NURSES are often underrated due to social stigma, insufficient knowledge or just pure misconception of their role.
In 1966, Virginia Henderson (1897-1996), an influential nurse, researcher, theorist and author in the United States who is famous for her definition of nursing, wrote: “The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge.”
In the 21st century, nursing is a global profession and nurses are getting attention for both the right and wrong reasons.
One such instance of the latter is the letter “Family members doing nurse’s job” (The Star, May 25). It sounded like a complaint, so I read it in full and noted the key grievances as:
1. A patient in a government hospital had to have someone (sister) take care of her because the nurses couldn’t do the job;
2. The writer said she’d heard that patients need someone to take care of them when they are admitted to government hospitals. She said she had seen people along the corridor of wards waiting with mats to take care of their loved ones; and
3. Nurses said they were too busy with other duties so they could not take care of the patient.
The writer then threw rhetorical questions about the nursing profession.
As a nurse leader who has been associated with Malaysian nursing for almost all my life, I will expose the falseness of the claims made by the writer from an academic and professional point of view.
First of all, I would like to acknowledge that government/public hospitals are very busy mainly because of lack of staff. The staffing ratio in Malaysian public hospitals is quite low. However, more nurses are being produced so we expect the situation to improve in the near future. This issue involves politics, the Health Ministry and making major policy changes, which is a time-consuming and complex process.
All of the key points I sorted out from the letter are serious accusations and, with proper evidence, can be investigated. However, no evidence was given or mentioned. It was more like “I heard”, “It seems”, “ If so”, “It is supposed to be”, hence, from a legal standpoint, this is a blatant propaganda against nurses.
When patients are admitted into a public hospital, they pay for their treatment and nursing services. So, in modern nursing practice, we refer to patients as “clients”.
Nurses nowadays need fulltime education and supplementary training in order to be able to perform all the necessary procedures.
To treat patients at the bedside, nurses require a licence and practising certificate. Certain procedures like venupuncture and particular specimen collection need specially trained nurses to perform.
A hospital’s management body knows that these are the legal boundaries that must be followed in order to maintain the standard of care. So the claim that patients would need their family member to take care of them all the time is simply not true.
The question that may arise is: “Is involving family members in patient care unprofessional or against nursing policy?”
To answer this, I refer to the 1998 Code Of Professional Conduct For Nurses published by the Nursing Board of Malaysia.
Under the chapter “Professional Nursing Practice”, article 1.1 Respect for Patient, it is clearly stated that “The nurse works cooperatively with the patient and his family and respects their decisions about his care.”
What this means is that nurses can involve family members in patient care. The issue here is the degree to which family members can be involved.
This pertains to basic activities of daily living (ADL) and procedures that must be continued at home after discharge from hospital and can be performed by the relative of the patient. This person must acquire the skill to perform these activities and procedures on the patient at home.
For example, for a patient with tracheotomy who requires tracheotomy suction (a sterile procedure) at home, the family member needs to learn from a nurse how to maintain sterility and avoid contamination before performing the procedure at home. This comes under the nursing role as educators.
For ADL, most patients feel comfortable when a person familiar to them helps them to perform the tasks. For example, most male patients do not feel comfortable with a female nurse helping them to change clothes so they often ask for a relative or a male nurse for assistance. We therefore encourage family member involvement in patient care to some degree.
People need to understand that nursing care is “personalised”, meaning that if a partially paralysed patient can use some of his limbs to perform daily activity, nurses will only perform the activities which the patient cannot do. If the patient can walk by himself, we will not offer any walking aid (unless walking is contradicted upon diagnosis). If a patient can use his hands to eat, the nurse will not spoon-feed him (unless indicated).
The goal of nursing care is to make patients as independent as possible. Our body joints and muscles have an atrophic nature so if we don’t use them, they would gradually lose functionality, resulting in even more complications.
There is a remarkable difference between a maid and a nurse. A maid will do almost everything for the patient, but a nurse will do only what is necessary and related to health. Most people do not understand this, and that is why there are criticisms and propaganda against our noble profession.
I would like to reiterate that nursing is not similar to a maid’s or caregiver’s job. We have to educate our people that nurses are one of the major workforce in the healthcare industry.
We are not only making a good name for ourselves but are also earning a lot of remittance from working in many foreign countries, especially the Middle East, and strengthening the economy of Malaysia.
I also welcome the Public Service Department’s announcement that there would be no moratorium on the intake of nurses into government service following a request from the Health Ministry. I would like to thank and congratulate the Health Minister for this timely decision.
Professor Zahrah Saad
Faculty of Nursing and Midwifery