FG - NMT 04102 2

THE UNITED REPUBLIC OF TANZANIA
THETITLE:
MODULE UNITED REPUBLIC
INFECTION OF TANZANIA
PREVENTION AND CONTROL
MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND

CHILDREN
DIRECTORATE OF HUMAN RESOURCE DEVELOPMENT
FACILITATOR’S GUIDE FOR ORDINARY DIPLOMA

IN NURSING AND MIDWIFERY
NTA LEVEL 4
NMT 04102: PROFESSIONALIMS IN NURSING
DECEMBER, 2018
© Ministry of Health, Community Development, Gender, Elderly and Children, Department of Human Resources
Development Nursing Training Section 2019, Dodoma, Tanzania
NMT 04101: Infection Prevention and Control

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Table of Contents
Acronyms................................................................................................................................................. iv
Preamble.................................................................................................................................................. v
Acknowledgement....................................................................................................................................vi
1.0 Background..................................................................................................................................... 1
2.0 Rationale......................................................................................................................................... 1
3.0 Goal and Objectives of the Facilitator’s Guide................................................................................2
3.1 Overall Goal for Facilitator’s Guide.................................................................................................2
3.2 Objectives for the Facilitator’s Guide...............................................................................................2
4.0 Introduction..................................................................................................................................... 2
4.1 Module Overview............................................................................................................................ 2
4.2 Who is the Module For?..................................................................................................................2
4.3 How is the Module Organized?.......................................................................................................2
4.4 How Should the Module be Used?..................................................................................................3
Session 1: Concepts of Customer Care in Relation to Nursing and Midwifery Practice.....................4
Session 2: Methods of Customer Care as Applied in Nursing and Midwifery Practice....................10
Session 3: Resolving Patients/Clients Concerns Using Customer Care Knowledge......................17
Session 4: Provision of Good Customer Service to Client/Patient ...................................................26
Session 5: Concepts of Advocacy in Relation to Nursing and Midwifery Practice.............................34
Session 6: Patient’s and Service Provider’s Rights in the Provision of Care.....................................41
Session 7: Concepts of Advocacy to Protect Patient’s/Client’s Rights...............................................46
Session 8: Professional, Legal and Ethical Principles related to Nursing and Midwifery Practice....52
Session 9: Legislation Guidelines In Providing Nursing And Midwifery Care....................................61
Session 10: Ethical Principles in Nursing and Midwifery Care...............................................................67

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Acronyms
AGYW Adolescents Girl and Young Women
AIDS Acquired Immune Deficiency Syndrome
AIHA American International Health Alliance
ARV Antiretroviral
VMMC Voluntary Medical Male Circumcision
WHO World Health Organization

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Preamble
The Ministry of Health Community Development Gender Elderly and Children among other roles
ensures that Tanzanians receive quality health care and service. This can be achieved through
production of competent nurses and midwives amongst other health cadres. The training of competent
nurses and midwives can be achieved through various teaching and learning materials; one of them being
facilitator’s guides and student’s manuals.
The directorate of human resources development in collaboration with partners conducted several
writers’ workshops to develop facilitator’s guides and student’s manuals. The availability of
standardized teaching and learning materials that is to say facilitator’s guides and student’s manual
enables proper acquisition of competence with minimal variation across health training institutions. The
achievement of clinical competence is acquired in step wise starting from classroom teaching using
facilitator’s guides and student’s manuals. This knowledge is then transferred to skills laboratory
teachings. In skills laboratory students learn clinical skills using models and maniquins and then shift to
clinical sites where more clinical skills on real patients are acquired. Clinical skills acquisition is an
important aspect and a bridge between gaining knowledge and clinical skills.
The increased demand for human resources for health to improve reproductive, maternal, newborn
child and adolescent health requires a thoughtful investment of human resources for health (HRH) on
the production side. The current approach of health service provision in support of task sharing, the
nurses and midwives are becoming the key ingredient for improving specific and general morbidity and
mortality indexes this includes maternal and newborn mortality rates and reducing the HIV and AIDs
burden through prevention, care & treatment. So it is necessary for them to be equipped with strong
knowledge, skills and attitudes upon their graduation. This will then improve the access to health
services to the community in which most of them are with limited purchasing power, residence in
underserved areas, and inadequate health literacy.
Considering the importance of facilitator’s guides and student’s manuals, it’s the hope of the Ministry
that tutors in nursing and midwifery health training institutions will use these guides as in fostering
acquisition of competence to learners of National Technical Award of education system of education.
Dr. Loishook Saitore Laizer

Director for Human Resource Development
Ministry of Health, Community Development, Gender, Elderly and Children
Acknowledgement
Ministry of Health, Community Development, Gender, Elderly and Children through the Directorate of
Human Resource Development, Nursing training section has reviewed Facilitator’s guide for Nursing
NMT 06209- Care of Patients with Surgical Conditions

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and Midwifery training program. The review was informed by revised curriculum of the same. The
successfully completion of this facilitator’s guide has been made possible by the commitment of the
technical team through a series of writers’ workshops. Understanding the crucial role of the team, the
Ministry would like to express sincere appreciation to all those who involved in the completion of this task.
Special gratitude goes to coordinators of Nursing and Midwifery training, technical expert from NACTE and other
facilitators who tirelessly supported the development of this guide whose names are listed with appreciation:-
SN FULL NAME INSTITUTION/ORGANIZATION

1. Ndementria Vermand ADNT-MOHCDGEC-Dodoma
2. Nassania Shango CDNT -MOHCDGEC-Dodoma
3. Dr. Talhiya Yahya HQAU- MOHCDGEC-Dodoma
4. Dr. Omary Nassoro HQAU- MOHCDGEC-Dodoma
5. Professor Eliezer Tumbwene Lecturer -Aga Khan University
6. Ramadhani Samainda NACTE-Dodoma
7. Dr. Patrick Mwidunda Program Manager-Amref Health Africa
8. Lupyana Kahemela Program Officer-Amref Health Africa
9. Joseph Pilot ICT Officer- Amref health Africa
10. Dr. Julius Masanika Program Director-Jhpiego-MBM-RTz
11. Dr. Wilson Kitinya Deputy Program Director-Jhpiego-MBM-RTz
12. Mary Rwegasira Senior- Gender Advisor-Jhpiego-MBM-RTz
13. Ukende Shalla Senior Midwifery Advisor-Jhpiego-MBM-RTz
14. Benison Muchunguzi Technical Officer-Jhpiego-MBM-RTz
15. Harriet Hamis Jhpiego-MCSP
16. Happiness Shetui Jhpiego-MBM-RTz
17. Theresia Venance Technical Officer-Gender-Jhpiego-MBM-RTz
18. Sarah George Program Assistant-Jhpiego-MBM-rtz
19. Miraji A. Mawaka Tutor-Military College of Medical Science Lugalo
20. David Abincha Tutor –Sumve School of Nursing
21. Bupe Mwandali Ass. Lecturer –Hubert Kairuki Memorial University
22. Mary Kipaya Principal- Kahama School of Nursing
23. Mwanaaisha Fakhi Tutor-State University of Zanzibar
24. Paul Magesa Ag. Principal –Newala School of Nursing
25. Dominic Daudi Tutor –Newala School of Nursing
26. Dr. Beatrice Mwilike Lecturer-MUHAS
27. Lilian Wilfred Tutor KCMC School of Nursing
28. Upendo Mamchony Tutor KCMC School of Nursing
29. Tito William Nurse Officer Muhimbili National Hospital
30. Sixtus Ruyumbu Nurse Officer- Mbeya Refferal
31. Dr Lenatus Kalolo Medical Specialist-Mbeya Refferal
32. Emmanuel Mwakapasa Principal Mbeya -OTM
33. Ruth Mkopi Senior Research Officer TFNC
34. Salma Karim Tutor- Dodoma Institute of Health and Allied Sciences
35. Athanas Paul Principal- Dodoma Institute of Health and Allied Sciences
36. Dr. Jiyenze Mwangu Kini Tutor -CEDHA
37. Joseph Mayunga Tutor- Kisare
38. Elizabeth Kijugu Principal-Kairuki School of Nursing
39. Charles Magwaza Principal Njombe School of Nursing
40. Alphonce Kalula ECSA
41. Meshack Makojijo Tutor Bugando School of Nursing
42. Stellah Kiwale Tutor- PHN Morogoro
43. Evance Anderson Tutor Geita School of Nursing

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44. Juliana Malingumu Tutor Mchukwi School of Nursing
45. Rehema Mtonga Tutor –Dar- es- Salaam
46. Masunga Isassero Assistant Lecturer -MUHAS
47. Paulo Masika Lyimo Tutor –Huruma Health training institute
48. George Muro Tutor -Arusha Lutheran Medical Centre
49. Fredina Rweyemamu Principal -Same School of Nursing
50. James Marwa Tutor-Tarime School of Nursing
51. Nturu Simwanza Tutor-Kondoa School of Nursing
52. Everlasting Lema Tutor-Machame Health Training Institute
53. Rackel Masibo Ag. Dean-St. Johns University
54. Shamila Mwanga Nursing Officer-Muhimbili National Hospital
55. Dr. Stephen Mwaisobwa Clinician-Chamwino DC
56. Evarist Urassa Tutor -KCMC School of Ophthalmic
57. Madia Petro Tutor-Edgar Maranta School of Nursing
58. Sr. Vincenzo Malale Principal-Edgar Maranta School of Nursing
59. Edwin Mkwama Tutor-Centre for Distance Education
60. Elizabeth Mwakalinga Tutor-Muhimbili School of Nursing
61. Mariam Barabara Tutor-KCMC School of Nursing
62. Lucas Edward ICT Officer-National Institute of Transport
63. Mbaruku Luga Driver-Mirembe School of Nursing
Lastly would like to thank the collaboration and financial support from Amref Health Africa and Jhpiego
through More and Better Midwives for rural Tanzania and Maternal and Child Survival programs who
made this task successfully completed.
Ndementria Arthur Vermand

Assistant Director Nursing Training Section,
Ministry of Health, Community Development, Gender, Elderly and Children

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1.0 Background
In 2015 the Ministry of Health, Community Development, Gender, Elderly and Children through the
Directorate of Human Resource Development, Nursing training section started the process of reviewing
the nursing and midwifery curricula NTA level 4-6. The process completed in the year 2017, its
implementation started in the same year. The rationale for review was to comply with the National
Council for Technical award (NACTE) Qualification framework which offers a climbing ladder for higher
skills opportunities. Amongst other rationale was to meet the demand of the current health care service
delivery. The demand is also aligned with human resource for health strategic plan and human
resource for health production plan which aims at increasing number of qualified human resource for
health.
The process of producing qualified human resources for health especially nurses and midwives require
the plentiful investment of resources in teaching at the classroom and practical setting and the
achievement of clinical competence is acquired in stepwise starting from classroom teaching to skills
laboratory teaching. In addition, WHO advocates for skilled and motivated health workers in producing
good health services and increase the performance of health systems (WHO World Health Report,
2006). Moreover, Primary Health Care Development Program (PHCDP) (2007-15) needs the nation to
strengthen and expand health services at all levels. This can only be achieved when the Nation has an
adequate, appropriately trained and competent workforce who can be deployed in the health facilities to
facilitate the provision of quality health care services.
In line with the revised curricula, the MOHCDGEC in collaboration with developing partners and team of
technical staff developed quality standardized training materials to support the implementation of
curricula. These training materials address the foreseen discrepancies in the implementation of the
curricula by training institutions.
This facilitator’s guide has been developed through a series of writers’ workshops (WW) approach. The
goal of Writer’s Workshops was to develop high-quality, standardized teaching materials and to build
the capacity of tutors to develop these materials. The new training package for NTA Level 4 includes
eleven (11) Facilitator’s Guides and Student’s Manuals. This guide consists of 10 sessions aimed at
equipping learners with required competences in Professionalism in Nursing
2.0 Rationale
The vision and mission of the National Health Policy in Tanzania focuses on establishing a health
system that is responsive to the needs of the people and leads to improved health status for all. Skilled
and motivated health workers are crucially important for producing good health by increasing the
performance of health systems (WHO, 2006). Training of skilled and motivated health workers requires
good investment in teaching and learning environment. Standardization and harmonization of teaching
and learning materials are key in producing qualified health care workers. In this regard, the Ministry
developed standardized training manuals (Facilitator’s Guides and Student’s Manuals) to support
institutions and Tutors to produce required competent health workforce. These training manuals
address the foreseen discrepancies in the implementation of the new curricula.
Therefore, this guide for Basic Technician Certificate in Nursing and Midwifery (NTA Levels 4) aims at
providing a room for student Nurses and Midwives to achieve skills that will enable them to perform
competently. It will establish a conducive and sustainable training environment that will allow students
and graduates to perform efficiently at their relevant levels. Moreover, this will enable them to aspire for
the attainment of higher knowledge, skills and attitude in promoting excellence in nursing practice.
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3.0 Goal and Objectives of the Facilitator’s Guide
3.1 Overall Goal for Facilitator’s Guide
The overall goal of this guide is to provide high quality, standardized competence-based training
materials for Basic Technician Certificate in Nursing and Midwifery (NTA level 4) program.
3.2 Objectives for the Facilitator’s Guide

• To provide high quality, standardized and competence-based training materials.
• To provide a guide for tutors to deliver high quality training materials.
• To enable students to learn more effectively.
4.0 Introduction
4.1 Module Overview
This module content has been prepared as a guide for tutors of NTA Level 6 for training students. The
session contents are based on the sub-enabling outcomes of the curriculum for NTA Level 4 Basic
Technician Certificate in Nursing and Midwifery. The module sub-enabling outcomes are as follows:
2.2.1 Explain concepts of customer care in relation to nursing and midwifery practice
2.2.2 Describe methods of customer care as applied in nursing and midwifery practice
2.2.3 Apply knowledge of customer care to resolve patients’/ clients’ concerns
2.2.4 Explain concepts of advocacy in relation to nursing and midwifery practice
2.2.5 Describe patient’s and service provider’s rights in the provision of care
2.2.6 Utilize knowledge and skills of advocacy to protect patient’s/client’s rights
2.2.7 Explain professional, legal and ethical principles related to nursing and midwifery practice
2.2.8 Utilize legislation guidelines in providing nursing and midwifery care
2.2.9 Apply ethical principles in nursing and midwifery care
4.2 Who is the Module For?

This module is intended for use primarily by tutors of NTA Level 4 certificate and diploma in nursing
schools.
The module’ sessions give guidance on the time and activities of the session and provide information
on how to teach the session to students. The sessions include different activities which focus on
increasing students’ knowledge, skills and attitudes.
4.3 How is the Module Organized?

The module is divided into 18 sessions; each session is divided into sections. The following are the
sections of each session:
 Session Title: The name of the session.
 Learning Tasks – Statements which indicate what the student is expected to learn at the end of the
session.
 Session Content – All the session contents are divided into steps. Each step has a heading and an
estimated time to teach that step. Also, this section includes instructions for the tutor and activities
with their instructions to be done during teaching of the contents.
 Key Points – Each session has a step which concludes the session contents near the end of a
session. This step summarizes the main points and ideas from the session.
 Evaluation – The last section of the session consists of short questions based on the learning
objectives to check the understanding of students.
 Handouts and Worksheets are additional information which can be used in the classroom while
teaching or later for students’ further learning and doing assignment. Handouts are used to provide
extra information related to the session topic that cannot fit into the session time. Handouts can be
used by the participants to study material on their own and to reference after the session.
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Sometimes, a handout will have questions or an exercise for the participants. The answers to the
questions are in the Facilitator Guide Handout, and not in the Student Manual Handout.
4.4 How Should the Module be Used?

Facilitators are expected to use this guide while facilitating students learning both in the classroom and
clinical settings. The contents of this guide are the basis for teaching students in Professionalism in
Nursing Facilitators are therefore advised to facilitate each session and provide relevant handouts and
worksheets during class hours, clinical hours and self-study times. Facilitators will provide guidance
and respond to all difficulties encountered by students
.
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Session 1: Concepts of Customer Care in Relation to Nursing and
Midwifery Practice
Total Session Time: 120 Minutes
Prerequisite: None
Learning Tasks
At the end of this session a learner is expected to be able to:
Define customer care
Explain principles of customer care
Differentiate between internal and external customer
Differentiate health customer care from other type of customer care
Identify value of quality of customer care in health
Explain the importance of providing good customer care to internal and external customer
Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 LCD Projector and computer
 Note Book and Pen
Session Overview
Step Time Activity/ Content
(min) Method
1 5 Presentation Session Title and Learning Tasks
2 10 Brainstorm/ Definition of Customer Care
Presentation
3 20 Presentation Principles of Customer Care
4 15 Presentation Difference Between Internal and External Customer
5 10 Difference between Health Customer Care from
Presentation, Buzzing other Type of Customer Care
6 15 Presentation Value of Quality of Customer Care in Health
7 35 Small group discussion Importance of Providing Good Customer Care to
Presentation Internal and External Customer
8 5
Presentation Key Points
9 5
Presentation Session Evaluation
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Session Contents
STEP 1: Presentation of Session Title and Learning Tasks (05 minutes)

READ or ASK students to read the learning tasks
ASK students if they have any questions before continuing
STEP 2: Definition of Customer Care (10 Minutes)

Activity: Brainstorming (5 minutes)
Ask students to brainstorm on the definition of Customer, Care and Customer Care
ALLOW few students to respond
WRITE their responses on the flip chart/ board
CLARIFY and SUMMARISE by using the content below
 Customer - is someone who receives one or more organization’s (health facility) services or
products who has a direct relationship with, or is directly affected by organization
 Care - Is any activity, work performed by health provider to meet needs and problems of a client
 Customer care - Is the art of meeting client’s needs and problems by providing or delivering
professional, helpful, high quality service and assistance.
o Is a series of activities performed by health provider to meet client satisfaction before, during,
and after the customer's requirements are met.
o Is the process of looking after customers to best ensure their satisfaction and delightful
interaction with a business and its brand, goods and services.
STEP 3: Principles of Customer Care (20 minutes)
 Professionalism
o All health provider should maintain a professional behavior and dress throughout patient
hospitalization as to build customer confidence.
 Respect
o Health care provider should respect and protect the dignity of each person.
o Assist customers/patient to maintain a sense of control and feel valued.
 Communication
o Patients need personal attention and thorough communication about their health. Health
concerns often cause a great deal of anxiety among patients and their family members. In
some cases, health issues are life-altering.
o Understanding as much as possible about what is happening with your body, why particular
procedures are being performed, and what to expect during and after any procedure can allay
some of that anxiety, so it is important to find health care providers who take time to
communicate clearly and effectively with the client by answering all of questions and educating
about health and care options. The health care provider should also be able to listen and
respond in a prompt and timely manner.
 Compassion
o In dealing with patients, you must keep in mind that they are your customers. It’s not that “the
customer is always right,” but they may be under stress from pain and worry about a medical
condition or about the ability to pay the bill. While you must follow proper procedures with any
job you have, you can always listen and be compassionate.
o Provide excellent customer service, health care providers must see their patients as human
beings first. A provider who communicates not only information, but also compassion, can
make a tremendous difference in how a patient experiences care.
o Health care professionals who deliver outstanding customer service are mindful on a day-to-
day basis that each patient is a person living with a unique set of circumstances, not just a box
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to check or a puzzle to solve. They make the effort to understand what their patients are
experiencing, treat them with empathy, and help them to feel as comfortable as possible.
 Courtesy
o Health care provider should treat others/ patient with courtesy at all times through
consideration, helping and supporting clients.
 Team work
o Encourage cooperation and teamwork among health workers and value each member of the
healthcare team as contribute to team spirit.
STEP 4: Difference between Internal and External Customer (10 Minutes)
Internal customer External customer
 An internal customer is someone who  External customers are the people that pay for
has a relationship with health facility, and use the products or services your health
though the person may or may not use facility offers. When brainstorming problems
your services. and designing solutions, these customers are
 It is often a person who works within the who you’re designing for.
health facility, such as general  Depends on the quality of our product or
employees and managers. services.
 Depends on the quality of our work or  Customers external to healthcare organizations
output include patients, patients' families and visitors,
 Internal customers include nurses, staff referring physicians, doctors' offices, blood
physicians and other professionals, donors, and third-party payers.
students, trainees, employees,  An external customer is a person who is not
departments, and committees. directly connected to your health facility other
 Internal customers need not be directly than by purchasing your product or service.
internal to the company. For instance, This customer could be a one-time purchaser
you may partner with other health or a person your work with long-term. External
facilities in order to deliver health customers are also known as “clients” or
services to the end user – the external “accounts”.
customer. Such internal customers all
have a hand in delivering the service to
your end client. Stakeholders and
shareholders are additional internal
customers, perhaps less obvious but
quite significant.
STEP 5: Difference between Health Customer Care from other Type of Customer
Care (10 Minutes)
 Customer service in health care is different than in other industries because the customers are
recipients of medical services that are critical to their health.
 A sense of urgency penetrates the medical field’s customer service structure, as patients are
attempting to navigate their way around the health care system. One thing that health care
organizations should consider is that patients can shop around for their medical services.
 If a patient has a negative customer service experience at a hospital, it is possible for that patient to
take his business elsewhere. As such, health care organizations must work hard and be innovative
about how they can maintain good customer service relations with their consumers.
STEP 6: Value of Quality of Customer Care in Health (15 Minutes)

 Health care quality is a level of value provided by any health care resource, as determined by some
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measurement.
 The goal of health care is to provide medical resources of high quality to all who need them; that is,
to ensure good quality of life, to cure illnesses when possible and to extend life expectancy
 Health care quality is the degree to which health care services for individuals and populations
increase the likelihood of desired health outcomes.
 In 1999, the Institute of Medicine released six domains to measure and describe quality of care in
health as follows:
o Safety – avoiding injuries to patients from care that is intended to help them.
o Effective – avoiding overuse and misuse of care.
o Patient-Centered – providing care that is unique to a patient's needs.
o Timely – reducing wait times and harmful delays for patients and providers
o Efficient – avoiding waste of equipment, supplies, ideas and energy.
o Equitable – providing care that does not vary across intrinsic personal characteristics.
Values of quality of customer care in health

 Respect - Every customer is your most important customer
 Personalize - Avoid preconceived notions and stereotypes
 Attention - Assess how customers want to be served and adjust
 Caring - Present a positive, supportive attitude
 Advocacy - Stay on your customer's side
Integrate the 5 values in our daily work by using the acronym GREAT
 Greet all customers & make them feel comfortable
 Respect cultural & other personal differences
 Evaluate how your customers want to be served.
 Adjust your approach to match your customer's needs.
 Thank your customers for their business.
STEP 7: Importance of Providing Good Customer Care to Internal and External

Customer (35 minutes)
Activity: Small Group Discussion (15 minutes)
DIVIDE students into small manageable groups

ASK students to discuss on the importance of providing good customer care to internal and
external customers
ALLOW students to discuss for 15 minutes
ALLOW few groups to present and the rest to add points not mentioned
CLARIFY and SUMMARIZE by using the contents below
 The best customer service builds trust.

o People will only stay loyal to a company if they have very good reason to. Otherwise, there is
plenty of competition available they could choose to move to.
o You have to work harder to keep customers and build their trust in your organization/services.
By providing the best in customer service, you will increase trust top your customers/clients
 Customer care matters more than the bills
o Large group of consumers say that customer service is much more important than the bill.
External and internal customers value good customer care more than paying for the service.
 Good customer care will build organization awareness
o When you provide the best in customer care people will talk about your organization. They will
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remember your services.
o Having satisfied customers leads to increased revenue and increased brand awareness.
 Good customer care reduces problems
o Problems are always going to arise for any organization no matter how hard you try to avoid
them.
o If customers know that they can voice complaints and those issues will be handled properly,
they will feel more comfortable to visit your organization for services.
 Good customer care increase productivity of an organization
o Having satisfied employees is the key contributor to a company’s success - especially in tough
economic times.
o Increased employee satisfaction
o Increased employee productivity and performance
STEP 8: Key Points (05 minutes)

 All health provider should maintain a professional behavior and dress throughout patient
hospitalization as to build customer confidence.
 In dealing with patients, you must keep in mind that they are your customers hence you must follow
proper procedures with any job you have, you can always listen and be compassionate
 It’s not that “the customer is always right, as they may go wrong at one point” this may be due to
stress from pain and worry about a medical condition or about the ability to pay the bill..
 As health provider, encourage cooperation and teamwork among health workers and value each
member of the healthcare team as contribute to team spirit
STEP 9: Session Evaluation (05 minutes)

 What is customer care?
 What are the principles of customer care?
 What is the difference between internal and external customer?
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References
Cook, S. (2008). Customer Care Excellence: How to create an effective Customer focus (5th Ed.).
Philadelphia: Kogan Page Publishers.
Dasha, S. K., & Pandab, A. K. (2011). Managing Customer Relationships in Private Health
Government of South Australia. (2006).Customer Services power point presentation. South Australia:
Volunteering S.A. Inc
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Session 2: Methods of Customer Care as Applied in Nursing and
Midwifery Practice
Prerequisite: None
Learning Tasks
Explain the role of nurse and midwife in customer care
Analyse customer needs and problems
Explain factors influencing customers satisfaction
Explain methods of dealing with unsatisfied customers
Resources Needed
Session Overview
Step Time (min) Activity/ Content
Method
1 5
Presentation Session Title and Learning Tasks
2 30 Brainstorm Roles of nurse and Midwife in Customer Care
Presentation
3 20 Presentation Customer needs and Problems
4 15 Presentation Factors Influencing Customers Satisfaction
5 40 Presentation Methods of Dealing with Unsatisfied Customers

Buzzing
6 5
7 5
Session Contents
READ or ASK participants to read the learning tasks
ASK participants if they have any questions before continuing
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STEP 2: Roles of Nurse and Midwife in Customer Care (30 Minutes)
ASK students to brainstorm on the roles of Nurse and Midwife in relation to customer care
Caregiver
 The caregiver role has traditionally included those activities that assist the client physically and
psychologically while preserving the client’s dignity.
 Caregiving encompasses the physical, psychosocial, developmental, cultural and spiritual levels.
 The nurse maintains a patient's dignity while providing knowledgeable, skilled care.
Holistic care
 The nurses also address psychosocial, developmental, cultural, and spiritual needs.
 The role of caregiver includes all of the tasks and skills that we associate with nursing care, but
also includes the other elements that make up the whole person.
Decision Maker
 As a decision maker, is to use critical thinking skills to make decisions, set goals, and promote
outcomes for a patient.
 These assessing critical thinking skills include patient, identifying the problem, planning and
implementing interventions, and evaluating the outcomes.
 A nurse uses clinical judgment - his or her ability to discern what is best for the patient - to
determine the best course of action for the patient.
Communicator
 Nurses communicate with the client, support persons, other health professionals, and people in the
community.
 In the role of communicator, nurses identify client problems and then communicate these verbally
or in writing to other members of the health team.
 The quality of a nurse’s communication is an important factor in nursing care.
 Barriers to effective communication can inhibit the healing process.
 The nurse has to communicate effectively with the patient and family members as well as other
members of the healthcare team.
Advocate
 As a patient advocate, the nurse's responsibility is to protect a patient's rights.
 In this role the nurse may represent the client’s needs and wishes to other health professionals,
such as relaying the client’s wishes for information to the physician.
 The nurse acts on the patient's behalf and supports their decisions, standing up for his or her best
interests at all times.
 This can empower a patient while recognizing that a patient's values supersede the health care
providers'.
Manager of Care
 The nurse works with other healthcare workers as the manager of care and ensures that the
patient's care is cohesive.
 The nurse directs and coordinates care by both professionals and nonprofessionals to confirm that
a patient's goals are being met.
Teacher
 As a teacher, nurses help patients learn about their health, medications, treatments, and
11
procedures as nurses help patients learn about their health, medications, treatments, and
procedures as well as deal with challenges they may face during and after their illness.
 Patients often have questions and might be confused about all that is happening to them, therefore
a nurse must instruct family members about how they can help the patient
Counselor
 Counseling is a process of helping a client to recognize and cope with stressful psychologic or
social problems, to developed improved interpersonal relationships, and to promote personal
growth.
 It involves providing emotional, intellectual, and psychologic support
Change agent
 The nurse acts as a change agent when assisting others, that is, clients, to make modifications in
their own behavior.
 Nurses also often act to make changes in a system such as clinical care, if it is not helping a client
return to health.
Manager
 The nurse manages the nursing care of individuals, families, and communities.
 The nurse-manager also delegates nursing activities to ancillary workers and other nurses, and
supervises and evaluates their performance.
STEP 3: Customer Needs and Problems (20 minutes)

 Friendliness
o Is the most basic of all customers needs, usually associated with being greeted graciously and
with warmth.
 Understanding and empathy
o Customers need to feel that the service person understands and appreciates their
circumstances and feelings without criticism or judgment.
o Customers have simple expectations that we who serve them can put ourselves in their shoes,
understanding what it is they came to us for in the first place.
 Fairness
o We all need to feel we are being treated fairly. Customers get very annoyed and defensive
when they feel they are subject to any class distinctions.
 Control
o Represents the customers’ need to feel they have an impact on the way things turn out.
o Our ability to meet this need for them comes from our own willingness to say “yes” much more
than we say “no.”
 Options and alternatives
o Customers need to feel that other avenues are available to getting what they want
accomplished.
o They realize that they may be charting virgin territory, and they depend on us to be “in the
know” and provide them with the “inside scoop.”
 Information
o “Tell me, show me – everything!” Customers need to be educated and informed about our
products and services, and they don’t want us leaving anything out!
o They don’t want to waste precious time doing homework on their own – they look to us to be
their walking, talking, information central.
STEP 4: Factors Influencing Customers Satisfaction (15 Minutes)

Activity: Buzzing (5 minutes)
ASK students to pair up and buzz on the factors influencing customer satisfaction
12
ALLOW few pairs of students to respond
Provider socio-demographic variables

 The character and personality of healthcare provider affect the quality of healthcare services. “The
physician’s appearance and relations with a patient affects the quality of service”
 Health care providers develop good rapport with their patients using some personality
characteristics such As respect, helpfulness, reliability, intelligence, and confidence.
Provider’s competence (Knowledge and skills)
 The quality of healthcare services mainly depends on practitioners’ knowledge and technical skills.
 Healthcare professionals should improve their competencies (i.e. the attitudes, knowledge, and
skills) to deliver high-quality services.
Provider’s motivation
 Motivation is very important in delivering high-quality services to patients.
 Healthcare providers identified nine organizational factors they believed influence their motivation
and consequently job satisfaction.
 These are:
o Pay
o Working environment
o Managerial leadership
o Organizational policies
o Co-workers
o Recognition
o Job security
o Job identity
o Chances for promotion.
Resources and facilities
 Availability of resources affects the quality of healthcare services.
Leadership and management
 Effective Leadership and management was mentioned as an important enabler of quality from the
perspective of providers, managers, policy-makers and payers.
 “Everything in the hospital is affected by the good leadership management
Collaboration and partnership development
 For practitioners having good support services is important: “I need to be assured that the clinical
laboratory works well (the test results are reliable), and that the nurse administers medicines on
time or does not administer a wrong medicine”
Patient personal factors
 Quality of patient care depends directly on the quality of patient education and responsibility,
patients’ knowledge of their rights influences their expectations of quality services. The factors may
further be summarized in the following diagram.
STEP 5: Methods of Dealing with Unsatisfied Customers (40 Minutes)

Activity: Small Group Discussion ( 20 minutes)
13
ASK students to discuss on how they can deal with unsatisfied customers
Customers’ temperament acts as the catalyst of the dispute, you must deal with it in a professional way
as follows:
Stay calm
 Even though the customer may not always be right, they are a customer and must be treated with
respect.
 It can be difficult to put your emotions and frustrations aside, but it is an absolute must when
dealing with irate customers.
 No matter how ridiculous or reasonably upset the customer may be, you must keep your
composure
Look and act professional
 Your body language speaks for itself.
 Approach the situation in a professional way regardless of your inherent emotion.
 Act sympathetic toward and understanding of the problem at hand and take proactive measures to
fix it.
 Example for an angry customer make your customer feel heard and do not react, first listen and put
yourself in his or her shoes--it makes a difference. Most people want to react, but the most
important thing is to fully understand the problem and see it from the customer's point of view
before reacting.
Do not take it personal
 There is a simple formula to follow in order to maximize customer loyalty.
 You must exceed your customers’ expectations and surmount competitors’ customer service
practices.
 After all, acquiring new customers can be five times more expensive than keeping current
customers.
Take ownership of the “mistake”
 Although it may be the first ineptitude the customer has encountered, you must take ownership of
any mistake – even if it is not truly your fault – and empathize with your patron.
Involve the manager
 What happens when the situation escalates beyond the point of comfort? At what point should staff
involve the manager?
 If and when it is truly necessary, simply having staff get the manager involved may help diffuse the
situation.
Refer them elsewhere
 Terminally dissatisfied customers who vociferously and repeatedly complain may not be the best
for your business
 You may want to refer them elsewhere in a polite and professional way.
 Permitting perpetual complaints from repeat customers sets an unwanted tone and atmosphere
that is undesirable for your establishment.

 The quality of a nurse’s communication is an important factor in nursing care hence, barriers to
effective communication can inhibit the healing process.
 Nurses can use various methods in dealing with unsatisfied customers depending on the situation
14
for example by staying calm, Looking and acting professionally, taking ownership of the “mistake
 There are several factors which can affect patients’ satisfaction, these include: timeliness, safety,
respect, appropriateness etc

 What are the nurses’ roles in ensuring good customer care?
 What are the customer’s needs and problems?
 What factors influence customers’ satisfaction?
15
References
Dasha, S. K., & Pandab, A. K. (2011). Managing Customer Relationships in Private Health
Government of South Australia. (2006).Customer Services power point presentation. South Australia:
Volunteering S.A. Inc
Mosadeghrad AM. Principles of healthcare management. Tehran: Dibagran Tehran; 2003.
16
Session 3: Resolving Patients/Clients Concerns Using Customer Care
Knowledge
Prerequisite: None
Learning Tasks
Define customer relation management
Outline elements of customer relation management in health care
Identify benefits of customer relation management in health Care
Demonstrate positive attitude in giving care to client/patient
Attend client enquiries and complaints
Resources Needed
Session Overview
Method
2 5 Brainstorm/ Definition of customer relation management
Presentation
3 10 Presentation Elements of Customer Relationship
Management for Health care Management
4 25 Buzzing/Presentation Benefits of customer relation management in
Health Care
5 40 Role Play /Presentation Demonstrating Positive Attitude in Giving Care
to Client/Patient
6 25 Presentation Attending client enquiries and complaints
7 5
8 5
17
Session Contents
STEP 2: Definition of Customer Relation Management (5 Minutes)
ASK students to brainstorm on the definition of customer relation management
 Customer Relationship Management (CRM) is a strategy that health facilities use to manage
interactions with available customers and potential customers.
o It helps organizations streamline processes, build customer relationships, increase sales,
improve customer service, and increase profitability.
o When people talk about CRM, they are usually referring to a CRM system, a tool that is used
for contact management, sales management, productivity, and more.
o A CRM system digitizes processes and automates tasks to improve the efficiency and efficacy
of customer relationship management.
o CRM software records customer contact information such as email, telephone, website social
media profile, and more. It can also automatically pull in other information, such as recent news
about the company's activity, and it can store details such as a client's personal preferences on
communications
STEP 3: Elements of Customer Relation Management for Health Care Providers

(10 minutes)
For healthcare providers, the three key elements of CRM are:
 Capturing data from across the enterprise and consolidating it into a database (also known as a
Master Customer Information File)
 Analysing the database to determine the best marketing opportunities, the best targets for those
opportunities, and the best ways to communicate with those targets. This can include marketing to:
o Patients
o Non-patient consumers
o Referring physicians (owned and non-owned)
o Non-referring physicians
 Identifying the return on investment from those campaigns
18
STEP 4: Benefits of Customer Relation Management in Health Care (25 Minutes)
ASK students to pair up and buzz on the benefits of customer relation management in health care
ALLOW few pairs of students to respond
It improves the bottom line.

 A CRM program allows you to target your efforts on your most profitable customers (consumers or
physicians) and people who "look like" your most profitable customers. For example, if you are
doing a promotion for prostate screenings, CRM will allow you to target men who not only are most
likely to need these services, but will also be more profitable customers for you.
 CRM also can improve your bottom line by lowering marketing expense. Since you know the best
people to market to, what to market to them, and which communications channels to employ, you
don't have to spend money marketing to others.
 Customer Relationship Management software records customer contact information such as email,
telephone, website social media profile, and more. It can also automatically pull in other
information, such as recent news about the company's activity, and it can store details such as a
client's personal preferences on communications
It is quantifiable.
 CRM allows you to track the return on investment of your programs. By using control groups
(people you don't market to, but "look like" the people you do market to), you can measure the
impact of the marketing campaign, and counter the objection that "they would have come anyway."
It enhances relationships (and your brand) with consumers and physicians.
 Your CRM program will enable you to send the right message to the right people at the right time,
thereby allowing them to take better care of their health. Programs such as these also can boost
customer loyalty. This is true for consumers and physicians.
 For consumers, for example, you can send women turning 40 a reminder to get a mammography.
At the same time, you can offer an incentive, such as a discount coupon to a spa.
 For physicians, you can offer special tours of new facilities, but only invite physicians who meet
certain referral criteria.
It helps to achieve your mission by improving the health of your community.
 This may seem counterintuitive, since you may be reducing the number of people to whom you are
marketing. But think about it:
 Through targeting, you are sending your messages to the people who most need the services
 Improving the bottom line will free up resources for charity care and other initiatives to help you
better serve your entire community.
19
STEP 5: Positive Attitude in Giving Care to Client/Patient (40 Minutes)
Activity: Role Play (30 minutes)
ASK learners to volunteer to play the role in demonstrating positive attitude in giving care to
client/patient.
The first learner will play as a client and another learner as a care giver (nurse) who will have a role
in demonstrating positive attitude in giving care to client.
Other three learners volunteer as waiting clients
TELL the client how s/he should behave during a role play
Refer learners to Worksheet 3.1: Role play on demonstrating positive attitude in giving
care to client/patient
EXPLAIN that this activity is aimed at training learners on positive attitude in giving care to
client/patient
TELL the rest of the learners to observe carefully.
LEAD a discussion after the role play
DEROLE the players
CLARIFY and SUMMARIZE by using the content below
Positive attitude in giving care to clients includes:
 Respect of dignity and rights of each person
 Interest of solving client’s problems
 Cooperativeness and respect to other health care team and clients
 Accepting others from different race and religion
 Cheerful, optimism and ready to learn new things from co-workers and clients
 Respect for rules and regulations of nursing profession
STEP 6: Attending client enquiries and complaints (25 Minutes)

Main complaints in the hospital setting includes but not limited to:
 The staff was rude
 The hospital was dirty
 I had to wait a long time to be seen
 The nurses don’t respond quickly to calls
 The nurses didn’t explain things to me
 I didn’t know what was going on and was scared
Below, are ways in which a nurse deal with customer complaints - as gracefully and successfully as
possible.
 Put your emotions aside
o The best way you can handle any customer sharing a complaint is without your personal
emotions getting in the way.
o Calmly listen to what they are saying, then just as calmly reply and react to them.
 Avoid challenging their complaint
o It's easy and - quite frankly - natural to want to tell a customer they are wrong in what they are
saying. However, this won't help you in your efforts to diffuse a customer from getting more
upset while sharing a complaint. Instead of challenging their complaint, listen to what they are
saying.
 Thank your customer
o Always smile and pretend to care even if things are not going on well, genuinely let them know
you are thankful they are sharing with you their complaint or concern. For example, you can tell
20
them that you appreciate them taking the time to talk to you about their concern and you want
to make sure you understand exactly what they are saying.
o This opens up the opportunity for you to further listen to them, while hopefully giving them the
understanding that you want to actually hear what they have to say.
 Acknowledge what they say
o Try your best to really hear what they are saying. Are they upset that something took too long?
Or possibly the services they got isn't what they had in mind? Or they are disappointed about a
specific health worker they encountered while seeking health services.
o Whatever the "real reason" it is they are complaining, acknowledge it and ensure you heard
what they said.
 Offer support
o Support comes in a variety of shapes and sizes. Sometimes it's simply listening to them even
more
o If you really listened to their complain, you should be able to suggest a handful of ways to
support them - or even better
o Keep in mind that support means giving the customer something in response to their complaint.
 Be flexible
o If no resolution is available to make your customer happy or at the very least, content, then
consider how else you can help them.
o Consult your senior if you are not at further resolutions
 Make sure your customers hear what you are saying
o After offering a resolution or identifying what you can - or cannot do - to accommodate any
requests they may have or simply to respond to the complaint they stated, ask the customer if
they have understood what you said.
o Make sure you do this in a non-demeaning way, but rather state your intent. Very simply, after
all has been discussed, ask your customer if they have understood how you can help them or
for that matter, how you are unable to do anything else to accommodate them.
 Offer an apology – with gratitude attached
o Let your patients/clients know you're sorry they were inconvenienced or disappointed or upset,
then also thank them for giving you the chance to work it out with them. For many customers,
this sincere effort goes a long way.
o And for the patients/clients who are still not satisfied, it still leaves an impression on them -
really mean it.
 Follow up
o After you've said you're sorry, showed your appreciation and overall gave them the support
they were hopefully looking for, consider how else you can help support patients/clients who
complain.
o One way to do this is to have upper management follow up with these patients/clients 24 to 48
hours after they have expressed their complaint. This is simply another way to show them you
care, as well as it suggests you still have their complaint and concerns top of mind.
o You can do this in a handwritten note sent to their home address - if you have this information -
or pick up the phone and call them personally. If this is part of your protocol, be sure to ask for
these contact details from them so you can use them later.

 Listening to customer is a vital element for customer care
 Customer Relationship Management is a strategy that health facilities use to manage interactions
with available customers and potential customers.
 Positive attitude in giving care to clients includes:
o Respect of dignity and rights of each person,
21
o Interest of solving client’s problems,
o Cooperativeness and respect to other health care team and clients,
o Accepting others from different race and religion
o Cheerful and optimism, ready to learn new things from co-workers and clients
o Respect for rules and regulations of nursing profession

 What are the elements of customer relation management?
 What are the benefits of customer relation management in health care?
22
References
Brent, N. J. (1997). Nurses and the law: A guide to principles and applications. USA: W. B. Saunders.
Marquis, B. L., & Huston, C. J. (2009). Leadership roles and management functions in nursing theory
and application (6th ed.). USA: Lippincott.
TNMC. (2007). Code of professional conduct for nurses and midwives in Tanzania. Dar es Salaam,
Tanzania.
23
Worksheet 3.1: Instructions for the Role Play on demonstrating positive attitude in
giving care to client/patient
Role Play Instruction

Go over the lesson plan for the resolving patients/clients concerns using customer care knowledge
session on positive attitude in giving care to client/patient with your small group.
Decide among your group who will play as a client, another learner as a care giver (nurse) who will
have a role in demonstrating positive attitude in giving care to client and other three learners volunteer
as waiting clients
 Practice the role play in your small group until you feel ready to deliver it to the class.
 Thereafter volunteers from one group will act as role players
Role Player 1- Service provider/Nurse
 You will act the role of a nurse. You will be attending a client who seem to be poor, feels pain
and has urine incontinence. There are other patients who seem to be well economically and
they want to be first attended.
 You have to use appropriate communication skills to ensure that you clearly understood by the
clients
 Your role will be to demonstrate respect of dignity and rights of each person; interest of solving
client’s problems; cooperativeness and respect to other health care team and clients; accepting
others from different race and religion; cheerful, optimism and ready to learn new things from
co-workers and clients; and respect for rules and regulations of nursing profession. Set
priorities and let all clients know and request them to wait and reassure them that you will
attend them all.
 Seek for the feedback if the patients is having other issue which needs your attention.
 Respond to client’s needs and look for the supporting system through social workers
 Your partners will play the part of a client, and other will be waiting for you to provide them with
health service.
Role Player 2- Client
 You will role play as client who looks to be poor and you feel pain and you have urine
incontinence. Ask the nurse to help you with some drinking water, and food.
Role Player 3 – clients waiting for nurse to attend them
 Get seated on the bench waiting for services, one of you will play as client who seem to have
better economic status and you want to be attended first.
 Write down your observation
Tutor/Instructor
Conduct De-brief Session
 Ask the nurse
o What do you think you did well (in terms of how you demonstrated positive attitude when
providing care to your client?
o What would you change next time?
 Ask the client
o What did the nurse do well?
o How did you feel when you were being attended?
o What suggestions would you give to the nurse to be more effective?
 Ask the waiting clients and other students who were observing
o What do you think the nurse did well?
o What suggestions would you give him/her to remember the next time s/he provides care to
clients?
24
o What did you learn about positive attitude in giving care to client/patient in this session?
o What did you learn about strategies for demonstrating positive attitude in giving care to
client/patient
o How will you apply what you learned today?
o What will you remember about positive attitude in giving care to client/patient from this role
play?
o What will you try to do the next time you practice positive attitude in giving care to
client/patient?
 De-role the role players
25
Session 4: Provision of Good Customer Service to Client/Patient
Prerequisite: None
Learning Tasks
Define customer service in health care setting
Outline characteristics of good customer service
Identify customer service skills for nurses
Explain strategies to provide patients with greater customer service
Plan good customer service to client/patient
Resources Needed
Session Overview
Method
2 5 Brainstorm /Presentation Definition of Customer Service
3 15 Presentation Characteristics of Good Customer Service
4 15 Buzzing /Presentation, Customer Service Skills for Nurses
5 30 Presentation Strategies to Provide Patients with Greater
Customer Service
6 40 Small Group Discussion Planning Good Customer Service to
/presentation Client/Patients
7 5
8 5
Session Contents
26
STEP 2: Definition of customer Service (05 Minutes)
Ask students to brainstorm on the meaning of customer service in health care setting
 Customer service is the act of taking care of the patients/clients’ needs by providing and delivering
professional, helpful, high quality health service and assistance before, during, and after the
patients/clients requirements are met.
 Customer service is meeting the needs and desires of any patients/clients seeking health services
in the health facility.
Step 3: Characteristics of Good Patient/ Client Customer Service (15 Minutes)

 Promptness:
o Promises for delivery of services must be on time. Delays and cancellations of services should
be avoided.
 Politeness:
o Good communication – great the client or patient by introducing yourself
o Politeness is almost a lost art. Saying 'hello,' 'good afternoon,' 'sir,' and 'thank you very much'
are a part of good customer service. For any business, using good manners is appropriate
whether the customer makes a purchase or not.
 Professionalism:
o All customers should be treated professionally, which means the use of competence or skill
expected of the professional. Professionalism shows the customer they're cared for
o Recap previous treatment
o Explain what to expect next.
 Personalization:
o Using the customer's name is very effective in producing loyalty. Customers like the idea that
whom they do business with knows them on a personal level.
o Ask for questions if any
Step 4: Customer Service Skills (15 Minutes)

ASK students to pair up and buzz on skills a nurse should possess for good customer services
ALLOW few pairs to respond and let other pairs to add on points not mentioned
WRITE their response on the flip chart/board
 Patience
 Attentiveness
 Clear communication skills
 Knowledge of the health care services provided in the health facility
 Ability to use positive language
 Time management skills
 Ability to ‘read’ customers
27
 Staying cool when under pressure
 Goal-oriented focus
Step 5: Strategies to Provide Patients with Greater Customer Service (30 Minutes)
 Start seeing patients as customers.
o Taking care of patients is what healthcare is all about. It may be hard for some people to think
of patients as customers, but they definitely are. Their choices bring thousands and even
millions of dollars into a hospital's resources.
o In most cases, they don't necessarily need to use your hospital, even though you good health
care providers. They may end up at the institution down the street that treats patients better.
 Be polite and respectful.
o Always, make sure patients are treated with politeness and respect. I know executives who
pretended to be patients inside their own institutions and were shocked by the lack of focus and
concern they received.
o Treating patients has become simply a job for many healthcare professionals. They manifest
boredom with their jobs by treating patients indifferently. That's not professional.
 Never show indifference to patients.
o Watch the way patients are treated when entering the outpatient department in health facilities.
If the illness is not life-threatening, patients are virtually given a number and told to sit down
and wait.
o Many otherwise competent and even brilliant healthcare professionals give patients the feeling
they are an inconvenience and a bother.
o Patients should not be made to feel inferior and misinformed.
 Don't contradict or argue
o Telling patients they are wrong about anything is just plain bad-mannered. Even when they
have incorrect information, they still should be given respect.
o If you disagree with them, politely explain why their point of view isn't necessarily correct.
o Your goal should be to explain and communicate, and then to continue to explain and
communicate.
o Help patients understand what is going on as treatment is being given. Patients should feel
they are just important, in the scheme of things, as you are.
 Tell patients you appreciate their business.
o Everybody likes to be thanked when purchasing an item in a retail store, but in all too many
healthcare venues, saying "thank you" is seen as inappropriate.
o Saying "thank you" has magic feelings for any kind of relationship. It's a great way to receive
your customers' come back to your hospital when they get sick.
 Use plain terms and simple explanations.
o It may be fun to throw around complicated jargon, but it results in misunderstandings and
sometimes errors.
o Nobody wants errors in today's healthcare environment. Always make sure your explanations
are not clouded with excessive and complicated words.
o Be brief and to the point. True professionals go out of their way to explain things in simple,
declarative sentences.
 Good manners will get you everywhere.

o Good manners are part and parcel of confidence and competence. Don't hide the truth even if
it creates problems for you.
o Treat patients the way you'd want to be treated. Saying the appropriate words can show
respect.
o Establishing eye contact is also part of good manners.
28
o Always show respect to others
 Keep seeing healthcare as a calling.
o Too many professionals begin to see healthcare as a job rather than a calling. There's a big
difference between the two.
o When healthcare becomes a job, mistakes are not far behind. Today there are so many
complicated variables in healthcare that it is easy to get off track. Remember who you are and
what your core business is.
o It might help to recall what brought you into the healthcare field. Was it to take care of people or
was it to make a lot of money?
 Stay in touch with patients.
o Many nurses don't think they have the time to stay in touch with patients after care is rendered.
o They tend to think it's unnecessary and creates too much stress. That rationale should never
be tolerated.
o Staying in touch with patients, even if it's an e-mail or a phone call, will pay off.
 Keep your promises.
o Many promises made to patients are never kept. Things like, "You'll get the best care here" and
"We treat each individual who comes to us with dignity and respect" and also, "You'll be just
fine in a week or so."
o The difference between empty talk and promises is that promises must be kept. And if it turns
out you overpromised, patients will lose faith in you.
STEP 6: Planning Good Customer Service to Client/Patients (40 minutes)

Activity: Small Group discussion (20 minutes)
ASK students to discuss on on key actions to be considered when planning for good customer
service to client/patients
 Develop a facility/unit values to implement the corporate mission and vision

 Review the past performance of the facility/unit and evaluate its current position in terms of
customer services
 Undertake review of the factors in the near and far environment which impact upon service quality
 Identify organizational paradigms – discuss with your colleagues what words you would use to
describe the culture of your organization
 Establish objectives for your customer service program – be clear about creteria for success
 Identify obstacles to progress – develop a plan of action to overcome these
 Utilize innovators – they can become service champions for the facility/unit
 Stay close to your customer monitor customer feedback and develop innovative ways of obtaining
this
 Develop service charter for customer and adhere to it
 Develop implementation plan for the service strategy
Refer learners to Worksheet 4.1: Example of Implementation plan in planning good customer to
clients/patients
29
 Promises for delivery of services must be on time. Delays and cancellations of services should be
avoided or communicated prior.
 Always, make sure patients are treated with politeness and respect.
 Make sure patients do not feel inferior and misinformed
 Always make sure your explanations are not clouded with excessive and complicated words

 What is the definition of customer service?
 What are the strategies of provide patients with greater customer service?
30
References
Baird, K.(2000). Customer care in health care. A grassroots approach to creating a culture of service
excellence. Jossey – Bass
Tanzania.
31
Worksheet 4.1: Example of Implementation plan in planning
good customer to clients/patients
SN Action/item Activities Resources Responsible Time

needed person frame
1. Develop a facility/unit Identify technical Stationaries Head of One day
values to implement the team quality
corporate mission and department
vision (Name)
Conduct a review Stationaries Administrative Two
of mission and Flip charts, officer (Name) days
vision marker pens,
and masking
tape, Note
Book and
Pen
LCD
Projector and
computer
Venue
Refreshments
Identify facility/unit Stationaries Head of One day
values Flip charts, facility /unity
marker pens, (Name)
and masking
tape, Note
Book and
Pen
LCD
Projector and
computer
Venue
Refreshments
Disseminate and Stationaries Head of One day
get approval of the Flip charts, facility /unity
values marker pens, (Name)
and masking
tape, Note
Book and
Pen
LCD
Projector and
computer
Venue
Refreshments
2. Review the past Identify technical Stationaries Head of One day
performance of the team Facility
32
facility/unit and evaluate Conduct review Stationaries Head of Two
its current position in past performance Flip charts, facility/unit days
terms of customer report to identify marker pens,
services areas for and masking
improvements(gap) tape, Note
Book and
Pen
LCD
Projector and
computer
Venue
Refreshments
Conduct Stationaries Head Two
assessment of the Flip charts, research weeks
current needs in marker pens, department
customer service and masking
provision tape, Note
Book and
Pen
LCD
Projector and
computer
Venue
Refreshments
Transport
Determine the Stationaries Head quality One day
current position of Flip charts, improvement
the facility/unit in marker pens, committee/unit
relation to and masking
customer care tape, Note
Book and
Pen
LCD
Projector and
computer
Venue
Refreshments
33
Session 5: Concepts of Advocacy in Relation to Nursing and Midwifery
Practice
Prerequisite: None
Learning Tasks
Define the term advocacy
Identify common areas requiring nurse patient advocacy
Explain steps for advocacy in nursing care
Identify the unique advocacy need of key population
Describe advocacy skills in nursing care
Resources Needed
Session Overview Box

Method
1 5
2 5 Brainstorm/ Definition of Advocacy
Presentation
3 10 Presentation Common Areas Requiring Nurse Patient
Advocacy
4 20 Presentation, Steps for Advocacy in Nursing Care
5 40 Small group Discussion/ Unique Advocacy Need of Key Population
Presentation
6 30 Presentation Advocacy Skills in Nursing Care
7 5
8 5
Session Contents
34
STEP 2: Definition advocacy (5 Minutes)

Ask students to brainstorm on the definition of advocacy

 Advocacy is the act of arguing in favor of, or support something, the practice of supporting
someone to make their voice (the way of doing something)
o In all its forms it seeks to ensure that people particularly those who are most Vulnerable in
society are able to, have their voice heard on issues that are important to them. Defend and
safeguard their rights. Have their views and wishes genuinely considered when decisions are
being made about their lives.
o Advocacy can mean many things, but in general, it refers to taking action. Advocacy simply
involves speaking and acting on behalf of yourself or others.
STEP 3: Common Areas Requiring Nurse Patient Advocacy (10 Minutes)

 End of life decision
 Technological advances
 Health care reimbursement
 Access to health care
 Provider- patient conflict regarding expectations and desired outcomes
 Withholding of information or lying to patient
 Insurance authorizations, denials and delays in coverage
 Medical errors
 Patient information disclosure ( privacy and confidentiality)
 Patient grievance and appeal processes
 Cultural and ethnic diversity and sensitivity
 Respect for patient dignity
 Policy development regarding healthcare rights of the patient
STEP 4: Steps for Advocacy in Nursing Care (20 Minutes)

 Advocacy begins with a problem or with a perception that there is a better alternative to a current
condition and seeks to solve that problem and/or implement the selected alternative. Steps for
advocacy include:
o Identifying the issue
o Developing solutions
o Building support
o Bringing issues, solutions, and political will together to ensure that the desired change takes
place.
o Monitoring and evaluating the entire process.
 It may well be necessary to revisit and revise several of these steps throughout the implementation
of your advocacy campaign. Successful advocacy does not proceed in a straight line and rarely
unfolds exactly according to plan. Be prepared for unforeseen events and consequences. Be
35
flexible.
 Some key stakeholders in the advocacy process includes:
o Government
o Civil society organisations
o Union federation
o Religious organisations
o Membership, moral authority, outreach
STEP 5: Unique Advocacy Need of Key Population (40 Minutes)

Activity: Small Group Discussion ( 20 minutes)
ASK students to discuss on the unique advocacy need of key population

 Key populations include both vulnerable and most-at-risk populations. They are important to the
dynamics of HIV transmission in a given setting and are essential partners in an effective response
to the epidemic.
 People living with HIV are considered a key population in all epidemic contexts.
 Most-at-risk populations is defined as men who have sex with men, transgender people, people
who inject drugs, people in prison and other closed settings and sex workers. Most-at-risk
populations are disproportionately affected by HIV in most, if not all, epidemic contexts.
Unique advocacy need of key population (KP)
 Advocate for an enabling environment that allows for the protection and promotion of the health of
all KP, and supports effective and efficient programming.
 Plan, monitor and evaluate advocacy efforts for effectiveness and in response to the needs of
those from KP.
 There is a growing recognition that gender norms and gender-based violence are some of the most
influential factors driving HIV transmission worldwide. Widespread ignorance around issues of
sexuality and gender commonly leads to stigma, discrimination and violence. All programme
activities need to address the disparities that result from gender discrimination and gender-based
violence and advocate for change.
 Ensure services and programmes implemented are non- stigmatizing, non-discriminatory,
accessible, acceptable, affordable and equitable for all key population.
 Improve the legal, policy, and social environment to allow access by KP to available health
services.
 Foster active, meaningful and collaborative involvement of community members from key affected
populations, including those that are HIV infected, in programmes and interventions.
 Develop, build upon and sustain collaborative partnerships to support coordinated, comprehensive,
transparent, accountable cost-effective public health approach responses to address the multiple
health needs of Key Population.
 Strong political leadership and commitment at all levels are integral to an effective and sustained
response to HIV and AIDS.
 Community empowerment and mobilization allows for the establishment of a safer environment,
36
increased solidarity and a strengthening of advocacy efforts.
 Advocate for improving living conditions of KP, strengthening strategies for the right to health and
redressing violations of human rights are regarded as critically important.
Step 6: Advocacy Skills in Nursing Care (30 Minutes)

. Below are skills that help nurse to advocate for their patients while providing health care services.
 Communicating
o Nurses educate patients and their families by interfacing with providers and payers to ensure
patients understand their diagnoses, prognoses, treatment options, and post treatment
instructions.
 Promoting Patient Safety, Empowerment, and Rights

o Nurses educate patients about their rights within the health care system, safety, procedures
and treatments, discharge instructions, costs, and insurance coverage.
 Nurses are tasked with presenting this information in a transparent and meaningful way to help the
patient fully understand their choices. This responsibility is a key component of being an advocate.
 A working knowledge of Medical Terminology and the Health Care System
o Understanding the complex nature of health care requires attention to detail and an excellent
grasp of medical terminology.
o Appropriate and thorough notation and documentation of issues expressed by patients
regarding their care is essential.
o Fully understanding a patient's preferences and goals and being able to communicate them to
providers is also important.
 Understanding how Health Care is Financed
o A key responsibility of a nurse advocate is helping patients navigate the stressful financial
aspects of healthcare. This includes educating patients on reimbursement, billing, and
financing options.
o Advocates also have extensive knowledge of insurance plans and their coverage options and
limitations.
 Resolution and Follow Up

o Through active listening, nurse advocates find solutions to patient concerns and bring issues to
the attention of providers and payers. This is especially important for patients with chronic
health conditions or complex medical needs where care may need to be coordinated among
multiple providers.
o Nurses work closely with both the patient and providers to ensure the patient continues to
receive the best care and outcomes realistically possible.
 Professionalism in Maintaining and Ensuring Patient Confidence
o Nurses should understand the legal and ethical issues surrounding private health information.
o They operate at a high level of discretion regarding patient and family information, complaints,
issues, and regulatory compliance.
o It is very important that nurses are trustworthy and have high ethical standards so they are
trusted liaisons among patients, caregivers, and health care professionals, which leads to
better and safer care.
 Being Proactive
o Alerting hospital administrators about potential legal issues regarding unresolved complaints is
one of the ways nurse advocates are proactive in the organizational environment.
o Health care advocates may also work as patient care coordinators ensuring all providers are
informed about treatments, tests, and medications.
o In some instances, they may be able to review the patient's health records for accuracy and
37
take necessary action to resolve any issues and quickly address patient concerns.
 Improving Systems and Policy
o A hospital advocate works to decrease risk to the hospital by ensuring that patients' complaints
and grievances are reported and acted upon in a timely manner - and that the hospital takes
steps to prevent reoccurrence in the future.
o The nurse who enter into a policy career may also help to develop policies to improve systems,
reduce overall health care costs and positively affect patient safety and outcomes.
 Relationship Building
o Health care advocates may have clinical or administrative backgrounds in the health care
system (e.g. former case managers, doctors, nurses) and can use their experiences to help
patients navigate the bureaucracy of this complex environment.
o The nurse works to create trusting relationships between patients and providers which helps to
reduce anxiety and fear and improve outcomes. They are vital members of the community and
serve to empower patients.
 Professional Development
o By enhancing job knowledge and professional credibility, nurse advocates will continue to be a
valuable asset to delivering the best patient outcomes
o A key responsibility of a nurse advocate is helping patients navigate the stressful financial
aspects of healthcare. This includes educating patients on reimbursement, billing, and
financing options

 Advocacy is the act of arguing in favor of, or support something, the practice of supporting
someone to make their voice (the way of doing something)
 Key populations include both vulnerable and most-at-risk populations. They are important to the
dynamics of HIV transmission in a given setting and are essential partners in an effective response
to the epidemic
 Nurses educate patients and their families by interfacing with providers and payers to ensure
patients understand their diagnoses, prognoses, treatment options, and post treatment instructions
 Appropriate and thorough notation and documentation of issues expressed by patients regarding
their care is essential.

 What are common area requiring patient advocacy?
 What are the steps of advocacy in nursing care?
38
References
Berman, A., Synder, S., Kozier & Erb’s. (2014). Fundamental of Nursing: Concepts, Process and
Practices (9th Ed.). Pearson New International
Craven, F.R., & Hirnle, C. J. (2008). Fundamentals of Nursing (6th Ed).Philadelphia, USA: Lippincott
Williams and Wilkins
TNMC. (2009). Nursing Ethics: A manual for Nurses. Dar es Salaam: Tanzania.
39
Session 6: Patient’s and Service Provider’s Rights in the Provision of
Care
Prerequisite: None
Learning Tasks
Define terms; patients’ rights, service providers rights
Explain patient’s rights in receiving nursing care
Explain nurse’s rights in providing nursing care
Resources Needed
Session Overview
Step Time (min) Activity/
Method Session
1 5 Presentation
Title and Learning Tasks
2 10 Brainstorm/ Definition of Patients’ Rights and Service
Presentation Providers Rights
3 35 Buzzing/ Presentation Patient’s Rights in Receiving Nursing Care
4 50 Small Group Discussion/ Nurse’s Rights in Providing Nursing Care
Presentation,
5 5
6 5
7 10
Presentation Take home assignment
SESSION CONTENTS
40
STEP 2: Definition of Patients’ Rights and Service Providers Rights (10 Minutes)
Ask students to brainstorm on definition of patients and service providers rights

 Patient’s rights are those rights attributed to a person seeking health care.
 Nurse’s rights are those rights attributed to a nurses providing health care services.
Step 3: Patient’s Rights in Receiving Nursing Care (35 Minutes)

ASK students to pair up and buzz on patients’ rights

 Right of information about his or her illness condition, the diagnostic and therapeutic measures
anticipated, and the written records of the care received.
 The patient has the right to considerate and respectful care, delivered in response to a request for
services and in a manner that provides continuity of care.
 The patient has the right to examine and receive an explanation of the bill regardless of source of
payment.
 Right to Safe and Healthy environment
 Right to accept or refuse treatment
 Be treated with compassion and love.
 Be respected and receive respectful care.
 Privacy and confidentiality of all records and communication regarding his/her care.
 Be informed about the available resources.
 Refuse services, procedures, activities such as research and treatments which are not comply with
the required standards.
 Be involved in decision making about the treatment and care. The Parents, guardians, family
members, or others can also be involved to choose and speak for patient/client who cannot make
decision for himself e.g. children, unconscious/mental ill patient, elderly.
 Access to health services, facilities and information regarding to their needs.
 Self-expression and self-determination (consent).
 Be aware with the hospital policy, rules and regulations which apply into his/her care including cost
of the services delivery.
 Complain, review and appeal in accordance with the established policy, rules and procedures. This
includes complaints about waiting times, operating hours, the actions of health care personnel, and
the adequacy of health care facilities
STEP 4: Nurse’s Rights in Providing Nursing Care (50 Minutes)

Activity: Small Group Exercise (20 minutes)
41
DIVIDE Students into small manageable groups
ASK Students to discuss using the following questions:

 What are the rights of nurses in providing nursing care?
ALLOW Students to discuss for 20 minutes

 Nurses have the right to practice in a manner that fulfills their obligations to society and to those
who receive nursing care.
 Nurses have the right to practice in environments that allow them to act in accordance with
professional standards
 Nurse has a right to a safe working environment which is compatible with efficient patient care and
treatment which is equipped with at least the minimum physical, material and personnel
requirements
 Nurses have the right to a work environment that supports and facilitates ethical practice, in
accordance with the Code of Ethics for Nurses and its interpretive statements.
 Nurses’ right to proper orientation and training at work place
 Nurses’ right to continuing professional development
 Right to have a positive working environment which is free of threats, intimidation and/or
interference;
 Nurses have the right to fair compensation for their work, consistent with their knowledge,
experience, and professional responsibilities.
 Nurses have the right to a work environment that is safe for themselves and their patients.
 Nurses have the right to negotiate the conditions of their employment, either as individuals or
collectively, in all practice settings. This can be done through professional Associations like,
TANNA
 Nurses have the right to freely and openly advocate for themselves and their patients, without fear
of retribution.
 Nurses have the right not to be abused in any form by physicians, pharmacists, administrators or
nursing directors. Any abuse that occurs should be dealt within a professional and in partial manner
by the nurse's employer.
 Nurses have the right to proper orientation and goal-directed in-service education in respect of the
modes and methods of treatment and procedures in caring clients/patients.
 Nurses have the right not to be exploited and abused by being floated to areas of practice that they
are not familiar with.
 The nurse has the right to practice in accordance with the scope which is legally permissible for
his/her specific practice. (TNMC, 2015)
 Nurse has a right to refuse to carry out a task reasonably regarded as outside the scope of his/her
practice and for which he/she has insufficient training or for which he/she has insufficient
knowledge or skill
 The nurse has a right to negotiate with the employer for such continuing professional development
and education as may be directly or indirectly related to his/her responsibilities in the community
 Right to in the case of a registered person, equal and full participation in such policy determination,
planning and decision-making as may concern the treatment and care of the patient
 Right not to participate in unethical or incompetent practice
 Right to refuse to implement a prescription or to participate in activities which, according to his/her
professional knowledge and judgment, are not in the interest of the patient;
 Right to have disclosed to him/her the diagnosis of patients for whom he/she accepts responsibility
42
 Right to safe working environment in which the degree of risks of injury, infection or other harmful
socio economic side effects are minimized
 Right to have a medical support or referral system to handle emergency situations responsibly
 Right to appeal against any kind of discrimination, inhuman and unlawfully treatment from
community members, employers, Government, local and religious leaders
 Nurses have the right to rest, leisure time and family life
 Right to entitled employee’s rights as per national laws and other national seculars.

 Patient’s rights are those rights attributed to a person seeking health care.
 Although it is recognized that a personal relationship between the health care provider and the
patient is essential for provision of care, legal precedent has established that the hospital itself also
has a responsibility to the patient.
 Nurse’s rights are those rights attributed to a nurses providing health care services

 What are the Patient’s rights in receiving nursing care?
 What are the nurse’s rights in providing nursing care?
STEP 7: Take Home Assignment (10 minutes)

Activity: Take Home Assignment (05 minutes)
DEVIDE students in a group of 3 to 8 students
ASK students to go in the clinical area and:
 Identify issue to be addressed in relation to advocacy of patient/ client rights
 Develop goals and strategies to advocate patient/client rights for the above identified issue
 Develop plan for action to advocate patient/client rights for the identified issue
ALLOCTE time for students to do the assignment and submit within one week
REFER students to recommended references
ALLOW each group to present in plenary in class
ALLOW discussion after each presentation
References
Williams and Wilkins
Fry, S.T., & Johnstone, M.J. (2008). Ethics in Nursing Practice: A guide to ethical decision making (3rd
Ed). United Kingdom: Blackwell
Kozier & Erb’s., Bernman, A., & Snyder, S. (2014). Fundamentals of Nursing Concepts and practice
(9th Ed.). Edinburgh Gate: Pearson Education Limited
Potter, P., & Perry, A. (2005). Fundamental of Nursing (6th Ed.). USA: Mosby Company
TANNA. (2017). Advocacy Plan. Dar es Salaam: Tanzania
TNMC. (2007). Code of Professional Conduct for Nurses and Midwives in Tanzania. Dar es Salaam:
Tanzania
TNMC. (2015). Scope of Practice for Nurses and Midwives in Tanzania. Dar es Salaam: Tanzania
43
44
Session 7: Concepts of Advocacy to Protect Patient’s/Client’s Rights
Total Session Time: 120 minutes
Prerequisites: None
Learning tasks
At the end of this session a leaner is expected to be able:

Identify issues to be addressed in relation to advocacy of patient’s/client’s rights
Develop goals and strategies to advocate patient/client rights
Develop plan for action to advocate patient/client right
Collaborate with other co- workers in addressing issues of client right
Resources Needed:
Session Overview
Step Time Activity/ Content
(min) Method
1 5 Presentation
Presentation of Session Title and Learning Tasks
2 30 Buzzing, Presentation Issues to be addressed in relation to advocacy
of patient’s/client’s rights
3 20 Brain storming, presentation Goals and strategies to advocate patient/client
rights
4 35 Small Group Discussion Plan for action to advocate patient/client right
5 20 Brain storming Collaboration with other co- workers in

addressing issues of client rights
6 5 Presentation Key point
7 5 Presentation Session Evaluation
SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning Objectives (5 minutes)
READ or ASK participants to read the learning objectives
45
STEP 2: Issues to be Addressed in Relation to Advocacy of Patient’s/Client’s
Rights (30 Minutes)
ASK Students to pair up and buzz on the following question for 2 minutes
What are the issues to be addressed in relation to advocacy of patient’s/client’s rights?
CLARIFY and SUMMARIZE by using the content below:-
 Providing patient with Information and promote informed consent
 Empowerment of patients and protect their autonomy
 Protection of the interests, human and legal rights of patients where they cannot protect on their
own
 Ensuring that patients have fair access to available resources
 Provision of support the patient no matter what the potential cost
 Representing the views/desires of the patient and not just her needs
 Providing patient with Information and promote informed consent
o Nurses are obligated to fulfil legal responsibilities and ethical expectations because of their role
in the clinical arena, and to serve as advocates for patients to be informed
o Before any procedure carried out to patient/client, the informed consent process serves as the
practical application of mutual participation and respect for the patient's autonomy.
o Shared decision making is at the foundation of a mutually respectful relationship between a
health care provider and a patient.
o As patient advocates and direct care providers, nurses have a unique opportunity to
meaningfully advocate for mutual decision making, a process that promotes
 Patient autonomy
 Comprehension
 Self-determination.
 Empowerment of patients and protect their autonomy
o Patients should be allowed or enabled to make autonomous decisions about their health care
o Autonomous decisions are those made intentionally and with substantial understanding and
freedom from controlling influences
 Protection of the interests, human and legal rights of patients where they cannot protect on their
own
o Patients require support to ensure their expressed needs are taken seriously and their interests
promoted
o Nurses should not abandon a patient, nor should they refuse to care for someone based on
personal preference, prejudice, or bias.
o Nurses have the professional responsibility to ensure patient safety in emergency situations
and not withdraw care until alternate care is available, regardless of the nurses’ personal
beliefs
 Ensuring that patients have fair access to available resources
o Providers must promote the fair and judicious use of resources and advocate for the needs of
individuals and groups that have traditionally been left out of the health care system.
o Providers should not do everything that may benefit an individual patient, since doing so may
interfere with the ability of other patients to obtain basic services; rather, providers should treat
each patient with as full a range of resources as is compatible with treating patients yet to
come.
o But providers should not be required to balance at the bedside the patient's interests against
those of others or of society.
46
o Nursing care is also a health resource, Nurses must continue to look for ways to balance
economics and caring in the allocation of health resources.
o Nurse should then utilize and employ different internal or external resources such as a social
worker, a physical therapist, an occupational therapist, a clergy member or a home health care
agency in the community and external to the nurse's healthcare agency.
 Provision of support the patient no matter what the potential cost
o Provide consultation, technical assistance, and support to patients advocates in accordingly.
Educating the patient and family members on the available medical resources
o Alleviating confusion or conflict between the patient and the physician, or between practitioners
o Asking relevant medical questions on behalf of the patient or other supporting persons
o Ensuring the patient and their support network understand the advice and information provided
by healthcare providers
o Arranging a second opinion when the patient is concerned about the information provided by
the treating professional
o Accompanying the patient and other supporting persons to medical appointments
o Providing regular contact with carers, practitioners, nurses, as well as the patients, to ensure
satisfactory medical support is being provided consistently over a period of time.
o Monitoring the patient’s sense of wellbeing, including while travelling or during changed
circumstances
o Modifying care to individual needs: whether in person, by telephone, text message or email
 Representing the views/desires of the patient and not just her needs
o Advocate's role must therefore be to protect and represent patient-perceived needs and
values.
o The patient, like the legal client can be argued to have a right to this kind of unrestricted
assistance from the advocate because it helps the patient to maintain her: “integrity as a
person ... the [advocate] makes his [patient's] interests his own in so far as this is necessary to
preserve and foster the [patient's] autonomy
o Representing patient wishes, rather than what the advocate wishes for the patient, is the best
way of protecting the integrity of the person when that person is unable to do this for herself.
Otherwise it is paternalism even if it is well intentioned
STEP 4: Goals and strategies to advocate patient/client rights (20 Minutes)

Activity: Brain storming (10 minutes)
Ask Students to brainstorm on the following question:
What are the goals and strategies to advocate patient’s/client’s rights?
ALLOW few Students to respond
 The overall goal of the client advocate is to protect clients’ rights.

o An advocate informs clients about their rights and provides them with the information they need
to make informed decisions.
o An advocate supports clients in their decisions, giving them full or at least mutual responsibility
in decision making when they are capable of it
o The advocate directly intervenes on the client’s behalf, often by influencing others.
Strategies to advocate patient/client rights
 Make caring for oneself a top priority.
47
 Develop and maintain healthy boundaries that ensure self-care and management, professional and
respectful relationships, and open conversations.
 Promote resources and people within the organization that you can trust to offer support and
assistance during challenging, conflicting, ethical or overwhelming situations.
 Educate and train associates identified to be informal leaders throughout the organization in
communication skills and service recovery techniques to broaden your reach and reduce your
burden.
STEP 5: Plan for Action to Advocate Patient/Client Rights (40 Minutes)

DIVIDE Students into small manageable groups
ASK Students to discuss using the following questions:
 What are the important components in developing plan of action to advocate
patient’s/client’s rights?
 Preparing advocacy action plan

o Develop the process
o The timelines
o Identify the role of those to be involved
o Role of allies and partner agencies
o Resources to be used
Table 1: Advocacy Action Plan for Patient’s/Client’s Rights

OBJECTIVES & TIME FRAME RESPONSIBLE PARTNERS RESOURCES/
ACTIVITIES PERSON BUDGET
NEEDED
STEP 6: Collaboration with Other Co – workers in Addressing Issues of Client

Rights (20 Minutes)
Activity: Brain storming ( 10 minutes)
What matters to include when collaborate with other co-workers in addressing issues of
patient’s/client’s rights?
48
 Effective health care requires collaboration between patients and physicians and other health care
professionals
 In fact, all members of the health care team regard themselves as advocates for the patient’s best
interests.
 These Advocates have no division between their loyalties to the patient and the hospital for which
nurses, doctors, and pharmacists work.
 The Advocates make certain that the patient is in the best informed position to make health care
decisions in collaboration with their HCP.
 First-hand knowledge of the patient’s medical history, relationships with HCPs, and personal
values make the Advocate necessary member of the care coordination and continuity team.

In advocating for patient’s rights a nurse has to:
 Protect patient’s human and legal rights and provide assistance in asserting these rights if the need
arises
 Act on behalf of patient and secure his/her patient’s health care rights and stand up for them
 Provide additional information to help a patient to decide whether or not to accept a treatment
 Defend patients’ rights in the general way by speaking out against policies or actions that put
patients in danger or in conflict with their rights.

 What are the issues which need to be addressed in relation to advocacy of patients’ / clients right?
 What is the main goal for advocating patient/client rights?
 What strategies which can be applied to advocate patient/client rights?
49
References
Williams and Wilkins Dasha, S. K., & Pandab, A. K. (2011). Managing Customer Relationships
in Private Health Care.
TNMC. (2007). Code of Professional Conduct for Nurses and Midwives in Tanzania.
Dar es Salaam: Tanzania
50
Session 8: Professional, Legal and Ethical Principles related to
Nursing and Midwifery Practice
Prerequisite: None
Learning Tasks
Define the terms nursing, patient and care.
Explain functions and roles of a nurse
Explain qualities of professional nurse
Explain historical background of nursing in Tanzania
Explain four elements of code of ethics for nurses
Explain moral
Resources principles applied in nursing practice
Needed
Session Overview
Step Time (min) Activity/Method Content
1 5
2 10 Brainstorm, Definition of Nursing, Profession Nursing, Patient
Presentation and Care
3 25 Presentation Functions and Roles of a Nurse
4 20 Small Group Discussion, Qualities of Professional Nurse
Presentation
5 15 Buzzing Presentation Historical Background of Nursing in Tanzania
6 15 Brainstorming, Four Elements of Code of Ethics for Nurses
Presentation
7 20 Buzzing, Moral Principles Applied in Nursing Practice
Presentation
8 5
9 5
Session Contents
51
STEP 2: Definition of Nursing, Nursing Profession, Patient and Care (10 Minutes)
 Nursing - Is the protection, promotion, and optimization of health and abilities, prevention of illness
and injury, alleviation of suffering through the diagnosis and treatment of human response, and
advocacy in the care of individuals, families, communities and populations ( ANA, 2003)
 Nursing profession - Is a field of practice whereby individual nurses has acquired all competencies
and demonstrate ongoing criteria of a profession
 Patient – Is a person receiving or registered to receive a medical treatment
o Client - Is a person using the services of health care facilities from a professional person
 Care - The provision of what is necessary for the health, welfare, maintenance, and protection of
someone or something i.e the care of the elderly’
STEP 3: Functions and Roles of a Nurse (25 Minutes)

 Caregiver.
o As a caregiver, nurses are expected to assist the client’s physical, psychological,
developmental, cultural and spiritual needs.
o It involves a full care to a completely dependent client, partial care for the partially dependent
client and supportive-educative care, in order to attain the highest possible level of health and
wellness.
 Communicator.
o Communication is very important in nursing roles. It is vital to establish nurse-client
relationship. Nurses who communicate effectively get better information about the client’s
problem either from the client itself or from his family.
o With better information nurses will be able to identify and implement better interventions and or
nursing care that promotes fast recovery, health and wellness.
 Teacher.
o Being a teacher is an important role for a nurse.
o It is nurses’ duty to give health education to the clients, families and community. However, the
nurse must be able to assess the knowledge level, learning needs and readiness of the clients,
families and community to give appropriate and necessary health care education they need to
restore and maintain their health.
 Client Advocate.
o A nurse may act as an advocator. An advocator is the one who expresses and defends the
cause of another or acts as representative.
o Some people who are ill maybe too weak to do on his own and or even to know hi rights to
health care. In this instance, the nurse may convey is client’s wish like change of
physician, change of food, upgrade his room or even to refuse a particular type of treatment.
 Counsellor.
o A nurse may act as a Counsellor. She provides emotional, intellectual and psychological
support.
o She helps a client to recognize with stressful psychological or social problems, to develop and
improved interpersonal relationship and to promote personal growth.
52
 Change Agent.
o As a change agent, oftentimes a nurse change or modify nursing care plan based on her
assessment on the client’s health condition.
o This change and modification will only happen when the intervention/s does not help and
improve a client’s health.
 Leader.
o Nurse often assumes the role of leader. Not all nurses have the ability and capacity to become
a leader.
o As a leader it allows you to participate in and guide teams that assess the effectiveness of
care, implement-based practices, and construct process improvement strategies.
o You may hold a variety of positions like shift team leader, ward in-charge, board of directors,
etc.
 Manager.
o As a Manager, a nurse has the authority, power, and responsibility for planning, organizing,
coordinating and directing work of others.
o She is responsible for setting goals, make decisions, and solve problems that the organization
may encounter.
o It is also her responsibility to supervise and evaluate the performance of her subordinates.
o The manager always ensures that nursing care for individuals, families and communities are
met.
 Case Manager.
o In some hospitals, a case manager is a primary nurse who provides direct care to the client or
family e.g. case manager for diabetic client, she has the responsibility to give health education,
measure the effectiveness of the nursing care plan and monitor the outcomes of intervention
whether effective or not.
 Researcher.
o Nurses often do research to improve nursing care, define and expand nursing knowledge.
STEP 4: Qualities of Professional Nurse (20 Minutes)

DIVIDE Students into small manageable groups of 5 to 8 students
ASK Students to discuss about qualities of a professional nurse.

 Should have a sound knowledge of the nursing profession, obtained from a reputed institute
o Should always be ready to learn more.
o As a nurse is more frequently in contact with the patients should have excellent communication
skills. These include speaking as well as listening skills
 A good nurse should be emotionally stable
o Nursing is a very stressful job. Every day the nurses witness severe traumatic situations,
surgeries and deaths.
o The nurse should be mentally strong and should not get disturbed by such incidences. Good
presence of mind is crucial (vital) in the nursing profession
o In any critical condition or medical emergency, if the doctor is not there, then the nurse should
53
not get confused. Should be confident enough to take the correct decisions
 The nurse should be able to openly talk with the patients and their family members in order to
understand their needs and expectations
o Should be able to explain the treatment given to the patient.
o Should be alert every moment about the condition of a patient.
o Should be able to notice a minor change in the patient’s health status.
 The nurse should Kind and empathetic
o The nurse should be calm and kind to the patients, even if they are aggressive
 A good nurse should be highly qualified and trained.
o Good professional skills are a must for the nurse
o Watchfulness is an important quality of a good nurse
o The nurse should understand the pains and suffering of patients
 A good nurse should be flexible about his/her working hours and responsibilities
o Should provide comfort and sympathy to the patients, instead of getting angry with them.
o Medical emergencies can occur at any time. Nurses often have to extend their duty hours, work
in overnight shifts, or work on weekends too
 A good nurse should have a strong physical endurance
o Should be able to perform a number of taxing maneuvers, stand up for a long period of time or
lift heavy objects/people on a daily basis.
 A nurse should have a respect for people and rules
o Should be devoted to the profession.
o Should be aware of different cultures and traditions and confidentiality requirements of the
patients. He/she should respect the wishes of the patients.
 A nurse should be active and cheerful
o Her/his presence should make the patient relaxed and comfortable.
o The nurse’s pleasant appearance can reduce the patient’s stress and pains.
o His/her voice should be soft and gentle.
STEP 5: Historical Background of Nursing in Tanzania (15 Minutes)

ASK students to pair up and buzz on key historical background of Nursing in Tanzania
The Historical Background of Nursing in Tanzania

 Is the pioneer in Nursing Education
 In 1860 she founded the first nursing school at St. Thomas Hospital, London
 By the middle of 18th century and the beginning of 19th century, nursing services started to be
delivered by civil nurses – women who did not belong to religious congregations
 In Tanzania traditional, the care of patients and women in child birth was carried out by elder,
married women in the community
 Western medicine was brought to Tanzania by then Tanganyika by the missionaries of the different
churches
 At the beginning the Africans preferred to trust their traditional midwives, therefore the missionaries
sought for cooperation with these traditional midwives
54
 They taught them personal hygiene by using soap and water and also simple midwifery techniques
Nursing Training in Tanzania

 In 1925-African District Sanitary Inspectors were trained in Dar es Salaam, Tanga and Tabora
 The students were taught Anatomy, Physiology, Elementary Medicine, Minor Surgery and Dental
Practice. In 1936 the course for Dispenser (later called Medical Assistants)
 As young men and women had some education at the mission primary schools, were trained to
become nurses, it was not difficult to obtain young men for the training, but there was strong
opposition to the idea of young women being allowed to attend child birth or to nurse male patient
 From 1930 to 1939 Several missions in Tanganyika took up the training of nurses and at this time,
a Matron in Chief was appointed
 In 1947 the first group of girls were trained as nurses by the government at Sewa Haji Hospital in
Dar es Salaam
 From 1950 – 1960 Thirteen school for nursing training were existing
 The nursing schools run by the missions as well as government were: Mweka, Tanga Princess
Margareth in Dar es Salaam, Mvumi, Peramiho, Kiomboi, Magila, Ndolage, Kolandoto, Mnero,
Sumve and Kongwa
 In 1951 a new course with an annual intake of 12 students was established at Tukuyu to train
Health Nurses .The course took two years, and included Midwifery, Child Care Nursing, Nutrition,
Hygiene, First Aid and domestic science
 In 1956 the medium of instruction in nursing schools was changed from Swahili to English except in
the Health Nursing Training Schools at Tukuyu, and after the independence in 1961, there were
few European nurses left
 One year up-grading course was introduced by the Ministry of Health for registered nurses and
midwives
 In 1963 this course was discontinued
 A new nursing syllabus was introduced, where by public health, midwifery and general nursing
were integrated for the purpose to prepare an “all-purpose nurse” who could work in a general
hospital, maternity ward or clinic
 In 1964 a 1-year up-grading course in a new format was introduced, the candidates were of 2
types; (Grade A & B)
 In 1966 a new syllabus was prepared which reverted to the old system of separate courses for
General Nursing which lasted 3 years and Midwifery one year, designed for primary school leavers
Up - Grading Courses
 In 1970 the up-grading programme changed. This time it was for grade ‘B’ nurses with a minimum
working experience of 3 – 4 years
 The course lasted for one and a half year
 After completion of the course they used the title of “Staff Nurse
 With the increasing demand for public Health Nurses, the former MCHA were upgraded to Public
Health Nurse ‘B’ for two years
 From 1973 to 1986 Specialist schools of nursing were established such as Ophthalmic, Pediatric,
Operating Theatre Management, public health, mental health and Nurse tutors
Bachelor of Science Degree and Masters Degree in Nursing

 In 1989 the Bachelor of Science Degree in Nursing started at the University of Dar es Salaam
 The course was under the Faculty of Medicine, Muhimbili Medical Centre Candidates eligible for
the course are:
o Pre-service candidates, Form VI leavers studied for four year
o In–service candidates, Diploma in Nursing studied for three years
55
The Tanganyika Nurses and Midwives Council
 In the year 1952 the Tanganyika Nurses and Midwives Council was set up and enacted in 1953 by
the act of Parliament as a “Statutory” body to govern the affairs of nurses. In 1997 the profession
was regulated under the reviewed Tanzania Nurses and Midwives Registration Act of 1997.
Currently the profession is regulated through Tanzania Nursing and Midwifery Act of 2010
STEP 6: Four Elements of Code of Ethics for Nurses (15 Minutes)

Activity: Brain storming ( 05 minutes)
What are the elements of code of ethics for nurses?
Nurses and people

 The nurse’s primary professional responsibility is to people requiring nursing care.
 In providing care, the nurse promotes an environment in which the human rights, values, customs
and spiritual beliefs of the individual, family and community are respected.
 The nurse ensures that the individual receives accurate, sufficient and timely information in a
culturally appropriate manner on which to base consent for care and related treatment.
 The nurse holds in confidence personal information and uses judgement in sharing this information.
 The nurse shares with society the responsibility for initiating and supporting action to meet the
health and social needs of the public, in particular those of vulnerable populations.
 The nurse advocates for equity and social justice in resource allocation, access to health care and
other social and economic services.
 The nurse demonstrates professional values such as respectfulness, responsiveness, compassion,
trustworthiness and integrity.
Nurses and practice

 The nurse carries personal responsibility and accountability for nursing practice, and for
maintaining competence by continual learning.
 The nurse maintains a standard of personal health such that the ability to provide care is not
compromised.
 The nurse uses judgement regarding individual competence when accepting and delegating
responsibility. The nurse at all times maintains standards of personal conduct which reflect well on
the profession and enhance its image and public confidence.
 The nurse, in providing care, ensures that use of technology and scientific advances are
compatible with the safety, dignity and rights of people.
 The nurse strives to foster and maintain a practice culture promoting ethical behaviour and open
dialogue.
Nurses and the profession

 The nurse assumes the major role in determining and implementing acceptable standards of
clinical nursing practice, management, research and education.
 The nurse is active in developing a core of research-based professional knowledge that supports
evidence-based practice.
56
 The nurse is active in developing and sustaining a core of professional values.
 The nurse, acting through the professional organisation, participates in creating a positive practice
environment and maintaining safe, equitable social and economic working conditions in nursing.
 The nurse practices to sustain and protect the natural environment and is aware of its
consequences on health. The nurse contributes to an ethical organizational environment and
challenges unethical practices and settings.
Nurses and co-workers

 The nurse sustains a collaborative and respectful relationship with co-workers in nursing and other
fields. The nurse takes appropriate action to safeguard individuals, families and communities when
their health is endangered by a co-worker or any other person.
 The nurse takes appropriate action to support and guide co-workers to advance ethical conduct.
Step 7: Moral Principles Applied in Nursing Practice (20 minutes)

ASK students to pair up and buzz on moral principles applied in nursing practice
Autonomy
 Autonomy refers to the right to make one's own decisions. Client is unique, has the right to be what
that person is, and has the right to choose personal goals.
 People have "inward autonomy" if they have the ability to make choices; they have "outward
autonomy" if their choices are not limited or imposed by others.
Beneficence
 Means "doing good." Nurses are obligated to do good, that is, to implement actions that benefit
clients and their support persons.
 However, doing good can also pose a risk of doing harm. For example, a nurse may advise a client
about a strenuous exercise program to improve general health, but should not do so if the client is
at risk of a heart attack.
Fidelity
 Means to be faithful to agreements and promises.
 By virtue of their standing as professional caregivers, nurses have responsibilities to clients,
employers, government, and society, as well as to themselves.
 Nurses often make promises such as “I’ll be right back with your pain medication” or “I’ll find out for
you.” Clients take such promises seriously, and so should nurses.
Justice
 From a broad perspective, justice states that like cases should be treated alike.
 A more restricted version of justice is distributive justice, which refers to the distribution of social
benefits and burdens based on various criteria that may include the following:
o Equality
o Individual need
o Individual effort
o Societal contribution
o Individual merit
o Legal entitlement
Nonmaleficence
 This is the duty not to inflict harm as well as to prevent and remove harm.
57
 Nonmaleficence may be included within the principle of beneficence, in which case nonmaleficence
would be more binding.
Veracity
 Refers to the obligation to tell the truth and not to lie or deceive others.

 Nursing profession is a field of practice whereby individual nurses has acquired all competencies
and demonstrate ongoing criteria of a profession
 Care is the provision of what is necessary for the health, welfare, maintenance, and protection of
someone or something i.e the care of the elderly’
 Nursing is a very stressful job. Every day the nurses witness severe traumatic situations, surgeries
and deaths. Therefore, a nurse should be mentally strong and should not get disturbed by such
incidences. Good presence of mind is crucial (vital) in the nursing profession

 What are the qualities of a professional nurse?
 What are the elements of code of ethics for nurses?
 What are the moral principles applied in nursing practice?
58
References
Williams and Wilkins Dasha, S. K., & Pandab, A. K. (2011). Managing Customer Relationships
in Private Health Care.
TNMC. (2007). Code of Professional Conduct for Nurses and Midwives in Tanzania.
Dar es Salaam: Tanzania
59
Session 9: Legislation Guidelines In Providing Nursing And Midwifery
Care
Prerequisite: None
Learning Tasks
Define the common terms related to legislation in nursing practice
Explain the importance of legislation in nursing practice
Describe nursing legislation guideline in Tanzania
Utilize legislation guideline in nursing practice
Resources Needed
 Nursing and Midwifery Act, 2010
 Nursing and Midwifery Regulations, 2010
Session Overview
Method
1 5
2 10 Brainstorm, Definition of Common Terms Related in Nursing
Presentation Practice
3 30 Presentation Importance of Legislation in Nursing Practice
4 30 Small Group Nursing Legislation Guideline in Tanzania

Discussion,
Presentation,
5 35 Small Group Utilization of Legislation Guideline in Nursing
Discussion, Practice
Presentation
6 5
7 5
Session Contents
60
STEP 2: Definition of Common Terms Related in Nursing Practice (10 Minutes)
Ask students to brainstorm on the definition of negligence, malpractice and legal liability
 Negligence: Is defined as a conduct which fall below the set standards which are established by
law or regulation (failure to conform with applicable standards of care)
 Malpractice: Means doing wrong or bad thing resulting to harm or tort
 Legal liability: Means that the performer must bear the punishment for his/her act or compensate
the aggrieved party.It must be proved that the conduct caused harmful consequence, which is
sometimes problematic.
STEP 3: Importance of Legislation in Nursing Practice (30 Minutes)

 It provides directives on professional conduct and practice.
 Provide public health protection, promotion and preservation of the public health, safety and
welfare through regulation and control of nursing and midwifery education and practice
 Guide the professionals so as to attain acceptable standards expected of them when discharging
their responsibilities.
 Guide the professionals in the ever changing world of education, practice, research, leadership and
management and the need for them to adopt and acquaint themselves with the change for the
betterment of the delivery of health care.
 Enable nurses and midwives to make decisions on patient care approaches and values within the
complex health care delivery system and environment in which the nurse/midwife practices.
 As a nurse or midwife licensed to practice by TNMC, you are personally accountable for your
practice, when caring for patients and clients you must adhere to the following guiding principles:
o Respect for humankind and life
o Obtain consent before you provide care
o .Maintain professional competence
o Take responsibility and be accountable for your acts
o Be trustworthy and exercise fairness
o Collaborate with other and act as a part of the team
o Protect confidential information
61
STEP 4: Nursing Legislation Guideline in Tanzania (30 Minutes)
DIVIDE Students into small manageable groups of 5 to 8 students and provide them with the Nursing
and Midwifery Act, 2010 and its regulations.
ASK Students to use the two documents to discuss about nursing legislation guidelines in Tanzania
 In Tanzania the legislation guideline which is governing nursing and midwifery practice is Tanzania
Nursing and Midwifery Act, 2010 together with its regulations. There are four prepared regulations
as follows;
 The Nursing and Midwifery (training) regulations,2010
o This regulation provides guide to any individual who wishes to establish nursing and midwifery
school. This includes the registration, licensing and implementation of curriculum
 The Nursing and Midwifery (practice) regulation, 2010
o This regulation provides guidance on the process to be adhered by a nurse practitioner and
those wishes to establish private nursing and midwifery practice
 The Nursing and Midwifery (fitness to practice) regulation,2010
o Regulation provides information on the process to be carried to deal with any reported
complaints to the Council on nursing misconduct
 The Nursing and Midwifery (registration, enrolment and licensing ) regulations,2010
o This regulation provides information on the categories for registration parties, conditions,
requirement and procedure to be followed for registration as well as well as the removal from
the register roll to Tanzanian and oversees Nurses and Midwives.
STEP 5: Utilization of Legislation Guideline in Nursing Practice (35 Minutes)

DIVIDE Students into small manageable groups of 5 to 8 students and provide them with the Nursing
and Midwifery Act, 2010 and its regulations.
ASK Students to use the two documents to identify parts of the Nursing and Midwifery Act, No. 1 of
2010 and discuss utilization of legislation guidelines in Nursing Practice.
 The Nursing and Midwifery (practice) regulation, 2010 provides guidance on the process to be
adhered by a nurse practitioners and those who wish to establish private nursing and midwifery
practice
 The Nursing and Midwifery (fitness to practice) regulation,2010 provides information on the
process to be carried when dealing with any reported complaints to the Council on nursing
misconduct
 The Nursing and Midwifery (registration, enrolment and licensing ) regulations,2010 provides
information on the categories for registration parties, conditions, requirement and procedure to be
followed for registration as well as the removal from the register to Tanzanian and oversees Nurses
and Midwives
 Types of Law in Nursing and Midwifery
o The Nursing and Midwifery Act, No. 1 of 2010 makes the provision for the protection, promotion
and preservation of the public health safety and welfare through regulation and control of
nursing and midwifery education and practice
62
o It divided into parts which include;
 Part I- Preliminary provisions. Gives definition of the related words used in the Act.
 Part II- Describe the establishment of the Council, including the composition of the Council
members, Functions of the Council, Committee and delegation of powers and function of
the Council
 Part III- Management and Staff of the Council, including appointment, the duties allocation
of the Registrar, Deputy Registrar and Supervisory authority.
 Part IV- Registration , Enrolment and Licensing procedure, includes eligibility for
registration, types of registration and indication for removal from the register or roll
 Part V- Registration and licensing procedure for private practice.
 Part VI- Disciplinary provisions, for any complaints or inquiries and appeal.
 Part VII- Financial provisions
 Part VIII- Offences and penalties, for illegal practice of any part of the Act.
 Part IX- Miscellaneous provisions.
 There are other public laws that governs the society behaviour in respect to relationships with
others and the government
 Nurses being among the society members are obliged to the established rules and penalties given
to people who violate them
 The Law can function as public or private rules. The following are types of Laws
o Statutory (Legislative) Law: The type of Law that provides guidance in professional practice
and changes (including prescriptive authorities) and proposed health care reforms. It concern
with criminal law which prevent assault and harm to the society and provide punishment for
crimes. Violation of criminal Law one punished by imprisonment or penalties
o Civil Law: The one that protect the right of individual within society and encourage fair and
equitable treatment and care
o Constitutional Law: The law state on the right of the citizen (society) of Tanzania for freedom of
speech, religion and equal protection. Nursing actions must take into accounts on these basic
rights which are consistent with the ethical principles of autonomy, confidentiality, respect for
person and veracity.
o Administrative Law: This involves the operation and regulation of the government both local
and central agencies activities related to education, public health and social welfare programs.
It consist legal power to all administrative agencies by legislative bodies to carry out their
powers.
 TNMC is one of the board that functions under the Nursing and Midwifery Act derived from this
Law.
63
 Negligence: Is defined as a conduct which fall below the set standards which are established by
law or regulation (failure to conform with applicable standards of care)
 Malpractice: Means doing wrong or bad thing resulting to harm or tort
 Legal liability: Means that the performer must bear the punishment for his/her act or compensate
the aggrieved party.It must be proved that the conduct caused harmful consequence, which is
sometimes problematic.

 What is the importance of legislation in nursing practice?
 What are legislation guidelines in Tanzania?
64
References
Mckimm &Jill,T (2015) Health care professionalism at a Glance. Wiley Blackwell
Priester, R (1992) Values Framework for Health System reform-Health Affairs
Assifi, N (2002) Key Advocacy Approaches
65
Session 10: Ethical Principles in Nursing and Midwifery Care
Prerequisite: None
Learning Tasks
Demonstrate beneficence and non-maleficence during nursing care
Demonstrate truthfulness to patients and co-workers during nursing practice
Practice confidentiality during nursing practice
Demonstrate respect for autonomy during nursing care
Demonstrate respect for autonomy during nursing care
Demonstrate justice during nursing care
Resources Needed
Session Overview
Method
2 10 Role play, Beneficence and Non-maleficence During Nursing
Presentation Care
3 5 Role play, Truthfulness to Patients and Co-workers During
Presentation Nursing Practice
4 15 Role play, Confidentiality During Nursing Practice
Presentation
5 10 Role play, Respect for Autonomy During Nursing Care
Presentation
6 5 Role play, Justice During Nursing Care
Presentation
7 5 Presentation Key Points
8 5 Presentation Session Evaluation
SESSION CONTENTS
66
STEP 2: Beneficence and Non-maleficence During Nursing Care (10 Minutes)

client/patient.
Refer learners to Worksheet 3.1: Role play on demonstrating positive attitude in giving care
to client/patient
client/patient
DEROLE the players
 The principle of “Non-Maleficence” requires an intention to avoid needless harm or injury that can
arise through acts of commission or omission.
 In common language, it can be considered “negligence” if you impose a careless or unreasonable
risk of harm upon another.
 The “Beneficence” principle refers to actions that promote the well-being of others.
 The duty of professionals should be to benefit a party, as well as to take positive steps to prevent
and to remove harm from the party.
 Non-maleficence reminds you that the primary concern when carrying out a task is to do no harm.
Beneficence promotes action that will support others.
 These two theories taken together state that you must act in a manner that cultivates benefit for
another, and at the same time protects that person from harm.
 A single action can be analysed and balances through both frameworks.
 You must look to reduce and eliminate negative impact of what work is being done and
simultaneously find the means to support the welfare of the recipient.
 If you neglect to control certain aspects of your work that have undesirable and harmful
consequences upon others then you are not abiding by the principle of non-maleficence.
 Similarly, in the case of beneficence, if you attempt to carry out a task in a given environment, you
must be sure that your action has positive impact in that context.
 These theories discourage selfish behavior which may directly or indirectly harm or deprive a
recipient community.
 Notions of harm and benefit are molded by context, and thus cultural, economic, social, religious,
political and other factors tie into how non-maleficence and beneficence are used for ethical
decision-making.
Step 3: Truthfulness to Patients and Co-workers During Nursing Practice (05

Minutes)
client/patient.
The first learner will play as a client and another learner as a care giver (nurse) who will have a role in
demonstrating positive attitude in giving care to client.
67
Refer learners to Worksheet 3.1: Role play on demonstrating positive attitude in giving care to
client/patient
client/patient
DEROLE the players
 Veracity refers to telling the truth. Although this seems straightforward, in practice choices are not
always clear.
 Should a nurse tell the truth when it is known that it will cause harm?
 Does a nurse tell a lie when it is known that the lie will relieve anxiety and fear? Lying to sick or
dying people is rarely justified. The loss of trust in the nurse and the anxiety caused by not knowing
the truth, for example, usually outweigh any benefit derived from lying.
 Therefore, as nurses let us ensure we always tell the truth
STEP 4: Confidentiality During Nursing Practice (25 Minutes)

ASK learners to volunteer to play the role in demonstrating confidentiality during nursing practice
The first learner will play as a patient’s relative who is also an executive in the government and
another learner as a care giver (nurse) who will have a role in demonstrating confidentiality during
nursing practice and the third learner to be the client
TELL the patient’s relative how s/he should behave during a role play
Refer learners to Worksheet 10.3: Role play on demonstrating confidentiality during Nursing
Practice
EXPLAIN that this activity is aimed at training learners on confidentiality during nursing practice
DEROLE the players
 Confidentiality is the process of ensuring that information is accessible only to those authorized to
have access. Confidentiality is important as
 it protects patient information and only be used for confidential purpose only.
 It is practicable that when confidential patient information required consent must be obtained from
individual patient or family
 Patients and clients should also understand that some information may made available to other
members of medical team for planning of care and services, therefore nurses duty is to maintain
confidentiality information that are revealed to them by patients or their family.
 It is nurse’s obligation to maintain confidentiality by not disclosing the information to unauthorized
people. Nurses have to practice confidentiality in delivering services through:
 Confidentiality and not to disclose the information
 Report incidence to colleagues in the health care team for continuity of care
 Store the information in a confidential manner
 Ensure patient /client signs consent form
 Communicate patient information to authorized health workers only for the purpose of care plan.
STEP 5: Respect for Autonomy During Nursing Care (10 Minutes)
68
client/patient.
to client/patient
client/patient
DEROLE the players
 This word is derived from the Greek words autos (“self ”) and nomos
 (“rule” or “law”), and therefore refers to self-rule. In contemporary discourse it has broad meanings,
including individual rights, privacy, and choice. Autonomy entails the ability to make a choice free
from external constraints.
 Nurses who follow this principle recognize that each client is unique, has the right to be what that
person is, and has the right to choose personal goals.
 People have "inward autonomy" if they have the ability to make choices; they have "outward
autonomy" if their choices are not limited or imposed by others.
 Honoring the principle of autonomy means that the nurse respects a client's right to make decisions
even when those choices seem to the nurse not to be in the client's best interest.
 It also means treating others with consideration. In a health care setting, this principle is violated,
for example, when a nurse disregards clients' subjective accounts of their symptoms (e.g.,pain).
 Finally, respect for autonomy means that people should not be treated as an impersonal source of
knowledge or training.
 This principle comes into play, for example, in the requirement that clients provide informed
consent before tests, procedures, or participating as a research subject can be carried out
69
STEP 6: Justice During Nursing Care (05 Minutes)
client/patient.
to client/patient
client/patient
DEROLE the players
 Justice is often referred to as fairness. Nurses often face decisions in which a sense of justice
should prevail. For example, a nurse making home visits finds one client tearful and depressed,
and knows she could help by staying for 30 more minutes to talk.
 However, that would take time from her next client, who is a diabetic who needs a great deal of
teaching and observation.
 The nurse will need to weigh the facts carefully in order. to divide her time justly among her clients.

 The principle of “Non-Maleficence” requires an intention to avoid needless harm or injury that can
arise through acts of commission or omission. In common language, it can be considered
“negligence” if you impose a careless or unreasonable risk of harm upon another.
 The “Beneficence” principle refers to actions that promote the well-being of others.The duty of
professionals should be to benefit a party, as well as to take positive steps to prevent and to
remove harm from the party.
 Veracity refers to telling the truth
 Confidentiality is important as it protects patient information and only be used for confidential
purpose only. It is practicable that when confidential patient information required consent must be
obtained from individual patient or family
 It is nurse’s obligation to maintain confidentiality by not disclosing the information to unauthorized
people

 What is beneficence?
 What is maleficence during nursing care?
 What is the meaning of autonomy?
70
References
Tanzania
71
.

as waiting clients
Practice the role play in your small group until you feel ready to deliver it to the class.
Thereafter volunteers from one group will act as role players
You will act the role of a nurse. You will be attending a client who seem to be poor, feels pain and has
urine incontinence. There are other patients who seem to be well economically and they want to be first
attended.
You have to use appropriate communication skills to ensure that you clearly understood by the clients
Your role will be to demonstrate respect of dignity and rights of each person; interest of solving client’s
problems; cooperativeness and respect to other health care team and clients; accepting others from
different race and religion; cheerful, optimism and ready to learn new things from co-workers and
clients; and respect for rules and regulations of nursing profession. Set priorities and let all clients know
and request them to wait and reassure them that you will attend them all.
Seek for the feedback if the patients is having other issue which needs your attention.
Respond to client’s needs and look for the supporting system through social workers
Your partners will play the part of a client, and other will be waiting for you to provide them with health
service.
You will role play as client who looks to be poor and you feel pain and you have urine incontinence. Ask
the nurse to help you with some drinking water, and food.
Get seated on the bench waiting for services, one of you will play as client who seem to have better
economic status and you want to be attended first.
Write down your observation
Tutor/Instructor
Ask the nurse
What do you think you did well (in terms of how you demonstrated positive attitude when providing care
to your client?
What would you change next time?
Ask the client
What did the nurse do well?
How did you feel when you were being attended?
What suggestions would you give to the nurse to be more effective?
Ask the waiting clients and other students who were observing
What do you think the nurse did well?
What suggestions would you give him/her to remember the next time s/he provides care to clients?
72
What did you learn about positive attitude in giving care to client/patient in this session?
What did you learn about strategies for demonstrating positive attitude in giving care to client/patient
How will you apply what you learned today?
What will you remember about positive attitude in giving care to client/patient from this role play?
What will you try to do the next time you practice positive attitude in giving care to client/patient?
De-role the role players

as waiting clients
attended.
service.
Tutor/Instructor
Ask the nurse
to your client?
Ask the client
73
Worksheet 10.3: Instructions for the Role Play on demonstrating confidentiality

during nursing practice

Go over the lesson plan for practicing confidentiality during nursing practice resolving patients/clients
concerns using customer care knowledge session on positive attitude in giving care to client/patient
with your small group.
as waiting clients
attended.
service.
Tutor/Instructor
74
Ask the nurse
to your client?
Ask the client

as waiting clients
attended.
service.
75
Tutor/Instructor
Ask the nurse
to your client?
Ask the client

as waiting clients
attended.
76
service.
Tutor/Instructor
Ask the nurse
to your client?
Ask the client

as waiting clients
attended.
77
service.
Tutor/Instructor
Ask the nurse
to your client?
Ask the client
78

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THE UNITED REPUBLIC OF TANZANIA

MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND

DIRECTORATE OF HUMAN RESOURCE DEVELOPMENT

FACILITATOR’S GUIDE FOR ORDINARY DIPLOMA

NMT 04102: PROFESSIONALIMS IN NURSING

NMT 04101: Infection Prevention and Control

NMT 04101: Infection Prevention and Control

NMT 04101: Infection Prevention and Control

Dr. Loishook Saitore Laizer

NMT 06209- Care of Patients with Surgical Conditions

SN FULL NAME INSTITUTION/ORGANIZATION

NMT 06209- Care of Patients with Surgical Conditions

Ndementria Arthur Vermand

NMT 06209- Care of Patients with Surgical Conditions

3.2 Objectives for the Facilitator’s Guide

4.2 Who is the Module For?

4.3 How is the Module Organized?

4.4 How Should the Module be Used?

Total Session Time: 120 Minutes

STEP 1: Presentation of Session Title and Learning Tasks (05 minutes)

STEP 2: Definition of Customer Care (10 Minutes)

STEP 6: Value of Quality of Customer Care in Health (15 Minutes)

Values of quality of customer care in health

STEP 7: Importance of Providing Good Customer Care to Internal and External

DIVIDE students into small manageable groups

 The best customer service builds trust.

STEP 8: Key Points (05 minutes)

STEP 9: Session Evaluation (05 minutes)

4 15 Presentation Factors Influencing Customers Satisfaction

5 40 Presentation Methods of Dealing with Unsatisfied Customers

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

STEP 3: Customer Needs and Problems (20 minutes)

STEP 4: Factors Influencing Customers Satisfaction (15 Minutes)

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

Provider socio-demographic variables

STEP 5: Methods of Dealing with Unsatisfied Customers (40 Minutes)

DIVIDE students into small manageable groups

ALLOW students to discuss for 20 minutes

CLARIFY and SUMMARIZE by using the contents below

STEP 6: Key Points (05 minutes)

STEP 7: Session Evaluation (05 minutes)

Total Session Time: 120 Minutes

STEP 2: Definition of Customer Relation Management (5 Minutes)

Activity: Brainstorming (5 minutes)

ASK students to brainstorm on the definition of customer relation management

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

STEP 3: Elements of Customer Relation Management for Health Care Providers

ALLOW few pairs of students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

It improves the bottom line.

STEP 6: Attending client enquiries and complaints (25 Minutes)