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International Perspectives¶View and visions for nursing: health care leaders speak out

2000; Wiley; Volume: 47; Issue: 1 Linguagem: Inglês

10.1046/j.1466-7657.2000.00008.x

1466-7657

K Stallknecht, Suzanne Gordon, Christopher Reeve, James P. Smith, Diana J. Mason, Linda Thomas,

Nursing Education, Practice, and Leadership

As President of the International Council of Nurses (ICN) I have the privilege of representing nurses globally. It has been my great honour to serve in this role as the ICN completed its first century and moved into its second. The first 100 years of modern nursing wrought remarkable progress based on the individual contributions of millions of nurses. For 70 years, the International Nursing Review (INR) has served as a beacon for nursing’s progress. Its new format as a quarterly, peer reviewed journal positions the INR to continue as a key resource for nurses in the new century. Our decision to recreate the INR as a peer reviewed journal grew from ICN’s deep commitment to increasing the knowledge base of nursing and improving nursing education. In the new millennium, evidence-based care will be increasingly important, especially in light of health care restructuring and the emphasis on cost-effectiveness. This reality demands that nurses investigate, observe, evaluate and record their work and the contributions they make to the health of their communities. Nurses must continue to conduct research and, as important, apply the results. We cannot afford to practice in a traditional way simply because that is the way we have always done it. We must continue to explore new technologies and methods and determine how to use them appropriately, effectively and economically to improve health. My personal desire is to inspire nurses throughout the world to go forward confident of their value and worth. We must not keep our heads down – we must proudly share credit for the achievements of modern nursing while continuing to strive to improve the health care systems in which we work. I urge you to use the pages of the International Nursing Review to describe your practice, and communicate your ideas, experience and research with your colleagues in all corners of the world. Shared knowledge, values, goals and ethical guidelines are the tools with which we will create positive local and global change. ICN’s 23rd president, Kirsten Stallknecht, began her nursing career at age 18. She became president of the Danish Nurses Organization (DNO) at age 30 and continued in that leadership position for 28 years. By reputation and strength, she is a formidable force in nursing and public life, not only in her native Denmark but throughout Europe and internationally. I want to express our sincere appreciation to all those who joined us in celebrating the inaugural issue of the redesigned International Nursing Review. We thank you for your written words. In future issues, the International Perspectives section will contain news items and commentaries of interest to nurses throughout the world. We welcome your ideas and input. Vivien De Back, Editor Whether they work in Boston or Bogota, Tokyo or Tehran, Marseilles or Melbourne, you can be sure of one thing – nurses’ work is one of the best kept secrets in the health care system. While it’s true that many people trust and like nurses, it’s equally true that few understand the complexity of nurses’ work; believe that nurses must be well-educated to do that work; and grasp the fact that caring for the sick and keeping the well healthy takes as much skill as the work that doctors do. Part of the problem of nursing’s invisibility lies with the media and political community’s traditional disdain or indifference to nursing/ women’s work. Doctors, hospital administrators, health policy experts and reporters aren’t the only ones who keep nursing work a secret. Nurses are some of the most ardent of secret bearers. Frightened that they will be considered to be ‘tooting their own horns’; that doctors will be angry with them if they break their traditional silence; or that they will be viewed as selfish if they ask for anything for themselves, nurses do not readily explain their work to the public. But if patients are to receive good nursing care and – most importantly – if health care is to be organized around care as well as cure, nurses must be secret sharers. What they must advertise is the content of their work. Nurses can do this by publishing in nursing, medical and other scientific journals. They can do this by reaching out to those health policy experts who claim to understand health care while, simultaneously, being utterly ignorant of nursing. And they can do this by aggressive campaigns to educate members of the media about their work. One of the most important things they can do is take advantage of everyday opportunities to educate those around them about nursing. In Tokyo, I spoke to a group of about 700 nurses. One of the nurses told me she had never really talked to her family about her work. She was always too busy caring for them to explain the care she gave to others. Now her children were grown up. Was it too late to talk to them about her work, she wondered? It’s never too late. The time to begin is now. When someone says, ‘Oh, you’re an oncology nurse, that must be so depressing’, tell them why it isn’t. If someone says, ‘Oh, I could never be a nurse, you do all that dirty work’, tell them how you changed the dressing on your patient’s prurulent chronic wound. But also talk about the conversation you had with the patient that allowed you to reach beyond her wound and into her life so that you could affirm her existence as a fellow human being. Tell them the story of the time you diagnosed a deflated lung because the first sign you noticed was that your patient had lost his sense of humour. Talk about how you encouraged the mother and father of a desperately ill infant to reach through the tangle of tubes and monitors to hold and rock that infant. Tell them about the time you cleaned a patient after he was incontinent. But instead of focusing on the dysfunction, describe how deftly you pulled the drapes around your patient’s bed so that his privacy and dignity was maintained. If your stories and actions bring you into conflict with physicians, administrators, policy makers, or even with other nurses, remember constructive conflict is at the heart of positive transformation. And so is public communication. Florence Nightingale said it best: ‘If we were perfect, no doubt an absolute hierarchy would be the best kind of government for all institutions. But, in our imperfect state of conscience and enlightenment, publicity, and the collision resulting from publicity, are the best guardians of the interests of the sick.’ Suzanne Gordon – a non-nurse – is a journalist and author based in Boston. Her latest book is titled Life Support: Three Nurses on the Front Lines. Her next book, written with Bernice Buresh and titled From Silence to Voice: What Nurses Know and Must Communicate with the Public, will be published this summer by the Canadian Nurses Association. Congratulations to the International Council of Nurses (ICN) upon the relaunch of the International Nursing Review. I am pleased to serve as the Honorary Patron for ICN. Nurses have been essential in maintaining my health and preparing me for recovery. I am lucky to have an outstanding team of nurses without whom I could not live my daily life. As somebody who unexpectedly became a member of a club I would not have wanted to join – the disabled – and as somebody who spent a lot of time in hospitals and has around-the-clock home care nursing, I know that nurses are the ones who really do the most for the patient. The doctors come and go. They handle literally thousands of patients, and even though they have the overall responsibility, the person with whom you develop the rapport, the person who can give you the psychological lift to get through a day when you may be feeling bad, the person who has to assess moods, the person who has to become a friend, the person who has to be calm in an emergency, the person who has to make the patient believe in himself or herself is the nurse. Nurses are really psychologists as well. They’re the ones who help you face reality. You may see a professional psychologist once or twice a week, but you rely much more on the staff you work with every day. I want to recognize the work of our nurses and thank them for their contribution in promoting good health in all of our communities. Millions of people around the world are restored to health and comforted in illness by the caring, compassion and expertise of nurses. Nursing is really a noble calling. Christopher Reeve, a distinguished actor and director, has been a quadriplegic since his catastrophic injury that occurred during an equestrian event in 1995. He is Chairman of the Board of the Christopher Reeve Paralysis Foundation ( http://www.paralysis.org) and Vice Chairman of the National (US) Organization on Disability. The relaunch of the International Nursing Review (INR) is very exciting and timely. It will certainly prove to be an authoritative voice for professional nursing internationally: for nursing practice, nursing education and nursing management. The content of INR will also be relevant to the work of other professionals and politicians involved in the planning and delivery of health care services worldwide. I have no doubt that the new International Nursing Review will become quickly recognized as a key resource for all nurses and a key reference source for researchers and scholars. All my very best wishes to the editor, editorial board and publishers for success with the new International Nursing Review in the journalistic and professional challenges ahead in the new millennium. Professor James P. Smith, OBE, FRCN is Founding Editor of the Journal of Advanced Nursing, Oxford, United Kingdom. Visions and heroism Over 100 years ago, some visionary nurses came together to form the International Council of Nurses (ICN). They knew the power of collective action and were prophetic in their understanding of the global context of nursing and health. Today, I believe they would be proud of the International Nursing Review, as the official journal of ICN and a vehicle for communicating about nursing throughout the world. Today, we are challenged with the legacy left by these international nurse leaders. What are our visions? I hope that our visions would reflect the diversity that we find in our profession, and yet, sound some common themes. One of my visions is that the profession and our world will come to celebrate the everyday heroism of nurses who are providing care to individuals, families and communities. Today’s health care systems in many nations are in turmoil. Costly, high tech care is increasingly embraced, while high touch care is minimized, sped up, or simply deleted as too costly. Heroism in nursing often entails committing ‘outrageous acts and everyday rebellions’ (a phrase taken from the title of a collection of essays by Gloria Steinham) to ensure that people are getting the health care they need. For most nurses, this means breaking the rules, speaking out, challenging institutional dogma, and taking other actions that put patients first. However, too few nurses are extending this heroism to local, national and international policy debates about health and health care. As we move forward in nursing’s science, let us not forget that we have a professional responsibility – and many would argue it is an ethical responsibility, as well – to influence and lead our communities’ and world’s efforts to promote the health of people through public policies that create and maintain health. I challenge the readers of INR to share with the journal their stories of heroism, whether they focus on the frontlines of patient care or in the arenas where public policies are made. Let’s embrace a common vision for nursing – a profession leading the way in caring for people and creating healthy communities. Diana J. Mason, RN, PhD, FAAN is Editor-in-Chief for the American Journal of Nursing, New York. Nurses of the world, unite. You have everything to gain from each other and noth- ing to lose. With its brand new look and with a different approach, the International Nursing Review provides the means for nurses working in incredibly diverse conditions to talk to each other on the record. Nursing is not easy work. It is sometimes painful, sometimes joyful, sometimes frightening, sometimes funny. At its best, the humanity of nursing is a powerful force for good in the world and in that context, to be a nurse carries awesome responsibilities. One of those responsibilities is to share information and disseminate knowledge so that nursing practice develops and the care delivered by nurses to their patients and clients improves. Sadly, the world has not come anywhere near to achieving health for all in the year 2000. It has achieved increasingly sophisticated communication networks. Such networks provide a powerful weapon in fighting the war on ill health. The power of the written word in providing a lasting record is formidable. Use it – because in doing so you make an important statement. When you read about nursing or write about nursing, you demonstrate a commitment to nursing. You become an active participant in that global force for good that is nursing. That is something to celebrate. From the United Kingdom, Nursing Standard salutes all nurses. Linda Thomas RN, is Editor-in-Chief of Nursing Standard, RCN Publishing, United Kingdom. The relaunch of the International Nursing Review challenges all of us to advance a healthier world in the new millennium. Much of the success of the last century is largely as a result of the early discoveries of Louis Pasteur, Robert Koch and others who identified germs as well as Joseph Lister’s introduction of antiseptic practices. The real advances were in the diffusion of discovery into practice – a diffusion facilitated by readers of this journal. The advances of medicine and health in this century will largely be from those outside the laboratory. We ought to strive toward a world with attainment of basic needs – adequate food, shelter and clothing – along with a basic knowledge of health or what we call, health literacy. The new ideal of health literacy links education with health. Health literacy is the ‘capacity of individuals to obtain, interpret, and understand basic health information and services necessary for appropriate health decision-making’. The ideal is that individuals have a contextualized idea of what constitutes and determines health and what actions they need to take to be healthy. Health literacy also means that policymakers and leaders outside of the health sector be aware of the social, economic and environmental determinants of health. Clearly, nurses have one of the greatest roles in influencing patients – injured, diseased and healthy – and nurses are key to developing health literacy amongst disparate publics. For example, some people might need to know about handwashing or to take a small dose of aspirin. Other patients may need to develop skills of caretaking and teaching of other family members. Such an idea of health literacy arms the individual to affect her personal health, those people in her life, and the environment in which we all live. Ideally, the International Nursing Review can advance the dialogue so that a critical health literate public emerges. Such people must have a basic understanding of personal health and hygiene AND know how to effect the community in which they live, in order to provide a health-friendly environment that includes appropriate services and preventive care. We now have the ability to lead in the development of an ideal 21st century – a century with a health literate public. Scott C. Ratzan, MD, MPA, MA is Editor-in-Chief of the Journal of Health Communication: International Perspectives. The journal focuses on promoting the vital life of the individual and the good health of the world’s people with presentation of research, progress in areas of technology and public health, ethics, politics/policy, and the application of health communication principles to the better health of individuals and communities. Médecins Sans Frontières (MSF) would like to congratulate the International Council of Nurses upon the relaunch of the International Nursing Review, a journal that has served as a forum for nurses of many nations for nearly 70 years. Although MSF was founded by a group of doctors and journalists 30 years ago, it is as a result of the commitment of the many nurses who worked and work for our organization that we are what we are now. MSF is one of the world’s largest independent organizations providing emergency relief. Last year almost 900 nurses worked in MSF teams in more than 80 different countries all over the world. MSF’s actions are first and foremost medical. However, the volunteers in the field also have the duty to speak out against human rights violations and war crimes that they witness. The courage, team spirit and dedication of nurses is critical to our success. Without their professionalism and hard work, MSF would not be able to accomplish the work for which it received the Nobel Peace Prize in 1999. MSF wishes the International Nursing Review a successful millennium in its new form and we thank nurses for their contribution to providing care to millions of men, women and children in danger, wherever they are, and helping them to regain control over their future. Dr Wilma Doedens is the Medical Advisor to field programs for Médecins Sans Frontières, Switzerland.