Prepared by Chanak Trikhatri

Introduction “Nursing is a healthcare profession focused on the detail-oriented care of individuals, families, and communities in attaining, maintaining, and recovering optimal health and functioning” (1998 in Royal College of Nursing, 2003). According to International Council of Nurses (ICN) Code of Ethics nurses are the individual who need to provide unbiased, quality care to individual and nurses are responsible for devoting themselves to serve quality care regardless of age, sex, race, nationality, culture, socio-economic status, disability or illness and politics

Introduction

Health care is changing dramatically due to advancement of medical sciences and technology, the abundance of clinical research and higher demands of consumers (Chan, S. 2002).

As a key profession of healthcare, these changes represent a significant challenge to the nursing profession and nursing education (Paterson, C., 2009).

TRENDS AND ISSUES

•TRENDS ▫Movement in a particular direction▫Trends in nursing: Development of new direction in any

particular phenomena or discipline according to time, environment and situation (Bhattarai, S., 2010).

• ISSUES▫Different opinions of a particular subject▫Various health issues in nursing world- abstract and critical-

different critical diseases, violence against women, women’s health , status and rights (Bhattarai, S., 2010).

Worldwide Major Advancement in Nursing • 2000 - Review of undergraduate nursing education by

New Zealand Nursing Council• 2002 – The Nursing and Midwifery Council takes over

from the UKCC as the UK's regulatory body• 2004 – The American Association of Colleges of Nursing

(AACN) recommends that all advanced practice nurses earn a Doctor of Nursing Practice degree.

• 2004 - The Health Practitioners Competence Assurance (2003) Act comes into full power on the 18 September, in New Zealand, these cover the requirements for nurses to have current competences relating to their scope of practice (Bhattarai, S., 2010).

Advancement of Nursing Profession in Nepal

•Tribhuvan University – IOM (Maharajgunj Nursing Campus)- ▫MN (Adult) - 2001 ▫MN (Pediatric) - 2002▫Bsc-2005▫PhD- 2012

•Lalitpur Nursing Campus-▫Become independent from UMN – Jan. 2004▫Started MN (WHD) – 2009▫Started MN (Adult) – ▫Started B. Sc. Nursing - 2011 (Bhattarai, S., 2010).

• Pokhara Nursing Campus▫BN 2006▫MN-

• Chitwan Medical College▫BN, B. Sc. Nursing, MN – 2009

• Biratnagar, Birgunj and Nepalgunj Nursing Campus▫BN- 2011

• Birgunj- MN- 2012• National Academy of Health Sciences- BN-• Purvanchal University- BN- 2001, BSC- 2005• Pokhara University- • BPKIHS- MN- , BN- 2012 (Bhattarai, S., 2010).

Advancement of Nursing Profession in Nepal

•Kathmandu University▫Bsc Nursing- 2005▫BNS- 2010

•CTEVT- PCL 2000•Licensure Examination- 2012 (2069)•Midwifery Association- •Skill Birth Attendance-2006•UGC/ NHRC- Support and Fund Provided for

promoting and motivating Nursing Research (Bhattarai, S., 2010).

Advancement of Nursing Profession in Nepal

Contemporary Nursing

Currently, volatility in nursing profession is being huge challenge itself.

Challenges for Nursing profession are: • Aging population • Complex consumer health values• Scientific advances and specialization• Limited resources• Health as a fundamental right• Changing duties and responsibilities

(Bhattarai, S., 2010)

Global Trends and Issues in Nursing Profession

Evidence based practice Community based nursing Decreased length of hospital stay Independent nursing practice Cultural transitional Nursing care Rapid advancement in New technology Nursing shortage Increasing chronic health conditions (Bhattarai,

S., 2010).

Global Trends in Nursing Education

•Demands for more and higher levels of education▫Increased student numbers , programmes, diversity.

•Technologically sound and Knowledge based

•Abroad study certificates and distance learning facilities

•Career oriented and focused n higher education system ▫Finances , Faculties ,curriculum and facilities (Willetts,

A., & Martineau, T., 2004).

Global Trends Contd.....Simplification of comparison and transfer of credit

among educational programs .

Continuous professional development by changing student profile, trend to lifelong learning

Privatization of higher education: Competition between public and private institutions to attract students is increasing (Willetts, A., & Martineau, T., 2004).

Global Trends Contd.....Methodological advancement in teaching-learning

activities • Practical and clinical based learning • Promotion of self directed /active learning• More creative and interactive models• Assessment of learning is made more diverse and multiple• Integration of educational technology and the use of

distance learning

Nursing TRENDS in NepalStrength Improved image of nursing:

▫Enrollment of students in nursing with secondary school education and with better SLC results in English, Mathematics and Science is increasing

▫One of the most desired female profession (for example in 2007, BPKIHS received 1900 applicants, Bir Hospital nursing Campus received over 3000 applicants for 40 places...)

▫Promising career

Nursing TRENDS in Nepal contd.....

Expansion of employment opportunities for nursesChanging rolesAdvancement in nursing and biomedical researchAdvancement in nursing education: PhD in IOM,2012.Use of more sophisticated equipment for diagnosis and

therapyInnovation in Teaching and Learning Methods:

• Interactive, student centred, impact of technology , skill/ simulation lab, web module, PBL etc.

Nursing TRENDS in Nepal contd...Preparation of Global NurseEmergence of New SpecialtiesIncreased awareness among peopleNew start in nursing researchAllocation of budget in health :

2009/10- 5.8%2011/12-6.2%

Nursing TRENDS in Nepal cont.... Migration of nurses outside the country:

▫ According to NNC record a total of 3461 Nepalese nurses have gone abroad for nursing work from 2002 to October 2011

Shortage of nurses:• Rural areas • Qualified nurses• Extended, overtime shift

Aging population:• Population is aging• Unique needs of the elderly- Gerontological nursing

Changing environment and disease pattern • Non-communicable diseases: Heart disease, Cancer, Diabetes, Renal

failure, etc. are increasing Tutors working half day in public and half day in private

institution: shortage , low pay scale

Critical Issues in Nursing Profession of Nepal in Education

Under financing of nursing education: ▫Poor provision of residence▫Poor library facilities ▫Migration of expert faculties

Enrolment issues: ▫Difference in total academic years of various course.▫Implementation is being done to make 3 years BN

course.▫Plan is to shift PCl Nursing course from University level

to CTEVT

Critical issues contd....Nursing curriculum:

▫Gap between theories taught and actual practiceLack of doctorial preparation faculty to teach master’s

level ▫Less competent –unable to guide and supervise

subordinates▫ Educational level of many senior nurses is below or at

the bachelor level only. ▫Emphasis on the years of experience for promotion

requirement increases the possibility of occupying higher leadership nursing positions by nurses with less educational qualifications and less competence.

▫This ultimately, denies young capable nurses opportunity to provide dynamic leadership.

Critical issues contd.... Image of nursing itself in the society

• Taken more as an academic programme• Huge demand all over the world• Huge number enrolling in nursing• Readily chosen by girl with high social status• The entry level qualification to enter nursing is still

considered low as compared to other developing countries

Critical issues In Clinical Practice Poor evaluation system:

• Lack of performance appraisal• Lack of encouragement for sincere workers

Lack of quality of nursing service• Provision of affiliation without fulfilling requirements• Profit based market

Health service structure:• Very conservation in nature • Only doctors are placed in high policy making level in the

health structure• After government abolished Department of Nursing from The

Ministry of Health in the early 1900s, nurses have been denied of the right to manage and control nursing services.

• In the absence of common platform where nurse's voice could be heard collectively, the frustration continues.

• Further, only limited positions are included for nurses in health structure at the national , regional and district level that allows to take leadership role

Critical Issues in Nursing Administration

Poor job description and lack of autonomy• Even having established job description, poor understanding and

execution• Lack of proper specification and monitoring

Position of nursing leaders:• Who are in leadership positions are not given authority

that matches their responsibilities• Those having the authority sometimes, are unable to use it

adequately and appropriately in lack of managerial skills that should have been developed through leadership training and staff development programs

Lack of supportive legislation: B.Sc. Nursing , H.A and Staff nurse, affiliation

Increased work load Lack of recognition

in Nursing Administration

Apathy prevailing upon both leaders and followers:• Lack of proper staff development opportunities• The political scenario of the nation• Limited scope for holding top positions- Burnout

syndrome• Excessive absenteeism, rapid turnover, low productivity

and sense of helplessness - apathy and anger.Lack of assertiveness among nurses:

• Involves thinking through goals and acting consistently with own values

• Lack of self esteem has contributed to lack of assertiveness

in Nursing AdministrationHeavy political influence in nursing:

• Political parties-NAN and NNC• Political influence affects many facets of education. Mainly,

 it is used to start new private nursing education institutions without qualified faculty and with little control over quality.

Managerial problems:• Over centralized decision making and control• Limited authority to campus –course content , staff

management, limited authority of campus chief and inadequate teachers.

Critical issues in nursing researchLack of nursing journals and research

• Lack of evidence based practice Limited publicationsEthical issues in nursing researchLack of pure nursing research

Potential problem Shortage of skilled nurses due to migration

and absenteeism (Chaudhary & Hammer, 2003)

Lack of leadership and initiative (Chan, 2002).

Dependent profession (Garcia- Prado & Chawla, 2006).

Hiring the unskilled nurses due to lack of skilled nurses (Khowaja, 2009).

Potential problem contd.

Poor health care outcome which ultimately determined the nursing profession negatively

Physician dominant medical profession Poor salary, Risk of having problem in personal life Lack of interest, confidence and Continuous

Professional Development (Willetts & Martineau, 2004).

Resources Female parliament member (Ahmed & Shaikh,

2008). Social inclusion Education and interest of education Social and non governmental organization Skilled nurses

Existing Nursing Role Globally • Nurse Practitioner • Clinical Nurse Specialist• Nurse Midwifery

Practitioner• Certified Registered Nurse

Anesthetist• RN-First Assistant• Nurse Case Managers • Nurse Entrepreneurs –Nurse

Led Clinics• Forensic Nurse• Nurse Legal Consultant• Nurse Educator • Nurse Scientist• Nurse Administrator

In Nepal• Care giver • Teacher• Client advocacy • Change agent • Counselor • Leader • Manager • Researcher • Communicator

Factors Influencing contemporary Nursing Practice •Science and technology

•Legislation•Public misconception: Low professional status stigma •Nursing shortages•Lack or absence of sufficient support of staff• Inadequate staffing•Financial constraints: left for better opportunities and

higher paying jobs, underpaid •Heavy workloads and stressful work

Solutions or opportunities

Proper provision and evolution of the nursing profession

Continues Professional Development Implementation of multidisciplinary team Increment in salary Rewarded the personnel for motivation

Nursing in futureNurses’ role will Continue evolve: The evolution is continue to provide for the foundation for the scope of practice, education and research necessary for nurses to lead and manage the health care environment of future.

Science and technology: Nurses will continued to manage technology. They get Skill in use of more sophisticated equipment for diagnosis and therapy.It helps:

Allow easy access to patient information Easy recording of patients’ treatment needs, patient’s progress,

medication and diet needs Ease of communication with hospital facilities Ease in data collecting and obtaining information Increase the knowledge and maintain high quality patient

centered self care to individuals , families and communities. Increase of health problem to be detected and performed

quickly

Empowerment in Nursing: Greater independence, autonomy, increasing respect in the profession and increase in the “power of nursing” also resulted to expansion in the role of nurses . Their involvement in decision making of health policy and politics will be increase more which empower nurses and will also lead to advancement of nursing profession .

Expansion of employment opportunities for Nurses : e.g. healing touch, therapeutic massage, use of natural herbs and vitamins And in outpatient facilities such as day surgery rehabilitation ,chemotherapy infusion centre, home care like older persons with disabilities, consumers preference for care in his/her own home.Emergence of Complimentary and Alternative Medicine:

accupuncture etc

Cont……..

• Consumerism in Health care: means different things to different people with different interests. In its

truest sense, consumerism is “a movement seeking to protect the rights of consumers” and engage the client in health consumption. like health insurance

• Nursing service should be cost-effective and can be the vital component of the “alternative setting “ movement

• Web-based Nursing Degrees: Online advanced degree programs have multiplied rapidly in the past few years. It is now possible to get a master degree on line.

• Nurses must work to acquire the skills necessary to successfully meet the demands of these emerging roles

• Nursing and Biomedical Research Scientific and technical research Evidence-based practice

▫ Integration of best research evidence with clinical expertise and patient values

▫ Accurate and well-informed decision making▫ More safe treatment and healthcare information

• Improvement in the standard of the nursing profession▫ Nursing curricula▫ Nurses’ and rights▫ Professional development ▫ Professional organizations

• Nurses should practice to the full extent of their education and training. • Nurses should achieve higher levels of education and training through

an improved education system that promotes seamless academic progression.

• Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in Nepal.

• Effective workforce planning and policy making require better data collection and information infrastructure.

• As we talk on Modern Nursing ,We the nurses have misunderstood the scope of our profession .

Conclusion In order to establish the respect for the profession and quality of the care, the hospitals and government have rigid authority and regulating body and should provide CPD (Continuous Professional Development) program and rewarded the personnel for motivation.

However, unsafe work environment, lack of political stability, high workloads, poor payment, and job dissatisfaction burnout respect of the nursing profession.

References Ahmed, J. & Shaikh, B. T. (2008). An All Time Low Budget for Healthcare in Pakistan.

Journal of the College of Physicians and Surgeons Pakistan, 18(6), 388-391.Bhattarai, S (2010). Trends and Issues in Nursing. 1st Edition. Dillibazaar: Makalu

Publication.Chan, S. (2002). Health and Nursing Policy Issue: Factor Influencing Nursing Leadership

Effectiveness in Hong Kong. Journal of Advanced Nursing, 38 (6), 615-623.Garcia- Prado, A. & Chawla, M. (2006). The impact of hospital management reforms on

absenteeism in Costa Rica. Health Policy and Planning, 21(2), 91-100.International Council of Nurses (2000). The ICN Code of Ethics for Nurses. Retrieved on

10 June, 2010, form http://faculty.uccb.ns.ca/sburrow/courses/resources/icncode.pdfPaterson, C., (2009). Get a Free Forum at Webs.com! Retrieved 12th July, 2009, from

http://www.freewebs.com/change-project/apps/forums/topics/show/780576-attitudes-toward-the-profession-of-nursing

Royal College of Nursing. (2003). Defining Nursing. Retrieved May 23, 2009 from http://www.rcn.org.uk/__data/assets/pdf_file/0008/78569/001998.pdf

Willetts, A., & Martineau, T. (2004). Ethical international recruitment of health professionals: Will codes of practice protect developing country health systems? Liverpool: Liverpool School of Tropical Medicine. Retrieved May 23, 2009 from www.liv.ac.uk/lstm/research/documents/codesofpracticereport.pdf

Thank you all !!!

Any Question???