by Judith King
HSS Copy and Content Editor
Instituted 49 years ago by the International Council of Nurses (ICN), International Nurses Day is observed every year on 12 May to commemorate the birthday of Florence Nightingale – the founder of modern nursing theory and practice, who balanced her nursing care with roles as a social reformer, statistician and educator, and pioneered the fields of preventive medicine and health system management.
The theme for this year's global campaign for International Nurses Day is: 'Our Nurses, Our Future', to focus thinking on what is required to address health challenges and enhance health care worldwide. HST celebrates our nurses who play such a valuable role in the health systems strengthening work we undertake, and make real and tangible changes in people's lives through their caring approach to patient services.
The impact of COVID-19 demonstrated to the entire human family how nursing services form a bridge between health, education and community development. The contribution of nursing to society will be ever more important in a future characterised by new disease outbreaks and pandemics. These will place unparalleled demands on health systems and the personnel who work within them.
Today's nurses serve in a world where health care is not evenly accessible to vulnerable, disadvantaged and under-served people. Social needs undermine the health and wellbeing of populations and settings, and chronic shortages of nursing staff cause demotivation and burn-out that affects the quality of health care.
Only a diverse, well-capacitated nursing workforce with skills to strengthen links between communities, health staff and facilities can efficiently organise and deliver holistic care, promote long-term, general health, innovate quality-improvement approaches, and train and mentor colleagues on various forms of nurse-initiated clinical management.
HST's SA SURE PRO project Nurses embody this approach in their delivery of person-centred, team-based care.
One aspect of diversification among the project's nursing team structure is the assignment of male Nurses for men's health.
HST Nurse Clinician Sithembiso Sithole provides comprehensive facility- and outreach-based care services for men in uMgungundlovu. "Male clients are more comfortable and open when attended by a male practitioner," he says. "This is important for health outcomes because men are fast-tracked for services, and client‒provider relationships are much stronger. This means that more male clients are gaining knowledge about their health issues and the assistance that is available to them. For example, I've noted that more men are becoming interested in receiving pre-exposure prophylaxis (PrEP) for HIV, which is a positive trend for epidemic control."
Nurse Clinician Sithembiso Sithole
Sir Sithole confirms that team-work is essential for service success. He values the ongoing learning that he gains in the workplace, in tandem with additional health-service training that he is currently undertaking. "Although male sexual dysfunction is not covered in the MINA Campaign service profile," he explains, "many men seek such advice and it affects their physical and psychological wellbeing, so I would like to learn more about this area to support and empower them."
Nurse Clinician Mphiliseni Nyandeni is based at Mason Street Clinic in Vryheid, Zululand, where he serves the Men's Clinic in providing HIV testing, counselling, treatment initiation and monitoring, as well as management of male patients with chronic and acute conditions. He also coaches and mentors Lay Counsellors, Adherence Counsellors and other Nurse Clinicians.
Nurse Clinician Mphiliseni Nyandeni
His qualifications in Primary Health Care, Adult Primary Care and Nurse-initiated Management of Antiretroviral Therapy (NIMART) equip him well for this role, and he plans to study further in the field of Advanced HIV Management and public health. Sir Nyandeni is committed to ensuring that comprehensive health services are accessible to all male patients. "I would urge healthcare workers to be respectful to our male clients, as we would to our own fathers," he says. "I'm inspired to do this work because HIV mostly affects our Black population, and I love my people."
Nurse Clinician Phiwayinkosi Phoswa provides holistic men's health services through the MINA Campaign at Richmond Clinic in uMgungundlovu. These include treating minor ailments, and conducting HIV testing, counselling and treatment management to achieve viral suppression. He also delivers health talks on common concerns for men such as prostate cancer and erectile dysfunction.
Nurse Clinician Phiwayinkosi Phoswa
"My passion for this role became stronger when I noticed the increased numbers of male clients coming to the clinic compared to the early phase of MINA programme implementation," he explains. "I hear male clients sharing more about their health concerns, and how much they value being able to talk about their issues with another male."
"Although men are generally reluctant to seek health care at facilities and wait in long queues, they want help," says Sir Phoswa. "They just need a therapeutic space with a non-judgemental listening ear, and they don't appreciate being shouted at. This is so important for case-finding and continuity of care, because many men tend to rely on women to be tested for HIV as a means of determining their own HIV status. It's also vital to encourage men to be treated at an early stage, especially for fatal illnesses like prostate cancer."
Nurse Clinician Teboho Lebenya was a Community Nurse before joining HST, and at KwaNjoko Clinic in Pongola, Zululand, he provides integrated TB and HIV services. "My love for helping people, especially to reduce or eliminate stigma against HIV-positive clients and linking them to care, is what drives me in this role," he says. "Every day I am able to educate patients about the benefits of HIV treatment so that they can live in health and reduce their risk of transmitting HIV."
Nurse Clinician Teboho Lebenya
"It's not only about delivering clinical services," Sir Lebenya notes. "Empathy and understanding people's various cultural values and moral perspectives ‒ especially those from rural communities – is essential for supporting them in their treatment journey. This in turn strengthens links between the facility and the community for enhancing people's knowledge and awareness to improve their health."
Sir Lebenya emphasises that team-work is central to successful service delivery, and he intends studying for a Master's degree focusing on advanced HIV management.
Community-based health service delivery is a key approach for ensuring universal health coverage, and the SA SURE PRO Outreach Teams are deployed to fulfil this focus area.
Sr Precious Khathi is a Nurse Clinician serving as an Outreach Team member in Pongola, Zululand, mapping community needs, especially for hard-to-reach populations, for planning of daily activities for integrated HIV and TB care, as well as other conditions.
Nurse Clinician and Outreach Team member, Precious Khathi
"Our team delivers medication and takes blood tests for patients working at sugarcane plots who cannot come to the clinic on their appointment dates," she explains. "We also conduct community campaigns to provide cervical cancer screening, child immunisation, and management of minor ailments."
Sr Khathi prizes her role. "It has given me the privilege of going to people's homes and understanding their social determinants of health in person. It is very fulfilling to empower and support them with health education, and to help them in their most vulnerable moments," she says. "Seeing patients progress from ill health to wellness is my motivation."
Having obtained her Bachelor of Nursing at the University of KwaZulu-Natal cum laude and a Postgraduate Diploma in Public Health from the University of Pretoria with a distinction, Sr Khathi is currently pursuing a Master's in Public Health.
"I love learning," she says, "and equally valuable is the experience I've gained in health facilities," she says. "Nurses form the backbone of the health sector – we are advocates for health promotion and disease prevention, so we should also take the advice that we give to patients for self-care, sufficient rest and a healthy lifestyle. My support comes from my hard-working team-mates, and I'm inspired by my managers – they all set the example of being prepared and full-hearted."
Nurse Clinician Thabisile Sithole also serves as an Outreach Team member during focused campaigns, and as a facility-based resource at the Ceza Hospital Gateway Clinic in Zululand, where she delivers integrated services for HIV, TB and sexually transmitted infections, along with care for patients with diabetes, hypertension, epilepsy, minor ailments and mental health conditions.
Nurse Clinician Thabisile Sithole
With a degree in Nursing Science from the University of Zululand, Sr Sithole intends studying further in Primary Health Care. "Good nursing requires being approachable, open to many different cultures and attitudes, and tending to people calmly and cautiously, gathering all the information one can and building a trusting relationship with patients," she says. "Along with our proven strategies, guidelines and data management systems, this enables us to bring more people into care and maintain their care plans."
Sr Sithole is inspired by support from her team leader and colleagues: "We work hand in hand to achieve our shared goal of helping our patients."
Beyond delivery of essential health services, our Nurses are uniquely qualified to equip patients, families and communities with the education tools needed to actively make informed health decisions that affect their lives.
Nurse Clinician Sindisiwe Thabede illustrates the varied nature of her role. Based at Overport Clinic in eThekwini, she explains that apart from service provision for patients with chronic conditions, her work entails advocacy for each individual patient; ensuring patient safety in terms of correct regimens, confidentiality and good clinical practice; health education for patients, and supervision and mentoring of staff on new policies and guidelines; and providing support to the Facility Manager in tracking performance against daily targets. For outreach services, she collaborates with Community Health Workers, supervises Outreach Team staff, and organises daily and weekend activities.
Nurse Clinician Sindisiwe Thabede
As a NIMART-trained Professional Nurse with qualifications in General, Midwifery, Psychiatric and Community Nursing as well as Adult Primary Care, Sr Sithole has found that she is best suited to project management for health promotion and preventative care. "I've covered a lot of ground in primary health care, health system management and in research," she explains, "but being at the bedside of a critically ill patient is too moving for me. My commitment is not only to reaching performance targets, but more broadly to accomplish the mission of creating a supportive environment for lifelong health."
In this, Sr Sithole draws on her technical engagement with the Ottawa Charter for Health Promotion, and has a special interest in building capacity for community action in this area. "I want to contribute to a competent health system that delivers effective, efficient, accessible, affordable, evidence-based and scientifically advanced care," she says, "and which prioritises the comfort, safety and autonomy of the patient."
Professional Nurse Felicity Basson ‒ who has progressively served HST over seven years as an SA SURE Nurse Mentor, Co-ordinator for Adolescent- and Youth-friendly Services, HIV Testing Services Co-ordinator and now Operations Manager – is an exemplar of how the nursing role translates clinical and managerial skills and knowledge into valuable health system contributions.
Professional Nurse and SA SURE Operations Manager, Felicity Basson
Her motivation is both professional and personal: she has lost close family members to AIDS, and she feels privileged to work in a programme designed to end the epidemic. "Our teams are very supportive," she notes, "and we tap into each other's expertise to accomplish our performance targets. Treatment is available, and HIV is no longer a death sentence."
Felicity hopes to add a Master's degree in Public Health to her qualifications in Nurse Management, Nursing Education, Occupational Health, and Public Health. "Stagnation is not an option," she says, "and each day's challenges give me an opportunity to learn more so that our patients receive the care that they deserve."
As we honour all nurses for their expertise, dedication, kindness, resilience and bravery in caring for patients, families and communities, Florence Nightingale's guidance is as relevant today as it was 160 years ago:
- Never, ever stop learning.
- Ground yourself and your work in facts and evidence.
- Muster the courage to follow your convictions.
- Treat every person holistically.
- Know your strengths and your weaknesses.
- Use your network to accomplish what you think you might be unable to accomplish on your own.
- Speak and write often about the lessons that you would like to share with others.
- If you see something that should be changed, solicit help from others.
- Keep your standards high.