WHO Consulting - Nursing Management in The New Paradigm.ppt

7/30/2019 WHO Consulting - Nursing Management in The New Paradigm.ppt

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NURSING MANAGEMENTIN THE NEW PARADIGM

Indonesian Hospitals Association22nd August 2005


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Deborah Hennessy

WHO Technical Advisor to MOH

Nursing, Midwifery, Human resources andService delivery

October 2000

September 2005


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New Paradigm in Nursing

A Paradigm ?

Why New?

How does this affect nursing management and

the nurse at the bedside or working in the

community

How does this affect Indonesia


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A Paradigm

A paradigm means a model

More than one model of nursing? Will describe

three (100,000 ref in one second on internet)

The reasons for change New

The models used in nursing in Indonesia


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Three models nursing care

Practising nurse role is to provide the best possiblenursing care:

1. Mechanical care tasks related to disease andbody function (Earliest)

2. Holistic - a patient needs physical, emotional,psychological and spiritual care (Later)

3. Ecological the nursing care of a patientrequires an understanding of interdependence

of patient's genetic and physical makeup, rolein family, community, culture, economic statusetc. (Current)


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Reasons for change in Health

Industry

Demand for quality care by patients

Rapid technological innovation and

increase in knowledge ( also internethealth)

Globalisation of Health Care Industry

Need to contain rising costs


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Reasons for Change in Nursing

Paradigm of Care

Increased patient acuity Emerging diseases

Advanced technologyAging population?

Decreased resources

A shortage of professional nurses? ^^^^ If better quality could export!


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Models require different Nursing

Skills

Mechanical task centred, delegated

Holistic patient centred, conscious of

biological, psychological, emotional and spiritualneeds, team work

Ecological

asking deeper questions about careneeded, recognise fundamental

interdependences, case mangement


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The Situation in Indonesia

Different models need different educational levels:

Qualifcatn Percentage

Mechanical - SPK 65%

Holistic - D3 30%

( metropolitan)

Ecological - S1 5%

( very few in clinical practice)

Specialist nursing training


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What does Indonesia need

Nurses who can provide best care:

Emergency care

For acutely ill

Chronically ill

Preventive care


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To make contribution

nurses need? (1 of 2 slides)

1. Knowledge - Does the nurse education prepare theprovider to be fit to practice in any of the three models?

2. Clinical Skill and competency -10 years researchemphasise extreme weakness

Are the D3s and S1 being employed to work in clinicalareas?

3. Attitude-? Motivation for quality performance

Depends on quality of management support andleadership


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nurses need? (2 of 2 slides)

4. Quality performance and management-

Very weak 2000/ 2001 research on performance management needs aswell as field assessments in 42 districts (MOH, 2001/ 2001-2005)

No job descriptions,

No clinical standards/ SOP,

No performance monitoring

Hard to fo l low any paradigm of nu rs ing witho ut the above

5. Good facilities and equipment- Generally far below standard


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Indonesia and disasters

1. Natural

Earthquakes, volcanoes, fires

Landslides, floods, Tsunamis

2. Disease

Malaria, TB, Dengue HF, Polio, Avian flue, Infection

3. Non-natural

Bombs, shootings, massacres, riots

Malnutrition


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nurses need? Knowledge - Many academies and university

programmes Great achievement. Quality of product?

Clinical Skill and competency

Attitude-Good? Motivation for quality clinicalperformance?

Quality performance and management-

Good facilities and equipment-


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Emergency Disease Facts

TB, Malaria and DHF High

Infection High

Polio Increasing

Malnutrition Increasing

All three models of nursing can make acontribution in this area mainly community


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Role of nurses in emergencies

and disasters

The nursing contribution within the health

care team is to provide emergency clinical

care (life saving, acute and rehabilitation),

undertake preventative activities, and

provide much needed emotional support.

(WHO HQ Jan 2005)


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Preparedness of Nurses and

Midwives to make contribution?

1. Disease

Malaria, TB, Dengue HF, Polio, Avian flue,

Infection?? Are nurses prepared??

2. Natural Earthquakes, volcanoes, fires Are nurses prepared??

Landslides, floods, Tsunamis ?

3. Non-natural

Bombs, shootings, massacres, riots???

Malnutrition??? Are nurses prepared??


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WHO technical assistance to

improve situation (1 of 2)WHO Indonesia

Assisted MOH develop policy and guidelines for clinicalPerformance Development and Management SystemIntroduced into 10 provinces.

A National Strategy and practical models to improveclinical education for all three paradigms of Nursing

1. Mechanical

2. Holistic

3. Ecological

Assistance to progress towards a Nursing and MidwiferyStatutory Authority (Council) to regulate standard ofpractice


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WHO technical assistance to

improve situation (2 of 2)WHO Indonesia continued

Community Health Nursing Certificate Course, especiallypost disaster

Community Mental Health Nursing Certificate course

Basic Emergency Skills certificate course and nationalagreement for intermediate and advanced skills courses.


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CPDMSa So lut ion?

CPDMS Implementation has a number ofprinciples

National Standards used by nurses andmidwives

Job Descriptions locally relevant

Identification of Key Clinical PerformanceIndicators (KCPI)

KCPI Monitoring Systems linked to qualityassurance initiatives and Hospital and DistrictPerformance Assessments,

Managements skills training

Reflective case discussions/ regular updating

Clinical Governance


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Quality

Assurance and

Accreditation

Non Clinical

Service

Clinical care

Radical

Improvement

Step by step

improvement

Standardization

Health Needs -Clear aims,

Indicators &

Measurements,

Monitoring SystemReducing

Patient harms

& errors

Medical careHospital Infection Control

Nursing care

Midwifery

care

Job description/ focus

patient care

Clinical Standards/SOP

Reflective Case

Discussion

Key Performance

Indicators

Field Assessment

Clinical Management

Training Standardization

Excellent

Service

Leadership

Commitment

Empowerment

etc

Monitoring,

feedback/

coaching

Clinical Governance -

Quality ImprovementLink with CPDMS


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Way Forward

PERSI role to assist the Nursing

profession provide high quality modelsof care by :

providing adequate managerial support,

equipment, incentives, leadership andensuring there is quality performance

management (CPDMS?)

Documents

WHO Consulting - Nursing Management in The New Paradigm.ppt