By Comrade Nurse Abdrafiu Alani Adeniji (National President, National Association of Nigeria Nurses and Midwives)
Nursing profession is perhaps one of the most underrated and misunderstood professions in the Nigerian society. Despite constituting the largest number of global health care professionals and being the most predominant component of any hospital personnel infrastructure (in the United States, the number of registered nurses is more than four times the number of practicing physicians), the truth remains that very few people understand the myriad roles and responsibilities of nurses until they are in need of nursing care themselves.
Nurses and their contributions are vital components of any reliable healthcare organisation striving for zero patient harm and quality care. It has been suggested that hospitals promoting better nursing environments with above-average staffing ratios experience lower patient mortality, particularly for patients considered “high-risk.”
According to Terry Fulmer, president of the John A. Hartford foundation, “whether people know it or not, they come into hospitals for nursing care.” For example, if a patient comes in for surgery, that operation may last hours, but subsequent nursing care may be required for days, weeks, and even months, depending on the patient’s trajectory.
Surgery is one thing, but it is the nursing care post-surgery that will determine how quickly patients recover, the success or failure of the intended surgical outcomes, and the quality of life recovered during a tenuous post-operative phase. In essence, the success and failure of the surgical, gynaecological, obstetrical, ophthalmological, dental, oncological, psychiatric and various medical cases are determined by the quality of nursing care services.
The Nigerian situation
Unfortunately in Nigeria, there are times when nurses, whose services are critical to patients’ treatment outcome, are not involved in patient care plan and management. Over here, the understanding of the public on who a nurse is so confusing because of the infiltration of the divine professional jurisdiction of nursing practices by quacks. The knowledge deficit is so massive that any female or anybody seen in white is called a nurse; thus, whatever misdemeanour coming from such a person is anchored on the image of the noble profession of nursing.
It is rather unfortunate however, that this lack of a deep understanding of the importance of the nursing profession and the resultant underrating of nurses is having adverse effects not only on healthcare systems but also on economies of the nation, continent and the world at large. There is no gainsaying that the nursing profession forms the pivot around which all other health professions revolve and as such is a determinant of the health care system in the society.
It has been recognised that the health system of any country is a reflection of how its nursing professionals are regarded and treated. The former ICN president aptly captures this in the following statement; “The wealth of our nations depends on the health of our populations, and the health of our populations depends on nursing” (Judith Shamian, Former ICN president, 2017).
What is nursing?
A classic definition of nursing has been given by Virginia Henderson, a distinguished American nurse educator and writer. She defined nursing as: “the art and science of caring, aimed at assisting the individual sick or well in the performance of those activities contributing to health or its recovery (or peaceful death) that he would have performed unaided if he has the strength, will or knowledge, and to do this in such a way as to help him gain independence, rapidly as possible.” She further stated that “this aspect of her work, this part of her functions, she initiates and controls; of this, she is master.”
The American Nurses’ Association defines nursing as the protection, promotion, and optimisation of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.
The International Council of Nursing (ICN) while expatiating these two definitions stated as follows; “Nursing, as an integral part of the health care system, encompasses the promotion of health, prevention of illness, and care of physically ill, mentally ill, and disabled people of all ages, in all health care and other community settings. Within this broad spectrum of health care, the phenomena of particular concern to nurses are individual, family, and group “responses to actual or potential health problems” (ANA, 1980, P.9).
These human responses range broadly from health restoring reactions to an individual episode of illness, to the development of policy in promoting the long-term health of a population. The unique function of nurses in caring for individuals, sick or well, is to assess their responses to their health status and to assist them in the performance of those activities contributing to health or recovery or to dignified death that they would perform unaided if they had the necessary strength, will, or knowledge and to do this in such a way as to help them gain full of partial independence as rapidly as possible (Henderson, 1977, p.4).
Within the total health care environment, nurses share with other health professionals and those in other sectors of public service the functions of planning, implementation, and evaluation to ensure the adequacy of the health system for promoting health, preventing illness, and caring for ill and disabled people.
ICN summarised the essence of nursing in this definition: “Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.”
Who is a nurse?
The nurse has been defined by the ICN as “a person who has completed a programme of basic, generalised nursing education and is authorised by the appropriate regulatory authority to practise nursing in his/her country.” It adds: “Basic nursing education is a formally recognised programme of study providing a broad and sound foundation in the behavioural, life, and nursing sciences for the general practice of nursing, for a leadership role, and for post-basic education for specialty or advanced nursing practice.”
According to the ICN, the nurse is prepared and authorised:
(1) to engage in the general scope of nursing practice, including the promotion of health, prevention of illness, and care of physically ill, mentally ill, and disabled people of all ages and in all health care and other community settings;
(2) to carry out health care teaching;
(3) to participate fully as a member of the health care team;
(4) to supervise and train nursing and health care auxiliaries; and
(5) to be involved in research. .
The above definitions obviously leave no doubt that the scope of nursing is not limited to the hospital or a clinical setting; it cuts across all facets of our society. It will interest the society at large to know that there are over 100 specialties in nursing – underscoring the fact that the nursing professional is a polyvalent entity who has a wide variety of functions in the healthcare system and the society at large.
Duties of the nurse
The functions of a professional nurse are multifaceted and can be categorised basically into three levels of competencies, namely: independent, interdependent and dependent roles. The independent roles are those ones that the nurse is able to perform without the supervision or assistance of anyone. And as Virginia Henderson stated in her definition, this aspect the nurse initiates, controls and is a master of.
The nurse has his or her professional jurisdiction especially in the nurses’ core competences wherein the nurse is trained, certified, and legally covered, recognised, registered and licensed to practise in and outside the country. These are the autonomous duties and responsibilities.
The interdependent roles of the nurse are those that he or she performs in collaboration with other professionals within and without the health profession. While a nurse needs the input of other healthcare professionals, these other professionals also need the input of nurses to be able to carry out their professional duties. The medical/surgical teams need information from firm/ward/ unit charge nurses about the patient to take an informed professional decision.
The nurse is trained to understand the importance of intersectoral/professional collaboration to the achievement and maintenance of good health and therefore works in conjunction with others in the pursuance of activities leading to health promotion and illness recovery
The third tier of the nurse’s functions comprises the dependent roles which are functions the nurse relies on other professionals to perform. This discussion will briefly consider a few of the polyvalent functions of the nurse the hospital/clinical setting and in the community setting.
(Continues in next edition)