NML-ISSUE 6 VOL 2

Issue 6 | Volume 2 | OCTOBER 1ST, 2024

Reframing the Value of Nursing and Midwifery in Healthcare Systems: Challenges and Opportunities

NMLTT NEWSLETTER

0 CONTENT: NURSES AND MIDWIVES LEADERS THINK TANK NEWSLETTER

● PAGE 1: EDITORS NOTE:

By Judith Hope Kiconco ● PAGE. 2-6: REFRAMING THE VALUE OF NURSING AND MIDWIFERY IN HEALTHCARE SYSTEMS: CHALLENGES AND OPPORTUNITIES Assoc Prof Rose C Nanyonga and Tracy K Kamau ● PAGE. 7-8: UNVEILING THE NURSES AND MIDWIVES CHRISTIAN FELLOWSHIP UGANDA (NMCF)

By Ms. Judith Hope Kiconco ● PAGE. 9-14: A REFLECTIVE ACCOUNT ON ATTENDANCE TO INTERNATIONAL COUNCIL OF NURSING CONGRESS 2023 MONTREAL, CANADA

By Elizabeth Pearson (Nurse / Lecturer and NHCC Uganda Director) ● PAGE: 16-17 INTERNATIONAL DAY OF THE MIDWIFE (IDM): FEATURE STORY 1 Interview by Elizabeth Pearson ● PAGE. 18-19: IDM HIGHLIGHTS ● PAGE 20-22: INTERNATIONAL DAY OF THE MIDWIFE (IDM): FEATURE STORY 2 Interview by Judith Hope Kiconco

1 EDITOR’S NOTE: EMPOWERING WOMEN IN HEALTHCARE: RECOGNIZING NURSES AND MIDWIVES ON INTERNATIONAL WOMEN’S DAY AND BEYOND

Although a few months have passed since May, the impact of our celebrations for both International Day of the Midwife (IDM, May 5) and International Nurses Day (IDN, May 12) will continue to resonate throughout the year. These annual events provide an opportunity to reflect on the invaluable contributions of nurses and midwives. The themes, "Midwives: A Vital Climate Solution" and "Our Nurses. Our Future. The Economic Power of Care," were timely reminders of the pivotal roles nurses and midwives play in shaping healthcare, not only in Uganda but across the globe.

In Uganda, nurses and midwives constitute over 70% of the healthcare workforce and deliver nearly 90% of patient care. The high dedication and expertise are instrumental in shaping not only the country's healthcare landscape but also the Nursing and Midwifery profession.

In this issue, the Nurses and Midwives Leadership Think Tank urges decision-makers to recognize the economic value of nursing and midwifery and ensure continued equitable compensation, access to education, and supportive work environments across the health sector.

As we carry forward the momentum from May's celebrations, let us continue to recognize and honor the contributions of nurses and midwives in our communities every day, and in every setting, ensuring that the spirit of the IDM/IND lives on well beyond May. More importantly, to the nurses and midwives, remember that recognition begins within and with us. By valuing ourselves, we can enhance our ability to serve others and elevate our profession. Celebrate your wins, no matter how small they may seem!

In related news, the Heroes in Health Awards (HIHA) nominations came to a close recently, and we want to congratulate all nominees, including the exceptional nurses and midwives who were recognized for their outstanding contributions. Being nominated is already a testament to one's excellence. We applaud every nominated individual and celebrate their dedication and commitment to delivering exceptional healthcare services. Your work does not go unnoticed.

We extend our advance congratulations to the upcoming winners. Your recognition serves as a beacon of inspiration to your colleagues and the communities you serve. We urge you to continue striving for excellence, pushing boundaries, and championing the noble profession of nursing and midwifery.

Thank you all for your dedication, compassion, and tireless efforts.

Judith Hope Kiconco (For the Chair of the NMLTT) Member of the Steering Committee, NMLTT. Newsletter Editor

2

REFRAMING THE VALUE OF NURSING AND MIDWIFERY IN HEALTHCARE SYSTEMS: CHALLENGES AND OPPORTUNITIES

By Nanyonga, R.C., and Kobukindo, T.K

Not too long ago, we celebrated the International Day of the Midwife and the Nurse IDM and IDN), significant occasions that highlight the indispensable roles of nursing and midwifery professionals in healthcare systems worldwide. The two international days serve as important reminders to prioritize the support and recognition of nurses and midwives (NM) within comprehensive health system strengthening strategies on a global scale.

But how do we amplify advocacy when the value of nursing and midwifery care is not routinely accounted for or documented in some of the basic instruments such as hospital bills? I believe a pivotal aspect demanding NM leaders’ attention is the need to reframe the value of NM from an economic dimension (Dick et al., 2017) which requires the effective capture of the value of nursing and midwifery care through the appropriate costing of nursing and midwifery activities. This entails developing systems that allow organizations to not only track the several ways in which NM contributes to patients’ recovery and improves prognosis but also to quantify and allocate appropriate financial resources in acknowledgment of their education, experience, expertise, and organizational and societal contributions. In this article, we argue that by accurately capturing nursing activities, organizations can gain insights into the diverse areas where nurses and midwives excel, including activities related to acquiring, deploying, and maintaining resources; activities related to transforming resources into services, and activities related to producing changes in patient conditions and impacting health and organizational outcomes (Dubois et al., 2013).

3 This data-driven approach not only illuminates nursing and midwifery impact but also provides a foundation for enhancing remuneration packages that reflect their level of skill, dedication, and positive influence on healthcare outcomes. Furthermore, prioritizing the appropriate cost of nursing activities fosters a culture of continuous improvement, encouraging ongoing enhancements in healthcare delivery and outcomes (Keepnews, 2011). It encourages investments in professional growth, advanced education, and innovative approaches, which are advantageous for patients, healthcare institutions, and the broader society.

Nonetheless, it's crucial to heed the wisdom shared by Keepnews (2011, p. 3) over a decade ago, emphasizing that while recognizing nursing's economic worth is important, it should not overshadow the core human values integral to nursing such as caring, compassion, respect, advocacy, and social justice. Put differently, our push to quantify the economic worth of NM activities should not minimize the fundamental values of empathy, care, and compassion inherent in these professions. As we near these important occasions, it remains crucial to acknowledge the pivotal role that nurses and midwives play in shaping efficient healthcare systems and to adopt strategies that uphold and reinforce their indispensable contributions (WHO, 2022).

As noted, one way to capture nursing and midwifery care activities is through quality care metrics and billing.

Hospital billing and reimbursement policies often reflect priorities and valuations, including Human Resources for Health (HRH). During a recent visit to a sick friend, one of us naturally found herself examining the hospital bill and was struck by the stark contrast in value allocation across billable items. For context, the itemized bill included 58 charges ranging from syringes, infusion sets, medication, theater fees, anesthetist fees, admission fees, hospital room charges, nursing care, procedure fees, and surgeons' fees. Nursing care was charged at just 15,000/- per day (around $4 for 24 hours). In contrast, the overnight admission (room) was billed at 200,000/($55), anesthetist fees for a major procedure at 800,000/−($218), and the Surgeons’ fee at 1,500,000/- ($409).

After reviewing several other hospital bills from different city hospitals, we found that the highest charge for 24-hour nursing care was 100,000/- ($27). While there is no intention to advocate for hospitals to increase their prices to reflect the value added by nurses, this discrepancy prompted reflection on the complex value distribution in our healthcare systems. If these bills are any indication, it becomes apparent that the true value added by nursing care is significantly undervalued. Nursing care encompasses a range of responsibilities beyond tasks, such as symptom recognition, safe medication administration, fall prevention, symptom alleviation, first aid administration, bedside care including safe practices to prevent bedsores and secondary infections for long-stay patients, counseling, referrals, and collaboration with healthcare teams. Nurses serve as frontline advocates, meeting patients' physical, emotional, and psychological needs. Recognizing nurses' crucial role in patient outcomes and healthcare quality, hospital billing policies should accurately reflect the value of nursing care through fair compensation and resource allocation. Revisiting value distributions can also lead to more equitable practices and a culture of appreciation for nursing professionals' expertise and impact (Keepnews, 2011).

Following the examination of the hospital bills, we discussed them with other nonmedical colleagues and asked what they thought of the perceived value of different items based on their prices. They all emphasized the high value of the doctors, and the room, followed by services like x-rays, lab tests, medications et cetera, placing nursing care at the bottom of the pile. This highlights a prevalent mindset favoring tangible, costly items over essential but intangible services like nursing care. It raises concerns about the eventual disconnect

4 between recognizing the indispensable role of nurses and midwives and potentially undervaluing their contributions in practice. Given that this was a somewhat high-level facility, we wonder if the response would have been different in a lower-level facility, where the rooms were basic, x-ray machines were unavailable, access to hospital sundries was nothing short of a miracle, and the only available service is nursing care, would nurses be more valued and appreciated then?

Even though nurses and midwives spend the most time with patients, organizations often overlook the revenue-generating potential of nursing care, viewing it as a liability rather than an asset. This mindset leads to disparities in how nurses are valued and compensated compared to other healthcare professionals.

Subsequently, nurse leaders encounter challenges in advocating for fair pay and securing investments in and for nursing and midwifery. The traditional categorization of nursing care costs as fixed hospital overheads, for example, hinders the recognition of their true value. Similarly, health systems face challenges in correlating their established and growing quality care metrics in nursing and midwifery with both direct and indirect nursing care expenses. This situation inadvertently impacts workforce morale and complicates compensation negotiations.

Indeed, research demonstrates that traditional approaches fail to capture the value of nursing care in terms of:

Intangible Value: As noted, nursing care encompasses a range of responsibilities beyond direct patient care, including advocacy, education, and coordination of care. These aspects of nursing contribute immensely to patient outcomes and satisfaction but are often overlooked or undervalued when captured as fixed overhead costs.

Complexity of Nursing Work: Nursing work is multifaceted and dynamic, involving varying levels of intensity and complexity depending on patient acuity and care needs. Using simplistic metrics like hours per patient per day may fail to capture the nuanced nature of nursing care delivery.

Impact on Workforce Morale: When contributions are not properly recognized and valued, it can lead to frustration, burnout, and disengagement, ultimately affecting the quality of patient care. In many hospitals in Kampala, Uganda, for example, an expectant woman will typically see both a nurse/midwife and a gynecologist during each antenatal visit, and during delivery, both professionals are present. While the attending gynecologist receives a fixed fee of UGX 1,000,000, regardless of the outcome, nurses and midwives are not compensated based on their contribution but must rely on their regular salary. In contrast, other healthcare cadres receive payments based on the number of patients they attend to. This disparity in compensation contributes to feelings of underappreciation and impacts morale.

Negotiation and Advocacy: Without clear recognition of the true cost and value of nursing care, nurses have limited leverage when negotiating for competitive pay, benefits, and improved working conditions. As a result, many nurses in Uganda are forced to take on 2 to 3 jobs at different health centers just to make ends meet.

5 To address these challenges and foster a more equitable and sustainable approach, healthcare organizations must shift towards recognizing nursing as a profit center rather than just a cost center. This involves: 1. Implementing robust systems for capturing the full scope of nursing activities and outcomes, including both direct and indirect contributions to patient care and organizational success.

2. Engaging nurses and nurse leaders in decision-making processes related to resource allocation, staffing models, and performance metrics.

3. Investing in technologies and data analytics that enable accurate measurement and evaluation of nursing productivity, efficiency, and impact on outcomes.

4. Advocating for policies and practices that ensure fair compensation, professional development opportunities, and recognition of nursing expertise and contributions within the healthcare ecosystem.

As healthcare delivery evolves to prioritize team-based care, wellness, population health, care coordination, patient-centeredness, data analytics, and quality improvement, nurses are primed to drive and spearhead these transformative changes through various nurse-led services and interventions. (Salmond and Echevarria, 2017). Relatedly, as we continue to celebrate nurses and midwives globally, “mere accolades may not suffice” if there's a systemic gap between recognition and tangible support, especially in resource-limited settings like Uganda. There's a need for intentional actionable changes including revisiting remuneration policies, investing in professional development, improving working conditions, and fostering a culture of appreciation to truly elevate the status and compensation of nurses and midwives in healthcare systems. Our advocacy narratives must strive to make a compelling investment case for nurses and midwives to address these disparities and shift the paradigm toward recognizing their true value.

1. Dick, T.K., Patrician, P.A., & Loan, L.A. (2017). The Value of Nursing Care: A Concept Analysis. Nursing Forum, 52, 357–365.

2. Keepnews, D. M. (2011). Mapping the economic value of nursing. Commissioned by the WSNA Professional Nursing & Health Care Council Washington State Nurses Association, 6. Available at: https://cdn.wsna.org/assets/entry-assets/3215/economic-value-of-nursing-white-paper.pdf 3. Brownie, S.M. (2018), The economic impact of nursing. J Clin Nurs, 27: 3825-3826. https://doi.org/10.1111/jocn.14182 Available at: https://onlinelibrary.wiley.com/doi/epdf/10.1111/jocn.14182 4. Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing.

Orthopaedic Nursing, 36(1), 12-25. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266427/ 5. Institute of Medicine. (2011). The Future of Nursing: Leading Change, Advancing Health. National Academies Press.

6. World Health Organization. (2022). The nursing and midwifery workforce in the African Region: optimizing and accelerating investments for resilient health systems: a regional technical report.

Available at: https://www.afro.who.int/publications/nursing-and-midwifery-workforce-african-regionoptimizing-and-accelerating-investments

6 7. Clarke, I. (2019). Nursing Care Value: A Paradigm Shift in Healthcare Economics. Journal of Nursing Management, 27(5), 1063-1072 8. Institute for Healthcare Improvement. (2022). Nursing as a Profit Center: A Business Case for Investment in Nursing. IHI White Paper.

9. Dubois, C. A., D’Amour, D., Pomey, M. P., Girard, F., & Brault, I. (2013). Conceptualizing performance of nursing care as a prerequisite for better measurement: a systematic and interpretive review. BMC Nursing, 12, 1-20. Available at: https://link.springer.com/article/10.1186/1472-6955-12-7 10. Lancet (2020). Unleashing the full potential of nursing. Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32794-1/fulltext Authors Dr. Rose Clarke Nanyonga is an Associate Professor of Nursing Leadership, Management, and Policy and ViceChancellor at Clarke International University Ms. Tracy Kobukindo Kamau is a Nurse & Public Health Specialist serving as Senior Manager of Education at Last Mile Health, where she supports efforts to strengthen the health system through the training of Frontline Health Workers, Community Health Workers, and Health System Leaders in Africa & Globally.

7 UNVEILING THE NURSES AND MIDWIVES CHRISTIAN FELLOWSHIP UGANDA (NMCF)

By Judith Hope Kiconco In this edition of the NMLTT newsletter, we closely examine the heart and soul of one of Uganda's Nurses’ and Midwives’ Associations. Join us as we explore the mission, vision, values, objectives, and dedicated leaders behind the Nurses and Midwives Christian Fellowship Uganda (NMCFU).

NMCFU is a beacon of hope and inspiration for Christian Nurses and Midwives across Uganda. Our mission is to equip and encourage them to integrate biblical principles and Christ-centered values into their clinical practice, leadership, education, and research. We envision a future where Christian Nurses and Midwives shine brightly as they live out their faith in their professional lives, bringing light to the darkest corners of healthcare.

At the core of NMCFU are our values: The word of God, love, excellence, compassion, and service.

These values guide everything we do, from our interactions with patients and colleagues to our commitment to continuous learning and improvement. Christian nurses and midwives strive to uphold these values in all aspects of our professional practice, knowing that they reflect the heart of our Savior.

At NMCFU, we're not just a fellowship but a force for change in nursing. Our strategic objectives, from promoting compassionate professional practice to mentoring the next generation of Christian Nurses and Midwives, are designed to empower our members to make a tangible difference in their workplaces and communities.

Through education, outreach, and advocacy, we're shaping the moral and ethical conscience of the nursing profession, locally and globally.

Behind NMCFU's success is a team of dedicated leaders who tirelessly work to fulfill our mission and objectives. Our executive committee, led by Chairperson Sylvia Sewagudde and Vice Chairperson Alice Akello, brings a wealth of experience and passion to their roles. From mission coordination to professional development, each member plays a vital role in steering NMCFU toward greater heights of impact and influence.

As we reflect on NMCFU's mission, vision, values, objectives, and leadership, we're reminded of our immense privilege and responsibility as Christian Nurses and Midwives. Let's not just be salt and light in our profession—let's be the change we want to see. Join us in NMCFU, and together, let's shine brightly for the glory of God and the benefit of those we serve.

8 Ready to take the next step in your journey as a Christian Nurse or Midwife? Join NMCFU and unlock a world of opportunities to integrate faith and service in healthcare. You'll gain access to exclusive resources, networking events, and mentorship programs as a member. Joining NMCFU is a simple process: complete the membership form and submit it to our fellowship email at christiannursesf@gmail.com Membership is open to Christian Nurses and Midwives of all denominations committed to our mission and values. Have questions about NMCFU or want to learn more about how you can get involved? Contact Sylvia Sewagudde, our chairperson, at 077-9-224-282.

9

A REFLECTIVE ACCOUNT ON ATTENDANCE TO INTERNATIONAL COUNCIL OF NURSING CONGRESS 2023 MONTREAL, CANADA

by Elizabeth Pearson (Nurse / Lecturer and NHCC Uganda Director) Description International Council of Nurses (ICN) Congress brings together leaders and colleagues in nursing from the global healthcare services to unite and learn, share, network, and build a better future for our healthcare systems and the nursing workforce. The theme: - “Nurses Together, a Force for Global Health” saw nearly two hundred thousand nurses attend the 2023 Congress in Montreal Canada which was hosted in partnership with the Canadian Nurses Association. This global platform gathers and empowers the global nursing community and provides an opportunity to connect work and discuss issues affecting the profession.

Having founded the National Health Care Conferences (NHCC) Uganda - the knowledge-sharing platform for Nurses and Midwives, a registered community interest organisation in the United Kingdom, whose aim is to foster shared learning by empowering health care professionals with skills, competencies, and tools to deliver improved care; and recently co-founder and Inaugural president of Uganda Nurses and Midwives Association UK (UNMA-UK), when the registration for the ICN Congress 2023 was activated, I knew that it was an opportunity I did not want to miss again. Using the Gibbs reflective practice cycle (Fig 1), I will share my reflective account of how my attendance at Congress enhanced my global leadership experience and ability to participate and learn from the global platform and improve my reflective practice abilities as required by the Nursing and Midwifery Council (NMC) (Finch, (2016) and Daly, (1998).

Fig. 1. Gibs Reflective Cycle

10 Feelings Like many Continued Professional Development (CPD) opportunities, the issue of funding to attend the Congress was the first immediate obstacle. My ability to attend was partly self-funded and supported by my family, mentors, and well-wishers. They attributed their belief and confidence in my vision and mission to continue to inspire and improve our professions’ value in society (Rasheed, et al (2019).

The experience presented that there was generally a high level of agreement in the reflective sessions and all leaders I had an opportunity to interact with all identified competencies, especially those related to collaborating with colleagues and stakeholders to improve patient outcomes and experiences. However, the value and emphasis on attending future Congress, which not only provides CPD but builds a registrants’ profile also provided me an advantage and unique contribution to my work on exploring the diaspora contribution to strengthening health care systems.

The hosts of ICN Congress 2023

Evaluation I have reflected on these in three dimensions: - as an Individual, the impact on the organisation, and then the profession (Atkins, and Murphy, (1994) and Jasper, (2003).

Individual perspective – Accessibility: Like many, obtaining the finance and permission to travel and enter Canada was a challenge. I submitted my online application in March but by the end of June, I still hadn't received a response. I was nervous and it was getting harder to plan. In the end, I contacted my network to pursue and chase my application in the hope

11 that it is cleared sooner than later. I received the permission -visa- the day before my scheduled flight.

The last 48 hours were intense.

Although I enjoyed attending and participating in this international Congress, I was somewhat disappointed when I thought of the colleagues who were not able to participate due to the very difficult and frustrating immigration permissions and visas.

While I was listening to many presentations on advanced nursing research at the conference and the various discussions, I realised that many nurses across the world can't have the same opportunity I had.

Consequently, they are not able in many cases to give advanced care or even a basic level of care for their patients. The disparity in healthcare and nurse training has become more evident than ever. There are various reasons perhaps for this including political will, economic, and cultural reasons. I began to feel that we need to think more about standardisation rather than globalisation for healthcare and nursing education.

Teamwork: Although it was a global opportunity, I was able to attend and join the other colleagues and leaders representing my country of origin. and then share my working experience in my country of residence.

There is a need to work more collaboratively and work as a team for instance we were all in different accommodations around the congress venue and this limited our ability to network after the sessions to formulate tangible actions following the different sessions and discussions to realise the individual growth opportunities.

Organization Benefits - I then thought of the organisation that I have co-founded and how my participation can be of influence on colleagues to encourage us to consider transformational leadership as an essential element of highperforming organizations in this era of rapid healthcare delivery system evolution and to be representing and present in policy decisions especially for acquiring knowledge and experiences.

Profession/fraternity - The benefit for attendance includes all participants/attendees an opportunity to submit their research work and studies and engage in a peer-to-peer review process… among other benefits. I have submitted my abstract for 2025 to be considered for poster or oral presentation.

Overall, during the closing remarks, the chief executive announced the new logo, and all participants stood up and gave a standing ovation. I hope that one day the congress will be held in one of the African countries.

Analysis The participation and attendance enhanced my communication skills by preparing for the sessions that were of interest to me and presenting my comments and queries to the panels (Gould, et al (2007). I gained a balanced and honest view of my contribution, ability, and unique identifier as a diaspora healthcare professional. The attendance also granted me the ability to interact with others

12 frankly and confidently. I realised that to build a successful leader, leaders need strong, clear messaging to get results by learning the needs and motivations of the key stakeholders.

these experiences are individual to us, we all have different perceptions of how we view and understand the world around us (Huston, (2008).

Action points

Conclusion My objective was to utilise the opportunity to connect with various global association leaders and explore the congress’ policy regarding cultural competence and the racism that is affecting the profession, especially in the UK. My approach to future opportunities will always be one of extra caution, critical observation, and the ability to utilise any opportunity to improve and enhance my contribution to any organisations that I am part of; and my overall contribution to the fraternity and profession at large positively (Huston, (2008).

I will always reflect on this episode as a critical learning experience of how the global platform works and where all the nurse leaders evidence their roles and responsibilities in contributing to alleviate the challenges.

It was my first time attending the Congress and it will not be my last. The experience catalysed my research and inquisitive mind to conduct a study on the benefits of attending the Congress in leadership development (Finch, (2016). The term ‘Frame of Reference’ (Schiff and Schiff, 1975) refers to our unique set of assumptions, feelings, beliefs, and behaviours that are shaped by our past experiences and cultural environment, and background. Because

In terms of informing my future practice, I have since followed up with the leaders and colleagues and we are part of a WhatsApp group where we discuss and meet in a professional working capacity and share learning.

Another benefit of attending is that all participants can submit their research work and studies and engage in a peer-to-peer review process. I have submitted my abstract for the next 2025 to be considered for poster or oral presentation.

Having observed the level of engagement and profile of participants that attend the Congress, it is obvious that it contributes to both the individual and the organisation. Since then, I have begun to encourage my colleagues both in the diaspora, especially those in the UK and those in Uganda, to prepare to attend the Congress next year with me as it will be celebrating 100 years. This is because the latest developments and continued updates to meet the changing demands of health advancement and interaction on global platforms are still lacking. The nursing agenda and strategy require our joint responsibility. We have the power to change, and we must be in the spaces in order to make the changes. #Nursing Power to Change the World.

13

Highlights with the team of 7 Ugandan nurse leaders who represented and participated including Registrar, Uganda Nurses and Midwives Council, Ms Christine Nimwesiga, and Uganda Nurses and Midwives Union President, Mr. Justus Cherop.

14

Interested in attending the 100th ICN congress in Finland? Join the team Contact Elizabeth Kasirye Omagino, Public Health Nurse Specialist MOH/MNRH, Department of Community Health, betiko2007@gmail.com +256752657595

References Angela Hollingsworth, and Mark Reynolds, (2020) The ED Nurse Manager’s Guide to Utilizing SWOT Analysis for Performance Improvement Experience Talks Volume 46, ISSUE 3, 368-372 Atkins, S. and Murphy, K. (1994) Reflective Practice. Nursing Standard, 8(39) 49-56.

Bolton, Gillie. (2014) Reflective Practice: Writing and Professional Development / Gillie Bolton. Fourth ed.

Daly, W..M. (1998) Critical thinking as an outcome of nursing education. What is it? Why is it important to nursing practice? Journal of Advanced Nursing 28 (2) 323-331.

Finch, Alison (2016) Revalidation And Reflective Practice. Nursing Management - UK. Vol. 23 Issue 1, p2225. 4p.

Gibbs, G. (1988) Learning by Doing: A guide to teaching and learning methods. Further Education Unit, Oxford: Oxford Polytechnic.

Gould, D., Berridge, E-J. And Kelly, D. (2007) The National Health Service Knowledge and Skills Framework and its implications for continuing professional development within nursing. Nurse Education Today 27 26-34.

Levett-Jones, T. L. (2007). Facilitating reflective practice and self-assessment of competence through the use of narratives. Nurse education in practice, 7(2), 112-119.

Jasper, M [2003] Beginning Reflective Practice Cheltenham: Nelson Thornes Reviewed by Melanie Oakley Editor of the British Journal of Anaesthetic and Recovery Nursing. (2003). British Journal of Anaesthetic and Recovery Nursing, 4(4), 17-17.

Nursing and Midwifery Council (NMC). The code 2018: Standards of conduct, performance, and ethics for nurses and midwives. London, NMC Rasheed SP, Younas A, and Sundus A. (2019) Self-awareness in nursing: A scoping review. J Clin Nurs.

28(5-6):762-774.

Royds, Kristina (2010) "Using Reflective Practice to Learn from Good and Bad Experiences." Learning Disability Practice 13.5: 20-23.

The Open University report on Breaking Barriers to Nursing (2019) Accessible via open. ac.

Uk/business/registered-nurse.

15

HIGHLIGHTS FROM ICM KIGALI: Ugandan senior and young midwives at the ICM Conference in Kigali, led by the Commissioner, of

Nursing and Midwifery Services, Ministry of Health, Sr. Agnes Chandia Baku (5th from right), and the President of the National Midwives Association of Uganda, Ms. Annette Kanyunyuzi (4th from left).

16 INTERNATIONAL DAY OF THE MIDWIFE (IDM): FEATURE STORY

Insights into Midwifery in the community practice Interview with Dorothy Gashuga, Midwife

By Elizabeth Pearson

experience in both clinical and research and greatly motivated me towards career growth as a researcher.

In addition, having worked with Knowledge for Change (K4C), a research-oriented organization I gained more knowledge and skills in research, and this unique position has seen me participate in providing evidence-based maternal childcare services, nursing and midwifery student global mentorship programs, and in several research-oriented programs as a research assistant and project lead.

I was later awarded a grant from the Royal Society of Tropical Medicine and a Commonwealth fellowship to study for a professional diploma in reproductive health at the Liverpool School of Tropical Medicine.

What made you decide to be a midwife?

About Dorothy With my first qualification as an enrolled comprehensive Nurse, I was determined to advance my career, and I am so excited that I have progressed to obtain a Bachelor’s degree from the Aga Khan University in Midwifery. I have 13 years of working experience.

I have always been committed and passionate about caring for mothers and babies. I have worked with both government and non-government Organizations as a midwife. This has enabled me to gain vast

I first qualified as an enrolled Comprehensive nurse which meant I was both a nurse and midwife.

However, while caring for women in labor I found that the midwifery profession was so satisfying, especially with positive maternal and child health outcomes. Both the mother, midwife, and caregivers are full of joy when they hear the baby cry. This made me choose to specialize in giving joy to the women that I care for in labor.

Briefly share a typical day or workload I have been working in a high-volume health center IV for many years. I remember there was a day shift in the labor ward when I had to deliver 8 mothers between 11 am and 3 pm. Of course, in such a scenario one calls for help from a colleague but in case of emergencies, it’s close to impossible to provide quality care with overwhelming numbers.

The beauty of midwifery is if all mothers deliver with

17 no complications no matter how hectic the shift is the outcomes are reassuring.

We are so hopeful that once the new staffing structures are implemented the issue of workload will be solved and hence the quality of care given to each mother improved. This will also help to facilitate providing woman-centered care in public health facilities.

example, I needed to pay 4.6 million every semester at the bachelor’s level. Luckily Aga Khan University offers some partial scholarships, and I managed to get half of the tuition for some of the semesters. I would like to enroll for my master’s degree next year. Hopefully, I will get funding for it this time. My advice is health workers should upgrade the sky is no longer a limit we need more PHDs in midwifery!

What do you observe to be the greatest barrier to midwifery care and how can we overcome them?

How do you manage to balance workplace demands and family? You can share some habits and lessons you have learned

Some of the barriers to midwifery care include a lack of an enabling environment and recurrent stockouts that can be improved by increasing the budget allocation to health care.

Inadequate staffing leads to workload and hence affects the quality of care this can be improved by implementing new staffing structures or by revising the staffing norms of high-volume facilities.

There is a need for continuous mentorship and refresher courses for all midwives to help phase out the outdated practices in midwifery in order to embrace evidence-based practices. More effort is needed in the dissemination of new protocols and guidelines at the health facility level.

Have you encountered any barriers to your career progression? How did you negotiate some of them and what advice do you have for others?

The greatest barrier to career progression is finances. Most of the courses are expensive, for

Wow, I must say both are full-time responsibilities but importantly one needs a support system in order to balance the two. This can be from a spouse, relative, or helper because sometimes there is a need to work long hours.

I have learned to maximize the day off from work and spend time with family.

What are your ambitions?

Having practiced as a midwife in a resource-limited setting for over 13 years, I have discovered that only a handful of midwives are involved in research yet there is a need to carry out more research in the field of midwifery. I would like to further my career toward public health, majoring in maternal child health, and sexual and reproductive health. My ambition is to advocate for the integration of research in the field of midwifery and leadership.

18

IDM/IDN 2024 HIGHLIGHTS A handshake from the Assistant District Health officer In Charge of Maternal Child Health Nursing in Rukungiri district Sr Christine Kakuru Komuhangi to H.E Jessica Alupo, Vice President of the Republic of Uganda

Representing the Minister of Health, Director General and Director Curative Services is Dr Waniaye John Baptist, and representing the Permanent Secretary Ministry of Health Richard Mugahi in attendance at the International Day of the Midwife 2024 celebrations in Gulu City, with the Commissioner of Nursing Services Sr. Agnes Chandia Baku.

19 UGANDAN MIDWIVES CELEBRATE INTERNATIONAL DAY OF MIDWIVES 2024

20

INTERNATIONAL DAY OF THE MIDWIFE (IDM): FEATURE STORY

A Champion for Midwifery Excellence in Uganda and Beyond: An Inspiring Conversation with Ms Suzan Asiimwe. By Judith Hope Kiconco

MS SUSAN ASIIMWE HEAD CLINICAL SERVICES, MARIE STOPES UGANDA •

•

•

Susan is a renowned midwifery expert and women’s health advocate with a clinical practice, education, and research background.

She holds a bachelor's and master’s degree in nursing science and midwifery from Makerere University and has extensive experience as a midwife and lecturer.

She is currently the Health of Clinical Services at Marie Stopes Uganda and a PhD fellow at KU Leuven University, Belgium.

Could You describe your current role, particularly the aspects that you find most challenging and rewarding?

In my current role as head of clinical services and lecturer, the challenge is primarily in managing a diverse team of healthcare professionals across various disciplines and levels. This involves ensuring strict adherence to quality standards and overseeing compliance with clinical protocols among doctors, midwives, and lab technicians, among others. On the other hand, the most fulfilling aspect of my role is the opportunity to mentor and guide not just midwives but also doctors and other healthcare providers.

Contributing to the

professional development and growth of the next generation of nurses and midwives has been incredibly rewarding.

How do you continue learning & growing as a professional? ●

●

I have chosen to progress in my career, starting from a modest position in midwifery and now pursuing a PhD in biomedical science (Medicine) at KU Leuven. This ongoing professional development has significantly enhanced my expertise in midwifery.

I have actively conducted research and published my findings in peer-reviewed journals to contribute to the latest evidence.

21 Participating in conferences, workshops, and online courses further expanded my clinical knowledge and skills. ● I have benefited from mentorship, which has guided my career growth. ● Networking and collaborating with peers have enriched my learning experience and encouraged interdisciplinary approaches to enhancing midwifery practices.

What industry trends are you currently watching and why?

Artificial Intelligence in Health Care: Currently, I'm monitoring the advancements in artificial intelligence (AI) within the healthcare sector. AI has the power to completely change healthcare delivery and patient treatment. For instance, labor monitoring has evolved from using the Pinard fetal scope to cardiotocography (CTG) for monitoring labor progress. Additionally, AI is enhancing appointment scheduling, supply chain management, and data management by transitioning from paper-based records to electronic health records (EHRs). These advancements lead to reduced patient waiting times, improved overall quality of care, and reduced the burden on healthcare providers.

Besides AI, I am also interested in Respectful Maternity Care (RMC), especially in resourcelimited hospital settings. This initiative is crucial as it emphasizes respect, autonomy, and dignity for women during childbirth. In our settings, pregnant women's voices are often ignored, RMC seeks to address these issues by prioritizing the needs, rights, and preferences of women in the care they receive.

As a Midwifery and Women's Health specialist, what has been more

valuable in your career, education, or experience?

Both education and experience have been invaluable in shaping my career and practice in Midwifery. Education has provided me with foundational knowledge, evidence-based practices, and critical thinking skills necessary for high-quality care and leadership. Experience has complemented my education by offering practical application, and teaching me patient interactions, communication, empathy, and cultural competence. The synergy between education and experience has been most valuable, enabling me to apply knowledge effectively, refine skills, and continuously improve as a midwifery practitioner.

Both elements are integral to my professional growth, competence, and ability to mentor, lead, and provide holistic care to women throughout their reproductive health journey.

How do you organize & manage your time, and what aspects of your work motivate you to maintain this schedule?

To manage my day-to-day schedules and perform in my different roles to meet expectations, •

•

•

I prioritize my Tasks by reviewing my schedule and setting priorities for the day.

I use a calendar to keep track of appointments, tasks, and deadlines. I also attend to emergencies as they come in.

I work closely with my team members to foster teamwork, which helps me delegate tasks to other team members where appropriate.

I block off time for different tasks (e.g.

Teaching and mentoring, administrative work, professional development).

22 What motivates me to keep the schedule is the passion to complete my tasks efficiently and on time, the opportunity to learn and grow from my team members, and the opportunity to mentor.

Working in a supportive and collaborative team environment to enhance job satisfaction.

Contributing to a team with shared goals and values can be very motivating.

This year's International Day of the Midwife (IDM) theme is "Midwives: A Vital Climate Solution." what does this mean to you?

Midwives help communities adapt to climate change and they act as emergency responders during climate catastrophes, midwives provide safe and ecologically sustainable health services.

The idea of midwives as a vital climate solution encompasses their potential to reduce the environmental impact of healthcare, enhance community resilience to climate impacts, support vulnerable populations, influence policy, and drive innovation in sustainable health practices.

Reflecting on the IDM, 2024, what is the most important message you want to send to the other midwives?

Dear Midwives, Your dedication and compassion make a profound difference in the lives of mothers, babies, and families. Continue to uphold the highest standards of care, support each other, and never stop advocating for the health and well-being of those we serve. Embrace opportunities for academic growth and lifelong learning to stay at the

forefront of midwifery practice. Engage in research to advance our field and contribute to evidencebased care. Advocate for policies and practices that promote safe and respectful childbirth experiences for all. Together, we can empower and uplift communities through our vital work

What books have made the most significant impact on your career?

Atomic Habits: - This book presents a framework for understanding how habits work and how small changes yield remarkable results over time.

Embracing this concept has helped me stay motivated and focused on refining my skills and habits over time rather than aiming for perfection.

When Breath Becomes Air: - This book is not just a memoir of illness but a deep story of Kalanithi’s life as he reflects on his purpose, his evolving identity as a doctor and he also delves into profound questions about what makes life meaningful and how to find purpose amidst adversity. This book is my reminder of the preciousness of life and why it’s important to find your purpose

Is there a quote that motivates you?

One quote that resonates with me is: "Success is not final, failure is not fatal: It is the courage to continue that counts." Winston Churchill reminds me that both success and failure are part of the journey, but what truly matters is the resilience and determination to keep moving forward despite challenges. It encourages perseverance and a positive mindset in the face of adversity, which I find motivating in various aspects of life and work.

23

WE WOULD LIKE TO HEAR FROM YOU EVALUATION OF THE NMLTT NEWSLETTER - SECOND EDITION 2024 From Issue One of the first edition which we published in May 2020, to this second edition, we have covered a variety of useful information about how to deliver better-improved care, how to look after yourselves as healthcare workers, and participated in the research.

With the generous support of one of our leaders, ALL editions have been made available with ease of access for FREE on the platform via https://www.issuu.com/nmltt/docs/nml-issue_11_final-rcn We would like to hear from you. Your evaluation and feedback are important to use and will help us to improve. Please take time to complete this short survey as we continue to monitor the effectiveness of this communication channel. You can also leave your comments via https://forms.gle/QvGv4FNxwaoiJ9DG7 We value your thoughts.

Thank you.

Elizabeth Pearson, @ezabe2

IMPORTANT CORRECTION

Dr. Slyvia Kiconco Monash University, 2023 In our previous issue, we erroneously included Dr. Kiconco in the list of nurses and midwives who have attained doctoral degrees. Dr. Kiconco is not a nurse.

Her PhD was in Epidemiology and her thesis was “Optimal diagnosis of polycystic ovary syndrome and associated long-term cardiometabolic outcomes. We apologize to our readers and Dr. Kiconco for this error

24

USEFUL CONTACTS

Please find below a list of useful contacts to forward your concerns appropriately.

UNMC queries:- info@unmc.ug UNMU:- info@unmu.ug CPD APP concerns: martin@unmc.ug National Organisations Education and Training Standards: - Department of Nursing at Ministry of Health HET (Min of Education and Sports) QUESTIONS? CALL: 0417 893600 (PRO) Mobile 0777108170 Some of the associations AGNMU: graduates@agnmu.org Critical Care Association:president@ccnau.org Midwifery Association: nationalmidwivesassociationug@gmail.com Nursing and Midwives Society: info@nursesandmidwivessociety.org Emergency Care Society of Uganda:- admin@ecsuganda.org Palliative Care Association of Uganda:- pxau.admin@pcau.org.ug Others NMLTT (Think-Tank Leaders):- uganursemidwife.leaders@gmail.com Writing articles for publication on the NHCC Uganda website:editors.nhccuganda@gmail.com Global networking Nursing Now Campaign Uganda:- nursingnowuganda@gmail.com

25

PROFESSIONAL RESOURCES

The Think Tank Newsletter editing team accepts articles on a rolling basis under the sub-themes below. ● ● ● ● ●

Research and Innovation Continuing Professional Development (CPD) Policy Leadership/Governance Clinical Practice Covid Response.

Think Tank is committed to supporting nurses and midwives through strategic advocacy. Advocate for Nurses and Midwives. Please send us your current email address to be included on our mailing list.

Our faith in you is steadfast. May you continue to rise to the challenge in this international year of the Health and Care Workers by WHO - 2021. More than ever, this nation needs you. We thank you, and May God bless you.

Copy to:

The Hon Minister for Health The Permanent Secretary, Ministry of Health The Permanent Secretary, Ministry of Education and Sports Commissioner Nursing Services, Ministry of Health Commissioner Health Education & Training, Ministry of Education and Sports The President of the Uganda Medical Association All Nurses and Midwives

26

NMLTT NEWSLETTER EDITING TEAM

M E NMLTT S

P C

E

M S

NMLTT C

E

M T S

NMLTT

C

E

Informed disclaimer:- All editing team members are Nurses, and they are all volunteering their time and expertise. However, the views expressed in the articles are of the authors or writers solely. Although the editing team does its very best and is responsible for vetting the information, the authors’ opinions remain. it is, therefore, upon the authors to make sure that what they submit is referenced appropriately and accurately.