6 December 2012

Nigeria: Ethical Issues in Nursing Practice


Picture this scenario: a nurse is beating a sick patient in bed. Reason: Madam Nurse was provoked by the patient's groans. A deadlier scenario: a weak but desperate asthmatic patient is in a struggle with a nurse who wants to strangulate him. This triggers an attack and the patient frantically reaches for his inhaler, only for the nurse to smash that life instrument on the ground, breaking, but not totally destroying it, before the desperate patient manages to get it out of sheer willpower. This may seem stranger than fiction, but these two events happened only recently. Welcome to the deadly world of Nigerian nurses.

A writer once recounted a nasty experience at the Igbobi Orthopaedics Hospital, Onipanu, Lagos, in the early 90s. Nurses on duty would, without conscience or character, visit the Casualty Ward, situated at the extreme end of the hospital, early in the morning and after a scornful "Good morning", begin to wish the patients dead: "Good morning. How many are dead and how many are still alive this morning, you mad people? If your suffering is too much, why don't you just die and let everyone else be at peace? Please stop all that useless noise because I am not the enemy from your mother's village who caused your calamity!"

It was not a joke: the nurses were heartless, mean and cruel. The patients, obviously in pain, were weak, vulnerable and in need of help, but the nurses tormented them day and night, until they were fairly strong, which may take many months, and then called the bluff of the morons in white uniform. Let no one be deceived: the case is still the same in 2012, in spite of the mechanisms put in place by public institutions like the University College Hospital, Ibadan, which have fairly well entrenched complaint channels. Many women in labour have, over the years, recounted angry tales of being harangued, scoffed at and spat on by nurses: "Please don't disturb us o! When you were enjoying the thing, were we there? Did you call us? This is your cross; you must carry it!" Really! Did the nurses desire husband-wife intimacy?

From Lagos to Kano, Kaduna to Enugu and Ibadan to Maiduguri, the story is the same: nurses carrying on as drunken lords and pirates in the public hospitals. They are caustic in their use of language, abusive in their approach to nearly everyone but their bosses, scornful of patients in need of care, intolerant of criticism, pompous at every turn, and inflamed by an inexplicable arrogance and an exaggerated sense of self importance. The story is particularly mystifying when you consider that the average female lawyer, magistrate, judge or doctor does not carry on like the female nurse. The female doctor does not suffer from any inferiority complex and is sensitive to patients' plight; the female lawyer knows she must keep her clients or perish in poverty; and the female judge or engineer knows that life is not all about office. So why is the nurse so different?

"The Nursing and Midwifery Council of Nigeria subscribes," by self-proclamation in its brochure, " to the fact that nursing is an inalienable right of citizens and, as such, the professional nurse has the responsibilities (sic) of assisting them to attain the optimal level of health. Its Code of Professional Conduct also posits that: "The nurse must provide care in such a manner as to enhance the integrity of the profession, safeguard the health of the individual client/patient and protect the interest of the society." That is not all. The nurse must, among others, "provide care to all members of the public without prejudice to their age, religion, ethnicity, race, nationality, gender, political inclination, health or social economic status; uphold the health consumer's human rights as provided in the constitution; ensure that the client/patient of legal age of 18 years and above gives informed consent for nursing intervention; avoid negligence, malpractice and assault while providing care to the client/patient; relate with a consumer in a professional manner only; not take bribe or gifts that can influence you to give preferential treatment; consider the views, culture and beliefs of the client/patient and his family in the design and implementation of his care/treatment regimen."

Indeed the code of conduct has graphic detail as its primary aims and objectives, spelt further in the brochure are "to maintain high standard of professional nursing and midwifery practice and enforce discipline within the profession." The brochure also defined "a nurse as someone who is trained to provide, preventive, supportive and restorative care to individuals, families and communities, independently, and in collaboration with other members of the health team, she must not fight, work cooperatively and collaborate with professional colleagues and other members of the health team for ethical procedure and as well exhibit esprit de corps in all situations". The questions therefore are Nigerian Nurses eschew arrogance? What becomes of a Principal Nurse Officer of a prestigious teaching hospital like University College Hospital, Ibadan to become a death trap to a patient admitted in a private hospital to lose her temperament and inflict verbal and physical assaults on a patient having severe abdominal pains? The esprit de corps preached in the code of conducts to support the nurses on duty in the private hospital became a nullity. What becomes of a nurse having an asthmatic patient in her family to deprive the patient of using his in hailer because of a minor rift at home?

If a quarter of these aims, objectives and ethos of the NMCN are achieved, Nigerian public health institutions would be an Eldorado.

Kolawole wrote from Osogbo

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