NURSING MANAGEMENT IN THE NEW PARADIGM

Indonesian Hospitals Association 22nd August 2005

Deborah Hennessy
WHO

Technical Advisor to MOH

Nursing, Midwifery, Human resources and Service delivery October 2000 September 2005

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

Three models nursing care

Practising nurse role is to provide the best possible nursing care: 1. Mechanical care tasks related to disease and body function (Earliest) 2. Holistic - a patient needs physical, emotional, psychological and spiritual care (Later) 3. Ecological the nursing care of a patient requires an understanding of interdependence of patient's genetic and physical makeup, role in family, community, culture, economic status etc. (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 internet health) Globalisation of Health Care Industry Need to contain rising costs

Reasons for Change in Nursing Paradigm of Care

patient acuity Emerging diseases Advanced technology Aging population? Decreased resources A shortage of professional nurses? ^^^^ If better quality could export!
Increased
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Models require different Nursing Skills

Mechanical task centred, delegated Holistic patient centred, conscious of biological, psychological, emotional and spiritual needs, team work Ecological asking deeper questions about care needed, 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 the provider to be fit to practice in any of the three models?
2. Clinical Skill and competency -10 years research emphasise extreme weakness Are the D3s and S1 being employed to work in clinical areas? 3. Attitude-? Motivation for quality performance Depends on quality of management support and leadership

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To make contribution nurses need? (2 of 2 slides)

4. Quality performance and managementVery weak 2000/ 2001 research on performance management needs as well as field assessments in 42 districts (MOH, 2001/ 2001-2005) No job descriptions, No clinical standards/ SOP, No performance monitoring Hard to follow any paradigm of nursing without 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 Disease Malaria, TB, Dengue HF, Polio, Avian flue, Infection Non-natural Bombs, shootings, massacres, riots Malnutrition
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2.

3.

To make contribution nurses need?

Knowledge - Many academies and university programmes Great achievement. Quality of product? Clinical Skill and competency

Attitude-Good? Motivation for quality clinical performance?

Quality performance and managementGood facilities and equipment14

Emergency Disease Facts

TB, Malaria and DHF Infection

High High

Polio

Increasing

Malnutrition Increasing All three models of nursing can make a contribution 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?? Natural Earthquakes, volcanoes, fires Landslides, floods, Tsunamis ?

2.

Are nurses prepared??

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 clinical Performance Development and Management System Introduced into 10 provinces.

A National Strategy and practical models to improve clinical education for all three paradigms of Nursing 1. Mechanical 2. Holistic 3. Ecological Assistance to progress towards a Nursing and Midwifery Statutory Authority (Council) to regulate standard of practice
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WHO technical assistance to improve situation (2 of 2)

WHO Indonesia continued

Community Health Nursing Certificate Course, especially post disaster

Community Mental Health Nursing Certificate course

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

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CPDMS a Solution?
CPDMS Implementation has a number of principles National Standards used by nurses and midwives Job Descriptions locally relevant Identification of Key Clinical Performance Indicators (KCPI) KCPI Monitoring Systems linked to quality assurance initiatives and Hospital and District Performance Assessments, Managements skills training Reflective case discussions/ regular updating 20

Clinical Governance Quality Improvement

Leadership Commitment Empowerment etc

Link with CPDMS

Non Clinical Service
Excellent Service

Radical Improvement Step by step improvement

Standardization

Quality Assurance and Accreditation

Health Needs -Clear aims, Indicators & Measurements, Monitoring System Field Assessment Job description/ focus patient care Clinical Standards/SOP

Medical care
Hospital Infection Control

Clinical care
Reducing Patient harms & errors

Nursing care Midwifery care

Reflective Case Discussion

Clinical Management Training

Standardization
Key Performance Indicators

Monitoring, feedback/ coaching

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Way Forward
PERSI role to assist the Nursing profession provide high quality models of care by : providing adequate managerial support, equipment, incentives, leadership and ensuring there is quality performance management (CPDMS?)
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