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Opinions of Wednesday, 8 July 2009

Columnist: Asigri, D. Z.

Nursing in a disreputable state!

As a health care professional with a nursing background I feel ashamed and humiliated whenever I read and reflect over Francis Kwaku Egu’s feature article of 2-6-2009 (Nurses in Korlebu and Akomfo Anokye Hospital: Why are some abusive?) Is it the case as the said article has shown, that nursing care delivered to patients in these two well noted University Teaching Hospitals that he observed (and possibly other hospitals) are in my view, shambolic and reminiscent to Dickensian era? What is rather baffling is the continuing silence by the nursing authorities within the said hospitals and above all, the Nurses and Midwifery Council of Ghana (NMC) as well as the Nurses Trade Union, on their failure to comment on the damaging issues raised by Francis Kwaku Egu article. There is a popular saying that ‘silence means concern’! A month has elapsed and yet no one within the nursing establishment especially from the clinical and managerial sectors has challenged the allegations made against the profession generally and this in my view does not augur well. I therefore take this opportunity to register my appreciation to Francis Kwaku Egu for his courageous effort in bringing this problem to the fore of all good thinking health care professionals in Ghana and the world as a whole. Francis, I thank you a million times! I would hate to pour scorn over some of Egu’s observations on nursing practice given in Korlebu or Akomfo Anokye Hospitals neither would I wish to be seen as being professionally biased or defensive rather than adhering to the principles of objectivity as a health care educator/researcher. But wow! wow!, in his opening paragraph, Francis Kwaku Egu candidly recognises the difficulties surrounding the nurse as a ‘person’, and nursing as an ‘art/science’ profession commends that, “...these nurses are in fact angles who will go to any length to support patients. Some even settle medical bills for poor and needy patients”. What an electrifying comment, Egu! Another issue of extreme professional concern raised by Egu is his assertion about the attitude of some nurses, that, “...they also exhibit violent behaviour towards patients to compensate their frustration”. What a chilling description that is!

In this article, Francis Kwaku Egu attempts to highlight on some deplorable incidents that he observed in the two major teaching hospitals such as overcrowding and poor management in relation to patient care. This observation cannot be wholly denied and I believe that our listening government led by Prof. Mills would not let wane his election manifesto in connection with health care provision in our country in this era. The suggestion that I would like to make to my colleagues at this point in time, is for the Ghana Nurses and Midwifery Board as well as the Nurses’ Trade Union to critically examine the urgent needs required that would enhance quality patient care. The important findings can then be directed to the responsible ministry for the appropriate action. Perhaps it can be argued that, that has been done on numerous times dating back to the now defunct NPP government but, there is no harm in continuing ‘drumming’ the key issues into the ears of the NDC government in the name of advocacy! We have to remember that quality patient care is a core nursing activity but the time and energy devoted to it, and hence the effectiveness that ensues, can vary considerably. In addressing any inadequacies or obstacles to the authorities, would it be unreasonable to write a conceptually well-structured review of the problems, not just a list of unorganised summary of professional issues in search of magnanimous attention? In fact, it is no good in us crying over spilt milk at this stage! The reality is that nursing education and practice has been brought into disrepute, and there is a need for a cleaning up of the entire system to include both the pre-post registration training programmes. Not an easy task, though! Citizenry has to be convinced by us taking drastic and radical action in place of the sloppy nursing techniques described in the above feature article in order that the nurse and nursing generally can be ‘trusted’ once more by Ghanaians. Indeed, any decent citizen who heard or read about the poor caring practices being meted to patients in the above hospitals and perhaps in other hospitals around the country would be appalled. A comprehensive health care system is therefore urgently needed to reassure the general public about the failing nursing standards in our hospitals, and I believe that our new NDC government can and will do it! As a registered nurse, it has been shown that he/she is responsible and accountable for her/his own practice and for the safety of his/her patients. From personal experience, in choosing to nurse or to help, where one’s role is to pay attention to someone else’s needs, one is entering into a relationship that is different from the normal and every day. There are times when it seems barely worthwhile, perhaps because one is battling against the odds or because the client and or patient is ungrateful, or because one feels drained and have seemingly nothing left to give. In times of stress it is sometimes easy to keep one’s head down, to ‘get on with it’ and not take time to reflect. Organisations, teams and individuals can collude with this attitude for a variety of reasons, including external pressures and internal fears of exposing one’s own inadequacies.

An alternative view point is that, nurses are required to work with a variety of people from different socio-cultural backgrounds. Two essential components of nursing are that the nurse is able to build and maintain helping and therapeutic relationships with patients and work as a member of a team. When caring for patients, or working with colleagues, nurses need to interact effectively with people at different levels. The curriculum provided enables the nurse to develop knowledge, skills and attitude to face up the challenges embedded in the caring process. It is argued that as the nurse becomes more aware of his/her own strengths and weaknesses in the care setting, the nurse would be able to understand her/himself and others and so be able to work and care for people from diverse cultures without a hindrance.

The view that I hold dearly is that, in nursing whether you work in a team, or have a leader in a group or peer group, it is important that regular attention is paid to the dynamics that are operating within the process. Within the group it is important to create a balance between focusing on the task, the individuals within the group and the group maintenance activities. The task needs will centre on say, the patient’s improvement by group members. The individual needs include professional development, support, reassurance, approval, acceptance, etc. The group maintenance needs includes issues of competiveness, rivalry, authority, inclusion/exclusion, sub-grouping, etc. Furthermore, whichever way a nursing team or group decides to manage their own dynamics, it is important to remember that the time to start focusing on what is happening in the process is when things are going well and not wait until the team is in a crisis (as in the allegations levelled against nurses as shown in Fracis Kwaku Egu-2.6.2009 feature article). There is a need to note too that, when the levels of conflict, hurt and fear rises it becomes much more difficult to see what is happening and to risk making changes. However, for some team of nurses it is only when they hit a crisis as identified in Egu’s article that, they create the motivation to face what is happening and sometimes, ‘crisis create the heat in which new learning can be forged’ (Hawkins 1986).

Furthermore, let us bear in mind that contemporary nursing, flourishes most in a learning development culture as I have shown above. It is built in a belief system that a great deal of the work in all caring professions is about creating the milieu and relationships in which patients and clients learn about themselves and their environment in a way that leaves them with more options than they arrived with. Further, it believes that caring professionals such as nurses are best able to facilitate others to learn if they are supported in constantly learning and developing themselves. Please wake up and be counted!!

Asigri, D. Z. (EdD)

Senior Lecturer

Practitioner Researcher

Middlessex University