MUNCHAUSEN SYNDROME

Do you remember factitious disorders in mental health. Factitious disorder is a serious mental condition where someone fakes an illness deliberately makes the symptoms more exaggerated, purposefully becomes sick or cause and injury with the main goal of assuming the patient's role. Factitious disorder can also happen when a family member or caregiver deliberately presents  others especially children under their care with fake symptoms, being injured or impaired in the view of obtaining material benefits or avoiding obligation or responsibility.

There are 2 types of factitious disorders.

1. Factitious disorders imposed on self - severe case is called munchausen syndrome
2. Factitious disorder imposed on another- severe case is called munchausen syndrome by proxy

The motives for these patients vary but there are a number of reasons such as: 

• attention achieved by being sick
• sympathy due to the illness
• emotional and physical nourishment and care given to someone who is sick or having a child who is sick (nurturance)

this can be distinguished form malingering disorder where the patient seek external gains such as disabilty payment or avoid specific duties or responsibilities, The diagnosis of factitious disorder can be made only after ruling out other psychiatric problems.

SYMPTOMS.

Factitious disorder entails an individual faking or producing illness or injury to lie to other and they can go to the depth to hid their deception making it difficult to diagnose the disorder. These individual will continue with their deception even without any benefits or reward even when there is a substantial evidence that doesn't support the illness.

The signs and symptoms :

• Convincing medical or psychological problem
• Extensive use of medial terms and the disease
• Inconsistent symptoms
• The condition getting worse for no apparent reason and it doesn't respond to normal therapy
• Seeking treatment from various doctors and they can use a fake name to get it going
• They seem reluctant in allowing medical professional talk to their families
• Frequent hospital admission
• Eagerness to have frequent test of perform risky operations
• Many surgical scars or numerous injuries
• Having few visitors while admitted
• ARGUING WITH MEDICAL PROFESSIONALS

For the case of factitious disorder imposed on another, someone falsely claims that another person has physical or symptoms of illness or actually cause injury or disease on another person with the intention of deceiving others. In most cases its the parent or caregiver harming a child or elderly person and can put the child or elderly person in serious danger.

In both cases they can fake illness by exaggerating existing symptoms of an illness that is existing so as to appear more sick or impaired. They even make up fake medical histories to the families, healthcare professionals like having cancer or AIDS. They will fake the symptoms to an extent of even faking seizures or fake an intense stomach pain you might think you missed a diagnosis of an inflamed appendix. These patients can cause harm to themselves by infecting themselves with bacteria to become sick. They can also inject themselves with feces, milk, they can injure or cut them selves. Some have been known to even take blood thinners, take diabetic medication just to mimic illnesses. They can go to an extent of contaminating their urine sample with blood.

patients with muschausen syndrome by proxy are known to switching medical providers frequently. They are experts in 'doctor shopping'. The perpetrator continues the abuse because maintaining the child in the patient role satisfies them  and the cure is to separate the child from the victim and in such a case this patient can again go ahead and harm a family member's child. This condition also affects the child as the child perceives that the only way they will receive love from the perpetrator is by playing along and pretending to be sick while in hospital to necessitate and admission.

warning signs for munchausen syndrome by proxy:

• A child with more than one medical problem which doesn't respond to treatment
• Unusually high lab findings that isn't in terms with clinical presentation
• Medically knowledgeable parents who are fascinated with medical details and hospital gossip, enjoys the hospital environment and is interested with other patients problems
• The suspected parent may work in healthcare of profess their interest in the same.
• The signs and symptoms of the child may lessen or vanish in the absence of the parent
• A patient who deteriorates whenever discharge plans are made.

There is also munchausen by internet where the patients with above symptoms seeks attention via the social media such as Facebook portraying some grave illness they can be posting about themselves or their children or family members but they deeply exaggerate their condition online.

PROFESSIONALISM IN NURSING. DO WE AS NURSES ADD UP TO THIS?

Understanding of the concept of professionalism in nursing, one need to first define the word profession. A profession is a chosen, paid occupation requiring prolonged training and formal qualification as described by Webster. Professionals should then display competent and skillful behaviors in alignment with their profession. What is meant when we say being professional,  this is the act of behaving in a manner defined and expected by the chosen profession.

The frame work of professionalism in nursing began with the mother of professional Nursing Florence Nightingale who set the bar rather high in regards to giving herself to others and her expectation of excellence in nursing practice. Florence Nightingale was an inventor, a visionary, a missionary and she delivered all with a commitment to passion and love. We as nurses, are no different. We hold the tremendous responsibility of upholding the values of our profession. Our core nursing values define the driving  force that dictates our beliefs and our behaviors. Nursing as a profession  has very unique values that can only be found among nurses globally such as honesty, pursuit for knowledge, responsibility for ones actions, belief in human dignity, equality in all patients and the desire to prevent and alleviate suffering meaning  that nursing profession highest desires are to help others in need to improve the quality of life for all same way Nightingale viewed nursing should be. In Kenya do we share the same vision as others globally or is nursing still a calling that those who believe its a profession are frustrated? Does the above values equate to your practice wherever you interface with patient, and this means also outside hospital and on social media? Professionalism in Nursing will always be judged in your personal behaviors and how you present yourself to ALL those around you and it through those behaviors, you will tell the world who you are.

What are these components of professionalism that we should always make sure we maintain them at all costs.

1. Your Attitude
2. Appearance
3. Willingness to help others

1. ATTITUDE
Attitude accounts for most when it comes to the image of nursing. As a nurse the way you view your world and portray that view to other matter big time. Right now you already have a picture of whom I might be talking about, that one nurse with a terrible attitude and always ensures that he/she the rest of the staff miserable and in most cases they are very successful in pulling every one into the puddle with them. Here is a little secret my dear nurses, people who behave that way are looking for attention and they suck everyone into to there drama so as to get attention and control their environment. The core principle of nursing profession is helping others not focusing on personal issues. Personal problems should be dealt with ate home not brought to the workplace. There are those nurse when they see students they see them as if they have come to reduce their workload, shame on you if your thoughts are in those line. Just because during your tenure as a student you were not given an easy time doesn't mean other should go though the same. If you are a preceptor Nurse i.e a student is under you observation take time and teach the student, I have observed this in Nairobi hospital, the attitude of nurses there above board and their nursing student, you will love their attitude towards what they are doing. A student with a bad perspective of nursing will always have attitude and will shame the nursing fraternity including YOU who is innocent. 

2. APPEARANCE

This is everywhere in the world of business and also social life. You will always be judged by your appearance whether socially or even in a workplace. Clean uniform, neat hair, clean flat shoes and a well groomed look makes the statement that you care about yourself as a person thus you have the capacity to care for others. Shady and sloppy people are seen as unorganized, lazy and uncaring since the can't care for themselves how will they care for other. Always remember that a little attention to how you look goes miles away to display your professionalism.

3. WILLINGNESS TO HELP OTHERS
I don't have a lot of experience in nursing but for the few years I have observed that nurses don't necessarily support each other as we should. We need solidarity in our beloved profession, instead what I see is more individualized approach, whereby we are more worried of ourselves than the whole profession. This also translates to our willingness to assist others, work together as a team as well as speaking positively about nursing profession as much as we can. Let us let go the negative energy so that the positive energy can grow in us since its us it affects if we don't. Always remember your nursing profession is wider and different than  your nursing job. There are times especially in the KNUN fb wall nurses tend to talk negatively about nursing profession because we don't like where we work and that you have control over. I appreciate that nursing is a tough profession physically, mentally and socially and with changes in economy the work environment will become more challenging.
To survive and thrive in nursing here in Kenya we have to pull together in the same direction as a profession and fight for representation in policy making in healthcare and other major health decision making organs in the government and the private sector. We should also pull together to ensure we get leadership/management positions that makes nurses representation be vital and of benefit. 
In conclusion, remember to always be in your professional character even in social media (kumbuka watoto wako tayari kupaka wauuguzi tope hata pasipo kosa).

In order to understand the concept of professionalism in nursing, we first need to define the word profession. Webster describes profession as a “chosen, paid occupation requiring prolonged training and formal qualification.”
Professionals, therefore can be defined as individuals expected to display competent and skillful behaviors in alignment with their profession. Being professional then is the act of behaving in a manner defined and expected by the chosen profession.
This framework for professionalism in nursing began with our early roots with Florence Nightingale who set the bar rather high in regards to giving herself to others and her expectation of excellence in nursing practice. She was an inventor, a visionary, a missionary and she delivered all with a commitment to passion and love.
We, as nurses, are no different. We bear the tremendous responsibility of upholding the values of our profession. Our core nursing values define the driving force that dictates our beliefs and our behaviors.
Nursing as a profession embodies many values inherent in those who pursue nursing careers. When nurses are asked to identify their core values, they are surprisingly consistent throughout the profession globally. They include honesty, responsibility, pursuit of new knowledge, belief in human dignity, equality of all patients and the desire to prevent and alleviate suffering. In other words, all of us as nurses have chosen this profession to help others in need and to improve the quality of life for all. That mantra has not changed since the days of Florence Nightingale.
So how does this transfer to the expectations of your practice wherever you interface with patients? Your professionalism will be judged in your personal behaviors and how you present yourself to all those around you, and through those behaviors, you tell the world who you are. Components of your professionalism include your attitude, your appearance and your willingness to help others. Let’s explore these a bit.
Attitude
Attitude in nursing is everything! The way you view your world and portray that view to others is everything. I am sure that you all can identify someone in your work environment with a terrible attitude that does their best to make the rest of the staff miserable.
Unfortunately, many times they are successful pulling everyone into the puddle with them. People behave like this because they are looking for attention and by sucking everyone else into their drama they get that attention and control the environment. This type of behavior is counter to the expectations of the nursing profession to focus on helping others rather than focusing on our own problems.
Personal issues need to be left at home and not taken into the work area. There are always going to be times when we face issues in our lives that threaten our positive outlook. I find it helpful to be grateful for everything I have. I believe that waking up in the morning is the best thing that can happen to me and the rest of the day becomes a gift.
I had the opportunity to meet a wonderful lady who lost her daughter to cancer recently. A tremendous lesson for her was to be grateful for every minute she had with her daughter and to convert the “have to’s” to the “get to’s.” When her daughter was depressed that she had to go for more chemotherapy, she reframed that to the fact that she “got to” go for more chemotherapy, which kept her alive for much longer.
If we begin to be grateful for what we have, our whole outlook on life changes and the way we relate to people becomes more meaningful. Be grateful because you “get to” be a nurse, you get to pick up your kids from sports, you get to go grocery shopping, you get to wake up in the morning - the list goes on and on.
Appearance
There is no way around the fact that people judge you by your personal appearance. Clean scrubs, neat hair, clean shoes and a well groomed look makes the statement that you care about yourself as a person and therefore have the capacity to care about others.
People that look sloppy may be perceived by others as unorganized, lazy, and uncaring. If you do not care about yourself, how can you truly care for others? A little attention to how you look goes a long way to display your professionalism.
Willingness to Help Others
What has amazed me in my nursing career for over 35 years is the observation that nurses do not necessarily support each other as we should. There needs to be solidarity in our profession, and yet, what I have observed, is a more individualized approach where we, as nurses, are more worried about ourselves than the whole of the profession. This translates into your willingness to help others and to work together as a team, as well as speak positively about your profession whenever you can.
Remember, your profession is different than your nursing job. At times we, as nurses, may tend to talk negatively about the nursing profession because we do not like where we work, and that you have control over. There is no question that nursing is a tough profession, both physically and mentally, and that with changes in the economy and the pressures of health care reform, the work environment will become even more challenging.
To survive and actually thrive in nursing, we will all need to pull together as a profession and begin by working together at the bedside and being great team players willing to support each other. Something magical happens when we give to others; wonderful things begin to come back to us in far greater ways than what we have originally given.
My parting message to you all is that nurses are the most trusted profession in the world, have so much to give. Show the world how wonderful we are by always putting your best foot forward not only for yourself, but for all of us in this wonderful profession! You go nurse!
- See more at: http://www.nursetogether.com/what-is-professionalism-in-nursing#sthash.wvPDk4UR.dpuf

MDG's, STILL A VISION TO KENYANS

Health is a basic human right and the new constitution guarantees all Kenyans the highest form of healthcare. However this remains just words in a book since Many Kenyans are dying from illnesses and conditions that are easily prevented and/or managed. They are dying because our government is yet to commit to ensuring every Kenyan receives quality accessible and affordable health care. You are probably wondering what I mean by  by quality, accessible and affordable healthcare!
QUALITY HEALTH CARE
When you attend a health facility there are stipulated protocols on how procedures are done and when there is a shortcut or modification it exposes both the service provider and you to more risks than the one you came to correct. In our country more than 80% of hospitals are poorly staffed, poorly equipped and have no infrastructure in relation to current norms and standards to add pepper, more than half of the facilities that were upgraded from dispensaries/health center status to hospitals in the last -4 years are still just paper work in government offices, the staff equipment and infrastructure remained the same. 
ACCESSIBLE HEALTH CARE
Every Kenyan must be able to access quality health care without challenges, i.e. We don't need to walk 20Km - 40Km to have access to a health facility. accessible health service can be achieved by ensuring roads are good and safe and the transport system are efficient e.t.c. The health facility must run for 24 hours every year, with enough staff to ensure it is efficient even at night. Citizens of Kenya this is your right to have all these in place just make the demand, health workers don't need to leave their workplace to help you realize these instead you go to the streets and demand for it as they continue working. We both loose if they go as we all loose our loved ones.
AFFORDABLE HEALTH SERVICE
The service being given should be affordable to the common Mwananchi. The BAMAKO INITIATIVE which Kenya is part of emphasizes on health care for all which should be of quality, accessible and affordable. Kenya is currently grappling with triple burden of diseases today i.e. 1) The infectious epidermic of yester-years (HIV/AIDS, TB,MALARIA) That is rapidly being overtaken by 2) Non- Communicable disease such as heart diseases, cancer, diabetes and injuries like accidents and assaults. 3) Mental illnesses that  insidiously coming up e.g. depression, use of drugs of addiction and personality disorders. However the government focus is stuck in the 90's with unbalanced focus on infectious diseases necessitating an increase in people dying of NCD's and injuries every year. It was only in the last times of the previous government that the minister of health and his colleague the minister for public health had Cancer when they realized that this disease have reached the top of the chain. That's why we are seeing many private hospital making cancer centers. Ask yourself this "in treatment of non communicable diseases do we have accessible and affordable health care?" Don't forget the distance you have to travel to confirm your diagnosis such that by the time you are diagnosed of having cancer, it has metastasize already or you are dead. This is just a tip of an iceberg, it gets worse, drug supply chain management in Kenya has been very poor before KEMSA was developed. There was a year where we lost Ksh. 500 million in drug wastage. Current events shows that up to 30% of medicines in Kenya are counterfeit meaning that instead being protected we are being exposed to toxic and poisonous products as result of inefficient government monitoring system. I Have to congratulate KEMSA for picking up but still its not trying hard enough to ensure efficient and effective medical supplies, since most medical equipment in public hospitals are well beyond there lifespan e.g the only radiotherapy machine in the country is 1970's model that exposes patients to excessive radiation and is prone to frequent breakdown thus a risk to patients. Overall,Kenya has 16 doctors per 100,000 population,3 dentist, 8 pharmacist and pharmacy technology, 1 degree nurse, 32 diploma nurse, and 96 certificate nurse, 16 clinical officers, 4 public health officers and 18 public health technician per 100,000 population each. According to WHO we are chronically understaffed and something must be done so as to have efficiency and effectiveness of quality accessible and affordable health care.. the current health staff needed as per the new staff establishment is 114,023 only 39165 position are filled meaning 74858 position remain vacant. Despite ever-growing challenges in the health sector, government investment in health sector as reflected by its budgetary allocation to health has remained a paltry 5% since the 1990's. The recommended percentage for African countries is 15% of the national budget (Abuja deceleration, which Kenya is a signatory) All these challenges in the health sector have impacted negatively on health service delivery making millennium development goals realization just a mirage. 
The fourth president of Kenya, His excellency Uhuru Kenyatta had a brilliant idea on reduction of child mortality and maternal deaths as we await to see the results, its just good on paper as the number of midwives is yet to be up scaled to a working number. We hope it will be done soon rather than later.

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A WORLD WITHOUT NURSES

Have you ever envisioned a world without nurses and ask yourself " WHAT WILL IT MEAN?" There are more than 7 Billion people in the world today but we have only 17 million Nurses, this number is already few compared to the population they are already serving every day. So ask yourself " In a world without nurses, WHY SHOULD YOU CARE?"

FEWER NURSES MEANS

• Your life could shorter. This is already experienced in third world countries especially Kenya where the life expectancy has been reducing drastically.
• You have higher chances of getting serious infections. Serious infections that are treatable and preventable will take our loved ones away from us. 
• You may experience more complications from surgery or hospitalization. These are situation that no one ever appreciates since nurses prevent patients from these complications that would others wise do more harm or even kill the the patients.
• Less nurses could mean life and death for acute care patients. acute care patients need a nurse the most since they require round the clock care meaning that the fewer the nurses the higher the chances of death for this patients.

Nurses can help you live longer, healthier and even happier lives. What is SECRET do nurses have to ensure that  their patients live longer, healthier and happier lives?

• Nurses care for people not conditions and they evaluate the whole person. The care from nurses focus on the whole well being of their patients, they don't just focus on the disease that has brought you to the hospital. Nurses view the patient in the bigger picture 'their life in general'
• Nurses Educate people. Nurse are constantly interacting with their clients and teaching them how to live healthy and better health seeking behavior.
• Nurses make prevention their priority. In a country that doesn't appreciate the few nurses they have  means they don't appreciate that nurses prevent the expected from occurring.

While technology and research advances so does the knowledge and intelligence of nurses from tertiary study and clinical placement to Continued Professional Development (CPD). This happens because education improves quality of care that's why we have nurses with PhD, Masters, Degree and Diploma.

Nurses are also getting older more than half the nurses in the world are over 40 yrs, 20% of nurses in the world will reach the age of retirement  in the next 5 years. Many countries share the same problem, the critical shortage of nurses. The USA will need 1 million more nurses by 2020, Australian official estimate90000 will retire by 2020, in the United Kingdom around 180,000 are expected to retire within the next 10years.In Kenya we have a chronic shortage with more than half the nurses retiring soon since there has been no better solution despite the growing population. That is nearly half of the nurses.

In a world without nurses:

• who will care for your loved ones?
• who will manage people with chronic illness?
• who will look after you?

WHY SHOULD YOU CARE?   YOU SHOULD. If your country has less nurses demand for more nurses don't really need to ask this for the citizens they serve. The citizens should ask this from the leaders they elected TO INCREASE THE NUMBER OF NURSES.

DYSLEXIA

It is a chronic reading problem. People with a learning difference like dyslexia may have trouble with reading, writing, spelling, math, and sometimes, music.

Experts say dyslexia has little to do with recognizing the visual form of words rather, the brains of people with dyslexia are wired differently, making it difficult for them to break the letters of written words into the distinct sounds of their language.

It can occur at any level of intellectual ability.
These people are visual, multidimensional thinkers who are intuitive, highly creative, and excel at hands-on learning.
That is, they do well in the arts, creativity, design, computing, and lateral thinking.

Dyslexia tends to run in families, and researchers have identified the genes that may be responsible for the condition.

Symptoms

People with dyslexia may have problems reading, spelling, writing, and pronouncing words.

Here are some early signs that are characteristics of people with dyslexia:

* Underachievement. It may be early or late in crawling, walking, or talking; appears intelligent but doesn't read, write, or spell at grade level; may be seen as not trying hard enough; may not perform well on tests despite a high IQ.
* Motor skills. Will have poor handwriting or trouble writing or copying. Poor coordination; does not do well at team sports. Difficulty with motor-oriented tasks. May be ambidextrous; confuses left and right, and over and under. Learns best through hands-on experiences.
* Language and reading skills. That is, gets dizzy, headache, or stomachache when reading. Doesn't read for pleasure. Shows transpositions, additions, substitutions, or reversals in letters, numbers, and words when reading or writing. Spells phonetically and inconsistently. Difficulty putting thoughts into words. May not like maths Math/numbers.
Difficulty learning to tell time or being on time. Can do arithmetic but not word problems. Trouble grasping algebra or higher math. Poor memory for sequences. Thinks using images or intuition, not words.
* Behavior. May be disorderly or disruptive in class. Is easily frustrated about school, reading, writing, or math. May wet the bed beyond appropriate age. Shows dramatic increase in difficulties under time pressure or emotional stress.
* Vision. May complain of vision problems that don't show up on standard tests. May lack depth perception and peripheral vision.

The most consistent thing about people with dyslexia may be their inconsistency, their skills and abilities may seem to vary from day to day.
A dyslexic child who can spell a word one day may be unable to spell it the following day.

An assessment for dyslexia includes reading or writing while the tester looks for signs of dyslexia, such as adding, dropping, or changing words; pulling words from other lines; or reversing or transposing words and letters.

While not diagnostic in itself, body language may provide a clue.
A person with dyslexia may frequently clear his or her throat, tap a pencil, or fidget during the testing out of anxiety about performing the test.

Dyslexia is a disorder present at birth and cannot be prevented or cured, but it can be managed with special instruction and support. Early intervention to address reading problems is important. Parents must understand that children with dyslexia can learn normally, but probably need to learn in a different way.

When you realise this, immediately visit the hospital with the child to help manage it.

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PAIN ASSESSMENT

This is how to best evaluate and describe your pain.
Use the acronymn, SOCRATES.

SITE:
Where is the pain? At what site is the pain at its maximum?

ONSET:
When did the pain start? Was it sudden or gradual?

CHARACTER:
How is the pain like? Is it stabbing, or like a burning sensation? Is it like someone 'standing on your chest'?

RADIATION:
Does the pain radiate (or move) from one part of the body to another?

ASSOCIATIONS:
Are there any other signs and symptoms associated (that come along) with the pain?

TIME COURSE:
Does the pain follow any time pattern? It is recurring or intermittent?

EXACERBATING FACTORS:
Does anything make the pain worse? Do you need to take any food or assume any position to lessen the pain?

SEVERITY:
How bad is the pain? On the scale of 1 - 10, can you rate the pain?

Get the best from your Nurse practitioner or MO  by giving the best pain assessment.

ENSURING THE SAFETY OF PATIENTS AND DELIVERY OF QUALITY HEALTH CARE

Quality is the optimal balance between possibilities realized and framework of norms and values. Errors pervade our lives in our homes, on the roads and in our place of work. In the hospitals setting health workers are also affected by near errors and the consequences of these adverse events. These health care errors and poor quality health care have affected all our lives directly or indirectly. Health and health care are very important and are among the basic pillars for a countries economic gains. There are also profound economic cost to a society if policy and action do not deliver optimum well being thus the government investment to health is a right they owe to the people who vote them in.

Nursing, the largest health profession is on of the main areas the government should invest in to ensure the delivery of Safe and Quality health to its people. Care provided by Nurses has the capacity to save lives, prevents complications, prevents suffering and save money and in order for the government of Kenya and her citizens to understand how nurses execute their responsibilities and roles it is important to under stand what nurses do exactly. It is so sad when I hear that an elected leader in Kenya can describe the role of a nurse in the hospitals as just giving drugs and injections and i bet he/she can't even survive through one day in a school of nursing. Let me shed some light to this political leader on the reasons why the content of his/her cranium is 99% water. Even for that simple procedure as Drug administration a lot happens, does this leader even know the 6 rights of a patient before a nurse administer that medication does this leader appreciate the knowledge content needed for the safety of the 6 rights. Away from the politician lets go back to patient safety and quality nursing care, an American journalist and nursing advocate, Suzanne Gordon, offers this summary to describe what a nurse actually does to ensure quality and safety to a patient:
"Using their considerable knowledge, [nurses] protect patients from the risks and consequences of illness, disability and infirmity, as well as from the risk  ans consequences of the treatment of illness. They also protect patients from the risks that occur when illness and vulnerability makes it difficult, impossible or lethal for patient to perform activities of daily living - ordinary acts like breathing, turning, going to the toilet, coughing or swallowing-  Nurses (MScN, BScN, diploma and enrolled) are constantly participating in the act of diagnosis, prescription and treatment and thus make a real difference in the outcome of the patients" .

This acknowledges the fact that Nurses have the biggest role to ensure quality of health care and safety of patients. A combined statement from WHO, ICN (International Council of Nurses) and ICM (International Confederation of midwives in March 2007 declared that increasing nursing work force capacity, improving skill mix and creating a positive workplace environments is critical in the general health of all nations. Despite this nurses in Kenya are being forced to work with insufficient staffing, overwhelming workloads and and inadequate skill mix resulting in avoidable deaths and injury thus many nurses abandon the profession creating chronic shortage of nurses thus compromising the health of the whole community. Insufficient staffing and overwhelming workload is one of the major causes of stress on the nurses leading to many error  with most ending up with the death of the patients. The only way to avoid this is by employing more workers and educating the community to practice preventive medicine. Inadequate skill mix or as i can call it career progression and addition of knowledge, this has been the worst area as the ministry hasn't been providing ways to motivate the nurses by having a clear path to career progression as many workers stagnate at the same job group thus the morale to work optimally.  On addition of knowledge, nurse have been having horizontal knowledge progression for decades with the top management being rigid to encourage  vertical knowledge progression as it is the trend in the scientific community (as you get fat get tall as well).

It is a high time the government starts to invest in nursing care since nursing does make substantial contribution to reduction in morbidity and mortality. Nursing interventions are cost effective through care and surveillance, education and interventions that prevent adverse outcomes and keep people well.  Investing in nursing care provides returns of better care outcomes and less use of expensive health care resources. These benefits extends beyond the wall of health care setting since those who recovered from or avoided illness can contribute to national productivity through participation in the community and the workforce. Despite the significance of nursing towards the health of their community they fail to acknowledge the values that nursing bring to their lives. Their is a risk to the community of loosing their loved ones if a nurse i overworked beyond limits of safety, has insufficient experience,  and less staff in the health facility. Thus the community should also be held responsible for the state of hospital near you because the community has the responsibility to ask for more workers and quality care in the health facilities that serves them. The leader especially the governor also has a responsibility to ensure that he has a healthy community with him any way he needs the numbers to be in that post so why not have accessible quality health care, why do they make health budgets that doesn't recognize the input from the nursing profession.

I have been talking about why we Kenyans need quality nursing care and the safety of the patients (our fellow community members). Now what do we require to so as to achieve all these according to the Australian Nursing Federation, 2009: 

• An adequate number of Nurses 

Nurse staffing levels of heath care setting have a significant effect on morbidity and mortality and the occurrence of adverse events, with higher staffing levels is associated with lower mortality, lower incidence of infections, decubitus ulcers, postoperative pulmonary complications, pneumonia and septicemia. 

•  An appropriate skill mix (proportion of MScN to BScN to Diploma to enrolled nurses)

An increase in registered nursing staff is associated with decrease in pneumonia,lower rates of "failure to rescue" and reduces incidence of death from shock or Cardiac arrest, GI bleeding, sepsis, deep venous thrombosis or pneumonia. Ensuring different proportion at each level of nursing is represented in the team the quality of care increases too. I congratulate KNH for realizing this.

• Nurses who are educationally and clinically prepared   

To produces nurses who are educationally an clinically prepare you need to make sure that they are always at pur with the current state health education through continuous professional development and awarding them scholarships to go out of the country and come with new better ideas towards quality care from other successful countries.

•  A manageable workload for nurses

Each additional patient allocated to nursing workload increases the likelihood of patient death; Increased over time is associated with urinary tract infection, decubitus ulcers, and increased workload with patients falls, respiratory infection and patients complaints. Nurses working shifts of 12.5 hr or more are three times more likely to make an error and working 40 hours a week increases the risk of error. Reducing nurses workload  by one patient per nurse (from 15 - 50 patients per nurse) is associated with several life saved per admission. There are also evidence that implementing nurse patient ratio to a good ratio of 1:4 is cost effective and requires a willing leader to ensure its implemented

• Provision of sufficient resources to enable nurses to deliver the best possible care

Each additional patient allocated to nursing workload is associated with a 23% increase in nurse burn out and a 15% increase in nurse burnout and a 15% increase in nurses job dissatisfaction. Insufficient resources, inadequate support and inadequate equipment are all associated with an increase in injuries to nurses, higher nurse turnover and an increase in errors .

In order for us Kenyans to achieve the dream of better quality health care we are all responsible, the community, the health care workers and the leaders. If health care isn't safe and of quality patients die and this affect even the government itself as productivity reduces. I urge everybody to take the responsibility with the current health workers strike.

As I wind up, to help enlighten the community members, health is your right and you can also go to the streets or go to court and demand why you are not receiving the essential service. as a citizen you can push for the employment more nurses to ease the workload and enable delivery on quality care and safety of their family. When a patient dies due to health workers error we are hurt but your families suffer the biggest, you deserve better ask for it. The next time you go to a hospital and find a very long line, tell your leader to do something about it. The nest time your family member dies in a line  since other dying patients were being attended to look for your leader, that's how much  your vote costs. Push for establishments of modern facilities, equipments and resources. Services such as ambulance services no health will ask that for your its in your docket to ask your leaders for emergency services in your community, ask your leaders for radiology machines.


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