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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