International Council of Nurses and person-centered care

Introduction

Person-centered care is of utmost importance to the nursing profession. Nurses focus on the person across multiple settings, such as ambulatory, hospital, and home care, and also in community and public health settings. At any level of care, nurses use the nursing process to structure care delivery as they assess clients, develop nursing diagnoses, plan and carry out interventions, and evaluate patient outcomes. The nurse's interventions are based on the nursing diagnoses and in support of the medical plan of care. The patient's outcomes would be in response to the nurse's interventions and the medical plan of care.

The International Council of Nurses (ICN) Code of Ethics notes that “(I)nherent in nursing is respect for human rights, including cultural rights, the right to life and choice, to dignity and to be treated with respect. Nursing care is respectful of and unrestricted by considerations of age, colour, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status” [1, p. 1]. In addition, ICN defines nursing as follows.

• Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings.

• Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people.

• Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles [2].

This paper describes ICN programmes, projects and policies that demonstrate attentiveness to the person at the center of health care delivery. In 2009, the 24th Quadrennial ICN Congress theme, “Leading Change: Building Healthier Nations,” is emblematic of ICN's world view. ICN's mission of ensuring quality nursing care for all and sound health policies globally underlies this paper. ICN is a federation of 132 national nurses associations representing the millions of nurses worldwide. ICN's website (www.icn.ch) provides greater detail on all of the content in this paper.

ICN and person-centered care: person, provider and community

ICN advocates and provides guidance for person-centered care in various environments, and works to influence and support nurses and other care givers who provide person-centered care. ICN recognizes, in keeping with its ethics code nursing definition, that the ‘person’ is nearly always part of a family or community and therefore, some of ICN's work can also be placed in that context.

Person-centered care: supporting personal health

The trend toward people being more active in becoming knowledgeable about health and disease is supported by information technology that offers a wide range of information from many sources. ICN collaborates with Johnson & Johnson to provide Patient Talk!^© on its website, providing health information for patients and consumers. Fact Sheets from ‘Acting on Osteoporosis’ to ‘Women and Stroke’ can be downloaded from the site.

ICN also develops and disseminates position statements for a broad array of topics with some of them being targeted at improving one's health or coping with disease or disability. Position statements including ‘Patient Safety,’ ‘Elimination of Substance Abuse in Young People,’ ‘Mental Health,’ and ‘Care of People with Disabilities’ are examples of documents available for individuals, families and care providers. ICN position statements provide guidance internationally through the National Nurses Associations and can be used locally to establish standards or approaches for most effective care.

The Florence Nightingale International Foundation (FNIF) and ICN collaborate on the FNIF Girl Child Education Fund. Through this fund, orphaned daughters of nurses in developing countries are back in school. In partnership with ICN member National Nurses Associations, funds go directly to education costs. Every girl in the programme is paired with a nurse volunteer to monitor her progress in school and home. With the education of these girls comes a better future for them and better health, in terms of lower HIV/AIDS infection rates, improved family planning, lower infant mortality, and fewer maternal deaths in childbirth.

Person-centered care: enabling the provider

ICN advocates for issues that help to educate nurses and other providers for safe and effective care. ICN publishes Nursing Matters Fact Sheets that address topics, such as ‘Ageing and Health’, ‘Children's Health’, ‘Communicable Diseases’, ‘Immunisation Safety’, and ‘Patient Safety’. As nurses and others develop policies and procedures, they are able to consult the ICN Fact Sheets for guidance and support of their work.

ICN Nursing Networks support care givers in their commitment to best practices. Nurses and others with similar interests come together within the networks to share best practices, standards and competencies in a selected area of practice. Of the 13 networks, those with direct impact on person-centered care would be Disaster Preparedness, Emergency Care, HIV/AIDS, Nurse Practitioner/Advanced Practice, Rural and Remote Nursing, and Telenursing.

As a means of supporting the quality of nursing worldwide, the Regulation Network seeks to support nurses in their work and development by bringing order, consistency, identity and control to the profession. The profession and its members are defined; the scope of practice is determined; standards of education and of ethical and competent practice are set; and systems of accountability are established through these means.

The ICN-Merck Nursing Mobile Library is a project in developing countries, where nurses deliver >80% of health care. Often the nurses are working in remote clinics, with little to no access to current health information. Others who have contributed to this programme are Elsevier Science, nursing organisations, local nurses, ministries of health, and health related non-governmental organisations (NGOs). The mobile libraries include current reference books for community health, epidemiology, maternal and child health, surgery and anaesthesiology, communicable diseases, HIV/AIDS, education, health promotion, management, and nursing practice. To date there are over 220 libraries in 16 developing countries.

The Global TB/MDR-TB Resource Centre is an ICN-Lily project involving nurses worldwide. In most countries with a high burden of TB, nurses are the primary health care provider, and often the only source of care. Lilly provided funding to support ICN in developing, jointly with other partners, guidelines for nurses in treating TB and MDR-TB. In addition, ICN developed a training of trainers program for nurses. Recently, ICN-Lily conferred special awards to nurses who demonstrated exceptional dedication to the fight against the scourge of tuberculosis. Nurses were honored from Kenya, Lesotho, Malawi, Philippines, Russia, South Africa, Swaziland, Uganda, and Zambia. International partners for the project include International Federation of Red Cross and Red Crescent Societies, International Hospital Federation, International Union against Tuberculosis and Lung Disease, Partners in Health, Stop TB Partnership, World Economic Forum, World Health Organization (WHO), and the World Medical Association.

Person-centered care: enhancing the health of the community

Human needs guide the work of nursing. ICN is strongly committed to clean and safe water as a universal need and fundamental human right. Water is an essential resource to meet basic human needs and to sustain livelihoods and development. In its advocacy role, ICN calls on nurses and National Nurses Associations to work to provide safe and accessible water to the whole population and to work with national and international bodies to ensure water safety, lobby for sound regulatory policies, and monitor the public health impact of deregulation and privatisation of the water supply.

An ICN programme that supports and reflects the proliferation of eHealth and Information, Communication and Technology (ICT) strategies, is the International Classification for Nursing Practice (ICNP^®). This terminology aims to be an integral part of the global information infrastructure informing health care practice and policy to improve patient care worldwide.

The 2007 Islamabad declaration on strengthening nursing and midwifery is another example of ICN's involvement with other agencies with the aim of strengthening nursing capabilities to ensure and improve person-centered care for women and children in the community. The declaration notes that all people should have access to competent nurses and midwives who provide care, supervision and support in all settings, especially countries in crisis or conflict. The declaration represented collaboration among ICN, WHO, Pakistan's Ministry of Health, and the International Confederation of Midwives.

Summary

ICN works with and for nurses and also collaboratively in carrying out its mission and goals, while recognizing that person-centered care is at the heart of health care, nursing, and medicine. Through its working relationships with WHO, governmental ministries and organizations, NGOs, and others, ICN's programmes and products have greater scope and effectiveness. The World Health Professions Alliance (WHPA), for example, brings nurses (ICN), physicians (WMA), pharmacists (FIP), and dentists (FDI) together on related issues and speaks on behalf of 23 million health care professionals.