Development and Implementation of Cornerstone Documents to Support Nursing Practice in Cambodia

By Henker, Richard; Prak, Manila et al. | Online Journal of Issues in Nursing, May 2015 | Go to article overview

Development and Implementation of Cornerstone Documents to Support Nursing Practice in Cambodia


Henker, Richard, Prak, Manila, Koy, Virya, Online Journal of Issues in Nursing


Nursing in Cambodia is transitioning from a task oriented role to a professional position that incorporates more critical thinking. Progress in the nursing profession in Cambodia has been associated with policy development at the Ministry of Health (MoH) that has included the implementation of evidence based protocols, introduction of the nursing process framework in 2004, implementation of the Code of Ethics for Nurses in 2013, and finalization of the Scope of Practice and Standards of Care for Cambodian Nurses in 2014 (see Table 1). This article describes the impact of the civil war and instability in Cambodia and provides a brief overview of nursing in Cambodia. We also review the process of developing and incorporating cornerstone documents in a resource scarce country.

Healthcare and health indices in Cambodia have improved considerably in the last few years due to the strong economic growth (e.g., Gross Domestic Product growth of 7.3% in 2013) in this low income country (Central Intelligence Agency, 2015). Infant, child, and maternal mortality have improved. For example, maternal mortality has decreased from 320 deaths per 100,000 births in 2005 to 170 deaths per 100,000 births in 2013 (United Nations Statistics Division. 20141. There has also been a decline in the rate of Human Immunodeficiency Virus infection (World Health Organization TWHOI, 2009T

Some of the current health-related challenges for the people of Cambodia include an increase in the incidence of road accidents and increased case numbers of infectious diseases, such as enterovirus 71, dengue fever, and malaria (WHO. 2009). Another concern regarding Cambodian healthcare services is the difference in resources available in rural compared to those in urban areas. Eighty percent of the population in Cambodia live in rural areas with lesser resources (Central Intelligence Aoencv. 2015T The Second Health Strategic Plan, developed by the Cambodian government, focuses on decentralization of healthcare services to decrease the disparity between care provided in urban and rural areas (Cambodia. 2008). Another health-related challenge is the continued recovery from a civil war that led to poverty and destruction of the healthcare system. The next section provides a brief background about the war and its impact on Cambodia to provide context for readers who may be unfamiliar with this history.

The Impact of the Civil War and the Khmer Rouge Regime: A Brief Overview

The evolution of nursing in Cambodia is strongly related to the rebuilding what occurred after tumultuous times in Cambodia from 1970 to 1993. In the early 1970s during the Vietnam War, North Vietnamese forces moved into Cambodia. Fighting by Cambodian troops was supported by the United States (U.S.) government and the U.S. Air Force was involved in bombing of North Vietnamese troops in Cambodia. In 1975, the government in Cambodia collapsed and leadership was assumed by the Khmer Rouge regime, led by Pol Pot.

The Khmer Rouge implemented reforms in an attempt to develop an agrarianbased, communist society. Cities were evacuated and currency was eliminated. The death of 1.17 to 3.42 million Cambodians occurred during the Khmer Rouge era due to genocide, infectious diseases, and starvation (Heuveline, 1998). Those killed were more likely to be educated individuals (McGrew. 1990). In 1979, the Khmer Rouge lost power and Vietnam invaded Cambodia. After nearly a decade of wartime, less than 50 physicians in Cambodia had survived (McGrew.1990)

During the Vietnamese occupation until the early 1990s, most healthcare was provided by Vietnamese healthcare workers. In 1992, the United Nations was able to start the healing process with the repatriation of refugees and removal of land mines in Cambodia. Although the Cambodian government has worked to increase the number of healthcare providers, the focus has changed to not only increase the number of providers, but to also improve the quality of patient care (Cambodia. …

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