nutrire", meaning to suckle, initially referring to wet nurses.
  • By the late 16th century, it referred to anyone who cared for the sick.
  • A midwife traditionally assisted women during childbirth, largely filling the void left by male doctors during ancient and medieval times.

STAGES OF THE DEVELOPMENT OF NURSING AND MIDWIFERY

  • Nursing and Midwifery have evolved through the following eras:
    • Primitive Era/Culture
    • Ancient Civilization Era
    • Christian Era
    • Middle Ages
    • Reformation Era
    • Nightingale's Era

STAGES OF THE DEVELOPMENT FROM PRIMITIVE ERA

  • Primitive Era:
    • Nursing was associated with women's humanitarian responsibilities.
    • Women cared for children and sick family members, with diseases often attributed to superstitions.
    • Nurses were sometimes viewed as slaves or “slave nurses.”

STAGES OF DEVELOPMENT IN ANCIENT CIVILIZATION

  • Ancient Civilization:
    • Health care was influenced heavily by religion and the supernatural.
    • Obstetrics was managed solely by midwives.
    • Nursing often seen as a servile occupation; nurses could be both male and female.

CHRISTIAN ERA

  • Early Christian values influenced attitudes toward sickness and care for the needy.
  • The principle of loving one's neighbor, including the sick, became integral to nursing practice.
  • Organized nursing began with the establishment of the Order of Deaconesses.
  • Prominent figures providing care during this period included Phoebe, Fabiola, and Paula.

MIDDLE AGES

  • The Middle Ages were marked by the persecution of female healers as the Roman Catholic Church condemned them as witches.
  • Women suffered harsh persecution, including torture and execution.
  • This period significantly degraded the status of women and nurses for centuries.

MIDWIFERY IN THE MIDDLE AGES

  • Midwifery was essential to women's health care before formal medical professions existed.
  • Medical knowledge was derived from Roman and Greek sources, which largely excluded women’s health issues.

INFLUENCE OF THE CRUSADERS ON NURSING

  • The Crusades formed the basis for three medical organizations that persist today: military, regular or religious, and secular orders.

THE REFORMATION

  • Between the 1500s and 1800s, the Renaissance and Reformation significantly impacted nursing, leading to dark days with minimal care for the poor and sick.

NIGHTINGALE’S ERA

  • Florence Nightingale is renowned as the founder of modern nursing.
  • Born into a wealthy family on May 12, 1820, in Florence, Italy, she believed she was divinely called to help others.
  • The Crimean War was a pivotal point in her career, revealing the inadequate care for soldiers and prompting her to improve healthcare through statistical evidence and reforms.
  • Nightingale implemented sanitary conditions, leading to a significant decrease in the soldiers’ death rates from 42% to 2%.
  • She established the Nightingale Training School for Nurses in 1860, modeled after her experiences during the war.

ACHIEVEMENTS OF FLORENCE NIGHTINGALE

  • Known as the first nurse researcher.
  • Advocated for holistic approaches to health care.
  • Developed nursing education processes.
  • Implemented sanitation practices that drastically reduced mortality rates.

IMPORTANCE OF NURSING AND MIDWIFERY HISTORY

  • Understanding nursing history is vital for advancing the profession.
  • Historical knowledge socializes new nurses, encourages critical thinking, and is essential for healthcare reform.
  • Provides perspectives on evolving health technologies and gender issues in nursing.

IMPORTANCE OF NURSING HISTORY CONT’D

  • Nursing history is shared among individuals, organizations, and educational institutions, aiding professional awareness and encouraging historical research.

REFERENCES

  • Andrist, L.C.; Nicholas, P.K. (2006). "A History of Nursing Ideas." Boston: Jones and Bartlett Publishers.
  • Cherry, B.; Jacob, S.R. (2005). "Contemporary Nursing: Issues, Trends and Management." 3rd Ed. St. Louis: Elsevier Inc.
  • Donahue, M.P. (1996). "Nursing the Finest Art: An Illustrated History." 2nd Ed. Boston: Mosby-Year Book, Inc.

LEGAL WITHIN NURSING AND MIDWIFERY

OBJECTIVES

  • By the end of the lecture, students will be able to:
    • Explain law, functions and the two main types of law
    • Discuss nursing law
    • Discuss the law of tort
    • Discuss common offences in nursing and midwifery
    • Explain criminal offences to person and property
    • Explain the nursing practice act and health professions regulatory bodies Act 2013
    • Discuss legal liabilities and methods to avoid legal issues in nursing and midwifery practice

DEFINITION OF LAW

  • Law is defined as the sum total of rules and regulations by which a society is governed.
  • It can also be viewed as a rule made by a government to order societal behavior, interested in fairness and justice.
  • Laws can be categorized as coded (written) or uncoded (unwritten).

NURSING LAW DEFINITION

  • Nursing law encompasses statutes, executive orders, regulations, and rules promoting and protecting individuals and communities through nursing service.
  • It serves to regulate nurses' conduct, is enforceable, applies to all nurses, and sets specific standards.
  • Nurses and midwives are accountable for their professional judgments and actions as per these laws.

FUNCTIONS OF LAW IN NURSING/MIDWIFERY

  • Establishes legality for nursing/midwifery actions.
  • Differentiates nurse/midwife responsibilities from those of other healthcare professionals.
  • Creates clear boundaries for independent actions by nurses/midwives.
  • Maintains nursing standards by holding nurses/midwives accountable.
  • Protects nurses/midwives from legal liability.

TYPES OF LAW

Two main categories:
  • Public Law (Criminal)
    • Governs interactions between individuals and the state, encompassing constitutional, administrative, and criminal laws.
  • Private Law (Civil Law)
    • Deals with relationships among private individuals covering issues like contracts and torts.

PUBLIC LAWS AFFECTING NURSES/MIDWIVES

  • Constitutional Laws:
    • Define government powers and protect citizens' rights.
  • Criminal Law:
    • Prevents acts or offenses that harm others, including homicide, manslaughter, theft, etc.

ADMINISTRATIVE LAWS

  • Developed by appointed agencies such as state boards, overseeing regulations like the Nurse Practice Act, Food, Drug and Cosmetic Act, etc.

PRIVATE LAW/CIVIL LAW TYPES

  • Contract Laws:
    • Enforces agreements among individuals.
  • Tort Laws:
    • Wrongful acts causing harm - may be unintentional (negligence) or intentional (assault, battery).

TORT LAWS

  • Protects against wrongs committed against individuals, with remedies often comprising compensation (damages).
Elements of a Tort:
  • Omission
  • Wrongful Act
  • Legal Damage
  • Legal Remedy

NEGLIGENCE

  • Defined as the failure to provide standard care that an individual would ordinarily use in similar circumstances. May lead to liability lawsuits.
  • Gross Negligence:
    • Criminal negligence, indicating serious carelessness.

EXAMPLES OF ACTS OF NEGLIGENCE

  • Overlooking surgical sponges or instruments.
  • Not raising a restless patient's bedside rails.
  • Leaving a baby unattended in a bath.
  • Failing to monitor vital signs leading to adverse outcomes.
MALPRACTICE
  • Refers to a professional person’s improper discharge of duties leading to harm.
  • Nurses are personally liable for acts of malpractice.
EXAMPLES OF MALPRACTICE
  • Medication errors (wrong dose/medication).
  • Performing duties beyond training (e.g., surgeries).
SIX ELEMENTS TO PROVE MALPRACTICE
  1. Duty:
    • Provide acceptable care.
  2. Breach of Duty:
    • Failure to act reasonably.
  3. Causation:
    • Link between act and injury must be established.
  4. Harm or Injury:
    • Documented harm must result from the breach.
  5. Damages:
    • Nurse responsible for damages in malpractice cases.
INTENTIONAL TORT LAW
  1. Assault:
    • Intentionally threatening physical harm.
  2. Battery:
    • Unlawful physical contact.
  3. False Imprisonment:
    • Unlawful restraint against a person's will.
  4. Defamation:
    • Injuring reputation through false statements.
  5. Invasion of Privacy:
    • Breach of patient confidentiality or consent violation.
LEGAL SAFEGUARDS IN NURSING PRACTICE
  • Includes licensure, informed consent, communication, documentation, and adherence to professional standards.

NURSING REGULATORY BODIES

  • Established standards to govern nursing practice in each jurisdiction.
  • Compliance with laws and regulations ensures safety and quality of care.

LEGAL LIABILITY IN NURSING AND MIDWIFERY

  • Legal liability involves being held accountable for actions in various areas of law, including torts and contracts.
  • Nurses have a duty to provide the standard of care appropriate to their training and to protect patient wellbeing.

SPIRITUAL NEEDS OF PATIENTS

  • Definition of Spirituality:
    • A sense of relationship to a transcendent dimension or a supernatural being.
  • Spirituality can be a lifelong relationship that assumes deeper meaning in times of crisis.

IMPORTANCE OF SPIRITUAL NEEDS

  • Spiritual needs impact client welfare and self-behavior.
  • These include dietary restrictions, healthcare preferences, and the need for spiritual support during health crises.

SPIRITUAL DISTRESS

  • It represents a challenge to one’s spiritual well-being, noted through physiological problems or situational factors.
  • Characterized by a lack of hope or meaning in life and can manifest through behavioral changes.

ASSESSMENT OF SPIRITUAL NEEDS SPIRITUALITY

  • Assessments should involve understanding clients’ religious backgrounds and spiritual beliefs, as part of comprehensive care.

NURSING AND MIDWIFERY THEORY

OBJECTIVES

  • Define necessary nursing theory terminologies.
  • Identify components of metaparadigms in nursing and midwifery.
  • Discuss the significance of nursing theories.
  • Highlight major nursing theories.

NURSING THEORY

  • A structured set of ideas that guide nursing practice based on evidence which helps develop sound decision-making.

METAPARADIGM CONCEPTS

Core Components:
  1. Person:
    • Client receiving nursing; includes individuals, families, and communities.
  2. Health:
    • The state of wellness experienced by an individual.
  3. Environment:
    • Encompasses internal and external surroundings affecting the client.
  4. Nursing:
    • Actions and characteristics of the nurse promoting health care.

MAJOR NURSING THEORIES

  • Prominent theories include:
    • Nightingale's Environmental Theory
    • Peplau's Interpersonal Theory
    • Henderson's Needs Theory
    • Orem's Self-Care Theory
NIGHTINGALE’S ENVIRONMENTAL THEORY
  • Emphasizes the environment's impact on patient recovery and health, linking health with five key environmental factors: fresh air, pure water, efficient drainage, cleanliness, and light.
PEPLAU’S INTERPERSONAL RELATIONSHIP MODEL
  • Focuses on the therapeutic relationship between nurse and client, progressing through stages of orientation, identification, exploitation, and resolution.
HENDERSON’S NEEDS THEORY
  • Describes the role of nursing in assisting patients to achieve independence, based on 14 fundamental needs.
OREM'S SELF-CARE THEORY
  • Focuses on individuals' ability to perform self-care and the role of nursing to address self-care deficits through supportive systems.

THANK YOU

REFERENCES

  • Berman, A. & Snyder, S. S. (2012). "Kozier & Erb’s Fundamentals of Nursing." 9th ed. Pearson Education Inc. New Jersey.
  • Beauchamp, T. L., & Childress, J. F. (2009). "Principles of Biomedical Ethics." 6th ed. Oxford University Press.

QUALITY ASSURANCE IN NURSING

OBJECTIVES

  • Understand the concept of quality assurance and its importance in health care.
  • Identify the stakeholders involved in quality assurance processes.
  • Discuss barriers against effective quality assurance in nursing and health system practices.

QUALITY ASSURANCE

  • Encompasses systematic processes involving continuous monitoring, measuring, and improving quality in healthcare services.

DIMENSIONS OF QUALITY HEALTH CARE

  • Access: Ease of receiving medical services.
  • Technical Performance: Adherence to quality standards.
  • Effectiveness: Achieving desired outcomes of care.
  • Efficiency: Minimizing waste in service delivery.

IMPACT OF QUALITY ASSURANCE

  • Enhances patient satisfaction and safety, fosters organizational trust, and governs the professional conduct of nursing staff.
  • Involves commitment from management, staff, and patients to ensure continuous improvement.

BARRIERS TO QUALITY ASSURANCE

  • Non-commitment from management, negative attitudes from staff, inadequacy of information, and lack of motivation.

THE HOSPITAL CHAPLAIN

  • Provides spiritual guidance and support to patients and families, conducting religious services, and addressing both spiritual and emotional needs in healthcare settings.

  • Role:

    • Provides sermons, counseling, and spiritual support for patients, facilitating religious practices during hospitalization.

SPIRITUALITY IN NURSING

  • Recognizing spirituality's role in patient care, promoting the inclusion of religious practices in treatment plans improves patient satisfaction and adherence to healthcare regimens.

THERAPEUTIC COMMUNICATION IN NURSING

  • Effective communication involves verbal and non-verbal interactions, tailored to patient needs to foster understanding and trust between patients and healthcare providers.

CONCLUSION

  • Understanding the history, legal aspects, ethical considerations, and frameworks of nursing leads to enhanced nursing practice, ensuring provision of quality, respectful, and culturally competent care to all patients.