Nurses: A Voice to Lead: Health Is A Human Right-Tshwane District Nurses

The purpose of this paper was to brief nurses under Tshwane District on the International Council of Nurses (ICN) 2018 International Nurses’ Day (IND) theme. The ICN toolkit was downloaded and a full exploration of the topic was embarked on and delivered to Tshwane District nurses on 11 May 2018. The paper applies the context under which nurses practise as well as Hildegard Peplau’s interpersonal relations model. This paper is divided into four parts: health is a human right; access to health care; investment and economic growth, and policy to practice – practice to policy. At the end the author makes recommendations according to context. Introduction and Background The International Council of Nurses (ICN) holds that health is a human right and is at the forefront of advocating for access to health and nurses are the key to delivering it ICN Toolkit [1]. The human right to health means that everyone has the right to the highest attainable standard of physical and mental health, which includes access to all medical services, sanitation, adequate food, decent housing, healthy working conditions, and a clean environment (National Economic and Social Rights Initiative [NESRI] sa). The case of Life Esidimeni in South Africa (Gauteng province) is a close example of health as a human right ‘denied’. The case of Esidimeni is an example of individuals and communities who suffered and still suffer due to lack of access and could not afford health care; of 144 patients who died presumably due to neglect and hunger while 20 patients are still missing and unaccounted for Nicholson. The president of the ICN, Annette Kennedy states that the right to health applies to nurses as well. “We know that improved quality and safety for patients depends on positive working environments for staff. That means the right to a safe working environment, adequate remuneration, and access to resources, and education. We must add in this the right to be heard and have a voice in decision making and policy development implementation!” Kennedy in ICN Toolkit [2]. Nurses and midwives in South Africa, this call is directed to you. South Africans have a Constitution South Africa, 1996 [3] that protects all citizens. Chapter 2 of the Constitution contains the ‘Bill of Rights’, and chapter 10 is on ‘Public Administration basic values and principles governing public administration’, put simply by the late Zola Skweyiya as ‘Batho Pele Principles’ South Africa, 1997 [4]. In the Department of Health Strategic Plan, 2014/15 – 2018/19 South Africa [5], organizational environment is highlighted which covers working conditions. This paper discusses health as a human right, access to health care, investment and economic growth and policy to practice – practice to policy in relation to the growth model of change and the ICN Toolkit, 2018 theme. Growth and development models of nursing look at the four central concepts of human as an intrinsic potential to change; human environment interaction as linear and irreversible, affecting change when applied at the appropriate time; health as change toward maximum potential, and examples of nursing implication stimulate re-patterning Leddy et al. [6]. Hildegard Peplau’s interpersonal relations model is the chosen model to guide this paper Health Is A Human Right In 2017 Puras presented a report stating the right of everyone to the enjoyment of the highest attainable standards of physical and mental health to the Human Rights Council of the United Nations ICN Toolkit [1]. The Constitution of the Republic of South Africa Act, 108 of 1996, places the obligation on the State to progressively realize socio-economic rights, including access to health care (Schedule 4; Section 9; Section 27 and 28 on health issues in the Constitution). In nursing and health practice, socially challenged groups including intellectually, cognitive and psychosocial disabilities, face neglect, abuse and violence at the hands of health practitioners. Meeting Biomedical Journal of Scientific & Technical Research Volume 8Issue 4: 2018 Cite this article: Bethabile Lovely Dolamo. Nurses: A Voice to Lead: Health Is A Human Right Tshwane District Nurses. BJSTR MS.ID.001697. DOI: 10.2671/BJSTR.2018.08.001697 2/6 the physical health needs of diverse consumers with serious mental illness (SMI) is impeded by organizational, environmental, and consumer-level barriers. According to the South African Nursing Council (SANC), nursing education in South Africa as a four-year programme (R425) includes psychiatric nursing as one of the modules SANC, [7], and these abuses can be eradicated by nurses as they are prepared to manage psychosocial disabilities and as ‘the voice to lead’. Establishing better care coordination networks, increasing mental health provider education on medical issues, and culturallytailoring health promotion programming provide plausible strategies for improving the physical health of this vulnerable population Jerel et al. [8]. Mental health policies and services are said to be in crisis; for example, Esidimeni in Gauteng province, and Tower Hospital in the Eastern Cape Timeslive [9]. Since most professional nurses are psychiatrically trained, nurses should make a bold political commitment and urgent policy response in resolving this crisis ICN Toolkit [1]. The third issue is failure to respect, protect and fulfil the right to health. This means treating clients as human beings in the terrain of personal, social, political and economic lives not only treating the pathology, the nursing process that permits the professional nurse to view the client in a holistic way (nursing care plans are bound to cover these). And the fundamental issue constraining ability to attain health for all is the lack of a people-centred approach to health. The fundamental of nursing practice is ‘caring’ and the ‘Nurse’s Pledge of Service’ reminds nurses just that: Nursing is a work of heart. Health is a human right focuses on social determinants of health as ICN IND2017 theme, ‘Nurses: the voice to lead – achieving sustainable development goals,’ Section 27 of the SA Constitution covers this area South Africa. This year’s (2018) theme is building on last year’s theme by now exploring access to health. The right to health should be used as a constructive tool for the health sector to provide the best care for individuals, communities and populations. In Peplau’s model, the nurse is concerned with the health needs of sick and well individuals, groups, families and communities Leddy & Pepper [6]. Therefore, nursing helps people to meet their present needs. There are six (6) core elements of an effective health system based on the right to health, namely health services, health workforce, health informatics, health financing, leadershipgovernance, and stewardship World Health Organisation [10]. Access to Health Care “If we do not engage consumers, patients, and family members in the health care process, we will not be effective at eliminating inequalities and improving health for all” (Kalahn Taylor-Clark in ICN Toolkit . Peplau views a person as an organism that lives in an unstable equilibrium and life is the process of striving in the direction of stable equilibrium Leddy & Pepper [6]. Nursing is the only health profession that attends to people’s needs in their most vulnerable times. This cannot be stated better than as expressed by the “Batho Pele Principles” South Africa [3]. Nurses are the closest health professionals who attend to clients’ needs. Access to health care is the key determinant in how well the health system meets the health needs of individuals and communities. Health as a human right is the cornerstone of universal health coverage and peoplecentred care, and access is central to it. According to Peplau Leddy et al. [6], health implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living. This International Nurses Day defines access as ‘the opportunity to reach and obtain appropriate health care services in situations of perceived need for care’. Access is about ‘enabling people to make the right steps of being able to contact or obtain health care as their needs require and having these health care needs fulfilled ICN Toolkit [1]. As in ‘Batho Pele Principles’, access does not only mean affordability, but involves both the user and the health service provider South Africa [4]. According to Peplau Leddy et al. [6], the relationship between the nurse and the client, which takes place within the environment, is a critical aspect of the therapeutic process. The following concepts are associated with the client’s expectation of the health service provider ICN Toolkit [1] a. Approachability – transparency, information, screening, outreach b. Acceptability – professional values, norms, culture, gender c. Availability and accommodation – geographical location, accommodation, hours of opening, appointments d. Affordability – direct cost, indirect cost, opportunity cost e. Appropriateness – technical and interpersonal quality, adequacy, coordination, and continuity. The user should have the ability to: a. Perceive – perception of needs and desire for care

consumer-level barriers. According to the South African Nursing Council (SANC), nursing education in South Africa as a four-year programme (R425) includes psychiatric nursing as one of the modules SANC, [7], and these abuses can be eradicated by nurses as they are prepared to manage psychosocial disabilities and as 'the voice to lead'.
Establishing better care coordination networks, increasing mental health provider education on medical issues, and culturallytailoring health promotion programming provide plausible strategies for improving the physical health of this vulnerable population Jerel et al. [8]. Mental health policies and services are said to be in crisis; for example, Esidimeni in Gauteng province, and Tower Hospital in the Eastern Cape Timeslive [9]. Since most professional nurses are psychiatrically trained, nurses should make a bold political commitment and urgent policy response in resolving this crisis ICN Toolkit [1]. The third issue is failure to respect, protect and fulfil the right to health. This means treating clients as human beings in the terrain of personal, social, political and economic lives not only treating the pathology, the nursing process that permits the professional nurse to view the client in a holistic way (nursing care plans are bound to cover these). And the fundamental issue constraining ability to attain health for all is the lack of a people-centred approach to health.
The fundamental of nursing practice is 'caring' and the 'Nurse's Pledge of Service' reminds nurses just that: Nursing is a work of heart. Health is a human right focuses on social determinants of health as ICN IND2017 theme, 'Nurses: the voice to lead -achieving sustainable development goals,' Section 27 of the SA Constitution covers this area South Africa. This year's (2018) theme is building on last year's theme by now exploring access to health. The right to health should be used as a constructive tool for the health sector to provide the best care for individuals, communities and populations.
In Peplau's model, the nurse is concerned with the health needs of sick and well individuals, groups, families and communities Leddy & Pepper [6]. Therefore, nursing helps people to meet their present needs. There are six (6) core elements of an effective health system based on the right to health, namely health services, health workforce, health informatics, health financing, leadershipgovernance, and stewardship World Health Organisation [10].

Access to Health Care
"If we do not engage consumers, patients, and family members in the health care process, we will not be effective at eliminating inequalities and improving health for all" (Kalahn Taylor-Clark in ICN Toolkit . Peplau views a person as an organism that lives in an unstable equilibrium and life is the process of striving in the direction of stable equilibrium Leddy & Pepper [6]. Nursing is the only health profession that attends to people's needs in their most vulnerable times. This cannot be stated better than as expressed by the "Batho Pele Principles" South Africa [3]. Nurses are the closest health professionals who attend to clients' needs. Access to health care is the key determinant in how well the health system meets the health needs of individuals and communities. Health as a human right is the cornerstone of universal health coverage and peoplecentred care, and access is central to it. According to Peplau Leddy et al. [6], health implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living.
This International Nurses Day defines access as 'the opportunity to reach and obtain appropriate health care services in situations of perceived need for care'. Access is about 'enabling people to make the right steps of being able to contact or obtain health care as their needs require and having these health care needs fulfilled ICN Toolkit [1]. As in 'Batho Pele Principles', access does not only mean affordability, but involves both the user and the health service provider South Africa [4]. According to Peplau Leddy et al. [6], the relationship between the nurse and the client, which takes place within the environment, is a critical aspect of the therapeutic process. The following concepts are associated with the client's expectation of the health service provider ICN Toolkit [1] a.
Approachability Access to health services means the timely use of personal health services to achieve the best health outcomes. It requires three distinct steps: gaining entry into the health care system through insurance coverage; accessing a location where the needed health care services are provided and finding a health provider whom the patient trusts and can communicate with (Healthy people sa).
According to the ICN Toolkit [11], for services to be accessible the first step is knowing that clients need the health care. The second step is that health care services are provided in a way that assists in empowering the user to identify health needs and access the appropriate health service.

Meeting Diverse Needs
People do not engage or access health services because of lack of culturally appropriate health care services; racist or discriminatory behaviour by health care staff; unaffordable cost of seeking health care, and lack of ability to attend appointments.
Acceptability of health services extends to more than just cultural  Health care institutions should provide satellite clinics to those populations to make easy-to-reach services available. Accessibility of or the ability to reach services is also affected by utilization of accessible transport to reach health services. The National Department of Health introduced engineering primary health care to reach out to such communities. The programme is ongoing but some communities are not benefiting from it as well as those whose work demands affect their ability to access health services during hours of operation Dolamo [12]. A twenty-four-hour health service at primary health care level has its own advantages and more disadvantages hence the service is failing.

Affordability of Care
The South African National Department of Health offers a free service especially to children under five and pregnant women.

People-Centred Care
Nursing helps people to meet their present needs. When these needs are met, more mature needs can emerge and the person moves forward Leddy et al. [6]. 'The client, not the nurse is the authority figure and decision maker, the nurse's role involves helping individuals and families in choosing the responsibilities for changing the health process' Rose Marie Risso Parse in ICN Toolkit [1]. As the nurses slip into the routine or delve into an overcrowded workplace, they lose awareness of the person as a whole, and lose sight of their uniqueness. Pattern-centred care refers to completing numerous tasks within a specific period of time with the risk that these tasks take precedence over engaging and meeting the holistic needs of the client. The common cause of pattern-centred care is the shortage of staff and skills-mix, and the caring component in nursing is lost in the process. Leverque, Harris and Grant [13] suggest that both resources and population characteristics can be modified to ensure continuing levels of access, but only resources can be modified in the short-term. Dimensions related to factors such as geographic access, resource availability, cultural acceptability, and quality of care to health system coverage have also been suggested (Equityhealth, sa).

Investment and Economic Growth
Owners of businesses usually focus on productivity without investing in human resources. Yet, happy and healthy people in the workplace are more productive than tired and unhealthy workers.
Sen ICN Toolkit, [1] maintains that economic growth without investment in human development is unsustainable -and unethical.
Health is a good investment -health as a human right with health as the backbone of the economy: no health no work, no wealth.
A healthy nation is a productive nation. 'Healthy nurse, healthy nation' inspires nurses to use their skills as advocates, educators, and role models to improve the health of the nation (ANA, sa).
Creating a healthy workplace environment for employees improves productivity and reduces costs related to absenteeism, turnover, workers' compensation and medical claims.
A healthy working environment is also important to keep the working community healthy for productivity. Consider Sibanye gold mine, with rock falling and stoppage of work with lack of productivity, and six dead mine workers in just one-month Cape talk [12]. Part of a healthy workplace environment is workplace culture -a great company culture can keep employees productive and even help the company retain the best employees, and happy workers are also more likely to stay (Inside, sa). It also involves physical, environmental and occupational health and safety, and Policy to Practice -Practice to Policy Mason [14] ICN Toolkit, [6] maintains that all action, even inaction, is political. Politics is, after all, only the exercise of influence over the allocation of scarce resources or the use of relationships and power to gain ascendancy among competing stakeholders to influence policy and the allocation of scarce resources. As nurses, we argue that when policy is made we do not 'have a seat at the

Recommendations Following This Presentation
The author makes the following recommendations specifically

Conclusion
The finger is pointing at 'you' and 'me' in providing "Health is a Human Right", whatever our position. It is high time nurses take the lead in the formulation and evaluation of policies related to health and health provision. We need to stop pointing a finger somewhere else and blaming someone else for our problems and those occurring in the workplace. Nurses can be part of solving them by being involved in policy formulation. The National Department of Health should give nurses the dignity they deserve and improve nurses' working conditions.