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Addressing barriers of nursing and midwifery practice autonomy in Ghana

George Yaw Segnitome | Doctor of Community Public Health | Part 2/2

Diminishing opportunities for training, education and professional development The Nurses and Midwifery Board of Australia14 states that nurses in general practice are required to undertake professional development. Midwives too. The accreditation standards of general practices in Australia also require nurses in general practice to be actively participating in continuing professional development and therefore infers a responsibility of the general practice to ensure that this occurs13. The Nursing and Midwifery Council of Ghana stresses continuous professional development (CPD) and this is contingent with the renewal of professional identification numbers (PIN). That notwithstanding the opportunity to go for further training in the area of long programme is dwindling. Informal information reveals that managers of Ghana Health Service (GHS) no longer sponsors nurses and midwives making advances for degree and masters programmes. Some hold the view that the levels do not bring value. Others say funds are not available to support long courses. In the contrary, undertaking education and training and credentialing provide nurses with additional skills to provide wider ranging care and to feel more confident about their role13. Similarly, frameworks for education and career pathways have been found to enhance the development of nurse-led care in the United Kingdom and New Zealand13.

Formal (policy, practice, statutory) barriers limiting services provided by nurses and midwives Regulations concerning whether or not Nurse Practitioners (NPs) can admit, manage, and discharge patients in a hospital are inconsistent and not always clear. Facility policies may interpret the requirements of the law as restricting NPs in independent practice regarding patient admission to, treatment in, and discharge from health care facilities; even though NPs are authorized to perform these functions in a separate portion of the Arizona Administrative Code. Within Yavapai County, Arizona, there are four hospitals –one federal, one rehabilitation, and two acute care hospitals13. Of the four facilities, the federal facility provides the most independent practice environment by far, in that it permits NPs to evaluate and treat patients in the outpatient, inpatient, and emergency room setting. With reference to the latter assertion, it is possible to make policies that will mandate nurses and midwives to evaluate and treat patients in the outpatient and inpatient setting. Where these functions are permitted they are not documented as “extended” roles so as to be considered for recognition. In a survey conducted by Drennan, J. et al16 it was observed that patients and parents were highly satisfied with the care they received from nurse/midwife prescribers and the majority were of the opinion that that nurses and midwives should have prescriptive authority. Non-recognition of Specializations in nursing and midwifery practices hampers the growth of nursing and midwifery. Generally, in Ghana there is no formal or structured recognition for nursing and midwifery specializations. Post basic programmes are available in nursing in Ghana. The basic programme places one at the entry point of a nurse or midwife upon completion of the professional course. An example is the three year programme in nursing or midwifery that enables one become a Registered Nurse or Registered Midwife in the case of Ghana. The post basic programmes have a duration of two (2) years at most. The duration of training might be inadequate for the products to be considered specialist in their field of study. A welcome development is the establishment of the Ghana College of Nurses and Midwives. The College was established and inaugurated on 23rd April 2013 under the provisions of the Specialist Health Training and Plant Medicine and Research Act 833 of 2011 (Part Three) and has a mission to promote specialist education and continuous professional development17. Nurse/Midwives specialist programmes would include paediatric nursing, accident and emergency, palliative care and oncology. The training for residents is for three (3) years full-time. It is hoped the graduates of the specialist programmes would be appropriately recognized by Ministry of Health, Ghana. In other jurisdictions, specialist posts were valued more by National Health Service trusts but also more by the nursing profession itself. The conclusion is that ways need to be found to reward and value the role of the nurse and midwife following specialization so that nursing and midwifery excellence can be recruited, retained and developed at the Ward or clinical level18.

Rurality Areas that create barriers for rural providers may provide opportunities in some ways for independent practice of NPs in rural areas. This is not always the case, and NPs are affected by rural practice issues like distance from support networks, professional isolation, lack of anonymity, spousal employment, long hours, and the requirement to be an ”expert generalist”15. One widely reported effects of practicing in a rural setting is lack of anonymity. The lack of anonymity refers to the lack of separation between personal and professional lives that occurs in rural communities. This lack of anonymity contributes to the trusted and knowledgeable status conferred upon the “old-timer”, or the individual who is known to the community, lived in the community for an extended period, and owns land. Lack of anonymity has been cited as an advantage for the rural nurse practitioner who may interact with patients outside the practice setting raising the question of whether it is a barrier or advantage15. Another significant barrier faced by the rural nurse/ midwife practitioner (NMP) is professional isolation. Isolation has been defined in the literature as “an actual separation from or a deficiency in a resource needed to fulfil professional responsibilities or needs”. Rural professional isolation of the Nurse or midwife is a barrier frequently raised in studies on rural practice. Isolation from continuing education has been an issue for both nursing and medicine and the decrease comfort level of providers in performing complex or infrequently practiced skills may be a quality concern. For the rural nurse/ midwife practitioner, issues of role confusion and workplace barriers compound professional isolation, may make it more difficult to collaborate in interdisciplinary settings. Other effects of isolation are lack of peer support and knowledge decay15. While rural populations tend to be older, poorer, and sicker than urban populations, they have fewer resources available to provide treatment comparable to urban practices15. Clearly the nurse-midwife is the “expert generalist” in the rural setting where they enjoy some level of health services autonomy. The disadvantages encountered in the area far outweigh the advantages. The factors to attract, retain them and sustain their practices need to be addressed. For instance, as part of their social responsibility telecommunication companies should make their services felt at the remotest of communities particularly in localities where health facilities are sited. The government should negotiate for the location of the telecommunication facilities. It has been established that rural people have developed economic and social links beyond their locality due to improved transport and communication means. Transportation, telephone and internet have superimposed communication and travel patterns that allow rural people to shop, utilise services and participate in recreation well beyond the local community19. The telecommunication network will draw the health personnel towards their peers and the rest of the world. In addition, the employer should institute what is known as Herzberg Factor Two (Hygiene Factors) placing premium on achievements, recognition and responsibility and of course, working conditions and remuneration20. It has also been found that financial and non-financial incentives such as better housing and accelerated promotions were moderately effective but preferential access to training and career development opportunities were very powerful nonfinancial strategies in motivating nurses to work in rural and remote areas.




CONCLUSION From the discussions we reckon that teamwork among health providers, opportunity for training, education and professional continuous development, clear policy blue-print, according specialist nurses and midwives the needed recognition, supporting and promoting the Herzberg Factor Two (Hygiene Factor) in the urban as well as the rural settings are essential means by which nursing and midwifery autonomy can be realized. The absence of these factors would make nursing and midwifery autonomy a non-starter.

RECOMMENDATION It is my candid opinion that the following be considered in the promotion of nursing and midwifery autonomy: To ensure that other professionals recognize the worth of nurses and midwives, we should demonstrate competence by designing and implementing models of patient care. The need to revive the Nursing Care Plan and make it user-friend in the clinics and hospital is long overdue. In addition nurses should demonstrate solidarity towards one another and be assertive and supportive of nursing and midwifery agenda. Need to develop Frameworks for education and career pathways to enhance the development of nurse led care. Responsibility lies with NMCG, GRNMA and GCNM. The NMCG and GRNA should collaborate to identify or review and document the expanded and or extended roles of nurses and midwives for determination by the MOH/GHS as policy There is the need to display the roles so identified at facility levels for appreciation by the public. NMCG and GCNM should determine and declare specialty programmes in nursing and midwifery and recommend same for appropriate recognition by the employer so that nursing and midwifery excellence can be recruited, retained and developed. Government should consider financial and nonfinancial incentives such as better working environments and housing as effective strategies for the rural nurses and midwives Accelerated promotions, in-service training and career development opportunities are powerful non-financial strategies in motivating nurses and midwives to work in rural and remote areas MOH/GHS to be responsible. Government should facilitate the provision of telecommunication services at the remotest of communities particularly in localities where health facilities are sited. The End

REFERENCES
1. Merriam Webster Dictionary. | 2. www.collinsdictionary.com. Accessed October 3, 2013. | 3. Wikipedia of the Free Encyclopaedia | 4. An Bord Altranais (2006). Nursing Board Scope of Practice, Supporting a Standard through Interactive Learning (http://www.nursingboard. ie/Scope/default.asp. Accessed on October 5, 2013) | 5. Batey Marjorie V and Lewis Francois (1982). Clarifying Autonomy and Accountability in Nursing Service. Accessed at https://www.researchgate.net on October 6, 2013. | 6. Kathleen A. Russel. Nurse Practice Acts Guide and Govern Nursing Practice. Retrieved at https://www.ncsbn.org/2012_JNR_NPA_ Guide.pdf on October 4, 2013. | 7. American College of Nurse-Midwives www.midwife.org. Retrieved on October 4, 2013. | 8. Nursing and Midwifery Council of Ghana. Functions. Retrieved at http://www.nmcgh.org/operations/ examination/9-featured/3-functions. Accessed on October 4, 2013. | 9. Nurses and Midwives Decree, 1972, National Redemption Council Decree (NRCD) 117, Article 39 subsection ‘h’) | 10. Legislative Instrument (L.I) 683 of the Nurses Regulations, 1971 of the 4th Schedule (Regulation 12 (2) | 11. www.campaignforaction.org/site, Retrieved on October 5, 2013. | 12. Eley D, et al (2012). Outcomes and opportunities: a nurse led model of chronic disease management in Australian general practice. Retrieved at http://espace.curtin.edu.au on October 6, 2013. | 13. Nursing competency standards in primary healthcare: an integrative review http://www.thesandsingpframework.com/documents/MML%20Literature%20 review.pdf. | 14. Nursing and Midwifer Board of Australia (2012). Continuous professional development-Retrieved at www.nursingmidwiferyboard. gov.au/documents/default.aspx?records. Accessed on October 8, 2013 | 15. Michael_MS_Reports www.nursing.arizona.edu/library/091_Frost. Accessed on October 8, 2013. | 16. Drennan J et al (2009) Independent Evaluation of the Nurse and Midwife Prescribing Initiative. University College Dublin, (www.hse.ie/eng/services/Publications/services/./prescribing_ initiative. Accessed on October 12, 2013). | 17. Jemima A. Denis-Antwi (Unpublished). Request for Submission of Candidates for 2014/15 Academic Year. | 18. Royal College Nursing (2009) (http://www.rcn.org. uk/__data/assets/pdf_file/0009/287784/003312.pdf. Accessed on October 12, 2013) | 19. Starting Strong Rural Community Economic Development Planning & Assessment Guide January 2011. Retrieved athttp://www. bankofideas.com.au/Downloads/Rural_Revitalisation Accessed on October 11, 2013. | 20. Herzberg's Motivators and Hygiene Factors. Retrieved at http://www.mindtools.com/pages/article/newTMM_74.htm. Accessed on October 12, 2013.

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INCIDENCES OF Interactive Digital Whiteboard IN THE TEACHING PRACTICE

Leidy D. Berroa M. | Post-doctorate in Educational Research

The 21st century confronts its citizens with new choices, opportunities and challenges due to the omnipresent trend of technology in all spheres of life: business and administration, government, education, economy and society itself. The profound changes experienced in the academic field must be seen with thoughts about the possibilities that new technologies imply.

The history of the interactive whiteboard goes back to the year 1990. It was similar to the computer with touch screen and mainly used for commercial presentations. The first plate that used the projection was the Smart Board in 1991 (Benassi, V.A., Overson, C.E., and Hakala, C.M., 2014). The cost of this new presentation device was quite high, so the IWB took several years to pass from use at business meetings to universities and even later to elementary schools. During the last ten years, the number of IWB in schools has increased very rapidly. The first IWB in the Czech school was in 1998 (Neumajer, 2012). By way of illustration, ZŠ Komenského in Trutnov has 17 IWBs at this time, when the first was purchased in 2006 (ZŠ Komenského, 2017).

The traditional paradigms of teaching and learning have been shaken by the impact of the integration of Information and Communication Technology (ICT) in educational practices, while teachers and trainers face challenges ranging from the acquisition of skills and literacy in the use of ICT for the delivery of the necessary tools that will lead students to become creators of knowledge and users. Thus, deeply immersed in the knowledge society, a society based on the critical, rational and reflective use of global and distributed information (Badarch, 2013) in which the most outstanding communication media are telematic networks, one of the largest Challenges to be overcome on our way to the 21st century is to train teachers and students to achieve competence and mastery over the use of technology instead of letting them be enslaved by it. The widespread use of ICT in all areas has a direct effect on the way in which the world is perceived. The permanent presence of telematic networks in all areas of life allows unlimited access to information and a relaxation of time and space barriers. ICT has shaken traditional approaches to teaching and learning and poses new challenges to the educational community, challenges that arise along with new teaching and learning environments and modes of instruction, mainly set in virtuality.

A deep integration of new technologies in education as a central means for teaching and learning processes will inevitably require teachers to change attitudes and teaching paradigms, such changes will force them to adapt to new methodological approaches, educational concepts and aspects of management, which will have to be established in technology-rich environments. Therefore, open and flexible teaching and learning processes, especially the use of interactive whiteboards, interactive and bidirectional communication systems, together with the emergence of alternative spaces designed to promote communication generate new needs and expectations that must be met the educators. The use of ICT in education favors interaction and collaboration among participants in the education sector. The focus of this research focuses on three main subjects: on the use and competence of ICT, on the teacher and the school community, and on the learning environment and teaching practices. This research is closely related to the national education policy, which seeks the implementation of ICT in pedagogical practices in all areas and institutional levels.

Start writing your assignment before you study

Edward Lambert | AIU Academic Coordinator

At AIU, a student is required to submit an assignment each month. So how can you start and finish a course in one month? The secret is to start writing your assignment even before you start to study the material. Normally a student will study a course by completing all of the reading before they start to write the assignment. This is not the best way to do an assignment.

The best way is to get an idea of what the assignment will be about, then start writing and preparing the assignment right away before you start to study. You open the template of an assignment for AIU. The template has a cover page, introduction, place for the body of the assignment, a conclusion and a bibliography. You prepare the cover page with your name and title of the course. Then you write a brief introduction to the subject matter that you will study. Your assignment is already partly done. You will write your assignment as you study. What are the advantages of started an assignment before you study? • As you study, you will be able to write as you develop ideas. Normally as you read, you have opinions and reactions fresh in the moment that you are reading. You want to write those ideas immediately into your assignment. Then all you have to do is edit the writing before you submit the essay. The editing part is easy because the ideas are already written. • It forces you to focus your studies in your topic. When you write your assignment as you study, the assignment is actually guiding your studies. As you write, you will think of a topic to write about, then you can focus your reading on that topic. Then you can develop that topic better because you are reading and developing the ideas directly into your assignment.

• You can measure how many pages that you need to write each day in order to finish your essay. Suppose that you want to write an essay of 15 pages. Consequently, you want to write roughly 1 page per day in your assignment. If after 10 days of studying, you have 6 pages written, then you know that you need to write 9 pages in the next 10 days. Or if you have written 12 pages in 13 days, then you know that you need to write 3 pages in the next 7 days. As you see how many pages you need to write, you can better measure the topics that you need to study to complete your assignment. • If you need to write more pages, then you can do more research. If you have completed the reading, but still do not have enough pages written, then you can choose supplemental study material to get more ideas. You can search for another source of material, like another book or video. Then include your thoughts and opinions about the other book or video. You will know earlier in your writing process if you need more material, because you have been writing as you study.

All you need to do is try this for one assignment. Then you will know that this is the best way to write an assignment. Start writing your assignment with a template even before you start studying. It will much easier to finish an assignment each and every month.

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