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INTRODUCTION


Nursing and midwifery services are vital for attaining health and development. They form the backbone of health care, representing over 50 % of the health profession.
As early as 1948, World Health Assembly (WHA) identified the need to strengthen the roles of nurses and midwives.
In 2001 the member states in the WHA stated that nurses and midwives play a crucial and cost effective role in reducing excess mortality, morbidity and disability and in promoting healthy life styles. Due to inadequate care and declining of the numbers of nurses and midwives, WHO launched the "Strategic Direction for Strengthening Nursing and Midwifery Services 2002-2008" (Resolution 54.12) targeting 5 main areas to scale up and enhance the development of nursing and midwifery services to respond to health needs on the basis of sound scientific and clinical evidence. (more reading at www.who.int/org.nursing) and (www.who.int/health.services-delivery/nursing/gagnm/index.htm)


COUNTRY SITUATION

The Directorate of Nursing Services under the Ministry of Health and Family Welfare is responsible for the delivery of nursing services and education.
There are approximately 22000 registered nurses out of which 14689 are working in the public sector, approximately 3000 are working in the private sector and 3000 are working abroad. The nurses are working in different capacities in the public sector and in different health care settings down to Upazila Health Complex.
There are 38 nursing institutes in the government sector and 5 private offering three years Diploma in General Nursing and one year Diploma in Midwifery/Orthopedic. The total intake of students is 1135 each year based on a central admission system.
There is one College of Nursing affiliated to the University of Dhaka offering two years Bachelor of Science Degree (BSc) in Nursing and Public Health Nursing with a total of 125 seats each year to prepare professional nurses with leadership, management and teaching abilities. Eight more nursing institutes and one college of nursing will be constructed. Approximately 90 nurses were awarded Master Degree in different fields from in country, offshore course and abroad.


Additional information

Bangladesh Nursing Council was established on ad hoc basis in 1971 and was formalised in 1983 as a regulatory body for nursing education and services.
The Directorate of Nursing Services was established in 1977 under MOH+FW. A Research Cell was established in the College of Nursing In 1998.


CURRENT WHO SUPPORT

WHO has been supporting Bangladesh in improving and strengthening the nursing and midwifery services since 1971.
The main areas given attention to are:

  • Facilitate capacity building and collaborative partnerships
  • Enhance and strengthen the managerial and technical care skills of nurses and midwives practice in order to meet the changes in population and practice needs, and
  • To foster an environment which enables the nurses and midwives to be more pro-active in decision-making regarding their own profession and health care development and thus take more active part in the national health system performance and policy matters.
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WHO supports Directorate of Nursing Services by:

A. Strengthening and enhancing the capability for effective management
To equip nurses and midwives with advanced knowledge and skills in Leadership and Management are vital for the nurses in every capacity and level. Hence the Directorate of Nursing Services in collaboration with International Council of Nurses and WHO decided to run a 2 years course (consisting of intensive workshops, individual development project and group projects with the aim to improve the quality of nursing care) under motto "Leadership for Change"(LFC) to encourage the nurses to develop their negotiation and communication skills together with management skills to enable them to be active contributors to the country's health development and effectively manage the patient care.

Training courses in Leadership and Management for Dy. Nursing Superintendent, Nursing Supervisors and District Public Health Nurses to update and enhance their managerial knowledge and skill.

B. Increased competency and capability of Nursing and Midwifery personnel

  1. Directorate of Nursing Services in collaboration with Adelaide University and WHO agreed to conduct a one year off-shore course in Clinical Nursing for 3 years to enable more nurses to be awarded a Master Degree.

  2. Infection control is one of the critical components to ensure quality in hospital services. Hence, in-service training workshops on infection control/prevention are being conducted to help the nurses to acquire better knowledge and skills to safe guard, prevent and reduce unnecessary sufferings for themselves and the patients. They will then also act as health promoters/educators.

    This activity has been introduced in:
    National Institute of Traumatology, Orthopedic and Rehabilitation (NITOR),
    Institute of Diseases of Chest and Hospital (IDCH), Dhaka
    Dinajpur Medical College Hospital
    Patuakhali General Hospital
    Noakhali General Hospital
    Narayangonj 200 bedded Hospital.
    Munshigonj General Hospital
    Pabna Sadar Hospital

  3. Behavior change communication (BCC) workshops are conducted with the aim to improve the inter-personal relationship towards the patients, their relatives and to establish more effective and better communication towards multidisciplinary health categories.
C. Improved quality of Nursing and Midwifery
As Bangladesh still suffers from a relative high maternal mortality and morbidity rate, Directorate of Nursing Services agreed to adopt and introduce Midwifery Standards of Practice for Safe Motherhood developed by SEARO.

Health personnel at 6 hospitals sites have already gone through the training. In order to improve quality and ensure more effective nursing care, selected Nursing Standards was developed and introduced in some hospital sites.
Midwifery- and Nursing Standards will be further implemented in Medical College Hospitals and District Hospitals.
Guidelines for management of hospital nursing services at the ward and hospital levels will be developed to support guidelines for quality improvement in nursing and midwifery care.

Midwifery Standards have been introduced in:
Dhaka Medical College Hospital
Comilla Medical College Hospital
Barisal Medical College Hospital
Mymensingh Medical College Hospital
Cox's Bazar Sadar, Hospital

General Hospital, Barisal
Kushtia General Hospital

Nursing Standards have been introduced in:
National Institute of Traumatology, Orthopaedic and Rehabilitation, Dhaka
Sir Salimullah Medical College Hospital, Mitford, Dhaka
Comilla General Hospital
Bogra Medical College Hospital
Faridpur Medical College Hospital
Jessore General Hospital

D. Develop Evidence bases in Nursing and Midwifery
A Research Cell was established as a functional unit of the College of Nursing in 1999 with technical support from WHO. Training courses are conducted to equip the nurses with professional knowledge on research methodology and undertake small-scale studies focusing on the need to ensure qualitative nursing care through evidence-based practices.

E. Strengthening of Nursing and Midwifery management and regulation
Priority issues related to workforce management will be strengthened based on the developed national guidelines. Bangladesh Council of Nurses will be further strengthened with special attention for establishing a operational system for accreditation of nursing and midwifery educational programmes and institutes.

KEY DOCUMENTS

  1. The Nursing Contribution to Future Health Care Delivery.
    A Policy paper (2002)
  2. National Plan of Action for Development in Bangladesh (1994)
  3. Report of the Director of Nursing Services (November 2002-August 2003)
  4. Code of Conduct for Nurses in Bangladesh (2003)
  5. Study Report on In-Depth Assessment of Nursing/Midwifery Workforce Management in Bangladesh (2002)
  6. Resolution of the WHO Regional Committee for South-East Asia (September 2003)

RELATED SITES

World Health Organization, HQ,Geneva:
www.whoint.org, www.who.int/health-services-delivery/nursing/partnets.htm, www.whoint/health-services-delivery/nursing
World Health Organization Regional Office,New Dehli:

www.whosea.org/nursing/contents.htm
, www.w3.whosea.org/nursing/index.htm
International Council of Nurses (ICN):
www.icn.ch
International Confederation of Midwives (ICM):
www.internationalmidwives.org
Journal of Advanced Nursing(JAN):
www.journalofadvancednursing.com
Australian Nursing Council (ANC):
www.anc.org.au
British Nursing Association (BNA):
www.bna.co.uk
Journal in Nursing Management:
www.nursingmanagement.com
List of Nursing Journals
www.ulib.iupui.edu/subjectareas/nursing/medjnl.html

 

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