Once again, DailyNurse is publishing a series of blog posts on nursing issues in the developing world by MScN nursing students at the Karachi, Pakistan campus of the Aga Khan School of Nursing and Midwifery.
These articles were written as part of a class assignment that involved composing and submitting short research articles for publication in a recommended nursing blog or journal. The object: to help them hone their English language communication skills as future nurse leaders in Pakistan’s healthcare system. As their instructor put it, one of the goals of the exercise is to encourage nursing students to become “Change Agents” in healthcare settings and the world. DailyNurse thanks the instructor and all of the Change Agents who submitted articles. We hope you will find the selected posts informative and thought-provoking.
The word “Nurse” is a noun and a verb, which means care or to care. Care includes showing interest and concern for a patient’s issues, and providing them with supervision and protection. The most important feature that differentiates nurses from other health care professionals is the quantity of time and quality of interaction that we share with our patients.
In the context of developing states like Pakistan, the majority of nurses face the issue of short staffing and extended duty hours. However, we must make time for showing concern for patients and therapeutic communication.
Therapeutic communication is of paramount importance in nursing. Many nursing theorists have discussed the various aspects of nursing communication. Hildegard Peplau described phases of the nurse-patient relationship to make it successful. Her phases include the orientation phase, working phase, and termination phase. But the issue is that there are always workload and time limitations for nurses to complete the task. Hence, as a traditional practice nurses used to spend most of their time in the working phase so they could complete their assigned duties within the time of their shift. Painfully, in this scenario patients can feel neglected due to lack of attention from the nursing staff.
In the above scenario, it is difficult to hold anyone held responsible for the lack of therapeutic communication and caring practices for patients. Nurses often claim that due to work overload they are simply unable to communicate effectively with patients.
The way forward
Therapeutic communication is one of the foremost important components to provide holistic care to patients. So, it must be considered a specific assignment rather than merely a simple talk between a nurse and a patient. Patients’ concerns and apprehensions must be addressed as a priority.
Bedside nurses must be provided with equal opportunities for participation in policymaking to enhance the application of policies in the practical arena.
Educators, supervisors, instructors, and researchers must have certain fixed clinical hours so they could discuss practical issues from their different perspectives.
There can be specific tools to assess the quality of the interpersonal relationship between nurses and patients.
Apart from vitals monitoring and medication, the specific role of counseling and discharge needs to be assigned to nurses to enhance patients’ level of satisfaction.
Different strategies can be applied to eliminate the communication gap between nurses and patients for instance there must be grouped training sessions to guide patients about their disease process and self-care regimes.
Although every patient is an individual and needs undivided attention it remains difficult for nurses, especially those in public sector hospitals. Most of the time one or two staff nurses are responsible for the whole ward. So, in such scenarios, pre-planned educational sessions can be helpful for both patients and nurses to create awareness in patients.
In Pakistan, the pandemic did little to raise the profile or status of the nursing profession. However, it does seem to be inspiring a movement among nurses and even physicians to reform the conditions that are hampering the work of nurses and the well-being of patients.
Back in April 2020, in an editorial in Pakistan’s Daily Times, Dr. Ghulam Nabi Kazi wrote, “In practice, nursing remains a neglected and least preferred line of work, despite the noble duty performed towards the treatment and quick recovery of patients, post-operative management or specialized interventions. Ninety (90) percent of nurses are females working in a highly misogynist culture, [who are] liable to sexual harassment and treated sub-optimally. They are often encumbered with long working hours, low wages, and poor career or promotion prospects or perks in comparison with officers with similar qualifications in other cadres.” Events and occasional editorials in Pakistani media sing the praises of Florence Nightingale, but in practice, low pay and lack of respect are driving a “brain drain” exodus of dedicated nurses to move to Kuwait or venture even further to find better treatment and higher salaries.
In this letter, Faryal Ghafoor, a Pakistani nurse and an MScN student at Aga Khan University School of Nursing and Midwifery outlines the key issues and the solutions nurses are pursuing to modernize the profession in Pakistan.
Despite our rigorous education and training, in developing nations like Pakistan, the respect for the nursing profession is little higher than it was in the West before the advent of Florence Nightingale.
Because in Pakistan the role of nurses is poorly defined, the general public has many misconceptions about the norms and values of the profession. The public views a nurse as a sort of servitor who dispenses medication on the orders of a doctor. Other roles of nurses are altogether ignored, and in the public sector, our ability to act as caregivers is often rigidly constrained by outdated mores and traditional practices. As a result, nurses are often unable to utilize their education to provide counseling, engage in advocacy or collaboration and remain restricted to the administration of medication.
A waste of an educated labor force
Many traditional and ongoing practices cause nurses to be overwhelmed with responsibilities that reduce the time they have to care for patients. In addition to performing inventory on supplies and managing staff, a nurse on a unit assists not only CNAs but ward attendants, Aya, and sanitary workers. The unavailability of service structure and monotony of tasks reduces the time they have to treat patients and—adding insult to injury, a nurse working in a Public sector job often ends up retiring on the same scale on which s/he was first appointed.
The perception of nursing as a profession designed to serve actual health care providers may correlate with the gendered nature of the profession in Pakistan. We are seeing more male nurses entering the profession but there remains substantial resistance and misconceptions about male nurses are almost as troubling as those about female nurses.
The impact of the commercial nurse education industry
Another significant issue that needs to be addressed is the burgeoning number of private nurse education programs. Despite the labor, long hours, and low pay, limited employment opportunities in Pakistan make nursing a highly attractive career option and as a result, private investors are cashing in by building new nursing schools to meet the demand. Unfortunately, their primary concerns revolve around profit and the bottom line, and the quality of education often seems to be an afterthought.
This is high time to bring reforms in Nursing Profession. There is a need to construct a positive image of nurses, without deconstructing the traditional image, the progressive image of nurses, and the quality of their services.
How can we improve conditions and keep nurses in the country?
Following are a few suggestions to reform the role of nurses, increase respect for the profession in Pakistan, and improve the conditions that are driving talented nurses to seek employment in other countries:
There must be a clear job description for nurses. There must be different domains of ward administration to look after the affairs of inventory, supplies and staffing. Nurses should be dedicated to patient care.
Nurses should use social media platforms to convey their values and concerns. By speaking out, they will help the public better understand the roles of nurses and the nursing profession.
There must be accredited courses of therapeutic communication in nursing to familiarize and encourage student nurses to communicate with patients. Thus, the gap between patients and nurses can be eliminated.
There must be specific tools to evaluate the care provided by nurses to patients. Nursing is a unique discipline. So, there must be a separate and unique audit system to assess and evaluate Nursing skills.
There must be criteria to include ongoing training programsspeak in every Nursing institution to meet the learning demands of nurses and to keep them updated about advances in knowledge.
Government lawmakers need to formulate service structure policies for the upgrowth of the nursing profession.
