THE TRAINED NURSES' ASSOCIATION OF INDIA (TNAI)

Baby- Friendly Hospital Initiative

Mother’s milk, beyond doubt, is unparalleled in nutritional value. The protection it provides to infants against diseases, and financial and social implications it has for a poor and over populated country like ours cannot be over-emphasised. Nurses as important members of health care team, play a pivotal role in collaborating and implementing the Baby-Friendly Hospital Initiative (BFHI) policy of quality infant and mother care.

Baby-friendly hospitals create an environment, which supports women in their desire to breastfeed. Staff at baby -friendly facilities provide assistance to breastfeeding mothers and implement policies which safeguard the breastfeeding relationship. Besides, it encompasses the entire spectrum from prenatal planning and training, for promotion and support of breastfeeding, to actual breastfeeding practices. While breastfeeding is integrated with Maternal and Child Nursing specialities, it is imperative that breastfeeding practices in child survival be given due emphasis.

The Trained Nurses’ Association of India therefore, emphasises the promotion of breastfeeding as a key strategy for child survival, as well as reproductive health. In terms of actual practice the TNAI advocates focusing on training in correct breastfeeding practices which includes the re-establishment’ of a breastfeeding culture.

The Trained Nurses’ Association of India accepts the concept and the definition of Baby–Friendly Hospital as framed by the UNICEF/WHO and National task Force as given in the foregoing para and believes that in order to be Baby-Friendly, all hospitals must fulfil the criteria for following the ten steps to successful breastfeeding. Each facility providing maternity services and care for new born infants should have the following:

Step 1. A written breastfeeding policy that is routinely communicated to all health care staff.

Step 2. Training all health care staff in skills necessary to implement this policy.

Step 3. Informing all pregnant women about the benefits and management of breastfeeding.

Step 4. Helping mothers initiate breastfeeding within a half an hour of birth.

Step 5. Showing mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants.

Step 6. Giving newborn infants no food or drink other than breast milk.

Step 7. Practising rooming-in, allow mothers and infants to remain together –24 hours a day.

Step 8. Encouraging breastfeeding on demand.

Step 9. Giving no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.

Step 10. Fostering the establishment of breastfeeding support groups and refer mothers to them on discharge from hospital or clinic.

The Trained Nurses’ Association of India acknowledges that to establish Baby-Friendly Networks, there is a need to harmonise its efforts with other maternal and child health care groups, the local hospitals, nursing homes and maternity centres, the community and above all with the government.

The TNAI through its Branches all over the country, can work towards establishing centres for conducting training programmes on B.F.H.I. and collaborate with governmental and non-governmental organizations to enable hospitals and maternity centres to become Baby-Friendly.

The TNAI urges its State Branches to adopt the following plan of action to achieve the objectives of Baby-Friendly Hospital Initiative. The plan should also include Training in Ten Steps to successful breastfeeding.

•    Defining the role of Nurses and nursing in relation to a mother-child care facility (hospital, nursing home, work place) and B.F.H.I. plan, of that institution or community.

•    Participation in national and international committees or bodies established to identify, encourage and recognize institutions following baby-friendly practices.

•    Involvement in the joint effort of the Baby Friendly Hospital Initiative National Task Force, comprising Government of India, UNICEF, WHO and professional organizations, viz., Indian Medical Association (IMA), Federation of Obstetric and Gynaecological Societies of India (FOGSI), Indian Academy of Paediatrics, National Neonatalogy Forum (IAPNNF) Breastfeeding Promotion Network of India (BPNI) Christian Medical Association of India (CMAI), Catholic Hospital Association of India (CHAI), International Baby Food Action Network (IBFAN), Association for Consumer Action on Safety and Health (ACASH).

•    Work towards bringing about necessary changes in nursing education to ensure adequate preparation of Nurses/ ANMs to enable them to carry out their responsibilities effectively in Baby-Friendly facilities. All Nurses in Speciality of Maternal Health and Paediatrics must be trained in the ten steps to successful breastfeeding as advocated by the UNICEF.

•    A special preparation for the Nursing Supervisors and Head Nurses to assume results-oriented leadership roles in protecting, promoting and supporting breastfeeding.

•    Initiate and participate in training of assessors. Ensure that Nurses trained as assessors must have in-depth knowledge of lactation management, and are well versed with the International Code of Marketing of Breast Milk Substitutes, and the Infant Milk Substitutes, Feeding Bottles and Infant Food.

•    Initiate and participate in research to determine additional baby-and mother-friendly practices, in the existing M.C.H. facilities, community and work places. Also to conduct research into issues related to policies and action.

•    Endeavour to bring about necessary changes in general education of schools, for creating awareness and right attitudes about the importance of breastfeeding and to re-establishing the ‘breastfeeding culture’.

•    The type of training that should be given to non-professional members, who are directly or indirectly involved in maternal and childcare.
 

Disaster Preparedness

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The Trained Nurses’ Association of India accepts the definition of Disaster as framed by WHO: "Disaster is any occurring that causes damage, economic disruption, loss of human life and deterioration in health services on a scale sufficient to warrant an extraordinary response from outside the affected community area." The present century has added a new ecological dimension to the definition of disaster: Chemical and nuclear catastrophes, oil spills, air, water and soil pollution, desertification, the greenhouse effect and environmental refuses.

The TNAI believes that the Nurses, as the key members of the health care team, can be of much assistance to the sufferers in and outside the hospital, including disaster situation. The disasters, particularly of high magnitude, like floods; earthquakes, wars, etc. bring about not only physical problems but also physiological, psychological and socio-economic problems. Nurses have a vital role to play in times of disasters because of their broad-based operations including study of humanities and social sciences. Whatever may be the cause of disaster, whether natural or man-made, Nurses are expected to handle the situation with competence.

Apart from "traditional" emergency relief and assistance in case of natural disasters, epidemics and other calamities, the TNAI puts emphasis on the reduction a and management of disasters. In practical terms, the TNAI focuses on training in preparedness, assessment of health needs, information and communication and planning for post-disaster activities. It sees its main role as helping State Branches to make workable arrangements for emergency preparedness plans on a nation–wide basis.

The underlying objectives of nursing actions in disaster are to effectively reduce the impact of disaster on human life and health, and to participate in the coordinated efforts of all groups to reduce loss of life, property damage, social and economic disruption and to initiate rehabilitation, It spans a broad spectrum from pre-disaster planning to training for disaster preparedness and relief action. While Disaster Nursing is not considered a clinical speciality integrated with Medical Surgical Nursing, it is important that Nurses be prepared to develop leadership qualities that will enable them to perform challenging roles in meeting the demands of disaster situations.

The TNAI recognizes that in emergency situations there is need to harmonise its efforts with health care groups, the local community, civil defence, army, police, fire brigade and various non-governmental bodies. Through its Branches all over the country, the TNAI can work towards establishing centres for conducting training programmes on disaster preparedness, and have a panel of Nursing who would spring into action when disaster strikes for providing relief work in collaboration with governmental and non-governmental organizations.

Pre-Disaster Planning and Training

(i) The role of Nurses and Nursing in relation to community or a hospital disaster preparedness plan: this should include training in immediate care, casualty evacuation, emergency treatment in hospital, psychological assistance to community and provision of safe water and sanitation.

(ii) The Identification of the type of organizations which will enable the Nursing staff to function most effectively during a disaster.

(iii) Special preparation that Chief Nurses, Supervisors and Head Nurses will need to assume leadership roles.

(iv) The kind of training that should be given to non-professional members of Nursing service who are directly or indirectly involved in patient care.

(v) First Aid training at the grass-root level especially in disaster-prone areas. In real life situations it is often the only way to save lives.

(vi) Creating awareness in the school children and their teachers as they are some of the most receptive groups to disaster preparedness education and training. Recognising the value of school children as "multipliers" of disaster information: tapping this potential can prove its long-term effectiveness.

(a) Participate in committees or bodies established to prepare, coordinate and supervise programmes for the control and prevention of specific health hazards during disasters.

(b) Define their position in relation to the management of the major health problems and solicit the cooperation of governments, the community and voluntary organizations for the adoption of preventive measures and development of the needed services.

(c) Initiate and participate in research relating to determining the magnitude and nature of the priority areas, appropriate measures to be taken, practices and techniques which enable people to cope with such situations, and prevention of disasters.

(d) Ensure that sufficient number of Nurses receive the specialised preparation required to work with particular groups.

(e) Support the international measures against those problems requiring international cooperation (provision of adequate nutrition, control of drug traffic, pollution control, etc.)

(f) Work for bringing about necessary changes in Nursing Education to ensure adequate preparation of Nurses in order to carry out their responsibilities effectively in combating disaster.


 

Nurses’ Role in Care of the Elderly
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The Trained Nurses' Association of India (TNAI) endorses the World Health Organization's (WHO) view that those who are ageing a special challenge to the application of the commitment to achieving `Health for All by the Year 2000 A.D.' The WHO mobilized world action to attain this goal by convening the World Assembly on Ageing in 1982 with the Theme: Add Life to Years.'

The global concern for the elderly has increased in proportion to the increase in their numbers. The breaking up of the joint family, and the decline of the traditional support system to the elderly are adding to the problems of the elderly.

The enhanced significance of gerontology has ushered in increasing extension of Nursing care services to the `well elderly' as opposed to the earlier trend of administering only to the such and dying elderly- the aim being to ensure quality of life for the elderly.

The TNAI reaffirms its commitment to provide holistic, quality Nursing care to the elderly in India. To achieve this TNAI through its network of Branches all over the country advocates and supports the implementation of governmental and non-governmental policies in the care of elderly as mentioned below:

•    Make concerted efforts towards a national policy on the elderly and consider them as a priority group, so that appropriate care and facilities are made available to them.

•    Propose realistic legislation protecting elderly and encourage related legislation activities.

•    Develop an adequate social security scheme for the elderly at all levels.

•    Confer concessions for travel (local and inter-state), health care, housing and other such essentials,

•    Establish comprehensive preventive, primitive rehabilitative care services for the elderly.

•    Involve Nurses in planning and implementing comprehensive care to the elderly at all levels. (Preventive, promotive rehabilitative).

•    Support the provision of periodical/annual medical examination.

•    Channelise the residual potential and unutilized energy by encouraging the elderly for self-care and self sufficiency.

•    Propose reinforcement of Nursing Care of the elderly at all levels of Nursing Education programmes.

•    TNAI also proposes establishment of specialization course in Geriatric Nursing.

•    TNAI recommends Nursing Research to improvise the Nursing care of the elderly and facilitate essential changes in Nursing services and management.

 The Trained Nurses’, Association of India (TNAI) endorses the United Nations’ Declaration of Human Rights (HR) proclamation that all people are born free and equal thus, enjoy basic principles of equality and non discrimination as set out in the declaration. Association believes that its members would collaborate with government, voluntary organisations and agencies working towards the protection of Human Rights

1. Members of the Association observed with concern the situation(s) involving violation of Human Rights.

• Nurses as care providers and women are increasingly becoming themselves victims of violence in many insidious ways and also witnessing growing range of violence against women viz. battering, beating, burning, sexual abuse, rape, disfigurement, mental torture and killing etc.

• Although access to health care services is one of the basic Human Right, yet many of our people living in urban slums and remote rural areas do not have access to basic health services because of poverty, illiteracy, ignorance, transport difficulties, inadequate communication links etc. People die with diseases and women during childbirth because of non-availability of timely accessible competent care.

• Nurses during their employment in different organisations directly or indirectly are likely to be in a ‘risky’ situation where they may be involved in inhuman or degrading treatment of their patient(s).

The Trained Nurses’ Association of India as a professional body urges all Nurse Practitioners and Nursing personnel to join advocating forces on Human Rights as follows: To assure that all human beings have the right to a healthy existence and to get timely and competent health care facilities within their means at their doorstep, and utilising these for their benefit.

• The Association has obligation in support of the Article 10 of 1984 UN convention against torture and other cruel, inhuman or degrading treatment or punishment. That, Nurses be aware and understand the component of Human Rights and implication of its violation, ethical obligation of nursing personnel in preventing violation of Human Rights and rehabilitation of the victim(s) of torture etc. Therefore, the TNAI recommends and supports the development of curriculum by Indian Nursing Council (INC) of Human Rights and Torture which is to be incorporated in basic and post basic programmes of nursing.

• The Trained Nurses’ Association of India also suggests that there should be Continuing Education programmes for nursing personnel on Human Rights which may be organised by TNAI State Branches, Government Sectors and Private Sectors etc.

• Nurses/Nursing Personnel as their ethical obligation should not take part in any form of diagnostic procedure/examination and treatment that deprives a person of respect to which he/she is entitled as a human being.

• Nurse is ethically obligated to report if Human Right of his/her patient is violated.

• The Association further recommends that Nurses while working with various age groups in different health care settings must create awareness about their rights as human being.

Nursing Ethics

India is a welfare state and it recognises health as a fundamental right of the people. Thus since independence (1947) there have been considerable changes in health policies of the Government in all effort to fulfil its commitments to the goal of "Health for All" through expanded and Primary Health Care, the primary functionaries and the largest component of health manpower.

Nurses while rendering care in a politically oriented health care system and due to bringing health services under the Consumer Protection Act are increasingly facing ethical issues. Nursing Ethics are the professional standard of conduct practised by Nurse practitioners related to or in accordance with approved moral behaviour in rendering health care services.

Issues influencing/affecting the ethical conduct of Nurses are influenced by: over stretching of health care facilities; inadequate nursing organisation structure to facilitate quality care; defective recruitment rules to ensure appropriate utilisation of Nurses; deficit education facilities and opportunities for Nurses on the job updating their skills and for further advancement; unprotective work environment; uncontrolled privatisation and commercialisation of health services; participation in practising of defensive investigations and treatment; fear of violation of the patient’s or client’s individuality and confidentiality etc.

The Trained Nurses’ Association of India believes that as a professional person each Nurse is ethically and morally responsible for giving the required care to each individual to the best of her/his ability and refraining from such acts that would harm or exploit the patient/client as well as themselves. Therefore, Nurses on the job must seek and avail necessary opportunities that would keep them abreast of the changes and also provide facilities and fora to render effective, efficient care and share their views mutually on issues/acts which they may consider unethical and immoral.

   The Association, therefore, in the interest of sustaining ethical behaviour of the Nurses recommends as follows:

• Only those procedures which are taught and learnt through prescribed educational programmes and on the job training should be carried out on the patient/client.

• Irrespective of caste, creed, religion, sex every person should be helped and cared to attain/maintain optimum levels of health.

Rights of Children
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The Trained Nurses’ Association of India endorses the UN Declaration of the Rights of the Child (1979), and feels that Nurses have an important role to play in activities related to the various aspects of protecting and promoting the principles set forth in the Declaration in Collaboration with Government, voluntary organisations and agencies working towards the welfare of children. The four main areas of children’s rights relate to their survival, development, protection and participation. A brief description of each area is given below:

Survival: Access to health care services (such as immunization and oral dehydration therapy), and to an adequate standard of living (including food, clean water, and a place to live). In addition, the child has the right to a name and a nationality.

Development: To allow every individual child the opportunity to develop to his or her potential, and to recognise a child’s rights to education, to rest and leisure, and to engage in cultural activities. (As per UN Convention 1989).

Protection: To provide protection for children in a wide range of circumstances- coping with mental or physical handicap; parentlessness, and those separated from their parents; economic, sexual and other forms of child exploitation; and the rights of children in times of armed conflict and of children who are in trouble with the law.

Participation: To protect the child’s right to freedom of expression and information, their participation by parents by giving due weightage to the views of children, in accordance with their age and maturity, and to raise them to be able to play an active role in the society at large.

The TNAI, through its infrastructure of Branches all over the country, can work towards, and carry out the under mentioned activities in this regard:

•    Protecting children from physical or mental harm and neglect, including all forms of sexual abuse and exploitation;

•    Protecting children from economic exploitation and work that may interfere with education or be harmful to health and well -being;

•    Providing special treatment, care and education to children with disabilities;

•    Providing free and compulsory Primary Education, discipline and respect for child’s dignity to prepare the child for life in a spirit of understanding, peace and tolerance.

•    Providing the children with time to rest and play and equal opportunities for cultural and artistic activities.

•    Advancing family health and welfare so that family unit is the place where children are wanted, protected, and cared for so that they grow up in health and dignity.

•    Providing equitable distribution of goods and services so that all children have adequate nutrition, housing, education and health care.

•    Fostering the delivery of primary health care services with emphasis on the prevention of disease and disability.

•    Enhancing means of protection and care for those with special needs such as orphans, neglected and refugee children