The ultimate mission of the MTRH Nursing department is better health for all people. This is in line with the Hospital’s mission which is to provide specialized quality health care services through teaching, research and training. This is also achieved through participation in national health planning. We accomplish this by educating each generation of nurse leaders, scholars, and practitioners; transforming health care practice; and advancing nursing sciences.
Values of the nursing department
The Nursing department in MTRH is a society of professions that hold an expansive view of health and believes that access to high-quality, patient-centered nursing care is a social right, not a privilege. It values integrity, dignity, rigor, curiosity and excellence. In its endeavor to provide quality nursing care services, the department emphasizes innovation grounded in creativity and the integration of practice, training and policy in service of social justice and health equity. We value the wise use of resources and are committed to inter-professional education, research, and practice, and mentorship of the next generation of nurse leaders. We strive to create a working environment that is caring and supports openness and transparency.
Philosophy of the nursing department
Each person is a unique biological, psychological, social being, who is influenced by and influences environments. Culture and society shape a person`s values, beliefs, behaviors, and perceptions about health and illness. We believe that individual differences are to be respected, free from bias and stereotyping. Individuals have the right to accurate and comprehensible information about their health care and available resources. Individuals have the right to participate in decisions concerning their care and their return to health.
Concern for the highest possible quality of life, respect for human value, and commitment to caring are the primary postulates of the MTRH nurses. Nursing involves an alliance with the patient to promote health, prevent disease, treat selected illness, and maintain or restore function. Nursing services are provided independently or in collaboration with other health professionals. Our Nursing care draws upon the integration of science and humanism, and theory developed through practice and research. We believe that the Nursing department has an obligation to effect public and colleague acceptance of the leadership capabilities of the MTRH’s nursing profession.
MTRH is committed to the advancement of nursing knowledge and the improvement of health care. It is hence, our responsibility to shape the design of health care and nursing education systems, because we believe that improving patient care improves education and, likewise, improving education improves patient care. An environment conducive to an interchange of ideas among hospital staff, nursing students at diploma, undergraduate and postgraduate level and hospital administration is essential. We believe that practice will be improved through sound clinical judgment, training and research.
Leadership of the nursing department
Leadership is necessary at all levels of the health care organization, including at the level of patient care, where it is seen in autonomy and accountability of practice, grounded in specialized practice knowledge. Leadership is fundamental to providing equitable health care for all people.
The MTRH nursing leadership is structured from the director of nursing,two deputy deputies (Nursing Clinical Services/Nursing Administration and Training) and four Assistant Directors of Nursing to the Principal Nursing Officers (Nurse Managers) at all specialized units in the hospital, who are ably deputized by ward in-charges and their deputy ward in-charges.
INFECTION PREVENTION AND CONTROL UNIT:
The old saying “prevention is better than cure” could not be more apt for infection prevention and control in MTRH. There was a time, when the consensus was that hospital-acquired infections could never be reduced to zero;
Performance Improvement in infection controls require entire Clinical departments and administration to work together in implementing changes intended to lower infection rates. The focus is less of product change but more on standard-of-care change, at times requiring gap analysis to identify opportunities for improvement.
QUALITY ASSURANCE IN NURSING CARE
Quality Assurance is an on-going, systematic comprehensive evaluation of health care services and the impact of those services on health care services. The principles of quality assurance entail customer focus, leadership continual improvement process approach and system approach to management. ISO (9001:2008) quality management systems are one of the models of quality assurance used at MTRH for continual improvement of health services.
Nursing care records are the most useful source of information on the quality of care to the patients. The role of a quality-nursing assurance officer at MTRH is hence to:
• Actively participate in the interdisciplinary quality improvement team,
• Develop mechanism for continually monitoring the effectiveness of nursing care both as collaborative and as an individual professional activity done through quality improvement team,
• Contribute innovations and improvement of patient care on the use of latest technology,
• Participating in improvement projects and patient safety initiatives ,
• Periodic and continuing appraisal and evaluation of health care situation of the patient through patient satisfaction surveys,
• Participate in research projects related to quality assurance,
• Identify any area of needed improvement in delivery of care through surveys and quality improvement rounds ,
• Collate, analyzes incidents reports and make follow up of the incidents and presents to management and represent quality assurance activities in the division of nursing.
Factors that affect quality assurance in nursing entails mostly
• Shortage of staffing in nurse patient ratio,
• Improper maintenance of equipment like the blood pressure machines, ventilators, oxygen flow meters etc.
• Lack of incident review procedure which has a corrective bearing on the treatment and the patients’ final recovery
ACHIEVING COMPETITIVE ADVANTAGE THROUGH QUALITY MANAGEMENT SYSTEM
Moi teaching and referral hospital has benefitted from the implemented quality management system through implementation of quality practices that focus on customer satisfaction and meeting or exceeding their expectations by establishing effective strategies at the start of every financial year.
The strategies are aimed at improving processes through establishing efficient and effective process management systems that improve productivity, lower costs, reduce unnecessary expenses, eliminate all non-value adding activities and ultimately maximize excellence and customer satisfaction. A quality management system therefore provides tools, techniques and methods of continuous process improvement in both the professional fields and academic world.
ACCIDENT & EMERGENCY DEPARTMENT
Nursing units: Emergency services and CAR-E.
The nursing unit has one nurse manager and one nurse incharge. It also has one clinical nurse educator (CNE) who updates and equips staffs on knowledge and practices in the unit.
Accident and emergency unit is the first point of contact and triage point for all patients who are above fourteen years of age. It renders 24 hour services for outpatient and inpatient services. The unit also attends to medical emergencies, traumas and also forms part of disaster management team in the hospital.
It has an average bed capacity of seven. Here patients can be observed for 24 Hours at the Emergency ward.
Accident and emergency department is subdivided into the following units;
A. Emergency room –Handles critically ill patients who come on wheel chairs and stretchers and general medical emergencies.
B. Ambulatory Section - Handle all other patients that are “stable”.
C. Emergency ward- It’s a seven bed capacity ward that admits patients for observation for not more than 24 hours.
D. Minor Theatre- Services rendered for outpatients include;
• Incision and drainage
• Removal of stitches
CENTER FOR ASSULT RECOVERY-ELDORET- (CAR-E)
It has one medical officer, five nurses, one social work, one data clerk and three counselors.
Cases handled include;
• Sexual violence
• Gender based violence
• Minor defilement
• Domestic violence
• Medical management
• Outreach programs
• Support groups meeting that occur twice a month.
• All services offered are free and sponsored by Ministry of Health (M.O.H)
• Attends to an average of 200 cases per month.
DEPARTMENT OF MEDICINE
The division of medicine consists of male medical unit admitting male patients above 14 years, female medical patient above 14 years, and cardiac centre unit managing patient with cardiac diseases. Both medical wards have a capacity of 48 beds in each ward. CCU has a capacity of 10 beds admitting all ages and sexes. Patients are admitted from casualty and various clinics (chest clinic, diabetic clinic, AMPATH and Oncology centre. Nursing students are attached for their practical experiments in the unit from various institutions. (MTRH, KMTC, Moi University and Baraton University).
Core nursing services include;
• Guidance and counseling services
The Moi Teaching and Referral Hospital (MTRH) Renal Unit is the second largest Public dialysis centre in the country after Kenyatta National Hospital. This unit had a humble beginning and has grown over the years to where it is now. It started in the year 2002 in a side room with one patient on peritoneal dialysis. Haemo-dialysis was started in 2003 with two Haemo-dialysis machines and a small portable water treatment plant for two machines. The number of patients has gone up steadily to over one hundred currently with over twenty having been done kidney transplants in the unit and other centers locally and internationally.
To enhance the provision of quality specialized health care for the renal patients, the hospital started higher diploma in Nephrology nursing at the hospital’s training centre in 2010. So far the unit has sixteen graduants from the centre with three currently in the training centre.
Renal Unit boasts of being the first unit in the hospital with hundred percent (100%) specialized nurses. Other important very key personnel in the unit are the nutritional and psychological counselor for nutritional and psychosocial support.
The number of patients on haemodialysis keeps on increasing with an average of 25 new patients per month. Sustainability of dialysis remains a big challenge to most patients because of the costs involved such as dialysis consumables and transport costs.
The mainstay management of patients with end stage renal disease is kidney transplant therefore we look forward to partner more with private sectors to do kidney transplant and be an excellent transplant centre in the region.
DEPARTMENT OF SURGERY
The department of surgery includes the following units:
• General Surgery
• Specialized Surgery
General Surgery includes the following specialties: Urology, Cardiothoracic, Burns, Plastic, Paediatric Surgery, ENT, Dental, General Surgery and Oncology. These specialities are admitted in Rehema, Kilimanjaro and Burns unit.
Specialized Surgery includes the following specialities: Orthopaedics and Trauma, Neurology, Ophthalmology. These specialities are admitted in Longonot, Sergoit, Baraka and Elgon Wards.
The department also offers outpatient services in ENT clinic and Ophthalmology clinic.
The hospital sterilization unit (CSSD) is also under the department of Surgery.
The department offers the following inpatient nursing services:
• Admission of surgical patients.
• Pre and Post operative care of patients.
• Drug administration, nutritional support and fluid therapy.
• Wound Care.
• Psychological counseling of patients.
• Participation in ward rounds.
• Teaching and mentoring students.
• Participating in research.
• Health education.
• Discharging patients.
• The department also offers the following nursing outpatient services:
• Taking vital signs.
• Syringing of patients ENT
• Measuring vision acquity.
• The department also offers Ophthalmology theatre services.
• Rehabilitative services (Physiotherapy and Occupational therapy.)
PAEDIATRICS AND CHILD HEALTH DIVISION
The division is a large unit which consists of 1 out-patient unit (Sick Child Clinic) and 3 in –patient units (New born unit, Upendo ward and Tumaini ward). We serve children between 1 day old to 14 years of age
The sick child clinic handles all ambulatory patients, emergency cases and all referrals-in from peripheral health facilities in the expansive western Kenya region. Approximately 100 patients are attended to and discharged or admitted per day while others may be referred to special clinics for further management and follow-up.
The New born unit on the other hand is an ultra-modern ward for neonates (1-28 days) with a bed capacity of 60 baby cots and 10 incubators. Since the inception of free maternity services in June 2013, there has been a steady increase in the number of neonates of approximately 70 neonates. The current staff establishment is at 60 with 35 of them being nurses and the rest cutting across other disciplines.
Upendo and Tumaini wards are both general paediatric medical wards with a bed capacity of 47 beds in each ward. There is an in built oncology ward within Upendo ward serving a myriad of oncology cases. A number of nurses have been trained on oncology care. We now have one nurse undertaking one month training on stoma care in Aga Khan Hospital, Nairobi.
One of the greatest achievements is construction of a decent paediatric unit that has been named Shoe for Africa paediatric Hospital. The unit is a 74 bed capacity and will accommodate all paediatric medical and surgical in-patient and out-patient services, to ensure that the services provided are timely, special units like ICU, HDU, theatre and 3 laboratories are in-built within the hospital-but are not yet operational. Children friendly services will be enabled through other service providers who will work in collaboration with in and out -patient service providers such as such Sally Test Paediatric Centre.
PRIVATE WING 1
The unit has a bed capacity of 54. However one of the rooms was allocated to serve as a linen store (double room) in PW1A and one room in PW1B serves as a doctor’s room. The operational bed capacity hence stands at 51. There are two wards. These are Pw1A -28 and Pw1B-23.
Clients in Private Wing 1 are attended to by consultants who are on call 24hours a day .Clients have a wide variety of rooms to choose from which include;
Full Private: These are self contained rooms
Semi Private : A single room
• Nursing process: Since the introduction of nursing process, there has been a marked improvement in nursing care services. The nurses have improved over time on reporting of patient’s progress. The nurses have also shown increase in the knowledge of patients as well as the course of nursing care due to systematic assessment, diagnosis, planning, Implementation and evaluation of care. The nurses are able to individualize patient care and accord the attention deserved to categories of patients based on their assessments.
• BLS: Nurses in the unit have undergone training on Basic Life Support. Those trained on BLS are scheduled for Advanced Cardiac Life Support training.
• Patient Safety: Nursing officers and other affected staff were sensitized on patient safety based on the WHO patient safety guidelines.
• Customer care: Customer’s satisfaction is one of the core goals in service delivery as it is an indicator of the client’s perception to the services they receive. The unit has implemented the recommendations of the QA survey 2013-2014. There has been notable decrease in client complaints and increased patient satisfaction.
PRIVATE WING 2
The unit is privileged to have a new concept of Clinical nurse educator who oversees the competence and update of nurse’s knowledge and practice in the unit.
The nursing team do daily receiving of patient reports, holistic nursing care, rounding, supportive supervision to non-nursing staff, spot-checks and mentoring.
Services offered IN THE UNIT are specialized outpatient, inpatient and diagnostic healthcare services through a team of qualified, dedicated and experienced professional staff with modern facilities.
We offer 24 hour service of which you have the option of choosing the clinician whom you prefer to attend to you. However there is a resident doctor 24/7 who will attend to you
DEPARTMENT OF MENTAL HEALTH
The department of mental health has two functional units i.e. Mental Health Unit and Alcohol & Drugs Abuse Rehabilitation Unit. The mental health unit has a capacity of 80 beds. The facility caters for adult in-patients with mental disorders. Outpatient services are provided at the hospital’s consultant clinics every Wednesday. On average, bed occupancy is at 75%.
Nursing interventions in the unit are designed to promote, maintain, and restore mental and physical health. This is achieved through milieu therapy, self- care activities, psychological interventions, psycho-education, and case management. Core nursing services provided are based on the nursing process model. When dealing with psychiatric patients, implementation of the nursing process does present unique challenges. Emotional problems may be vague and not clearly visible like many physiological disruptions. Emotional problems can also show different symptoms and arise from a number of causes. Similarly, past events may lead to very different form of present behaviors. Most psychiatric patients are unable to describe their problems. They may be highly withdrawn, anxious, or out of touch with reality. Their ability to participate in the problem solving process is limited. However, through effective nursing process the nurse is able to establish a relationship based on trust and directed toward maximizing the patient’s strengths, maintaining integrity, and promoting adaptive responses to stress.
The department has embraced the nursing process to enhance individualized patient care. It also participates in both the nursing process and ISO audits. Major tasks of a Clinical Nurse Educator include bridging gaps between theory and practice among nurses.
The department has also gone out of its way to visit Eldoret special school in order to provide mental health services to needy students/children. This is done on monthly basis and it is hoped that this gesture will in future be extended to other needy members of society.
Working in mental health settings is challenging. This can lead to both psychological and emotional strain on the part of care providers. In order to motivate the staff, the department in collaboration with the hospital management, organizes team building activities.
ALCOHOL & DRUG ABUSE - REHABILITATION UNIT (ADA-R) MTRH
The alcohol & drug abuse- rehabilitation centre (ADA –R) is committed and operate towards institutional vision of becoming a world class health facility through its mission of being a specialized quality healthcare and teaching facilities through Research, Training, Capacity Building, Innovation and participation in National Health Planning.
For this vision & mission to be achieved, ADA-R services are integrated in multi-disciplinary team care where the nursing services are key to rehabilitation success. Other staff are:- Psychiatrist, Occupational Therapist , Psychological counselor, Nutritionist, Social worker, Records clerk, Secretary, Catering, Support staff, Security and Housekeeping.
At ADA-R Unit, the nurse is actively involved in the admission of patients which includes; Assessment, Screening, Treatment, and Orientation process that may take 2-3 hours. The nurse professionally manages the detoxification process with general patient care to control and reduce dysfunctional behaviors associated with substance abuse.
The core nursing services at the ADA-R are to observe for dysfunctional behavior changes and perform crisis interventions which are goal-oriented so as to prevent self harm and destruction to others and property. S/he further facilitates the process of dealing with disenfranchised and dysfunctional grief emanating from the dysfunctional behavior. Continuous re-orientation of patients, individual health education on medication in use, self care and general hygiene always keep the nurses on the alert.
Quality assurance measures are ensured by limiting the number of admissions to bed capacity to avoid bed sharing and congestion which are sole basis for nosocomial infections and a challenge to effective rehabilitation. Meetings between staff and patients are held every alternate day where patients share their views and are addressed effectively.
To manage the general population needing rehabilitation out-patient clinic has been started since March this year, every Monday & is very active.
CLINICAL NURSE EDUCATORS
The concept of clinical nurse education was born in MTRH in 2013. This was in line with its strife to be a world class referral hospital. Clinical nurse educators are the key link pin in bridging the gap between knowledge possessed, knowledge practiced and evidence based practice. Nurse educators play a pivotal role in strengthening the nursing workforce, serving as role models and providing the leadership needed to implement evidence-based practice. MTRH has a total of 15 CNEs serving over 800 clinical nurses.
• Implementation of the nursing process as a nursing care model:
• Development and implementation of clinical protocols:
• Coaching and mentorship:
• Patient and clinician safety:
• Education days:
We are looking forward to launching an e-learning platform for in-service training to address the learning needs of nurses at the comfort of their units & homes. On this platform all presentations will be accessed as well as online continuous education courses that can earn the nurses certificates and improve delivery of quality care.
CLINICAL AUDIT AND NURSING RESEARCH
Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against set standards and the implementation of change. The key component of clinical audit is that performance is reviewed/audited to ensure that what should be done is being done, and if not it provides a structure to enable improvements to be made. Clinical audit comes under the clinical governance umbrella and forms part of the system for improving the standard of clinical practice. Clinical governance is a systematic approach to maintaining and improving the quality of patient care within a health system. It provides framework through which health organizations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish. The six pillars of clinical governance include; Clinical Effectiveness, Research & Development, Openness, Risk Management, Education & Training and Clinical Audit.
The clinical audit unit is tasked with making regular audits on patient care services provided in the hospital to ensure that quality holistic care is given to the patients in line with the current standards in operation. It also identifies areas for service improvements, develops and carry out action plans to rectify or improve service provision while monitoring to ensure that these recommendations are implemented.
Data from patient files is collected daily and fed into the SPSS software. This data is analyzed on a monthly basis and a report is written and submitted to the management for action. Several researches have been conducted by the unit using the data collected and a number of surveys have also been done to give answers to issues raised concerning the care that the patients received. Findings from the surveys and the researches done have been shared with the management and various divisions in the hospital for corrective actions. Findings from the research done have been published in various referred journals.
The unit has also collaborated with the Clinical Nurse Educators in the implementation of a few projects in the nursing department including the evaluation of the nursing process uptake by the primary nurses.