Returning Nursing to Nightingale: The Bigger Picture of MainstreamingKenya-Nursing Process

Abstract

Application of all Nursing Process steps as a standard practice in nursing at national scale is a very rare occurrence in clinical practice and in nursing literature. This paper presents lessons learnt in the bigger picture of mainstreaming Nursing Process within a public sector context at national level covering issues on policy, financing, training, implementation (practice and management) and effects. It discusses Nursing Process in context; structuring discussion in a way integrating nursing theories, facilitating professional empowerment, ensuring higher quality nursing care, and nursing visibility and contributions in healthcare delivery. Based on practical experience in integrating Virginia Henderson’s need theory, Orem’s health systems theory, total nursing care and team nursing within Nursing Process, it suggests replacement of medical model paradigm with caring model paradigm to facilitate effective independence and meaningful dependence and interdependence in nursing operations. Thus significant organizational cultural shift is proposed. Nursing Process is presented as the principal vehicle propelling nursing profession and practices forward, sampling success stories that demonstrate effectiveness and improved patient care. On standardization of nursing language, new innovative ideas under Nursing Process steps of assessment, diagnosis, planning and documentation are presented with suggestions of a new approach in measuring Nursing Process implementation using Benner’s “stages of clinical competence” scale, focusing on levels of knowledge and skills in Nursing Process. In that thinking Nursing Process implementation is likely to succeed through challenges, especially when competency level is reached and surpassed; notwithstanding exogenous challenges such as restructuring in a health system or a political system that bear influence on nursing operations. It is proposed that nurturing Nursing Process implementation through training to competency level within the premise of “totality of knowledge and experience” is critical in achieving reasonable nursing visibility in clinical settings, enhancing quality nursing care, and ensuring sustainability through the principle of critical mass. Thus a significant shift from developing individual nurses in single bits to collective development of a nursing workforce in Nursing Process must be made, availing a committed and cohesive critical mass of nurses working towards achieving desired professional and organizational goals despite challenges; promoting Nursing Process practices to the level of organizational culture in healthcare delivery. This requires time, resources, commitment and above all, strong and focused leaderships in nursing.